Effect of Study Design on Sample Size in Studies Intended to Evaluate Bioequivalence of Inhaled Short‐Acting β‐Agonist Formulations

PubMed Central

Zeng, Yaohui; Singh, Sachinkumar; Wang, Kai

2017-01-01

Abstract Pharmacodynamic studies that use methacholine challenge to assess bioequivalence of generic and innovator albuterol formulations are generally designed per published Food and Drug Administration guidance, with 3 reference doses and 1 test dose (3‐by‐1 design). These studies are challenging and expensive to conduct, typically requiring large sample sizes. We proposed 14 modified study designs as alternatives to the Food and Drug Administration–recommended 3‐by‐1 design, hypothesizing that adding reference and/or test doses would reduce sample size and cost. We used Monte Carlo simulation to estimate sample size. Simulation inputs were selected based on published studies and our own experience with this type of trial. We also estimated effects of these modified study designs on study cost. Most of these altered designs reduced sample size and cost relative to the 3‐by‐1 design, some decreasing cost by more than 40%. The most effective single study dose to add was 180 μg of test formulation, which resulted in an estimated 30% relative cost reduction. Adding a single test dose of 90 μg was less effective, producing only a 13% cost reduction. Adding a lone reference dose of either 180, 270, or 360 μg yielded little benefit (less than 10% cost reduction), whereas adding 720 μg resulted in a 19% cost reduction. Of the 14 study design modifications we evaluated, the most effective was addition of both a 90‐μg test dose and a 720‐μg reference dose (42% cost reduction). Combining a 180‐μg test dose and a 720‐μg reference dose produced an estimated 36% cost reduction. PMID:29281130

24 CFR 200.97 - Adjustments resulting from cost certification.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Adjustments resulting from cost certification. (a) Fee simple site. Upon receipt of the mortgagor's... held under a leasehold or other interest less than a fee, the cost, if any, of acquiring the leasehold or other interest is considered an allowable expense which may be added to actual cost provided that...

Mitochondrial DNA sequence analysis of four Alzheimer`s and Parkinson`s disease patients

DOE Office of Scientific and Technical Information (OSTI.GOV)

Brown, M.D.; Shoffner, J.M.; Wallace, D.C.

1996-01-22

The mitochondrial DNA (mtDNA) sequence was determined on 3 patients with Alzheimer`s disease (AD) exhibiting AD plus Parkinson`s disease (PD) neuropathologic changes and one patient with PD. Patient mtDNA sequences were compared to the standard Cambridge sequence to identify base changes. In the first AD + PD patient, 2 of the 15 nucleotide substitutions may contribute to the neuropathology, a nucleotide pair (np) 4336 transition in the tRNA{sup Gln} gene found 7.4 times more frequently in patients than in controls, and a unique np 721 transition in the 12S rRNA gene which was not found in 70 other patients ormore » 905 controls. In the second AD + PD patient, 27 nucleotide substitutions were detected, including an np 3397 transition in the ND1 gene which converts a conserved methionine to a valine. In the third AD + PD patient, 2 polymorphic base substitutions frequently found at increased frequency in Leber`s hereditary optic neuropathy patients were observed, an np 4216 transition in ND1 and an np 13708 transition in the ND5 gene. For the PD patient, 2 novel variants were observed among 25 base substitutions, an np 1709 substitution in the 16S rRNA gene and an np 15851 missense mutation in the cytb gene. Further studies will be required to demonstrate a casual role for these base substitutions in neurodegenerative disease. 68 refs., 2 tabs.« less

A low-cost, practical method for increasing smokers' interest in smoking cessation programs.

PubMed

McDonald, Paul W

2004-01-01

Low participation rates reduce the public health impact of smoking cessation programs. Two barriers for improving participation are the cost of media campaigns and the proportion of smokers motivated to quit smoking. The objective of this study was to examine the feasibility of using classified newspaper ads and messages aimed at each stage of change to enhance participation in smoking cessation programs. Three classified ads were run concurrently in a local daily newspaper for five consecutive days. The ads were designed to engage smokers in each of Prochaska's five stages of change. Each ad invited smokers or former smokers to call the local health department to participate in a paid focus group to design a new health department program. Calls were received from 181 eligible smokers, including 124 who provided data for the study. Thirty-seven, 34, and 29 percent of smoking respondents were in precontemplation, contemplation and preparation respectively. Half of ex-smokers were in the action stage. Ads cost 174 dollars (Cdn), thus the cost per recruit was less than a dollar. Classified ads can recruit smokers from all stages of change. Compared to traditional mass media, classified ads may also be a highly cost-efficient promotional strategy. Results provide justification for further research.

Cost-Effectiveness Analysis of Elective Neck Dissection in Patients With Clinically Node-Negative Oral Cavity Cancer.

PubMed

Acevedo, Joseph R; Fero, Katherine E; Wilson, Bayard; Sacco, Assuntina G; Mell, Loren K; Coffey, Charles S; Murphy, James D

2016-11-10

Purpose Recently, a large randomized trial found a survival advantage among patients who received elective neck dissection in conjunction with primary surgery for clinically node-negative oral cavity cancer compared with those receiving primary surgery alone. However, elective neck dissection comes with greater upfront cost and patient morbidity. We present a cost-effectiveness analysis of elective neck dissection for the initial surgical management of early-stage oral cavity cancer. Methods We constructed a Markov model to simulate primary, adjuvant, and salvage therapy; disease recurrence; and survival in patients with T1/T2 clinically node-negative oral cavity squamous cell carcinoma. Transition probabilities were derived from clinical trial data; costs (in 2015 US dollars) and health utilities were estimated from the literature. Incremental cost-effectiveness ratios, expressed as dollar per quality-adjusted life-year (QALY), were calculated with incremental cost-effectiveness ratios less than $100,000/QALY considered cost effective. We conducted one-way and probabilistic sensitivity analyses to examine model uncertainty. Results Our base-case model found that over a lifetime the addition of elective neck dissection to primary surgery reduced overall costs by $6,000 and improved effectiveness by 0.42 QALYs compared with primary surgery alone. The decrease in overall cost despite the added neck dissection was a result of less use of salvage therapy. On one-way sensitivity analysis, the model was most sensitive to assumptions about disease recurrence, survival, and the health utility reduction from a neck dissection. Probabilistic sensitivity analysis found that treatment with elective neck dissection was cost effective 76% of the time at a willingness-to-pay threshold of $100,000/QALY. Conclusion Our study found that the addition of elective neck dissection reduces costs and improves health outcomes, making this a cost-effective treatment strategy for patients with early-stage oral cavity cancer.

Lowering transit crime may save energy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

Shifting travelers from less-energy-efficient automobiles to more-energy-efficient transit vehicles is an essential energy conservation measure. During peak travel periods the average auto carries 1.4 persons and consumes 16 times more fuel per passenger mile than an urban bus carrying an average of 75 passengers. Today's travelers are using transit for less than 3 percent of their urban trips. Travelers reject transit because its costs--in terms of time, money, and quality of service--are higher than those for the auto. One element of the higher cost of using transit is the increased exposure to crime which occurs when a traveler shifts frommore » his private car to mass transit. The increased exposure is the result of the additional time transit travelers spend getting to and waiting at transit stops, as well as the additional time spent riding, and the lack of privacy while on transit. Furthermore, transit travelers have no control over their route, which may go through high-crime areas. In contrast, traveling by auto not only eliminates the time getting to and waiting at transit stops, but it also provides a secure compartment which can be locked. Traveling companions can be chosen to limit exposure to crime. In addition, auto travel provides the opportunity to select the safest and shortest route. Between the two extremes of high exposure to crime presented by public transit and low exposure to crime offered by private autos lies para-transit, such as taxis, carpools, and jitneys (small buses that carry passengers over a regular route according to a flexible schedule). (MCW)« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

More than 3,000 electric utilities in the United States provide electricity to sustain the Nation`s economic growth and promote the well-being of its inhabitants. At the end of 1996, the net generating capability of the electric power industry stood at more than 776,000 megawatts. Sales to ultimate consumers in 1996 exceeded 3.1 trillion kilowatthours at a total cost of more than $210 billion. In addition, the industry added over 9 million new customers during the period from 1990 through 1996. The above statistics provide an indication of the size of the electric power industry. Propelled by events of the recentmore » past, the industry is currently in the midst of changing from a vertically integrated and regulated monopoly to a functionally unbundled industry with a competitive market for power generation. Advances in power generation technology, perceived inefficiencies in the industry, large variations in regional electricity prices, and the trend to competitive markets in other regulated industries have all contributed to the transition. Industry changes brought on by this movement are ongoing, and the industry will remain in a transitional state for the next few years or more. During the transition, many issues are being examined, evaluated, and debated. This report focuses on three of them: how wholesale and retail prices have changed since 1990; the power and ability of independent system operators (ISOs) to provide transmission services on a nondiscriminatory basis; and how issues that affect consumer choice, including stranded costs and the determination of retail prices, may be handled either by the US Congress or by State legislatures.« less

[The relationship between fertility and income: a review of some interpretations].

PubMed

Llovet, J J

1989-01-01

The relationship between fertility and income has been a preoccupation of demography since Malthus published the Principles of Population. Of the various approaches surveyed in this article, the economic analysis of fertility pioneered by Gary Becker based on neoclassical consumption theory argues the most strongly for a positive influence of income on fertility. Becker's model views children as consumer goods competing with alternative goods as parents attempt to maximize their utility or satisfaction. The indifference curves, budget lines and other analytical apparatus of microeconomic research are central to this approach. Blake and other opponents have questioned the appropriateness of microeconomic analysis in understanding family size and fertility. The theory of the demographic transition, unlike Becker's approach, views the income-fertility relationship as fundamentally negative. Although there is general consensus that the theory of demographic transition is a cornerstone of demography, there is less agreement as to its actual status. It appears to be less a truly developed theory based on a refined conceptual framework than a description or typology of apparent regularities observed in the past. Various authors have criticized specific elements of economic analysis of fertility. Okun rejected explanations of family size based on orthodox consumption theory because the costs of children, unlike the costs of consumer goods, are not the same for all households, while Mincer added analysis of opportunity costs, in this case referring essentially to the value of the time spent by mothers in child rearing instead of other activities. Several other analysts have suggested modification to the microeconomic approach. 2 recent reflections have contributed to an empirical and theortical synthesis of earlier work incorporating elements of demographic transition theory. Eva Mueller and Kathleen Short, in a work with considerable relevance to the Third World, have attempted to reconcile apparently contradictory findings by distinguishing between direct and indirect costs, by examining the time frame of references to income level, and by carefully distinguishing between macro- and microlevel studies conducted in rural or urban areas. Easterlin's work attempts to describe and explain the great fertility changes that occur in the process of modernization, including the fertility-income relationship. He includes in his analysis the supply of children--the number of surviving children a couple would have if they made no attempt to control their fertility--and the costs of fertility regulation. It appears from a review of this literature that the relationship between income and fertility is not universally either positive or negative. Economic analyses can contribute to clarification of the relative influence of income and other varibles that determine fertility levels and trends.

Effect of Study Design on Sample Size in Studies Intended to Evaluate Bioequivalence of Inhaled Short-Acting β-Agonist Formulations.

PubMed

Zeng, Yaohui; Singh, Sachinkumar; Wang, Kai; Ahrens, Richard C

2018-04-01

Pharmacodynamic studies that use methacholine challenge to assess bioequivalence of generic and innovator albuterol formulations are generally designed per published Food and Drug Administration guidance, with 3 reference doses and 1 test dose (3-by-1 design). These studies are challenging and expensive to conduct, typically requiring large sample sizes. We proposed 14 modified study designs as alternatives to the Food and Drug Administration-recommended 3-by-1 design, hypothesizing that adding reference and/or test doses would reduce sample size and cost. We used Monte Carlo simulation to estimate sample size. Simulation inputs were selected based on published studies and our own experience with this type of trial. We also estimated effects of these modified study designs on study cost. Most of these altered designs reduced sample size and cost relative to the 3-by-1 design, some decreasing cost by more than 40%. The most effective single study dose to add was 180 μg of test formulation, which resulted in an estimated 30% relative cost reduction. Adding a single test dose of 90 μg was less effective, producing only a 13% cost reduction. Adding a lone reference dose of either 180, 270, or 360 μg yielded little benefit (less than 10% cost reduction), whereas adding 720 μg resulted in a 19% cost reduction. Of the 14 study design modifications we evaluated, the most effective was addition of both a 90-μg test dose and a 720-μg reference dose (42% cost reduction). Combining a 180-μg test dose and a 720-μg reference dose produced an estimated 36% cost reduction. © 2017, The Authors. The Journal of Clinical Pharmacology published by Wiley Periodicals, Inc. on behalf of American College of Clinical Pharmacology.

Skill Mix, Experience, and Readiness.

DTIC Science & Technology

1983-10-01

percent less manpower at a life -cycle cost savings of 12 percent. The squadron-effectiveness analysis balances the cost and effec- tiveness of people...Function," Journal of PoliticalEconomy, Vol. 76, 1971 [4] Naval Personnel Research and Development Center, SR 80-7, " Life Cycle Navy Enlisted Billet...Approach"e to Attrition Ieuation Moels," 5 pp., Fob 1962, AD Al 12 462 Matnaganat," 30 PP., Jan I992 AD A112 910 Uiversity of Minnesota PP 331*alhniversity

Recruitment strategy cost and impact on minority accrual to a breast cancer prevention trial.

PubMed

Dew, Alexander; Khan, Seema; Babinski, Christie; Michel, Nancy; Heffernan, Marie; Stephan, Stefanie; Jordan, Neil; Jovanovic, Borko; Carney, Paula; Bergan, Raymond

2013-04-01

Recruitment of minorities to cancer prevention trials is difficult and costly. Early-phase cancer prevention trials have fewer resources to promote recruitment. Identifying cost-effective strategies that can replace or supplement traditional recruitment methods and improve minority accrual to small, early-phase cancer prevention trials are of critical importance. To compare the costs of accrual strategies used in a small breast cancer prevention trial and assess their impact on recruitment and minority accrual. A total of 1196 potential subjects with a known recruitment source contacted study coordinators about the SOY study, a breast cancer prevention trial. Recruitment strategies for this study included recruitment from within the Northwestern University network (internal strategy), advertisements placed on public transportation (Chicago Transit Authority (CTA)), health-related events, media (print/radio/television), and direct mail. Total recruitment strategy cost included the cost of study personnel and material costs calculated from itemized receipts. Incremental cost-effectiveness ratios (ICERs) were calculated to compare the relative cost-effectiveness of each recruitment strategy. If a strategy was more costly and less effective than its comparator, then that strategy was considered dominated. Scenarios that were not dominated were compared. The primary effectiveness measure was the number of consents. Separate ICERs were calculated using the number of minority consents as the effectiveness measure. The total cost of SOY study recruitment was US$164,585, which included the cost of materials (US$26,133) and personnel (US$138,452). The internal referral strategy was the largest source of trial contacts (748/1196; 63%), consents (107/150; 71%), and minority consents (17/34; 50%) and was the most expensive strategy (US$139,033). CTA ads generated the second largest number of trial contacts (326/1196; 27%), the most minority contacts (184/321; 57%), and 16 minority consents (16/34; 47%), at a total cost of US$15,562. The other three strategies yielded many fewer contacts and consents. The methods of health events, CTA ads, and the internal strategy showed some evidence of cost-effectiveness (ICER: US$581, US$717, and US$1524, respectively). The CTA strategy was the most cost-effective strategy for minority accrual (ICER: US$908). Recall bias may have limited the accuracy of estimated time spent on recruitment by study personnel. Also, costs spent specifically on minority accrual were unobtainable; results may not be generalizable to other settings; and cost-effectiveness data for the methods of media, health events, and direct mail should be interpreted with caution since these methods generated few consents. Public transportation ads have the potential to generate numerous minority contacts and consents at a reasonable cost within an urban setting. Combined with traditional methods of recruitment, this method can lead to timelier study completion and increased minority accrual. Future research should prospectively track recruitment and costs in order to better assess the cost-effectiveness of recruitment methods used to target minority populations.

Overview of escalator applications in rail transit

NASA Technical Reports Server (NTRS)

Deshpande, G.; Rubenstein, L.

1980-01-01

The difference in operating environment and in construction between escalators in transit and nontransit use, the impact of recent escalator innovations, and areas which could benefit from urban mass transportation administration sponsored research and development are determined. Several factors causing a more severe transit escalator operating environment are identified. There are no significant design differences between transit and nontransit escalators. Recent innovations that have affected performance and cost include outdoor escalators, extra flat steps at both landings, and modular escalators. Data were collected by interviews at transit agencies. Long term, unscheduled, escalator maintenance records were available for analysis from one property. A description of escalator operating principles is provided. Transit represents less than 5% of the U.S. escalator market. Transit agencies have limited leverage on escalator industry practices. A substantial impact on transit escalator cost and performance can be achieved by research identifying when and how to apply and specify several of the more recent innovations. Purchase of escalators under long term (25 year) maintenance contracts is one method that has been used to promote escalators manufactured for minimum life cycle cost.

[Economic impact of an automated dispensing system in an intensive care unit].

PubMed

Kheniene, F; Bedouch, P; Durand, M; Marie, F; Brudieu, E; Tourlonnias, M-M; Bongi, P; Allenet, B; Calop, J

2008-03-01

Automated dispensing systems (ADS) allow a reduction of medication errors and an improvement of drug distribution in clinical ward. The objective of this study was to evaluate the economic impact of ADS in an intensive care unit. A cost-benefit model was constructed based on the hospital perspective. The system was evaluated before-after implementation of an ADS in a 12-bed cardiovascular intensive care unit of a French teaching hospital: (a) by a measuring nurse and pharmacy technician working time required for various tasks; (b) by measuring the cost of drug storage and the cost of expired drug; (c) by measuring the nurses' acceptability. After ADS was installed, nursing personnel spent less time on medication-related activities (mean of 1.9 hour/day of nursing time). Pharmacy technicians spent more time on floor-stock activities (mean of 0.7 hour/day of technician time). Implementation reduced the cost of drug storage by 56% (14,742 euros) and cost of expired drug by 9,086 euros per year. Finally, cost-benefit analysis including potential savings in terms of working time showed a net benefit of 71,586 euros (14,317 euros/year). The ADS was given high marks by the nurses; 77% wanted to keep it on their unit. Implementation of ADS is expected to generate direct savings for the hospital and working time reallocation, for nurses to interact with patients and for pharmacy technicians to get involved on the ward.

Comparison of high-speed rail and maglev system costs

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rote, D.M.

1998-07-01

This paper compares the two modes of transportation, and notes important similarities and differences in the technologies and in how they can be implemented to their best advantage. Problems with making fair comparisons of the costs and benefits are discussed and cost breakdowns based on data reported in the literature are presented and discussed in detail. Cost data from proposed and actual construction projects around the world are summarized and discussed. Results from the National Maglev Initiative and the recently-published Commercial Feasibility Study are included in the discussion. Finally, estimates will be given of the expected cost differences between HSRmore » and maglev systems implemented under simple and complex terrain conditions. The extent to which the added benefits of maglev technology offset the added costs is examined.« less

Cost-effectiveness analysis of interventions for migraine in four low- and middle-income countries.

PubMed

Linde, Mattias; Steiner, Timothy J; Chisholm, Dan

2015-02-18

Evidence of the cost and effects of interventions for reducing the global burden of migraine remains scarce. Our objective was to estimate the population-level cost-effectiveness of evidence-based migraine interventions and their contributions towards reducing current burden in low- and middle-income countries. Using a standard WHO approach to cost-effectiveness analysis (CHOICE), we modelled core set intervention strategies for migraine, taking account of coverage and efficacy as well as non-adherence. The setting was primary health care including pharmacies. We modelled 26 intervention strategies implemented during 10 years. These included first-line acute and prophylactic drugs, and the expected consequences of adding consumer-education and provider-training. Total population-level costs and effectiveness (healthy life years [HLY] gained) were combined to form average and incremental cost-effectiveness ratios. We executed runs of the model for the general populations of China, India, Russia and Zambia. Of the strategies considered, acute treatment of attacks with acetylsalicylic acid (ASA) was by far the most cost-effective and generated a HLY for less than US$ 100. Adding educational actions increased annual costs by 1-2 US cents per capita of the population. Cost-effectiveness ratios then became slightly less favourable but still less than US$ 100 per HLY gained for ASA. An incremental cost of > US$ 10,000 would have to be paid per extra HLY by adding a triptan in a stepped-care treatment paradigm. For prophylaxis, amitriptyline was more cost-effective than propranolol or topiramate. Self-management with simple analgesics was by far the most cost-effective strategy for migraine treatment in low- and middle-income countries and represents a highly efficient use of health resources. Consumer education and provider training are expected to accelerate progress towards desired levels of coverage and adherence, cost relatively little to implement, and can therefore be considered also economically attractive. Evidence-based interventions for migraine should have as much a claim on scarce health resources as those for other chronic, non-communicable conditions that impose a significant burden on societies.

Phoenix Transit Sunday Dial-a-Ride

DOT National Transportation Integrated Search

1983-06-01

A local taxi operator began subsidized dial-a-ride service in Phoenix, AR, when the city found that Sunday fixed-route transit service would be more costly. Regular cabs and wheelchair vans are billed at a fixed hourly rate less fares collected. Over...

Necitumumab in Metastatic Squamous Cell Lung Cancer: Establishing a Value-Based Cost.

PubMed

Goldstein, Daniel A; Chen, Qiushi; Ayer, Turgay; Howard, David H; Lipscomb, Joseph; Ramalingam, Suresh S; Khuri, Fadlo R; Flowers, Christopher R

2015-12-01

The SQUIRE trial demonstrated that adding necitumumab to chemotherapy for patients with metastatic squamous cell lung cancer (mSqCLC) increased median overall survival by 1.6 months (hazard ratio, 0.84). However, the costs and value associated with this intervention remains unclear. Value-based pricing links the price of a drug to the benefit that it provides and is a novel method to establish prices for new treatments. To evaluate the range of drug costs for which adding necitumumab to chemotherapy could be considered cost-effective. We developed a Markov model using data from multiple sources, including the SQUIRE trial, which compared standard chemotherapy with and without necitumumab as first-line treatment of mSqCLC, to evaluate the costs and patient life expectancies associated with each regimen. In the analysis, patients were modeled to receive gemcitabine and cisplatin for 6 cycles or gemcitabine, cisplatin, and necitumumab for 6 cycles followed by maintenance necitumumab. Our model's clinical inputs were the survival estimates and frequency of adverse events (AEs) described in the SQUIRE trial. Log-logistic models were fitted to the survival distributions in the SQUIRE trial. The cost inputs included drug costs, based on the Medicare average sale prices, and costs for drug administration and management of AEs, based on Medicare reimbursement rates (all in 2014 US dollars). We evaluated incremental cost-effectiveness ratios (ICERs) for the use of necitumumab across a range of values for its cost. Model robustness was assessed by probabilistic sensitivity analyses, based on 10 000 Monte Carlo simulations, sampling values from the distributions of all model parameters. In the base case analysis, the addition of necitumumab to the treatment regimen produced an incremental survival benefit of 0.15 life-years and 0.11 quality-adjusted life-years (QALYs). The probabilistic sensitivity analyses established that when necitumumab cost less than $563 and less than $1309 per cycle, there was 90% confidence that the ICER for adding necitumumab would be less than $100 000 per QALY and less than $200 000 per QALY, respectively. These findings provide a value-based range for the cost of necitumumab from $563 to $1309 per cycle. This study provides a framework for establishing value-based pricing for new oncology drugs entering the US marketplace.

How much do persons with Alzheimer's disease cost Medicare?

PubMed

Taylor, D H; Sloan, F A

2000-06-01

Medicare claims are increasingly being used to identify persons with chronic diseases such as Alzheimer's disease (AD) for the purpose of determining the cost to Medicare of caring for such persons. Past work has been limited by the use of only 1 or 2 years of claims data to identify cases, leading to worries that this might lead to an undercount of prevalent cases and bias cost findings. To analyze the average total cost to the Medicare program in 1994 of persons with a claims-based diagnosis of AD, using a 12-year period of claims history to identify prevalent cases, and to investigate the effect on cost of time since diagnosis. A cross-sectional design with a 12-year retrospective period to identify persons with AD. Medical care practices, hospitals, and other providers of services to Medicare beneficiaries in the US in 1994. Respondents to the screener (n = 10,858) and community (5429) and institutional (n = 1341) questionnaire of the 1994 National Long Term Care Survey, with and without a claims-based diagnosis of AD. Average total cost to Medicare in 1994, measured as the actual amount Medicare paid for inpatient, outpatient, home health, skilled nursing facility, hospice, and Part B services, including payments to physicians, and other items such as durable medical equipment. We also measured disability in a variety of ways, including cognition, activity limitations, and residence in a nursing home. The average total cost to Medicare of persons with a claims-based diagnosis of AD was $6021 versus $2310 (P < .001) for persons without a diagnosis. When adjusting for patient characteristics, the ratio of cost between persons with AD and those without was reduced to about 1.6 to 1. Time since diagnosis was an important predictor of average total cost in 1994, with each additional year since diagnosis resulting in a $248 (P = .04) decrease in total cost (about 10% of the total sample mean cost of $2426). There was mixed evidence that persons with a diagnosis of AD incurred less cost than otherwise similarly disabled Medicare beneficiaries. Time since diagnosis with AD is an important predictor of cost and one that should be explicitly included in any rate-setting formula. Expanding the period used to identify cases resulted in an increase in the unadjusted ratio of cost of a Medicare beneficiary with AD relative to one without primarily because our control group costs are lower compared with those of past work.

Lessons Learned from Testing the Quality Cost Model of Advanced Practice Nursing (APN) Transitional Care

PubMed Central

Brooten, Dorothy; Naylor, Mary D.; York, Ruth; Brown, Linda P.; Munro, Barbara Hazard; Hollingsworth, Andrea O.; Cohen, Susan M.; Finkler, Steven; Deatrick, Janet; Youngblut, JoAnne M.

2013-01-01

Purpose To describe the development, testing, modification, and results of the Quality Cost Model of Advanced Practice Nurses (APNs) Transitional Care on patient outcomes and health care costs in the United States over 22 years, and to delineate what has been learned for nursing education, practice, and further research. Organizing Construct The Quality Cost Model of APN Transitional Care. Methods Review of published results of seven randomized clinical trials with very low birth-weight (VLBW) infants; women with unplanned cesarean births, high risk pregnancies, and hysterectomy surgery; elders with cardiac medical and surgical diagnoses and common diagnostic related groups (DRGs); and women with high risk pregnancies in which half of physician prenatal care was substituted with APN care. Ongoing work with the model is linking the process of APN care with the outcomes and costs of care. Findings APN intervention has consistently resulted in improved patient outcomes and reduced health care costs across groups. Groups with APN providers were rehospitalized for less time at less cost, reflecting early detection and intervention. Optimal number and timing of postdischarge home visits and telephone contacts by the APNs and patterns of rehospitalizations and acute care visits varied by group. Conclusions To keep people well over time, APNs must have depth of knowledge and excellent clinical and interpersonal skills that are the hallmark of specialist practice, an in-depth understanding of systems and how to work within them, and sufficient patient contact to effect positive outcomes at low cost. PMID:12501741

Cost effectiveness of budesonide/formoterol added to tiotropium bromide versus placebo added to tiotropium bromide in patients with chronic obstructive pulmonary disease: Australian, Canadian and Swedish healthcare perspectives.

PubMed

Mittmann, Nicole; Hernandez, Paul; Mellström, Carl; Brannman, Lance; Welte, Tobias

2011-05-01

Chronic obstructive pulmonary disease (COPD) is a progressive inflammatory lung disease associated with increasing morbidity and mortality and an economic burden that stretches beyond the patient to healthcare systems. Avoiding exacerbations and subsequent hospitalizations is an important clinical aim and can avoid significant costs associated with the disease. International guidelines recommend the addition of an inhaled corticosteroid (ICS) to a long-acting β₂-adrenoceptor agonist (LABA) for patients with severe to very severe COPD and a history of exacerbations. To evaluate retrospectively over a 3-month period, the cost effectiveness of budesonide/formoterol added to tiotropium bromide (tiotropium) compared with placebo added to tiotropium in COPD patients eligible for ICS/LABA combination therapy, based on the CLIMB study (NCT00496470). A cost-effectiveness analysis of data from the 12-week, randomized, double-blind CLIMB study of COPD patients (n = 659; eligible for ICS/LABA; aged ≥ 40 years) comparing budesonide/formoterol (Symbicort® Turbuhaler® 320/9 μg twice daily) added to tiotropium (18 μg daily) or placebo added to tiotropium was conducted. A severe exacerbation was defined as a requirement for systemic glucocorticosteroids and/or ED visit and/or hospitalization. The effectiveness variable used for this analysis was the number of severe exacerbations avoided. Direct costs (medications, hospitalizations, ED and GP visits) were calculated by applying year 2009 unit costs from Australia ($A), Canada ($Can) and Sweden (Swedish krona [SEK]) to the study's pooled resource use. One-way sensitivity analyses for each country's mean incremental cost-effectiveness ratio and sensitivity to overall exacerbations were conducted. Bootstrapping was performed to estimate the variation around resource use, exacerbations and each country's mean incremental cost-effectiveness ratio. The mean number of severe exacerbations per patient 3-month period was 0.11 in the budesonide/formoterol added to tiotropium arm and 0.29 in the placebo added to tiotropium arm--a 62% reduction in the rate of severe exacerbations. Treatment with budesonide/formoterol added to tiotropium costs less in Australia and Canada (-$A90 [-€58] and -$Can4.51 [-€3]) and only slightly more in Sweden (SEK444 [€43]), i.e. the savings associated with fewer exacerbations more than offset the additional budesonide/formoterol drug cost in Australia and Canada, and partially offset it in Sweden. In the Australian and Canadian perspectives, budesonide/formoterol added to tiotropium was a dominant treatment (fewer exacerbations at a lower cost) compared with placebo added to tiotropium. In Sweden, the estimated incremental cost per avoided exacerbation was SEK2502 (€244.40). Budesonide/formoterol added to tiotropium was the dominant strategy compared with placebo added to tiotropium based on a 12-week study in COPD patients eligible for ICS/LABA combination therapy in Australia and Canada, and appears to be a cost-effective strategy in Sweden.

Understanding Time-driven Activity-based Costing.

PubMed

Sharan, Alok D; Schroeder, Gregory D; West, Michael E; Vaccaro, Alexander R

2016-03-01

Transitioning to a value-based health care system will require providers to increasingly scrutinize their outcomes and costs. Although there has been a great deal of effort to understand outcomes, cost accounting in health care has been a greater challenge. Currently the cost accounting methods used by hospitals and providers are based off a fee-for-service system. As resources become increasingly scarce and the health care system attempts to understand which services provide the greatest value, it will be critically important to understand the true costs of delivering a service. An understanding of the true costs of a particular service will help providers make smarter decisions on how to allocate and utilize resources as well as determine which activities are nonvalue added. Achieving value will require providers to have a greater focus on accurate outcome data as well as better methods of cost accounting.

Computationally efficient characterization of potential energy surfaces based on fingerprint distances

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schaefer, Bastian; Goedecker, Stefan, E-mail: stefan.goedecker@unibas.ch

2016-07-21

An analysis of the network defined by the potential energy minima of multi-atomic systems and their connectivity via reaction pathways that go through transition states allows us to understand important characteristics like thermodynamic, dynamic, and structural properties. Unfortunately computing the transition states and reaction pathways in addition to the significant energetically low-lying local minima is a computationally demanding task. We here introduce a computationally efficient method that is based on a combination of the minima hopping global optimization method and the insight that uphill barriers tend to increase with increasing structural distances of the educt and product states. This methodmore » allows us to replace the exact connectivity information and transition state energies with alternative and approximate concepts. Without adding any significant additional cost to the minima hopping global optimization approach, this method allows us to generate an approximate network of the minima, their connectivity, and a rough measure for the energy needed for their interconversion. This can be used to obtain a first qualitative idea on important physical and chemical properties by means of a disconnectivity graph analysis. Besides the physical insight obtained by such an analysis, the gained knowledge can be used to make a decision if it is worthwhile or not to invest computational resources for an exact computation of the transition states and the reaction pathways. Furthermore it is demonstrated that the here presented method can be used for finding physically reasonable interconversion pathways that are promising input pathways for methods like transition path sampling or discrete path sampling.« less

Economic messages in prescription drug advertisements in medical journals.

PubMed

Neumann, Peter J; Zivin Bambauer, Kara; Ramakrishnan, Vijay; Stewart, Kate A; Bell, Chaim M

2002-09-01

The extent to which pharmaceutical companies promote the economic advantages of their products in advertisements in medical journals, and whether such claims are supported by evidence, has not been quantified. Our objectives were to examine how often prescription drug advertisements in leading medical journals contain economic messages, and to determine the types of promotional claims made and whether supporting evidence is provided. All prescription drug advertisements appearing in six leading general medical and specialty journals in 3 selected months annually from 1990 to 1999 were reviewed. Using a standard data collection form, two reviewers examined each ad for economic content-including mention of the drug's price, value, cost saving, or cost-effectiveness. Economic messages appeared in 237 (11.1%) of the 2144 advertisements examined. Proportion of ads with economic content has increased over time (P = 0.003). Most frequently, economic ads contained statements that drugs were "less expensive" or "cost less" than alternative treatments (50.6% of economic ads). Supporting evidence for economic claims was clearly reported in 63.7% of cases, and typically referred to published drug prices rather than more detailed economic analysis. Ads for calcium channel blocking agents and ACE inhibitors frequently contained economic messages. Economic messages about prescription drugs are used in advertisements in leading medical journals and their frequency may be rising. Physicians should be aware of this phenomenon, and its potential impact on their prescribing decisions. More scrutiny of the supporting evidence underlying economic claims by the medical community and regulators may be needed.

Incremental Benefit of a Home Visit Following Discharge for Patients with Multiple Chronic Conditions Receiving Transitional Care

PubMed Central

Jackson, Carlos; Kasper, Elizabeth W.; Williams, Christianna

2016-01-01

Abstract Transitional care management is effective at reducing hospital readmissions among patients with multiple chronic conditions, but evidence is lacking on the relative benefit of the home visit as a component of transitional care. The sample included non-dual Medicaid recipients with multiple chronic conditions enrolled in Community Care of North Carolina (CCNC), with a hospital discharge between July 2010 and December 2012. Using claims data and care management records, this study retrospectively examined whether home visits reduced the odds of 30-day readmission compared to less intensive transitional care support, using multivariate logistic regression to control for demographic and clinical characteristics. Additionally, the researchers examined group differences within clinical risk strata on inpatient admissions and total cost of care in the 6 months following hospital discharge. Of 35,174 discharges receiving transitional care from a CCNC care manager, 21% (N = 7468) included a home visit. In multivariate analysis, home visits significantly reduced the odds of readmission within 30 days (odds ratio = 0.52, 95% confidence interval 0.48–0.57). At the 6-month follow-up, home visits were associated with fewer inpatient admissions within 4 of 6 clinical risk strata, and lower total costs of care for highest risk patients (average per member per month cost difference $970; P < 0.01). For complex chronic patients, home visits reduced the likelihood of a 30-day readmission by almost half compared to less intensive forms of nurse-led transitional care support. Higher risk patients experienced the greatest benefit in terms of number of inpatient admissions and total cost of care in the 6 months following discharge. (Population Health Management 2016;19:163–170) PMID:26431255

THE RECRYSTALLIZATION TEMPERATURE OF IRON AS AFFECTED BY DILUTE TRANSITIONAL ELEMENTS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Abrahamson, E.P. II; Blakeney, B.S. Jr.

1960-01-01

The effect of the transition elements in binary solid solution additions upon the recrystalization temperature of iron has been investigated. All these elements immediately raise the temperature, most having their major effect in less than 0.10 at.%. A correlation is noted between the rate of change of recrystallization temperature with at.% solute and the electron configuration of the added element. An explanation is proposed to account for this phenomena. (auth)

Cost-effectiveness of live oral attenuated human rotavirus vaccine in Tanzania.

PubMed

Ruhago, George M; Ngalesoni, Frida N; Robberstad, Bjarne; Norheim, Ole F

2015-01-01

Globally, diarrhoea is the second leading cause of morbidity and mortality, responsible for the annual loss of about 10% of the total global childhood disease burden. In Tanzania, Rotavirus infection is the major cause of severe diarrhoea and diarrhoeal mortality in children under five years. Immunisation can reduce the burden, and Tanzania added rotavirus vaccine to its national immunisation programme in January 2013. This study explores the cost effectiveness of introducing rotavirus vaccine within the Tanzania Expanded Programme on Immunisation (EPI). We quantified all health system implementation costs, including programme costs, to calculate the cost effectiveness of adding rotavirus immunisation to EPI and the existing provision of diarrhoea treatment (oral rehydration salts and intravenous fluids) to children. We used ingredients and step down costing methods. Cost and coverage data were collected in 2012 at one urban and one rural district hospital and a health centre in Tanzania. We used Disability Adjusted Life Years (DALYs) as the outcome measure and estimated incremental costs and health outcomes using a Markov transition model with weekly cycles up to a five-year time horizon. The average unit cost per vaccine dose at 93% coverage is US$ 8.4, with marked difference between the urban facility US$ 5.2; and the rural facility US$ 9.8. RV1 vaccine added to current diarrhoea treatment is highly cost effective compared to diarrhoea treatment given alone, with incremental cost effectiveness ratio of US$ 112 per DALY averted, varying from US$ 80-218 in sensitivity analysis. The intervention approaches a 100% probability of being cost effective at a much lower level of willingness-to-pay than the US$609 per capita Tanzania gross domestic product (GDP). The combination of rotavirus immunisation with diarrhoea treatment is likely to be cost effective when willingness to pay for health is higher than USD 112 per DALY. Universal coverage of the vaccine will accelerate progress towards achievement of the child health Millennium Development Goals.

Screening, prevention and treatment of cervical cancer -- a global and regional generalized cost-effectiveness analysis.

PubMed

Ginsberg, Gary Michael; Edejer, Tessa Tan-Torres; Lauer, Jeremy A; Sepulveda, Cecilia

2009-10-09

The paper calculates regional generalized cost-effectiveness estimates of screening, prevention, treatment and combined interventions for cervical cancer. Using standardised WHO-CHOICE methodology, a cervical cancer model was employed to provide estimates of screening, vaccination and treatment effectiveness. Intervention effectiveness was determined via a population state-transition model (PopMod) that simulates the evolution of a sub-regional population accounting for births, deaths and disease epidemiology. Economic costs of procedures and treatment were estimated, including programme overhead and training costs. In regions characterized by high income, low mortality and high existing treatment coverage, the addition of any screening programme to the current high treatment levels is very cost-effective. However, based on projections of the future price per dose (representing the economic costs of the vaccination excluding monopolistic rents and vaccine development cost) vaccination is the most cost-effective intervention. In regions characterized by low income, low mortality and existing treatment coverage around 50%, expanding treatment with or without combining it with screening appears to be cost-effective or very cost-effective. Abandoning treatment in favour of screening in a no-treatment scenario would not be cost-effective. Vaccination is usually the most cost-effective intervention. Penta or tri-annual PAP smears appear to be cost-effective, though when combined with HPV-DNA testing they are not cost-effective. In regions characterized by low income, high mortality and low treatment levels, expanding treatment with or without adding screening would be very cost-effective. A one off vaccination plus expanding treatment was usually very cost-effective. One-off PAP or VIA screening at age 40 are more cost-effective than other interventions though less effective overall. From a cost-effectiveness perspective, consideration should be given to implementing vaccination (depending on cost per dose and longevity of efficacy) and screening programmes on a worldwide basis to reduce the burden of disease from cervical cancer. Treatment should also be increased where coverage is low.

Economic Burden of Atopic Dermatitis in High-Risk Infants Receiving Cow's Milk or Partially Hydrolyzed 100% Whey-Based Formula.

PubMed

Bhanegaonkar, Abhijeet; Horodniceanu, Erica G; Ji, Xiang; Detzel, Patrick; Boguniewicz, Mark; Chamlin, Sarah; Lake, Alan; Czerkies, Laura A; Botteman, Marc F; Saavedra, José M

2015-05-01

To estimate the health and economic impact of feeding partially hydrolyzed formula-whey (PHF-W) instead of standard cow's milk formula (CMF) for the first 4 months of life among US infants at high risk for developing atopic dermatitis (AD). A Markov model was developed integrating published data, a survey of US pediatricians, costing sources and market data, and expert opinion. Key modeled outcomes included reduction in AD risk, time spent post AD diagnosis, days without AD flare, and AD-related costs. Costs and clinical consequences were discounted at 3% annually. An estimated absolute 14-percentage point reduction in AD risk was calculated with the use of PHF-W compared with CMF (95% CI for difference, 3%-22%). Relative to CMF, PHF-W decreased the time spent post-AD diagnosis by 8.3 months (95% CI, 2.78-13.31) per child and increased days without AD flare by 39 days (95% CI, 13-63) per child. The AD-related, 6-year total cost estimate was $495 less (95% CI, -$813 to -$157) per child with PHF-W ($724 per child; 95% CI, $385-$1269) compared with CMF ($1219 per child; 95% CI, $741-$1824). Utilization of PHF-W in place of CMF as the initial infant formula administered to high-risk US infants not exclusively breastfed during the first 4 months of life may reduce the incidence and economic burden of AD. Broad implementation of this strategy could result in a minimum savings of $355 million per year to society. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Automated drug dispensing systems in the intensive care unit: a financial analysis.

PubMed

Chapuis, Claire; Bedouch, Pierrick; Detavernier, Maxime; Durand, Michel; Francony, Gilles; Lavagne, Pierre; Foroni, Luc; Albaladejo, Pierre; Allenet, Benoit; Payen, Jean-Francois

2015-09-09

To evaluate the economic impact of automated-drug dispensing systems (ADS) in surgical intensive care units (ICUs). A financial analysis was conducted in three adult ICUs of one university hospital, where ADS were implemented, one in each unit, to replace the traditional floor stock system. Costs were estimated before and after implementation of the ADS on the basis of floor stock inventories, expired drugs, and time spent by nurses and pharmacy technicians on medication-related work activities. A financial analysis was conducted that included operating cash flows, investment cash flows, global cash flow and net present value. After ADS implementation, nurses spent less time on medication-related activities with an average of 14.7 hours saved per day/33 beds. Pharmacy technicians spent more time on floor-stock activities with an average of 3.5 additional hours per day across the three ICUs. The cost of drug storage was reduced by €44,298 and the cost of expired drugs was reduced by €14,772 per year across the three ICUs. Five years after the initial investment, the global cash flow was €148,229 and the net present value of the project was positive by €510,404. The financial modeling of the ADS implementation in three ICUs showed a high return on investment for the hospital. Medication-related costs and nursing time dedicated to medications are reduced with ADS.

Effects of independently altering body weight and body mass on the metabolic cost of running.

PubMed

Teunissen, Lennart P J; Grabowski, Alena; Kram, Rodger

2007-12-01

The metabolic cost of running is substantial, despite the savings from elastic energy storage and return. Previous studies suggest that generating vertical force to support body weight and horizontal forces to brake and propel body mass are the major determinants of the metabolic cost of running. In the present study, we investigated how independently altering body weight and body mass affects the metabolic cost of running. Based on previous studies, we hypothesized that reducing body weight would decrease metabolic rate proportionally, and adding mass and weight would increase metabolic rate proportionally. Further, because previous studies show that adding mass alone does not affect the forces generated on the ground, we hypothesized that adding mass alone would have no substantial effect on metabolic rate. We manipulated the body weight and body mass of 10 recreational human runners and measured their metabolic rates while they ran at 3 m s(-1). We reduced weight using a harness system, increased mass and weight using lead worn about the waist, and increased mass alone using a combination of weight support and added load. We found that net metabolic rate decreased in less than direct proportion to reduced body weight, increased in slightly more than direct proportion to added load (added mass and weight), and was not substantially different from normal running with added mass alone. Adding mass alone was not an effective method for determining the metabolic cost attributable to braking/propelling body mass. Runners loaded with mass alone did not generate greater vertical or horizontal impulses and their metabolic costs did not substantially differ from those of normal running. Our results show that generating force to support body weight is the primary determinant of the metabolic cost of running. Extrapolating our reduced weight data to zero weight suggests that supporting body weight comprises at most 74% of the net cost of running. However, 74% is probably an overestimate of the metabolic demand of body weight to support itself because in reduced gravity conditions decrements in horizontal impulse accompanied decrements in vertical impulse.

Lipid metabolism and mitochondrial energy production are key pathways involved in adipose tissue of cows transitioning from feed restriction to ad libitum diets

USDA-ARS?s Scientific Manuscript database

Feed costs account for over 70% of the annual expenditures in cow/calf production. The majority of the nutrients are used to support the cow’s maintenance requirements and substrate cycling has been identified as one of the major contributors toward this type of energy expenditure. The objective of ...

76 FR 14543 - Federal Acquisition Regulation; Proper Use and Management of Cost-Reimbursement Contracts

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-16

... above the contracting officer. FAR 7.105(b)(5)(iv) was added to discuss the strategy to transition from... ADMINISTRATION 48 CFR Parts 1, 2, 7, 16, 32, 42, and 50 [FAC 2005-50; FAR Case 2008-030; Item I; Docket 2011-0082... to the Regulatory Secretariat on or before May 16, 2011 to be considered in the formulation of a...

Cost-utility analysis of memantine extended release added to cholinesterase inhibitors compared to cholinesterase inhibitor monotherapy for the treatment of moderate-to-severe dementia of the Alzheimer's type in the US.

PubMed

Saint-Laurent Thibault, Catherine; Özer Stillman, Ipek; Chen, Stephanie; Getsios, Denis; Proskorovsky, Irina; Hernandez, Luis; Dixit, Shailja

2015-01-01

This study evaluates the cost-effectiveness of memantine extended release (ER) as an add-on therapy to acetylcholinesterase inhibitor (AChEI) [combination therapy] for treatment of patients with moderate-to-severe Alzheimer's disease (AD) from both a healthcare payer and a societal perspective over 3 years when compared to AChEI monotherapy in the US. A phase III trial evaluated the efficacy and safety of memantine ER for treatment of AD patients taking an AChEI. The analysis assessed the long-term costs and health outcomes using an individual patient simulation in which AD progression is modeled in terms of cognition, behavior, and functioning changes. Input parameters are based on patient-level trial data, published literature, and publicly available data sources. Changes in anti-psychotic medication use are incorporated based on a published retrospective cohort study. Costs include drug acquisition and monitoring, total AD-related medical care, and informal care associated with caregiver time. Incremental cost-utility ratio (ICUR), life years, care time for caregiver, time in community and institution, time on anti-psychotics, time by disease severity, and time without severe symptoms are reported. Costs and health outcomes are discounted at 3% per annum. Considering a societal perspective over 3 years, this analysis shows that memantine ER combined with an AChEI provides better clinical outcomes and lower costs than AChEI monotherapy. Discounted average savings were estimated at $18,355 and $20,947 per patient and quality-adjusted life-years (QALYs) increased by an average of 0.12 and 0.13 from a societal and healthcare payer perspective, respectively. Patients on combination therapy spent an average of 4 months longer living at home and spend less time in moderate-severe and severe stages of the disease. Combination therapy for patients with moderate-to-severe AD is a cost-effective treatment compared to AChEI monotherapy in the US.

Stranded cost securitization: Analytical considerations

DOE Office of Scientific and Technical Information (OSTI.GOV)

Abbott, S.

1997-10-01

Securitization is a promising financing approach by which utilities may recover their stranded costs while lowering their cost of capital, permitting them to offer rate reductions to customers. However, there are important issues to analyze before determining that securitization will be an attractive option for bondholders. To facilitate the transition to a competitive electric market, numerous state legislatures have passed or are considering legislation that, while mandating competition, allows utilities to recover their stranded costs through the imposition of a competitive transition fee. To accommodate securitization of revenues from the fees, statutes typically designate as a property right the futuremore » revenues from these fees and the utility may sell, assign, or transfer the rights to a financing vehicle. Securities may be issued by a trust or other special purpose vehicle supported by future revenues from these fees. Because of the unique characteristics of the highly regulated utility industry and the {open_quotes}asset{close_quotes} that is securitized, the credit analysis of stranded cost securities differs from that of most other assets. For example, underwriting and servicing issues, which are key items of interest in other segments of the ABS market, are less of a concern in a stranded cost context.« less

Agricultural anaerobic digestion power plants in Ireland and Germany: policy and practice.

PubMed

Auer, Agathe; Vande Burgt, Nathan H; Abram, Florence; Barry, Gerald; Fenton, Owen; Markey, Bryan K; Nolan, Stephen; Richards, Karl; Bolton, Declan; De Waal, Theo; Gordon, Stephen V; O'Flaherty, Vincent; Whyte, Paul; Zintl, Annetta

2017-02-01

The process of anaerobic digestion (AD) is valued as a carbon-neutral energy source, while simultaneously treating organic waste, making it safer for disposal or use as a fertilizer on agricultural land. The AD process in many European nations, such as Germany, has grown from use of small, localized digesters to the operation of large-scale treatment facilities, which contribute significantly to national renewable energy quotas. However, these large AD plants are costly to run and demand intensive farming of energy crops for feedstock. Current policy in Germany has transitioned to support funding for smaller digesters, while also limiting the use of energy crops. AD within Ireland, as a new technology, is affected by ambiguous governmental policies concerning waste and energy. A clear governmental strategy supporting on-site AD processing of agricultural waste will significantly reduce Ireland's carbon footprint, improve the safety and bioavailability of agricultural waste, and provide an indigenous renewable energy source. © 2016 Society of Chemical Industry. © 2016 Society of Chemical Industry.

Marginal Hospital Cost of Surgery-related Hospital-acquired Pressure Ulcers.

PubMed

Spector, William D; Limcangco, Rhona; Owens, Pamela L; Steiner, Claudia A

2016-09-01

Patients who develop hospital-acquired pressure ulcers (HAPUs) are more likely to die, have longer hospital stays, and are at greater risk of infections. Patients undergoing surgery are prone to developing pressure ulcers (PUs). To estimate the hospital marginal cost of a HAPU for adults patients who were hospitalized for major surgeries, adjusted for patient characteristics, comorbidities, procedures, and hospital characteristics. Data are from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases and the Medicare Patient Safety Monitoring System for 2011 and 2012. PU information was obtained using retrospective structured record review from trained MPMS data abstractors. Costs are derived using HCUP hospital-specific cost-to-charge ratios. Marginal cost estimates were made using Extended Estimating Equations. We estimated the marginal cost at the 25th, 50th, and 75th percentiles of the cost distribution using Simultaneous Quantile Regression. We find that 3.5% of major surgical patients developed HAPUs and that the HAPUs added ∼$8200 to the cost of a surgical stay after adjusting for comorbidities, patient characteristics, procedures, and hospital characteristics. This is an ∼44% addition to the cost of a major surgical stay but less than half of the unadjusted cost difference. In addition, we find that for high-cost stays (75th percentile) HAPUs added ∼$12,100, whereas for low-cost stays (25th percentile) HAPUs added ∼$3900. This paper suggests that HAPUs add ∼44% to the cost of major surgical hospital stays, but the amount varies depending on the total cost of the visit.

Cost-effectiveness of PCSK9 Inhibitor Therapy in Patients With Heterozygous Familial Hypercholesterolemia or Atherosclerotic Cardiovascular Disease.

PubMed

Kazi, Dhruv S; Moran, Andrew E; Coxson, Pamela G; Penko, Joanne; Ollendorf, Daniel A; Pearson, Steven D; Tice, Jeffrey A; Guzman, David; Bibbins-Domingo, Kirsten

2016-08-16

Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors were recently approved for lowering low-density lipoprotein cholesterol in heterozygous familial hypercholesterolemia (FH) or atherosclerotic cardiovascular disease (ASCVD) and have potential for broad ASCVD prevention. Their long-term cost-effectiveness and effect on total health care spending are uncertain. To estimate the cost-effectiveness of PCSK9 inhibitors and their potential effect on US health care spending. The Cardiovascular Disease Policy Model, a simulation model of US adults aged 35 to 94 years, was used to evaluate cost-effectiveness of PCSK9 inhibitors or ezetimibe in heterozygous FH or ASCVD. The model incorporated 2015 annual PCSK9 inhibitor costs of $14,350 (based on mean wholesale acquisition costs of evolocumab and alirocumab); adopted a health-system perspective, lifetime horizon; and included probabilistic sensitivity analyses to explore uncertainty. Statin therapy compared with addition of ezetimibe or PCSK9 inhibitors. Lifetime major adverse cardiovascular events (MACE: cardiovascular death, nonfatal myocardial infarction, or stroke), incremental cost per quality-adjusted life-year (QALY), and total effect on US health care spending over 5 years. Adding PCSK9 inhibitors to statins in heterozygous FH was estimated to prevent 316,300 MACE at a cost of $503,000 per QALY gained compared with adding ezetimibe to statins (80% uncertainty interval [UI], $493,000-$1,737,000). In ASCVD, adding PCSK9 inhibitors to statins was estimated to prevent 4.3 million MACE compared with adding ezetimibe at $414,000 per QALY (80% UI, $277,000-$1,539,000). Reducing annual drug costs to $4536 per patient or less would be needed for PCSK9 inhibitors to be cost-effective at less than $100,000 per QALY. At 2015 prices, PCSK9 inhibitor use in all eligible patients was estimated to reduce cardiovascular care costs by $29 billion over 5 years, but drug costs increased by an estimated $592 billion (a 38% increase over 2015 prescription drug expenditures). In contrast, initiating statins in these high-risk populations in all statin-tolerant individuals who are not currently using statins was estimated to save $12 billion. Assuming 2015 prices, PCSK9 inhibitor use in patients with heterozygous FH or ASCVD did not meet generally acceptable incremental cost-effectiveness thresholds and was estimated to increase US health care costs substantially. Reducing annual drug prices from more than $14,000 to $4536 would be necessary to meet a $100,000 per QALY threshold.

The cost-effectiveness of NBPTS teacher certification.

PubMed

Yeh, Stuart S

2010-06-01

A cost-effectiveness analysis of the National Board for Professional Teaching Standards (NBPTS) program suggests that Board certification is less cost-effective than a range of alternative approaches for raising student achievement, including comprehensive school reform, class size reduction, a 10% increase in per pupil expenditure, the use of value-added statistical methods to identify effective teachers, and the implementation of systems where student performance in math and reading is rapidly assessed 2-5 times per week. The most cost-effective approach, rapid assessment, is three magnitudes as cost-effective as Board certification.

Automatic Control of Personal Rapid Transit Vehicles

NASA Technical Reports Server (NTRS)

Smith, P. D.

1972-01-01

The requirements for automatic longitudinal control of a string of closely packed personal vehicles are outlined. Optimal control theory is used to design feedback controllers for strings of vehicles. An important modification of the usual optimal control scheme is the inclusion of jerk in the cost functional. While the inclusion of the jerk term was considered, the effect of its inclusion was not sufficiently studied. Adding the jerk term will increase passenger comfort.

The economics of stranded investment - a two-way street

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cearley, R.; McKinzie, L.

In the transition to deregulation, the risk, costs and benefits of utility assets are transferred from the customer to the investor, creating potential stranded benefits as well as stranded costs. Investors may be better or worse off depending on whether an asset`s cost is below or above market. Regulators can minimize unintended wealth transfers by compensating each potential loser in the transition. The amount of investment stranded - i.e., the portion of plant that is above market value - does seem to be a murky issue. This article sets a framework for evaluating stranded investment and traces the possible welfaremore » effects of different policies to address it. It defines {open_quote}stranded costs,{close_quote} {open_quote}stranded investment,{close_quote} and {open_quote}stranded benefits.{close_quote} It addresses their interrelationship, and shows that the redefinition of property rights during the transition to a competitive market is what leads to stranded investment. The elimination of the utility`s exclusive franchise - i.e., its obligation to serve and customers` obligation to pay - leads to the redefinition of those property rights as they pertain to the costs, benefits and risks associated with existing utility generation. Finally, the authors address the possible welfare implications from this transition.« less

Improving Military Educational Benefits

DTIC Science & Technology

1983-03-16

military to take advantage of their educational benefits . o Adding recruiters or increasing bonuses are less costly ways to increase the number of...as members left to take advantage of their benefits --poorer retention would cancel out five percentage points of that gain. The overall cost of our...IMPROVING MILITARY EDUCATIONAL BENEFITS Statement of Robert F. Hale Assistant Director for National Security and International Affairs

Compliant walking appears metabolically advantageous at extreme step lengths.

PubMed

Kim, Jaehoon; Bertram, John E A

2018-05-19

Humans alter gait in response to unusual gait circumstances to accomplish the task of walking. For instance, subjects spontaneously increase leg compliance at a step length threshold as step length increases. Here we test the hypothesis that this transition occurs based on the level of energy expenditure, where compliant walking becomes less energetically demanding at long step lengths. To map and compare the metabolic cost of normal and compliant walking as step length increases. 10 healthy individuals walked on a treadmill using progressively increasing step lengths (100%, 120%, 140% and 160% of preferred step length), in both normal and compliant leg walking as energy expenditure was recorded via indirect calorimetry. Leg compliance was controlled by lowering the center-of-mass trajectory during stance, forcing the leg to flex and extend as the body moved over the foot contact. For normal step lengths, compliant leg walking was more costly than normal walking gait, but compliant leg walking energetic cost did not increase as rapidly for longer step lengths. This led to an intersection between normal and compliant walking cost curves at 114% relative step length (regression analysis; r 2  = 0.92 for normal walking; r 2  = 0.65 for compliant walking). Compliant leg walking is less energetically demanding at longer step lengths where a spontaneous shift to compliant walking has been observed, suggesting the human motor control system is sensitive to energetic requirements and will employ alternate movement patterns if advantageous strategies are available. The transition could be attributed to the interplay between (i) leg work controlling body travel during single stance and (ii) leg work to control energy loss in the step-to-step transition. Compliant leg walking requires more stance leg work at normal step lengths, but involves less energy loss at the step-to-step transition for very long steps. Copyright © 2018 Elsevier B.V. All rights reserved.

Long and spatially variable Neolithic Demographic Transition in the North American Southwest

PubMed Central

Kohler, Timothy A.; Reese, Kelsey M.

2014-01-01

In many places of the world, a Neolithic Demographic Transition (NDT) is visible as a several-hundred-year period of increased birth rates coupled with stable mortality rates, resulting in dramatic population growth that is eventually curtailed by increased mortality. Similar processes can be reconstructed in particular detail for the North American Southwest, revealing an anomalously long and spatially variable NDT. Irrigation-dependent societies experienced relatively low birth rates but were quick to achieve a high degree of sociopolitical complexity, whereas societies dependent on dry or rainfed farming experienced higher birth rates but less initial sociopolitical complexity. Low birth rates after A.D. 1200 mark the beginning of the decline of the Hohokam. Overall in the Southwest, birth rates increased slowly from 1100 B.C. to A.D. 500, and remained at high levels with some fluctuation until decreasing rapidly beginning A.D. 1300. Life expectancy at 15 increased slowly from 900 B.C. to A.D. 700, and then increased rapidly for 200 y before fluctuating and then declining after A.D. 1400. Life expectancy at birth, on the other hand, generally declined from 1100 B.C. to A.D. 1100/1200, before rebounding. Farmers took two millennia (∼1100 B.C. to ∼A.D. 1000) to reach the carrying capacity of the agricultural niche in the Southwest. PMID:24982134

Generalizing the transition from amplitude to oscillation death in coupled oscillators.

PubMed

Zou, Wei; Senthilkumar, D V; Koseska, Aneta; Kurths, Jürgen

2013-11-01

Amplitude death (AD) and oscillation death (OD) are two structurally different oscillation quenching types in coupled nonlinear oscillators. The transition from AD to OD has been recently realized due to the interplay between heterogeneity and coupling strength [A. Koseska et al., Phys. Rev. Lett. 111, 024103 (2013)]. We identify here the transition from AD to OD in nonlinear oscillators with couplings of distinct natures. It is demonstrated that the presence of time delay in the coupling cannot induce such a transition in identical oscillators, but it can indeed facilitate its occurrence with a low degree of heterogeneity. Moreover, it is further shown that the AD to OD transition is reliably observed in identical oscillators with dynamic and conjugate couplings. The coexistence of AD and OD and rich stable OD configurations after the transition are revealed, which are of great significance for potential applications in physics, biology, and control studies.

Dynamical AdS strings across horizons

DOE PAGES

Ishii, Takaaki; Murata, Keiju

2016-03-01

We examine the nonlinear classical dynamics of a fundamental string in anti-deSitter spacetime. The string is dual to the flux tube between an external quark-antiquark pair in $N = 4$ super Yang-Mills theory. We perturb the string by shaking the endpoints and compute its time evolution numerically. We find that with sufficiently strong perturbations the string continues extending and plunges into the Poincare´ horizon. In the evolution, effective horizons are also dynamically created on the string worldsheet. The quark and antiquark are thus causally disconnected, and the string transitions to two straight strings. The forces acting on the endpoints vanishmore » with a power law whose slope depends on the perturbations. Lastly, the condition for this transition to occur is that energy injection exceeds the static energy between the quark-antiquark pair.« less

Holographic Chern-Simons defects

DOE PAGES

Fujita, Mitsutoshi; Melby-Thompson, Charles M.; Meyer, René; ...

2016-06-28

Here, we study SU(N ) Yang-Mills-Chern-Simons theory in the presence of defects that shift the Chern-Simons level from a holographic point of view by embedding the system in string theory. The model is a D3-D7 system in Type IIB string theory, whose gravity dual is given by the AdS soliton background with probe D7 branes attaching to the AdS boundary along the defects. We holographically renormalize the free energy of the defect system with sources, from which we obtain the correlation functions for certain operators naturally associated to these defects. We find interesting phase transitions when the separation of themore » defects as well as the temperature are varied. We also discuss some implications for the Fractional Quantum Hall Effect and for 2-dimensional QCD.« less

Organizational culture during the accident response process

DOE Office of Scientific and Technical Information (OSTI.GOV)

Shurberg, D.A.; Haber, S.B.

1992-01-01

The ability of an organization to effectively move from an anticipatory to an ad hoc strategy may well depend on the organization having the ability to balance these two apparently dichotomous cultural styles. The organization which is most capable of making the necessary transition in an optimal manner may well exhibit some aspects of both cultural styles during normal operations. Data collected at one NPP does exhibit this pattern of results, with the organization exhibiting a clear hierarchical chain of command and perceived conventional behavioral expectations as well as exhibiting a more decentralized and collegial approach to decisionmaking, a teammore » work orientation, and informal communications. Thus, it is expected that this organization possesses the capabilities to make a successful transition from an anticipatory to an ad hoc strategy. Data collected at a second NPP more strongly exhibits the traditional style suggested as being important during the anticipatory strategy, with more formal communications and bureaucratically controlled decision-making. This organization may experience difficulty if faced with the need to make a transition from an anticipatory to an ad hoc strategy. These conclusions are further validated based on observation of Emergency Preparedness Exercise Inspections, which suggest that the more anticipatory types of behaviors actually inhibit successful performance during an ad hoc response. The final validation of these hypotheses needs to be demonstrated with cultural data collected during emergency simulations. The mechanism to obtain such data during these types of situations is an area for future research.« less

Organizational culture during the accident response process

DOE Office of Scientific and Technical Information (OSTI.GOV)

Shurberg, D.A.; Haber, S.B.

1992-08-01

The ability of an organization to effectively move from an anticipatory to an ad hoc strategy may well depend on the organization having the ability to balance these two apparently dichotomous cultural styles. The organization which is most capable of making the necessary transition in an optimal manner may well exhibit some aspects of both cultural styles during normal operations. Data collected at one NPP does exhibit this pattern of results, with the organization exhibiting a clear hierarchical chain of command and perceived conventional behavioral expectations as well as exhibiting a more decentralized and collegial approach to decisionmaking, a teammore » work orientation, and informal communications. Thus, it is expected that this organization possesses the capabilities to make a successful transition from an anticipatory to an ad hoc strategy. Data collected at a second NPP more strongly exhibits the traditional style suggested as being important during the anticipatory strategy, with more formal communications and bureaucratically controlled decision-making. This organization may experience difficulty if faced with the need to make a transition from an anticipatory to an ad hoc strategy. These conclusions are further validated based on observation of Emergency Preparedness Exercise Inspections, which suggest that the more anticipatory types of behaviors actually inhibit successful performance during an ad hoc response. The final validation of these hypotheses needs to be demonstrated with cultural data collected during emergency simulations. The mechanism to obtain such data during these types of situations is an area for future research.« less

NREL Evaluates Performance of Fast-Charge Electric Buses

DOE Office of Scientific and Technical Information (OSTI.GOV)

2016-09-16

This real-world performance evaluation is designed to enhance understanding of the overall usage and effectiveness of electric buses in transit operation and to provide unbiased technical information to other agencies interested in adding such vehicles to their fleets. Initial results indicate that the electric buses under study offer significant fuel and emissions savings. The final results will help Foothill Transit optimize the energy-saving potential of its transit fleet. NREL's performance evaluations help vehicle manufacturers fine-tune their designs and help fleet managers select fuel-efficient, low-emission vehicles that meet their bottom line and operational goals. help Foothill Transit optimize the energy-saving potentialmore » of its transit fleet. NREL's performance evaluations help vehicle manufacturers fine-tune their designs and help fleet managers select fuel-efficient, low-emission vehicles that meet their bottom line and operational goals.« less

An Insurer's Care Transition Program Emphasizes Medication Reconciliation, Reduces Readmissions And Costs.

PubMed

Polinski, Jennifer M; Moore, Janice M; Kyrychenko, Pavlo; Gagnon, Michael; Matlin, Olga S; Fredell, Joshua W; Brennan, Troyen A; Shrank, William H

2016-07-01

Adverse drug events and the challenges of clarifying and adhering to complex medication regimens are central drivers of hospital readmissions. Medication reconciliation programs can reduce the incidence of adverse drug events after discharge, but evidence regarding the impact of medication reconciliation on readmission rates and health care costs is less clear. We studied an insurer-initiated care transition program based on medication reconciliation delivered by pharmacists via home visits and telephone and explored its effects on high-risk patients. We examined whether voluntary program participation was associated with improved medication use, reduced readmissions, and savings net of program costs. Program participants had a 50 percent reduced relative risk of readmission within thirty days of discharge and an absolute risk reduction of 11.1 percent. The program saved $2 for every $1 spent. These results represent real-world evidence that insurer-initiated, pharmacist-led care transition programs, focused on but not limited to medication reconciliation, have the potential to both improve clinical outcomes and reduce total costs of care. Project HOPE—The People-to-People Health Foundation, Inc.

Health outcomes of bedaquiline in the treatment of multidrug-resistant tuberculosis in selected high burden countries.

PubMed

Lu, Xiaoyan; Smare, Caitlin; Kambili, Chrispin; El Khoury, Antoine C; Wolfson, Lara J

2017-01-26

Less than one-third of patients who are estimated to be infected with multidrug-resistant tuberculosis (MDR-TB) receive MDR-TB treatment regimens, and only 48% of those who received treatment have successful outcomes. Despite current regimens, newer, more effective and cost-effective approaches to treatment are needed. The aim of the study was to project health outcomes and impact on healthcare resources of adding bedaquiline to the treatment regimen of MDR-TB in selected high burden countries: Estonia, Russia, South Africa, Peru, China, the Philippines, and India. This study adapted an existing Markov model to estimate the health outcomes and impact on total healthcare costs of adding bedaquiline to current MDR-TB treatment regimens. A price threshold analysis was conducted to determine the price range at which bedaquiline would be cost-effective. Adding bedaquiline to the background regimen (BR) resulted in increased disability-adjusted life years (DALYs) averted, and reduced total healthcare costs (excluding treatment acquisition costs) compared with BR alone in all countries analyzed. Addition of bedaquiline to BR resulted in savings to healthcare costs compared with BR alone in all countries analyzed, with the highest impact expected in Russia (US$194 million) and South Africa (US$43 million). The price per regimen at which bedaquiline would be cost-effective ranged between US$23,904-US$203,492 in Estonia, Russia, Peru, South Africa, and China (high and upper middle-income countries) and between US$6,996-US$20,323 in the Philippines and India (lower middle-income countries); however, these cost-effective prices do not necessarily address concerns about affordability. Adding bedaquiline to BR provides improvements in health outcomes and reductions in healthcare costs in high MDR-TB burden countries. The range of prices per regimen for which bedaquiline would be cost-effective varied between countries.

Systematic Approach to Better Understanding Integration Costs: Preprint

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stark, Gregory B.

2015-09-28

When someone mentions integration costs, thoughts of the costs of integrating renewable generation into an existing system come to mind. We think about how variability and uncertainty can increase power system cycling costs as increasing amounts of wind or solar generation are incorporated into the generation mix. However, seldom do we think about what happens to system costs when new baseload generation is added to an existing system or when generation self-schedules. What happens when a highly flexible combined-cycle plant is added? Do system costs go up, or do they go down? Are other, non-cycling, maintenance costs impacted? In thismore » paper we investigate six technologies and operating practices--including VG, baseload generation, generation mix, gas prices, self-scheduling, and fast-start generation--and how changes in these areas can impact a system's operating costs. This paper provides a working definition of integration costs and four components of variable costs. It describes the study approach and how a production cost modeling-based method was used to determine the cost effects, and, as a part of the study approach section, it describes the test system and data used for the comparisons. Finally, it presents the research findings, and, in closing, suggests three areas for future work.« less

Rivastigmine for Alzheimer's disease: Canadian interpretation of intermediate outcome measures and cost implications.

PubMed

Baladi, J F; Bailey, P A; Black, S; Bouchard, R W; Farcnik, K D; Gauthier, S; Kertesz, A; Mohr, E; Robillard, A

2000-12-01

Clinical studies have shown that patients with Alzheimer's disease (AD) who are treated with rivastigmine have statistically significantly better scores on 5 scales used to assess AD than control patients receiving placebo. However, the clinical meaning and cost implications of these differences are not clear. The purpose of this study was to assess the clinical meaning and cost implications of statistically significant results obtained in clinical trials of rivastigmine for the treatment of AD. Potential cost implications for the health care system, caregivers, and society are considered. Data on clinical effects of rivastigmine were obtained from published North American and European clinical studies of patients with mild to moderately severe AD receiving rivastigmine 6 to 12 mg/d (n = 828) or placebo (n = 647). Differences in scores on the Alzheimer's Disease Assessment Scale-Cognitive Function, Clinician's Interview-Based Impression of Change with both clinical and caregiver information considered, Progressive Deterioration Scale, Mini-Mental State Examination (MMSE), and Global Deterioration Scale were assessed. A convenience panel of 9 Canadian specialists experienced in the treatment of AD provided their opinions on the clinical importance of the trial results. Chart review was performed to identify specific behaviors that improved, and cost implications of improvements were assessed. The panel determined that statistically significant differences in scores on all scales except the MMSE were likely associated with functional or cognitive differences that were clinically relevant for patients, reflecting stabilization that would have beneficial consequences for caregivers and health care resource use. Subsequent chart review showed that improvement on specific scale items confirmed the physician panel's opinion. Analysis of possible cost implications to society indicated that medication expenditures would be offset largely by delays in the need for paid home care and institutionalization, positive effects on caregiver health, and less time lost from work for the caregiver. From the perspective of a Canadian specialist panel, rivastigmine treatment for AD produces clinically relevant effects for patients that are beneficial to caregivers. These effects suggest decreased use of caregiver resources and delays in the need for institutionalization, both of which reduce societal costs.

Clinical and cost implications of amyloid beta detection with amyloid beta positron emission tomography imaging in early Alzheimer's disease - the case of florbetapir.

PubMed

Hornberger, John; Bae, Jay; Watson, Ian; Johnston, Joe; Happich, Michael

2017-04-01

Amyloid beta (Aβ) positron emission tomography (PET) imaging helps estimate Aβ neuritic plaque density in patients with cognitive impairment who are under evaluation for Alzheimer's disease (AD). This study aims to evaluate the cost-effectiveness of the Aβ-PET scan as an adjunct to standard diagnostic assessment for diagnosis of AD in France, using florbetapir as an example. A state-transition probability analysis was developed adopting the French Health Technology Assessment (HTA) perspective per guidance. Parameters included test characteristics, rate of cognitive decline, treatment effect, costs, and quality of life. Additional scenarios assessed the validity of the analytical framework, including: (1) earlier evaluation/treatment; (2) cerebrospinal fluid (CSF) as a comparator; and (3) use of other diagnostic procedures. Outputs included differences in quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs). All benefits and costs were discounted for time preferences. Sensitivity analyses were performed to assess the robustness of findings and key influencers of outcomes. Aβ-PET used as an adjunct to standard diagnostic assessment increased QALYs by 0.021 years and 10 year costs by €470 per patient. The ICER was €21,888 per QALY gained compared to standard diagnostic assessment alone. When compared with CSF, Aβ-PET costs €24,084 per QALY gained. In other scenarios, Aβ-PET was consistently cost-effective relative to the commonly used affordability threshold (€40,000 per QALY). Over 95% of simulations in the sensitivity analysis were cost-effective. Aβ-PET is projected to affordably increase QALYs from the French HTA perspective per guidance over a range of clinical scenarios, comparators, and input parameters.

Hybrid Airships: Intratheater Operations Cost-Benefit Analysis

DTIC Science & Technology

2011-06-01

airships (HA) in an intratheater humanitarian assistance scenario. A linear programming model was used to study various mixes of hybrid airships...i.e. 200 tons) must be moved as quickly as possible (or during sealift transit), then HA operating costs of $3,000 per hour or less also make them a ...for Future Research ................................................................................ 52 Appendix A : Examples of HA Concepts/Prototypes

Evolution of trophic transmission in parasites: Why add intermediate hosts?

USGS Publications Warehouse

Choisy, Marc; Brown, Sam P.; Lafferty, Kevin D.; Thomas, Frédéric

2003-01-01

Although multihost complex life cycles (CLCs) are common in several distantly related groups of parasites, their evolution remains poorly understood. In this article, we argue that under particular circumstances, adding a second host to a single-host life cycle is likely to enhance transmission (i.e., reaching the target host). For instance, in several situations, the propagules of a parasite exploiting a predator species will achieve a higher host-finding success by encysting in a prey of the target predator than by other dispersal modes. In such a case, selection should favor the transition from a singleto a two-host life cycle that includes the prey species as an intermediate host. We use an optimality model to explore this idea, and we discuss it in relation to dispersal strategies known among free-living species, especially animal dispersal. The model found that selection favored a complex life cycle only if intermediate hosts were more abundant than definitive hosts. The selective value of a complex life cycle increased with predation rates by definitive hosts on intermediate hosts. In exploring trade-offs between transmission strategies, we found that more costly trade-offs made it more difficult to evolve a CLC while less costly trade-offs between traits could favor a mixed strategy.

Kinetic energy classification and smoothing for compact B-spline basis sets in quantum Monte Carlo

DOE PAGES

Krogel, Jaron T.; Reboredo, Fernando A.

2018-01-25

Quantum Monte Carlo calculations of defect properties of transition metal oxides have become feasible in recent years due to increases in computing power. As the system size has grown, availability of on-node memory has become a limiting factor. Saving memory while minimizing computational cost is now a priority. The main growth in memory demand stems from the B-spline representation of the single particle orbitals, especially for heavier elements such as transition metals where semi-core states are present. Despite the associated memory costs, splines are computationally efficient. In this paper, we explore alternatives to reduce the memory usage of splined orbitalsmore » without significantly affecting numerical fidelity or computational efficiency. We make use of the kinetic energy operator to both classify and smooth the occupied set of orbitals prior to splining. By using a partitioning scheme based on the per-orbital kinetic energy distributions, we show that memory savings of about 50% is possible for select transition metal oxide systems. Finally, for production supercells of practical interest, our scheme incurs a performance penalty of less than 5%.« less

Kinetic energy classification and smoothing for compact B-spline basis sets in quantum Monte Carlo

DOE Office of Scientific and Technical Information (OSTI.GOV)

Krogel, Jaron T.; Reboredo, Fernando A.

Quantum Monte Carlo calculations of defect properties of transition metal oxides have become feasible in recent years due to increases in computing power. As the system size has grown, availability of on-node memory has become a limiting factor. Saving memory while minimizing computational cost is now a priority. The main growth in memory demand stems from the B-spline representation of the single particle orbitals, especially for heavier elements such as transition metals where semi-core states are present. Despite the associated memory costs, splines are computationally efficient. In this paper, we explore alternatives to reduce the memory usage of splined orbitalsmore » without significantly affecting numerical fidelity or computational efficiency. We make use of the kinetic energy operator to both classify and smooth the occupied set of orbitals prior to splining. By using a partitioning scheme based on the per-orbital kinetic energy distributions, we show that memory savings of about 50% is possible for select transition metal oxide systems. Finally, for production supercells of practical interest, our scheme incurs a performance penalty of less than 5%.« less

Cost Comparison of Laparoscopic versus Open Procedures at the Sydney Women's Endosurgery Centre

PubMed Central

Chou, Danny; Cario, Gregory

1998-01-01

Objectives: The objective of this study was to provide a cost comparison between laparoscopic surgery and open surgery from January 1996 to January 1998. The setting for this study was three private hospitals and one public hospital associated with the Sydney Women's Endosurgery Centre. Cost analysis was done using the costing provided by the private and public hospitals representing the total amount charged to the patient or the fund for their entire stay including disposable laparoscopic instruments and miscellaneous charges. We looked at laparoscopic hysterectomy, abdominal hysterectomy, vaginal hysterectomy, laparoscopic Burch colposuspension and open Burch colposus-pension. Despite the difficulties and limitations using our method of cost analysis, it appears that laparoscopic surgery is a less costly alternative to open abdominal surgery, particularly where the amount of disposable instruments are kept to a minimum. When the added advantages of early return to normal activities, family and workplace are added in, it is clear that providers of health care in the public and private sector will see laparoscopic surgery as an increasingly desirable option.

Phase transition and entropy inequality of noncommutative black holes in a new extended phase space

DOE Office of Scientific and Technical Information (OSTI.GOV)

Miao, Yan-Gang; Xu, Zhen-Ming, E-mail: miaoyg@nankai.edu.cn, E-mail: xuzhenm@mail.nankai.edu.cn

We analyze the thermodynamics of the noncommutative high-dimensional Schwarzschild-Tangherlini AdS black hole with the non-Gaussian smeared matter distribution by regarding a noncommutative parameter as an independent thermodynamic variable named as the noncommutative pressure . In the new extended phase space that includes this noncommutative pressure and its conjugate variable, we reveal that the noncommutative pressure and the original thermodynamic pressure related to the negative cosmological constant make the opposite effects in the phase transition of the noncommutative black hole, i.e. the former dominates the UV regime while the latter does the IR regime, respectively. In addition, by means of themore » reverse isoperimetric inequality, we indicate that only the black hole with the Gaussian smeared matter distribution holds the maximum entropy for a given thermodynamic volume among the noncommutative black holes with various matter distributions.« less

Mapping the Dynamics Landscape of Conformational Transitions in Enzyme: The Adenylate Kinase Case

PubMed Central

Li, Dechang; Liu, Ming S.; Ji, Baohua

2015-01-01

Conformational transition describes the essential dynamics and mechanism of enzymes in pursuing their various functions. The fundamental and practical challenge to researchers is to quantitatively describe the roles of large-scale dynamic transitions for regulating the catalytic processes. In this study, we tackled this challenge by exploring the pathways and free energy landscape of conformational changes in adenylate kinase (AdK), a key ubiquitous enzyme for cellular energy homeostasis. Using explicit long-timescale (up to microseconds) molecular dynamics and bias-exchange metadynamics simulations, we determined at the atomistic level the intermediate conformational states and mapped the transition pathways of AdK in the presence and absence of ligands. There is clearly chronological operation of the functional domains of AdK. Specifically in the ligand-free AdK, there is no significant energy barrier in the free energy landscape separating the open and closed states. Instead there are multiple intermediate conformational states, which facilitate the rapid transitions of AdK. In the ligand-bound AdK, the closed conformation is energetically most favored with a large energy barrier to open it up, and the conformational population prefers to shift to the closed form coupled with transitions. The results suggest a perspective for a hybrid of conformational selection and induced fit operations of ligand binding to AdK. These observations, depicted in the most comprehensive and quantitative way to date, to our knowledge, emphasize the underlying intrinsic dynamics of AdK and reveal the sophisticated conformational transitions of AdK in fulfilling its enzymatic functions. The developed methodology can also apply to other proteins and biomolecular systems. PMID:26244746

Low-Cost Robotic Assessment of Visuo-Motor Deficits in Alzheimer's Disease.

PubMed

Bartoli, Eleonora; Caso, Francesca; Magnani, Giuseppe; Baud-Bovy, Gabriel

2017-07-01

A low-cost robotic interface was used to assess the visuo-motor performance of patients with Alzheimer's disease (AD). Twenty AD patients and twenty age-matched controls participated in this work. The battery of tests included simple reaction times, position tracking, and stabilization tasks performed with both hands. The regularity, velocity, visual and haptic feedback were manipulated to vary movement complexity. Reaction times and movement tracking error were analyzed. Results show a marked group effect on a subset of conditions, in particular when the patients could not rely on the visual feedback of hand movement. The visuo-motor performance correlated with the measures of global cognitive functioning and with different memory-related abilities. Our results support the hypothesis that the ability to recall and use visuo-spatial associations might underlie the impairment in complex motor behavior that has been reported in AD patients. Importantly, the patients had preserved learning effects across sessions, which might relate to visuo-motor deficits being less evident in every-day life and clinical assessments. This robotic assessment, lasting less than 1 h, provides detailed information about the integrity of visuo-motor abilities. The data can aid the understanding of the complex pattern of deficits that characterizes this pervasive disease.

Paying for convenience: comparing the cost of takeaway meals with their healthier home-cooked counterparts in New Zealand.

PubMed

Mackay, Sally; Vandevijvere, Stefanie; Xie, Pei; Lee, Amanda; Swinburn, Boyd

2017-09-01

Convenience and cost impact on people's meal decisions. Takeaway and pre-prepared foods save preparation time but may contribute to poorer-quality diets. Analysing the impact of time on relative cost differences between meals of varying convenience contributes to understanding the barrier of time to selecting healthy meals. Six popular New Zealand takeaway meals were identified from two large national surveys and compared with similar, but healthier, home-made and home-assembled meals that met nutrition targets consistent with New Zealand Eating and Activity Guidelines. The cost of each complete meal, cost per kilogram, and confidence intervals of the cost of each meal type were calculated. The time-inclusive cost was calculated by adding waiting or preparation time cost at the minimum wage. A large urban area in New Zealand. For five of six popular meals, the mean cost of the home-made and home-assembled meals was cheaper than the takeaway meals. When the cost of time was added, all home-assembled meal options were the cheapest and half of the home-made meals were at least as expensive as the takeaway meals. The home-prepared meals were designed to provide less saturated fat and Na and more vegetables than their takeaway counterparts; however, the home-assembled meals provided more Na than the home-made meals. Healthier home-made and home-assembled meals were, except one, cheaper options than takeaways. When the cost of time was added, either the home-made or the takeaway meal was the most expensive. This research questions whether takeaways are better value than home-prepared meals.

Nutrient density: addressing the challenge of obesity.

PubMed

Drewnowski, Adam

2017-10-30

Obesity rates are increasing worldwide. Potential reasons include excessive consumption of sugary beverages and energy-dense foods instead of more nutrient-rich options. On a per kJ basis, energy-dense grains, added sugars and fats cost less, whereas lean meats, seafood, leafy greens and whole fruit generally cost more. Given that consumer food choices are often driven by price, the observed social inequities in diet quality and health can be explained, in part, by nutrition economics. Achieving a nutrient-rich diet at an affordable cost has become progressively more difficult within the constraints of global food supply. However, given the necessary metrics and educational tools, it may be possible to eat better for less. New metrics of nutrient density help consumers identify foods, processed and unprocessed, that are nutrient-rich, affordable and appealing. Affordability metrics, created by adding food prices to food composition data, permit calculations of both kJ and nutrients per penny, allowing for new studies on the economic drivers of food choice. Merging dietary intake data with local or national food prices permits the estimation of individual-level diet costs. New metrics of nutrient balance can help identify those food patterns that provide optimal nutritional value. Behavioural factors, including cooking at home, have been associated with nutrition resilience, defined as healthier diets at lower cost. Studies of the energy and nutrient costs of the global food supply and diverse food patterns will permit a better understanding of the socioeconomic determinants of health. Dietary advice ought to be accompanied by economic feasibility studies.

Innovative Soft-Sided Waste Packaging System Implementation at a Small Department of Energy Environmental Restoration/Waste Management (ER/WM) Site

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wolf, J.

2002-02-28

Weiss Associates (WA) performs a broad range of environmental restoration/waste management (ER/WM) activities for the U.S. Department of Energy (DOE) at the former Laboratory for Energy-Related Health Research (LEHR), University of California, Davis (UC Davis). Over the last three years, the LEHR ER/WM program transitioned from a baseline packaging system of steel, 2.7 cubic meter (3.5-cubic yard) B-25 boxes to a 7.0 cubic meter (9.1-cubic yard) soft-sided container (Lift Liner) system. The transition increased efficiencies in processing, packaging, and storage, and when combined with decreased procurement costs, achieved a $402,000 cost savings (Table I). Additional disposal costs between $128,600 andmore » $182,600 were avoided by minimizing void space. Future cost savings by the end of fiscal year 2003 are projected between $250,640 and $1,003,360.« less

Incorporating Linear Synchronous Transit Interpolation into the Growing String Method: Algorithm and Applications.

PubMed

Behn, Andrew; Zimmerman, Paul M; Bell, Alexis T; Head-Gordon, Martin

2011-12-13

The growing string method is a powerful tool in the systematic study of chemical reactions with theoretical methods which allows for the rapid identification of transition states connecting known reactant and product structures. However, the efficiency of this method is heavily influenced by the choice of interpolation scheme when adding new nodes to the string during optimization. In particular, the use of Cartesian coordinates with cubic spline interpolation often produces guess structures which are far from the final reaction path and require many optimization steps (and thus many energy and gradient calculations) to yield a reasonable final structure. In this paper, we present a new method for interpolating and reparameterizing nodes within the growing string method using the linear synchronous transit method of Halgren and Lipscomb. When applied to the alanine dipeptide rearrangement and a simplified cationic alkyl ring condensation reaction, a significant speedup in terms of computational cost is achieved (30-50%).

Phase transitions in 3D gravity and fractal dimension

NASA Astrophysics Data System (ADS)

Dong, Xi; Maguire, Shaun; Maloney, Alexander; Maxfield, Henry

2018-05-01

We show that for three dimensional gravity with higher genus boundary conditions, if the theory possesses a sufficiently light scalar, there is a second order phase transition where the scalar field condenses. This three dimensional version of the holographic superconducting phase transition occurs even though the pure gravity solutions are locally AdS3. This is in addition to the first order Hawking-Page-like phase transitions between different locally AdS3 handlebodies. This implies that the Rényi entropies of holographic CFTs will undergo phase transitions as the Rényi parameter is varied, as long as the theory possesses a scalar operator which is lighter than a certain critical dimension. We show that this critical dimension has an elegant mathematical interpretation as the Hausdorff dimension of the limit set of a quotient group of AdS3, and use this to compute it, analytically near the boundary of moduli space and numerically in the interior of moduli space. We compare this to a CFT computation generalizing recent work of Belin, Keller and Zadeh, bounding the critical dimension using higher genus conformal blocks, and find a surprisingly good match.

The cosmic QCD phase transition with dense matter and its gravitational waves from holography

NASA Astrophysics Data System (ADS)

Ahmadvand, M.; Bitaghsir Fadafan, K.

2018-04-01

Consistent with cosmological constraints, there are scenarios with the large lepton asymmetry which can lead to the finite baryochemical potential at the cosmic QCD phase transition scale. In this paper, we investigate this possibility in the holographic models. Using the holographic renormalization method, we find the first order Hawking-Page phase transition, between the Reissner-Nordström AdS black hole and thermal charged AdS space, corresponding to the de/confinement phase transition. We obtain the gravitational wave spectra generated during the evolution of bubbles for a range of the bubble wall velocity and examine the reliability of the scenarios and consequent calculations by gravitational wave experiments.

Assessing the costs, benefits, cost-effectiveness, and cost-benefit of psychological assessment: we should, we can, and here's how.

PubMed

Yates, Brian T; Taub, Jennifer

2003-12-01

To the extent that assessment improves the effectiveness of treatment, prevention, or other services, it can be said to be effective. If an assessment is as effective as alternatives for improving treatment and less costly, it can be said to be cost-effective. If that improvement in the effectiveness of the service is monetary or monetizable, the assessment can be judged beneficial. And, if the sum of monetary and monetizable benefits of assessment exceeds the sum of the costs of treatment, the assessment can be said to be cost-beneficial. An overview of cost-related issues is followed by practical strategies that researchers and administrators can use to measure incremental costs, incremental effectiveness, and incremental benefits of adding psychological assessments to other psychological interventions.

Research and development on membrane processes for removal of acid gases during coal gasification. Final report, 20 June 1975-19 October 1976

DOE Office of Scientific and Technical Information (OSTI.GOV)

Petersen, R.J.; Cadotte, J.E.; Conway, E.J.

1976-01-01

The object of this program was to develop novel and unique membranes for separating acid gases from coal gasification streams. Many candidate membranes, including cationic, hydrophilic, and silicone, were tested. Optimum separation properties were possessed by membranes formulated from crosslinked methyl cellulose coated on polysulfone support films. The observed separation properties were explained theoretically by the solubility of the various gases in the water contained within the membranes rather than by activated transport. Each of the acid gas clean-up processes considered required additional sulfur clean-up, a guard chamber, and a Claus plant for recovering sulfur. These additional costs were calculatedmore » and added to the base costs for acid gas removal from the raw SNG. When the additional costs were added to the costs of the Rectisol, Benfield, Sulfinol, and fluidized dolomite processes the total costs ranged from 43 to 49 cents/Mscf. For the membrane process the additional sulfur removal costs were about 3.3 cents/Mscf to be added to the base costs for acid gas removal. The best membrane composition found during this program, one which exhibited a CO/sub 2//H/sub 2/ selectivity of 13 at a CO/sub 2/ flux of 6 ft/sup 3//ft/sup 2/-hr-100 psi, would entail a process cost of about 53 cents/Mscf with these additions. This is about 7 cents/Mscf more than for the average of the other processes. No better membrane performance is predicted on the basis of the experiments performed. Without a shift in several cost factors, membranes cannot be competitive. The possibility that reduced energy availability could lead to such shifts should not be discounted but is not foreseen in the near future.« less

Thermodynamics and phase transition of charged AdS black holes with a global monopole

NASA Astrophysics Data System (ADS)

Deng, Gao-Ming; Fan, Jinbo; Li, Xinfei; Huang, Yong-Chang

2018-01-01

Thermodynamical properties of charged AdS black holes with a global monopole still remain obscure. In this paper, we investigate the thermodynamics and phase transition of the black holes in the extended phase space. It is shown that thermodynamical quantities of the black holes exhibit an interesting dependence on the internal global monopole, and they perfectly satisfy both the first law of thermodynamics and Smarr relation. Furthermore, analysis of the local and the global thermodynamical stability manifests that the charged AdS black hole undergoes an elegant phase transition at critical point. Of special interest, critical behaviors of the black holes resemble a Van der Waals liquid-gas system. Our results not only reveal the effect of a global monopole on thermodynamics of AdS black holes, but also further support that Van der Waals-like behavior of the black holes is a universal phenomenon.

America's School Leftovers.

ERIC Educational Resources Information Center

Passmore, David L.

1991-01-01

Compared to other countries, the United States spends less for the transition from school to work of non-college-bound students. Costs of such training need to be viewed as an investment in productivity and competitiveness and in a better outlook for this forgotten group. (SK)

Incremental burden of congestive heart failure among elderly with Alzheimer's.

PubMed

Chhatre, Sumedha; Weiner, Mark G; Jayadevappa, Ravishankar; Johnson, Jerry C

2009-07-01

A complex relationship exists between Alzheimer's disease (AD) and other co-existing co-morbidities such as congestive heart failure (CHF) with implications for health resource utilization (HRU) and cost of care. Study objective was to assess HRU and cost of care in elderly with AD and with or without concomitant CHF. All elderly (> or =65 years) from an academic healthcare system diagnosed with AD in 1999 (n = 904) and matched AD-free controls (n = 3616). Each group was subdivided into those with and without a CHF diagnosis. Costs and HRU were obtained from Medicare databases for 1999 and 2000. Costs and HRU were compared using ANOVA and Wilcoxon rank sum tests. Regressions were used to model the effect of AD and CHF on outcomes. Mean annual cost were 20,888 US dollars for AD + CHF group, 5,473 US dollars for only AD group, 17,700 US dollars for only CHF group and 4,578 US dollars for the control group (no-AD and no-CHF). After adjusting for covariates, AD + CHF group had an eight-fold increase in total cost, while only CHF group had five-fold increase in total cost, compared to the control group. Regressions for inpatient costs, outpatient costs and inpatient pharmacy costs exhibited comparable trends. For elderly AD patients, a co-occurring diagnosis of CHF can result in a substantial increase in cost and HRU. This necessitates additional considerations if health care expenditures are to be reduced, particularly inpatient expenditure.

The benefits of redesigning Benin's vaccine supply chain.

PubMed

Brown, Shawn T; Schreiber, Benjamin; Cakouros, Brigid E; Wateska, Angela R; Dicko, Hamadou M; Connor, Diana L; Jaillard, Philippe; Mvundura, Mercy; Norman, Bryan A; Levin, Carol; Rajgopal, Jayant; Avella, Mélanie; Lebrun, Caroline; Claypool, Erin; Paul, Proma; Lee, Bruce Y

2014-07-07

New vaccine introductions have put strains on vaccine supply chains around the world. While increasing storage and transportation may be the most straightforward options, it is also important to consider what financial and operational benefits can be incurred. In 2012, suboptimal vaccine coverage and impending vaccine introductions prompted the Republic of Benin's Ministry of Health (MOH) to explore ways to improve their vaccine supply chain. Working alongside the Beninese MOH, we utilized our computational model, HERMES, to explore the impact on cost and vaccine availability of three possible options: (1) consolidating the Commune level to a Health Zone level, (2) removing the Commune level completely, and (3) removing the Commune level and expanding to 12 Department Stores. We also analyzed the impact of adding shipping loops during delivery. At baseline, new vaccine introductions without any changes to the current system increased the logistics cost per dose ($0.23 to $0.26) and dropped the vaccine availability to 71%. While implementing the Commune level removal scenario had the same capital costs as implementing the Health Zone scenario, the Health Zone scenario had lower operating costs. This increased to an overall cost savings of $504,255 when implementing shipping loops. The best redesign option proved to be the synergistic approach of converting to the Health Zone design and using shipping loops (serving ten Health Posts/loop). While a transition to either redesign or only adding shipping loops was beneficial, implementing a redesign option and shipping loops can yield both lower capital expenditures and operating costs. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

What Drives Country Differences in Cost of Alzheimer's Disease? An Explanation from Resource Use in the GERAS Study.

PubMed

Reed, Catherine; Happich, Michael; Argimon, Josep Maria; Haro, Josep Maria; Wimo, Anders; Bruno, Giuseppe; Dodel, Richard; Jones, Roy W; Vellas, Bruno; Belger, Mark

2017-01-01

Country differences in resource use and costs of Alzheimer's disease (AD) may be driven by differences in health care systems and resource availability. To compare country resource utilization drivers of societal costs for AD dementia over 18 months. GERAS is an observational study in France (n = 419), Germany (n = 550), and the UK (n = 526). Resource use of AD patients and caregivers contributing to >1% of total societal costs (year 2010) was assessed for country differences, adjusting for participant characteristics. Mean 18-month societal costs per patient were France €33,339, Germany €38,197, and UK €37,899 (£32,501). Caregiver time spent on basic and instrumental activities of daily living (ADL) contributed the most to societal costs (54% France, 64% Germany, 65% UK). Caregivers in France spent less time on ADL than UK caregivers and missed fewer work days than in other countries. Compared with other countries, patients in France used more community care services overall and were more likely to use home aid. Patients in Germany were least likely to use temporary accommodation or to be institutionalized at 18 months. UK caregivers spent the most time on instrumental ADL, UK patients used fewest outpatient resources, and UK patients/caregivers were most likely to receive financial support. Caregiver time on ADL contributed the most to societal costs and differed across countries, possibly due to use of community care services and institutionalization. Other resources had different patterns of use across countries, reflecting country-specific health and social care systems.

Recall and Believability of the Tips From Former Smokers Campaign Among University Students

PubMed Central

Ickes, Melinda. J.; Butler, Karen; Rayens, Mary Kay; Noland, Melody; Wiggins, Amanda T.; Hahn, Ellen J.

2016-01-01

Background Tobacco media campaigns are effective, but less is known regarding the impact on college students. Purpose The purpose was to test the effects of an on-campus Tips television campaign on frequency and believability of ads recalled and to assess demographic and personal factors associated with believability. Methods A quasi-experimental pre-post design was used to assess the 8-week campaign with three Tips ads. Two randomly-selected cohorts of college students (N = 1,593) from a large public university completed online surveys pre- and post-campaign. Group comparisons using chi-square tests, two-sample t-tests, and logistic regression, controlling for residence or cohort; predictors of believability using proportional odds modeling. Results Ads were recalled by significantly more students (68%) post-campaign. Believability for one or more ads was lower for males, undergraduates, those belonging to fraternity/sorority, and current polytobacco users (p<.05). Believability was greater for those who recalled seeing the ads more often (p<.05). Discussion Sub-groups of college students, including males and undergraduates, reported less ad believability, which should be considered when designing communication strategies. Translation to Health Education Practice Considering the potential impact and cost-effective nature of on-campus TV media campaigns, these ads need to be integrated into current campus tobacco control strategies. PMID:28396713

Recall and Believability of the Tips From Former Smokers Campaign Among University Students.

PubMed

Ickes, Melinda J; Butler, Karen; Rayens, Mary Kay; Noland, Melody; Wiggins, Amanda T; Hahn, Ellen J

2016-01-01

Tobacco media campaigns are effective, but less is known regarding the impact on college students. The purpose was to test the effects of an on-campus Tips television campaign on frequency and believability of ads recalled and to assess demographic and personal factors associated with believability. A quasi-experimental pre-post design was used to assess the 8-week campaign with three Tips ads. Two randomly-selected cohorts of college students ( N = 1,593) from a large public university completed online surveys pre- and post-campaign. Group comparisons using chi-square tests, two-sample t-tests, and logistic regression, controlling for residence or cohort; predictors of believability using proportional odds modeling. Ads were recalled by significantly more students (68%) post-campaign. Believability for one or more ads was lower for males, undergraduates, those belonging to fraternity/sorority, and current polytobacco users ( p <.05). Believability was greater for those who recalled seeing the ads more often ( p <.05). Sub-groups of college students, including males and undergraduates, reported less ad believability, which should be considered when designing communication strategies. Considering the potential impact and cost-effective nature of on-campus TV media campaigns, these ads need to be integrated into current campus tobacco control strategies.

A consistent and unified picture for critical phenomena of f(R) AdS black holes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mo, Jie-Xiong; Li, Gu-Qiang; Wu, Yu-Cheng, E-mail: mojiexiong@gmail.com, E-mail: zsgqli@hotmail.com, E-mail: wuyucheng0827@163.com

A consistent and unified picture for critical phenomena of charged AdS black holes in f ( R ) gravity is drawn in this paper. Firstly, we investigate the phase transition in canonical ensemble. We derive the explicit solutions corresponding to the divergence of C {sub Q} . The two solutions merge into one when the condition Q {sub c} =√(−1/3 R {sub 0}) is satisfied. The curve of specific heat for Q < Q {sub c} has two divergent points and can be divided into three regions. Both the large radius region and the small radius region are thermodynamically stablemore » with positive specific heat while the medium radius region is unstable with negative specific heat. However, when Q > Q {sub c} , the specific heat is always positive, implying the black holes are locally stable and no phase transition will take place. Secondly, both the T − r {sub +} curve and T − S curve f ( R ) AdS black holes are investigated and they exhibit Van der Vaals like behavior as the P − v curve in the former research. Critical physical quantities are obtained and they are consistent with those derived from the specific heat analysis. We carry out numerical check of Maxwell equal area law for the cases Q =0.2 Q {sub c} , 0.4 Q {sub c} , 0.6 Q {sub c} , 0.8 Q {sub c} . The relative errors are amazingly small and can be negligible. So the Maxwell equal area law holds for T − S curve of f ( R ) black holes. Thirdly, we establish geometrothermodynamics for f ( R ) AdS black hole to examine the phase structure. It is shown that the Legendre invariant scalar curvature R would diverge exactly where the specific heat diverges. To summarize, the above three perspectives are consistent with each other, thus providing a unified picture which deepens the understanding of critical phenomena of f ( R ) AdS black holes.« less

[Efficacy of memantine in the treatment of Alzheimer's disease].

PubMed

Molinuevo Guix, J L; Lladó Plarrumaní, A

2005-12-01

Alzheimer's disease (AD) is a neurodegenerative disorder clinically characterized by cognitive loss with impairment of daily living activities. The benefits presently observed with the approved treatments are mainly symptomatic without clear evidence of neuroprotection. N-methyl-D-aspartate (NMDA) glutamate receptor antagonists have very extensive therapeutic potential in several central nervous system disorders and can be used in chronic neurodegenerative diseases and in other neurological diseases such as epilepsy. Memantine, a moderate-low affinity, uncompetitive NMDA receptor antagonist, is the only antiglutamatergic drug currently approved for the treatment of moderate to severe AD. Several studies have demonstrated that treatment with memantine has cognitive and functional benefits through all disease stages, while it is safe and well tolerated. Additionally, memantine generates an indirect positive effect on the caregiver, which results in some social benefits. This fact, together with a delay on the transition towards a greater dependence stage is probably associated with a decrease in the number of patients institutionalized. From a socio-economic perspective, these effects mean lower global cost of disease, therefore being a cost-effective drug.

A Claims-Based Examination of Health Care Costs Among Spouses of Patients With Alzheimer's Disease.

PubMed

Gilden, Daniel M; Kubisiak, Joanna M; Kahle-Wrobleski, Kristin; Ball, Daniel E; Bowman, Lee

2017-06-01

Spouses of Alzheimer's disease patients (AD spouses) may experience substantial health effects associated with their partner's chronic cognitive and behavioral dysfunction. Studies examining associations between the medical experiences of AD spouses in the period before and after their partner's AD diagnosis are limited, particularly those which measure health care resource use and cost. AD patients were identified through multiple Medicare claims containing an AD diagnostic code. Their spouses were identified through special coding in the Medicare eligibility records. The AD spouses were matched demographically to the spouses of Medicare beneficiaries without a history of AD. Longitudinal and annual cross-sectional Medicare cost comparisons utilized log-transformed linear regression. The longitudinal period of observation began 12 months before the AD patient's initial claim listing AD and continued for up to 38 months afterwards. The study identified 16,322 AD spouses. Total per person costs were 24% higher in AD spouses than in the controls ($694/month vs $561/month). AD spouses' excess costs began 3 months before their partners' AD diagnoses and continued for ≥30 months. Being an AD spouse predicted 29% higher Medicare costs after adjustment for chronic health status (P < .001). Increasing AD patient care complexity had a substantial impact on AD spouse Medicare costs (P < .001). This study documents a link between the health status of AD spouses and AD patients. Additional research is required to elicit the mechanism behind the association between AD spouse and AD patient diagnosis. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Cost-effectiveness of adding indoor residual spraying to case management in Afghan refugee settlements in Northwest Pakistan during a prolonged malaria epidemic.

PubMed

Howard, Natasha; Guinness, Lorna; Rowland, Mark; Durrani, Naeem; Hansen, Kristian S

2017-10-01

Financing of malaria control for displaced populations is limited in scope and duration, making cost-effectiveness analyses relevant but difficult. This study analyses cost-effectiveness of adding prevention through targeted indoor residual spraying (IRS) to case management in Afghan refugee settlements in Pakistan during a prolonged malaria epidemic. An intervention study design was selected, taking a societal perspective. Provider and household costs of vector control and case management were collected from provider records and community survey. Health outcomes (e.g. cases and DALYs averted) were derived and incremental cost-effectiveness ratios (ICERs) for cases prevented and DALYs averted calculated. Population, treatment cost, women's time, days of productivity lost, case fatality rate, cases prevented, and DALY assumptions were tested in sensitivity analysis. Malaria incidence peaked at 44/1,000 population in year 2, declining to 14/1,000 in year 5. In total, 370,000 malaria cases, 80% vivax, were diagnosed and treated and an estimated 67,988 vivax cases and 18,578 falciparum and mixed cases prevented. Mean annual programme cost per capita was US$0.56. The additional cost of including IRS over five years per case prevented was US$39; US$50 for vivax (US$43 in years 1-3, US$80 in years 4-5) and US$182 for falciparum (US$139 in years 1-3 and US$680 in years 4-5). Per DALY averted this was US$266 (US$220 in years 1-3 and US$486 in years 4-5) and thus 'highly cost-effective' or cost-effective using WHO and comparison thresholds. Adding IRS was cost-effective in this moderate endemicity, low mortality setting. It was more cost-effective when transmission was highest, becoming less so as transmission reduced. Because vivax was three times more common than falciparum and the case fatality rate was low, cost-effectiveness estimations for cases prevented appear reliable and more definitive for vivax malaria.

Developing a rural transitional care community case management program using clinical nurse specialists.

PubMed

Baldwin, Kathleen M; Black, Denice; Hammond, Sheri

2014-01-01

This quality improvement project developed a community nursing case management program to decrease preventable readmissions to the hospital and emergency department by providing telephonic case management and, if needed, onsite assessment and treatment by a clinical nurse specialist (CNS) with prescriptive authority. As more people reach Medicare age, the number of individuals with worsening chronic diseases with dramatically increases unless appropriate disease management programs are developed. Care transitions can result in breakdown in continuity of care, resulting in increased preventable readmissions, particularly for indigent patients. The CNS is uniquely educated to managing care transitions and coordination of community resources to prevent readmissions. After a thorough SWOT (strengths, weaknesses, opportunities, and threats) analysis, we developed and implemented a cost-avoidance model to prevent readmissions in our uninsured and underinsured patients. The project CNS used a wide array of interventions to decrease readmissions. In the last 2 years, there have been a total of 22 less than 30-day readmissions to the emergency department or hospital in 13 patients, a significant decrease from readmissions in these patients prior to the program. Three of them required transfer to a larger hospital for a higher level of care. Using advanced practice nurses in transitional care can prevent readmissions, resulting in cost avoidance. The coordination of community resources during transition from hospital to home is a job best suited to CNSs, because they are educated to work within organizations/systems. The money we saved with this project more than justified the cost of hiring a CNS to lead it. More research is needed into this technology. Guidelines for this intervention need to be developed. Replicating our cost-avoidance transitional care model can help other facilities limit that loss.

Transition from AdS universe to DS universe in the BPP model

NASA Astrophysics Data System (ADS)

Kim, Wontae; Yoon, Myungseok

2007-04-01

It can be shown that in the BPP model the smooth phase transition from the asymptotically decelerated AdS universe to the asymptotically accelerated DS universe is possible by solving the modified semiclassical equations of motion. This transition comes from noncommutative Poisson algebra, which gives the constant curvature scalars asymptotically. The decelerated expansion of the early universe is due to the negative energy density with the negative pressure induced by quantum back reaction, and the accelerated late-time universe comes from the positive energy and the negative pressure which behave like dark energy source in recent cosmological models.

Implications of comorbidity on costs for patients with Alzheimer disease.

PubMed

Kuo, Tzu-Chun; Zhao, Yang; Weir, Sharada; Kramer, Marilyn Schlein; Ash, Arlene S

2008-08-01

No prior studies have used a comprehensive clinical classification system to examine the effect of differences in overall illness burden and the presence of other diseases on costs for patients with Alzheimer disease (AD) when compared with demographically matched nondemented controls. Of a total of 627,775 enrollees who were eligible for medical and pharmacy benefits for 2003 and 2004 in the MarketScan Medicare Supplemental and Coordination of Benefits Database, we found 25,109 AD patients. For each case, 3 demographically matched nondemented controls were selected using propensity scores. Applying the diagnostic cost groups (DCGs) model to all enrollees, 2003 diagnoses were used to estimate prospective relative risk scores (RRSs) that predict 2004 costs from all illness other than AD. RRSs were then used to control for illness burden to estimate AD's independent effect on costs. Compared with the control group, the AD cohort has more comorbid conditions (8.1 vs. 6.5) and higher illness burden (1.23 vs. 1.04). Individuals with AD are more likely to have mental health conditions, neurologic conditions, cognitive disorders, cerebrovascular disease, diabetes with acute complications, and injuries. Annual costs for AD patients are $3567 (34%) higher than for controls. Excess costs attributable to AD, after controlling for non-AD illness burden, are estimated at $2307 per year with outpatient pharmacy being the key driver ($1711 in excess costs). AD patients are sicker and more expensive than demographically matched controls. Even after adjusting for differences in illness burden, costs remain higher for AD patients.

39 CFR 777.24 - Replacement housing payments.

Code of Federal Regulations, 2014 CFR

2014-07-01

... displaced persons who lawfully and continuously owned and occupied a displacement dwelling for not less than... residential displaced persons who were tenants and lawfully and continuously occupied, a displacement dwelling... the sum of: (i) The amount which must be added to the acquisition cost of the displacement dwelling to...

39 CFR 777.24 - Replacement housing payments.

Code of Federal Regulations, 2010 CFR

2010-07-01

... displaced persons who lawfully and continuously owned and occupied a displacement dwelling for not less than... residential displaced persons who were tenants and lawfully and continuously occupied, a displacement dwelling... the sum of: (i) The amount which must be added to the acquisition cost of the displacement dwelling to...

39 CFR 777.24 - Replacement housing payments.

Code of Federal Regulations, 2013 CFR

2013-07-01

... displaced persons who lawfully and continuously owned and occupied a displacement dwelling for not less than... residential displaced persons who were tenants and lawfully and continuously occupied, a displacement dwelling... the sum of: (i) The amount which must be added to the acquisition cost of the displacement dwelling to...

39 CFR 777.24 - Replacement housing payments.

Code of Federal Regulations, 2012 CFR

2012-07-01

... displaced persons who lawfully and continuously owned and occupied a displacement dwelling for not less than... residential displaced persons who were tenants and lawfully and continuously occupied, a displacement dwelling... the sum of: (i) The amount which must be added to the acquisition cost of the displacement dwelling to...

39 CFR 777.24 - Replacement housing payments.

Code of Federal Regulations, 2011 CFR

2011-07-01

... displaced persons who lawfully and continuously owned and occupied a displacement dwelling for not less than... residential displaced persons who were tenants and lawfully and continuously occupied, a displacement dwelling... the sum of: (i) The amount which must be added to the acquisition cost of the displacement dwelling to...

46 CFR 381.8 - Subsidized vessel participation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... from MARAD an amount for the operating-differential subsidy (ODS) likely to be paid for the carriage of... subsidized bidders; (2) Deriving “augmented bids” for the subsidized operators by adding the ODS amount to... on MARAD's calculation of anticipated costs (less ODS in the case of a subsidized vessel) for the...

Innovative and Cost Effective Remediation of Orbital Debris

DTIC Science & Technology

2014-04-25

to face international opposition because it could be used offensively to disable spacecraft. 4 Technical Analysis Most of StreamSat’s... LDR ). 5 They demonstrated droplet dispersion of less than 1 micro radian for some generators and devised an instrument for measuring the...error can be limited to less than one micro radian using existing technology and techniques. During transit, external forces will alter the path of

Critical behavior and microscopic structure of charged AdS black holes via an alternative phase space

NASA Astrophysics Data System (ADS)

Dehyadegari, Amin; Sheykhi, Ahmad; Montakhab, Afshin

2017-05-01

It has been argued that charged Anti-de Sitter (AdS) black holes have similar thermodynamic behavior as the Van der Waals fluid system, provided one treats the cosmological constant as a thermodynamic variable (pressure) in an extended phase space. In this paper, we disclose the deep connection between charged AdS black holes and Van der Waals fluid system from an alternative point of view. We consider the mass of an AdS black hole as a function of square of the charge Q2 instead of the standard Q, i.e. M = M (S ,Q2 , P). We first justify such a change of view mathematically and then ask if a phase transition can occur as a function of Q2 for fixed P. Therefore, we write the equation of state as Q2 =Q2 (T , Ψ) where Ψ (conjugate of Q2) is the inverse of the specific volume, Ψ = 1 / v. This allows us to complete the analogy of charged AdS black holes with Van der Waals fluid system and derive the phase transition as well as critical exponents of the system. We identify a thermodynamic instability in this new picture with real analogy to Van der Waals fluid with physically relevant Maxwell construction. We therefore study the critical behavior of isotherms in Q2- Ψ diagram and deduce all the critical exponents of the system and determine that the system exhibits a small-large black hole phase transition at the critical point (Tc , Qc2 ,Ψc). This alternative view is important as one can imagine such a change for a given single black hole i.e. acquiring charge which induces the phase transition. Finally, we disclose the microscopic properties of charged AdS black holes by using thermodynamic geometry. Interestingly, we find that scalar curvature has a gap between small and large black holes, and this gap becomes exceedingly large as one moves away from the critical point along the transition line. Therefore, we are able to attribute the sudden enlargement of the black hole to the strong repulsive nature of the internal constituents at the phase transition.

Total staff costs to implement a decision support system in nursing.

PubMed

Castilho, Valéria; Lima, Antônio Fernandes Costa; Fugulin, Fernanda Maria Togeiro; Peres, Heloisa Helena Ciqueto; Gaidzinski, Raquel Rapone

2014-01-01

to identify the direct labor (DL) costs to put in practice a decision support system (DSS) in nursing at the University Hospital of the University of São Paulo (HU-USP). the development of the DSS was mapped in four sub-processes: Conception, Elaboration, Construction and Transition. To calculate the DL, the baseline salary per professional category was added to the five-year additional remuneration, representation fees and social charges, and then divided by the number of hours contracted, resulting in the hour wage/professional, which was multiplied by the time spend on each activity in the sub-processes. the DL cost corresponded to R$ 752,618.56 (100%), R$ 26,000.00 (3.45%) of which were funded by a funding agency, while R$ 726,618.56 (96,55%) came from Hospital and University resources. considering the total DL cost, 72.1% related to staff wages for the informatics consulting company and 27.9% to the DL of professionals at the HU and the School of Nursing.

Semiempirical models of H-mode discharges

DOE Office of Scientific and Technical Information (OSTI.GOV)

Singer, C.E.; Redi, M.; Boyd, D.

1985-05-01

The H-mode transition can lead to a rapid increase in tokamak plasma confinement. A semiempirical transport model was derived from global OH and L-mode confinement scalings and then applied to simulation of H-mode discharges. The radial diffusivities in the model also depend on local density and pressure gradients and satisfy an appropriate dimensional constraint. Examples are shown of the application of this and similar models to the detailed simulation of two discharges which exhibit an H-mode transition. The models reproduce essential features of plasma confinement in the ohmic heating, low and high confinement phases of these discharges. In particular, themore » evolution of plasma energy content through the H-mode transition can be reproduced without any sudden or ad hoc modification of the plasma transport formulation.« less

COMPARISON OF CLEAN DIESEL BUSES TO CNG BUSES

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lowell, D.; Parsley, W.; Bush,C

2003-08-24

Using previously published data on regulated and unregulated emissions, this paper will compare the environmental performance of current generation transit buses operated on compressed natural gas (CNG) to current generation transit buses operated on ultra low sulfur diesel fuel (ULSD) and incorporating diesel particulate filters (DPF). Unregulated emissions evaluated include toxic compounds associated with adverse health effects (carbonyl, PAH, NPAH, benzene) as well as PM particle count and size distribution. For all regulated and unregulated emissions, both technologies are shown to be comparable. DPF equipped diesel buses and CNG buses have virtually identical levels of PM mass emissions and particlemore » number emissions. DPF-equipped diesel buses have lower HC and CO emissions and lower emissions of toxic substances such as benzene, carbonyls and PAHs than CNG buses. CNG buses have lower NOx emissions than DPF-equipped buses, though CNG bus NOx emissions are shown to be much more variable. In addition, this paper will compare the capital and operating costs of CNG and DPF-equipped buses. The cost comparison is primarily based on the experience of MTA New York City Transit in operating CNG buses since 1995 and DPF-equipped buses fueled with ULSD since 2001. Published data on the experience of other large transit agencies in operating CNG buses is used to validate the NYCT experience. The incremental cost (compared to ''baseline'' diesel) of operating a typical 200-bus depot is shown to be six times higher for CNG buses than for ''clean diesel'' buses. The contributors to this increased cost for CNG buses are almost equally split between increased capital costs for purchase of buses and installation of fueling infrastructure, and increased operating costs for purchase of fuel, bus maintenance, and fuel station maintenance.« less

Mechanical and energetic consequences of rolling foot shape in human walking

PubMed Central

Adamczyk, Peter G.; Kuo, Arthur D.

2013-01-01

SUMMARY During human walking, the center of pressure under the foot progresses forward smoothly during each step, creating a wheel-like motion between the leg and the ground. This rolling motion might appear to aid walking economy, but the mechanisms that may lead to such a benefit are unclear, as the leg is not literally a wheel. We propose that there is indeed a benefit, but less from rolling than from smoother transitions between pendulum-like stance legs. The velocity of the body center of mass (COM) must be redirected in that transition, and a longer foot reduces the work required for the redirection. Here we develop a dynamic walking model that predicts different effects from altering foot length as opposed to foot radius, and test it by attaching rigid, arc-like foot bottoms to humans walking with fixed ankles. The model suggests that smooth rolling is relatively insensitive to arc radius, whereas work for the step-to-step transition decreases approximately quadratically with foot length. We measured the separate effects of arc-foot length and radius on COM velocity fluctuations, work performed by the legs and metabolic cost. Experimental data (N=8) show that foot length indeed has much greater effect on both the mechanical work of the step-to-step transition (23% variation, P=0.04) and the overall energetic cost of walking (6%, P=0.03) than foot radius (no significant effect, P>0.05). We found the minimum metabolic energy cost for an arc foot length of approximately 29% of leg length, roughly comparable to human foot length. Our results suggest that the foot's apparently wheel-like action derives less benefit from rolling per se than from reduced work to redirect the body COM. PMID:23580717

Mechanical and energetic consequences of rolling foot shape in human walking.

PubMed

Adamczyk, Peter G; Kuo, Arthur D

2013-07-15

During human walking, the center of pressure under the foot progresses forward smoothly during each step, creating a wheel-like motion between the leg and the ground. This rolling motion might appear to aid walking economy, but the mechanisms that may lead to such a benefit are unclear, as the leg is not literally a wheel. We propose that there is indeed a benefit, but less from rolling than from smoother transitions between pendulum-like stance legs. The velocity of the body center of mass (COM) must be redirected in that transition, and a longer foot reduces the work required for the redirection. Here we develop a dynamic walking model that predicts different effects from altering foot length as opposed to foot radius, and test it by attaching rigid, arc-like foot bottoms to humans walking with fixed ankles. The model suggests that smooth rolling is relatively insensitive to arc radius, whereas work for the step-to-step transition decreases approximately quadratically with foot length. We measured the separate effects of arc-foot length and radius on COM velocity fluctuations, work performed by the legs and metabolic cost. Experimental data (N=8) show that foot length indeed has much greater effect on both the mechanical work of the step-to-step transition (23% variation, P=0.04) and the overall energetic cost of walking (6%, P=0.03) than foot radius (no significant effect, P>0.05). We found the minimum metabolic energy cost for an arc foot length of approximately 29% of leg length, roughly comparable to human foot length. Our results suggest that the foot's apparently wheel-like action derives less benefit from rolling per se than from reduced work to redirect the body COM.

The cost of Alzheimer's disease in China and re-estimation of costs worldwide.

PubMed

Jia, Jianping; Wei, Cuibai; Chen, Shuoqi; Li, Fangyu; Tang, Yi; Qin, Wei; Zhao, Lina; Jin, Hongmei; Xu, Hui; Wang, Fen; Zhou, Aihong; Zuo, Xiumei; Wu, Liyong; Han, Ying; Han, Yue; Huang, Liyuan; Wang, Qi; Li, Dan; Chu, Changbiao; Shi, Lu; Gong, Min; Du, Yifeng; Zhang, Jiewen; Zhang, Junjian; Zhou, Chunkui; Lv, Jihui; Lv, Yang; Xie, Haiqun; Ji, Yong; Li, Fang; Yu, Enyan; Luo, Benyan; Wang, Yanjiang; Yang, Shanshan; Qu, Qiumin; Guo, Qihao; Liang, Furu; Zhang, Jintao; Tan, Lan; Shen, Lu; Zhang, Kunnan; Zhang, Jinbiao; Peng, Dantao; Tang, Muni; Lv, Peiyuan; Fang, Boyan; Chu, Lan; Jia, Longfei; Gauthier, Serge

2018-04-01

The socioeconomic costs of Alzheimer's disease (AD) in China and its impact on global economic burden remain uncertain. We collected data from 3098 patients with AD in 81 representative centers across China and estimated AD costs for individual patient and total patients in China in 2015. Based on this data, we re-estimated the worldwide costs of AD. The annual socioeconomic cost per patient was US $19,144.36, and total costs were US $167.74 billion in 2015. The annual total costs are predicted to reach US $507.49 billion in 2030 and US $1.89 trillion in 2050. Based on our results, the global estimates of costs for dementia were US $957.56 billion in 2015, and will be US $2.54 trillion in 2030, and US $9.12 trillion in 2050, much more than the predictions by the World Alzheimer Report 2015. China bears a heavy burden of AD costs, which greatly change the estimates of AD cost worldwide. Copyright © 2017 the Alzheimer's Association. Published by Elsevier Inc. All rights reserved.

Changing paradigm from one target one ligand towards multi target directed ligand design for key drug targets of Alzheimer disease: An important role of Insilco methods in multi target directed ligands design.

PubMed

Kumar, Akhil; Tiwari, Ashish; Sharma, Ashok

2018-03-15

Alzheimer disease (AD) is now considered as a multifactorial neurodegenerative disorder and rapidly increasing to an alarming situation and causing higher death rate. One target one ligand hypothesis is not able to provide complete solution of AD due to multifactorial nature of disease and one target one drug seems to fail to provide better treatment against AD. Moreover, current available treatments are limited and most of the upcoming treatments under clinical trials are based on modulating single target. So the current AD drug discovery research shifting towards new approach for better solution that simultaneously modulate more than one targets in the neurodegenerative cascade. This can be achieved by network pharmacology, multi-modal therapies, multifaceted, and/or the more recently proposed term "multi-targeted designed drugs. Drug discovery project is tedious, costly and long term project. Moreover, multi target AD drug discovery added extra challenges such as good binding affinity of ligands for multiple targets, optimal ADME/T properties, no/less off target side effect and crossing of the blood brain barrier. These hurdles may be addressed by insilico methods for efficient solution in less time and cost as computational methods successfully applied to single target drug discovery project. Here we are summarizing some of the most prominent and computationally explored single target against AD and further we discussed successful example of dual or multiple inhibitors for same targets. Moreover we focused on ligand and structure based computational approach to design MTDL against AD. However is not an easy task to balance dual activity in a single molecule but computational approach such as virtual screening docking, QSAR, simulation and free energy are useful in future MTDLs drug discovery alone or in combination with fragment based method. However, rational and logical implementations of computational drug designing methods are capable of assisting AD drug discovery and play an important role in optimizing multi-target drug discovery. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Tight-binding model for materials at mesoscale

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tai, Yuan-Yen; Choi, Hongchul; Zhu, Wei

2016-12-21

TBM3 is an open source package for computational simulations of quantum materials at multiple scales in length and time. The project originated to investigate the multiferroic behavior in transition-metal oxide heterostructures. The framework has also been designed to study emergent phemona in other quantum materials like 2-dimensional transition-metal dichalcogenides, graphene, topological insulators, and skyrmion in materials, etc. In the long term, we will enable the package for transport and time-resolved phenomena. TBM3 is currently a C++ based numerical tool package and framework for the design and construction of any kind of lattice structures with multi-orbital and spin degrees of freedom.more » The fortran based portion of the package will be added in the near future. The design of TBM3 is in a highly flexible and reusable framework and the tight-binding parameters can be modeled or informed by DFT calculations. It is currently GPU enabled and feature of CPU enabled MPI will be added in the future.« less

Impact of rivastigmine on costs and on time spent in caregiving for families of patients with Alzheimer's disease.

PubMed

Marin, Deborah; Amaya, Karine; Casciano, Roman; Puder, Katherine L; Casciano, Julian; Chang, Sobin; Snyder, Edward H; Cheng, Isaac; Cuccia, Anthony J

2003-12-01

Alzheimer's disease (AD) places a significant burden on health care systems worldwide. As new treatments are developed, their cost-effectiveness is often assessed to help health care professionals make informed decisions. In addition to the more common practice of assessing direct medical costs, indirect costs, including time spent in caregiving, should be evaluated. This study examined the potential effects of the dual cholinesterase inhibitor rivastigmine (Exelon) on caregivers of patients with AD. Results from two 26-week, placebo-controlled trials have demonstrated the clinically relevant and statistically significant efficacy of rivastigmine (6-12 mg/day) compared to placebo, on cognition, activities of daily living, and global functioning. By delaying progression of AD, significant savings in caregiver burden are anticipated, as measured by time spent caregiving and its related costs. Data collected in a prospective, observational study of AD patients and their caregivers were used to establish the relationship between disease severity (based on Mini-Mental State Examination [MMSE] score) and time spent caregiving (according to the 5-item Caregivers Activity Survey score). A significant correlation was observed between the two scores (N = 43, r = -.56, p < .0001), demonstrating that more time for supervision from caregivers is required as the disease progresses. This finding was used to estimate the reduced caregiver burden resulting from the delay in disease progression that was demonstrated with use of rivastigmine. Over a 2-year period, the reduction in time spent in caregiving reached 691 hours for caregivers of patients with mild AD (MMSE score 21-30), resulting in a total savings of approximately 11,253 dollars. Treatment of patients with moderately severe AD was also evaluated. The trend was similar but the impact was less, suggesting an economic benefit to early therapy. Early diagnosis and a pharmacologic intervention that allows the patients to remain at home longer by delaying disease progression would have a beneficial impact on patients, caregivers, and payers, and should therefore be encouraged through initiatives designed to identify and treat patients early in the course of disease.

Cost effectiveness of adding clostridial collagenase ointment to selective debridement in individuals with stage IV pressure ulcers.

PubMed

Carter, Marissa J; Gilligan, Adrienne M; Waycaster, Curtis R; Schaum, Kathleen; Fife, Caroline E

2017-03-01

The purpose of this study was to determine the cost effectiveness (from a payer's perspective) of adding clostridial collagenase ointment (CCO) to selective debridement compared with selective debridement alone (non-CCO) in the treatment of stage IV pressure ulcers among patients identified from the US Wound Registry. A 3-state Markov model was developed to determine costs and outcomes between the CCO and non-CCO groups over a 2-year time horizon. Outcome data were derived from a retrospective clinical study and included the proportion of pressure ulcers that were closed (epithelialized) over 2 years and the time to wound closure. Transition probabilities for the Markov states were estimated from the clinical study. In the Markov model, the clinical outcome is presented as ulcer-free weeks, which represents the time the wound is in the epithelialized state. Costs for each 4-week cycle were based on frequencies of clinic visits, debridement, and CCO application rates from the clinical study. The final model outputs were cumulative costs (in US dollars), clinical outcome (ulcer-free weeks), and incremental cost-effectiveness ratio (ICER) at 2 years. Compared with the non-CCO group, the CCO group incurred lower costs ($11,151 vs $17,596) and greater benefits (33.9 vs 16.8 ulcer-free weeks), resulting in an economically dominant ICER of -$375 per ulcer. Thus, for each additional ulcer-free week that can be gained, there is a concurrent cost savings of $375 if CCO treatment is selected. Over a 2-year period, an additional 17.2 ulcer-free weeks can be gained with concurrent cost savings of $6,445 for each patient. In this Markov model based on real-world data from the US Wound Registry, the addition of CCO to selective debridement in the treatment of pressure ulcers was economically dominant over selective debridement alone, resulting in greater benefit to the patient at lower cost.

Thermoplastic film prevents proppant flowback

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nguyen, P.D.; Weaver, J.D.; Parker, M.A.

1996-02-05

Thermoplastic film added to proppants is effective and economical for preventing proppant flowback after an hydraulic fracturing treatment. Most other methods, such as resin-coated proppant and fiber, for controlling proppant flowback have drawbacks that added to treatment costs by requiring long downtime, costly additives, or frequent equipment replacement. Thermoplastic film does not react chemically with fracturing fluids. After the proppant is placed in the fracture, the film strips intertwine with the proppant grains or at higher temperatures, the strips become adhesive and shrink forming consolidated clusters that hold open the newly created fractures and prevent proppant from flowing back. Themore » low cost of the film means that the strips can be used throughout the fracturing job or in selected stages. The strips are compatible with fracturing fluid chemistry, including breakers and crosslinkers, and can be used in wells with a wide range of bottom hole temperatures. The end result is a well that can be brought back on-line in a short time with little proppant flowback. This paper reviews the cost benefits and performance of these proppants.« less

Alcohol Advertising on Boston's Massachusetts Bay Transportation Authority Transit System: An Assessment of Youths' and Adults' Exposure

PubMed Central

Nyborn, Justin A.; Wukitsch, Kimberly; Nhean, Siphannay

2009-01-01

Objectives. We investigated the frequency with which alcohol advertisements appeared on Massachusetts Bay Transportation Authority (MBTA) transit lines in Boston, MA, and we calculated adult and youths' exposure to the ads. Methods. We measured the nature and extent of alcohol advertisements on 4 Boston transit lines on 2 separate weekdays 1 month apart in June and July of 2008. We calculated weekday ad exposure for all passengers (all ages) and for Boston Public School student passengers (aged 11–18 years). Results. Alcohol ads were viewed an estimated 1 212 960 times across all Boston-area transit passengers during an average weekday, reaching the equivalent of 42.7% of that population. Alcohol ads were viewed an estimated 18 269 times by Boston Public School student transit passengers during an average weekday, reaching the equivalent of 54.1% of that population. Conclusions. Advertisers reached the equivalent of half of all Boston Public School transit passengers aged 11 to 18 years and the equivalent of nearly half of all transit passengers in the Boston area with an alcohol advertisement each day. Because of the high exposure of underage youths to alcohol advertisements, we recommend that the MBTA prohibit alcohol advertising on the Boston transit system. PMID:19890170

Ad hoc cost analysis of the new gastrointestinal bleeding algorithm in patients with ventricular assist device.

PubMed

Hirose, Hitoshi; Sarosiek, Konrad; Cavarocchi, Nicholas C

2014-01-01

Gastrointestinal bleed (GIB) is a known complication in patients receiving nonpulsatile ventricular assist devices (VAD). Previously, we reported a new algorithm for the workup of GIB in VAD patients using deep bowel enteroscopy. In this new algorithm, patients underwent fewer procedures, received less transfusions, and took less time to make the diagnosis than the traditional GIB algorithm group. Concurrently, we reviewed the cost-effectiveness of this new algorithm compared with the traditional workup. The procedure charges for the diagnosis and treatment of each episode of GIB was ~ $2,902 in the new algorithm group versus ~ $9,013 in the traditional algorithm group (p < 0.0001). Following the new algorithm in VAD patients with GIB resulted in fewer transfusions and diagnostic tests while attaining a substantial cost savings per episode of bleeding.

A quiet flow Ludwieg tube for study of transition in compressible boundary layers: Design and feasibility

NASA Technical Reports Server (NTRS)

Schneider, Steven P.

1990-01-01

Since Ludwieg tubes have been around for many years, and NASA has already established the feasibility of creating quiet-flow wind tunnels, the major question addressed was the cost of the proposed facility. Cost estimates were obtained for major system components, and new designs which allowed fabrication at lower cost were developed. A large fraction of the facility cost comes from the fabrication of the highly polished quiet-flow supersonic nozzle. Methods for the design of this nozzle were studied at length in an attempt to find an effective but less expensive design. Progress was sufficient to show that a quality facility can be fabricated at a reasonable cost.

32 CFR 564.58 - Determination of amount allowable.

Code of Federal Regulations, 2013 CFR

2013-07-01

... the property immediately prior to the accident or incident. Subject to the foregoing, the amount... to the condition in which it was immediately prior to the accident or incident. However, if as the... less than that prior to the accident or incident, the difference in value will be added to the cost of...

32 CFR 564.58 - Determination of amount allowable.

Code of Federal Regulations, 2014 CFR

2014-07-01

... the property immediately prior to the accident or incident. Subject to the foregoing, the amount... to the condition in which it was immediately prior to the accident or incident. However, if as the... less than that prior to the accident or incident, the difference in value will be added to the cost of...

77 FR 64480 - Notice of Final Determination of Sales at Less Than Fair Value: Circular Welded Carbon-Quality...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-22

... INFORMATION CONTACT: John Drury or Ericka Ukrow, AD/CVD Operations, Office 7, Import Administration... conducted sales and cost verifications between June 18 and 28, 2012 of the questionnaire responses submitted by Al Jazeera. We used standard verification procedures, including examination of relevant accounting...

Long-Term Outcomes of Adding HPV Vaccine to the Anal Intraepithelial Neoplasia Treatment Regimen in HIV-Positive Men Who Have Sex With Men

PubMed Central

Deshmukh, Ashish A.; Chhatwal, Jagpreet; Chiao, Elizabeth Y.; Nyitray, Alan G.; Das, Prajnan; Cantor, Scott B.

2015-01-01

Background. Recent evidence shows that quadrivalent human papillomavirus (qHPV) vaccination in men who have sex with men (MSM) who have a history of high-grade anal intraepithelial neoplasia (HGAIN) was associated with a 50% reduction in the risk of recurrent HGAIN. We evaluated the long-term clinical and economic outcomes of adding the qHPV vaccine to the treatment regimen for HGAIN in human immunodeficiency virus (HIV)–positive MSM aged ≥27 years. Methods. We constructed a Markov model based on anal histology in HIV-positive MSM comparing qHPV vaccination with no vaccination after treatment for HGAIN, the current practice. The model parameters, including baseline prevalence, disease transitions, costs, and utilities, were either obtained from the literature or calibrated using a natural history model of anal carcinogenesis. The model outputs included lifetime costs, quality-adjusted life years, and lifetime risk of developing anal cancer. We estimated the incremental cost-effectiveness ratio of qHPV vaccination compared to no qHPV vaccination and decrease in lifetime risk of anal cancer. We also conducted deterministic and probabilistic sensitivity analyses to evaluate the robustness of the results. Results. Use of qHPV vaccination after treatment for HGAIN decreased the lifetime risk of anal cancer by 63% compared with no vaccination. The qHPV vaccination strategy was cost saving; it decreased lifetime costs by $419 and increased quality-adjusted life years by 0.16. Results were robust to the sensitivity analysis. Conclusions. Vaccinating HIV-positive MSM aged ≥27 years with qHPV vaccine after treatment for HGAIN is a cost-saving strategy. Therefore, expansion of current vaccination guidelines to include this population should be a high priority. PMID:26223993

Excess Costs Associated with Possible Misdiagnosis of Alzheimer’s Disease Among Patients with Vascular Dementia in a UK CPRD Population

PubMed Central

Happich, Michael; Kirson, Noam Y.; Desai, Urvi; King, Sarah; Birnbaum, Howard G.; Reed, Catherine; Belger, Mark; Lenox-Smith, Alan; Price, David

2016-01-01

Background: Prior diagnosis of Alzheimer’s disease (AD) among patients later diagnosed with vascular dementia (VaD) has been associated with excess costs, suggesting potential benefits of earlier rule-out of AD diagnosis. Objective: To investigate whether prior diagnosis with AD among patients with VaD is associated with excess costs in the UK. Methods: Patients with a final VaD diagnosis, continuous data visibility for≥6 months prior to index date, and linkage to Hospital Episode Statistics data were retrospectively selected from de-identified Clinical Practice Research Datalink data. Patients with AD diagnosis before a final VaD diagnosis were matched to similar patients with no prior AD diagnosis using propensity score methods. Annual excess healthcare costs were calculated for 5 years post-index, stratified by time to final diagnosis. Results: Of 9,311 patients with VaD, 508 (6%) had prior AD diagnosis with a median time to VaD diagnosis exceeding 2 years from index date. Over the entire follow-up period, patients with prior AD diagnosis had accumulated healthcare costs that were approximately GBP2,000 higher than those for matched counterparts (mostly due to higher hospitalization costs). Cost differentials peaked particularly in the period including the final VaD diagnosis, with excess costs quickly declining thereafter. Conclusion: Potential misdiagnosis of AD among UK patients with VaD resulted in substantial excess costs. The decline in excess costs following a final VaD diagnosis suggests potential benefits from earlier rule-out of AD. PMID:27163798

The cost-effectiveness of tumor-treating fields therapy in patients with newly diagnosed glioblastoma.

PubMed

Bernard-Arnoux, F; Lamure, M; Ducray, F; Aulagner, G; Honnorat, J; Armoiry, X

2016-08-01

There is strong concern about the costs associated with adding tumor-treating fields (TTF) therapy to standard first-line treatment for glioblastoma (GBM). Hence, we aimed to determine the cost-effectiveness of TTF therapy for the treatment of newly diagnosed patients with GBM. We developed a 3-health-state Markov model. The perspective was that of the French Health Insurance, and the horizon was lifetime. We calculated the transition probabilities from the survival parameters reported in the EF-14 trial. The main outcome measure was incremental effectiveness expressed as life-years gained (LYG). Input costs were derived from the literature. We calculated the incremental cost-effectiveness ratio (ICER) expressed as cost/LYG. We used 1-way deterministic and probabilistic sensitivity analysis to evaluate the model uncertainty. In the base-case analysis, adding TTF therapy to standard of care resulted in increases of life expectancy of 4.08 months (0.34 LYG) and €185 476 per patient. The ICER was €549 909/LYG. The discounted ICER was €596 411/LYG. Parameters with the most influence on ICER were the cost of TTF therapy, followed equally by overall survival and progression-free survival in both arms. The probabilistic sensitivity analysis showed a 95% confidence interval of the ICER of €447 017/LYG to €745 805/LYG with 0% chance to be cost-effective at a threshold of €100 000/LYG. The ICER of TTF therapy at first-line treatment is far beyond conventional thresholds due to the prohibitive announced cost of the device. Strong price regulation by health authorities could make this technology more affordable and consequently accessible to patients. © The Author(s) 2016. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Cost-effectiveness analysis of the bivalent and quadrivalent human papillomavirus vaccines from a societal perspective in Colombia.

PubMed

Aponte-González, Johanna; Fajardo-Bernal, Luisa; Diaz, Jorge; Eslava-Schmalbach, Javier; Gamboa, Oscar; Hay, Joel W

2013-01-01

To compare costs and effectiveness of three strategies used against cervical cancer (CC) and genital warts: (i) Screening for CC; (ii) Bivalent Human Papillomavirus (HPV) 16/18 vaccine added to screening; (iii) Quadrivalent HPV 6/11/16/18 vaccine added to screening. A Markov model was designed in order to simulate the natural history of the disease from 12 years of age (vaccination) until death. Transition probabilities were selected or adjusted to match the HPV infection profile in Colombia. A systematic review was undertaken in order to derive efficacy values for the two vaccines as well as for the operational characteristics of the cytology test. The societal perspective was used. Effectiveness was measured in number of averted Disability Adjusted Life Years (DALYS). At commercial prices reported for 2010 the two vaccines were shown to be non-cost-effective alternatives when compared with the existing screening strategy. Sensitivity analyses showed that results are affected by the cost of vaccines and their efficacy values, making it difficult to determine with certainty which of the two vaccines has the best cost-effectiveness profile. To be 'cost-effective' vaccines should cost between 141 and 147 USD (Unite States Dollars) per vaccinated girl at the most. But at lower prices such as those recommended by WHO or the price of other vaccines in Colombia, HPV vaccination could be considered very cost-effective. HPV vaccination could be a convenient alternative for the prevention of CC in Colombia. However, the price of the vaccine should be lower for this vaccination strategy to be cost-effective. It is also important to take into consideration the willingness to pay, budgetary impact, and program implications, in order to determine the relevance of a vaccination program in this country, as well as which vaccine should be selected for use in the program.

Cost-Effectiveness Analysis of the Bivalent and Quadrivalent Human Papillomavirus Vaccines from a Societal Perspective in Colombia

PubMed Central

Aponte-González, Johanna; Fajardo-Bernal, Luisa; Diaz, Jorge; Eslava-Schmalbach, Javier; Gamboa, Oscar; Hay, Joel W.

2013-01-01

Objective To compare costs and effectiveness of three strategies used against cervical cancer (CC) and genital warts: (i) Screening for CC; (ii) Bivalent Human Papillomavirus (HPV) 16/18 vaccine added to screening; (iii) Quadrivalent HPV 6/11/16/18 vaccine added to screening. Methods A Markov model was designed in order to simulate the natural history of the disease from 12 years of age (vaccination) until death. Transition probabilities were selected or adjusted to match the HPV infection profile in Colombia. A systematic review was undertaken in order to derive efficacy values for the two vaccines as well as for the operational characteristics of the cytology test. The societal perspective was used. Effectiveness was measured in number of averted Disability Adjusted Life Years (DALYS). Results At commercial prices reported for 2010 the two vaccines were shown to be non-cost-effective alternatives when compared with the existing screening strategy. Sensitivity analyses showed that results are affected by the cost of vaccines and their efficacy values, making it difficult to determine with certainty which of the two vaccines has the best cost-effectiveness profile. To be ‘cost-effective’ vaccines should cost between 141 and 147 USD (Unite States Dollars) per vaccinated girl at the most. But at lower prices such as those recommended by WHO or the price of other vaccines in Colombia, HPV vaccination could be considered very cost-effective. Conclusions HPV vaccination could be a convenient alternative for the prevention of CC in Colombia. However, the price of the vaccine should be lower for this vaccination strategy to be cost-effective. It is also important to take into consideration the willingness to pay, budgetary impact, and program implications, in order to determine the relevance of a vaccination program in this country, as well as which vaccine should be selected for use in the program. PMID:24260441

A Cost-Effectiveness Analysis of Blended Versus Face-to-Face Delivery of Evidence-Based Medicine to Medical Students.

PubMed

Maloney, Stephen; Nicklen, Peter; Rivers, George; Foo, Jonathan; Ooi, Ying Ying; Reeves, Scott; Walsh, Kieran; Ilic, Dragan

2015-07-21

Blended learning describes a combination of teaching methods, often utilizing digital technologies. Research suggests that learner outcomes can be improved through some blended learning formats. However, the cost-effectiveness of delivering blended learning is unclear. This study aimed to determine the cost-effectiveness of a face-to-face learning and blended learning approach for evidence-based medicine training within a medical program. The economic evaluation was conducted as part of a randomized controlled trial (RCT) comparing the evidence-based medicine (EBM) competency of medical students who participated in two different modes of education delivery. In the traditional face-to-face method, students received ten 2-hour classes. In the blended learning approach, students received the same total face-to-face hours but with different activities and additional online and mobile learning. Online activities utilized YouTube and a library guide indexing electronic databases, guides, and books. Mobile learning involved self-directed interactions with patients in their regular clinical placements. The attribution and differentiation of costs between the interventions within the RCT was measured in conjunction with measured outcomes of effectiveness. An incremental cost-effectiveness ratio was calculated comparing the ongoing operation costs of each method with the level of EBM proficiency achieved. Present value analysis was used to calculate the break-even point considering the transition cost and the difference in ongoing operation cost. The incremental cost-effectiveness ratio indicated that it costs 24% less to educate a student to the same level of EBM competency via the blended learning approach used in the study, when excluding transition costs. The sunk cost of approximately AUD $40,000 to transition to the blended model exceeds any savings from using the approach within the first year of its implementation; however, a break-even point is achieved within its third iteration and relative savings in the subsequent years. The sensitivity analysis indicates that approaches with higher transition costs, or staffing requirements over that of a traditional method, are likely to result in negative value propositions. Under the study conditions, a blended learning approach was more cost-effective to operate and resulted in improved value for the institution after the third year iteration, when compared to the traditional face-to-face model. The wider applicability of the findings are dependent on the type of blended learning utilized, staffing expertise, and educational context.

Resource Use and Cost of Alzheimer's Disease in France: 18-Month Results from the GERAS Observational Study.

PubMed

Rapp, Thomas; Andrieu, Sandrine; Chartier, Florence; Deberdt, Walter; Reed, Catherine; Belger, Mark; Vellas, Bruno

2018-03-01

There is little longitudinal data on resource use and costs associated with Alzheimer's disease (AD) in France. To evaluate resource use and societal costs associated with AD in a French cohort of patients and their caregivers and the effect of patient cognitive decline on costs over an 18-month period. Community-dwelling patients with mild, moderate, or moderately severe/severe AD dementia (n = 419) were followed-up for 18 months. Total societal costs were estimated by applying 2010 unit costs to resource use, including outpatient visits, hospital days, institutionalization, and caregiver hours. Cognitive function was assessed by Mini-Mental State Examination scores. Mean cumulative total costs over the 18-month period were €24,140 for patients with mild AD dementia, €34,287 for those with moderate AD dementia, and €44,171 for those with moderately severe/severe AD dementia (P < 0.001; ANOVA comparison between severity groups). The biggest contributor to total societal costs was caregiver informal care (>50% of total costs at all stages of AD dementia). Cognitive decline (≥3-point decrease in Mini-Mental State Examination score or institutionalization) was associated with a 12.5% increase in total costs (P = 0.02). Significant differences were observed across severity groups for caregiver time (P < 0.001); mean monthly caregiver time increased at each time point over the 18 months in each severity group. Increasing severity of AD dementia in France is associated with increased use of resources as well as increased total societal and patient costs; informal care was the greatest cost contributor. Clinically meaningful cognitive decline is associated with significantly increased costs. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Recruitment techniques for alcohol pharmacotherapy clinical trials: A cost-benefit analysis.

PubMed

Tompkins, D Andrew; Sides, Jessica A; Harrison, Joseph A; Strain, Eric C

2015-12-01

Alcohol use disorders (AUDs) represent a large public health burden with relatively few efficacious pharmacotherapies. Randomized controlled trials (RCTs) for new AUD therapies can be hampered by ineffective recruitment, leading to increased trial costs. The current analyses examined the effectiveness of recruitment efforts during two consecutive outpatient RCTs of novel AUD pharmacotherapies conducted between 2009 and 2012. During an initial phone screen, participants identified an ad source for learning about the study. Qualified persons were then scheduled for in-person screens. The present analyses examined demographic differences amongst the eight ad sources utilized. Recruitment effectiveness was determined by dividing the number of persons meeting criteria for an in-person screen by the total number of callers from each ad source. Cost-effectiveness was determined by dividing total ad source cost by number of screens, participants randomized, and completers. 1,813 calls resulted in 1,005 completed phone screens. The most common ad source was TV (34%), followed by print (29%), word-of-mouth (11%), flyer (8%), internet (5%), radio (5%), bus ad (2%), and billboard (1%). Participants reporting bus ads (46%), billboard (44%), or print ads (34%) were significantly more likely than the other sources to meet criteria to be scheduled for in-person screens. The most cost-effective ad source was print ($2,506 per completer), while bus ad was the least cost-effective ($13,376 per completer). Recruitment in AUD RCTs can be successful using diverse advertising methods. The present analyses favored use of print ads as most cost-effective.

Using Multicountry Ecological and Observational Studies to Determine Dietary Risk Factors for Alzheimer's Disease.

PubMed

Grant, William B

2016-07-01

Rates of Alzheimer's disease (AD) are rising worldwide. The most important risk factors seem to be linked to diet. For example, when Japan made the nutrition transition from the traditional Japanese diet to the Western diet, AD rates rose from 1% in 1985 to 7% in 2008. Foods protective against AD include fruits, vegetables, grains, low-fat dairy products, legumes, and fish, whereas risk factors include meat, sweets, and high-fat dairy products. The evidence comes from ecological and observational studies as well as investigations of the mechanisms whereby dietary factors affect risk. The mechanisms linking dietary risk factors to AD are fairly well known and include increased oxidative stress from metal ions such as copper as well as from advanced glycation end products associated with high-temperature cooking, increased homocysteine concentrations, and cholesterol and its effects on amyloid beta, insulin resistance, and obesity. Lower 25-hydroxyvitamin D concentrations also are associated with increased risk of AD. In addition to reviewing the journal literature, a new ecological study was conducted using AD prevalence from 10 countries (Brazil, Chile, Cuba, Egypt, India, Mongolia, Nigeria, Republic of Korea, Sri Lanka, and the United States) along with dietary supply data 5, 10, and 15 years before the prevalence data. Dietary supply of meat or animal products less milk 5 years before AD prevalence had the highest correlations with AD prevalence in this study. Thus, reducing meat consumption could significantly reduce the risk of AD as well as of several cancers, diabetes mellitus type 2, stroke, and, likely, chronic kidney disease. • Single-country ecological data can be used to find links between diet and AD because the national diet changes, such as during the nutrition transition to a Western diet. • Multicountry ecological studies can be used to find links between dietary factors and risk of AD. • Prospective observational studies are useful in linking dietary components and patterns to risk of AD. • The most important dietary link to AD appears to be meat consumption, with eggs and high-fat dairy also contributing. • Diets high in grains, fruits, vegetables, and fish are associated with reduced risk of AD, but these factors cannot counter the effects of meat, eggs, and high-fat dairy. • Higher vitamin D status is associated with reduced risk of AD.

A quiet flow Ludwieg tube for study of transition in compressible boundary layers: Design and feasibility

NASA Technical Reports Server (NTRS)

Schneider, Steven P.

1991-01-01

Laminar-turbulent transition in high speed boundary layers is a complicated problem which is still poorly understood, partly because of experimental ambiguities caused by operating in noisy wind tunnels. The NASA Langley experience with quiet tunnel design has been used to design a quiet flow tunnel which can be constructed less expensively. Fabrication techniques have been investigated, and inviscid, boundary layer, and stability computer codes have been adapted for use in the nozzle design. Construction of such a facility seems feasible, at a reasonable cost. Two facilities have been proposed: a large one, with a quiet flow region large enough to study the end of transition, and a smaller and less expensive one, capable of studying low Reynolds number issues such as receptivity. Funding for either facility remains to be obtained, although key facility elements have been obtained and are being integrated into the existing Purdue supersonic facilities.

The Road Less Traveled: Sustainable Transportation for Campuses.

ERIC Educational Resources Information Center

Toor, Will

2003-01-01

Provides a survey of innovative approaches to campus transportation in the United States. Explains that the high costs of parking expansion have propelled many institutions toward a transportation demand management strategy, using parking pricing, transit passes for students and employees, and investment in bicycle infrastructure to shift many…

Cost-effectiveness development for the postoperative care of craniotomy patients: a safe transitions pathway in neurological surgery.

PubMed

Osorio, Joseph A; Safaee, Michael M; Viner, Jennifer; Sankaran, Sujatha; Imershein, Sarah; Adigun, Ezekiel; Weigel, Gabriela; Berger, Mitchel S; McDermott, Michael W

2018-05-01

OBJECTIVE The authors' institution is in the top 5th percentile for hospital cost in the nation, and the neurointensive care unit (NICU) is one of the costliest units. The NICU is more expensive than other units because of lower staff/patient ratio and because of the equipment necessary to monitor patient care. The cost differential between the NICU and Neuro transitional care unit (NTCU) is $1504 per day. The goal of this study was to evaluate and to pilot a program to improve efficiency and lower cost by modifying the postoperative care of patients who have undergone a craniotomy, sending them to the NTCU as opposed to the NICU. Implementation of the pilot will expand and utilize neurosurgery beds available on the NTCU and reduce the burden on NICU beds for critically ill patient admissions. METHODS Ten patients who underwent craniotomy to treat supratentorial brain tumors were included. Prior to implementation of the pilot, inclusion criteria were designed for patient selection. Patients included were less than 65 years of age, had no comorbid conditions requiring postoperative intensive care unit (ICU) care, had a supratentorial meningioma less than 3 cm in size, had no intraoperative events, had routine extubation, and underwent surgery lasting fewer than 5 hours and had blood loss less than 500 ml. The Safe Transitions Pathway (STP) was started in August 2016. RESULTS Ten tumor patients have utilized the STP (5 convexity meningiomas, 2 metastatic tumors, 3 gliomas). Patients' ages ranged from 29 to 75 years (median 49 years; an exception to the age limit of 65 years was made for one 75-year-old patient). Discharge from the hospital averaged 2.2 days postoperative, with 1 discharged on postoperative day (POD) 1, 7 discharged on POD 2, 1 discharged on POD 3, and 1 discharged on POD 4. Preliminary data indicate that quality and safety for patients following the STP (moving from the operating room [OR] to the neuro transitional care unit [OR-NTCU]) are no different from those of patients following the traditional OR-NICU pathway. No patients required escalation in level of nursing care, and there were no readmissions. This group has been followed for greater than 1 month, and there were no morbidities. CONCLUSIONS The STP is a new and efficient pathway for the postoperative care of neurosurgery patients. The STP has reduced hospital cost by $22,560 for the first 10 patients, and there were no morbidities. Since this pilot, the authors have expanded the pathway to include other surgical cases and now routinely schedule craniotomy patients for the (OR-NTCU) pathway. The potential cost reduction in one year could reach $500,000 if we reach our potential of 20 patients per month.

Amplitude death and synchronized states in nonlinear time-delay systems coupled through mean-field diffusion

NASA Astrophysics Data System (ADS)

Banerjee, Tanmoy; Biswas, Debabrata

2013-12-01

We explore and experimentally demonstrate the phenomena of amplitude death (AD) and the corresponding transitions through synchronized states that lead to AD in coupled intrinsic time-delayed hyperchaotic oscillators interacting through mean-field diffusion. We identify a novel synchronization transition scenario leading to AD, namely transitions among AD, generalized anticipatory synchronization (GAS), complete synchronization (CS), and generalized lag synchronization (GLS). This transition is mediated by variation of the difference of intrinsic time-delays associated with the individual systems and has no analogue in non-delayed systems or coupled oscillators with coupling time-delay. We further show that, for equal intrinsic time-delays, increasing coupling strength results in a transition from the unsynchronized state to AD state via in-phase (complete) synchronized states. Using Krasovskii-Lyapunov theory, we derive the stability conditions that predict the parametric region of occurrence of GAS, GLS, and CS; also, using a linear stability analysis, we derive the condition of occurrence of AD. We use the error function of proper synchronization manifold and a modified form of the similarity function to provide the quantitative support to GLS and GAS. We demonstrate all the scenarios in an electronic circuit experiment; the experimental time-series, phase-plane plots, and generalized autocorrelation function computed from the experimental time series data are used to confirm the occurrence of all the phenomena in the coupled oscillators.

Nonperturbative QCD Coupling and its $$\\beta$$-function from Light-Front Holography

DOE PAGES

Brodskey, Stanley J.; de Teramond, Guy; Deur, Alexandre P.

2010-05-28

The light-front holographic mapping of classical gravity in AdS space, modified by a positive-sign dilaton background, leads to a non-perturbative effective couplingmore » $$\\alpha_s^{AdS}(Q^2)$$. It agrees with hadron physics data extracted from different observables, such as the effective charge defined by the Bjorken sum rule, as well as with the predictions of models with built-in confinement and lattice simulations. It also displays a transition from perturbative to nonperturbative conformal regimes at a momentum scale $$ \\sim 1$$ GeV. The resulting $$\\beta$$-function appears to capture the essential characteristics of the full $$\\beta$$-function of QCD, thus giving further support to the application of the gauge/gravity duality to the confining dynamics of strongly coupled QCD. Commensurate scale relations relate observables to each other without scheme or scale ambiguity. In this paper we extrapolate these relations to the nonperturbative domain, thus extending the range of predictions based on $$\\alpha_s^{AdS}(Q^2)$$.« less

The cost-effectiveness of male HPV vaccination in the United States.

PubMed

Chesson, Harrell W; Ekwueme, Donatus U; Saraiya, Mona; Dunne, Eileen F; Markowitz, Lauri E

2011-10-26

The objective of this study was to estimate the cost-effectiveness of adding human papillomavirus (HPV) vaccination of 12-year-old males to a female-only vaccination program for ages 12-26 years in the United States. We used a simplified model of HPV transmission to estimate the reduction in the health and economic burden of HPV-associated diseases in males and females as a result of HPV vaccination. Estimates of the incidence, cost-per-case, and quality-of-life impact of HPV-associated health outcomes were based on the literature. The HPV-associated outcomes included were: cervical intraepithelial neoplasia (CIN); genital warts; juvenile-onset recurrent respiratory papillomatosis (RRP); and cervical, vaginal, vulvar, anal, oropharyngeal, and penile cancers. The cost-effectiveness of male vaccination depended on vaccine coverage of females. When including all HPV-associated outcomes in the analysis, the incremental cost per quality-adjusted life year (QALY) gained by adding male vaccination to a female-only vaccination program was $23,600 in the lower female coverage scenario (20% coverage at age 12 years) and $184,300 in the higher female coverage scenario (75% coverage at age 12 years). The cost-effectiveness of male vaccination appeared less favorable when compared to a strategy of increased female vaccination coverage. For example, we found that increasing coverage of 12-year-old girls would be more cost-effective than adding male vaccination even if the increased female vaccination strategy incurred program costs of $350 per additional girl vaccinated. HPV vaccination of 12-year-old males might potentially be cost-effective, particularly if female HPV vaccination coverage is low and if all potential health benefits of HPV vaccination are included in the analysis. However, increasing female coverage could be a more efficient strategy than male vaccination for reducing the overall health burden of HPV in the population. Published by Elsevier Ltd.

Value management program: performance, quantification, and presentation of imaging value-added actions.

PubMed

Patel, Samir

2015-03-01

Health care is in a state of transition, shifting from volume-based success to value-based success. Hospital executives and referring physicians often do not understand the total value a radiology group provides. A template for easy, cost-effective implementation in clinical practice for most radiology groups to demonstrate the value they provide to their clients (patients, physicians, health care executives) has not been well described. A value management program was developed to document all of the value-added activities performed by on-site radiologists, quantify them in terms of time spent on each activity (investment), and present the benefits to internal and external stakeholders (outcomes). The radiology value-added matrix is the platform from which value-added activities are categorized and synthesized into a template for defining investments and outcomes. The value management program was first implemented systemwide in 2013. Across all serviced locations, 9,931.75 hours were invested. An annual executive summary report template demonstrating outcomes is given to clients. The mean and median individual value-added hours per radiologist were 134.52 and 113.33, respectively. If this program were extrapolated to the entire field of radiology, approximately 30,000 radiologists, this would have resulted in 10,641,161 uncompensated value-added hours documented in 2013, with an estimated economic value of $2.21 billion. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Cost-effectiveness of adding indoor residual spraying to case management in Afghan refugee settlements in Northwest Pakistan during a prolonged malaria epidemic

PubMed Central

Guinness, Lorna; Rowland, Mark; Durrani, Naeem; Hansen, Kristian S.

2017-01-01

Introduction Financing of malaria control for displaced populations is limited in scope and duration, making cost-effectiveness analyses relevant but difficult. This study analyses cost-effectiveness of adding prevention through targeted indoor residual spraying (IRS) to case management in Afghan refugee settlements in Pakistan during a prolonged malaria epidemic. Methods/Findings An intervention study design was selected, taking a societal perspective. Provider and household costs of vector control and case management were collected from provider records and community survey. Health outcomes (e.g. cases and DALYs averted) were derived and incremental cost-effectiveness ratios (ICERs) for cases prevented and DALYs averted calculated. Population, treatment cost, women’s time, days of productivity lost, case fatality rate, cases prevented, and DALY assumptions were tested in sensitivity analysis. Malaria incidence peaked at 44/1,000 population in year 2, declining to 14/1,000 in year 5. In total, 370,000 malaria cases, 80% vivax, were diagnosed and treated and an estimated 67,988 vivax cases and 18,578 falciparum and mixed cases prevented. Mean annual programme cost per capita was US$0.56. The additional cost of including IRS over five years per case prevented was US$39; US$50 for vivax (US$43 in years 1–3, US$80 in years 4–5) and US$182 for falciparum (US$139 in years 1–3 and US$680 in years 4–5). Per DALY averted this was US$266 (US$220 in years 1–3 and US$486 in years 4–5) and thus ‘highly cost-effective’ or cost-effective using WHO and comparison thresholds. Conclusions Adding IRS was cost-effective in this moderate endemicity, low mortality setting. It was more cost-effective when transmission was highest, becoming less so as transmission reduced. Because vivax was three times more common than falciparum and the case fatality rate was low, cost-effectiveness estimations for cases prevented appear reliable and more definitive for vivax malaria. PMID:29059179

Small capacity, low cost (Ni-H2) design concept for commercial, military, and higher-volume aerospace applications

NASA Technical Reports Server (NTRS)

Wheeler, James R.; Cook, William D.; Smith, Ron

1991-01-01

Nickel Hydrogen (Ni/H2) batteries have become the technology of choice for both commercial and defense related satellites in geosynchronous orbits. Their use for low earth orbit (LEO) applications is not as advanced, but seems just as inevitable because of their inherent advantages over nickel cadmium batteries. These include superior energy density, longer cycle life, and better tolerance to over-charge and reversal. Ni/H2 cells have the added advantage in both construction and operation of not presenting the environmental possibility of cadmium pollution. Unfortunately, but necessarily, the design of these cells has been driven to high cost by the sophistication of the satellites and their uses. Now, using most of the same concepts but less costly materials and techniques, a low cost, small cell design was developed. Combined with the concept of the common pressure vessel, this new design promises to be ideal for the small-sat and commercial markets which, increasingly, are calling for large numbers of less expensive satellites.

Cost-effectiveness of targeted and tailored interventions on colorectal cancer screening use.

PubMed

Lairson, David R; DiCarlo, Melissa; Myers, Ronald E; Wolf, Thomas; Cocroft, James; Sifri, Randa; Rosenthal, Michael; Vernon, Sally W; Wender, Richard

2008-02-15

Colorectal cancer (CRC) screening is cost-effective but underused. The objective of this study was to determine the cost-effectiveness of targeted and tailored behavioral interventions to increase CRC screening use by conducting an economic analysis associated with a randomized trial among patients in a large, racially and ethnically diverse, urban family practice in Philadelphia. The incremental costs per unit increase were measured in individuals who were screened during the 24 months after intervention. Percent increase in screening was adjusted for baseline differences in the study groups. Each intervention arm received a targeted screening invitation letter, stool blood test (SBT) cards, informational booklet, and reminder letter. Tailored interventions incrementally added tailored messages and reminder telephone calls. Program costs of the targeted intervention were 42 dollars per participant. Additional costs of adding tailored print materials and of delivering a reminder telephone call were 150 dollars and 200 dollars per participant, respectively. The cost per additional individual screened was 319 dollars when comparing the no intervention group with the targeted intervention group. The targeted intervention was more effective and less costly than the tailored intervention. Although tailoring plus reminder telephone call was the most effective strategy, it was very costly per additional individual screened. Mailed SBT cards significantly boosted CRC screening use. However, going beyond the targeted intervention to include tailoring or tailoring plus reminder calls in the manner used in this study did not appear to be an economically attractive strategy. Cancer 2008. (c) 2007 American Cancer Society.

Economic burden associated with alcohol dependence in a German primary care sample: a bottom-up study.

PubMed

Manthey, Jakob; Laramée, Philippe; Parrott, Steve; Rehm, Jürgen

2016-08-31

A considerable economic burden has been repeatedly associated with alcohol dependence (AD) - mostly calculated using aggregate data and alcohol-attributable fractions (top-down approach). However, this approach is limited by a number of assumptions, which are hard to test. Thus, cost estimates should ideally be validated with studies using individual data to estimate the same costs (bottom-up approach). However, bottom-up studies on the economic burden associated with AD are lacking. Our study aimed to fill this gap using the bottom-up approach to examine costs for AD, and also stratified the results by the following subgroups: sex, age, diagnostic approach and severity of AD, as relevant variations could be expected by these factors. 1356 primary health care patients, representative for two German regions. AD was diagnosed by a standardized instrument and treating physicians. Individual costs were calculated by combining resource use and productivity data representing a period of six months prior to the time of interview, with unit costs derived from the literature or official statistics. The economic burden associated with AD was determined via excess costs by comparing utilization of various health care resources and impaired productivity between people with and without AD, controlling for relevant confounders. Additional analyses for several AD characteristics were performed. Mean costs among alcohol dependent patients were 50 % higher compared to the remaining patients, resulting in 1836 € excess costs per alcohol dependent patient in 6 months. More than half of these excess costs incurred through increased productivity loss among alcohol dependent patients. Treatment for alcohol problems represents only 6 % of these costs. The economic burden associated with AD incurred mainly among males and among 30 to 49 year old patients. Both diagnostic approaches were significantly related to the economic burden, while costs increased with alcohol use disorder severity but not with other AD severity indicators. Our study confirms previous studies using top-down approaches to estimate the economic burden associated with AD. Further, we highlight the need for efforts aimed at preventing adverse outcomes for health and occupational situation associated with alcohol dependence based on factors associated with particularly high economic burden.

Air quality impacts of transit improvement, preferential lane, and carpool programs: an annotated bibliography of demonstration and analytical experience. Final report

DOE Office of Scientific and Technical Information (OSTI.GOV)

DiRenzo, J.F.; Rubin, R.B.

1978-03-01

In accordance with the Clean Air Act Amendments of 1977, the Environmental Protection Agency is evaluating the use and cost-effectiveness of alternative short-range transit fare and service improvement strategies, carpool and vanpool strategies, and strategies involving the preferential treatment of high occupancy vehicles to improve air quality in urban areas. The evaluation of individual strategies and combinations of the above strategies includes their emission and air quality impacts and their related energy, noise, and economic impacts. A comprehensive literature review was also conducted, as part of this evaluation, to identify both observed and projected travel, emission, air quality, energy, noise,more » and economic impacts of the short-range low-cost strategies of interest.« less

Recruitment techniques for alcohol pharmacotherapy clinical trials: A cost-benefit analysis

PubMed Central

Tompkins, D. Andrew; Sides, Jessica A.; Harrison, Joseph A.; Strain, Eric C.

2014-01-01

Objectives Alcohol use disorders (AUDs) represent a large public health burden with relatively few efficacious pharmacotherapies. Randomized controlled trials (RCTs) for new AUD therapies can be hampered by ineffective recruitment, leading to increased trial costs. The current analyses examined the effectiveness of recruitment efforts during two consecutive outpatient RCTs of novel AUD pharmacotherapies conducted between 2009 and 2012. Methods During an initial phone screen, participants identified an ad source for learning about the study. Qualified persons were then scheduled for in-person screens. The present analyses examined demographic differences amongst the eight ad sources utilized. Recruitment effectiveness was determined by dividing the number of persons meeting criteria for an in-person screen by the total number of callers from each ad source. Cost-effectiveness was determined by dividing total ad source cost by number of screens, participants randomized, and completers. Results 1,813 calls resulted in 1,005 completed phone screens. The most common ad source was TV (34%), followed by print (29%), word-of-mouth (11%), flyer (8%), internet (5%), radio (5%), bus ad (2%), and billboard (1%). Participants reporting bus ads (46%), billboard (44%), or print ads (34%) were significantly more likely than the other sources to meet criteria to be scheduled for in-person screens. The most cost-effective ad source was print ($2,506 per completer), while bus ad was the least cost-effective ($13,376 per completer). Conclusions Recruitment in AUD RCTs can be successful using diverse advertising methods. The present analyses favored use of print ads as most cost-effective. PMID:26752979

Transition projects, Fiscal Year 1996: Multi-Year Program Plan (MYPP) for WBS 1.31, 7.1, and 6.13. Revision 1, Volume 1

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cartmell, D.B.

1995-09-01

Based on US Department of Energy (DOE), Richland Operations Office (RL) review, specific areas of Westinghouse Hanford Company (WHC), Transition Projects ``Draft`` Multi-Year Program Plan (MYPP) were revised in preparation for the RL approval ceremony on September 26, 1995. These changes were reviewed with the appropriate RL Project Manager. The changes have been incorporated to the MYPP electronic file, and hard copies replacing the ``Draft`` MYPP will be distributed after the formal signing. In addition to the comments received, a summary level schedule and outyear estimates for the K Basin deactivation beginning in FY 2001 have been included. The Kmore » Basin outyear waste data is nearing completion this week and will be incorporated. This exclusion was discussed with Mr. N.D. Moorer, RL, Facility Transition Program Support/Integration. The attached MYPP scope/schedule reflects the Integrated Target Case submitted in the April 1995 Activity Data Sheets (ADS) with the exception of B Plant and the Plutonium Finishing Plant (PFP). The 8 Plant assumption in FY 1997 reflects the planning case in the FY 1997 ADS with a shortfall of $5 million. PFP assumptions have been revised from the FY 1997 ADS based on the direction provided this past summer by DOE-Headquarters. This includes the acceleration of the polycube stabilization back to its originally planned completion date. Although the overall program repricing in FY 1996 allowed the scheduled acceleration to fall with the funding allocation, the FY 1997 total reflects a shortfall of $6 million.« less

Financial modeling of current surgical robotic system in outpatient laparoscopic cholecystectomy: how should we think about the expense?

PubMed

Schwaitzberg, S D

2016-05-01

More than 500,000 robotically assisted procedures were performed worldwide in 2013. Despite broad adoption, there remains a lack of clarity concerning the added cost of the robotic system to the procedure especially in light of an increasing number of ambulatory procedures which are now marketed by hospitals, surgeons and the manufacturer. These procedures are associated with much less reimbursement than inpatient procedures. It is unclear whether these added expenses can be absorbed in these scenarios. Reports vary in opinion concerning the added net costs during robotically assisted laparoscopic hernia or cholecystectomy. The worldwide revenues, procedures, and the installed base of robotic system data were reviewed and reanalyzed from the 2013 Intuitive Surgical Investors report. This provided an opportunity to look cost per case projections from the vantage point of actual revenue. This analysis was based on revenue of 2.27 billion US dollars in the three categories of capital acquisition, instrumentation and accessories, and service revenue. These revenues were then spread across 523,000 cases with varying assumptions. Without regard to expense offsets, the additional cost ranges from $2908 to $8675 depending on what system was purchased and the ability to distribute costs against case volume. Estimates of commercial and government revenue were then compared against these expenses. The use of the extraordinary technology in the face of low-morbidity low-cost established minimally invasive procedures needs to withstand scrutiny of outcome assessment, revenue and expense considerations and appropriateness review in order to create financially viable approaches to high-volume minimally invasive procedures. Revenue estimates associated with outpatient reimbursement make it difficult to support these expenses, recognizing inpatient procedures represent a different net financial picture.

Photon orbits and thermodynamic phase transition of d -dimensional charged AdS black holes

NASA Astrophysics Data System (ADS)

Wei, Shao-Wen; Liu, Yu-Xiao

2018-05-01

We study the relationship between the null geodesics and thermodynamic phase transition for the charged AdS black hole. In the reduced parameter space, we find that there exist nonmonotonic behaviors of the photon sphere radius and the minimum impact parameter for the pressure below its critical value. The study also shows that the changes of the photon sphere radius and the minimum impact parameter can serve as order parameters for the small-large black hole phase transition. In particular, these changes have an universal exponent of 1/2 near the critical point for any dimension d of spacetime. These results imply that there may exist universal critical behavior of gravity near the thermodynamic critical point of the black hole system.

Using Google AdWords for international multilingual recruitment to health research websites.

PubMed

Gross, Margaret S; Liu, Nancy H; Contreras, Omar; Muñoz, Ricardo F; Leykin, Yan

2014-01-20

Google AdWords, the placement of sponsored links in Google search results, is a potent method of recruitment to Internet-based health studies and interventions. However, the performance of Google AdWords varies considerably depending on the language and the location of the target audience. Our goal was to describe differences in AdWords performance when recruiting participants to the same study conducted in four languages and to determine whether AdWords campaigns can be optimized in order to increase recruitment while decreasing costs. Google AdWords were used to recruit participants to the Mood Screener, a multilingual online depression screening tool available in English, Russian, Spanish, and Chinese. Two distinct recruitment periods are described: (1) "Unmanaged", a 6-month period in which ads were allowed to run using only the AdWords tool itself, with no human intervention, and (2) "Managed", a separate 7-week period during which we systematically sought to optimize our recruitment campaigns. During 6 months of unmanaged recruitment, our ads were shown over 1.3 million times, resulting in over 60,000 site visits. The average click-through rate (ratio of ads clicked to ads displayed) varied from 1.86% for Chinese ads to 8.48% for Russian ads, as did the average cost-per-click (from US $0.20 for Chinese ads to US $0.50 for English ads). Although Chinese speakers' click-through rate was lowest, their rate of consenting to participate was the highest, at 3.62%, with English speakers exhibiting the lowest consent rate (0.97%). The conversion cost (cost to recruit a consenting participant) varied from US $10.80 for Russian speakers to US $51.88 for English speakers. During the 7 weeks of "managed" recruitment, we attempted to improve AdWords' performance in regards to the consent rate and cost by systematically deleting underperforming ads and adjusting keywords. We were able to increase the number of people who consent after coming to the site by 91.8% while also decreasing per-consent cost by 23.3%. Our results illustrate the need to linguistically and culturally adapt Google AdWords campaigns and to manage them carefully to ensure the most cost-effective results.

Reduced costs of reproduction in females mediate a shift from a male-biased to a female-biased lifespan in humans

PubMed Central

Bolund, Elisabeth; Lummaa, Virpi; Smith, Ken R.; Hanson, Heidi A.; Maklakov, Alexei A.

2016-01-01

The causes underlying sex differences in lifespan are strongly debated. While females commonly outlive males in humans, this is generally less pronounced in societies before the demographic transition to low mortality and fertility rates. Life-history theory suggests that reduced reproduction should benefit female lifespan when females pay higher costs of reproduction than males. Using unique longitudinal demographic records on 140,600 reproducing individuals from the Utah Population Database, we demonstrate a shift from male-biased to female-biased adult lifespans in individuals born before versus during the demographic transition. Only women paid a cost of reproduction in terms of shortened post-reproductive lifespan at high parities. Therefore, as fertility decreased over time, female lifespan increased, while male lifespan remained largely stable, supporting the theory that differential costs of reproduction in the two sexes result in the shifting patterns of sex differences in lifespan across human populations. Further, our results have important implications for demographic forecasts in human populations and advance our understanding of lifespan evolution. PMID:27087670

Changing vessel routes could significantly reduce the cost of future offshore wind projects.

PubMed

Samoteskul, Kateryna; Firestone, Jeremy; Corbett, James; Callahan, John

2014-08-01

With the recent emphasis on offshore wind energy Coastal and Marine Spatial Planning (CMSP) has become one of the main frameworks used to plan and manage the increasingly complex web of ocean and coastal uses. As wind development becomes more prevalent, existing users of the ocean space, such as commercial shippers, will be compelled to share their historically open-access waters with these projects. Here, we demonstrate the utility of using cost-effectiveness analysis (CEA) to support siting decisions within a CMSP framework. In this study, we assume that large-scale offshore wind development will take place in the US Mid-Atlantic within the next decades. We then evaluate whether building projects nearshore or far from shore would be more cost-effective. Building projects nearshore is assumed to require rerouting of the commercial vessel traffic traveling between the US Mid-Atlantic ports by an average of 18.5 km per trip. We focus on less than 1500 transits by large deep-draft vessels. We estimate that over 29 years of the study, commercial shippers would incur an additional $0.2 billion (in 2012$) in direct and indirect costs. Building wind projects closer to shore where vessels used to transit would generate approximately $13.4 billion (in 2012$) in savings. Considering the large cost savings, modifying areas where vessels transit needs to be included in the portfolio of policies used to support the growth of the offshore wind industry in the US. Copyright © 2014 Elsevier Ltd. All rights reserved.

Parallel spatial direct numerical simulations on the Intel iPSC/860 hypercube

NASA Technical Reports Server (NTRS)

Joslin, Ronald D.; Zubair, Mohammad

1993-01-01

The implementation and performance of a parallel spatial direct numerical simulation (PSDNS) approach on the Intel iPSC/860 hypercube is documented. The direct numerical simulation approach is used to compute spatially evolving disturbances associated with the laminar-to-turbulent transition in boundary-layer flows. The feasibility of using the PSDNS on the hypercube to perform transition studies is examined. The results indicate that the direct numerical simulation approach can effectively be parallelized on a distributed-memory parallel machine. By increasing the number of processors nearly ideal linear speedups are achieved with nonoptimized routines; slower than linear speedups are achieved with optimized (machine dependent library) routines. This slower than linear speedup results because the Fast Fourier Transform (FFT) routine dominates the computational cost and because the routine indicates less than ideal speedups. However with the machine-dependent routines the total computational cost decreases by a factor of 4 to 5 compared with standard FORTRAN routines. The computational cost increases linearly with spanwise wall-normal and streamwise grid refinements. The hypercube with 32 processors was estimated to require approximately twice the amount of Cray supercomputer single processor time to complete a comparable simulation; however it is estimated that a subgrid-scale model which reduces the required number of grid points and becomes a large-eddy simulation (PSLES) would reduce the computational cost and memory requirements by a factor of 10 over the PSDNS. This PSLES implementation would enable transition simulations on the hypercube at a reasonable computational cost.

Ventilator caregiver education through the use of high-fidelity pediatric simulators: a pilot study.

PubMed

Tofil, Nancy M; Rutledge, Chrystal; Zinkan, J Lynn; Youngblood, Amber Q; Stone, Julie; Peterson, Dawn Taylor; Slayton, Donna; Makris, Chris; Magruder, Terri; White, Marjorie Lee

2013-11-01

Introduction. Home ventilator programs (HVP) have been developed to train parents of critically ill children. Simulators are used in health care, but not often for parents. We added simulation to our HVP and assessed parents' response. Methods. In July 2008, the HVP at Children's of Alabama added simulation to parent training. Debriefing was provided after the training session to reinforce correct skills and critical thinking. Follow-up surveys were completed after training. Results. Fifteen families participated. All parents were confident in changing tracheostomies, knowing signs of breathing difficulties, and responding to alarms. 71% strongly agree that simulation resulted in feeling better prepared to care for their child. 86% felt simulation improved their confidence in taking care of their child. Conclusion. Simulators provide a crucial transition between learned skills and application. This novel use of simulation-based education improves parents' confidence in emergencies and may lead to shortened training resulting in cost savings.

All-optical materials design of chiral edge modes in transition-metal dichalcogenides

DOE PAGES

Claassen, Martin; Jia, Chunjing; Moritz, Brian; ...

2016-10-10

Monolayer transition-metal dichalcogenides are novel materials which at low energies constitute a condensed-matter realization of massive relativistic fermions in two dimensions. Here, we show that this picture breaks for optical pumping—instead, the added complexity of a realistic materials description leads to a new mechanism to optically induce topologically protected chiral edge modes, facilitating optically switchable conduction channels that are insensitive to disorder. In contrast to graphene and previously discussed toy models, the underlying mechanism relies on the intrinsic three-band nature of transition-metal dichalcogenide monolayers near the band edges. Photo-induced band inversions scale linearly in applied pump field and exhibit transitionsmore » from one to two chiral edge modes on sweeping from red to blue detuning. As a result, we develop an ab initio strategy to understand non-equilibrium Floquet–Bloch bands and topological transitions, and illustrate for WS 2 that control of chiral edge modes can be dictated solely from symmetry principles and is not qualitatively sensitive to microscopic materials details.« less

Comparison of costs of percutaneous transluminal coronary angioplasty and coronary bypass surgery for patients with angina pectoris.

PubMed

van den Brand, M; van Halem, C; van den Brink, F; de Feyter, P; Serruys, P; Suryapranata, H; Meeter, K; Bos, E; van Dalen, F J

1990-08-01

To determine the costs of a procedure, the total costs of the department that provides the service must be considered and, in addition, the direct cost of the specific procedure. Applying this principle to the cost accounting of angioplasty and bypass surgery results in a direct, i.e. procedural, cost, including the initial hospital stay, of respectively 8694 Dfl and 20,987 Dfl. A review of the follow-up data for the first year after the original intervention revealed a 2% reintervention rate for bypass surgery, while this percentage was 29% for angioplasty. Adding the first year costs involved with reinterventions to the procedural costs results in a 1-year cost of angioplasty and bypass operation of 13,625 Dfl and 21,363 Dfl, respectively. It is concluded that because of reinterventions in the first year, a mark up of 57% on the procedural cost of angioplasty must be added to cover 1-year costs, while for bypass surgery this is only 1%. Nevertheless, the 1-year cost for angioplasty is still 36% less than for bypass surgery. As reinterventions after PTCA may stay considerably higher than for CABG for several years, the mark-up percentages will be substantially higher for longer time spans. This may tend to equalize the total costs of PTCA and CABG over time spans of perhaps 5-8 years. Sufficient data are not available to verify this statement. Clinicians must realize that choosing the most appropriate procedure is not only a matter of medical assessment but also a matter of cost effectiveness. CABG can be seen as an 'investment decision' while PTCA tends to become a decision with characteristics of 'maintenance planning'!

Cost-effectiveness of treating wet age-related macular degeneration at the Kuopio University Hospital in Finland based on a two-eye Markov transition model.

PubMed

Vottonen, Pasi; Kankaanpää, Eila

2016-11-01

Wet age-related macular degeneration (AMD) is the leading cause of blindness worldwide, which can be treated with regular intraocular anti-vascular endothelial growth factor (VEGF) injections. In this study, we wanted to evaluate whether less frequent injections of aflibercept would make it more cost-effective when compared with ranibizumab and low priced bevacizumab. We used a two-eye model to simulate the progression and the treatment of the disease. We selected an 8-year period, 3-month cycles and five health states based on the visual acuity of the better-seeing eye. The transition probabilities and utilities attached to the health states were gathered from previous studies. We conducted the analysis from the hospital perspective and we used the health care costs obtained from Kuopio University Hospital. The costs of intraocular adverse events were taken into account. The incremental cost-effectiveness ratio (ICER) with 3% discount rate (€/QALY) for aflibercept compared with monthly bevacizumab was 1 801 228 and when compared with ranibizumab given as needed, the ICER was minus 3 716 943. The sensitivity analysis showed that a change of 20% of the estimated model parameters or a longer follow-up period did not influence these conclusions. A two-eye Markov transition model was developed to analyse the cost-effectiveness of wet AMD treatment, as quality of life years (QALYs) are largely based on the visual acuity of the better-seeing eye. Monthly injected bevacizumab was the most cost-effective treatment and monthly ranibizumab the least effective. © 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Radioisotope fueled pulsed power generation system for propulsion and electrical power for deep space missions

NASA Astrophysics Data System (ADS)

Howe, Troy

Space exploration missions to the moon, Mars, and other celestial bodies have allowed for great scientific leaps to enhance our knowledge of the universe; yet the astronomical cost of these missions limits their utility to only a few select agencies. Reducing the cost of exploratory space travel will give rise to a new era of exploration, where private investors, universities, and world governments can send satellites to far off planets and gather important data. By using radioisotope power sources and thermal storage devices, a duty cycle can be introduced to extract large amounts of energy in short amounts of time, allowing for efficient space travel. The same device can also provide electrical power for subsystems such as communications, drills, lasers, or other components that can provide valuable scientific information. This project examines the use of multiple radioisotope sources combined with a thermal capacitor using Phase Change Materials (PCMs) which can collect energy over a period of time. The result of this design culminates in a variety of possible spacecraft with their own varying costs, transit times, and objectives. Among the most promising are missions to Mars which cost less than 17M, missions that can provide power to satellite constellations for decades, or missions that can deliver large, Opportunity-sized (185kg) payloads to mars for less than 53M. All made available to a much wider range of customer with commercially available satellite launches from earth. The true cost of such progress though lies in the sometimes substantial increase in transit times for these missions.

Independent Production Cost Estimate: XM1 Tank Main Armament Evaluation

DTIC Science & Technology

1977-11-01

r V. REFERtNCfcS 1. Ammunition Cost Research Study, Gerald W. Kalal and Patrick Gannon, Jun 76, AD-A-029330. 2. Ammunition Cost Research: Medium...Bore Cannon Ammunition, Annexes A-E, Patrick Gannon, Celestino George, Gerald Kalal , Kathleen Keleher, Paul Riedesel, Joseph Robinson, Sep 75, AD-A...016104. 3. Cost Estimating Relationships for Manufacturing Hardware Cost of Gun/Howitzer Cannons, Gerald W. Kalal , Aug 72, AD-75-7163. 4. ARRCOM

Mayo Clinic employees responded to new requirements for cost sharing by reducing possibly unneeded health services use.

PubMed

Shah, Nilay D; Naessens, James M; Wood, Douglas L; Stroebel, Robert J; Litchy, William; Wagie, Amy; Fan, Jiaquan; Nesse, Robert

2011-11-01

Some health plans have experimented with increasing consumer cost sharing, on the theory that consumers will use less unnecessary health care if they are expected to bear some of the financial responsibility for it. However, it is unclear whether the resulting decrease in use is sustained beyond one or two years. In 2004 Mayo Clinic's self-funded health plan increased cost sharing for its employees and their dependents for specialty care visits (adding a $25 copayment to the high-premium option) and other services such as imaging, testing, and outpatient procedures (adding 10 or 20 percent coinsurance, depending on the option). The plan also removed all cost sharing for visits to primary care providers and for preventive services such as colorectal screening and mammography. The result was large decreases in the use of diagnostic testing and outpatient procedures that were sustained for four years, and an immediate decrease in the use of imaging that later rebounded (possibly to levels below the expected trend). Beneficiaries decreased visits to specialists but did not make greater use of primary care services. These results suggest that implementing relatively low levels of cost sharing can lead to a long-term decrease in utilization.

Holographic repulsion and confinement in gauge theory

NASA Astrophysics Data System (ADS)

Husain, Viqar; Kothawala, Dawood

2013-02-01

We show that for asymptotically anti-de Sitter (AdS) backgrounds with negative energy, such as the AdS soliton and regulated negative-mass AdS-Schwarzshild metrics, the Wilson loop expectation value in the AdS/CFT conjecture exhibits a Coulomb to confinement transition. We also show that the quark-antiquark (q \\bar{q}) potential can be interpreted as affine time along null geodesics on the minimal string worldsheet and that its intrinsic curvature provides a signature of transition to confinement phase. Our results suggest a generic (holographic) relationship between confinement in gauge theory and repulsive gravity, which in turn is connected with singularity avoidance in quantum gravity. Communicated by P R L V Moniz

Foothill Transit Agency Battery Electric Bus Progress Report, Data Period Focus: Jan. 2017 through Dec. 2017

DOE Office of Scientific and Technical Information (OSTI.GOV)

Eudy, Leslie

This report summarizes results of a battery electric bus (BEB) evaluation at Foothill Transit, located in the San Gabriel Valley area of Los Angeles. Foothill Transit is collaborating with the California Air Resources Board and the U.S. Department of Energy's National Renewable Energy Laboratory (NREL) to evaluate the buses in revenue service. The focus of this evaluation is to compare the performance and the operating costs of the BEBs to that of conventional technology buses and to track progress over time. Previous reports documented results from April 2014 through December 2016. This report extends the data analysis through December 2017.more » NREL plans to publish progress reports on the Foothill Transit fleet every six months through 2020.« less

The use of the transition cost accounting system in health services research

PubMed Central

Azoulay, Arik; Doris, Nadine M; Filion, Kristian B; Caron, Joanna; Pilote, Louise; Eisenberg, Mark J

2007-01-01

The Transition cost accounting system integrates clinical, resource utilization, and financial information and is currently being used by several hospitals in Canada and the United States to calculate the costs of patient care. Our objectives were to review the use of hospital-based cost accounting systems to measure costs of treatment and discuss potential use of the Transition cost accounting system in health services research. Such systems provide internal reports to administrators for formulating major policies and strategic plans for future activities. Our review suggests that the Transition cost accounting information system may useful for estimating in-hospital costs of treatment. PMID:17686148

The use of the transition cost accounting system in health services research.

PubMed

Azoulay, Arik; Doris, Nadine M; Filion, Kristian B; Caron, Joanna; Pilote, Louise; Eisenberg, Mark J

2007-08-08

The Transition cost accounting system integrates clinical, resource utilization, and financial information and is currently being used by several hospitals in Canada and the United States to calculate the costs of patient care. Our objectives were to review the use of hospital-based cost accounting systems to measure costs of treatment and discuss potential use of the Transition cost accounting system in health services research. Such systems provide internal reports to administrators for formulating major policies and strategic plans for future activities. Our review suggests that the Transition cost accounting information system may useful for estimating in-hospital costs of treatment.

Analysis of user cost and service trade-offs in transit and paratransit services

DOE Office of Scientific and Technical Information (OSTI.GOV)

Louviere, J.; Kocur, G.

1979-08-01

The Xenia Model Transit Service served as a test of several alternative transit services operated in a small city setting. Research was designed to test a new method for assessing user tradeoffs in costs and service based on attitudinal methods. Termed direct response assessment, the methods were developed in psychology and have been extended to application in utility assessment. A tradeoff survey was administered as part of a home interview survey. Data from the tradeoff survey were used to develop separate equations for each sample respondent to explain and describe their tradeoffs over transit fare, travel time, walk distance, typemore » of service, and headway. An aggregate equation was also developed, assuming that all respondents shared common tradeoffs. These equations were employed to retrospectively predict changes in transit system patronage since system inception in 1974. Both sets of models performed well, producing forecasts that were in the same direction and range of experience, although magnitudes were somewhat different. Coefficients of the individual tradeoff equations were then analyzed to see if they could be predicted on the basis of interpersonal characteristics of the respondents. Results indicated that differences in coefficients could be attributed to some differences in individuals such as income and auto ownership. Overall results were promising for policy evaluation and forecasting.« less

The costs of transit fare prepayment programs : a parametric cost analysis.

DOT National Transportation Integrated Search

Despite the renewed interest in transit fare prepayment plans over the past : 10 years, few transit managers have a clear idea of how much it costs to operate : and maintain a fare prepayment program. This report provides transit managers : with the ...

Transition duct system with arcuate ceramic liner for delivering hot-temperature gases in a combustion turbine engine

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wiebe, David J.

A transition duct system (10) for delivering hot-temperature gases from a plurality of combustors in a combustion turbine engine is provided. The system includes an exit piece (16) for each combustor. The exit piece may include an arcuate connecting segment (36). An arcuate ceramic liner (60) may be inwardly disposed onto a metal outer shell (38) along the arcuate connecting segment of the exit piece. Structural arrangements are provided to securely attach the ceramic liner in the presence of substantial flow path pressurization. Cost-effective serviceability of the transition duct systems is realizable since the liner can be readily removed andmore » replaced as needed.« less

Increased photocatalytic activity of TiO 2 mesoporous microspheres from codoping with transition metals and nitrogen

DOE PAGES

Mathis, John E.; Lieffers, Justin J.; Mitra, Chandrima; ...

2015-11-06

The composition of anatase TiO 2 was modified by codoping using combinations of a transition metal and nitrogen in order to increase its photocatalytic activity and extend it performance in the visible region of the electromagnetic spectrum. The transition metals (Mn, Co, Ni, Cu) were added during the hydrothermal preparation of mesoporous TiO 2 particles, and the nitrogen was introduced by post-annealing in flowing ammonia gas at high temperature. The samples were analyzed by SEM, XRD, BET, inductively-coupled plasma spectroscopy, and diffuse reflectance UV-vis spectroscopy. The photocatalytic activity was assessed by observing the change in methylene blue concentrations under bothmore » UV-vis and visible-only light irradiation. As a result, the photocatalytic activity of the (Mn,N), (Co,N), (Cu,N), and Ni,N) codoped TiO 2 was significantly enhanced relative to (N) TiO 2.« less

Design of a smart, survivable sensor system for rapid transit applications

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hogan, J.R.; Mitchell, J.L.

1994-08-01

An application of smart sensor technology developed by Sandia National Laboratories has been proposed for real-time monitoring and tracking in the transportation industry. Its primary purpose is to reduce operating costs by improving preventative maintenance scheduling, reducing the number, severity and consequence of accidents and by reducing losses due to theft. The concept uses a strap-on sensor package, the Green Box, that can be attached to any vehicle. The Green Box is designed as a valued-added component, integrated into existing transportation industry systems and standards. The device, designed to provide advanced warning of component failures, would be capable of survivingmore » most typical accidents. In an accident, the system would send a distress signal notifying authorities of the location and condition of the cargo; permitting them to respond in the most effective manner. In addition, the Green Box is adaptable for use as a notification/locator system to enhance the security of operators and passengers for various modes of public transportation. The modular architecture which facilitates system integration in a number of different applications is discussed. A test plan for evaluating performance in both normal and abnormal operating and accident conditions is described.« less

An electronic flight bag for NextGen avionics

NASA Astrophysics Data System (ADS)

Zelazo, D. Eyton

2012-06-01

The introduction of the Next Generation Air Transportation System (NextGen) initiative by the Federal Aviation Administration (FAA) will impose new requirements for cockpit avionics. A similar program is also taking place in Europe by the European Organisation for the Safety of Air Navigation (Eurocontrol) called the Single European Sky Air Traffic Management Research (SESAR) initiative. NextGen will require aircraft to utilize Automatic Dependent Surveillance-Broadcast (ADS-B) in/out technology, requiring substantial changes to existing cockpit display systems. There are two ways that aircraft operators can upgrade their aircraft in order to utilize ADS-B technology. The first is to replace existing primary flight displays with new displays that are ADS-B compatible. The second, less costly approach is to install an advanced Class 3 Electronic Flight Bag (EFB) system. The installation of Class 3 EFBs in the cockpit will allow aircraft operators to utilize ADS-B technology in a lesser amount of time with a decreased cost of implementation and will provide additional benefits to the operator. This paper describes a Class 3 EFB, the NexisTM Flight-Intelligence System, which has been designed to allow users a direct interface with NextGen avionics sensors while additionally providing the pilot with all the necessary information to meet NextGen requirements.

Analog geometry in an expanding fluid from AdS/CFT perspective

NASA Astrophysics Data System (ADS)

Bilić, Neven; Domazet, Silvije; Tolić, Dijana

2015-04-01

The dynamics of an expanding hadron fluid at temperatures below the chiral transition is studied in the framework of AdS/CFT correspondence. We establish a correspondence between the asymptotic AdS geometry in the 4 + 1 dimensional bulk with the analog spacetime geometry on its 3 + 1 dimensional boundary with the background fluid undergoing a spherical Bjorken type expansion. The analog metric tensor on the boundary depends locally on the soft pion dispersion relation and the four-velocity of the fluid. The AdS/CFT correspondence provides a relation between the pion velocity and the critical temperature of the chiral phase transition.

A Cost-Effectiveness Analysis of Blended Versus Face-to-Face Delivery of Evidence-Based Medicine to Medical Students

PubMed Central

Nicklen, Peter; Rivers, George; Foo, Jonathan; Ooi, Ying Ying; Reeves, Scott; Walsh, Kieran; Ilic, Dragan

2015-01-01

Background Blended learning describes a combination of teaching methods, often utilizing digital technologies. Research suggests that learner outcomes can be improved through some blended learning formats. However, the cost-effectiveness of delivering blended learning is unclear. Objective This study aimed to determine the cost-effectiveness of a face-to-face learning and blended learning approach for evidence-based medicine training within a medical program. Methods The economic evaluation was conducted as part of a randomized controlled trial (RCT) comparing the evidence-based medicine (EBM) competency of medical students who participated in two different modes of education delivery. In the traditional face-to-face method, students received ten 2-hour classes. In the blended learning approach, students received the same total face-to-face hours but with different activities and additional online and mobile learning. Online activities utilized YouTube and a library guide indexing electronic databases, guides, and books. Mobile learning involved self-directed interactions with patients in their regular clinical placements. The attribution and differentiation of costs between the interventions within the RCT was measured in conjunction with measured outcomes of effectiveness. An incremental cost-effectiveness ratio was calculated comparing the ongoing operation costs of each method with the level of EBM proficiency achieved. Present value analysis was used to calculate the break-even point considering the transition cost and the difference in ongoing operation cost. Results The incremental cost-effectiveness ratio indicated that it costs 24% less to educate a student to the same level of EBM competency via the blended learning approach used in the study, when excluding transition costs. The sunk cost of approximately AUD $40,000 to transition to the blended model exceeds any savings from using the approach within the first year of its implementation; however, a break-even point is achieved within its third iteration and relative savings in the subsequent years. The sensitivity analysis indicates that approaches with higher transition costs, or staffing requirements over that of a traditional method, are likely to result in negative value propositions. Conclusions Under the study conditions, a blended learning approach was more cost-effective to operate and resulted in improved value for the institution after the third year iteration, when compared to the traditional face-to-face model. The wider applicability of the findings are dependent on the type of blended learning utilized, staffing expertise, and educational context. PMID:26197801

Using Google AdWords for International Multilingual Recruitment to Health Research Websites

PubMed Central

Gross, Margaret S; Liu, Nancy H; Contreras, Omar; Muñoz, Ricardo F

2014-01-01

Background Google AdWords, the placement of sponsored links in Google search results, is a potent method of recruitment to Internet-based health studies and interventions. However, the performance of Google AdWords varies considerably depending on the language and the location of the target audience. Objective Our goal was to describe differences in AdWords performance when recruiting participants to the same study conducted in four languages and to determine whether AdWords campaigns can be optimized in order to increase recruitment while decreasing costs. Methods Google AdWords were used to recruit participants to the Mood Screener, a multilingual online depression screening tool available in English, Russian, Spanish, and Chinese. Two distinct recruitment periods are described: (1) “Unmanaged”, a 6-month period in which ads were allowed to run using only the AdWords tool itself, with no human intervention, and (2) “Managed”, a separate 7-week period during which we systematically sought to optimize our recruitment campaigns. Results During 6 months of unmanaged recruitment, our ads were shown over 1.3 million times, resulting in over 60,000 site visits. The average click-through rate (ratio of ads clicked to ads displayed) varied from 1.86% for Chinese ads to 8.48% for Russian ads, as did the average cost-per-click (from US $0.20 for Chinese ads to US $0.50 for English ads). Although Chinese speakers’ click-through rate was lowest, their rate of consenting to participate was the highest, at 3.62%, with English speakers exhibiting the lowest consent rate (0.97%). The conversion cost (cost to recruit a consenting participant) varied from US $10.80 for Russian speakers to US $51.88 for English speakers. During the 7 weeks of “managed” recruitment, we attempted to improve AdWords’ performance in regards to the consent rate and cost by systematically deleting underperforming ads and adjusting keywords. We were able to increase the number of people who consent after coming to the site by 91.8% while also decreasing per-consent cost by 23.3%. Conclusions Our results illustrate the need to linguistically and culturally adapt Google AdWords campaigns and to manage them carefully to ensure the most cost-effective results. PMID:24446166

Zipping and Unzipping of Adenylate Kinase: Atomistic Insights into the Ensemble of Open ↔ Closed Transitions

PubMed Central

Beckstein, Oliver; Denning, Elizabeth J.; Perilla, Juan R.; Woolf, Thomas B.

2009-01-01

Adenylate kinase (AdK), a phosphotransferase enzyme, plays an important role in cellular energy homeostasis. It undergoes a large conformational change between an open and a closed state, even in the absence of substrate. We investigate the apo-AdK transition at the atomic level both with free energy calculations and our new dynamic importance sampling (DIMS) molecular dynamics (MD) method. DIMS is shown to sample biologically relevant conformations as verified by comparing an ensemble of hundreds of DIMS transitions to AdK crystal structure intermediates. The simulations reveal in atomic detail how hinge regions partially and intermittently unfold during the transition. Conserved salt bridges are seen to have important structural and dynamic roles; in particular four ionic bonds are identified that open in a sequential, zipper-like fashion and thus dominate the free energy landscape of the transition. Transitions between the closed and open conformations only have to overcome moderate free energy barriers. Unexpectedly, the closed and open state encompass broad free energy basins that contain conformations differing in domain hinge motions by up to 40°. The significance of these extended states is discussed in relation to recent experimental FRET measurements. Taken together, these results demonstrate how a small number of cooperative key interactions can shape the overall dynamics of an enzyme and suggest an “all-or-nothing” mechanism for the opening and closing of AdK. Our efficient DIMS-MD computer simulation approach can provide a detailed picture of a functionally important macromolecular transition and thus help to interpret and suggest experiments to probe the conformational landscape of dynamic proteins such as AdK. PMID:19751742

An Economic comparison of sludge irradiation and alternative methods of municipal sludge treatment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ahlstrom, S.B.; McGuire, H.E.

1977-11-01

The relative economics of radiation treatment and other sludge treatment processes are reported. The desirability of radiation treatment is assessed in terms of cost and the quality of the treated sludge product. The major conclusions of this study are: radiation treatment is a high-level disinfection process. Therefore, it should only be considered if high levels of disinfection are required for widespread reuse of the sludge; the handling, transporting and pathogen growback problems associated with disinfected wet sludge makes it less attractive for reuse than dry sludge; radiation of composted sludge produces a product of similar quality at less cost thanmore » any thermal treatment and/or flash drying treatment option for situations where a high degree of disinfection is required; and heavy metal concerns, especially cadmium, may limit the reuse of sludge despite high disinfection levels. It is recommended that radiation treatment of sludge, particularly dry sludge, continue to be studied. A sensitivity analysis investigating the optimal conditions under which sludge irradiation operates should be instigated. Furthermore, costs of adding sludge irradiation to existing sludge treatment schemes should be determined.« less

Planning Ahead or Living a Day at a Time? A Family History of AD and Retirement Planning.

PubMed

Zick, Cathleen D; Smith, Ken R; Mayer, Robert N

2016-09-01

We assess whether a family history of Alzheimer's disease (AD) is associated with the odds that healthy family members' engage in retirement planning activities. This is a cross-sectional study utilizing individual-level data from the Utah Population Database that have been linked to Medicare records and to responses from a retirement planning survey. Engagement in 3 retirement planning activities was estimated as a function of the number of parents and grandparents diagnosed with AD along with a set of fundamental socioeconomic and demographic covariates. Adults who had a parent with AD were 86% more likely to have seen a professional financial advisor and 40% less likely to plan to retire before age 65. Caregiving costs and/or knowledge of the familial risk of developing AD may provide adult children with a forewarning of their own future financial needs that, in turn, motivates them to engage in retirement planning. © The Author(s) 2016.

Gelatin/graphene systems for low cost energy storage

DOE Office of Scientific and Technical Information (OSTI.GOV)

Landi, Giovanni; Fedi, Filippo; Sorrentino, Andrea

2014-05-15

In this work, we introduce the possibility to use a low cost, biodegradable material for temporary energy storage devices. Here, we report the use of biologically derived organic electrodes composed of gelatin ad graphene. The graphene was obtained by mild sonication in a mixture of volatile solvents of natural graphite flakes and subsequent centrifugation. The presence of exfoliated graphene sheets was detected by atomic force microscopy (AFM) and Raman spectroscopy. The homogeneous dispersion in gelatin demonstrates a good compatibility between the gelatin molecules and the graphene particles. The electrical characterization of the resulting nanocomposites suggests the possible applications as materialsmore » for transient, low cost energy storage device.« less

Four-Year Cost-effectiveness of Cognitive Behavior Therapy for Preventing First-episode Psychosis: The Dutch Early Detection Intervention Evaluation (EDIE-NL) Trial.

PubMed

Ising, Helga K; Lokkerbol, Joran; Rietdijk, Judith; Dragt, Sara; Klaassen, Rianne M C; Kraan, Tamar; Boonstra, Nynke; Nieman, Dorien H; van den Berg, David P G; Linszen, Don H; Wunderink, Lex; Veling, Wim; Smit, Filip; van der Gaag, Mark

2017-03-01

This study aims to evaluate the long-term cost-effectiveness of add-on cognitive behavior therapy (CBT) for the prevention of psychosis for individuals at ultrahigh risk (UHR) of psychosis. The Dutch Early Detection and Intervention randomized controlled trial was used, comparing routine care (RC; n = 101) with routine care plus CBT for UHR (here called CBTuhr; n = 95). A cost-effectiveness analysis was conducted with treatment response (defined as proportion of averted transitions to psychosis) as an outcome and a cost-utility analysis with quality-adjusted life years (QALYs) gained as a secondary outcome. The proportion of averted transitions to psychosis was significantly higher in the CBTuhr condition (with a risk difference of 0.122; b = 1.324, SEb = 0.017, z = 7.99, P < 0.001). CBTuhr showed an 83% probability of being more effective and less costly than RC by -US$ 5777 (savings) per participant. In addition, over the 4-year follow-up period, cumulative QALY health gains were marginally (but not significantly) higher in CBTuhr than for RC (2.63 vs. 2.46) and the CBTuhr intervention had a 75% probability of being the superior treatment (more QALY gains at lower costs) and a 92% probability of being cost-effective compared with RC at the Dutch threshold value (US$ 24 560; €20 000 per QALY). Add-on preventive CBTuhr had a high likelihood (83%) of resulting in more averted transitions to psychosis and lower costs as compared with RC. In addition, the intervention had a high likelihood (75%) of resulting in more QALY gains and lower costs as compared to RC. © The Author 2016. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com

Economic Cost of the Therapeutic Workplace Intervention Added to Methadone Maintenance

PubMed Central

Knealing, Todd W.; Roebuck, M. Christopher; Wong, Conrad J.; Silverman, Kenneth

2008-01-01

The therapeutic workplace is a novel intervention that uses access to paid training and employment to reinforce drug abstinence within the context of standard methadone maintenance. We used the Drug Abuse Treatment Cost Analysis Program as a standard method of estimating the economic costs of this intervention. Over a one-year period, the therapeutic workplace served 122 methadone maintenance clients who had a median length of stay of 22 weeks. The workplace maintained a mean daily census of 48 clients. The combined cost of methadone maintenance and the therapeutic workplace was estimated at $362 per week. This cost is less than other treatments that might be used to promote abstinence in individuals who continue to use drugs during methadone treatment. Given prior evidence of effectiveness, these cost data may be useful to policymakers, social service agencies, and researchers interested in using or further developing the therapeutic workplace intervention. PMID:17614239

Who Should Bear the Cost of Convenience? A Cost-effectiveness Analysis Comparing External Beam and Brachytherapy Radiotherapy Techniques for Early Stage Breast Cancer.

PubMed

McGuffin, M; Merino, T; Keller, B; Pignol, J-P

2017-03-01

Standard treatment for early breast cancer includes whole breast irradiation (WBI) after breast-conserving surgery. Recently, accelerated partial breast irradiation (APBI) has been proposed for well-selected patients. A cost and cost-effectiveness analysis was carried out comparing WBI with two APBI techniques. An activity-based costing method was used to determine the treatment cost from a societal perspective of WBI, high dose rate brachytherapy (HDR) and permanent breast seed implants (PBSI). A Markov model comparing the three techniques was developed with downstream costs, utilities and probabilities adapted from the literature. Sensitivity analyses were carried out for a wide range of variables, including treatment costs, patient costs, utilities and probability of developing recurrences. Overall, HDR was the most expensive ($14 400), followed by PBSI ($8700), with WBI proving the least expensive ($6200). The least costly method to the health care system was WBI, whereas PBSI and HDR were less costly for the patient. Under cost-effectiveness analyses, downstream costs added about $10 000 to the total societal cost of the treatment. As the outcomes are very similar between techniques, WBI dominated under cost-effectiveness analyses. WBI was found to be the most cost-effective radiotherapy technique for early breast cancer. However, both APBI techniques were less costly to the patient. Although innovation may increase costs for the health care system it can provide cost savings for the patient in addition to convenience. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

An algorithm for minimum-cost set-point ordering in a cryogenic wind tunnel

NASA Technical Reports Server (NTRS)

Tripp, J. S.

1981-01-01

An algorithm for minimum cost ordering of set points in a cryogenic wind tunnel is developed. The procedure generates a matrix of dynamic state transition costs, which is evaluated by means of a single-volume lumped model of the cryogenic wind tunnel and the use of some idealized minimum-costs, which is evaluated by means of a single-volume lumped model of the cryogenic wind tunnel and the use of some idealized minimum-cost state-transition control strategies. A branch and bound algorithm is employed to determine the least costly sequence of state transitions from the transition-cost matrix. Some numerical results based on data for the National Transonic Facility are presented which show a strong preference for state transitions that consume to coolant. Results also show that the choice of the terminal set point in an open odering can produce a wide variation in total cost.

An extended cost-effectiveness analysis of publicly financed HPV vaccination to prevent cervical cancer in China.

PubMed

Levin, Carol E; Sharma, Monisha; Olson, Zachary; Verguet, Stéphane; Shi, Ju-Fang; Wang, Shao-Ming; Qiao, You-Lin; Jamison, Dean T; Kim, Jane J

2015-06-04

Cervical cancer screening and existing health insurance schemes in China fall short of reaching women with prevention and treatment services, especially in rural areas where the disease burden is greatest. We conducted an extended cost-effectiveness analysis (ECEA) to evaluate public financing of HPV vaccination to prevent cervical cancer, adding new dimensions to conventional cost-effectiveness analysis through an explicit inclusion of equity and impact on financial risk protection. We synthesized available epidemiological, clinical, and economic data from China using an individual-based Monte Carlo simulation model of cervical cancer to estimate the distribution of deaths averted by income quintile, comparing vaccination plus screening against current practice. We also estimated reductions in cervical cancer incidence, net costs to the government (HPV vaccination costs minus cervical cancer treatment costs averted), and patient cost savings, as well as the incremental government health care costs per death averted. HPV vaccination is cost-effective across all income groups when the cost is less than US $50 per vaccinated girl. Compared to screening alone, adding preadolescent HPV vaccination followed by cervical cancer screening in adulthood could reduce cancer by 44 percent across all income groups, while providing relatively higher financial protection to the poorest women. The absolute numbers of cervical cancer deaths averted and the financial risk protection from HPV vaccination are highest among women in the lowest quintile; women in the bottom income quintiles received higher benefits than those in the upper wealth quintiles. Patient cost savings represent a large proportion of poor women's average per capita income, reaching 60 percent among women in the bottom income quintile and declining to 15 percent among women in the wealthiest quintile. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Health plan budget impact analysis for pimecrolimus.

PubMed

Chang, Jane; Sung, Jennifer

2005-01-01

Budget impact models are useful tools for managed care organizations to make drug formulary decisions. The objective of this study was to estimate the incremental budgetary change in per-member-per-month (PMPM) medical and pharmacy costs for atopic dermatitis (AD) or eczema after the introduction of pimecrolimus cream 1%, a topical calcineurin inhibitor. Estimates of the percentage of patients seeking care, treatment patterns, and quantities of medications dispensed for AD were measured using 2001 and 2002 medical and pharmacy records in a proprietary database for health plans distributed throughout the United States. Approximately 2.5 million health plan members had continuous health insurance coverage during the study period. Costs for medications were assigned using the 2003 wholesale acquisition cost, and costs for physician visits were based on average 2003 Medicare reimbursement rates. Efficacy data from clinical trials were used to model the impact of pimecrolimus on subsequent physician visits. Sensitivity analyses were performed to evaluate the impact of varying the percentage of patients seeking care, practice patterns, medication quantities, percentage of pimecrolimus users, and levels of patient cost sharing. The estimated percentage of health plan members seeking care for AD in 2001 was 3.2%. The estimated total cost PMPM for AD treatment prior to introduction of pimecrolimus was 0.362 dollars for all covered lives, assuming no patient cost sharing. In the year after its introduction, 5.2% of the AD population filled a prescription for pimecrolimus. The incremental increase in pharmacy benefit cost was 0.008 dollars PMPM in 2003 dollars, but the total incremental medical and pharmacy cost was 0.002 dollars PMPM after accounting for the projected reduction in physician visit costs, representing a 0.7% increase in all AD-related costs. Based on sensitivity analyses, the incremental total cost PMPM after the introduction of pimecrolimus ranged from -0.004 dollars to 0.026 dollars. Using claims data for the medical treatment of AD in 2001-2002 and the utilization of pimecrolimus, the addition of pimecrolimus as a treatment option for AD had a minimal impact on PMPM costs for AD-related care in 2003 dollars. As with all pharmacoeconomic models, health plans should perform their own budget forecasting using assumptions derived from their own pharmacy and medical claims data.

Comparison of geographic methods to assess travel patterns of persons diagnosed with HIV in Philadelphia: how close is close enough?

PubMed

Eberhart, Michael G; Share, Amanda M; Shpaner, Mark; Brady, Kathleen A

2015-02-01

Travel distance to medical care has been assessed using a variety of geographic methods. Network analyses are less common, but may generate more accurate estimates of travel costs. We compared straight-line distances and driving distance, as well as average drive time and travel time on a public transit network for 1789 persons diagnosed with HIV between 2010 and 2012 to identify differences overall, and by distinct geographic areas of Philadelphia. Paired t-tests were used to assess differences across methods, and analysis of variance was used to assess between-group differences. Driving distances were significantly longer than straight-line distances (p<0.001) and transit times were significantly longer than driving times (p<0.001). Persons living in the northeast section of the city traveled greater distances, and at greater cost of time and effort, than persons in all other areas of the city (p<0.001). Persons living in the northwest section of the city traveled farther and longer than all other areas except the northeast (p<0.0001). Network analyses that include public transit will likely produce a more realistic estimate of the travel costs, and may improve models to predict medical care outcomes. Copyright © 2014 Elsevier Inc. All rights reserved.

Impact of The Real Cost Campaign on Adolescents’ Recall, Attitudes, and Risk Perceptions about Tobacco Use: A National Study

PubMed Central

Huang, Li-Ling; Lazard, Allison J.; Pepper, Jessica K.; Noar, Seth M.; Ranney, Leah M.; Goldstein, Adam O.

2017-01-01

The Food and Drug Administration’s (FDA) The Real Cost campaign advertisements (ads) have targeted U.S. youth with messages designed to prevent and reduce tobacco use. This study examined exposure to The Real Cost campaign, including ad and slogan recall, and associations with attitudes and risk perceptions among U.S. adolescents. We analyzed data from a nationally representative sample of adolescents aged 13 to 17 years (n = 1125) surveyed by phone from October 2014 to June 2015. We assessed aided recall of and attitudes toward four campaign ads and the one slogan. Logistic regression models assessed whether aided recall of The Real Cost ads or slogan was associated with perceived likelihood of serious health consequences of cigarette smoking. Most (88%) adolescents reported seeing or hearing at least one of four ads for The Real Cost, and 54% recalled The Real Cost slogan. The majority of adolescents reported more negative attitudes toward tobacco products after seeing or hearing the ads. Recall of any The Real Cost ad was significantly associated with greater perceptions of serious health consequences of cigarette smoking (Adjusted Odd Ratios (AOR) = 5.58, 95% Confidence Interval (CI) = 1.20–25.90). The FDA’s The Real Cost campaign has achieved very high reach and is associated with more negative attitudes toward tobacco products and greater risk perceptions of cigarette smoking among U.S. adolescents. PMID:28054993

The Rise of IPv6: Benefits and Costs of Transforming Military Cyberspace

DTIC Science & Technology

2015-04-01

people, the structure of the Internet is changing for the first time in its history with the ex- haustion of the IP version four ( IPv4 ) protocol and the...have.4 The need to transition from IPv4 to IPv6 is not hy- pothetical since the global supply of IP addresses in IPv4 is quickly be- ing exhausted...Registry (RIR) IPv4 Address Run-Down Model Year RI R Ad dr es s Po ol (/ 8s ) 2013 2014 2015 2016 2017 2018 2019 2020 4.5 4 3.5 3 2.5 2 1.5 1 0.5

Economic, Environmental and Health Implications of Enhanced Ventilation in Office Buildings.

PubMed

MacNaughton, Piers; Pegues, James; Satish, Usha; Santanam, Suresh; Spengler, John; Allen, Joseph

2015-11-18

Current building ventilation standards are based on acceptable minimums. Three decades of research demonstrates the human health benefits of increased ventilation above these minimums. Recent research also shows the benefits on human decision-making performance in office workers, which translates to increased productivity. However, adoption of enhanced ventilation strategies is lagging. We sought to evaluate two of the perceived potential barriers to more widespread adoption-Economic and environmental costs. We estimated the energy consumption and associated per building occupant costs for office buildings in seven U.S. cities, representing different climate zones for three ventilation scenarios (standard practice (20 cfm/person), 30% enhanced ventilation, and 40 cfm/person) and four different heating, ventilation and air conditioning (HVAC) system strategies (Variable Air Volume (VAV) with reheat and a Fan Coil Unit (FCU), both with and without an energy recovery ventilator). We also estimated emissions of greenhouse gases associated with this increased energy usage, and, for comparison, converted this to the equivalent number of vehicles using greenhouse gas equivalencies. Lastly, we paired results from our previous research on cognitive function and ventilation with labor statistics to estimate the economic benefit of increased productivity associated with increasing ventilation rates. Doubling the ventilation rate from the American Society of Heating, Refrigeration and Air-Conditioning Engineers minimum cost less than $40 per person per year in all climate zones investigated. Using an energy recovery ventilation system significantly reduced energy costs, and in some scenarios led to a net savings. At the highest ventilation rate, adding an ERV essentially neutralized the environmental impact of enhanced ventilation (0.03 additional cars on the road per building across all cities). The same change in ventilation improved the performance of workers by 8%, equivalent to a $6500 increase in employee productivity each year. Reduced absenteeism and improved health are also seen with enhanced ventilation. The health benefits associated with enhanced ventilation rates far exceed the per-person energy costs relative to salary costs. Environmental impacts can be mitigated at regional, building, and individual-level scales through the transition to renewable energy sources, adoption of energy efficient systems and ventilation strategies, and promotion of other sustainable policies.

Economic, Environmental and Health Implications of Enhanced Ventilation in Office Buildings

PubMed Central

MacNaughton, Piers; Pegues, James; Satish, Usha; Santanam, Suresh; Spengler, John; Allen, Joseph

2015-01-01

Introduction: Current building ventilation standards are based on acceptable minimums. Three decades of research demonstrates the human health benefits of increased ventilation above these minimums. Recent research also shows the benefits on human decision-making performance in office workers, which translates to increased productivity. However, adoption of enhanced ventilation strategies is lagging. We sought to evaluate two of the perceived potential barriers to more widespread adoption—Economic and environmental costs. Methods: We estimated the energy consumption and associated per building occupant costs for office buildings in seven U.S. cities, representing different climate zones for three ventilation scenarios (standard practice (20 cfm/person), 30% enhanced ventilation, and 40 cfm/person) and four different heating, ventilation and air conditioning (HVAC) system strategies (Variable Air Volume (VAV) with reheat and a Fan Coil Unit (FCU), both with and without an energy recovery ventilator). We also estimated emissions of greenhouse gases associated with this increased energy usage, and, for comparison, converted this to the equivalent number of vehicles using greenhouse gas equivalencies. Lastly, we paired results from our previous research on cognitive function and ventilation with labor statistics to estimate the economic benefit of increased productivity associated with increasing ventilation rates. Results: Doubling the ventilation rate from the American Society of Heating, Refrigeration and Air-Conditioning Engineers minimum cost less than $40 per person per year in all climate zones investigated. Using an energy recovery ventilation system significantly reduced energy costs, and in some scenarios led to a net savings. At the highest ventilation rate, adding an ERV essentially neutralized the environmental impact of enhanced ventilation (0.03 additional cars on the road per building across all cities). The same change in ventilation improved the performance of workers by 8%, equivalent to a $6500 increase in employee productivity each year. Reduced absenteeism and improved health are also seen with enhanced ventilation. Conclusions: The health benefits associated with enhanced ventilation rates far exceed the per-person energy costs relative to salary costs. Environmental impacts can be mitigated at regional, building, and individual-level scales through the transition to renewable energy sources, adoption of energy efficient systems and ventilation strategies, and promotion of other sustainable policies. PMID:26593933

Cost-effectiveness analysis of prophylactic cervical cancer vaccination in Japanese women.

PubMed

Konno, Ryo; Sasagawa, Toshiyuki; Fukuda, Takashi; Van Kriekinge, Georges; Demarteau, Nadia

2010-04-01

The incidence of cervical cancer (CC) is high in Japan and is further increasing among women younger than 30 years. This burden could be reduced by the implementation of a CC vaccine, but its cost-effectiveness is unknown. We quantified the clinical impact and assessed the cost-effectiveness of adding CC vaccination at age 12 to the current screening in place in Japan with a lifetime Markov model adapted to the Japanese setting. Transition probabilities and utility values were obtained from public databases. Direct costs for treatment and screening were estimated using Japanese medical fees. Annual costs and benefits were discounted at 3%. Sensitivity analyses were conducted on the age at vaccination, the vaccine characteristics, the discount rates, the proportion of human papillomavirus types 16/18 in cancer, and the screening coverage. Vaccinating a 12-year-old cohort was predicted to reduce CC incidence and deaths from CC by 73%. These clinical effects were associated with an incremental cost-effectiveness ratio of yen1.8 million per quality-adjusted life year gained. The incremental cost-effectiveness ratio of vaccinating all 10- to 45-year-old women was yen2.8 million per quality-adjusted life year, still below the threshold value. The implementation of a CC vaccination in Japan could reduce the CC burden in a very cost-effective manner for women up to 45 years.

Tradeoffs between costs and greenhouse gas emissions in the design of urban transit systems

NASA Astrophysics Data System (ADS)

Griswold, Julia B.; Madanat, Samer; Horvath, Arpad

2013-12-01

Recent investments in the transit sector to address greenhouse gas emissions have concentrated on purchasing efficient replacement vehicles and inducing mode shift from the private automobile. There has been little focus on the potential of network and operational improvements, such as changes in headways, route spacing, and stop spacing, to reduce transit emissions. Most models of transit system design consider user and agency cost while ignoring emissions and the potential environmental benefit of operational improvements. We use a model to evaluate the user and agency costs as well as greenhouse gas benefit of design and operational improvements to transit systems. We examine how the operational characteristics of urban transit systems affect both costs and greenhouse gas emissions. The research identifies the Pareto frontier for designing an idealized transit network. Modes considered include bus, bus rapid transit (BRT), light rail transit (LRT), and metro (heavy) rail, with cost and emissions parameters appropriate for the United States. Passenger demand follows a many-to-many travel pattern with uniformly distributed origins and destinations. The approaches described could be used to optimize the network design of existing bus service or help to select a mode and design attributes for a new transit system. The results show that BRT provides the lowest cost but not the lowest emissions for our large city scenarios. Bus and LRT systems have low costs and the lowest emissions for our small city scenarios. Relatively large reductions in emissions from the cost-optimal system can be achieved with only minor increases in user travel time.

The effectiveness and cost-effectiveness of donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease (review of Technology Appraisal No. 111): a systematic review and economic model.

PubMed

Bond, M; Rogers, G; Peters, J; Anderson, R; Hoyle, M; Miners, A; Moxham, T; Davis, S; Thokala, P; Wailoo, A; Jeffreys, M; Hyde, C

2012-01-01

Alzheimer’s disease (AD) is the most commonly occurring form of dementia. It is predominantly a disease of later life, affecting 5% of those over 65 in the UK. Review and update guidance to the NHS in England and Wales on the clinical effectiveness and cost-effectiveness of donepezil, galantamine, rivastigmine [acetylcholinesterase inhibitors (AChEIs)] and memantine within their licensed indications for the treatment of AD, which was issued in November 2006 (amended September 2007 and August 2009). Electronic databases were searched for systematic reviews and/or metaanalyses, randomised controlled trials (RCTs) and ongoing research in November 2009 and updated in March 2010; this updated search revealed no new includable studies. The databases searched included The Cochrane Library (2009 Issue 4, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials), MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, PsycINFO, EconLit, ISI Web of Science Databases--Science Citation Index, Conference Proceedings Citation Index, and BIOSIS; the Centre for Reviews and Dissemination (CRD) databases--NHS Economic Evaluation Database, Health Technology Assessment, and Database of Abstracts of Reviews of Effects. The clinical effectiveness systematic review was undertaken following the principles published by the NHS CRD. We included RCTs whose population was people with AD. The intervention and comparators depended on disease severity, measured by the Mini Mental State Examination (MMSE). mild AD (MMSE 21-26)--donepezil, galantamine and rivastigmine; moderate AD (MMSE 10-20)--donepezil, galantamine, rivastigmine and memantine; severe AD (MMSE < 10)--memantine. Comparators: mild AD (MMSE 21-26)--placebo or best supportive care (BSC); moderate AD (MMSE 10-20)--donepezil, galantamine, rivastigmine, memantine, placebo or BSC; severe AD (MMSE < 10)--placebo or BSC. The outcomes were clinical, global, functional, behavioural, quality of life, adverse events, costs and cost-effectiveness. Where appropriate, data were pooled using pair-wise meta-analysis, multiple outcome measures, metaregression and mixedtreatment comparisons. The decision model was based broadly on the structure of the three-state Markov model described in the previous technology assessment report, based upon time to institutionalisation, parameterised with updated estimates of effectiveness, costs and utilities. Notwithstanding the uncertainty of our results, we found in the base case that the AChEIs are probably cost saving at a willingness-to-pay (WTP) of £’30,000 per qualityadjusted life-year (QALY) for people with mild-to-moderate AD. For this class of drugs, there is a > 99% probability that the AChEIs are more cost-effective than BSC. These analyses assume that the AChEIs have no effect on survival. For the AChEIs, in people with mild to moderate AD, the probabilistic sensitivity analyses suggested that donepezil is the most cost-effective, with a 28% probability of being the most cost-effective option at a WTP of £’30,000 per QALY (27% at a WTP of £’20,000 per QALY). In the deterministic results, donepezil dominates the other drugs and BSC, which, along with rivastigmine patches, are associated with greater costs and fewer QALYs. Thus, although galantamine has a slightly cheaper total cost than donepezil (£’69,592 vs £’69,624), the slightly greater QALY gains from donepezil (1.616 vs 1.617) are enough for donepezil to dominate galantamine.The probability that memantine is cost-effective in a moderate to severe cohort compared with BSC at a WTP of £’30,000 per QALY is 38% (and 28% at a WTP of £’20,000 per QALY). The deterministic ICER for memantine is £’32,100 per/QALY and the probabilistic ICER is £’36,700 per/QALY. Trials were of 6 months maximum follow-up, lacked reporting of key outcomes, provided no subgroup analyses and used insensitive measures. Searches were limited to English language, The model does not include behavioural symptoms and there is uncertainty about the model structure and parameters. The additional clinical effectiveness evidence identified continues to suggest clinical benefit from the AChEIs in alleviating AD symptoms, although there is debate about the magnitude of the effect. Although there is also new evidence on the effectiveness of memantine, it remains less supportive of this drug’s use than the evidence for AChEIs. The conclusions concerning cost-effectiveness are quite different from the previous assessment. This is because both the changes in effectiveness and costs between drug use and non-drug use underlying the ICERs are very small. This leads to highly uncertain results, which are very sensitive to change. RESEARCH PRIORITIES: RCTs to include mortality, time to institutionalisation and quality of life, powered for subgroup analysis. The National Institute for Health Research Health Technology Assessment programme.

Examining hydrogen transitions.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Plotkin, S. E.; Energy Systems

2007-03-01

This report describes the results of an effort to identify key analytic issues associated with modeling a transition to hydrogen as a fuel for light duty vehicles, and using insights gained from this effort to suggest ways to improve ongoing modeling efforts. The study reported on here examined multiple hydrogen scenarios reported in the literature, identified modeling issues associated with those scenario analyses, and examined three DOE-sponsored hydrogen transition models in the context of those modeling issues. The three hydrogen transition models are HyTrans (contractor: Oak Ridge National Laboratory), MARKAL/DOE* (Brookhaven National Laboratory), and NEMS-H2 (OnLocation, Inc). The goals ofmore » these models are (1) to help DOE improve its R&D effort by identifying key technology and other roadblocks to a transition and testing its technical program goals to determine whether they are likely to lead to the market success of hydrogen technologies, (2) to evaluate alternative policies to promote a transition, and (3) to estimate the costs and benefits of alternative pathways to hydrogen development.« less

The Traffic Adaptive Data Dissemination (TrAD) Protocol for both Urban and Highway Scenarios.

PubMed

Tian, Bin; Hou, Kun Mean; Zhou, Haiying

2016-06-21

The worldwide economic cost of road crashes and injuries is estimated to be US$518 billion per year and the annual congestion cost in France is estimated to be €5.9 billion. Vehicular Ad hoc Networks (VANETs) are one solution to improve transport features such as traffic safety, traffic jam and infotainment on wheels, where a great number of event-driven messages need to be disseminated in a timely way in a region of interest. In comparison with traditional wireless networks, VANETs have to consider the highly dynamic network topology and lossy links due to node mobility. Inter-Vehicle Communication (IVC) protocols are the keystone of VANETs. According to our survey, most of the proposed IVC protocols focus on either highway or urban scenarios, but not on both. Furthermore, too few protocols, considering both scenarios, can achieve high performance. In this paper, an infrastructure-less Traffic Adaptive data Dissemination (TrAD) protocol which takes into account road traffic and network traffic status for both highway and urban scenarios will be presented. TrAD has double broadcast suppression techniques and is designed to adapt efficiently to the irregular road topology. The performance of the TrAD protocol was evaluated quantitatively by means of realistic simulations taking into account different real road maps, traffic routes and vehicular densities. The obtained simulation results show that TrAD is more efficient in terms of packet delivery ratio, number of transmissions and delay in comparison with the performance of three well-known reference protocols. Moreover, TrAD can also tolerate a reasonable degree of GPS drift and still achieve efficient data dissemination.

The Traffic Adaptive Data Dissemination (TrAD) Protocol for both Urban and Highway Scenarios

PubMed Central

Tian, Bin; Hou, Kun Mean; Zhou, Haiying

2016-01-01

The worldwide economic cost of road crashes and injuries is estimated to be US$518 billion per year and the annual congestion cost in France is estimated to be €5.9 billion. Vehicular Ad hoc Networks (VANETs) are one solution to improve transport features such as traffic safety, traffic jam and infotainment on wheels, where a great number of event-driven messages need to be disseminated in a timely way in a region of interest. In comparison with traditional wireless networks, VANETs have to consider the highly dynamic network topology and lossy links due to node mobility. Inter-Vehicle Communication (IVC) protocols are the keystone of VANETs. According to our survey, most of the proposed IVC protocols focus on either highway or urban scenarios, but not on both. Furthermore, too few protocols, considering both scenarios, can achieve high performance. In this paper, an infrastructure-less Traffic Adaptive data Dissemination (TrAD) protocol which takes into account road traffic and network traffic status for both highway and urban scenarios will be presented. TrAD has double broadcast suppression techniques and is designed to adapt efficiently to the irregular road topology. The performance of the TrAD protocol was evaluated quantitatively by means of realistic simulations taking into account different real road maps, traffic routes and vehicular densities. The obtained simulation results show that TrAD is more efficient in terms of packet delivery ratio, number of transmissions and delay in comparison with the performance of three well-known reference protocols. Moreover, TrAD can also tolerate a reasonable degree of GPS drift and still achieve efficient data dissemination. PMID:27338393

Study of activity based costing implementation for palm oil production using value-added and non-value-added activity consideration in PT XYZ palm oil mill

NASA Astrophysics Data System (ADS)

Sembiring, M. T.; Wahyuni, D.; Sinaga, T. S.; Silaban, A.

2018-02-01

Cost allocation at manufacturing industry particularly in Palm Oil Mill still widely practiced based on estimation. It leads to cost distortion. Besides, processing time determined by company is not in accordance with actual processing time in work station. Hence, the purpose of this study is to eliminates non-value-added activities therefore processing time could be shortened and production cost could be reduced. Activity Based Costing Method is used in this research to calculate production cost with Value Added and Non-Value-Added Activities consideration. The result of this study is processing time decreasing for 35.75% at Weighting Bridge Station, 29.77% at Sorting Station, 5.05% at Loading Ramp Station, and 0.79% at Sterilizer Station. Cost of Manufactured for Crude Palm Oil are IDR 5.236,81/kg calculated by Traditional Method, IDR 4.583,37/kg calculated by Activity Based Costing Method before implementation of Activity Improvement and IDR 4.581,71/kg after implementation of Activity Improvement Meanwhile Cost of Manufactured for Palm Kernel are IDR 2.159,50/kg calculated by Traditional Method, IDR 4.584,63/kg calculated by Activity Based Costing Method before implementation of Activity Improvement and IDR 4.582,97/kg after implementation of Activity Improvement.

The clinical and economic burden of newly diagnosed Alzheimer's disease in a medicare advantage population.

PubMed

Suehs, Brandon T; Davis, Cralen D; Alvir, Jose; van Amerongen, Derek; Pharmd, Nick C Patel; Joshi, Ashish V; Faison, Warachal E; Shah, Sonali N

2013-06-01

Alzheimer's disease (AD) represents a serious public health issue affecting approximately 5.4 million individuals in the United States and is projected to affect up to 16 million by 2050. This study examined health care resource utilization (HCRU), costs, and comorbidity burden immediately preceding new diagnosis of AD and 2 years after diagnosis. This study utilized a claims-based, retrospective cohort design. Medicare Advantage members newly diagnosed with AD (n = 3374) were compared to matched non-AD controls (n = 6748). All patients with AD were required to have 12 months of continuous enrollment prior to AD diagnosis (International Classification of Diseases, Clinical Modification [ICD-9] 331.0), during which time no diagnosis of AD, a related dementia, or an AD medication was observed. Non-AD controls demonstrated no diagnosis of AD, a related dementia, or a prescription claim for an AD medication treatment during their health plan enrollment. Medical and pharmacy claims data were used to measure HCRU, costs, and comorbidity burden over a period of 36 months (12 months pre-diagnosis and 24 months post-diagnosis). The HCRU and costs were greater for AD members during the year prior to diagnosis and during postdiagnosis years 1 and 2 compared to controls. The AD members also displayed greater comorbidity than their non-AD counterparts during postdiagnosis years 1 and 2, as measured by 2 different comorbidity indices. Members newly diagnosed with AD demonstrated greater HCRU, health care costs, and comorbidity burden compared to matched non-AD controls.

Effect of polyethelene oxide on the thermal degradation of cellulose biofilm – Low cost material for soft tissue repair in dentistry

PubMed Central

Tyler, Rakim; Schiraldi, David; Roperto, Renato; Faddoul, Fady; Teich, Sorin

2017-01-01

Background Bio cellulose is a byproduct of sweet tea fermentation known as kombusha. During the biosynthesis by bacteria cellulose chains are polymerized by enzyme from activated glucose. The single chains are then extruded through the bacterial cell wall. Interestingly, a potential of the Kombucha’s byproduct bio cellulose (BC) as biomaterial had come into focus only in the past few decades. The unique physical and mechanical properties such as high purity, an ultrafine and highly crystalline network structure, a superior mechanical strength, flexibility, pronounced permeability to gases and liquids, and an excellent compatibility with living tissue that reinforced by biodegradability, biocompatibility, large swelling ratios. Material and Methods The bio-cellulose film specimens were provided by the R.P Dressel dental materials laboratory, Department of Comprehensive Care, School of Dental Medicine, Case Western Reserve University, Cleveland, US. The films were harvested, washed with water and dried at room temperature overnight. 1wt% of PEG-2000 and 10wt% of NaOH were added into ultrapure water to prepare PEG/NaOH solution. Then bio-cellulose film was added to the mixture and swell for 3 h at room temperature. All bio-cellulose film specimens were all used in the TA Instruments Q500 Thermogravmetric Analyzer to investigate weight percent lost and degradation. The TGA was under ambient air conditions at a heating rate of 10ºC/min. Results and Conclusions PEG control exhibited one transition with the peak at 380ºC. Cellulose and cellulose/ PEG films showed 3 major transitions. Interestingly, the cellulose/PEG film showed slightly elevated temperatures when compared to the corresponding transitions for cellulose control. The thermal gravimetric analysis (TGA) degradation curves were analyzed. Cellulose control film exhibited two zero order transitions, that indicate the independence of the rate of degradation from the amount on the initial substance. The activation energies for three transitions for cellulose and cellulose/PEG showed increasingly higher values for the transitions at higher temperatures. Key words:TGA, Bio-cellulose, PEG. PMID:28828153

Effects of adding LiBF4 on the glass-transition kinetics of 1,2-propanediol

NASA Astrophysics Data System (ADS)

Terashima, Yukio; Takeda, Kiyoshi

2017-11-01

By applying an isoconversional method to differential-scanning calorimetry (DSC) data, we have discovered that the addition of LiBF4 significantly affects the activation energy Eα of the glass transition of 1,2-propanediol. Depending upon its concentration, the dynamics of the glass transition are affected more by adding LiBF4 at an early stage of the glass-to-liquid transition rather than at later stages. As the mole fraction x of LiBF4 increases, the value of Eα initially increases, but it decreases dramatically during the glass transition. The abrupt decline in Eα suggests that the addition of LiBF4 breaks cooperative rearranging motions into smaller parts. The expansion of cooperativity, and its fragmentation with increasing temperature, can be explained in terms of competition between the hydrogen-bond networks of the alcohol solvent and the ionic interactions due to the added salt. The variability of Eα with temperature is found to correlate exponentially with the dynamic fragility.

Solar Concentration for Electricity and Cooking

NASA Astrophysics Data System (ADS)

Kim, Mike; Fourt, Connor; Schwartz, Pete; Lee, Michael; Frostholm, Taylor; Fernandes, Josh; Tower, Jared

2012-11-01

Over 8000 Schefflers exist worldwide, mostly in Africa and Asia. Having constructed the first Scheffler reflector in North America 2 years ago, the next goal was to make it less expensive. The original model took 4 students 2 months and about 1000. In order to lower the cost and construction time the design was minimized, less expensive materials were used, and the construction process was automated. The original complex frame took 1000 people-hours and it was minimized to a day. Instead of using aluminum for the reflective dish, we turned to using aluminized Mylar, which cut the cost by over 90%. A thermal storage unit was added to extend cooking time well into the evening. Finally, a concentrated solar module of High Efficiency Photo Voltaics (HEPV) is to be placed at the focus of the concentrator to generate electricity and water as a byproduct. The final cost is estimated to be about 200 (0.10 per thermal watt) including the HEPV, an 80% cost reduction. Such technology is practical in the U.S. as well as developing nations.

Physical Theory of Voltage Fade in Lithium- and Manganese-Rich Transition Metal Oxides

DOE PAGES

Rinaldo, Steven G.; Gallagher, Kevin G.; Long, Brandon R.; ...

2015-03-04

Lithium- and manganese-rich (LMR) transition metal oxide cathodes are of interest for lithium-ion battery applications due to their increased energy density and decreased cost. However, the advantages in energy density and cost are offset, in part, due to the phenomena of voltage fade. Specifically, the voltage profiles (voltage as a function of capacity) of LMR cathodes transform from a high energy configuration to a lower energy configuration as they are repeatedly charged (Li removed) and discharged (Li inserted). Here, we propose a physical model of voltage fade that accounts for the emergence of a low voltage Li phase due tomore » the introduction of transition metal ion defects within a parent Li phase. The phenomenological model was re-cast in a general form and experimental LMR charge profiles were de-convoluted to extract the evolutionary behavior of various components of LMR capacitance profiles. Evolution of the voltage fade component was found to follow a universal growth curve with a maximal voltage fade capacity of ≈ 20% of the initial total capacity.« less

Kinetic energy classification and smoothing for compact B-spline basis sets in quantum Monte Carlo

NASA Astrophysics Data System (ADS)

Krogel, Jaron T.; Reboredo, Fernando A.

2018-01-01

Quantum Monte Carlo calculations of defect properties of transition metal oxides have become feasible in recent years due to increases in computing power. As the system size has grown, availability of on-node memory has become a limiting factor. Saving memory while minimizing computational cost is now a priority. The main growth in memory demand stems from the B-spline representation of the single particle orbitals, especially for heavier elements such as transition metals where semi-core states are present. Despite the associated memory costs, splines are computationally efficient. In this work, we explore alternatives to reduce the memory usage of splined orbitals without significantly affecting numerical fidelity or computational efficiency. We make use of the kinetic energy operator to both classify and smooth the occupied set of orbitals prior to splining. By using a partitioning scheme based on the per-orbital kinetic energy distributions, we show that memory savings of about 50% is possible for select transition metal oxide systems. For production supercells of practical interest, our scheme incurs a performance penalty of less than 5%.

A Cost of Illness Study of Children with High-Functioning Autism Spectrum Disorders and Comorbid Anxiety Disorders as Compared to Clinically Anxious and Typically Developing Children

ERIC Educational Resources Information Center

Steensel, Francisca J.; Dirksen, Carmen D.; Bögels, Susan M.

2013-01-01

The study's aim was to estimate the societal costs of children with high-functioning ASD and comorbid anxiety disorder(s) (ASD + AD-group; n = 73), and to compare these costs to children with anxiety disorders (AD-group; n = 34), and typically developing children (controls; n = 87). Mean total costs for the ASD + AD-group amounted €17,380 per…

Benchmarking Brown Dwarf Models With a Non-irradiated Transiting Brown Dwarf in Praesepe

NASA Astrophysics Data System (ADS)

Beatty, Thomas; Marley, Mark; Line, Michael; Gizis, John

2018-05-01

We wish to use 9.4 hours of Spitzer time to observe two eclipses, one each at 3.6um and 4.5um, of the transiting brown dwarf AD 3116b. AD 3116b is a 54.2+/-4.3 MJ, 1.08+/-0.07 RJ object on a 1.98 day orbit about a 3200K M-dwarf. Uniquely, AD 3116 and its host star are both members of Praesepe, a 690+/-60 Myr old open cluster. AD 3116b is thus one of two transiting brown dwarfs for which we have a robust isochronal age that is not dependent upon brown dwarf evolutionary models, and the youngest brown dwarf for which this is the case. Importantly, the flux AD 3116b receives from its host star is only 0.7% of its predicted internal luminosity (Saumon & Marley 2008). This makes AD 3116b the first known transiting brown dwarf that simultaneously has a well-defined age, and that receives a negligible amount of external irradiation, and a unique laboratory to test radius and luminosity predictions from brown dwarf evolutionary models. Our goal is to measure the emission from the brown dwarf. AD 3116b should have large, 25 mmag, eclipse depths in the Spitzer bandpasses, and we expect to measure them with a precision of +/-0.50 mmag at 3.6um and +/-0.54 mmag at 4.5um. This will allow us to make measure AD 3116b?s internal effective temperature to +/-40K. We will also use the upcoming Gaia DR2 parallaxes to measure AD 3116b's absolute IRAC magnitudes and color, and hence determine the cloud properties of the atmosphere. As the only known brown dwarf with an independently measured mass, radius, and age, Spitzer measurements of AD 3116b's luminosity and clouds will provide a critical benchmark for brown dwarf observation and theory.

Phase transition of charged-AdS black holes and quasinormal modes: A time domain analysis

NASA Astrophysics Data System (ADS)

Chabab, M.; El Moumni, H.; Iraoui, S.; Masmar, K.

2017-10-01

In this work, we investigate the time evolution of a massless scalar perturbation around small and large RN-AdS4 black holes for the purpose of probing the thermodynamic phase transition. We show that below the critical point the scalar perturbation decays faster with increasing of the black hole size, both for small and large black hole phases. Our analysis of the time profile of quasinormal mode reveals a sharp distinction between the behaviors of both phases, providing a reliable tool to probe the black hole phase transition. However at the critical point P=Pc, as the black hole size extends, we note that the damping time increases and the perturbation decays faster, the oscillation frequencies raise either in small and large black hole phase. In this case the time evolution approach fails to track the AdS4 black hole phase.

On the thermodynamics of the black hole and hairy black hole transitions in the asymptotically flat spacetime with a box

NASA Astrophysics Data System (ADS)

Peng, Yan; Wang, Bin; Liu, Yunqi

2018-03-01

We study the asymptotically flat quasi-local black hole/hairy black hole model with nonzero mass of the scalar field. We disclose effects of the scalar mass on transitions in a grand canonical ensemble with condensation behaviors of the parameter ψ 2, which is similar to approaches in holographic theories. We find that a more negative scalar mass makes the phase transition easier. We also obtain the analytical relation ψ 2∝ (Tc-T)^{1/2} around the critical phase transition points, implying a second order phase transition. Besides the parameter ψ 2, we show that metric solutions can be used to disclose properties of the transitions. In this work, we observe that phase transitions in a box are strikingly similar to holographic transitions in AdS gravity and the similarity provides insights into holographic theories.

How broadcast volume and emotional content affect youth recall of anti-tobacco advertising.

PubMed

Biener, Lois; Wakefield, Melanie; Shiner, Cecilia M; Siegel, Michael

2008-07-01

Televised anti-tobacco advertising has been shown to be effective for discouraging smoking initiation; however, purchasing broadcasting time is very costly. This study investigated the relative impact of the broadcast volume (media weight) and the emotional content of an ad as predictors of advertising recall. The data come from a random-digit-dialed survey conducted in 2001 and 2002 of 3863 youth aged 12-17. Media weight was based on commercial TV ratings data. The emotional intensity of advertisements was derived from the ratings made by independent youth judges. Data analyses were conducted between 2005 and 2007. Results indicated that media weight was a significant predictor of recall, but the emotional content of the ad was an even stronger predictor. Also, ads low in emotional intensity required more media weight than those high in emotional intensity to achieve the same amount of increase in recall. This study extends prior research that highlights the importance of emotional intensity for effective anti-tobacco advertising. It also indicates that, relative to unemotional advertisements, emotionally arousing advertisements require fewer broadcasts to achieve the same level of recall, and hence are likely to be less costly to a public health campaign.

The Decoy Effect Within Alcohol Purchasing Decisions.

PubMed

Monk, Rebecca L; Qureshi, Adam W; Leatherbarrow, Thomas; Hughes, Annalise

2016-08-23

The decoy effect is the phenomenon where the introduction of a third choice to a decision dyad changes the distribution of preferences between options. Examine whether this effect exists in alcohol purchasing decisions and whether testing context impacts this. Fifty-two participants tested in either a bar or library context and were asked to choose one of a series of beer and water deals presented for timed intervals. In some cases, two options were presented (with similar attractiveness) and in other cases a third, less preferable, decoy option was added. A basic decoy effect in both alcohol and water purchasing decisions. Specifically, there were reductions in the selection of both the original options when the decoy was added into choice dyads. A significant interaction demonstrated in the bar context there was a significant difference such that there was a slight increase in participants selecting the most cost effective option when the decoy was added, and a simultaneous decrease in those choosing the moderately cost effective option. There were no such differences observed in the library condition. The same product may be perceived differently across contexts and, as such, consumers in a pub environment may be particularly vulnerable to the decoy effect.

Effects of Catalytic Action and Ligand Binding on Conformational Ensembles of Adenylate Kinase.

PubMed

Onuk, Emre; Badger, John; Wang, Yu Jing; Bardhan, Jaydeep; Chishti, Yasmin; Akcakaya, Murat; Brooks, Dana H; Erdogmus, Deniz; Minh, David D L; Makowski, Lee

2017-08-29

Crystal structures of adenylate kinase (AdK) from Escherichia coli capture two states: an "open" conformation (apo) obtained in the absence of ligands and a "closed" conformation in which ligands are bound. Other AdK crystal structures suggest intermediate conformations that may lie on the transition pathway between these two states. To characterize the transition from open to closed states in solution, X-ray solution scattering data were collected from AdK in the apo form and with progressively increasing concentrations of five different ligands. Scattering data from apo AdK are consistent with scattering predicted from the crystal structure of AdK in the open conformation. In contrast, data from AdK samples saturated with Ap5A do not agree with that calculated from AdK in the closed conformation. Using cluster analysis of available structures, we selected representative structures in five conformational states: open, partially open, intermediate, partially closed, and closed. We used these structures to estimate the relative abundances of these states for each experimental condition. X-ray solution scattering data obtained from AdK with AMP are dominated by scattering from AdK in the open conformation. For AdK in the presence of high concentrations of ATP and ADP, the conformational ensemble shifts to a mixture of partially open and closed states. Even when AdK is saturated with Ap5A, a significant proportion of AdK remains in a partially open conformation. These results are consistent with an induced-fit model in which the transition of AdK from an open state to a closed state is initiated by ATP binding.

Mess in mass transit: though demand is up, the service is down

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1979-07-16

Mass transit systems (bus and rail), in poor mechanical and physical condition, are facing an economic crisis. Most industries that had been constructing new rail or bus equipment have now quit production completely or nearly so. San Diego is buying trolleys for its 16-mile line to the Mexican border, on which construction will begin in late 1979, from a West German supplier. The background of how the US got into this situation is reviewed. American's love affair with the automobile put the transit systems in financial trouble with poor ridership, and now the companies are afraid to reconstruct, thinking perhapsmore » Americans will revert to the automobile if gasoline again becomes plentiful. As the US attempts to remedy the transit situation, there should be a burden sharing between local and Federal governments. Local transit authorities should carry the operating costs, but even if they are heavily traveled, fares meet only 48% of operating costs. Therefore, communities will have to find ways to raise money in order to keep the systems running. The Carter Administration did not seize on mass transit as a means of conserving gasoline, but President Carter did say that part of the windfall tax on oil companies would be set aside for mass transport. But some progress is noted: Baltimore is digging its first subway; Buffalo began construction of a 6.5-mile subway and elevated-transit system; and Atlanta put into operation the first 6.7-mile segment of MARTA. Improvisions in many cities are noted, such as, leasing commercial buses and pressing school buses into operation. (MCW)« less

Steam bottoming cycle for an adiabatic diesel engine

NASA Technical Reports Server (NTRS)

Poulin, E.; Demier, R.; Krepchin, I.; Walker, D.

1984-01-01

Steam bottoming cycles using adiabatic diesel engine exhaust heat which projected substantial performance and economic benefits for long haul trucks were studied. Steam cycle and system component variables, system cost, size and performance were analyzed. An 811 K/6.90 MPa state of the art reciprocating expander steam system with a monotube boiler and radiator core condenser was selected for preliminary design. The costs of the diesel with bottoming system (TC/B) and a NASA specified turbocompound adiabatic diesel with aftercooling with the same total output were compared, the annual fuel savings less the added maintenance cost was determined to cover the increase initial cost of the TC/B system in a payback period of 2.3 years. Steam bottoming system freeze protection strategies were developed, technological advances required for improved system reliability are considered and the cost and performance of advanced systes are evaluated.

High temperature thermal energy storage in moving sand

NASA Technical Reports Server (NTRS)

Turner, R. H.; Awaya, H. I.

1978-01-01

Several high-temperature (to 500 C) heat-storage systems using sand as the storage medium are described. The advantages of sand as a storage medium include low cost for sand, widespread availability, non-toxicity, non-degradation characteristics, easy containment, and safety. The systems considered include: stationary sand with closely spaced tubes throughout the volume, the use of a fluidized bed, use of conveyor belt transporter, and the use of a blower rapid transport system. For a stationary sand bed, very close spacing of heat transfer tubes throughout the volume is required, manifesting as high power related system cost. The suggestion of moving sand past or around pipes is intended to reduce the power related costs at the penalty of added system complexity. Preliminary system cost estimates are offered. These rough calculations indicate that mobile sand heat storage systems cost less than the stationary sand approach.

A cost-effectiveness analysis of fixed-combination therapies in patients with open-angle glaucoma: a European perspective.

PubMed

Hommer, A; Wickstrøm, J; Friis, M M; Steeds, C; Thygesen, J; Ferreras, A; Gouws, P; Buchholz, P

2008-04-01

To compare the efficacy and cost implications of the use of the intraocular pressure-lowering prostaglandin analogues bimatoprost, travoprost, and latanoprost as fixed-combination therapies with timolol, a beta-adrenergic receptor antagonist. A decision analytic cost-effectiveness model was constructed. Since no head-to-head studies comparing the three treatment options exist, the analysis was based on an indirect comparison. Hence, the model was based on efficacy data from five randomized, controlled, clinical studies. The studies were comparable with respect to study design, time horizon, patient population and type of end point presented. The measure of effectiveness was the percentage reduction of the intraocular pressure level from baseline. The cost evaluated was the cost of medication and clinical visits to the ophthalmologist. All drug costs were market prices inclusive of value-added tax, and visit costs were priced using official physician fees. Cost-effectiveness analyses were carried out in five European countries: Spain, Italy, United Kingdom, Norway and Sweden. The time horizon for the analyses was 3 months. The analysis showed that fixed-combination bimatoprost/timolol was more effective and less costly than fixed-combination travoprost/timolol and fixed-combination latanoprost/timolol in three out of the five countries analyzed. In two countries, bimatoprost/timolol was less costly than latanoprost/timolol, and cost the same as travoprost/timolol. This cost-effectiveness analysis showed that the fixed combination of bimatoprost 0.03%/timolol 0.5% administered once daily was a cost-effective treatment option for patients with primary open-angle glaucoma. This study was limited by available clinical data: without a head-to-head trial, indirect comparisons were necessary. In the United Kingdom, Sweden, Norway, Italy, and Spain, from a health service viewpoint, bimatoprost/timolol was a slightly more effective as well as less costly treatment strategy when compared to both travoprost/timolol and latanoprost/timolol.

The state of energy storage in electric utility systems and its effect on renewable energy resources

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rau, N S

1994-08-01

This report describes the state of the art of electric energy storage technologies and discusses how adding intermittent renewable energy technologies (IRETs) to a utility network affects the benefits from storage dispatch. Load leveling was the mode of storage dispatch examined in the study. However, the report recommended that other modes be examined in the future for kilowatt and kilowatt-hour optimization of storage. The motivation to install storage with IRET generation can arise from two considerations: reliability and enhancement of the value of energy. Because adding storage increases cost, reliability-related storage is attractive only if the accruing benefits exceed themore » cost of storage installation. The study revealed that the operation of storage should not be guided by the output of the IRET but rather by system marginal costs. Consequently, in planning studies to quantify benefits, storage should not be considered as an entity belonging to the system and not as a component of IRETS. The study also indicted that because the infusion of IRET energy tends to reduce system marginal cost, the benefits from load leveling (value of energy) would be reduced. However, if a system has storage, particularly if the storage is underutilized, its dispatch can be reoriented to enhance the benefits of IRET integration.« less

Cost Effectiveness Analysis of Quasi-In-Motion Wireless Power Transfer for Plug-In Hybrid Electric Transit Buses from Fleet Perspective

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wang, Lijuan; Gonder, Jeff; Brooker, Aaron

This study evaluated the costs and benefits associated with the use of stationary-wireless-power-transfer-enabled plug-in hybrid electric buses and determined the cost effectiveness relative to conventional buses and hybrid electric buses. A factorial design was performed over a number of different battery sizes, charging power levels, and f bus stop charging stations. The net present costs were calculated for each vehicle design and provided the basis for design evaluation. In all cases, given the assumed economic conditions, the conventional bus achieved the lowest net present cost while the optimal plug-in hybrid electric bus scenario beat out the hybrid electric comparison scenario.more » The parameter sensitivity was also investigated under favorable and unfavorable market penetration assumptions.« less

Solar project cost report for Ingham County, Medical Care Facility, Okemos, Michigan

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

The solar energy system supplies service hot water for a 204 bed medical and geriatric care facility with laundry and kitchen. The system was designed at the time the building was designed. The 9,374 ft/sup 2/ of collectors were manufactured by Revere Copper and Brass, Inc., and are mounted at grade level behind the building. Solar heated water for use in heating service water is stored in a 5000 gallon hot water storage tank. The heaviest use of hot water occurs during the day so the requirement for thermal storage is modest. The construction costs of this solar project aremore » presented. Category costs are listed by materials, direct labor, ad subcontract costs. The subcontract costs include both materials, labor, overhead and profit for electrical, control and other minor subcontractors. The installed cost of the system was $312,825 not including prime contractor overhead and profit and general and administrative costs. (MHR)« less

Consumer Vehicle Choice Model Documentation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liu, Changzheng; Greene, David L

In response to the Fuel Economy and Greenhouse Gas (GHG) emissions standards, automobile manufacturers will need to adopt new technologies to improve the fuel economy of their vehicles and to reduce the overall GHG emissions of their fleets. The U.S. Environmental Protection Agency (EPA) has developed the Optimization Model for reducing GHGs from Automobiles (OMEGA) to estimate the costs and benefits of meeting GHG emission standards through different technology packages. However, the model does not simulate the impact that increased technology costs will have on vehicle sales or on consumer surplus. As the model documentation states, “While OMEGA incorporates functionsmore » which generally minimize the cost of meeting a specified carbon dioxide (CO2) target, it is not an economic simulation model which adjusts vehicle sales in response to the cost of the technology added to each vehicle.” Changes in the mix of vehicles sold, caused by the costs and benefits of added fuel economy technologies, could make it easier or more difficult for manufacturers to meet fuel economy and emissions standards, and impacts on consumer surplus could raise the costs or augment the benefits of the standards. Because the OMEGA model does not presently estimate such impacts, the EPA is investigating the feasibility of developing an adjunct to the OMEGA model to make such estimates. This project is an effort to develop and test a candidate model. The project statement of work spells out the key functional requirements for the new model.« less

Order of wetting transitions in electrolyte solutions.

PubMed

Ibagon, Ingrid; Bier, Markus; Dietrich, S

2014-05-07

For wetting films in dilute electrolyte solutions close to charged walls we present analytic expressions for their effective interface potentials. The analysis of these expressions renders the conditions under which corresponding wetting transitions can be first- or second-order. Within mean field theory we consider two models, one with short- and one with long-ranged solvent-solvent and solvent-wall interactions. The analytic results reveal in a transparent way that wetting transitions in electrolyte solutions, which occur far away from their critical point (i.e., the bulk correlation length is less than half of the Debye length) are always first-order if the solvent-solvent and solvent-wall interactions are short-ranged. In contrast, wetting transitions close to the bulk critical point of the solvent (i.e., the bulk correlation length is larger than the Debye length) exhibit the same wetting behavior as the pure, i.e., salt-free, solvent. If the salt-free solvent is governed by long-ranged solvent-solvent as well as long-ranged solvent-wall interactions and exhibits critical wetting, adding salt can cause the occurrence of an ion-induced first-order thin-thick transition which precedes the subsequent continuous wetting as for the salt-free solvent.

Improving the Performance at Elevated Temperature of High Voltage Graphite/LiNi 0.5Mn 1.5O 4 Cells with Added Lithium Catechol Dimethyl Borate

DOE PAGES

Dong, Yingnan; Demeaux, Julien; Zhang, Yuzi; ...

2016-12-13

Performance of LiNi 0.5Mn 1.5O 4/graphite cells cycled to 4.8 V at 55°C with the 1.2 M LiPF 6 in EC/EMC (3/7, STD electrolyte) with and without added lithium catechol dimethyl borate (LiCDMB) has been investigated. The incorporation of 0.5 wt% LiCDMB to the STD electrolyte results in an improved capacity retention and coulombic efficiency upon cycling at 55°C. Ex-situ analysis of the electrode surfaces via a combination of SEM, TEM, and XPS reveals that oxidation of LiCDMB at high potential results in the deposition of a passivation layer on the electrode surface, preventing transition metal ion dissolution from themore » cathode and subsequent deposition on the anode. NMR investigations of the bulk electrolyte stored at 85°C reveals that added LiCDMB prevents the thermal decomposition of LiPF 6.« less

Improving the Performance at Elevated Temperature of High Voltage Graphite/LiNi 0.5Mn 1.5O 4 Cells with Added Lithium Catechol Dimethyl Borate

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dong, Yingnan; Demeaux, Julien; Zhang, Yuzi

Performance of LiNi 0.5Mn 1.5O 4/graphite cells cycled to 4.8 V at 55°C with the 1.2 M LiPF 6 in EC/EMC (3/7, STD electrolyte) with and without added lithium catechol dimethyl borate (LiCDMB) has been investigated. The incorporation of 0.5 wt% LiCDMB to the STD electrolyte results in an improved capacity retention and coulombic efficiency upon cycling at 55°C. Ex-situ analysis of the electrode surfaces via a combination of SEM, TEM, and XPS reveals that oxidation of LiCDMB at high potential results in the deposition of a passivation layer on the electrode surface, preventing transition metal ion dissolution from themore » cathode and subsequent deposition on the anode. NMR investigations of the bulk electrolyte stored at 85°C reveals that added LiCDMB prevents the thermal decomposition of LiPF 6.« less

Casimir force phase transitions in the graphene family

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rodriguez-Lopez, Pablo; Kort-Kamp, Wilton J. M.; Dalvit, Diego A. R.

The Casimir force is a universal interaction induced by electromagnetic quantum fluctuations between any types of objects. We found that the expansion of the graphene family by adding silicene, germanene and stanene (2D allotropes of Si, Ge, and Sn), lends itself as a platform to probe Dirac-like physics in honeycomb staggered systems in such a ubiquitous interaction. Here, we discover Casimir force phase transitions between these staggered 2D materials induced by the complex interplay between Dirac physics, spin-orbit coupling and externally applied fields. Particularly, we find that the interaction energy experiences different power law distance decays, magnitudes and dependences onmore » characteristic physical constants. Furthermore, due to the topological properties of these materials, repulsive and quantized Casimir interactions become possible.« less

Casimir force phase transitions in the graphene family

DOE PAGES

Rodriguez-Lopez, Pablo; Kort-Kamp, Wilton J. M.; Dalvit, Diego A. R.; ...

2017-03-15

The Casimir force is a universal interaction induced by electromagnetic quantum fluctuations between any types of objects. We found that the expansion of the graphene family by adding silicene, germanene and stanene (2D allotropes of Si, Ge, and Sn), lends itself as a platform to probe Dirac-like physics in honeycomb staggered systems in such a ubiquitous interaction. Here, we discover Casimir force phase transitions between these staggered 2D materials induced by the complex interplay between Dirac physics, spin-orbit coupling and externally applied fields. Particularly, we find that the interaction energy experiences different power law distance decays, magnitudes and dependences onmore » characteristic physical constants. Furthermore, due to the topological properties of these materials, repulsive and quantized Casimir interactions become possible.« less

American Fuel Cell Bus Project Evaluation. Second Report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Eudy, Leslie; Post, Matthew

2015-09-01

This report presents results of the American Fuel Cell Bus (AFCB) Project, a demonstration of fuel cell electric buses operating in the Coachella Valley area of California. The prototype AFCB was developed as part of the Federal Transit Administration's (FTA's) National Fuel Cell Bus Program. Through the non-profit consortia CALSTART, a team led by SunLine Transit Agency and BAE Systems developed a new fuel cell electric bus for demonstration. SunLine added two more AFCBs to its fleet in 2014 and another in 2015. FTA and the AFCB project team are collaborating with the U.S. Department of Energy (DOE) and DOE'smore » National Renewable Energy Laboratory to evaluate the buses in revenue service. This report summarizes the performance results for the buses through June 2015.« less

Methodological considerations in cost of illness studies on Alzheimer disease

PubMed Central

2012-01-01

Cost-of-illness studies (COI) can identify and measure all the costs of a particular disease, including the direct, indirect and intangible dimensions. They are intended to provide estimates about the economic impact of costly disease. Alzheimer disease (AD) is a relevant example to review cost of illness studies because of its costliness.The aim of this study was to review relevant published cost studies of AD to analyze the method used and to identify which dimension had to be improved from a methodological perspective. First, we described the key points of cost study methodology. Secondly, cost studies relating to AD were systematically reviewed, focussing on an analysis of the different methods used. The methodological choices of the studies were analysed using an analytical grid which contains the main methodological items of COI studies. Seventeen articles were retained. Depending on the studies, annual total costs per patient vary from $2,935 to $52, 954. The methods, data sources, and estimated cost categories in each study varied widely. The review showed that cost studies adopted different approaches to estimate costs of AD, reflecting a lack of consensus on the methodology of cost studies. To increase its credibility, closer agreement among researchers on the methodological principles of cost studies would be desirable. PMID:22963680

Value-Added Electricity Services: New Roles for Utilities and Third-Party Providers

DOE Office of Scientific and Technical Information (OSTI.GOV)

Blansfield, J.; Wood, L.; Katofsky, R.

New energy generation, storage, delivery, and end-use technologies support a broad range of value-added electricity services for retail electricity customers. Sophisticated energy management services, distributed generation coupled with storage, and electric vehicle charging are just a few examples of emerging offerings. Who should provide value-added services — utilities or third parties, or both, and under what conditions? What policy and regulatory changes may be needed to promote competition and innovation, to account for utility costs to enable these services, and to protect consumers? The report approaches the issues from three perspectives: utilities, third-party service providers, and consumers: -Jonathan Blansfield andmore » Lisa Wood, Institute for Electric Innovation -Ryan Katofsky, Benjamin Stafford and Danny Waggoner, Advanced Energy Economy -National Association of State Utility Consumer Advocates« less

Cost-effectiveness of TNF inhibitors vs synthetic disease-modifying antirheumatic drugs in patients with rheumatoid arthritis: a Markov model study based on two longitudinal observational studies.

PubMed

Kvamme, Maria K; Lie, Elisabeth; Uhlig, Till; Moger, Tron A; Kvien, Tore K; Kristiansen, Ivar S

2015-07-01

The objective of this study was to estimate the additional costs and health benefits of adding a TNF inhibitor (TNFi) (adalimumab, certolizumab, etanercept, golimumab, infliximab) to a synthetic DMARD (sDMARD), e.g. MTX, in patients with RA. We developed the Norwegian RA model as a Markov model simulating 10 years of treatment with either TNFi plus sDMARDs (TNFi strategy) or sDMARDs alone (synthetic strategy). Patients in both strategies started in one of seven health states, based on the Short Form-6 Dimensions (SF-6D). The patients could move to better or worse health states according to transition probabilities. In the TNFi strategy, patients could stay on TNFi (including switch of TNFi), or switch to non-TNFi-biologics (abatacept, rituximab, tocilizumab), sDMARDs or no DMARD. In the synthetic strategy, patients remained on sDMARDs. Data from two observational studies were used for the assessment of resource use and utilities in the health states. Health benefits were evaluated using the EuroQol-5 Dimensions (EQ-5D) and SF-6D. The Norwegian RA model predicted that 10-year discounted health care costs totalled €124,942 (€475,266 including production losses) for the TNFi strategy and €65,584 (€436,517) for the synthetic strategy. The cost per additionally gained quality-adjusted life-year of adding a TNFi was €92,557 (€60,227 including production losses) using SF-6D and €61,285 (€39,841) using EQ-5D. Including health care costs only, the probability that TNFi treatment was cost-effective was 90% when using EQ-5D, assuming a Norwegian willingness-to-pay level of €67,300. TNFi treatment for RA is cost-effective when accounting for production losses. Excluding production losses, TNFi treatment is cost-effective using EQ-5D, but not SF-6D. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Mass transit : bus rapid transit shows promise

DOT National Transportation Integrated Search

2001-09-17

The U. S. General Accounting Office (GAO) was asked to (1) examine the federal role in supporting Bus Rapid Transit; (2) compare the capital costs, operating costs, and performance characteristics of Bus Rapid Transit and Light Rail systems; and (3) ...

The costs of caring: medical costs of Alzheimer's disease and the managed care environment.

PubMed

Murman, D L

2001-01-01

This review summarizes the medical costs associated with Alzheimer's disease (AD) and related dementias, as well as the payers responsible for these medical costs in the US health care system. It is clear from this review that AD and related dementias are associated with substantial medical costs. The payers responsible for a majority of these costs are families of patients with AD and the US government through the Medicare and Medicaid programs. In an attempt to control expenditures, Medicare and Medicaid have turned to managed care principles and managed care organizations. The increase in "managed" dementia care gives rise to several potential problems for patients with AD, along with many opportunities for systematic improvement in the quality of dementia care. Evidence-based disease management programs provide the greatest opportunities for improving managed dementia care but will require the development of dementia-specific quality of care measures to evaluate and continually improve them.

Cost Analysis and Surgical Site Infection Rates in Total Knee Arthroplasty Comparing Traditional vs. Single-Use Instrumentation.

PubMed

Siegel, Geoffrey W; Patel, Neil N; Milshteyn, Michael A; Buzas, David; Lombardo, Daniel J; Morawa, Lawrence G

2015-12-01

Surgical site infections (SSIs) are a significant complications in total knee arthroplasty (TKA). The purpose of this study was to evaluate if traditional vs. single-use instrumentation had an effect on SSI's. We compared SSI rates and costs of TKAs performed with single-use (449) and traditional (169) TKA instrumentation trays. Total OR Time was, on average, 30 min less when single-use instrumentation was used. SSIs decreased in the single-use group (n=1) compared to the traditional group (n=5) (P=0.006). Single-use instrumentation added $490 in initial costs; however it saved between $480 and $600. Single-use instrumentation may provide a benefit to the patient by potentially decreasing the risk of infection and reducing the overall hospital costs. Copyright © 2015 Elsevier Inc. All rights reserved.

Recall and Effectiveness of Messages Promoting Smoke-Free Policies in Rural Communities.

PubMed

Rayens, Mary Kay; Butler, Karen M; Wiggins, Amanda T; Kostygina, Ganna; Langley, Ronald E; Hahn, Ellen J

2016-05-01

Low-cost media campaigns increase demand for smoke-free policies in underserved rural areas. The study examined the impact of loss- and gain-framed smoke-free print ads on recall and perceived effectiveness in rural communities, controlling for personal characteristics. Following 6- to 9-month print media campaigns in three rural counties, recall and perceived effectiveness of loss-framed (ie, targeting dangers of secondhand smoke [SHS]) and gain-framed (ie, highlighting positive aspects of smoke-free air) ads were assessed using random-digit-dial phone surveys. Respondents were asked if they remembered each ad, whether they liked it, whether they were prompted to contact a smoke-free coalition, whether the ad made them think, and whether it prompted emotion. Mixed modeling assessed whether personal factors predicted ad recall or perceived effectiveness. Loss-framed ads were less likely to be recalled but more likely to prompt emotion. For ads of both frame types, females reported greater recall and perceived effectiveness than males. Those with less education reported higher perceived effectiveness of the ads but lower recall. Nonsmokers were more likely than smokers to perceive the ads as effective. Knowledge of SHS risk and support for smoke-free workplaces were positively associated with recall and effectiveness. Ad recall and perceived effectiveness were associated with framing and demographic and personal characteristics. Smoke-free efforts in rural areas may be bolstered by continuing to promote benefits of smoke-free workplace policies and educate on SHS risks. Rural areas may need to provide a combination of ad types and framing strategies to appeal to a wide audience. Rural communities are disproportionately affected by SHS and less likely to be protected by smoke-free policies. This study adds evidence-based guidance for tailoring rural smoke-free media campaigns using different framing: gain-framed messages (ie, benefits of smoke-free environments) to promote recall and loss-framed content (ie, dangers of SHS) to prompt emotion. Further, gain-framed messages that are localized to the rural community may be especially effective. Findings support designing smoke-free campaigns in rural communities with the audience in mind by tailoring messages to age, sex, and education level. © The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Recall and Effectiveness of Messages Promoting Smoke-Free Policies in Rural Communities

PubMed Central

Butler, Karen M.; Wiggins, Amanda T.; Kostygina, Ganna; Langley, Ronald E.; Hahn, Ellen J.

2016-01-01

Abstract Introduction: Low-cost media campaigns increase demand for smoke-free policies in underserved rural areas. The study examined the impact of loss- and gain-framed smoke-free print ads on recall and perceived effectiveness in rural communities, controlling for personal characteristics. Methods: Following 6- to 9-month print media campaigns in three rural counties, recall and perceived effectiveness of loss-framed (ie, targeting dangers of secondhand smoke [SHS]) and gain-framed (ie, highlighting positive aspects of smoke-free air) ads were assessed using random-digit-dial phone surveys. Respondents were asked if they remembered each ad, whether they liked it, whether they were prompted to contact a smoke-free coalition, whether the ad made them think, and whether it prompted emotion. Mixed modeling assessed whether personal factors predicted ad recall or perceived effectiveness. Results: Loss-framed ads were less likely to be recalled but more likely to prompt emotion. For ads of both frame types, females reported greater recall and perceived effectiveness than males. Those with less education reported higher perceived effectiveness of the ads but lower recall. Nonsmokers were more likely than smokers to perceive the ads as effective. Knowledge of SHS risk and support for smoke-free workplaces were positively associated with recall and effectiveness. Conclusions: Ad recall and perceived effectiveness were associated with framing and demographic and personal characteristics. Smoke-free efforts in rural areas may be bolstered by continuing to promote benefits of smoke-free workplace policies and educate on SHS risks. Rural areas may need to provide a combination of ad types and framing strategies to appeal to a wide audience. Implications: Rural communities are disproportionately affected by SHS and less likely to be protected by smoke-free policies. This study adds evidence-based guidance for tailoring rural smoke-free media campaigns using different framing: gain-framed messages (ie, benefits of smoke-free environments) to promote recall and loss-framed content (ie, dangers of SHS) to prompt emotion. Further, gain-framed messages that are localized to the rural community may be especially effective. Findings support designing smoke-free campaigns in rural communities with the audience in mind by tailoring messages to age, sex, and education level. PMID:26385925

Costs and added value of haemodialysis and peritoneal dialysis outsourcing agreements.

PubMed

Lamas Barreiro, J M; Alonso Suárez, M; Saavedra Alonso, J A; Gándara Martínez, A

2011-01-01

Despite the discrepancy in results from Spanish studies on the costs of dialysis, it is assumed that peritoneal dialysis (PD) is more efficient than haemodialysis (HD). To analyse the costs and added value of HD and PD outsourcing agreements in Galicia, the medical transport for HD and the relationship between the cost of the agreement and the cost of consumables used in continuous ambulatory peritoneal dialysis (CAPD) with bicarbonate. The cost of the outsourcing agreements and the staff was obtained from official publications. The cost of PD and medical transport were calculated using health service data for one month and extrapolating it to one year. The cost of CAPD consumables was provided by the suppliers. The added value was calculated from the investments generated for each agreement treating 40 patients. Expressed as patient/year, the mean costs for treatment were €21595 and €25664 in HD and PD, respectively. Medical transport varied between €3323 and €6338, while those of the CAPD agreement and consumables were €19268 and €12057, respectively. The added value was greater with the HD agreement, especially considering the jobs created. One cannot generalise that the cost of PD, which is significantly influenced by prescriptions, is lower than that of HD. It would be appropriate to review the additional cost to consumables in the CAPD agreement. The added value generated by dialysis agreements should be considered in future studies and in health planning. More controlled studies are needed to better understand this issue.

Exchange coupling transformations in Cu (II) heterospin complexes of “breathing crystals” under structural phase transitions

DOE Office of Scientific and Technical Information (OSTI.GOV)

Morozov, Vitaly A.; Petrova, Marina V.; Lukzen, Nikita N., E-mail: luk@tomo.nsc.ru

2015-08-15

Family of “breathing crystals” is the polymer-chain complexes of Cu(hfac){sub 2} with nitroxides. The polymer chains consist of one-, two- or three-spin clusters. The “breathing crystals” experience simultaneous magnetic and Jahn-Teller type structural phase transitions with change of total cluster spin and drastic change of bond lengths (ca. 10-12%). For the first time the intra-cluster magnetic couplings in ”breathing crystals” have been calculated both by band structure methods GGA + U and hybrid DFT (B3LYP and PBE0) for the isolated exchange clusters. The temperature dependence of the magnetic coupling constant was calculated for two polymer-chain compounds of the “breathing crystal”more » family - C{sub 21}H{sub 19}CuF{sub 12}N{sub 4}O{sub 6} with the chains containing two-spin clusters and C{sub 22}H{sub 21}CuF{sub 12}N{sub 4}O{sub 6} with the chains of alternating three-spin clusters and one-spin sites. It was found that adding a Hubbard-like parameter not only to the copper 3d electrons but also to the oxygen 2p electrons (GGA + U{sub d} + U{sub p} approach) results in an improved description of exchange coupling in the “breathing crystal” compounds. At the same time treatment of the isolated clusters by a large basis hybrid DFT with high computational cost provides a similar quality fit of the experimental magneto-chemical data as that for the GGA + U{sub d} + U{sub p} band structure calculation scheme. Our calculations also showed that in spite of the abrupt transformation of the magnetic coupling constant under the phase transition, the band gap in the “breathing crystals” remains about the same value with temperature decrease.« less

Holographic research on phase transitions for a five dimensional AdS black hole with conformally coupled scalar hair

NASA Astrophysics Data System (ADS)

Li, Hui-Ling; Yang, Shu-Zheng; Zu, Xiao-Tao

2017-01-01

In the framework of holography, we survey the phase structure for a higher dimensional hairy black hole including the effects of the scalar field hair. It is worth emphasizing that, not only black hole entropy, but also entanglement entropy and two point correlation function exhibit the Van der Waals-like phase transition in a fixed scalar charge ensemble. Furthermore, by making use of numerical computation, we show that the Maxwell's equal area law is valid for the first order phase transition. In addition, we also discuss how the hair parameter affects the black hole's phase transition.

The impact of reinforcement contingencies on AD/HD: a review and theoretical appraisal.

PubMed

Luman, Marjolein; Oosterlaan, Jaap; Sergeant, Joseph A

2005-02-01

One of the core deficits in attention deficit/hyperactivity disorder (AD/HD) is thought to be an aberrant sensitivity to reinforcement, such as reward and response cost. Twenty-two studies (N=1181 children) employing AD/HD and reinforcement contingencies are reviewed from vantage points: task performance, motivation, and psychophysiology. Results indicate that reinforcement contingencies have a positive impact on task performance and levels of motivation for both children with AD/HD and normal controls. There is evidence that the effect related to task performance is somewhat more prominent in AD/HD. There is some evidence that a high intensity of reinforcement is highly effective in AD/HD. Children with AD/HD prefer immediate over delayed reward. From a psychophysiological point of view, children with AD/HD seem less sensitive to reinforcement compared to controls. While comorbid disorders are suggested to be confounders of the dependent variables, many studies do not examine the effect of oppositional defiant disorder (ODD) and conduct disorder (CD). We discuss the implications of the findings for five theoretical frameworks, including the model by, the cognitive-energetic model (CEM), the dual-pathway model and the BIS/BAS model. Results show a discrepancy between the theoretical models and the behavioural findings.

Multi-Skyrmions on AdS2 × S2, rational maps and popcorn transitions

NASA Astrophysics Data System (ADS)

Canfora, Fabrizio; Tallarita, Gianni

2017-08-01

By combining two different techniques to construct multi-soliton solutions of the (3 + 1)-dimensional Skyrme model, the generalized hedgehog and the rational map ansatz, we find multi-Skyrmion configurations in AdS2 ×S2. We construct Skyrmionic multi-layered configurations such that the total Baryon charge is the product of the number of kinks along the radial AdS2 direction and the degree of the rational map. We show that, for fixed total Baryon charge, as one increases the charge density on ∂ (AdS2 ×S2) , it becomes increasingly convenient energetically to have configurations with more peaks in the radial AdS2 direction but a lower degree of the rational map. This has a direct relation with the so-called holographic popcorn transitions in which, when the charge density is high, multi-layered configurations with low charge on each layer are favored over configurations with few layers but with higher charge on each layer. The case in which the geometry is M2 ×S2 can also be analyzed.

Development of new maskless manufacturing method for anti-reflection structure and application to large-area lens with curved surface

NASA Astrophysics Data System (ADS)

Yamamoto, Kazuya; Takaoka, Toshimitsu; Fukui, Hidetoshi; Haruta, Yasuyuki; Yamashita, Tomoya; Kitagawa, Seiichiro

2016-03-01

In general, thin-film coating process is widely applied on optical lens surface as anti-reflection function. In normal production process, at first lens is manufactured by molding, then anti-reflection is added by thin-film coating. In recent years, instead of thin-film coating, sub-wavelength structures adding on surface of molding die are widely studied and development to keep anti-reflection performance. As merits, applying sub-wavelength structure, coating process becomes unnecessary and it is possible to reduce man-hour costs. In addition to cost merit, these are some technical advantages on this study. Adhesion of coating depends on material of plastic, and it is impossible to apply anti-reflection function on arbitrary surface. Sub-wavelength structure can solve both problems. Manufacturing method of anti-reflection structure can be divided into two types mainly. One method is with the resist patterning, and the other is mask-less method that does not require patterning. What we have developed is new mask-less method which is no need for resist patterning and possible to impart an anti-reflection structure to large area and curved lens surface, and can be expected to apply to various market segments. We report developed technique and characteristics of production lens.

Transition Core Properties during Conversion of the NBSR from HEU to LEU Fuel

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hanson, A. L.; Diamond, D.

2013-10-31

The transition of the NBSR from HEU to LEU fuel is challenging due to reactivity constraints and the need to maintain an uninterrupted science program, the mission of the NBSR. The transition cannot occur with a full change of HEU to LEU fuel elements since the excess reactivity would be large enough that the NBSR would violate the technical specification for shutdown margin. Manufacturing LEU fuel elements to represent irradiated fuel elements would be cost prohibitive since 26 one-of-a-kind fuel elements would need to be manufactured. For this report a gradual transition from the present HEU fuel to the proposedmore » LEU fuel was studied. The gradual change approach would follow the present fuel management scheme and replace four HEU fuel elements with four LEU fuel elements each cycle. This manuscript reports the results of a series of calculations to predict the neutronic characteristics and how the neutronics will change during the transition from HEU to LEU in the NBSR.« less

Cost analysis of substitutive renal therapies in children.

PubMed

Camargo, Maria Fernanda Carvalho de; Barbosa, Klenio de Souza; Fetter, Seiji Kumon; Bastos, Ana; Feltran, Luciana de Santis; Koch-Nogueira, Paulo Cesar

End-stage renal disease is a health problem that consumes public and private resources. This study aimed to identify the cost of hemodialysis (either daily or conventional hemodialysis) and transplantation in children and adolescents. This was a retrospective cohort of pediatric patients with End-stage renal disease who underwent hemodialysis followed by kidney transplant. All costs incurred in the treatment were collected and the monthly total cost was calculated per patient and for each renal therapy. Subsequently, a dynamic panel data model was estimated. The study included 30 children who underwent hemodialysis (16 conventional/14 daily hemodialysis) followed by renal transplantation. The mean monthly outlay for hemodialysis was USD 3500 and USD 1900 for transplant. Hemodialysis costs added up to over USD 87,000 in 40 months for conventional dialysis patients and USD 131,000 in 50 months for daily dialysis patients. In turn, transplant costs in 50 months reached USD 48,000 and USD 70,000, for conventional and daily dialysis patients, respectively. For conventional dialysis patients, transplant is less costly when therapy exceeds 16 months, whereas for daily dialysis patients, the threshold is around 13 months. Transplantation is less expensive than dialysis in children, and the estimated thresholds indicate that renal transplant should be the preferred treatment for pediatric patients. Copyright © 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

Transition duct system with straight ceramic liner for delivering hot-temperature gases in a combustion turbine engine

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wiebe, David J.

A transition duct system (10) for delivering hot-temperature gases from a plurality of combustors in a combustion turbine engine is provided. The system includes an exit piece (16) for each combustor. The exit piece may include a straight path segment (26) for receiving a gas flow from a respective combustor. A straight ceramic liner (40) may be inwardly disposed onto a metal outer shell (38) along the straight path segment of the exit piece. Structural arrangements are provided to securely attach the ceramic liner in the presence of substantial flow path pressurization. Cost-effective serviceability of the transition duct systems ismore » realizable since the liner can be readily removed and replaced as needed.« less

48 CFR 9904.417-60 - Illustrations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... should be added to the construction-in-progress account in recognition of the cost of money related to... should be added to the construction-in-progress account in recognition of the cost of money while under... the costs were incurred at a fairly uniform rate throughout the period. Because of the pattern of cost...

The economic cost of Alzheimer's disease: Family or public health burden?

PubMed Central

Castro, Diego M.; Dillon, Carol; Machnicki, Gerardo; Allegri, Ricardo F.

2010-01-01

Alzheimer’s disease (AD) patients suffer progressive cognitive, behavioral and functional impairment which result in a heavy burden to patients, families, and the public-health system. AD entails both direct and indirect costs. Indirect costs (such as loss or reduction of income by the patient or family members) are the most important costs in early and community-dwelling AD patients. Direct costs (such as medical treatment or social services) increase when the disorder progresses, and the patient is institutionalized or a formal caregiver is required. Drug therapies represent an increase in direct cost but can reduce some other direct or indirect costs involved. Several studies have projected overall savings to society when using drug therapies and all relevant cost are considered, where results depend on specific patient and care setting characteristics. Dementia should be the focus of analysis when public health policies are being devised. South American countries should strengthen their policy and planning capabilities by gathering more local evidence about the burden of AD and how it can be shaped by treatment options. PMID:29213697

The economic cost of Alzheimer's disease: Family or public health burden?

PubMed

Castro, Diego M; Dillon, Carol; Machnicki, Gerardo; Allegri, Ricardo F

2010-01-01

Alzheimer's disease (AD) patients suffer progressive cognitive, behavioral and functional impairment which result in a heavy burden to patients, families, and the public-health system. AD entails both direct and indirect costs. Indirect costs (such as loss or reduction of income by the patient or family members) are the most important costs in early and community-dwelling AD patients. Direct costs (such as medical treatment or social services) increase when the disorder progresses, and the patient is institutionalized or a formal caregiver is required. Drug therapies represent an increase in direct cost but can reduce some other direct or indirect costs involved. Several studies have projected overall savings to society when using drug therapies and all relevant cost are considered, where results depend on specific patient and care setting characteristics. Dementia should be the focus of analysis when public health policies are being devised. South American countries should strengthen their policy and planning capabilities by gathering more local evidence about the burden of AD and how it can be shaped by treatment options.

Decision-theoretic approach to data acquisition for transit operations planning

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ritchie, S.G.

The most costly element of transportation planning and modeling activities in the past has usually been that of data acquisition. This is even truer today when the unit costs of data collection are increasing rapidly and at the same time budgets are severely limited by continuing policies of fiscal austerity in the public sector. The overall objectives of this research were to improve the decisions and decision-making capabilities of transit operators or planners in short-range transit planning, and to improve the quality and cost-effectiveness of associated route or corridor-level data collection and service monitoring activities. A new approach was presentedmore » for sequentially updating the parameters of both simple and multiple linear regression models with stochastic regressors, and for determining the expected value of sample information and expected net gain of sampling for associated sample designs. A new approach was also presented for estimating and updating (both spatially and temporally) the parameters of multinomial logit discrete choice models, and for determining associated optimal sample designs for attribute-based and choice-based sampling methods. The approach provides an effective framework for addressing the issue of optimal sampling method and sample size, which to date have been largely unresolved. The application of these methodologies and the feasibility of the decision-theoretic approach was illustrated with a hypothetical case study example.« less

Food equipment manufacturer takes a slice out of its scrap rate

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bernard, D.; Hannahs, J.; Carter, M.

1996-09-01

The PMI Food Equipment Group began manufacturing circular slicer knives for its commercial Hobart line of slicers in the early 1930s. The company manufacturers the only cast knife in the food industry. The cast knives offer superior edge retention and overall corrosion resistance. The slicer knives are cast in PMI`s foundry. The casting process sometimes produces shrinkage voids or gas bubbles in the knife blank. Surface discontinuities often do not appear until rough cutting or final machining, i.e., after several hours of value-added manufacturing. Knife blanks with these discontinuities were scrapped and sent back to the foundry for remelting. Tomore » scrap the knives at that point meant the cost for casting plus the value-added machining added up to a considerable amount. Weld repair allows the recovery of casting and machining expenses equal to a significant percentage of the total manufacturing cost of slicer knives. Repair costs include welding, grinding, shipping, surface finishing and material handling. Other good applications for this GMAW-P process include repair of jet engine components, rotating process industry equipment, and hardfacing of cutting tools and dies. In addition, dissimilar metals and any material that is heat treated to develop its properties such as precision investment castings are excellent applications. The low resultant distortion, elimination of postweld heat treatment and non-line-of-site welding capability solves thin wall, limited access and precision machined component repair challenges.« less

Clinical effectiveness and cost-effectiveness of quadrivalent human papillomavirus vaccination in HIV-negative men who have sex with men to prevent recurrent high-grade anal intraepithelial neoplasia.

PubMed

Deshmukh, Ashish A; Chiao, Elizabeth Y; Das, Prajnan; Cantor, Scott B

2014-12-05

We examined the long-term clinical and economic benefits of quadrivalent human papillomavirus (qHPV) vaccine as a secondary/adjunct prevention strategy in the prevention of recurrent high-grade intraepithelial neoplasia (HGAIN) in HIV-negative men who have sex with men (MSM) and are 27 years or older. We constructed a Markov model to evaluate the clinical effectiveness and cost-effectiveness of two strategies: (1) no qHPV vaccine after treatment for HGAIN versus (2) qHPV vaccine after treatment for HGAIN. Model parameters, including natural history of anal cancer, vaccine efficacy measured in terms of hazard ratio (HR) (decrease in the risk of recurrent HGAIN), HGAIN treatment efficacy, utilities, and costs, were obtained from the literature. The outcomes were measured in terms of lifetime risk of anal cancer, lifetime cost, quality-adjusted life years, and incremental cost-effectiveness ratios (ICERs). Sensitivity analysis was conducted on all model parameters. We found that vaccinating HIV-negative MSM reduced the lifetime risk of anal cancer by 60.77% at an ICER of US$87,240 per quality-adjusted life-year. The results were highly sensitive to vaccine efficacy, transition of HGAIN to anal cancer, cost of treatment for HGAIN, vaccine degree of protection over time, and the vaccine duration of protection and less sensitive to HPV clearance, cost of qHPV vaccine, and the transitions from normal to low-grade anal intraepithelial neoplasia (LGAIN) and normal to HGAIN. With an HR of 0.3, the ICER was well below a $50,000 willingness-to-pay threshold; with an HR of 0.5, the ICER was still below a threshold of $100,000. The most critical disease-related factor influencing the cost-effectiveness was the progression of HGAIN to anal cancer. At an annual transition probability below 0.001, the ICER was below $50,000. Vaccinating HIV-negative MSM treated for HGAIN decreases the lifetime risk of anal cancer and is likely to be a cost-effective intervention. Published by Elsevier Ltd.

Maxwell’s equal area law for Lovelock thermodynamics

NASA Astrophysics Data System (ADS)

Xu, Hao; Xu, Zhen-Ming

We present the construction of Maxwell’s equal area law for the Guass-Bonnet AdS black holes in d = 5, 6 and third-order Lovelock AdS black holes in d = 7, 8. The equal area law can be used to find the number and location of the points of intersection in the plots of Gibbs free energy, so that we can get the thermodynamically preferred solution which corresponds to the first-order phase transition. We obtain the radius of the small and large black holes in the phase transition which share the same Gibbs free energy. The case with two critical points is explored in much more details. The latent heat is also studied.

SUBTASK 7.2 GLOBAL WARMING AND GREEHOUSE GASES

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jaroslav Solc; Kurt Eylands; Jaroslav Solc Jr.

2005-01-01

Evaluation of current climatic trends and reconstruction of paleoclimatic conditions for Devils Lake have been conducted based on diatom-inferred salinity for the last 2000 years. The 3-year cross-disciplinary research, funded by the U.S. Department of Energy (DOE) was carried out by the Energy & Environmental Research Center (EERC) and St. Croix Watershed Research Station (SCWRS) at the Science Museum of Minnesota. The results indicate that frequent climatic fluctuations resulting in alternating periods of drought and wet conditions are typical for the northern Great Plains and suggest that the severity and length of extremes exceeded those on modern record. Devils Lakemore » has experienced five fresh periods and two minor freshening periods in the last 2000 years. Transitions between fresh and saline periods have been relatively fast, representing lake level changes that have been similar to those observed in the last 150 years. From 0 to 1070 A.D., Devils Lake showed more variable behavior, with fresh phases centered at 200, 500, 700, and 1000 A.D. From 1070 A.D. to present, Devils Lake was generally saline, experiencing two minor freshening periods at 1305-1315 and 1800-1820 A.D and the major current freshening from 1960 A.D. to present.« less

AdS/QCD and Applications of Light-Front Holography

DOE Office of Scientific and Technical Information (OSTI.GOV)

Brodsky, Stanley J.; /SLAC /Southern Denmark U., CP3-Origins; Cao, Fu-Guang

2012-02-16

Light-Front Holography leads to a rigorous connection between hadronic amplitudes in a higher dimensional anti-de Sitter (AdS) space and frame-independent light-front wavefunctions of hadrons in 3 + 1 physical space-time, thus providing a compelling physical interpretation of the AdS/CFT correspondence principle and AdS/QCD, a useful framework which describes the correspondence between theories in a modified AdS5 background and confining field theories in physical space-time. To a first semiclassical approximation, where quantum loops and quark masses are not included, this approach leads to a single-variable light-front Schroedinger equation which determines the eigenspectrum and the light-front wavefunctions of hadrons for general spinmore » and orbital angular momentum. The coordinate z in AdS space is uniquely identified with a Lorentz-invariant coordinate {zeta} which measures the separation of the constituents within a hadron at equal light-front time. The internal structure of hadrons is explicitly introduced and the angular momentum of the constituents plays a key role. We give an overview of the light-front holographic approach to strongly coupled QCD. In particular, we study the photon-to-meson transition form factors (TFFs) F{sub M{gamma}}(Q{sup 2}) for {gamma}{gamma}* {yields} M using light-front holographic methods. The results for the TFFs for the {eta} and {eta}' mesons are also presented. Some novel features of QCD are discussed, including the consequences of confinement for quark and gluon condensates. A method for computing the hadronization of quark and gluon jets at the amplitude level is outlined.« less

The Economics of Big Area Addtiive Manufacturing

DOE Office of Scientific and Technical Information (OSTI.GOV)

Post, Brian; Lloyd, Peter D; Lindahl, John

Case studies on the economics of Additive Manufacturing (AM) suggest that processing time is the dominant cost in manufacturing. Most additive processes have similar performance metrics: small part sizes, low production rates and expensive feedstocks. Big Area Additive Manufacturing is based on transitioning polymer extrusion technology from a wire to a pellet feedstock. Utilizing pellets significantly increases deposition speed and lowers material cost by utilizing low cost injection molding feedstock. The use of carbon fiber reinforced polymers eliminates the need for a heated chamber, significantly reducing machine power requirements and size constraints. We hypothesize that the increase in productivity coupledmore » with decrease in feedstock and energy costs will enable AM to become more competitive with conventional manufacturing processes for many applications. As a test case, we compare the cost of using traditional fused deposition modeling (FDM) with BAAM for additively manufacturing composite tooling.« less

Health and economic impact of human papillomavirus 16 and 18 vaccination of preadolescent girls and cervical cancer screening of adult women in Peru.

PubMed

Goldie, Sue J; Levin, Carol; Mosqueira-Lovón, N Rocio; Ortendahl, Jesse; Kim, Jane; O'Shea, Meredith; Diaz Sanchez, Mireia; Mendoza Araujo, Maria Ana

2012-12-01

To estimate the benefits, cost-effectiveness (i.e., value for money), and required financial costs (e.g., affordability) of adding human papillomavirus (HPV) vaccination to Peru's cervical cancer screening program. Evidence (e.g., coverage, delivery costs) from an HPV vaccination demonstration project conducted in Peru was combined with epidemiological data in an empirically calibrated mathematical model to assess screening (HPV DNA testing three to five times per lifetime) and HPV vaccination under different cost, coverage, and efficacy assumptions. Model outcomes included lifetime risk of cancer reduction, cancer cases averted, lives saved, average life expectancy gains, short-term financial costs, and discounted long-term economic costs. Status quo low levels of screening (e.g., cytologic screening at 10.0% coverage) reduced lifetime risk of cervical cancer by 11.9%, compared to not screening. Adding vaccination of preadolescent girls at a coverage achieved in the demonstration program (82.0%) produced an additional 46.1% reduction, and would cost less than US$ 500 per year of life saved (YLS) at ~US$ 7/dose or ~US$ 1 300 at ~US$ 20/dose. One year of vaccination was estimated to cost ~US$ 5 million at ~US$ 5/dose or ~US$ 16 million at ~US$ 20/dose, including programmatic costs. Enhanced screening in adult women combined with preadolescent vaccination had incremental cost-effectiveness ratios lower than Peru's 2005 per capita gross domestic product (GDP; US$ 2 852, in 2009 US$), and would be considered cost-effective. Preadolescent HPV vaccination, followed by enhanced HPV DNA screening in adult women, could prevent two out of three cervical cancer deaths. Several strategies would be considered "good value" for resources invested, provided vaccine prices are low. While financial costs imply substantial immediate investments, the high-value payoff should motivate creative mechanisms for financing and scale-up of delivery programs.

Iron, zinc and copper in the Alzheimer’s disease brain: a quantitative meta-analysis. Some insight on the influence of citation bias on scientific opinion

PubMed Central

Schrag, Matthew; Mueller, Claudius; Oyoyo, Udochukwu; Kirsch, Wolff M.

2011-01-01

Dysfunctional homeostasis of transition metals is believed to play a role in the pathogenesis of Alzheimer’s disease (AD). Although questioned by some, brain copper, zinc, and particularly iron overload are widely accepted features of AD which have led to the hypothesis that oxidative stress generated from aberrant homeostasis of these transition metals might be a pathogenic mechanism behind AD. This meta-analysis compiled and critically assessed available quantitative data on brain iron, zinc and copper levels in AD patients compared to aged controls. The results were very heterogeneous. A series of heavily cited articles from one laboratory reported a large increase in iron in AD neocortex compared to age-matched controls (p<0.0001) while seven laboratories failed to reproduce these findings reporting no significant difference between the groups (p=0.76). A more than three-fold citation bias was found to favor outlier studies reporting increases in iron and this bias was particularly prominent among narrative review articles. Additionally, while zinc was not significantly changed in the neocortex (p=0.29), copper was significantly depleted in AD (p=0.0003). In light of these findings, it will be important to re-evaluate the hypothesis that transition metal overload accounts for oxidative injury noted in AD. PMID:21600264

Cost-effectiveness of liraglutide versus lixisenatide as add-on therapies to basal insulin in type 2 diabetes

PubMed Central

2018-01-01

Background We assessed the cost-effectiveness of the glucagon-like peptide 1 receptor agonists liraglutide 1.8 mg and lixisenatide 20 μg (both added to basal insulin) in patients with type 2 diabetes (T2D) in Sweden. Methods The Swedish Institute for Health Economics cohort model for T2D was used to compare liraglutide and lixisenatide (both added to basal insulin), with a societal perspective and with comparative treatment effects derived by indirect treatment comparison (ITC). Drug prices were 2016 values, and all other costs 2015 values. The cost-effectiveness of IDegLira (fixed-ratio combination of insulin degludec and liraglutide) versus lixisenatide plus basal insulin was also assessed, under different sets of assumptions. Results From the ITC, decreases in HbA1c were –1.32% and –0.43% with liraglutide and lixisenatide, respectively; decreases in BMI were –1.29 and –0.65 kg/m2, respectively. An estimated 2348 cases of retinopathy, 265 of neuropathy and 991 of nephropathy would be avoided with liraglutide compared with lixisenatide in a cohort of 10,000 patients aged over 40 years. In the base-case analysis, total direct costs were higher with liraglutide than lixisenatide, but costs associated with complications were lower. The cost/quality-adjusted life-year (QALY) for liraglutide added to basal insulin was SEK30,802. Base-case findings were robust in sensitivity analyses, except when glycated haemoglobin (HbA1c) differences for liraglutide added to basal insulin were abolished, suggesting these benefits were driving the cost/QALY. With liraglutide 1.2 mg instead of liraglutide 1.8 mg (adjusted for efficacy and cost), liraglutide added to basal insulin was dominant over lixisenatide 20μg.IDegLira was dominant versus lixisenatide plus basal insulin when a defined daily dose was used in the model. Conclusions The costs/QALY for liraglutide, 1.8 or 1.2 mg, added to basal insulin, and for IDegLira (all compared with lixisenatide 20 μg added to basal insulin) were below the threshold considered low by Swedish authorities. In some scenarios, liraglutide and IDegLira were cost-saving. PMID:29408938

Cost-effectiveness of liraglutide versus lixisenatide as add-on therapies to basal insulin in type 2 diabetes.

PubMed

Ericsson, Åsa; Glah, Divina; Lorenzi, Maria; Jansen, Jeroen P; Fridhammar, Adam

2018-01-01

We assessed the cost-effectiveness of the glucagon-like peptide 1 receptor agonists liraglutide 1.8 mg and lixisenatide 20 μg (both added to basal insulin) in patients with type 2 diabetes (T2D) in Sweden. The Swedish Institute for Health Economics cohort model for T2D was used to compare liraglutide and lixisenatide (both added to basal insulin), with a societal perspective and with comparative treatment effects derived by indirect treatment comparison (ITC). Drug prices were 2016 values, and all other costs 2015 values. The cost-effectiveness of IDegLira (fixed-ratio combination of insulin degludec and liraglutide) versus lixisenatide plus basal insulin was also assessed, under different sets of assumptions. From the ITC, decreases in HbA1c were -1.32% and -0.43% with liraglutide and lixisenatide, respectively; decreases in BMI were -1.29 and -0.65 kg/m2, respectively. An estimated 2348 cases of retinopathy, 265 of neuropathy and 991 of nephropathy would be avoided with liraglutide compared with lixisenatide in a cohort of 10,000 patients aged over 40 years. In the base-case analysis, total direct costs were higher with liraglutide than lixisenatide, but costs associated with complications were lower. The cost/quality-adjusted life-year (QALY) for liraglutide added to basal insulin was SEK30,802. Base-case findings were robust in sensitivity analyses, except when glycated haemoglobin (HbA1c) differences for liraglutide added to basal insulin were abolished, suggesting these benefits were driving the cost/QALY. With liraglutide 1.2 mg instead of liraglutide 1.8 mg (adjusted for efficacy and cost), liraglutide added to basal insulin was dominant over lixisenatide 20μg.IDegLira was dominant versus lixisenatide plus basal insulin when a defined daily dose was used in the model. The costs/QALY for liraglutide, 1.8 or 1.2 mg, added to basal insulin, and for IDegLira (all compared with lixisenatide 20 μg added to basal insulin) were below the threshold considered low by Swedish authorities. In some scenarios, liraglutide and IDegLira were cost-saving.

Using U.S. Medicare records to evaluate the indirect health effects on spouses: a case study in Alzheimer's disease patients.

PubMed

Gilden, Daniel M; Kubisiak, Joanna M; Kahle-Wrobleski, Kristin; Ball, Daniel E; Bowman, Lee

2014-07-07

The burden experienced by spouses of patients with Alzheimer's disease (AD) may have negative consequences for their physical health. We describe here a method for analyzing United States Medicare records to determine the changes in health service use and costs experienced by spouses after their marital partner receives an AD diagnosis. We initially identified all beneficiaries in the 2001-2005 Medicare 5% sample who had multiple claims listing the ICD-9 diagnostic code for AD, 331.0. The 5% sample includes spouses who share a Medicare account with their marital partners because they lack a sufficient work history for full eligibility on their own. A matched cohort study assessed incremental health costs in the spouses of AD patients versus a control group of spouses of non-AD patients. Longitudinal and cross-sectional analyses tracked the impact of a patient's AD diagnosis on his or her spouse's healthcare costs. Our method located 54,593 AD patients of whom 11.5% had spouses identifiable via a shared Medicare account. AD diagnosis in one member of a couple was associated with significantly higher monthly Medicare payments for the other member's healthcare. The spouses' elevated costs commenced 2 to 3 months before their partners' AD diagnosis and persisted over the follow-up period. After 31 months, the cumulative additional Medicare reimbursements totaled a mean $4,600 in the spouses of AD patients. This excess was significant even after accounting for differences in baseline health status between the cohorts. The study methodology provides a framework for comprehensively evaluating medical costs of both chronically ill patients and their spouses. This method also provides monthly data, which makes possible a longitudinal evaluation of the cost effects of specific health events. The observed correlations provide a coherent demonstration of the interdependence between AD patients' and spouses' health. Future research should examine caregiving burden and other possible factors contributing to the AD spouses' health outcomes. It should also extend the method presented here to evaluations of other chronic diseases of the elderly.

Using U.S. Medicare records to evaluate the indirect health effects on spouses: a case study in Alzheimer’s disease patients

PubMed Central

2014-01-01

Background The burden experienced by spouses of patients with Alzheimer’s disease (AD) may have negative consequences for their physical health. We describe here a method for analyzing United States Medicare records to determine the changes in health service use and costs experienced by spouses after their marital partner receives an AD diagnosis. Methods We initially identified all beneficiaries in the 2001–2005 Medicare 5% sample who had multiple claims listing the ICD-9 diagnostic code for AD, 331.0. The 5% sample includes spouses who share a Medicare account with their marital partners because they lack a sufficient work history for full eligibility on their own. A matched cohort study assessed incremental health costs in the spouses of AD patients versus a control group of spouses of non-AD patients. Longitudinal and cross-sectional analyses tracked the impact of a patient’s AD diagnosis on his or her spouse’s healthcare costs. Results Our method located 54,593 AD patients of whom 11.5% had spouses identifiable via a shared Medicare account. AD diagnosis in one member of a couple was associated with significantly higher monthly Medicare payments for the other member’s healthcare. The spouses’ elevated costs commenced 2 to 3 months before their partners’ AD diagnosis and persisted over the follow-up period. After 31 months, the cumulative additional Medicare reimbursements totaled a mean $4,600 in the spouses of AD patients. This excess was significant even after accounting for differences in baseline health status between the cohorts. Conclusion The study methodology provides a framework for comprehensively evaluating medical costs of both chronically ill patients and their spouses. This method also provides monthly data, which makes possible a longitudinal evaluation of the cost effects of specific health events. The observed correlations provide a coherent demonstration of the interdependence between AD patients’ and spouses’ health. Future research should examine caregiving burden and other possible factors contributing to the AD spouses’ health outcomes. It should also extend the method presented here to evaluations of other chronic diseases of the elderly. PMID:25001114

Reducing youth exposure to alcohol ads: targeting public transit.

PubMed

Simon, Michele

2008-07-01

Underage drinking is a major public health problem. Youth drink more heavily than adults and are more vulnerable to the adverse effects of alcohol. Previous research has demonstrated the connection between alcohol advertising and underage drinking. Restricting outdoor advertising in general and transit ads in particular, represents an important opportunity to reduce youth exposure. To address this problem, the Marin Institute, an alcohol industry watchdog group in Northern California, conducted a survey of alcohol ads on San Francisco bus shelters. The survey received sufficient media attention to lead the billboard company, CBS Outdoor, into taking down the ads. Marin Institute also surveyed the 25 largest transit agencies; results showed that 75 percent of responding agencies currently have policies that ban alcohol advertising. However, as the experience in San Francisco demonstrated, having a policy on paper does not necessarily mean it is being followed. Communities must be diligent in holding accountable government officials, the alcohol industry, and the media companies through which advertising occurs.

Reducing Youth Exposure to Alcohol Ads: Targeting Public Transit

PubMed Central

2008-01-01

Underage drinking is a major public health problem. Youth drink more heavily than adults and are more vulnerable to the adverse effects of alcohol. Previous research has demonstrated the connection between alcohol advertising and underage drinking. Restricting outdoor advertising in general and transit ads in particular, represents an important opportunity to reduce youth exposure. To address this problem, the Marin Institute, an alcohol industry watchdog group in Northern California, conducted a survey of alcohol ads on San Francisco bus shelters. The survey received sufficient media attention to lead the billboard company, CBS Outdoor, into taking down the ads. Marin Institute also surveyed the 25 largest transit agencies; results showed that 75 percent of responding agencies currently have policies that ban alcohol advertising. However, as the experience in San Francisco demonstrated, having a policy on paper does not necessarily mean it is being followed. Communities must be diligent in holding accountable government officials, the alcohol industry, and the media companies through which advertising occurs. PMID:18389374

Information contents of drug advertisements: an Indian experience.

PubMed

Lal, A

1998-11-01

To critically analyze the drug information contained in Indian pharmaceutical advertisements. Analysis of pharmaceutical advertisements supplied by drug representatives (DRs) to prescribers from July 1, 1995, to June 30, 1996. A university-affiliated urban teaching hospital in India. 585 pharmaceutical ad pamphlets. The ads supplied by DRs to physicians in different clinical departments of the hospital were collected. These were distributed to different systems/categories and a special reference to fixed-dose drug combinations was given. The drug information contained in these ads was evaluated by using a checklist, framed by incorporating the World Health Organization ethical guidelines for medicinal drug promotion and some relevant items from other studies. The most frequently occurring ads were for antimicrobial agents. The ads on fixed-dose drug combinations constituted 37.9% of the total. More than 85% of the ads mentioned the generic name, brand name, contents, and pharmaceutical dosage forms, as well as the name and address of the company. The information concerning adverse effects, precautions, contraindications, warnings, major interactions, ingredients known to cause problems, pharmacology, drug overdose, references, drug storage, and cost was present in less than 40% of these ads. There has been inadequate information in pharmaceutical ads supplied by DRs to the physicians in India. The current scenario could be improved by formulating some definite legislative guidelines for the minimum level of information to be included in pharmaceutical ads and adhering to that legislation.

Developing the Water Supply System for Travel to Mars

NASA Technical Reports Server (NTRS)

Jones, Harry W.; Fisher, John W.; Delzeit, Lance D.; Flynn, Michael T.; Kliss, Mark H.

2016-01-01

What water supply method should be used on a trip to Mars? Two alternate approaches are using fuel cell and stored water, as was done for short missions such as Apollo and the Space Shuttle, or recycling most of the water, as on long missions including the International Space Station (ISS). Stored water is inexpensive for brief missions but its launch mass and cost become very large for long missions. Recycling systems have much lower total mass and cost for long missions, but they have high development cost and are more expensive to operate than storage. A Mars transit mission would have an intermediate duration of about 450 days out and back. Since Mars transit is about ten times longer than a brief mission but probably less than one-tenth as long as ISS, it is not clear if stored or recycled water would be best. Recycling system design is complicated because water is used for different purposes, drinking, food preparation, washing, and flushing the urinal, and because wastewater has different forms, humidity condensate, dirty wash water, and urine and flush water. The uses have different requirements and the wastewater resources have different contaminants and processing requirements. The most cost-effective water supply system may recycle some wastewater sources and also provide safety reserve water from storage. Different water supply technologies are compared using mass, cost, reliability, and other factors.

Transitions from private to public health coverage among children: estimating effects on out-of-pocket medical costs and health insurance premium costs.

PubMed

Shaefer, H Luke; Grogan, Colleen M; Pollack, Harold A

2011-06-01

To assess the effects of transitions from private to public health insurance by children on out-of-pocket medical expenditures and health insurance premium costs. Data are drawn from the 1996 and 2001 panels of the Survey of Income and Program Participation. We construct a nationally representative, longitudinal sample of children, ages 0-18, and their families for the period 1998-2003, a period in which states raised public health insurance eligibility rates for children. We exploit the Survey of Income and Program Participation's longitudinal design to identify children in our sample who transition from private to public health insurance. We then use a bootstrapped instrumental variable approach to estimate the effects of these transitions on out-of-pocket expenditures and health insurance premium costs. Children who transition from private to public coverage are relatively low-income, are disproportionately likely to live in single-mother households, and are more likely to be Black or of Hispanic origin. Child health status is highly predictive of transitions. We estimate that these transitions provide a cash-equivalent transfer of nearly U.S.$1,500 annually for families in the form of reduced out-of-pocket and health insurance premium costs. Transitions from private to public health coverage by children can bring important social benefits to vulnerable families. This suggests that instead of being a net societal cost, such transitions may provide an important social benefit. © Health Research and Educational Trust.

The Cost-Effectiveness of Replacing the Bottom Quartile of Novice Teachers through Value-Added Teacher Assessment

ERIC Educational Resources Information Center

Yeh, Stuart S.; Ritter, Joseph

2009-01-01

A cost-effectiveness analysis was conducted of Gordon, Kane, and Staiger's (2006) proposal to raise student achievement by identifying and replacing the bottom quartile of novice teachers, using value-added assessment of teacher performance. The cost effectiveness of this proposal was compared to the cost effectiveness of voucher programs, charter…

Public transit, obesity, and medical costs: assessing the magnitudes.

PubMed

Edwards, Ryan D

2008-01-01

This paper assesses the potential benefits of increased walking and reduced obesity associated with taking public transit in terms of dollars of medical costs saved and disability avoided. I conduct a new analysis of a nationally representative U.S. transportation survey to gauge the net increase in walking associated with public transit usage. I translate minutes spent walking into energy expenditures and reductions in obesity prevalence, estimating the present value of costs and disability that may be avoided. Taking public transit is associated with walking 8.3 more minutes per day on average, or an additional 25.7-39.0 kcal. Hill et al. [Hill, J.O., Wyatt, H.R., Reed, G.W., Peters, J.C., 2003. Obesity and the environment: Where do we go from here? Science 299 (5608), 853-855] estimate that an increase in net expenditure of 100 kcal/day can stop the increase in obesity in 90% of the population. Additional walking associated with public transit could save $5500 per person in present value by reducing obesity-related medical costs. Savings in quality-adjusted life years could be even higher. While no silver bullet, walking associated with public transit can have a substantial impact on obesity, costs, and well-being. Further research is warranted on the net impact of transit usage on all behaviors, including caloric intake and other types of exercise, and on whether policies can promote transit usage at acceptable cost.

Cost-Effectiveness of Deep Brain Stimulation for Advanced Parkinson's Disease in the United States.

PubMed

Pietzsch, Jan B; Garner, Abigail M; Marks, William J

2016-10-01

Deep brain stimulation (DBS), which uses an implantable device to modulate brain activity, is clinically superior to medical therapy for treating advanced Parkinson's disease (PD). We studied the cost-effectiveness of DBS in conjunction with medical therapy compared to best medical therapy (BMT) alone, using the latest clinical and cost data for the U.S. healthcare system. We used a decision-analytic state-transition (Markov) model to project PD progression and associated costs for the two treatment strategies. We estimated the discounted incremental cost-effectiveness ratio (ICER) in U.S. dollars per quality-adjusted life-year (QALY) from the Medicare payer perspective, considering a ten-year horizon, and evaluated the robustness of our projections through extensive deterministic sensitivity analyses. Over ten years, DBS treatment led to discounted total costs of $130,510 compared to $91,026 for BMT and added 1.69 QALYs more than BMT, resulting in an ICER of $23,404 per QALY. This ICER was relatively insensitive to variations in input parameters, with neurostimulator replacement, costs for DBS implantation, and costs for treatment of disease-related falls having the greatest effects. Across all investigated scenarios, including a five-year horizon, ICERs remained under $50,000 per QALY. Longer follow-up periods and younger treatment age were associated with greater cost-effectiveness. DBS is a cost-effective treatment strategy for advanced PD in the U.S. healthcare system across a wide range of assumptions. DBS yields substantial improvements in health-related quality of life at a value profile that compares favorably to other well-accepted therapies. © 2016 International Neuromodulation Society.

Thermodynamics, stability and Hawking-Page transition of Kerr black holes from Rényi statistics

NASA Astrophysics Data System (ADS)

Czinner, Viktor G.; Iguchi, Hideo

2017-12-01

Thermodynamics of rotating black holes described by the Rényi formula as equilibrium and zeroth law compatible entropy function is investigated. We show that similarly to the standard Boltzmann approach, isolated Kerr black holes are stable with respect to axisymmetric perturbations in the Rényi model. On the other hand, when the black holes are surrounded by a bath of thermal radiation, slowly rotating black holes can also be in stable equilibrium with the heat bath at a fixed temperature, in contrast to the Boltzmann description. For the question of possible phase transitions in the system, we show that a Hawking-Page transition and a first order small black hole/large black hole transition occur, analogous to the picture of rotating black holes in AdS space. These results confirm the similarity between the Rényi-asymptotically flat and Boltzmann-AdS approaches to black hole thermodynamics in the rotating case as well. We derive the relations between the thermodynamic parameters based on this correspondence.

Cellulosic ethanol: status and innovation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lynd, Lee R.; Liang, Xiaoyu; Biddy, Mary J.

Although the purchase price of cellulosic feedstocks is competitive with petroleum on an energy basis, the cost of lignocellulose conversion to ethanol using today's technology is high. Cost reductions can be pursued via either in-paradigm or new-paradigm innovation. Here, as an example of new-paradigm innovation, consolidated bioprocessing using thermophilic bacteria combined with milling during fermentation (cotreatment) is analyzed. Acknowledging the nascent state of this approach, our analysis indicates potential for radically improved cost competitiveness and feasibility at smaller scale compared to current technology, arising from (a) R&D-driven advances (consolidated bioprocessing with cotreatment in lieu of thermochemical pretreatment and added fungalmore » cellulase), and (b) configurational changes (fuel pellet coproduction instead of electricity, gas boiler(s) in lieu of a solid fuel boiler).« less

Cellulosic ethanol: status and innovation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lynd, Lee R.; Liang, Xiaoyu; Biddy, Mary J.

Although the purchase price of cellulosic feedstocks is competitive with petroleum on an energy basis, the cost of lignocellulose conversion to ethanol using today’s technology is high. Cost reductions can be pursued via either in-paradigm or new-paradigm innovation. As an example of new-paradigm innovation, consolidated bioprocessing using thermophilic bacteria combined with milling during fermentation (cotreatment) is analyzed. Acknowledging the nascent state of this approach, our analysis indicates potential for radically improved cost competitiveness and feasibility at smaller scale compared to current technology, arising from (a) R&D-driven advances (consolidated bioprocessing with cotreatment in lieu of thermochemical pretreatment and added fungal cellulase),more » and (b) configurational changes (fuel pellet coproduction instead of electricity, gas boiler(s) in lieu of a solid fuel boiler).« less

Cellulosic ethanol: status and innovation

DOE PAGES

Lynd, Lee R.; Liang, Xiaoyu; Biddy, Mary J.; ...

2017-05-18

Although the purchase price of cellulosic feedstocks is competitive with petroleum on an energy basis, the cost of lignocellulose conversion to ethanol using today's technology is high. Cost reductions can be pursued via either in-paradigm or new-paradigm innovation. Here, as an example of new-paradigm innovation, consolidated bioprocessing using thermophilic bacteria combined with milling during fermentation (cotreatment) is analyzed. Acknowledging the nascent state of this approach, our analysis indicates potential for radically improved cost competitiveness and feasibility at smaller scale compared to current technology, arising from (a) R&D-driven advances (consolidated bioprocessing with cotreatment in lieu of thermochemical pretreatment and added fungalmore » cellulase), and (b) configurational changes (fuel pellet coproduction instead of electricity, gas boiler(s) in lieu of a solid fuel boiler).« less

Analytic estimation of recycled products added value as a means for effective environmental management

NASA Astrophysics Data System (ADS)

Batzias, Dimitris F.

2012-12-01

In this work, we present an analytic estimation of recycled products added value in order to provide a means for determining the degree of recycling that maximizes profit, taking also into account the social interest by including the subsidy of the corresponding investment. A methodology has been developed based on Life Cycle Product (LCP) with emphasis on added values H, R as fractions of production and recycle cost, respectively (H, R >1, since profit is included), which decrease by the corresponding rates h, r in the recycle course, due to deterioration of quality. At macrolevel, the claim that "an increase of exergy price, as a result of available cheap energy sources becoming more scarce, leads to less recovered quantity of any recyclable material" is proved by means of the tradeoff between the partial benefits due to material saving and resources degradation/consumption (assessed in monetary terms).

Added Value of Reliability to a Microgrid: Simulations of Three California Buildings

DOE Office of Scientific and Technical Information (OSTI.GOV)

Marnay, Chris; Lai, Judy; Stadler, Michael

The Distributed Energy Resources Customer Adoption Model is used to estimate the value an Oakland nursing home, a Riverside high school, and a Sunnyvale data center would need to put on higher electricity service reliability for them to adopt a Consortium for Electric Reliability Technology Solutions Microgrid (CM) based on economics alone. A fraction of each building's load is deemed critical based on its mission, and the added cost of CM capability to meet it added to on-site generation options. The three sites are analyzed with various resources available as microgrid components. Results show that the value placed on highermore » reliability often does not have to be significant for CM to appear attractive, about 25 $/kWcdota and up, but the carbon footprint consequences are mixed because storage is often used to shift cheaper off-peak electricity to use during afternoon hours in competition with the solar sources.« less

Cost-benefit analysis of Xpert MTB/RIF for tuberculosis suspects in German hospitals.

PubMed

Diel, Roland; Nienhaus, Albert; Hillemann, Doris; Richter, Elvira

2016-02-01

Our objective was to assess the cost-benefit of enhancing or replacing the conventional sputum smear with the real-time PCR Xpert MTB/RIF method in the inpatient diagnostic schema for tuberculosis (TB).Recent data from published per-case cost studies for TB/multidrug-resistant (MDR)-TB and from comparative analyses of sputum microscopy, mycobacterial culture, Xpert MTB/RIF and drug susceptibility testing, performed at the German National Reference Center for Mycobacteria, were used. Potential cost savings of Xpert MTB/RIF, based on test accuracy and multiple cost drivers, were calculated for diagnosing TB/MDR-TB suspects from the hospital perspective.Implementing Xpert MTB/RIF as an add-on in smear-positive and smear-negative TB suspects saves on average €48.72 and €503, respectively, per admitted patient as compared with the conventional approach. In smear-positive and smear-negative MDR-TB suspects, cost savings amount to €189.56 and €515.25 per person, respectively. Full replacement of microscopy by Xpert MTB/RIF saves €449.98. In probabilistic Monte-Carlo simulation, adding Xpert MTB/RIF is less costly in 46.4% and 76.2% of smear-positive TB and MDR-TB suspects, respectively, but 100% less expensive in all smear-negative suspects. Full replacement by Xpert MTB/RIF is also consistently cost-saving.Using Xpert MTB/RIF as an add-on to and even as a replacement for sputum smear examination may significantly reduce expenditures in TB suspects. Copyright ©ERS 2016.

Comparison of feed energy costs of maintenance, lean deposition, and fat deposition in three lines of mice selected for heat loss.

PubMed

Eggert, D L; Nielsen, M K

2006-02-01

Three replications of mouse selection populations for high heat loss (MH), low heat loss (ML), and a nonselected control (MC) were used to estimate the feed energy costs of maintenance and gain and to test whether selection had changed these costs. At 21 and 49 d of age, mice were weighed and subjected to dual x-ray densitometry measurement for prediction of body composition. At 21 d, mice were randomly assigned to an ad libitum, an 80% of ad libitum, or a 60% of ad libitum feeding group for 28-d collection of individual feed intake. Data were analyzed using 3 approaches. The first approach was an attempt to partition energy intake between costs for maintenance, fat deposition, and lean deposition for each replicate, sex, and line by multiple regression of feed intake on the sum of daily metabolic weight (kg(0.75)), fat gain, and lean gain. Approach II was a less restrictive attempt to partition energy intake between costs for maintenance and total gain for each replicate, sex, and line by multiple regression of feed intake on the sum of daily metabolic weight and total gain. Approach III used multiple regression on the entire data set with pooled regressions on fat and lean gains, and subclass regressions for maintenance. Contrasts were conducted to test the effect of selection (MH - ML) and asymmetry of selection [(MH + ML)/2 - MC] for the various energy costs. In approach I, there were no differences between lines for costs of maintenance, fat deposition, or protein deposition, but we question our ability to estimate these accurately. In approach II, selection changed both cost of maintenance (P = 0.03) and gain (P = 0.05); MH mice had greater per unit costs than ML mice for both. Asymmetry of the selection response was found in approach II for the cost of maintenance (P = 0.06). In approach III, the effect of selection (P < 0.01) contributed to differences in the maintenance cost, but asymmetry of selection (P > 0.17) was not evident. Sex effects were found for the cost of fat deposition (P = 0.02) in approach I and the cost of gain (P = 0.001) in approach II; females had a greater cost per unit than males. When costs per unit of fat and per unit of lean gain were assumed to be the same for both sexes (approach III), females had a somewhat greater estimate for maintenance cost (P = 0.10). We conclude that selection for heat loss has changed the costs for maintenance per unit size but probably not the costs for gain.

Evaluation of a proposal for reliable low-cost grid power with 100% wind, water, and solar.

PubMed

Clack, Christopher T M; Qvist, Staffan A; Apt, Jay; Bazilian, Morgan; Brandt, Adam R; Caldeira, Ken; Davis, Steven J; Diakov, Victor; Handschy, Mark A; Hines, Paul D H; Jaramillo, Paulina; Kammen, Daniel M; Long, Jane C S; Morgan, M Granger; Reed, Adam; Sivaram, Varun; Sweeney, James; Tynan, George R; Victor, David G; Weyant, John P; Whitacre, Jay F

2017-06-27

A number of analyses, meta-analyses, and assessments, including those performed by the Intergovernmental Panel on Climate Change, the National Oceanic and Atmospheric Administration, the National Renewable Energy Laboratory, and the International Energy Agency, have concluded that deployment of a diverse portfolio of clean energy technologies makes a transition to a low-carbon-emission energy system both more feasible and less costly than other pathways. In contrast, Jacobson et al. [Jacobson MZ, Delucchi MA, Cameron MA, Frew BA (2015) Proc Natl Acad Sci USA 112(49):15060-15065] argue that it is feasible to provide "low-cost solutions to the grid reliability problem with 100% penetration of WWS [wind, water and solar power] across all energy sectors in the continental United States between 2050 and 2055", with only electricity and hydrogen as energy carriers. In this paper, we evaluate that study and find significant shortcomings in the analysis. In particular, we point out that this work used invalid modeling tools, contained modeling errors, and made implausible and inadequately supported assumptions. Policy makers should treat with caution any visions of a rapid, reliable, and low-cost transition to entire energy systems that relies almost exclusively on wind, solar, and hydroelectric power.

Evaluation of a proposal for reliable low-cost grid power with 100% wind, water, and solar

PubMed Central

Apt, Jay; Bazilian, Morgan; Diakov, Victor; Hines, Paul D. H.; Jaramillo, Paulina; Kammen, Daniel M.; Long, Jane C. S.; Morgan, M. Granger; Reed, Adam; Sivaram, Varun; Sweeney, James; Tynan, George R.; Victor, David G.; Weyant, John P.; Whitacre, Jay F.

2017-01-01

A number of analyses, meta-analyses, and assessments, including those performed by the Intergovernmental Panel on Climate Change, the National Oceanic and Atmospheric Administration, the National Renewable Energy Laboratory, and the International Energy Agency, have concluded that deployment of a diverse portfolio of clean energy technologies makes a transition to a low-carbon-emission energy system both more feasible and less costly than other pathways. In contrast, Jacobson et al. [Jacobson MZ, Delucchi MA, Cameron MA, Frew BA (2015) Proc Natl Acad Sci USA 112(49):15060–15065] argue that it is feasible to provide “low-cost solutions to the grid reliability problem with 100% penetration of WWS [wind, water and solar power] across all energy sectors in the continental United States between 2050 and 2055”, with only electricity and hydrogen as energy carriers. In this paper, we evaluate that study and find significant shortcomings in the analysis. In particular, we point out that this work used invalid modeling tools, contained modeling errors, and made implausible and inadequately supported assumptions. Policy makers should treat with caution any visions of a rapid, reliable, and low-cost transition to entire energy systems that relies almost exclusively on wind, solar, and hydroelectric power. PMID:28630353

The cost of meeting increased cooling-water demands for CO2 capture and storage utilizing non-traditional waters from geologic saline formations

NASA Astrophysics Data System (ADS)

Klise, Geoffrey T.; Roach, Jesse D.; Kobos, Peter H.; Heath, Jason E.; Gutierrez, Karen A.

2013-05-01

Deep (> ˜800 m) saline water-bearing formations in the United States have substantial pore volume that is targeted for storage of carbon dioxide (CO2) and the associated saline water can be extracted to increase CO2 storage efficiency, manage pressure build up, and create a new water source that, once treated, can be used for power-plant cooling or other purposes. Extraction, treatment and disposal costs of saline formation water to meet added water demands from CO2 capture and storage (CCS) are discussed. This underutilized water source may be important in meeting new water demand associated with CCS. For a representative natural gas combined-cycle (NGCC) power plant, simultaneous extraction of brine from the storage formation could provide enough water to meet all CCS-related cooling demands for 177 out of the 185 (96 %) saline formations analyzed in this study. Calculated total cost of water extraction, treatment and disposal is less than 4.00 US Dollars (USD) m-3 for 93 % of the 185 formations considered. In 90 % of 185 formations, treated water costs are less than 10.00 USD tonne-1 of CO2 injected. On average, this represents approximately 6 % of the total CO2 capture and injection costs for the NGCC scenario.

Cost-effective smoke-free multiunit housing media campaigns: connecting with local communities.

PubMed

Modayil, Mary V; Consolacion, Theodora B; Isler, Jonathan; Soria, Sandra; Stevens, Colleen

2011-11-01

Presented are cost-effective paid media strategies to educate Californians to advocate for stronger smoke-free multiunit housing (SF-MUH) policies between 2006 and 2008. Included is a summary of general market and specific ethnic market costs that correspond to SF-MUH attitudes and home smoking bans. Statewide questionnaires indicated that half of the intended general market saw an antitobacco TV ad and half of the intended ethnic markets heard radio ads. Analyses indicated that it cost $0.67 and $0.78 per person to see Caution Tape and Apartment TV ads, respectively. Slightly higher per capita costs corresponded with positive attitudes toward SF-MUH: $0.87 for Caution Tape and $1.00 for Apartment. Lessons learned from this campaign included effectiveness of specific ads in ethnic markets, impact on SF-MUH work plan policy objectives, and the need for collaborations among state and local partners throughout the message development process.

Low Cost, Single Layer Replacement for the Back-Sheet and Encapsulant Layers

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kempe, M. D.; Thapa, P.

2008-01-01

Ethylene propylene diene monomer (EPDM) based polymers have been formulated for specific use in photovoltaic modules to produce better performance and longer term stability at a lower cost than standard materials. EPDM formulations are advantageous over ethylene vinyl-acetate (EVA) because they can use the same lamination/cure cycle as EVA, they do not need a second back-sheet protective material (e.g. PET/Tedlar), they have a lower glass transition temperature, no melting transition, more constant mechanical moduli as a function of temperature, they are less polar than EVA (provides better corrosion protection), and they have excellent damp heat (85 C/85% relative humidity) resistancemore » against delamination. Module designs typically use EVA on the back side of cells despite the fact that transparency is not advantageous. We have developed a single encapsulant layer that will replace standard module back-sheet constructions consisting of EVA/PET/Tedlar. Because a single low-cost material layer is used, it will provide a significant materials cost savings of about $6 to $8/m{sup 2} as compared to traditional back-sheets. Electrical insulation tests were conducted using 0.85 mm thick stainless steel sheets as a model for a cell. It was found that a polymer layer thickness of about 0.33mm provided better high voltage electrical insulation than a combined film of Tedla (0.038 mm)/PET (0.051 mm)/EVA (0.55 mm). When formulated with a white pigment, reflectivity was comparable to Tedlar{trademark}. Upon accelerated exposure to light at 60C and 60% RH it was found that an EVA layer in front of these materials would decompose before significant yellowing and delamination of the back EPDM layer occurs.« less

Projected effectiveness and added value of HIV vaccination campaigns in South Africa: A modeling study.

PubMed

de Montigny, Simon; Adamson, Blythe J S; Mâsse, Benoît R; Garrison, Louis P; Kublin, James G; Gilbert, Peter B; Dimitrov, Dobromir T

2018-04-17

Promising multi-dose HIV vaccine regimens are being tested in trials in South Africa. We estimated the potential epidemiological and economic impact of HIV vaccine campaigns compared to continuous vaccination, assuming that vaccine efficacy is transient and dependent on immune response. We used a dynamic economic mathematical model of HIV transmission calibrated to 2012 epidemiological data to simulate vaccination with anticipated antiretroviral treatment scale-up in South Africa. We estimate that biennial vaccination with a 70% efficacious vaccine reaching 20% of the sexually active population could prevent 480,000-650,000 HIV infections (13.8-15.3% of all infections) over 10 years. Assuming a launch price of $15 per dose, vaccination was found to be cost-effective, with an incremental cost-effectiveness ratio of $13,746 per quality-adjusted life-year as compared to no vaccination. Increasing vaccination coverage to 50% will prevent more infections but is less likely to achieve cost-effectiveness. Campaign vaccination is consistently more effective and costs less than continuous vaccination across scenarios. Results suggest that a partially effective HIV vaccine will have substantial impact on the HIV epidemic in South Africa and offer good value if priced less than $105 for a five-dose series. Vaccination campaigns every two years may offer greater value for money than continuous vaccination reaching the same coverage level.

Shortened length of stay and hospital cost reduction with implementation of an accelerated clinical care pathway after elective colon resection.

PubMed

Stephen, Antonia E; Berger, David L

2003-03-01

Patient care pathways have been developed for operative procedures with documented improvements in length of stay and cost without compromising outcome. The average hospital stay after colonic resection is 5 to 10 days. This study describes a clinical pathway for colon resections and examines patient outcome before and after institution of the pathway. One hundred thirty-eight patients underwent elective colon resections at our institution by a single surgeon before (n = 52) and after (n = 86) introduction of a clinical pathway. Length of stay, postoperative complications, readmissions, and cost per patient were compared between the 2 groups. Mean total length of stay (+/- standard deviation [SD]) was less in the postclinical pathway patients (3.7 +/- 1.5 days) compared to preclinical pathway patients (6.6 +/- 3.3 days) (P <.001). When adjusted for age, sex, diagnosis, and type of operation, the difference in length of stay remains statistically significant (P <.001). There was 1 readmission in the prepathway group and 8 readmissions in the postpathway group. When the readmissions were added to the original admissions, the mean length of stay in the postpathway patients was 4.2 +/- 2.8 days and in the prepathway patients was 6.9 +/- 4.1 days (P <.001). The average cost per patient (+/- standard error of the mean), with readmission costs added, was 9310 +/- 5170 US dollars in the prepathway group and 7070 +/- 3670 US dollars in the postpathway group (P =.002). The institution of a clinical pathway for elective, open colon resections can be done safely with improvements in cost and length of stay.

The costs of future polio risk management policies.

PubMed

Tebbens, Radboud J Duintjer; Sangrujee, Nalinee; Thompson, Kimberly M

2006-12-01

Decisionmakers need information about the anticipated future costs of maintaining polio eradication as a function of the policy options under consideration. Given the large portfolio of options, we reviewed and synthesized the existing cost data relevant to current policies to provide context for future policies. We model the expected future costs of different strategies for continued vaccination, surveillance, and other costs that require significant potential resource commitments. We estimate the costs of different potential policy portfolios for low-, middle-, and high-income countries to demonstrate the variability in these costs. We estimate that a global transition from routine immunization with oral poliovirus vaccine (OPV) to inactivated poliovirus vaccine (IPV) would increase the costs of managing polio globally, although routine IPV use remains less costly than routine OPV use with supplemental immunization activities. The costs of surveillance and a stockpile, while small compared to routine vaccination costs, represent important expenditures to ensure adequate response to potential outbreaks. The uncertainty and sensitivity analyses highlight important uncertainty in the aggregated costs and demonstrates that the discount rate and uncertainty in price and administration cost of IPV drives the expected incremental cost of routine IPV vs. OPV immunization.

Exergy & economic analysis of biogas fueled solid oxide fuel cell systems

NASA Astrophysics Data System (ADS)

Siefert, Nicholas S.; Litster, Shawn

2014-12-01

We present an exergy and an economic analysis of a power plant that uses biogas produced from a thermophilic anaerobic digester (AD) to fuel a solid oxide fuel cell (SOFC). We performed a 4-variable parametric analysis of the AD-SOFC system in order to determine the optimal design operation conditions, depending on the objective function of interest. We present results on the exergy efficiency (%), power normalized capital cost ( kW-1), and the internal rate of return on investment, IRR, (% yr-1) as a function of the current density, the stack pressure, the fuel utilization, and the total air stoichiometric ratio. To the authors' knowledge, this is the first AD-SOFC paper to include the cost of the AD when conducting economic optimization of the AD-SOFC plant. Our calculations show that adding a new AD-SOFC system to an existing waste water treatment (WWT) plant could yield positives values of IRR at today's average electricity prices and could significantly out-compete other options for using biogas to generate electricity. AD-SOFC systems could likely convert WWT plants into net generators of electricity rather than net consumers of electricity while generating economically viable rates of return on investment if the costs of SOFC systems are within a factor of two of the DOE/SECA cost targets.

Added sugar intake in South Africa: findings from the Adult Prospective Urban and Rural Epidemiology cohort study.

PubMed

Vorster, Hester H; Kruger, Annamarie; Wentzel-Viljoen, Edelweiss; Kruger, H Salome; Margetts, Barrie M

2014-06-01

Obesity and other noncommunicable disease (NCD) risk factors are increasing in low- and middle-income countries. There are few data on the association between increased added sugar intake and NCD risk in these countries. We assessed the relation between added sugar intake and NCD risk factors in an African cohort study. Added sugars were defined as all monosaccharides and disaccharides added to foods and beverages during processing, cooking, and at the table. We conducted a 5-y follow-up of a cohort of 2010 urban and rural men and women aged 30-70 y of age at recruitment in 2005 from the North West Province in South Africa. Added sugar intake, particularly in rural areas, has increased rapidly in the past 5 y. In rural areas, the proportion of adults who consumed sucrose-sweetened beverages approximately doubled (for men, from 25% to 56%; for women, from 33% to 63%) in the past 5 y. After adjustment, subjects who consumed more added sugars (≥10% energy from added sugars) compared with those who consumed less added sugars had a higher waist circumference [mean difference (95% CI): 1.07 cm (0.35, 1.79 cm)] and body mass index (in kg/m²) [0.43 (0.12, 0.74)] and lower HDL cholesterol [-0.08 mmol/L (-0.14, 0.002 mmol/L)]. This cohort showed dramatic increases in added sugars and sucrose-sweetened beverage consumption in both urban and rural areas. Increased consumption was associated with increased NCD risk factors. In addition, the study showed that the nutrition transition has reached a remote rural area in South Africa. Urgent action is needed to address these trends. © 2014 American Society for Nutrition.

Evaluation of the U.S. Department of Energy Challenge Home Program Certification of Production Builders

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kerrigan, P.; Loomis, H.

2014-09-01

The purpose of this project was to evaluate integrated packages of advanced measures in individual test homes to assess their performance with respect to Building America program goals, specifically compliance with the DOE Challenge Home Program. BSC consulted on the construction of five test houses by three cold climate production builders in three U.S. cities and worked with the builders to develop a design package tailored to the cost-related impacts for each builder. Also, BSC provided support through performance testing of the five test homes. Overall, the builders have concluded that the energy related upgrades (either through the prescriptive ormore » performance path) represent reasonable upgrades. The builders commented that while not every improvement in specification was cost effective (as in a reasonable payback period), many were improvements that could improve the marketability of the homes and serve to attract more energy efficiency discerning prospective homeowners. However, the builders did express reservations on the associated checklists and added certifications. An increase in administrative time was observed with all builders. The checklists and certifications also inherently increase cost due to: adding services to the scope of work for various trades, such as HERS Rater, HVAC contractor; and increased material costs related to the checklists, especially the EPA Indoor airPLUS and EPA WaterSense® Efficient Hot Water Distribution requirement.« less

Fairness in optimizing bus-crew scheduling process.

PubMed

Ma, Jihui; Song, Cuiying; Ceder, Avishai Avi; Liu, Tao; Guan, Wei

2017-01-01

This work proposes a model considering fairness in the problem of crew scheduling for bus drivers (CSP-BD) using a hybrid ant-colony optimization (HACO) algorithm to solve it. The main contributions of this work are the following: (a) a valid approach for cases with a special cost structure and constraints considering the fairness of working time and idle time; (b) an improved algorithm incorporating Gamma heuristic function and selecting rules. The relationships of each cost are examined with ten bus lines collected from the Beijing Public Transport Holdings (Group) Co., Ltd., one of the largest bus transit companies in the world. It shows that unfair cost is indirectly related to common cost, fixed cost and extra cost and also the unfair cost approaches to common and fixed cost when its coefficient is twice of common cost coefficient. Furthermore, the longest time for the tested bus line with 1108 pieces, 74 blocks is less than 30 minutes. The results indicate that the HACO-based algorithm can be a feasible and efficient optimization technique for CSP-BD, especially with large scale problems.

How Broadcast Volume and Emotional Content Affect Youth Recall of Anti-Tobacco Advertising

PubMed Central

Biener, Lois; Wakefield, Melanie; Shiner, Cecilia M.; Siegel, Michael

2008-01-01

Background Televised anti-tobacco advertising has been shown to be effective for discouraging smoking initiation; however, purchasing broadcasting time is very costly. This study investigated the relative impact of the broadcast volume (media weight) and the emotional content of an ad as predictors of advertising recall. Methods The data come from a random-digit-dialed survey conducted in 2001 and 2002 of 3863 youth aged 12–17. Media weight was based on commercial TV ratings data. The emotional intensity of advertisements was derived from the ratings made by independent youth judges. Results Data analyses were conducted between 2005 and 2007. Results indicated that media weight was a significant predictor of recall, but the emotional content of the ad was an even stronger predictor. Also, ads low in emotional intensity required more media weight than those high in emotional intensity to achieve the same amount of increase in recall. Conclusions This study extends prior research that highlights the importance of emotional intensity for effective anti-tobacco advertising. It also indicates that, relative to unemotional advertisements, emotionally arousing advertisements require fewer broadcasts to achieve the same level of recall, and hence are likely to be less costly to a public health campaign. PMID:18482819

Geosensors to Support Crop Production: Current Applications and User Requirements

PubMed Central

Thessler, Sirpa; Kooistra, Lammert; Teye, Frederick; Huitu, Hanna; Bregt, Arnold K.

2011-01-01

Sensor technology, which benefits from high temporal measuring resolution, real-time data transfer and high spatial resolution of sensor data that shows in-field variations, has the potential to provide added value for crop production. The present paper explores how sensors and sensor networks have been utilised in the crop production process and what their added-value and the main bottlenecks are from the perspective of users. The focus is on sensor based applications and on requirements that users pose for them. Literature and two use cases were reviewed and applications were classified according to the crop production process: sensing of growth conditions, fertilising, irrigation, plant protection, harvesting and fleet control. The potential of sensor technology was widely acknowledged along the crop production chain. Users of the sensors require easy-to-use and reliable applications that are actionable in crop production at reasonable costs. The challenges are to develop sensor technology, data interoperability and management tools as well as data and measurement services in a way that requirements can be met, and potential benefits and added value can be realized in the farms in terms of higher yields, improved quality of yields, decreased input costs and production risks, and less work time and load. PMID:22163978

The Functional Transitions Model: Maximizing Ability in the Context of Progressive Disability Associated with Alzheimer's Disease

ERIC Educational Resources Information Center

Slaughter, Susan; Bankes, Jane

2007-01-01

The Functional Transitions Model (FTM) integrates the theoretical notions of progressive functional decline associated with Alzheimer's disease (AD), excess disability, and transitions occurring intermittently along the trajectory of functional decline. Application of the Functional Transitions Model to clinical practice encompasses the paradox of…

The Road to ICD-10-CM/PCS Implementation: Forecasting the Transition for Providers, Payers, and Other Healthcare Organizations

PubMed Central

Sanders, Tekla B; Bowens, Felicia M; Pierce, William; Stasher-Booker, Bridgette; Thompson, Erica Q; Jones, Warren A

2012-01-01

This article will examine the benefits and challenges of the US healthcare system's upcoming conversion to use of the International Classification of Diseases, Tenth Revision, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) and will review the cost implications of the transition. Benefits including improved quality of care, potential cost savings from increased accuracy of payments and reduction of unpaid claims, and improved tracking of healthcare data related to public health and bioterrorism events are discussed. Challenges are noted in the areas of planning and implementation, the financial cost of the transition, a shortage of qualified coders, the need for further training and education of the healthcare workforce, and the loss of productivity during the transition. Although the transition will require substantial implementation and conversion costs, potential benefits can be achieved in the areas of data integrity, fraud detection, enhanced cost analysis capabilities, and improved monitoring of patients’ health outcomes that will yield greater cost savings over time. The discussion concludes with recommendations to healthcare organizations of ways in which technological advances and workforce training and development opportunities can ease the transition to the new coding system. PMID:22548024

Cost-effectiveness of sitagliptin-based treatment regimens in European patients with type 2 diabetes and haemoglobin A1c above target on metformin monotherapy.

PubMed

Schwarz, B; Gouveia, M; Chen, J; Nocea, G; Jameson, K; Cook, J; Krishnarajah, G; Alemao, E; Yin, D; Sintonen, H

2008-06-01

Sitagliptin is a novel oral incretin enhancer that acts by inhibiting the dipeptidyl peptidase 4 enzyme and is indicated in Europe as a treatment adjunct to metformin (MF), sulphonylurea (SU), MF plus SU and diet and exercise, in the management of type 2 diabetes mellitus. The objective of the current analysis was to evaluate the cost-effectiveness of adding sitagliptin to the regimens of patients with haemoglobin A1c (HbA1C) above the International Diabetes Federation goal (6.5%) while on MF in six European countries: Austria, Finland, Portugal, Scotland (United Kingdom), Spain and Sweden. A discrete event simulation model, which employed the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model risk equations for predicting risks of diabetes-related complication, was used. Lifetime costs and benefits were projected for alternative treatment strategies of adding sitagliptin, compared with adding rosiglitazone or a SU to MF in patients not at HbA1C goal on MF monotherapy. Changes in HbA1C as well as side effects associated with these different treatment strategies were based on clinical trial data. Mean baseline values from local epidemiologic studies involving patients with type 2 diabetes not at HbA1C goal on MF monotherapy were included in the current analysis. Costs of medications, side effects and direct costs of diabetes-related complications were based on country-specific data. UKPDS-based disutility weights associated with diabetes complications were incorporated. Disutilities associated with medication side effects were based on published data. All future costs and benefits were discounted according to local guidelines on cost-effectiveness analysis. One-way sensitivity analyses were conducted by varying key input parameters. The discounted incremental cost-effectiveness ratios (ICER) associated with the addition of sitagliptin to MF, compared with adding rosiglitazone, in the different countries analysed ranged from treatment with sitagliptin being dominant (cost saving with improved health outcome) to its being cost-effective [4,766 euros per quality-adjusted life year (QALY)]. Treatment with sitagliptin added to MF was cost-effective compared with adding a SU, with discounted ICER values ranging from 5949 euros/QALY to 20,350 euros/QALY across countries. Sensitivity analyses showed that these results were robust to changes in input parameters, including clinical efficacy, costs and utility weights for both diabetes-related complications and hypoglycaemia. Compared with adding rosiglitazone or a SU to MF, adding sitagliptin to MF is projected to be either cost saving or cost-effective for patients with type 2 diabetes who are not at HbA1C goal on MF.

Advanced Hydrogen Liquefaction Process

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schwartz, Joseph; Kromer, Brian; Neu, Ben

2011-09-28

The project identified and quantified ways to reduce the cost of hydrogen liquefaction, and reduce the cost of hydrogen distribution. The goal was to reduce the power consumption by 20% and then to reduce the capital cost. Optimizing the process, improving process equipment, and improving ortho-para conversion significantly reduced the power consumption of liquefaction, but by less than 20%. Because the efficiency improvement was less than the target, the program was stopped before the capital cost was addressed. These efficiency improvements could provide a benefit to the public to improve the design of future hydrogen liquefiers. The project increased themore » understanding of hydrogen liquefaction by modeling different processes and thoroughly examining ortho-para separation and conversion. The process modeling provided a benefit to the public because the project incorporated para hydrogen into the process modeling software, so liquefaction processes can be modeled more accurately than using only normal hydrogen. Adding catalyst to the first heat exchanger, a simple method to reduce liquefaction power, was identified, analyzed, and quantified. The demonstrated performance of ortho-para separation is sufficient for at least one identified process concept to show reduced power cost when compared to hydrogen liquefaction processes using conventional ortho-para conversion. The impact of improved ortho-para conversion can be significant because ortho para conversion uses about 20-25% of the total liquefaction power, but performance improvement is necessary to realize a substantial benefit. Most of the energy used in liquefaction is for gas compression. Improvements in hydrogen compression will have a significant impact on overall liquefier efficiency. Improvements to turbines, heat exchangers, and other process equipment will have less impact.« less

The Reliability, Impact, and Cost-Effectiveness of Value-Added Teacher Assessment Methods

ERIC Educational Resources Information Center

Yeh, Stuart S.

2012-01-01

This article reviews evidence regarding the intertemporal reliability of teacher rankings based on value-added methods. Value-added methods exhibit low reliability, yet are broadly supported by prominent educational researchers and are increasingly being used to evaluate and fire teachers. The article then presents a cost-effectiveness analysis…

Recruitment to online therapies for depression: pilot cluster randomized controlled trial.

PubMed

Jones, Ray B; Goldsmith, Lesley; Hewson, Paul; Williams, Christopher J

2013-03-05

Raising awareness of online cognitive behavioral therapy (CBT) could benefit many people with depression, but we do not know how purchasing online advertising compares to placing free links from relevant local websites in increasing uptake. To pilot a cluster randomized controlled trial (RCT) comparing purchase of Google AdWords with placing free website links in raising awareness of online CBT resources for depression in order to better understand research design issues. We compared two online interventions with a control without intervention. The pilot RCT had 4 arms, each with 4 British postcode areas: (A) geographically targeted AdWords, (B) adverts placed on local websites by contacting website owners and requesting links be added, (C) both interventions, (D) control. Participants were directed to our research project website linking to two freely available online CBT resource sites (Moodgym and Living Life To The Full (LLTTF)) and two other depression support sites. We used data from (1) AdWords, (2) Google Analytics for our project website and for LLTTF, and (3) research project website. We compared two outcomes: (1) numbers with depression accessing the research project website, and then chose an onward link to one of the two CBT websites, and (2) numbers registering with LLTTF. We documented costs, and explored intervention and assessment methods to make general recommendations to inform researchers aiming to use similar methodologies in future studies. Trying to place local website links appeared much less cost effective than AdWords and although may prove useful for service delivery, was not worth pursuing in the context of the current study design. Our AdWords intervention was effective in recruiting people to the project website but our location targeting "leaked" and was not as geographically specific as claimed. The impact on online CBT was also diluted by offering participants other choices of destinations. Measuring the impact on LLTTF use was difficult as the total number using LLTTF was less than 5% of all users and record linkage across websites was impossible. Confounding activity may have resulted in some increase in registrations in the control arm. Practitioners should consider online advertising to increase uptake of online therapy but need to check its additional value. A cluster RCT using location targeted adverts is feasible and this research design provides the best evidence of cost-effectiveness. Although our British pilot study is limited to online CBT for depression, a cluster RCT with similar design would be appropriate for other online treatments and countries and our recommendations may apply. They include ways of dealing with possible contamination (buffer zones and AdWords techniques), confounding factors (large number of clusters), advertising dose (in proportion to total number of users), record linkage (landing within target website), and length of study (4-6 months). clinicaltrials.gov (Registration No. NCT01469689); http://clinicaltrials.gov/ct2/show/NCT01469689 (Archived by WebCite at http://www.webcitation.org/6EtTthDOp).

Direct optimization, affine gap costs, and node stability.

PubMed

Aagesen, Lone

2005-09-01

The outcome of a phylogenetic analysis based on DNA sequence data is highly dependent on the homology-assignment step and may vary with alignment parameter costs. Robustness to changes in parameter costs is therefore a desired quality of a data set because the final conclusions will be less dependent on selecting a precise optimal cost set. Here, node stability is explored in relationship to separate versus combined analysis in three different data sets, all including several data partitions. Robustness to changes in cost sets is measured as number of successive changes that can be made in a given cost set before a specific clade is lost. The changes are in all cases base change cost, gap penalties, and adding/removing/changing affine gap costs. When combining data partitions, the number of clades that appear in the entire parameter space is not remarkably increased, in some cases this number even decreased. However, when combining data partitions the trees from cost sets including affine gap costs were always more similar than the trees were from cost sets without affine gap costs. This was not the case when the data partitions were analyzed independently. When data sets were combined approximately 80% of the clades found under cost sets including affine gap costs resisted at least one change to the cost set.

Cost-Effectiveness of Pertuzumab in Human Epidermal Growth Factor Receptor 2–Positive Metastatic Breast Cancer

PubMed Central

Qian, Yushen; Pollom, Erqi L.; King, Martin T.; Dudley, Sara A.; Shaffer, Jenny L.; Chang, Daniel T.; Gibbs, Iris C.; Goldhaber-Fiebert, Jeremy D.; Horst, Kathleen C.

2016-01-01

Purpose The Clinical Evaluation of Pertuzumab and Trastuzumab (CLEOPATRA) study showed a 15.7-month survival benefit with the addition of pertuzumab to docetaxel and trastuzumab (THP) as first-line treatment for patients with human epidermal growth factor receptor 2 (HER2) –overexpressing metastatic breast cancer. We performed a cost-effectiveness analysis to assess the value of adding pertuzumab. Patient and Methods We developed a decision-analytic Markov model to evaluate the cost effectiveness of docetaxel plus trastuzumab (TH) with or without pertuzumab in US patients with metastatic breast cancer. The model followed patients weekly over their remaining lifetimes. Health states included stable disease, progressing disease, hospice, and death. Transition probabilities were based on the CLEOPATRA study. Costs reflected the 2014 Medicare rates. Health state utilities were the same as those used in other recent cost-effectiveness studies of trastuzumab and pertuzumab. Outcomes included health benefits expressed as discounted quality-adjusted life-years (QALYs), costs in US dollars, and cost effectiveness expressed as an incremental cost-effectiveness ratio. One- and multiway deterministic and probabilistic sensitivity analyses explored the effects of specific assumptions. Results Modeled median survival was 39.4 months for TH and 56.9 months for THP. The addition of pertuzumab resulted in an additional 1.81 life-years gained, or 0.62 QALYs, at a cost of $472,668 per QALY gained. Deterministic sensitivity analysis showed that THP is unlikely to be cost effective even under the most favorable assumptions, and probabilistic sensitivity analysis predicted 0% chance of cost effectiveness at a willingness to pay of $100,000 per QALY gained. Conclusion THP in patients with metastatic HER2-positive breast cancer is unlikely to be cost effective in the United States. PMID:26351332

Assessment of the benefits and costs associated with the adoption of the recommended fire safety practices for rail transit materials selection

DOT National Transportation Integrated Search

1982-12-01

This report presents the results of an assessment of the benefits and costs associated with the adoption of Recommended Fire Safety Practices for Rail Transit Materials Selection for rapid rail transit and light rail transit vehicles. The potential b...

Development of Economic Factors in Tunnel Construction

DOT National Transportation Integrated Search

1977-12-01

The escalating cost of underground construction of urban transportation systems has made transit planning, especially construction cost estimating, difficult. This is a study of the cost of construction of underground, rapid transit tunnels in soft g...

Phases of higher spin black holes: Hawking-Page, transitions between black holes, and a critical point

NASA Astrophysics Data System (ADS)

Bañados, Máximo; Düring, Gustavo; Faraggi, Alberto; Reyes, Ignacio A.

2017-08-01

We study the thermodynamic phase diagram of three-dimensional s l (N ;R ) higher spin black holes. By analyzing the semiclassical partition function we uncover a rich structure that includes Hawking-Page transitions to the AdS3 vacuum, first order phase transitions among black hole states, and a second order critical point. Our analysis is explicit for N =4 but we extrapolate some of our conclusions to arbitrary N . In particular, we argue that even N is stable in the ensemble under consideration but odd N is not.

Understanding a Value Chain in Health Care.

PubMed

Sharan, Alok D; Schroeder, Gregory D; West, Michael E; Vaccaro, Alexander R

2015-10-01

As the US health care system transitions toward a value-based system, providers and health care organizations will have to closely scrutinize their current processes of care. To do this, a value chain analysis can be performed to ensure that only the most efficient steps are followed in patient care. Ultimately this will produce a higher quality or equal quality product for less cost by eliminating wasteful steps along the way.

The economic impact of moderate stage Alzheimer's disease in Italy: evidence from the UP-TECH randomized trial.

PubMed

Chiatti, Carlos; Furneri, Gianluca; Rimland, Joseph M; Demma, Federica; Bonfranceschi, Franco; Cassetta, Laura; Masera, Filippo; Cherubini, Antonio; Corsonello, Andrea; Lattanzio, Fabrizia

2015-09-01

There is consensus that dementia is the most burdensome disease for modern societies. Few cost-of-illness studies examined the complexity of Alzheimer's disease (AD) burden, considering at the same time health and social care, cash allowances, informal care, and out-of-pocket expenditure by families. This is a comprehensive cost-of-illness study based on the baseline data from a randomized controlled trial (UP-TECH) enrolling 438 patients with moderate AD and their primary caregiver living in the community. The societal burden of AD, composed of public, patient, and informal care costs, was about €20,000/yr. Out of this, the cost borne by the public sector was €4,534/yr. The main driver of public cost was the national cash-for-care allowance (€2,324/yr), followed by drug prescriptions (€1,402/yr). Out-of-pocket expenditure predominantly concerned the cost of private care workers. The value of informal care peaked at €13,590/yr. Socioeconomic factors do not influence AD public cost, but do affect the level of out-of-pocket expenditure. The burden of AD reflects the structure of Italian welfare. The families predominantly manage AD patients. The public expenditure is mostly for drugs and cash-for-care benefits. From a State perspective in the short term, the advantage of these care arrangements is clear, compared to the cost of residential care. However, if caregivers are not adequately supported, savings may be soon offset by higher risk of caregiver morbidity and mortality produced by high burden and stress. The study has been registered on the website www.clinicaltrials.org ( NCT01700556).

Evaluation of the long-term cost-effectiveness of IDegLira versus liraglutide added to basal insulin for patients with type 2 diabetes failing to achieve glycemic control on basal insulin in the USA.

PubMed

Hunt, B; Mocarski, M; Valentine, W J; Langer, J

2017-07-01

IDegLira, a fixed ratio combination of insulin degludec and glucagon-like peptide-1 receptor agonist liraglutide, utilizes the complementary mechanisms of action of these two agents to improve glycemic control with low risk of hypoglycemia and avoidance of weight gain. The aim of the present analysis was to assess the long-term cost-effectiveness of IDegLira vs liraglutide added to basal insulin, for patients with type 2 diabetes not achieving glycemic control on basal insulin in the US setting. Projections of lifetime costs and clinical outcomes were made using the IMS CORE Diabetes Model. Treatment effect data for patients receiving IDegLira and liraglutide added to basal insulin were modeled based on the outcomes of a published indirect comparison, as no head-to-head clinical trial data is currently available. Costs were accounted in 2015 US dollars ($) from a healthcare payer perspective. IDegLira was associated with small improvements in quality-adjusted life expectancy compared with liraglutide added to basal insulin (8.94 vs 8.91 discounted quality-adjusted life years [QALYs]). The key driver of improved clinical outcomes was the greater reduction in glycated hemoglobin associated with IDegLira. IDegLira was associated with mean costs savings of $17,687 over patient lifetimes vs liraglutide added to basal insulin, resulting from lower treatment costs and cost savings as a result of complications avoided. The present long-term modeling analysis found that IDegLira was dominant vs liraglutide added to basal insulin for patients with type 2 diabetes failing to achieve glycemic control on basal insulin in the US, improving clinical outcomes and reducing direct costs.

Growth dominates choice in network percolation

NASA Astrophysics Data System (ADS)

Vijayaraghavan, Vikram S.; Noël, Pierre-André; Waagen, Alex; D'Souza, Raissa M.

2013-09-01

The onset of large-scale connectivity in a network (i.e., percolation) often has a major impact on the function of the system. Traditionally, graph percolation is analyzed by adding edges to a fixed set of initially isolated nodes. Several years ago, it was shown that adding nodes as well as edges to the graph can yield an infinite order transition, which is much smoother than the traditional second-order transition. More recently, it was shown that adding edges via a competitive process to a fixed set of initially isolated nodes can lead to a delayed, extremely abrupt percolation transition with a significant jump in large but finite systems. Here we analyze a process that combines both node arrival and edge competition. If started from a small collection of seed nodes, we show that the impact of node arrival dominates: although we can significantly delay percolation, the transition is of infinite order. Thus, node arrival can mitigate the trade-off between delay and abruptness that is characteristic of explosive percolation transitions. This realization may inspire new design rules where network growth can temper the effects of delay, creating opportunities for network intervention and control.

Transition duct system with metal liners for delivering hot-temperature gases in a combustion turbine engine

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wiebe, David J.

A transition duct system (10) for delivering hot-temperature gases from a plurality of combustors in a combustion turbine engine is provided. The system includes an exit piece (16) for each combustor. The exit piece may include a straight path segment (26) and an arcuate connecting segment (36). A respective straight metal liner (92) and an arcuate metal liner (94) may be each inwardly disposed onto a metal outer shell (38) along the straight path segment and the arcuate connecting segment (36) of the exit piece. Structural arrangements are provided to securely attach the respective liners in the presence of substantialmore » flow path pressurization. Cost-effective serviceability of the transition duct systems is realizable since the liners can be readily removed and replaced as needed.« less

Ocean thermal energy conversion cold water pipe preliminary design project. Appendices to final report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1979-11-20

NOAA/DOE has selected three concepts for a baseline design of the cold water pipe (CWP) for OTEC plants: (1) a FRP CWP of sandwich wall construction suspended from the Applied Physical Laboratory/John Hopkins University (APL/JHU) barge at a site 200 miles east of the coast of Brazil using a horizontal deployment scheme; (2) an elastomer CWP suspended from the APL/JHU barge off the southeast coast of Puerto Rico using either a horizontal or vertical deployment scheme; and (3) a polyethylene CWP (single or multiple pipe) suspended from the Gibbs and Cox spar at the Puerto Rico site using a horizontalmore » deployment scheme. TRW has developed a baseline design for each of these configurations. This volume of the report includes the following appendices: (A) fiberglass reinforced plastic cold water pipe (specification and drawingss); (B) specification for polyethylene CWP; (C) elastomer pipe drawings; (D) drawings for OTEC 10/40 hull/CWP transitions; (E) structural design of OTEC 10/40 CWP support and CWP transitions; (F) universal transition joint for CWP; (G) dynamic spherical seal of CWP; (H) at-sea deployment loads - surface towing loads; (I) OTEC 10/40 CWP deployment up-ending loads; (J) cost estimates for OTEC 10/40 hull/CWP transitions; and (K) OTEC 10/40 CWP deployment scenario and cost estimate. (WHK)« less

Impact of dropout of female volunteer community health workers: An exploration in Dhaka urban slums

PubMed Central

2012-01-01

Background The model of volunteer community health workers (CHWs) is a common approach to serving the poor communities in developing countries. BRAC, a large NGO in Bangladesh, is a pioneer in this area, has been using female CHWs as core workers in its community-based health programs since 1977. After 25 years of implementing of the CHW model in rural areas, BRAC has begun using female CHWs in urban slums through a community-based maternal health intervention. However, BRAC experiences high dropout rates among CHWs suggesting a need to better understand the impact of their dropout which would help to reduce dropout and increase program sustainability. The main objective of the study was to estimate impact of dropout of volunteer CHWs from both BRAC and community perspectives. Also, we estimated cost of possible strategies to reduce dropout and compared whether these costs were more or less than the costs borne by BRAC and the community. Methods We used the ‘ingredient approach’ to estimate the cost of recruiting and training of CHWs and the so-called ‘friction cost approach’ to estimate the cost of replacement of CHWs after adapting. Finally, we estimated forgone services in the community due to CHW dropout applying the concept of the friction period. Results In 2009, average cost per regular CHW was US$ 59.28 which was US$ 60.04 for an ad-hoc CHW if a CHW participated a three-week basic training, a one-day refresher training, one incentive day and worked for a month in the community after recruitment. One month absence of a CHW with standard performance in the community meant substantial forgone health services like health education, antenatal visits, deliveries, referrals of complicated cases, and distribution of drugs and health commodities. However, with an additional investment of US$ 121 yearly per CHW BRAC could save another US$ 60 invested an ad-hoc CHW plus forgone services in the community. Conclusion Although CHWs work as volunteers in Dhaka urban slums impact of their dropout is immense both in financial term and forgone services. High cost of dropout makes the program less sustainable. However, simple and financially competitive strategies can improve the sustainability of the program. PMID:22897922

Online advertising as a public health and recruitment tool: comparison of different media campaigns to increase demand for smoking cessation interventions.

PubMed

Graham, Amanda L; Milner, Pat; Saul, Jessie E; Pfaff, Lillian

2008-12-15

To improve the overall impact (reach x efficacy) of cessation treatments and to reduce the population prevalence of smoking, innovative strategies are needed that increase consumer demand for and use of cessation treatments. Given that 12 million people search for smoking cessation information each year, online advertising may represent a cost-efficient approach to reach and recruit online smokers to treatment. Online ads can be implemented in many forms, and surveys consistently show that consumers are receptive. Few studies have examined the potential of online advertising to recruit smokers to cessation treatments. The aims of the study were to (1) demonstrate the feasibility of online advertising as a strategy to increase consumer demand for cessation treatments, (2) illustrate the tools that can be used to track and evaluate the impact of online advertising on treatment utilization, and (3) highlight some of the methodological challenges and future directions for researchers. An observational design was used to examine the impact of online advertising compared to traditional recruitment approaches (billboards, television and radio ads, outdoor advertising, direct mail, and physician detailing) on several dependent variables: (1) number of individuals who enrolled in Web- or telephone-based cessation treatment, (2) the demographic, smoking, and treatment utilization characteristics of smokers recruited to treatment, and (3) the cost to enroll smokers. Several creative approaches to online ads (banner ads, paid search) were tested on national and local websites and search engines. The comparison group was comprised of individuals who registered for Web-based cessation treatment in response to traditional advertising during the same time period. A total of 130,214 individuals responded to advertising during the study period: 23,923 (18.4%) responded to traditional recruitment approaches and 106,291 (81.6%) to online ads. Of those who clicked on an online ad, 9655 (9.1%) registered for cessation treatment: 6.8% (n = 7268) for Web only, 1.1% (n = 1119) for phone only, and 1.2% (n = 1268) for Web and phone. Compared to traditional recruitment approaches, online ads recruited a higher percentage of males, young adults, racial/ethnic minorities, those with a high school education or less, and dependent smokers. Cost-effectiveness analyses compare favorably to traditional recruitment strategies, with costs as low as US $5-$8 per enrolled smoker. Developing and evaluating new ways to increase consumer demand for evidence-based cessation services is critical to cost-efficiently reduce population smoking prevalence. Results suggest that online advertising is a promising approach to recruit smokers to Web- and telephone-based cessation interventions. The enrollment rate of 9.1% exceeds most studies of traditional recruitment approaches. The powerful targeting capabilities of online advertising present new opportunities to reach subgroups of smokers who may not respond to other forms of advertising. Online advertising also provides unique evaluation opportunities and challenges to determine rigorously its impact and value.

Online Advertising as a Public Health and Recruitment Tool: Comparison of Different Media Campaigns to Increase Demand for Smoking Cessation Interventions

PubMed Central

Milner, Pat; Saul, Jessie E; Pfaff, Lillian

2008-01-01

Background To improve the overall impact (reach × efficacy) of cessation treatments and to reduce the population prevalence of smoking, innovative strategies are needed that increase consumer demand for and use of cessation treatments. Given that 12 million people search for smoking cessation information each year, online advertising may represent a cost-efficient approach to reach and recruit online smokers to treatment. Online ads can be implemented in many forms, and surveys consistently show that consumers are receptive. Few studies have examined the potential of online advertising to recruit smokers to cessation treatments. Objective The aims of the study were to (1) demonstrate the feasibility of online advertising as a strategy to increase consumer demand for cessation treatments, (2) illustrate the tools that can be used to track and evaluate the impact of online advertising on treatment utilization, and (3) highlight some of the methodological challenges and future directions for researchers. Methods An observational design was used to examine the impact of online advertising compared to traditional recruitment approaches (billboards, television and radio ads, outdoor advertising, direct mail, and physician detailing) on several dependent variables: (1) number of individuals who enrolled in Web- or telephone-based cessation treatment, (2) the demographic, smoking, and treatment utilization characteristics of smokers recruited to treatment, and (3) the cost to enroll smokers. Several creative approaches to online ads (banner ads, paid search) were tested on national and local websites and search engines. The comparison group was comprised of individuals who registered for Web-based cessation treatment in response to traditional advertising during the same time period. Results A total of 130,214 individuals responded to advertising during the study period: 23,923 (18.4%) responded to traditional recruitment approaches and 106,291 (81.6%) to online ads. Of those who clicked on an online ad, 9655 (9.1%) registered for cessation treatment: 6.8% (n = 7268) for Web only, 1.1% (n = 1119) for phone only, and 1.2% (n = 1268) for Web and phone. Compared to traditional recruitment approaches, online ads recruited a higher percentage of males, young adults, racial/ethnic minorities, those with a high school education or less, and dependent smokers. Cost-effectiveness analyses compare favorably to traditional recruitment strategies, with costs as low as US $5-$8 per enrolled smoker. Conclusions Developing and evaluating new ways to increase consumer demand for evidence-based cessation services is critical to cost-efficiently reduce population smoking prevalence. Results suggest that online advertising is a promising approach to recruit smokers to Web- and telephone-based cessation interventions. The enrollment rate of 9.1% exceeds most studies of traditional recruitment approaches. The powerful targeting capabilities of online advertising present new opportunities to reach subgroups of smokers who may not respond to other forms of advertising. Online advertising also provides unique evaluation opportunities and challenges to determine rigorously its impact and value. PMID:19073542

Computational fluid dynamics modeling of laminar, transitional, and turbulent flows with sensitivity to streamline curvature and rotational effects

NASA Astrophysics Data System (ADS)

Chitta, Varun

Modeling of complex flows involving the combined effects of flow transition and streamline curvature using two advanced turbulence models, one in the Reynolds-averaged Navier-Stokes (RANS) category and the other in the hybrid RANS-Large eddy simulation (LES) category is considered in this research effort. In the first part of the research, a new scalar eddy-viscosity model (EVM) is proposed, designed to exhibit physically correct responses to flow transition, streamline curvature, and system rotation effects. The four equation model developed herein is a curvature-sensitized version of a commercially available three-equation transition-sensitive model. The physical effects of rotation and curvature (RC) enter the model through the added transport equation, analogous to a transverse turbulent velocity scale. The eddy-viscosity has been redefined such that the proposed model is constrained to reduce to the original transition-sensitive model definition in nonrotating flows or in regions with negligible RC effects. In the second part of the research, the developed four-equation model is combined with a LES technique using a new hybrid modeling framework, dynamic hybrid RANS-LES. The new framework is highly generalized, allowing coupling of any desired LES model with any given RANS model and addresses several deficiencies inherent in most current hybrid models. In the present research effort, the DHRL model comprises of the proposed four-equation model for RANS component and the MILES scheme for LES component. Both the models were implemented into a commercial computational fluid dynamics (CFD) solver and tested on a number of engineering and generic flow problems. Results from both the RANS and hybrid models show successful resolution of the combined effects of transition and curvature with reasonable engineering accuracy, and for only a small increase in computational cost. In addition, results from the hybrid model indicate significant levels of turbulent fluctuations in the flowfield, improved accuracy compared to RANS models predictions, and are obtained at a significant reduction of computational cost compared to full LES models. The results suggest that the advanced turbulence modeling techniques presented in this research effort have potential as practical tools for solving low/high Re flows over blunt/curved bodies for the prediction of transition and RC effects.

Cost-effectiveness of a health-social partnership transitional program for post-discharge medical patients.

PubMed

Wong, Frances Kam Yuet; Chau, June; So, Ching; Tam, Stanley Ku Fu; McGhee, Sarah

2012-12-24

Readmissions are costly and have implications for quality of care. Studies have been reported to support effects of transitional care programs in reducing hospital readmissions and enhancing clinical outcomes. However, there is a paucity of studies executing full economic evaluation to assess the cost-effectiveness of these transitional care programs. This study is therefore launched to fill this knowledge gap. Cost-effectiveness analysis was conducted alongside a randomized controlled trial that examined the effects of a Health-Social Transitional Care Management Program (HSTCMP) for medical patients discharged from an acute regional hospital in Hong Kong. The cost and health outcomes were compared between the patients receiving the HSTCMP and usual care. The total costs comprised the pre-program, program, and healthcare utilization costs. Quality of life was measured with SF-36 and transformed to utility values between 0 and 1. The readmission rates within 28 (control 10.2%, study 4.0%) and 84 days (control 19.4%, study 8.1%) were significantly higher in the control group. Utility values showed no difference between the control and study groups at baseline (p = 0.308). Utility values for the study group were significantly higher than in the control group at 28 (p < 0.001) and 84 days (p = 0.002). The study group also had a significantly higher QALYs gain (p < 0.001) over time at 28 and 84 days when compared with the control group. The intervention had an 89% chance of being cost-effective at the threshold of £20000/QALY. Previous studies on transitional care focused mainly on clinical outcomes and not too many included cost as an outcome measure. Studies examining the cost-effectiveness of the post-discharge support services are scanty. This study is the first to examine the cost-effectiveness of a transitional care program that used nurse-led services participated by volunteers. Results have shown that a health-social partnership transitional care program is cost-effective in reducing healthcare costs and attaining QALY gains. Economic evaluation helps to inform funders and guide decisions for the effective use of competing healthcare resources.

Sleep Stage Transition Dynamics Reveal Specific Stage 2 Vulnerability in Insomnia.

PubMed

Wei, Yishul; Colombo, Michele A; Ramautar, Jennifer R; Blanken, Tessa F; van der Werf, Ysbrand D; Spiegelhalder, Kai; Feige, Bernd; Riemann, Dieter; Van Someren, Eus J W

2017-09-01

Objective sleep impairments in insomnia disorder (ID) are insufficiently understood. The present study evaluated whether whole-night sleep stage dynamics derived from polysomnography (PSG) differ between people with ID and matched controls and whether sleep stage dynamic features discriminate them better than conventional sleep parameters. Eighty-eight participants aged 21-70 years, including 46 with ID and 42 age- and sex-matched controls without sleep complaints, were recruited through www.sleepregistry.nl and completed two nights of laboratory PSG. Data of 100 people with ID and 100 age- and sex-matched controls from a previously reported study were used to validate the generalizability of findings. The second night was used to obtain, in addition to conventional sleep parameters, probabilities of transitions between stages and bout duration distributions of each stage. Group differences were evaluated with nonparametric tests. People with ID showed higher empirical probabilities to transition from stage N2 to the lighter sleep stage N1 or wakefulness and a faster decaying stage N2 bout survival function. The increased transition probability from stage N2 to stage N1 discriminated people with ID better than any of their deviations in conventional sleep parameters, including less total sleep time, less sleep efficiency, more stage N1, and more wake after sleep onset. Moreover, adding this transition probability significantly improved the discriminating power of a multiple logistic regression model based on conventional sleep parameters. Quantification of sleep stage dynamics revealed a particular vulnerability of stage N2 in insomnia. The feature characterizes insomnia better than-and independently of-any conventional sleep parameter. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

Biomarkers in Sporadic and Familial Alzheimer's Disease.

PubMed

Lista, Simone; O'Bryant, Sid E; Blennow, Kaj; Dubois, Bruno; Hugon, Jacques; Zetterberg, Henrik; Hampel, Harald

2015-01-01

Most forms of Alzheimer's disease (AD) are sporadic (sAD) or inherited in a non-Mendelian fashion, and less than 1% of cases are autosomal-dominant. Forms of sAD do not exhibit familial aggregation and are characterized by complex genetic and environmental interactions. Recently, the expansion of genomic methodologies, in association with substantially larger combined cohorts, has resulted in various genome-wide association studies that have identified several novel genetic associations of AD. Currently, the most effective methods for establishing the diagnosis of AD are defined by multi-modal pathways, starting with clinical and neuropsychological assessment, cerebrospinal fluid (CSF) analysis, and brain-imaging procedures, all of which have significant cost- and access-to-care barriers. Consequently, research efforts have focused on the development and validation of non-invasive and generalizable blood-based biomarkers. Among the modalities conceptualized by the systems biology paradigm and utilized in the "exploratory biomarker discovery arena", proteome analysis has received the most attention. However, metabolomics, lipidomics, transcriptomics, and epigenomics have recently become key modalities in the search for AD biomarkers. Interestingly, biomarker changes for familial AD (fAD), in many but not all cases, seem similar to those for sAD. The integration of neurogenetics with systems biology/physiology-based strategies and high-throughput technologies for molecular profiling is expected to help identify the causes, mechanisms, and biomarkers associated with the various forms of AD. Moreover, in order to hypothesize the dynamic trajectories of biomarkers through disease stages and elucidate the mechanisms of biomarker alterations, updated and more sophisticated theoretical models have been proposed for both sAD and fAD.

Cost Utility Analysis of Topical Steroids Compared With Dietary Elimination for Treatment of Eosinophilic Esophagitis.

PubMed

Cotton, Cary C; Erim, Daniel; Eluri, Swathi; Palmer, Sarah H; Green, Daniel J; Wolf, W Asher; Runge, Thomas M; Wheeler, Stephanie; Shaheen, Nicholas J; Dellon, Evan S

2017-06-01

Topical corticosteroids or dietary elimination are recommended as first-line therapies for eosinophilic esophagitis, but data to directly compare these therapies are scant. We performed a cost utility comparison of topical corticosteroids and the 6-food elimination diet (SFED) in treatment of eosinophilic esophagitis, from the payer perspective. We used a modified Markov model based on current clinical guidelines, in which transition between states depended on histologic response simulated at the individual cohort-member level. Simulation parameters were defined by systematic review and meta-analysis to determine the base-case estimates and bounds of uncertainty for sensitivity analysis. Meta-regression models included adjustment for differences in study and cohort characteristics. In the base-case scenario, topical fluticasone was about as effective as SFED but more expensive at a 5-year time horizon ($9261.58 vs $5719.72 per person). SFED was more effective and less expensive than topical fluticasone and topical budesonide in the base-case scenario. Probabilistic sensitivity analysis revealed little uncertainty in relative treatment effectiveness. There was somewhat greater uncertainty in the relative cost of treatments; most simulations found SFED to be less expensive. In a cost utility analysis comparing topical corticosteroids and SFED for first-line treatment of eosinophilic esophagitis, the therapies were similar in effectiveness. SFED was on average less expensive, and more cost effective in most simulations, than topical budesonide and topical fluticasone, from a payer perspective and not accounting for patient-level costs or quality of life. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

Economic analysis of fuel ethanol production from winter hulled barley by the EDGE (Enhanced Dry Grind Enzymatic) process.

PubMed

Nghiem, Nhuan P; Ramírez, Edna C; McAloon, Andrew J; Yee, Winnie; Johnston, David B; Hicks, Kevin B

2011-06-01

A process and cost model was developed for fuel ethanol production from winter barley based on the EDGE (Enhanced Dry Grind Enzymatic) process. In this process, in addition to β-glucanases, which are added to reduce the viscosity of the mash, β-glucosidase is also added to completely hydrolyze the oligomers obtained during the hydrolysis of β-glucans to glucose. The model allows determination of capital costs, operating costs, and ethanol production cost for a plant producing 40 million gallons of denatured fuel ethanol annually. A sensitivity study was also performed to examine the effects of β-glucosidase and barley costs on the final ethanol production cost. The results of this study clearly demonstrate the economic benefit of adding β-glucosidase. Lower ethanol production cost was obtained compared to that obtained without β-glucosidase addition in all cases except one where highest β-glucosidase cost allowance and lowest barley cost were used. Copyright © 2011 Elsevier Ltd. All rights reserved.

Machine learning-based method for personalized and cost-effective detection of Alzheimer's disease.

PubMed

Escudero, Javier; Ifeachor, Emmanuel; Zajicek, John P; Green, Colin; Shearer, James; Pearson, Stephen

2013-01-01

Diagnosis of Alzheimer's disease (AD) is often difficult, especially early in the disease process at the stage of mild cognitive impairment (MCI). Yet, it is at this stage that treatment is most likely to be effective, so there would be great advantages in improving the diagnosis process. We describe and test a machine learning approach for personalized and cost-effective diagnosis of AD. It uses locally weighted learning to tailor a classifier model to each patient and computes the sequence of biomarkers most informative or cost-effective to diagnose patients. Using ADNI data, we classified AD versus controls and MCI patients who progressed to AD within a year, against those who did not. The approach performed similarly to considering all data at once, while significantly reducing the number (and cost) of the biomarkers needed to achieve a confident diagnosis for each patient. Thus, it may contribute to a personalized and effective detection of AD, and may prove useful in clinical settings.

Deconstructing the Age-Prevalence Curve of Alcohol Dependence: Why “Maturing Out” is only a Small Piece of the Puzzle

PubMed Central

Vergés, Alvaro; Jackson, Kristina M.; Bucholz, Kathleen K.; Grant, Julia D.; Trull, Timothy J.; Wood, Phillip K.; Sher, Kenneth J.

2012-01-01

Epidemiological studies have consistently demonstrated that heavy alcohol use and alcohol dependence (AD), tend to increase in adolescence and emerging adulthood and then show a large decline in the late 20s, a phenomenon called “maturing out”. This decline has been explained as an effect of “role incompatibility” in which involvement in new roles and activities interferes with a heavy drinking lifestyle. However, maturing out has been conceived mostly as a decrease in offset, with little attention paid to reductions in new onset or recurrence across decades of life. Moreover, although role incompatibility processes have been studied with young samples, little is known about the effect of life transitions (e.g., marriage, parenthood, changes in employment status) on AD later in life and whether similar effects are observed. Using longitudinal data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative epidemiologic survey, we examined the patterns of stability and change in AD across the lifespan and the differential effect of life transitions on AD across different age strata. Results showed that persistence of alcohol dependence tended to increase with age, although not dramatically, and that onset and recurrence tended to decrease with age. Moreover, the effects of life transitions on the course of AD varied across the lifespan and were different for men and women. These results indicate that life transitions differentially affect the patterns of stability and change in younger versus older people, have a different impact for men and women, and highlight the need to consider the unique aspects of each stage of adult development on the course of AD. PMID:22060948

Guidebook : managing operating costs for rural and small urban public transit systems.

DOT National Transportation Integrated Search

2013-05-01

This guidebook is a resource for rural and small urban transit agency managers to use in better understanding, predicting, and managing operational costs. Doing so can improve the efficiency, effectiveness, and sustainability of public transit in the...

Autonomous dial-a-ride transit : benefit-cost evaluation

DOT National Transportation Integrated Search

1998-08-01

Among public transit and for-hire modes, fixed-route bus and rail are most effective in maintaining high ridership in high density areas such as urban centers. The cost effectiveness of fixed-route transit, however, depends on close proximity to the ...

Impact of Flexibility Options on Grid Economic Carrying Capacity of Solar and Wind: Three Case Studies

DOE Office of Scientific and Technical Information (OSTI.GOV)

Denholm, Paul; Novacheck, Joshua; Jorgenson, Jennie

In this study, we attempt to quantify the benefits of various options of grid flexibility by measuring their impact on two measures: economic carrying capacity and system costs. Flexibility can increase ECC and reduce overall system costs. In some cases, options that provide a limited increase in ECC can provide significant operational savings, thus demonstrating the need to evaluate flexibility options using multiple metrics. The value of flexibility options varies regionally due to different generation mixes and types of renewables. The more rapid decline in PV value compared to wind makes PV more dependent on adding flexibility options, including transmissionmore » and energy storage.« less

Critical Components of Exit Transition Services to Postsecondary Education for Students with Disabilities in Southwest Virginia

ERIC Educational Resources Information Center

Lee, Gerald Dale, Jr.

2017-01-01

Students with disabilities face the challenges of transitioning from secondary school to higher education with the added difficulties associated with specific physical, emotional, or learning disabilities. In this qualitative study, this researcher (a) observed practices that transition service professionals used during exit transition meetings…

Weed Dynamics during Transition to Conservation Agriculture in Western Kenya Maize Production

PubMed Central

Odhiambo, Judith A.; Norton, Urszula; Ashilenje, Dennis; Omondi, Emmanuel C.; Norton, Jay B.

2015-01-01

Weed competition is a significant problem in maize (Zea mays, L.) production in Sub-Saharan Africa. Better understanding of weed management and costs in maize intercropped with beans (Phaseolus vulgaris, L.) during transition to conservation agricultural systems is needed. Changes in weed population and maize growth were assessed for a period of three years at Bungoma where crops are grown twice per year and at Trans-Nzoia where crops are grown once per year. Treatments included three tillage practices: minimum (MT), no-till (NT) and conventional (CT) applied to three cropping systems: continuous maize/bean intercropping (TYPICAL), maize/bean intercropping with relayed mucuna after bean harvest (RELAY) and maize, bean and mucuna planted in a strip intercropping arrangement (STRIP). Herbicides were used in NT, shallow hand hoeing and herbicides were used in MT and deep hoeing with no herbicides were used in CT. Weed and maize performance in the maize phase of each cropping system were assessed at both locations and costs of weed control were estimated at Manor House only. Weed density of grass and forb species declined significantly under MT and NT at Manor House and of grass species only at Mabanga. The greatest declines of more than 50% were observed as early as within one year of the transition to MT and NT in STRIP and TYPICAL cropping systems at Manor House. Transitioning to conservation based systems resulted in a decline of four out of five most dominant weed species. At the same time, no negative impact of MT or NT on maize growth was observed. Corresponding costs of weed management were reduced by $148.40 ha-1 in MT and $149.60 ha-1 in NT compared with CT. In conclusion, farmers can benefit from effective and less expensive weed management alternatives early in the process of transitioning to reduced tillage operations. PMID:26237404

Weed Dynamics during Transition to Conservation Agriculture in Western Kenya Maize Production.

PubMed

Odhiambo, Judith A; Norton, Urszula; Ashilenje, Dennis; Omondi, Emmanuel C; Norton, Jay B

2015-01-01

Weed competition is a significant problem in maize (Zea mays, L.) production in Sub-Saharan Africa. Better understanding of weed management and costs in maize intercropped with beans (Phaseolus vulgaris, L.) during transition to conservation agricultural systems is needed. Changes in weed population and maize growth were assessed for a period of three years at Bungoma where crops are grown twice per year and at Trans-Nzoia where crops are grown once per year. Treatments included three tillage practices: minimum (MT), no-till (NT) and conventional (CT) applied to three cropping systems: continuous maize/bean intercropping (TYPICAL), maize/bean intercropping with relayed mucuna after bean harvest (RELAY) and maize, bean and mucuna planted in a strip intercropping arrangement (STRIP). Herbicides were used in NT, shallow hand hoeing and herbicides were used in MT and deep hoeing with no herbicides were used in CT. Weed and maize performance in the maize phase of each cropping system were assessed at both locations and costs of weed control were estimated at Manor House only. Weed density of grass and forb species declined significantly under MT and NT at Manor House and of grass species only at Mabanga. The greatest declines of more than 50% were observed as early as within one year of the transition to MT and NT in STRIP and TYPICAL cropping systems at Manor House. Transitioning to conservation based systems resulted in a decline of four out of five most dominant weed species. At the same time, no negative impact of MT or NT on maize growth was observed. Corresponding costs of weed management were reduced by $148.40 ha(-1) in MT and $149.60 ha(-1) in NT compared with CT. In conclusion, farmers can benefit from effective and less expensive weed management alternatives early in the process of transitioning to reduced tillage operations.

Tunneling and speedup in quantum optimization for permutation-symmetric problems

DOE PAGES

Muthukrishnan, Siddharth; Albash, Tameem; Lidar, Daniel A.

2016-07-21

Tunneling is often claimed to be the key mechanism underlying possible speedups in quantum optimization via quantum annealing (QA), especially for problems featuring a cost function with tall and thin barriers. We present and analyze several counterexamples from the class of perturbed Hamming weight optimization problems with qubit permutation symmetry. We first show that, for these problems, the adiabatic dynamics that make tunneling possible should be understood not in terms of the cost function but rather the semiclassical potential arising from the spin-coherent path-integral formalism. We then provide an example where the shape of the barrier in the final costmore » function is short and wide, which might suggest no quantum advantage for QA, yet where tunneling renders QA superior to simulated annealing in the adiabatic regime. However, the adiabatic dynamics turn out not be optimal. Instead, an evolution involving a sequence of diabatic transitions through many avoided-level crossings, involving no tunneling, is optimal and outperforms adiabatic QA. We show that this phenomenon of speedup by diabatic transitions is not unique to this example, and we provide an example where it provides an exponential speedup over adiabatic QA. In yet another twist, we show that a classical algorithm, spin-vector dynamics, is at least as efficient as diabatic QA. Lastly, in a different example with a convex cost function, the diabatic transitions result in a speedup relative to both adiabatic QA with tunneling and classical spin-vector dynamics.« less

Tunneling and speedup in quantum optimization for permutation-symmetric problems

DOE Office of Scientific and Technical Information (OSTI.GOV)

Muthukrishnan, Siddharth; Albash, Tameem; Lidar, Daniel A.

Tunneling is often claimed to be the key mechanism underlying possible speedups in quantum optimization via quantum annealing (QA), especially for problems featuring a cost function with tall and thin barriers. We present and analyze several counterexamples from the class of perturbed Hamming weight optimization problems with qubit permutation symmetry. We first show that, for these problems, the adiabatic dynamics that make tunneling possible should be understood not in terms of the cost function but rather the semiclassical potential arising from the spin-coherent path-integral formalism. We then provide an example where the shape of the barrier in the final costmore » function is short and wide, which might suggest no quantum advantage for QA, yet where tunneling renders QA superior to simulated annealing in the adiabatic regime. However, the adiabatic dynamics turn out not be optimal. Instead, an evolution involving a sequence of diabatic transitions through many avoided-level crossings, involving no tunneling, is optimal and outperforms adiabatic QA. We show that this phenomenon of speedup by diabatic transitions is not unique to this example, and we provide an example where it provides an exponential speedup over adiabatic QA. In yet another twist, we show that a classical algorithm, spin-vector dynamics, is at least as efficient as diabatic QA. Lastly, in a different example with a convex cost function, the diabatic transitions result in a speedup relative to both adiabatic QA with tunneling and classical spin-vector dynamics.« less

13 CFR 120.882 - Eligible Project costs for 504 loans.

Code of Federal Regulations, 2012 CFR

2012-01-01

... expansion may be refinanced and added to the expansion cost if: (1) Substantially all (85% or more) of the...). Prepayment penalties, financing fees, and other financing costs must also be added to the amount being... current fair market value of the fixed assets serving as collateral for the Refinancing Project, including...

Mifamurtide for high-grade, resectable, nonmetastatic osteosarcoma following surgical resection: a cost-effectiveness analysis.

PubMed

Johal, Sukhvinder; Ralston, Stephen; Knight, Christopher

2013-12-01

Mifamurtide is an immune macrophage stimulant that when added to standard chemotherapy has demonstrated survival benefit for newly diagnosed osteosarcoma. The objectives of this study were to investigate the cost-effectiveness of adding mifamurtide to standard three- or four-agent chemotherapy for high-grade, resectable, nonmetastatic osteosarcoma following surgical resection and the issues of obtaining robust cost-effectiveness estimates for ultra-orphan drugs, given the shortage of data. An economic evaluation was conducted from the perspective of the UK's National Health Service as part of the manufacturer's submission to the National Institute for Health and Care Excellence. The disease process was simplified to a transition through a series of health states, modeled by using a Markov approach. Data to inform the model were derived from patient-level data of Study INT-0133, published literature, and expert opinion. The final efficacy measure was life-years gained (LYG), and utilities were used to obtain quality-adjusted life-years (QALYs). For a 60-year time frame and a discount rate of 3.5% for outcomes, patients receiving mifamurtide benefited from an average additional 1.57 years of life and 1.34 QALYs, compared with patients receiving chemotherapy alone, giving an incremental cost-effectiveness ratio (ICER) of £58,737 per LYG and £68,734 per QALY. Because treatment effects were both substantial in restoring health and sustained over a very long period, the National Institute for Health and Care Excellence changed its guidance to allow a discount of 1.5% for outcomes to be applied in these special circumstances. By using this discount factor, it was found that patients receiving mifamurtide had an average additional 2.58 years of life and 2.20 QALYs compared with patients receiving chemotherapy alone, resulting in an ICER of £35,765 per LYG and £41,933 per QALY. Mifamurtide's ICER is cost-effective compared with that of other orphan and ultra-orphan drugs, for which prices and corresponding cost-effectiveness estimates are high. Copyright © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Comparison of costs and outcomes of dapagliflozin with other glucose-lowering therapy classes added to metformin using a short-term cost-effectiveness model in the US setting.

PubMed

Chakravarty, Abhiroop; Rastogi, Mohini; Dhankhar, Praveen; Bell, Kelly F

2018-05-01

To compare 1-year costs and benefits of dapagliflozin (DAPA), a sodium-glucose cotransporter-2 (SGLT-2) inhibitor, with those of other treatments for type 2 diabetes (T2D), such as glucagon-like peptide-1 receptor agonists (GLP-1RAs), sulfonylureas (SUs), thiazolidinediones (TZDs), and dipeptidyl peptidase-4 inhibitors (DPP-4i), all combined with metformin. A short-term decision-analytic model with a 1-year time horizon was developed from a payer's perspective in the United States setting. Costs and benefits associated with four clinical end-points (glycated hemoglobin [A1C], body weight, systolic blood pressure [SBP], and risk of hypoglycemia) were evaluated in the analysis. The impact of DAPA and other glucose-lowering therapy classes on these clinical end-points was estimated from a network meta-analysis (NMA). Data for costs and quality-adjusted life-years (QALYs) associated with a per-unit change in these clinical end-points were taken from published literature. Drug prices were taken from an annual wholesale price list. All costs were inflation-adjusted to December 2016 costs using the medical care component of the consumer price index. Total costs (both medical and drug costs), total QALYs, and incremental cost-effectiveness ratios (ICERs) were estimated. Sensitivity analyses (SA) were performed to explore uncertainty in the inputs. To assess face validity, results from the short-term model were compared with long-term models published for these drugs. The total annual medical cost for DAPA was less than that for GLP-1RA ($186 less), DPP-4i ($1,142 less), SU ($2,474 less), and TZD ($1,640 less). Treatment with DAPA resulted in an average QALY gain of 0.0107, 0.0587, 0.1137, and 0.0715 per treated patient when compared with GLP-1RA, DPP-4i, SU, and TZD, respectively. ICERs for DAPA vs SU and TZD were $19,005 and $25,835, respectively. DAPA was a cost-saving option when compared with GLP-1RAs and DPP-4is. Among all four clinical end-points, change in weight had the greatest impact on total annual costs and ICERS. Sensitivity analysis showed that results were robust, and results from the short-term model were found to be similar to those of published long-term models. This analysis showed that DAPA was cost-saving compared with GLP-1RA and DPP-4i, and cost-effective compared with SU and TZD in the US setting over 1 year. Furthermore, the results suggest that, among the four composite clinical end-points, change in weight and SBP had an impact on cost-effectiveness results.

Recall of "The Real Cost" Anti-Smoking Campaign Is Specifically Associated With Endorsement of Campaign-Targeted Beliefs.

PubMed

Kranzler, Elissa C; Gibson, Laura A; Hornik, Robert C

2017-10-01

Though previous research suggests the FDA's "The Real Cost" anti-smoking campaign has reduced smoking initiation, the theorized pathway of effects (through targeted beliefs) has not been evaluated. This study assesses the relationship between recall of campaign television advertisements and ad-specific anti-smoking beliefs. Respondents in a nationally representative survey of nonsmoking youths age 13-17 (n = 4,831) reported exposure to four The Real Cost advertisements and a fake ad, smoking-relevant beliefs, and nonsmoking intentions. Analyses separately predicted each targeted belief from specific ad recall, adjusting for potential confounders and survey weights. Parallel analyses with non-targeted beliefs showed smaller effects, strengthening claims of campaign effects. Recall of four campaign ads (but not the fake ad) significantly predicted endorsement of the ad-targeted belief (Mean β = .13). Two-sided sign tests indicated stronger ad recall associations with the targeted belief relative to the non-targeted belief (p < .05). Logistic regression analyses indicated that respondents who endorsed campaign-targeted beliefs were more likely to have no intention to smoke (p < .01). This study is the first to demonstrate a relationship between recall of ads from The Real Cost campaign and the theorized pathway of effects (through targeted beliefs). These analyses also provide a methodological template for showing campaign effects despite limitations of available data.

Rapid Transit Noise Abatement and Cost Requirements (MBTA Pilot Study)

DOT National Transportation Integrated Search

1973-06-01

A methodology is described, based on a study conducted on the Massachusetts Bay Transit Authority Blue, Red and Orange Lines, to assess the acoustic noise climate of an urban rail transit system and the appropriate technology to cost-effectively redu...

Transit forecasting accuracy : ridership forecasts and capital cost estimates, final research report.

DOT National Transportation Integrated Search

2009-01-01

In 1992, Pickrell published a seminal piece examining the accuracy of ridership forecasts and capital cost estimates for fixed-guideway transit systems in the US. His research created heated discussions in the transit industry regarding the ability o...

Effectiveness and Cost Effectiveness of Oral Pre-Exposure Prophylaxis in a Portfolio of Prevention Programs for Injection Drug Users in Mixed HIV Epidemics

PubMed Central

Alistar, Sabina S.; Owens, Douglas K.; Brandeau, Margaret L.

2014-01-01

Background Pre-exposure prophylaxis with oral antiretroviral treatment (oral PrEP) for HIV-uninfected injection drug users (IDUs) is potentially useful in controlling HIV epidemics with a significant injection drug use component. We estimated the effectiveness and cost effectiveness of strategies for using oral PrEP in various combinations with methadone maintenance treatment (MMT) and antiretroviral treatment (ART) in Ukraine, a representative case for mixed HIV epidemics. Methods and Findings We developed a dynamic compartmental model of the HIV epidemic in a population of non-IDUs, IDUs who inject opiates, and IDUs in MMT, adding an oral PrEP program (tenofovir/emtricitabine, 49% susceptibility reduction) for uninfected IDUs. We analyzed intervention portfolios consisting of oral PrEP (25% or 50% of uninfected IDUs), MMT (25% of IDUs), and ART (80% of all eligible patients). We measured health care costs, quality-adjusted life years (QALYs), HIV prevalence, HIV infections averted, and incremental cost effectiveness. A combination of PrEP for 50% of IDUs and MMT lowered HIV prevalence the most in both IDUs and the general population. ART combined with MMT and PrEP (50% access) averted the most infections (14,267). For a PrEP cost of $950, the most cost-effective strategy was MMT, at $520/QALY gained versus no intervention. The next most cost-effective strategy consisted of MMT and ART, costing $1,000/QALY gained compared to MMT alone. Further adding PrEP (25% access) was also cost effective by World Health Organization standards, at $1,700/QALY gained. PrEP alone became as cost effective as MMT at a cost of $650, and cost saving at $370 or less. Conclusions Oral PrEP for IDUs can be part of an effective and cost-effective strategy to control HIV in regions where injection drug use is a significant driver of the epidemic. Where budgets are limited, focusing on MMT and ART access should be the priority, unless PrEP has low cost. PMID:24489747

Estimation of Survival Probabilities for Use in Cost-effectiveness Analyses: A Comparison of a Multi-state Modeling Survival Analysis Approach with Partitioned Survival and Markov Decision-Analytic Modeling

PubMed Central

Williams, Claire; Lewsey, James D.; Mackay, Daniel F.; Briggs, Andrew H.

2016-01-01

Modeling of clinical-effectiveness in a cost-effectiveness analysis typically involves some form of partitioned survival or Markov decision-analytic modeling. The health states progression-free, progression and death and the transitions between them are frequently of interest. With partitioned survival, progression is not modeled directly as a state; instead, time in that state is derived from the difference in area between the overall survival and the progression-free survival curves. With Markov decision-analytic modeling, a priori assumptions are often made with regard to the transitions rather than using the individual patient data directly to model them. This article compares a multi-state modeling survival regression approach to these two common methods. As a case study, we use a trial comparing rituximab in combination with fludarabine and cyclophosphamide v. fludarabine and cyclophosphamide alone for the first-line treatment of chronic lymphocytic leukemia. We calculated mean Life Years and QALYs that involved extrapolation of survival outcomes in the trial. We adapted an existing multi-state modeling approach to incorporate parametric distributions for transition hazards, to allow extrapolation. The comparison showed that, due to the different assumptions used in the different approaches, a discrepancy in results was evident. The partitioned survival and Markov decision-analytic modeling deemed the treatment cost-effective with ICERs of just over £16,000 and £13,000, respectively. However, the results with the multi-state modeling were less conclusive, with an ICER of just over £29,000. This work has illustrated that it is imperative to check whether assumptions are realistic, as different model choices can influence clinical and cost-effectiveness results. PMID:27698003

Estimation of Survival Probabilities for Use in Cost-effectiveness Analyses: A Comparison of a Multi-state Modeling Survival Analysis Approach with Partitioned Survival and Markov Decision-Analytic Modeling.

PubMed

Williams, Claire; Lewsey, James D; Mackay, Daniel F; Briggs, Andrew H

2017-05-01

Modeling of clinical-effectiveness in a cost-effectiveness analysis typically involves some form of partitioned survival or Markov decision-analytic modeling. The health states progression-free, progression and death and the transitions between them are frequently of interest. With partitioned survival, progression is not modeled directly as a state; instead, time in that state is derived from the difference in area between the overall survival and the progression-free survival curves. With Markov decision-analytic modeling, a priori assumptions are often made with regard to the transitions rather than using the individual patient data directly to model them. This article compares a multi-state modeling survival regression approach to these two common methods. As a case study, we use a trial comparing rituximab in combination with fludarabine and cyclophosphamide v. fludarabine and cyclophosphamide alone for the first-line treatment of chronic lymphocytic leukemia. We calculated mean Life Years and QALYs that involved extrapolation of survival outcomes in the trial. We adapted an existing multi-state modeling approach to incorporate parametric distributions for transition hazards, to allow extrapolation. The comparison showed that, due to the different assumptions used in the different approaches, a discrepancy in results was evident. The partitioned survival and Markov decision-analytic modeling deemed the treatment cost-effective with ICERs of just over £16,000 and £13,000, respectively. However, the results with the multi-state modeling were less conclusive, with an ICER of just over £29,000. This work has illustrated that it is imperative to check whether assumptions are realistic, as different model choices can influence clinical and cost-effectiveness results.

When and why do old adults outsource control to the environment?

PubMed

Mayr, Ulrich; Spieler, Daniel H; Hutcheon, Thomas G

2015-09-01

Old adults' tendency to rely on information present in the environment rather than internal representations has been frequently noted, but is not well understood. The fade-out paradigm provides a useful model situation to study this internal-to-external shift across the life span: Subjects need to transition from an initial, cued task-switching phase to a fade-out phase where only 1 task remains relevant. Old adults exhibit large response-time "fade-out costs," mainly because they continue to consult the task cues. Here we show that age differences in fade-out costs remain very large even when we insert between the task-switching and the fade-out phase 20 single-task trials without task cues (during which even old adults' performance becomes highly fluent; Experiment 1), but costs in old adults are eliminated when presenting an on-screen instruction to focus on the 1 remaining task at the transition point between the task-switching and fade-out phase (Experiment 2). Furthermore, old adults, but not young adults, also exhibited "fade-in costs" when they were instructed to perform an initial single-task phase that would be followed by the cued task-switching phase (Experiment 3). Combined, these results show that old adults' tendency to overutilize external support is not a problem of perseverating earlier-relevant control settings. Instead, old adults seem less likely to initiate the necessary reconfiguration process when transitioning from 1 phase to the next because they use underspecified task models that lack the higher-level distinction between those contexts that do and that do not require external support. (c) 2015 APA, all rights reserved).

Health Trajectories of Family Caregivers: Associations With Care Transitions and Adult Day Service Use

PubMed Central

Liu, Yin; Kim, Kyungmin; Zarit, Steven H.

2017-01-01

Objective The study examines family caregivers’ health changes over 1 year on four health dimensions and explores the association of differential health trajectories with adult day service (ADS) use and caregiving transitions. Method The participants were 153 primary caregivers of individuals with dementia (IWDs) who provided information on care situations and their own health at baseline, 6-month, and 12-month interviews. Results Caregivers showed increasing functional limitations and decreasing bodily pain over time, whereas role limitation and general health perception remained stable. Furthermore, caregivers’ trajectories of functional limitation were associated with their extent of ADS use at baseline and their relatives’ placement. Discussion Health is multidimensional; all dimensions of caregiver health do not change in a uniform manner. The findings underscore the importance of the association of caregiving transitions and caregiver health and the potential health benefits of ADS use for family caregivers. PMID:25348275

Health trajectories of family caregivers: associations with care transitions and adult day service use.

PubMed

Liu, Yin; Kim, Kyungmin; Zarit, Steven H

2015-06-01

The study examines family caregivers' health changes over 1 year on four health dimensions and explores the association of differential health trajectories with adult day service (ADS) use and caregiving transitions. The participants were 153 primary caregivers of individuals with dementia (IWDs) who provided information on care situations and their own health at baseline, 6-month, and 12-month interviews. Caregivers showed increasing functional limitations and decreasing bodily pain over time, whereas role limitation and general health perception remained stable. Furthermore, caregivers' trajectories of functional limitation were associated with their extent of ADS use at baseline and their relatives' placement. Health is multidimensional; all dimensions of caregiver health do not change in a uniform manner. The findings underscore the importance of the association of caregiving transitions and caregiver health and the potential health benefits of ADS use for family caregivers. © The Author(s) 2014.

SPECT in Alzheimer`s disease and the dementias

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bonte, F.J.

1991-12-31

Among 90 patients with a clinical diagnosis of Alzheimer`s disease (AD), two subgroups were identified for special study, including 42 patients who had a history of dementia in one or more first-degree relatives, and 14 who had a diagnosis of early AD. Of the 42 patients with a family history of dementia, 34 out of the 35 patients whose final clinical diagnosis was possible or probable AD had positive SPECT rCBF studies. Studies in the 14 patients thought to have very early AD were positive in 11 cases. This finding suggests that altered cortical physiology, and hence, rCBF, occurs quitemore » early in the course of AD, perhaps before the onset of symptoms. It is possible that Xenon 133 rCBF studies might be used to detect the presence of subclinical AD in a population of individuals at risk to this disorder. Despite the drawbacks of a radionuclide with poor photon energy, Xenon 133, with its low cost and round-the-clock availability, deserves further study. Although the physical characteristics of Xenon 127 might make it preferable as a SPECT tracer, it is still not regularly available, and some instrument systems are not designed to handle its higher photon energies.« less

Localized AdS_{5}×S^{5} Black Holes.

PubMed

Dias, Óscar J C; Santos, Jorge E; Way, Benson

2016-10-07

According to heuristic arguments, global AdS_{5}×S^{5} black holes are expected to undergo a phase transition in the microcanonical ensemble. At high energies, one expects black holes that respect the symmetries of the S^{5}; at low energies, one expects "localized" black holes that appear pointlike on the S^{5}. According to anti-de Sitter/conformal field theory correspondence, N=4 supersymmetric Yang-Mills (SYM) theory on a 3-sphere should therefore exhibit spontaneous R-symmetry breaking at strong coupling. In this Letter, we numerically construct these localized black holes. We extrapolate the location of this phase transition, and compute the expectation value of the broken scalar operator with lowest conformal dimension. Via the correspondence, these results offer quantitative predictions for N=4 SYM theory.

Cost-effectiveness of different screening strategies for osteoporosis in postmenopausal women.

PubMed

Nayak, Smita; Roberts, Mark S; Greenspan, Susan L

2011-12-06

The best strategies to screen postmenopausal women for osteoporosis are not clear. To identify the cost-effectiveness of various screening strategies. Individual-level state-transition cost-effectiveness model. Published literature. U.S. women aged 55 years or older. Lifetime. Payer. Screening strategies composed of alternative tests (central dual-energy x-ray absorptiometry [DXA], calcaneal quantitative ultrasonography [QUS], and the Simple Calculated Osteoporosis Risk Estimation [SCORE] tool) initiation ages, treatment thresholds, and rescreening intervals. Oral bisphosphonate treatment was assumed, with a base-case adherence rate of 50% and a 5-year on/off treatment pattern. Incremental cost-effectiveness ratios (2010 U.S. dollars per quality-adjusted life-year [QALY] gained). At all evaluated ages, screening was superior to not screening. In general, quality-adjusted life-days gained with screening tended to increase with age. At all initiation ages, the best strategy with an incremental cost-effectiveness ratio (ICER) of less than $50,000 per QALY was DXA screening with a T-score threshold of -2.5 or less for treatment and with follow-up screening every 5 years. Across screening initiation ages, the best strategy with an ICER less than $50,000 per QALY was initiation of screening at age 55 years by using DXA -2.5 with rescreening every 5 years. The best strategy with an ICER less than $100,000 per QALY was initiation of screening at age 55 years by using DXA with a T-score threshold of -2.0 or less for treatment and then rescreening every 10 years. No other strategy that involved treatment of women with osteopenia had an ICER less than $100,000 per QALY. Many other strategies, including strategies with SCORE or QUS prescreening, were also cost-effective, and in general the differences in effectiveness and costs between evaluated strategies was small. Probabilistic sensitivity analysis did not reveal a consistently superior strategy. Data were primarily from white women. Screening initiation at ages younger than 55 years were not examined. Only osteoporotic fractures of the hip, vertebrae, and wrist were modeled. Many strategies for postmenopausal osteoporosis screening are effective and cost-effective, including strategies involving screening initiation at age 55 years. No strategy substantially outperforms another. National Center for Research Resources.

Record high magnetic ordering temperature in a lanthanide at extreme pressure

DOE PAGES

Lim, J.; Fabbris, G.; Haskel, D.; ...

2017-11-07

Today's best permanent magnet materials, SmCo 5 and Nd 2Fe 14B, could likely be made signi fi cantly more powerful were it not necessary to dilute the strong magnetism of the rare earth ions (Sm, Nd) with the 3 d transition elements (Fe, Co). Since the rare-earth metals order magnetically at relatively low temperatures T o <= 292 K, transition elements must be added to bring T o to temperatures well above ambient. Under pressure T o (P) for the neighboring lanthanides Gd, Tb, and Dy follows a notably nonmonotonic, but nearly identical, dependence to similar to 60 GPa. Atmore » higher pressures, however, Tb and Dy exhibit highly anomalous behavior, T o for Dy soaring to temperatures well above ambient. In conclusion, we suggest that this anomalously high magnetic ordering temperature is an heretofore unrecognized feature of the Kondo lattice state.« less

Record high magnetic ordering temperature in a lanthanide at extreme pressure

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lim, J.; Fabbris, G.; Haskel, D.

Today's best permanent magnet materials, SmCo 5 and Nd 2Fe 14B, could likely be made signi fi cantly more powerful were it not necessary to dilute the strong magnetism of the rare earth ions (Sm, Nd) with the 3 d transition elements (Fe, Co). Since the rare-earth metals order magnetically at relatively low temperatures T o <= 292 K, transition elements must be added to bring T o to temperatures well above ambient. Under pressure T o (P) for the neighboring lanthanides Gd, Tb, and Dy follows a notably nonmonotonic, but nearly identical, dependence to similar to 60 GPa. Atmore » higher pressures, however, Tb and Dy exhibit highly anomalous behavior, T o for Dy soaring to temperatures well above ambient. In conclusion, we suggest that this anomalously high magnetic ordering temperature is an heretofore unrecognized feature of the Kondo lattice state.« less

Transit bus life cycle cost and year 2007 emissions estimation.

DOT National Transportation Integrated Search

2007-06-01

The report presents a study of transit bus life cycle cost (LCC) analysis, and projected transit bus emissions and fuel economy for 2007 : model year buses. It covers four bus types: diesel buses using ultra low sulfur diesel (ULSD), diesel buses usi...

Study on the effect of transition curve to the dynamic characteristics of high-temperature superconducting maglev

NASA Astrophysics Data System (ADS)

Qian, Nan; Zheng, Botian; Gou, Yanfeng; Chen, Ping; Zheng, Jun; Deng, Zigang

2015-12-01

High temperature superconducting (HTS) maglev technology is becoming more and more mature, and many key technologies have been deeply studied. However, the transition curve plays a key role in HTS maglev system, and related studies have not been carried out. In this paper series of simulations were conducted to test the lateral and vertical vibration of HTS maglev when passing through curves. Two magnetic guideways, of which one has transition curves but the other does not, are designed to test the vibration characteristics of a mini HTS maglev model running though curves. Results show that after adding transition curves between straight line and circular curve the vibration of HTS maglev model in lateral and vertical directions are all weakened in different degrees. It proves that adding transition curve into HTS maglev system is favorable and necessary.

77 FR 12448 - Airworthiness Directives; Pratt & Whitney Division Turbofan Engines

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-01

... Delta Airlines, Inc. requested that we specify replacing affected FMUs with FMU P/N 53U044, or later FAA... actual cost of the AD; not other costs. We did not change the AD. Request To Replace FMUs On-Wing United Parcel Service Co. requested that we include in the AD the option to perform on-wing replacements of...

Technical and economic assessment of different options for minor actinide transmutation: the French case

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chabert, C.; Coquelet-Pascal, C.; Saturnin, A.

Studies have been performed to assess the industrial perspectives of partitioning and transmutation of long-lived elements. These studies were carried out in tight connection with GEN-IV systems development. The results include the technical and economic evaluation of fuel cycle scenarios along with different options for optimizing the processes between the minor actinide transmutation in fast neutron reactors, their interim storage and geological disposal of ultimate waste. The results are analysed through several criteria (impacts on waste, on waste repository, on fuel cycle plants, on radiological exposure of workers, on costs and on industrial risks). These scenario evaluations take place inmore » the French context which considers the deployment of the first Sodium-cooled Fast Reactor (SFR) in 2040. 3 management options of minor actinides have been studied: no transmutation, transmutation in SFR and transmutation in an accelerator-driven system (ADS). Concerning economics the study shows that the cost overrun related to the transmutation process could vary between 5 to 9% in SFR and 26 % in the case of ADS.« less

Economic evaluation of a multifactorial, interdisciplinary intervention versus usual care to reduce frailty in frail older people.

PubMed

Fairhall, Nicola; Sherrington, Catherine; Kurrle, Susan E; Lord, Stephen R; Lockwood, Keri; Howard, Kirsten; Hayes, Alison; Monaghan, Noeline; Langron, Colleen; Aggar, Christina; Cameron, Ian D

2015-01-01

To compare the costs and cost-effectiveness of a multifactorial interdisciplinary intervention versus usual care for older people who are frail. Cost-effectiveness study embedded within a randomized controlled trial. Community-based intervention in Sydney, Australia. A total of 241 community-dwelling people 70 years or older who met the Cardiovascular Health Study criteria for frailty. A 12-month multifactorial, interdisciplinary intervention targeting identified frailty characteristics versus usual care. Health and social service use, frailty, and health-related quality of life (EQ-5D) were measured over the 12-month intervention period. The difference between the mean cost per person for 12 months in the intervention and control groups (incremental cost) and the ratio between incremental cost and effectiveness were calculated. A total of 216 participants (90%) completed the study. The prevalence of frailty was 14.7% lower in the intervention group compared with the control group at 12 months (95% CI 2.4%-27.0%; P = .02). There was no significant between-group difference in EQ-5D utility scores. The cost for 1 extra person to transition out of frailty was $A15,955 (at 2011 prices). In the "very frail" subgroup (participants met >3 Cardiovascular Health Study frailty criteria), the intervention was both more effective and less costly than the control. A cost-effectiveness acceptability curve shows that the intervention would be cost-effective with 80% certainty if decision makers were willing to pay $A50,000 per extra person transitioning from frailty. In the very frail subpopulation, this reduced to $25,000. For frail older people residing in the community, a 12-month multifactorial intervention provided better value for money than usual care, particularly for the very frail, in whom it has a high probability of being cost saving, as well as effective. Trial registration: ACTRN12608000250336. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Transport and percolation in complex networks

NASA Astrophysics Data System (ADS)

Li, Guanliang

To design complex networks with optimal transport properties such as flow efficiency, we consider three approaches to understanding transport and percolation in complex networks. We analyze the effects of randomizing the strengths of connections, randomly adding long-range connections to regular lattices, and percolation of spatially constrained networks. Various real-world networks often have links that are differentiated in terms of their strength, intensity, or capacity. We study the distribution P(σ) of the equivalent conductance for Erdoḧs-Rényi (ER) and scale-free (SF) weighted resistor networks with N nodes, for which links are assigned with conductance σ i ≡ e-axi, where xi is a random variable with 0 < xi < 1. We find, both analytically and numerically, that P(σ) for ER networks exhibits two regimes: (i) For σ < e-apc, P(σ) is independent of N and scales as a power law P(σ) ˜ sk/a-1 . Here pc = 1/ is the critical percolation threshold of the network and is the average degree of the network. (ii) For σ > e -apc, P(σ) has strong N dependence and scales as P(σ) ˜ f(σ, apc/N1/3). Transport properties are greatly affected by the topology of networks. We investigate the transport problem in lattices with long-range connections and subject to a cost constraint, seeking design principles for optimal transport networks. Our network is built from a regular d-dimensional lattice to be improved by adding long-range connections with probability Pij ˜ r-aij , where rij is the lattice distance between site i and j. We introduce a cost constraint on the total length of the additional links and find optimal transport in the system for α = d + 1, established here for d = 1, 2 and 3 for regular lattices and df for fractals. Remarkably, this cost constraint approach remains optimal, regardless of the strategy used for transport, whether based on local or global knowledge of the network structure. To further understand the role that long-range connections play in optimizing the transport of complex systems, we study the percolation of spatially constrained networks. We now consider originally empty lattices embedded in d dimensions by adding long-range connections with the same power law probability p(r) ˜ r -α. We find that, for α ≤ d, the percolation transition belongs to the universality class of percolation in ER networks, while for α > 2d it belongs to the universality class of percolation in regular lattices (for one-dimensional linear chain, there is no percolation transition). However for d < α < 2d, the percolation properties show new intermediate behavior different from ER networks, with critical exponents that depend on α.

Shuttle bit rate synchronizer. [signal to noise ratios and error analysis

NASA Technical Reports Server (NTRS)

Huey, D. C.; Fultz, G. L.

1974-01-01

A shuttle bit rate synchronizer brassboard unit was designed, fabricated, and tested, which meets or exceeds the contractual specifications. The bit rate synchronizer operates at signal-to-noise ratios (in a bit rate bandwidth) down to -5 dB while exhibiting less than 0.6 dB bit error rate degradation. The mean acquisition time was measured to be less than 2 seconds. The synchronizer is designed around a digital data transition tracking loop whose phase and data detectors are integrate-and-dump filters matched to the Manchester encoded bits specified. It meets the reliability (no adjustments or tweaking) and versatility (multiple bit rates) of the shuttle S-band communication system through an implementation which is all digital after the initial stage of analog AGC and A/D conversion.

Relative Economic Merits of Storage and Combustion Turbines for Meeting Peak Capacity Requirements under Increased Penetration of Solar Photovoltaics

DOE Office of Scientific and Technical Information (OSTI.GOV)

Denholm, Paul; Diakov, Victor; Margolis, Robert

Batteries with several hours of capacity provide an alternative to combustion turbines for meeting peak capacity requirements. Even when compared to state-of-the-art highly flexible combustion turbines, batteries can provide a greater operational value, which is reflected in a lower system-wide production cost. By shifting load and providing operating reserves, batteries can reduce the cost of operating the power system to a traditional electric utility. This added value means that, depending on battery life, batteries can have a higher cost than a combustion turbine of equal capacity and still produce a system with equal or lower overall life-cycle cost. For amore » utility considering investing in new capacity, the cost premium for batteries is highly sensitive to a variety of factors, including lifetime, natural gas costs, PV penetration, and grid generation mix. In addition, as PV penetration increases, the net electricity demand profile changes, which may reduce the amount of battery energy capacity needed to reliably meet peak demand.« less

Economic Evaluation of Dupilumab for the Treatment of Moderate-to-Severe Atopic Dermatitis in Adults.

PubMed

Kuznik, Andreas; Bégo-Le-Bagousse, Gaëlle; Eckert, Laurent; Gadkari, Abhijit; Simpson, Eric; Graham, Christopher N; Miles, LaStella; Mastey, Vera; Mahajan, Puneet; Sullivan, Sean D

2017-12-01

Dupilumab significantly improves signs and symptoms of atopic dermatitis (AD), including pruritus, symptoms of anxiety and depression, and health-related quality of life versus placebo in adults with moderate-to-severe AD. Since the cost-effectiveness of dupilumab has not been evaluated, the objective of this analysis was to estimate a value-based price range in which dupilumab would be considered cost-effective compared with supportive care (SC) for treatment of moderate-to-severe AD in an adult population. A health economic model was developed to evaluate from the US payer perspective the long-term costs and benefits of dupilumab treatment administered every other week (q2w). Dupilumab q2w was compared with SC; robustness of assumptions and results were tested using sensitivity and scenario analyses. Clinical data were derived from the dupilumab LIBERTY AD SOLO trials; healthcare use and cost data were from health insurance claims histories of adult patients with AD. The annual price of maintenance therapy with dupilumab to be considered cost-effective was estimated for decision thresholds of US$100,000 and $150,000 per quality-adjusted life-year (QALY) gained. In the base case, the annual maintenance price for dupilumab therapy to be considered cost-effective would be $28,770 at a $100,000 per QALY gained threshold, and $39,940 at a $150,000 threshold. Results were generally robust to parameter variations in one-way and probabilistic sensitivity analyses. Dupilumab q2w compared with SC is cost-effective for the treatment of moderate-to-severe AD in US adults at an annual price of maintenance therapy in the range of $29,000-$40,000 at the $100,000-$150,000 per QALY thresholds. Sanofi and Regeneron Pharmaceuticals, Inc.

The dynamic nature of risk perceptions after a fatal transit accident.

PubMed

Wernstedt, Kris; Murray-Tuite, Pamela

2015-03-01

In 2009, two trains of Washington, DC's Metrorail system collided, resulting in nine deaths and 50 serious injuries. Based on a multiwave survey of Metrorail users in the months after the crash, this article reports how the accident appears to have (1) changed over time the tradeoffs among safety, speed, frequency of service, cost, and reliability that the transit users stated they were willing to make in the postaccident period and (2) altered transit users' concerns about safety as a function of time and distance from the accident site. We employ conditional logit models to examine tradeoffs among stated preferences for system performance measures after the accident, as well as the influence that respondent characteristics of transit use, location, income, age, and gender have on these preference tradeoffs. As expected, respondents appear averse to longer headways between trains, longer travel durations, higher travel costs, a higher number of late trains, and a higher number of fatalities. The models also show evidence of higher aversion to fatalities from transit system operation among females compared to males. In addition, respondents less experienced with Metrorail travel and those with lower household incomes show higher aversion to fatalities, and this aversion increases as a subject's psychological distance from the accident site decreases. Contrary to expectations shaped by previous studies, aversion to fatalities appears to have increased between the early months after the accident and the end of the survey period, and the expected relationship between age and aversion to fatalities is not statistically significant. © 2014 Society for Risk Analysis.

Cost-effectiveness of multidisciplinary care in mild to moderate chronic kidney disease in the United States: A modeling study

PubMed Central

Malcolm, Elizabeth; Goldhaber-Fiebert, Jeremy D.

2018-01-01

Background Multidisciplinary care (MDC) programs have been proposed as a way to alleviate the cost and morbidity associated with chronic kidney disease (CKD) in the US. Methods and findings We assessed the cost-effectiveness of a theoretical Medicare-based MDC program for CKD compared to usual CKD care in Medicare beneficiaries with stage 3 and 4 CKD between 45 and 84 years old in the US. The program used nephrologists, advanced practitioners, educators, dieticians, and social workers. From Medicare claims and published literature, we developed a novel deterministic Markov model for CKD progression and calibrated it to long-term risks of mortality and progression to end-stage renal disease. We then used the model to project accrued discounted costs and quality-adjusted life years (QALYs) over patients’ remaining lifetime. We estimated the incremental cost-effectiveness ratio (ICER) of MDC, or the cost of the intervention per QALY gained. MDC added 0.23 (95% CI: 0.08, 0.42) QALYs over usual care, costing $51,285 per QALY gained (net monetary benefit of $23,100 at a threshold of $150,000 per QALY gained; 95% CI: $6,252, $44,323). In all subpopulations analyzed, ICERs ranged from $42,663 to $72,432 per QALY gained. MDC was generally more cost-effective in patients with higher urine albumin excretion. Although ICERs were higher in younger patients, MDC could yield greater improvements in health in younger than older patients. MDC remained cost-effective when we decreased its effectiveness to 25% of the base case or increased the cost 5-fold. The program costed less than $70,000 per QALY in 95% of probabilistic sensitivity analyses and less than $87,500 per QALY in 99% of analyses. Limitations of our study include its theoretical nature and being less generalizable to populations at low risk for progression to ESRD. We did not study the potential impact of MDC on hospitalization (cardiovascular or other). Conclusions Our model estimates that a Medicare-funded MDC program could reduce the need for dialysis, prolong life expectancy, and meet conventional cost-effectiveness thresholds in middle-aged to elderly patients with mild to moderate CKD. PMID:29584720

Explosive synchronization coexists with classical synchronization in the Kuramoto model

DOE Office of Scientific and Technical Information (OSTI.GOV)

Danziger, Michael M., E-mail: michael.danziger@biu.ac.il; Havlin, Shlomo; Moskalenko, Olga I.

2016-06-15

Explosive synchronization has recently been reported in a system of adaptively coupled Kuramoto oscillators, without any conditions on the frequency or degree of the nodes. Here, we find that, in fact, the explosive phase coexists with the standard phase of the Kuramoto oscillators. We determine this by extending the mean-field theory of adaptively coupled oscillators with full coupling to the case with partial coupling of a fraction f. This analysis shows that a metastable region exists for all finite values of f > 0, and therefore explosive synchronization is expected for any perturbation of adaptively coupling added to the standard Kuramoto model.more » We verify this theory with GPU-accelerated simulations on very large networks (N ∼ 10{sup 6}) and find that, in fact, an explosive transition with hysteresis is observed for all finite couplings. By demonstrating that explosive transitions coexist with standard transitions in the limit of f → 0, we show that this behavior is far more likely to occur naturally than was previously believed.« less

Stable lattice Boltzmann model for Maxwell equations in media

NASA Astrophysics Data System (ADS)

Hauser, A.; Verhey, J. L.

2017-12-01

The present work shows a method for stable simulations via the lattice Boltzmann (LB) model for electromagnetic waves (EM) transiting homogeneous media. LB models for such media were already presented in the literature, but they suffer from numerical instability when the media transitions are sharp. We use one of these models in the limit of pure vacuum derived from Liu and Yan [Appl. Math. Model. 38, 1710 (2014), 10.1016/j.apm.2013.09.009] and apply an extension that treats the effects of polarization and magnetization separately. We show simulations of simple examples in which EM waves travel into media to quantify error scaling, stability, accuracy, and time scaling. For conductive media, we use the Strang splitting and check the simulations accuracy at the example of the skin effect. Like pure EM propagation, the error for the static limits, which are constructed with a current density added in a first-order scheme, can be less than 1 % . The presented method is an easily implemented alternative for the stabilization of simulation for EM waves propagating in spatially complex structured media properties and arbitrary transitions.

Q ‑ Φ criticality and microstructure of charged AdS black holes in f(R) gravity

NASA Astrophysics Data System (ADS)

Deng, Gao-Ming; Huang, Yong-Chang

2017-12-01

The phase transition and critical behaviors of charged AdS black holes in f(R) gravity with a conformally invariant Maxwell (CIM) source and constant curvature are further investigated. As a highlight, this research is carried out by employing new state parameters (T,Q, Φ) and contributes to deeper understanding of the thermodynamics and phase structure of black holes. Our analyses manifest that the charged f(R)-CIM AdS black hole undergoes a first-order small-large black hole phase transition, and the critical behaviors qualitatively behave like a Van der Waals liquid-vapor system. However, differing from the case in Einstein’s gravity, phase structures of the black holes in f(R) theory exhibit an interesting dependence on gravity modification parameters. Moreover, we adopt the thermodynamic geometry to probe the black hole microscopic properties. The results show that, on the one hand, both the Ruppeiner curvature and heat capacity diverge exactly at the critical point, on the other hand, the f(R)-CIM AdS black hole possesses the property as ideal Fermi gases. Of special interest, we discover a microscopic similarity between the black holes and a Van der Waals liquid-vapor system.

Strategie de commande optimale de la production electrique dans un site isole

NASA Astrophysics Data System (ADS)

Barris, Nicolas

Hydro-Quebec manages more than 20 isolated power grids all over the province. The grids are located in small villages where the electricity demand is rather small. Those villages being far away from each other and from the main electricity production facilities, energy is produced locally using diesel generators. Electricity production costs at the isolated power grids are very important due to elevated diesel prices and transportation costs. However, the price of electricity is the same for the entire province, with no regards to the production costs of the electricity consumed. These two factors combined result in yearly exploitation losses for Hydro-Quebec. For any given village, several diesel generators are required to satisfy the demand. When the load increases, it becomes necessary to increase the capacity either by adding a generator to the production or by switching to a more powerful generator. The same thing happens when the load decreases. Every decision regarding changes in the production is included in the control strategy, which is based on predetermined parameters. These parameters were specified according to empirical studies and the knowledge base of the engineers managing the isolated power grids, but without any optimisation approach. The objective of the presented work is to minimize the diesel consumption by optimizing the parameters included in the control strategy. Its impact would be to limit the exploitation losses generated by the isolated power grids and the CO2 equivalent emissions without adding new equipment or completely changing the nature of the strategy. To satisfy this objective, the isolated power grid simulator OPERA is used along with the optimization library NOMAD and the data of three villages in northern Quebec. The preliminary optimization instance for the first village showed that some modifications to the existing control strategy must be done to better achieve the minimization objective. The main optimization processes consist of three different optimization approaches: the optimization of one set of parameters for all the villages, the optimization of one set of parameters per village, and the optimization of one set of parameters per diesel generator configuration per village. In the first scenario, the optimization of one set of parameters for all the villages leads to compromises for all three villages without allowing a full potential reduction for any village. Therefore, it is proven that applying one set of parameters to all the villages is not suitable for finding an optimal solution. In the second scenario, the optimization of one set of parameters per village allows an improvement over the previous results. At this point, it is shown that it is crucial to remove from the production the less efficient configurations when they are next to more efficient configurations. In the third scenario, the optimization of one set of parameters per configuration per village requires a very large number of function evaluations but does not result in any satisfying solution. In order to improve the performance of the optimization, it has been decided that the problem structure would be used. Two different approaches are considered: optimizing one set of parameters at a time and optimizing different rules included in the control strategy one at a time. In both cases, results are similar but calculation costs differ, the second method being much more cost efficient. The optimal values of the ultimate rules parameters can be directly linked to the efficient transition points that favor an efficient operation of the isolated power grids. Indeed, these transition points are defined in such a way that the high efficiency zone of every configuration is used. Therefore, it seems possible to directly identify on the graphs these optimal transition points and define the parameters in the control strategy without even having to run any optimization process. The diesel consumption reduction for all three villages is about 1.9%. Considering elevated diesel costs and the existence of about 20 other isolated power grids, the use of the developed methods together with a calibration of OPERA would allow a substantial reduction of Hydro-Quebec's annual deficit. Also, since one of the developed methods is very cost effective and produces equivalent results, it could be possible to use it during other processes; for example, when buying new equipment for the grid it could be possible to assess its full potential, under an optimized control strategy, and improve the net present value.

Adding bevacizumab to single agent chemotherapy for the treatment of platinum-resistant recurrent ovarian cancer: A cost effectiveness analysis of the AURELIA trial.

PubMed

Wysham, Weiya Z; Schaffer, Elisabeth M; Coles, Theresa; Roque, Dario R; Wheeler, Stephanie B; Kim, Kenneth H

2017-05-01

AURELIA, a randomized phase III trial of adding bevacizumab (B) to single agent chemotherapy (CT) for the treatment of platinum-resistant recurrent ovarian cancer, demonstrated improved progression free survival (PFS) in the B+CT arm compared to CT alone. We aimed to evaluate the cost effectiveness of adding B to CT in the treatment of platinum-resistant recurrent ovarian cancer. A decision tree model was constructed to evaluate the cost effectiveness of adding bevacizumab (B) to single agent chemotherapy (CT) based on the arms of the AURELIA trial. Costs, quality-adjusted life years (QALYs), and progression free survival (PFS) were modeled over fifteen months. Model inputs were extracted from published literature and public sources. Incremental cost effectiveness ratios (ICERs) per QALY gained and ICERs per progression free life year saved (PF-LYS) were calculated. One-way sensitivity analyses were performed to evaluate the robustness of results. The ICER associated with B+CT is $410,455 per QALY gained and $217,080 per PF-LYS. At a willingness to pay (WTP) threshold of $50,000/QALY, adding B to single agent CT is not cost effective for this patient population. Even at a WTP threshold of $100,000/QALY, B+CT is not cost effective. These findings are robust to sensitivity analyses. Despite gains in QALY and PFS, the addition of B to single agent CT for treatment of platinum-resistant recurrent ovarian cancer is not cost effective. Benefits, risks, and costs associated with treatment should be taken into consideration when prescribing chemotherapy for this patient population. Copyright © 2017 Elsevier Inc. All rights reserved.

48 CFR 9904.412-64 - Transition method.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Transition method. 9904... ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.412-64 Transition method. To be acceptable, any method of... previously provided for, shall not be redundantly provided for under revised methods. Conversely, costs that...

48 CFR 9904.412-64 - Transition method.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 7 2013-10-01 2012-10-01 true Transition method. 9904.412... ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.412-64 Transition method. To be acceptable, any method of... previously provided for, shall not be redundantly provided for under revised methods. Conversely, costs that...

48 CFR 9904.412-64 - Transition method.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 7 2014-10-01 2014-10-01 false Transition method. 9904... ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.412-64 Transition method. To be acceptable, any method of... previously provided for, shall not be redundantly provided for under revised methods. Conversely, costs that...

48 CFR 9904.412-64 - Transition method.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 7 2012-10-01 2012-10-01 false Transition method. 9904... ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.412-64 Transition method. To be acceptable, any method of... previously provided for, shall not be redundantly provided for under revised methods. Conversely, costs that...

Pioneering Heat Pump Project

DOE Office of Scientific and Technical Information (OSTI.GOV)

Aschliman, Dave; Lubbehusen, Mike

2015-06-30

This project was initiated at a time when ground coupled heat pump systems in this region were limited in size and quantity. There were economic pressures with costs for natural gas and electric utilities that had many organizations considering ground coupled heat pumps; The research has added to the understanding of how ground temperatures fluctuate seasonally and how this affects the performance and operation of the heat pumps. This was done by using a series of temperature sensors buried within the middle of one of the vertical bore fields with sensors located at various depths below grade. Trending of themore » data showed that there is a lag in ground temperature with respect to air temperatures in the shoulder months, however as full cooling and heating season arrives, the heat rejection and heat extraction from the ground has a significant effect on the ground temps; Additionally it is better understood that while a large community geothermal bore field serving multiple buildings does provide a convenient central plant to use, it introduces complexity of not being able to easily model and predict how each building will contribute to the loads in real time. Additional controllers and programming were added to provide more insight into this real time load profile and allow for intelligent shedding of load via a dry cooler during cool nights in lieu of rejecting to the ground loop. This serves as a means to ‘condition’ the ground loop and mitigate thermal creep of the field, as is typically observed; and It has been observed when compared to traditional heating and cooling equipment, there is still a cost premium to use ground source heat pumps that is driven mostly by the cost for vertical bore holes. Horizontal loop systems are less costly to install, but do not perform as well in this climate zone for heating mode« less

A liquid crystal-based sensor for the simple and sensitive detection of cellulase and cysteine.

PubMed

Wang, Yi; Hu, Qiongzheng; Tian, Tongtong; Gao, Yan'an; Yu, Li

2016-11-01

A liquid crystal (LC)-based sensor, which is capable of monitoring enzymatic activity at the aqueous/LC interface and detecting cellulase and cysteine (Cys), was herein reported. When functionalized with a surfactant, dodecyl β-d-glucopyranoside, the 4-cyano-4'-pentylbiphenyl (5CB) displays a dark-to-bright transition in the optical appearance for cellulase. We attribute this change to the orientational transition of LCs, as a result of enzymatic hydrolysis between cellulase and surfactant. Furthermore, by adding cellulase and Cu(2+), our surfactant-LCs system performs an interesting ability to detect Cys, even though Cys could not interact with surfactant or LC directly. Alternatively, through the strong binding between Cys and Cu(2+), cellulase was able to hydrolyze surfactant in the presence of Cu(2+), leading to the transition of LCs from dark to bright. The detection limit of the LC sensor was around 1×10(-5)mg/mL and 82.5μM for cellulase and Cys, respectively. The LC-based sensor may contribute to the development of low-cost, expedient, and label-free detection for cellulase and Cys and the design strategy may also provide a novel way for detecting multiple analytes. Copyright © 2016 Elsevier B.V. All rights reserved.

Hot-Electron Photon Counters for Detecting Terahertz Photons

NASA Technical Reports Server (NTRS)

Karasik, Boris; Sergeyev, Andrei

2005-01-01

A document proposes the development of hot-electron photon counters (HEPCs) for detecting terahertz photons in spaceborne far-infrared astronomical instruments. These would be superconducting- transition-edge devices: they would contain superconducting bridges that would have such low heat capacities that single terahertz photons would cause transient increases in their electron temperatures through the superconducting- transition range, thereby yielding measurable increases in electrical resistance. Single devices or imaging arrays of the devices would be fabricated as submicron-sized bridges made from films of disordered Ti (which has a superconducting- transition temperature of .0.35 K) between Nb contacts on bulk silicon or sapphire substrates. In operation, these devices would be cooled to a temperature of .0.3 K. The proposed devices would cost less to fabricate and operate, relative to integrating bolometers of equal sensitivity, which must be operated at a temperature of approx. = 0.1 K.

Critical phenomena and chemical potential of a charged AdS black hole

NASA Astrophysics Data System (ADS)

Wei, Shao-Wen; Liang, Bin; Liu, Yu-Xiao

2017-12-01

Inspired by the interpretation of the cosmological constant from the boundary gauge theory, we here treat it as the number of colors N and its conjugate quantity as the associated chemical potential μ in the black hole side. Then the thermodynamics and the chemical potential for a five-dimensional charged AdS black hole are studied. It is found that there exists a small-large black hole phase transition of van der Waals type. The critical phenomena are investigated in the N2-μ chart. The result implies that the phase transition can occur for large number of colors N , while is forbidden for small number. This to some extent implies that the interaction of the system increases with the number. In particular, in the reduced parameter space, all the thermodynamic quantities can be rescaled with the black hole charge such that these reduced quantities are charge-independent. Then we obtain the coexistence curve and the phase diagram. The latent heat is also numerically calculated. Moreover, the heat capacity and the thermodynamic scalar are studied. The result indicates that the information of the first-order black hole phase transition is encoded in the heat capacity and scalar. However, the phase transition point cannot be directly calculated with them. Nevertheless, the critical point linked to a second-order phase transition can be determined by either the heat capacity or the scalar. In addition, we calculate the critical exponents of the heat capacity and the scalar for the saturated small and large black holes near the critical point.

Would Current International Space Station (ISS) Recycling Life Support Systems Save Mass on a Mars Transit?

NASA Technical Reports Server (NTRS)

Jones, Harry W.

2017-01-01

The oxygen and water are recycled on the International Space Station (ISS) to save the cost of launching their mass into orbit. Usually recycling systems are justified by showing that their launch mass would be much lower than the mass of the oxygen or water they produce. Short missions such as Apollo or space shuttle directly provide stored oxygen and water, since the needed total mass of oxygen and water is much less than that of there cycling equipment. Ten year or longer missions such as the ISS or a future moon base easily save mass by recycling while short missions of days or weeks do not. Mars transit and long Mars surface missions have an intermediate duration, typically one to one and a half years. Some of the current ISS recycling systems would save mass if used on a Mars transit but others would not.

Medical Devices Transition to Information Systems: Lessons Learned

PubMed Central

Charters, Kathleen G.

2012-01-01

Medical devices designed to network can share data with a Clinical Information System (CIS), making that data available within clinician workflow. Some lessons learned by transitioning anesthesia reporting and monitoring devices (ARMDs) on a local area network (LAN) to integration of anesthesia documentation within a CIS include the following categories: access, contracting, deployment, implementation, planning, security, support, training and workflow integration. Areas identified for improvement include: Vendor requirements for access reconciled with the organizations’ security policies and procedures. Include clauses supporting transition from stand-alone devices to information integrated into clinical workflow in the medical device procurement contract. Resolve deployment and implementation barriers that make the process less efficient and more costly. Include effective field communication and creative alternatives in planning. Build training on the baseline knowledge of trainees. Include effective help desk processes and metrics. Have a process for determining where problems originate when systems share information. PMID:24199054

Molecular Origins of Thermal Transitions in Polyelectrolyte Assemblies

NASA Astrophysics Data System (ADS)

Yildirim, Erol; Zhang, Yanpu; Antila, Hanne S.; Lutkenhaus, Jodie L.; Sammalkorpi, Maria; Aalto Team; Texas A&M Team

2015-03-01

Polyelectrolyte (PE) multilayers and complexes formed from oppositely charged polymers can exhibit extraordinary superhydrophobicity, mechanical strength and responsiveness resulting in applications ranging functional membranes, optics, sensors and drug delivery. Depending on the assembly conditions, PE assemblies may undergo a thermal transition from glassy to soft behavior under heating. Our earlier work using thermal analysis measurements shows a distinct thermal transition for PE layer-by-layer (LbL) systems assembled with added salt but no analogous transition in films assembled without added salt or dry systems. These findings raise interesting questions on the nature of the thermal transition; here, we explore its molecular origins through characterization of the PE aggregates by temperature-controlled all-atom molecular dynamics simulations. We show via molecular simulations the thermal transition results from the existence of an LCST (lower critical solution temperature) in the PE systems: the diffusion behavior, hydrogen bond formation, and bridging capacity of water molecules plasticizing the complex changes at the transition temperature. We quantify the behavior, map its chemistry specificity through comparison of strongly and weakly charged PE complexes, and connect the findings to our interrelated QCM-D experiments.

SMOOTHING ROTATION CURVES AND MASS PROFILES

DOE Office of Scientific and Technical Information (OSTI.GOV)

Berrier, Joel C.; Sellwood, J. A.

2015-02-01

We show that spiral activity can erase pronounced features in disk galaxy rotation curves. We present simulations of growing disks, in which the added material has a physically motivated distribution, as well as other examples of physically less realistic accretion. In all cases, attempts to create unrealistic rotation curves were unsuccessful because spiral activity rapidly smoothed away features in the disk mass profile. The added material was redistributed radially by the spiral activity, which was itself provoked by the density feature. In the case of a ridge-like feature in the surface density profile, we show that two unstable spiral modesmore » develop, and the associated angular momentum changes in horseshoe orbits remove particles from the ridge and spread them both inward and outward. This process rapidly erases the density feature from the disk. We also find that the lack of a feature when transitioning from disk to halo dominance in the rotation curves of disk galaxies, the so called ''disk-halo conspiracy'', could also be accounted for by this mechanism. We do not create perfectly exponential mass profiles in the disk, but suggest that this mechanism contributes to their creation.« less

Holographic helical superconductor with higher curvature corrections

NASA Astrophysics Data System (ADS)

Mukhopadhyay, Subir; Paul, Chandrima

2018-01-01

We study SU(2) × U(1) gauge theory with Chern-Simons term, coupled to scalar field in adjoint, in Einstein-Gauss-Bonnet gravity. We explore phases of holographic superconductor in terms of the condensates and free energies in the background of AdS black hole and AdS soliton. In the case of black hole, we find with increasing strength of higher curvature terms, transition temperature decreases. For AdS soliton, the critical value of chemical potential increases as the higher curvature terms dominate.

Part-time Labor, Work Rules, and Transit Costs

DOT National Transportation Integrated Search

1981-01-01

This report examines two major issues: (1)the impact of labor union work rules : on bus transit operating costs and (2)the magnitude of cost savings that can be : expected from the use of part-time drivers. These issues are examined within : the cont...

Cost-effectiveness of pharmacological and psychosocial interventions for schizophrenia.

PubMed

Phanthunane, Pudtan; Vos, Theo; Whiteford, Harvey; Bertram, Melanie

2011-05-13

Information on cost-effectiveness of interventions to treat schizophrenia can assist health policy decision making, particularly given the lack of health resources in developing countries like Thailand. This study aims to determine the optimal treatment package, including drug and non-drug interventions, for schizophrenia in Thailand. A Markov model was used to evaluate the cost-effectiveness of typical antipsychotics, generic risperidone, olanzapine, clozapine and family interventions. Health outcomes were measured in disability adjusted life years. We evaluated intervention benefit by estimating a change in disease severity, taking into account potential side effects. Intervention costs included outpatient treatment costs, hospitalization costs as well as time and travel costs of patients and families. Uncertainty was evaluated using Monte Carlo simulation. A sensitivity analysis of the expected range cost of generic risperidone was undertaken. Generic risperidone is more cost-effective than typicals if it can be produced for less than 10 baht per 2 mg tablet. Risperidone was the cheapest treatment with higher drug costs offset by lower hospital costs in comparison to typicals. The most cost-effective combination of treatments was a combination of risperidone (dominant intervention). Adding family intervention has an incremental cost-effectiveness ratio of 1,900 baht/DALY with a 100% probability of a result less than a threshold for very cost-effective interventions of one times GDP or 110,000 baht per DALY. Treating the most severe one third of patients with clozapine instead of risperidone had an incremental cost-effectiveness ratio of 320,000 baht/DALY with just over 50% probability of a result below three times GDP per capita. There are good economic arguments to recommend generic risperidone as first line treatment in combination with family intervention. As the uncertainty interval indicates the addition of clozapine may be dominated and there are serious side effects, treating severe patients with clozapine is advisable only for patients who do not respond to risperidone and only in the presence of a stricter side effect monitoring system than currently exists.

Body-mass, survival, and pairing consequences of winter-diet restriction in wood ducks

USGS Publications Warehouse

Demarest, D.W.; Kaminski, R.M.; Brennan, L.A.; Boyle, C.R.

1997-01-01

We conducted feeding experiments with captive, wild-strain wood ducks (Aix sponsa) during winters 1990-91 and 1991-92 to test effects of increasing levels of food restriction on body mass dynamics, mortality, and pair formation. Male and female wood ducks fed restricted diets (i.e., 5, 10, 15, or 20% less food [g] than consumed on the previous day by a control group fed ad libitum) weighed less (P ??? 0.037) than birds fed ad libitum; those on 15 and 20% restricted diets weighed least. Increased mortality and decreased pair formation occurred only within the 20% restricted group (P ??? 0.049). We concluded that food restriction ranging between 15 and 20% of ad libitum intake may signify a threshold above which survival and reproduction of captive wood ducks may be impaired. Because energy costs of free living are greater than in captivity, a lower threshold may exist for wild wood ducks. Research is needed to validate the threshold theory for free-ranging wood ducks and other waterfowl, and to evaluate its potential application for conservation of winter foraging habitat. Conservation of bottomland hardwood ecosystems, which provide important foraging habitat for migrating and wintering wood ducks, should be encouraged to prevent potential negative effects on wood duck life-cycle events.

Building America Case Study: Meeting DOE Challenge Home Program Certification, Chicago, Illinois; Denver, Colorado; Devens, Massachusetts (Fact Sheet)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

The purpose of this project was to evaluate integrated packages of advanced measures in individual test homes to assess their performance with respect to Building America Program goals, specifically compliance with the DOE Challenge Home Program. BSC consulted on the construction of five test houses by three Cold Climate production builders in three separate US cities. BSC worked with the builders to develop a design package tailored to the cost-related impacts for each builder. Therefore, the resulting design packages do vary from builder to builder. BSC provided support through this research project on the design, construction and performance testing ofmore » the five test homes. Overall, the builders have concluded that the energy related upgrades (either through the prescriptive or performance path) represent reasonable upgrades. The builders commented that while not every improvement in specification was cost effective (as in a reasonable payback period), many were improvements that could improve the marketability of the homes and serve to attract more energy efficiency discerning prospective homeowners. However, the builders did express reservations on the associated checklists and added certifications. An increase in administrative time was observed with all builders. The checklists and certifications also inherently increase cost due to: 1. Adding services to the scope of work for various trades, such as HERS Rater, HVAC contractor. 2. Increased material costs related to the checklists, especially the EPA Indoor airPLUS and EPA WaterSense Efficient Hot Water Distribution requirement.« less

Evaluation of the U.S. Department of Energy Challenge Home Program Certification of Production Builders

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kerrigan, P.; Loomis, H.

2014-09-01

The purpose of this project was to evaluate integrated packages of advanced measures in individual test homes to assess their performance with respect to Building America Program goals, specifically compliance with the DOE Challenge Home Program. BSC consulted on the construction of five test houses by three Cold Climate production builders in three separate US cities. BSC worked with the builders to develop a design package tailored to the cost-related impacts for each builder. Therefore, the resulting design packages do vary from builder to builder. BSC provided support through this research project on the design, construction and performance testing ofmore » the five test homes. Overall, the builders have concluded that the energy related upgrades (either through the prescriptive or performance path) represent reasonable upgrades. The builders commented that while not every improvement in specification was cost effective (as in a reasonable payback period), many were improvements that could improve the marketability of the homes and serve to attract more energy efficiency discerning prospective homeowners. However, the builders did express reservations on the associated checklists and added certifications. An increase in administrative time was observed with all builders. The checklists and certifications also inherently increase cost due to: 1. Adding services to the scope of work for various trades, such as HERS Rater, HVAC contractor; 2. Increased material costs related to the checklists, especially the EPA Indoor airPLUS and EPA WaterSense(R) Efficient Hot Water Distribution requirement.« less

Economic value of atopic dermatitis prevention via infant formula use in high-risk Malaysian infants.

PubMed

Bhanegaonkar, Abhijeet J; Horodniceanu, Erica G; Abdul Latiff, Amir Hamzah; Woodhull, Sanjay; Khoo, Phaik Choo; Detzel, Patrick; Ji, Xiang; Botteman, Marc F

2015-04-01

Breastfeeding is best for infants and the World Health Organization recommends exclusive breastfeeding for at least the first 6 months of life. For those who are unable to be breastfed, previous studies demonstrate that feeding high-risk infants with hydrolyzed formulas instead of cow's milk formula (CMF) may decrease the risk of atopic dermatitis (AD). To estimate the economic impact of feeding high-risk, not exclusively breastfed, urban Malaysian infants with partiallyhydrolyzed whey-based formula (PHF-W) instead of CMF for the first 17 weeks of life as an AD risk reduction strategy. A cohort Markov model simulated the AD incidence and burden from birth to age 6 years in the target population fed with PHF-W vs. CMF. The model integrated published clinical and epidemiologic data, local cost data, and expert opinion. Modeled outcomes included AD-risk reduction, time spent post AD diagnosis, days without AD flare, quality-adjusted life years (QALYs), and costs (direct and indirect). Outcomes were discounted at 3% per year. Costs are expressed in Malaysian Ringgit (MYR; MYR 1,000 = United States dollar [US $]316.50). Feeding a high-risk infant PHF-W vs. CMF resulted in a 14% point reduction in AD risk (95% confidence interval [CI], 3%-23%), a 0.69-year (95% CI, 0.25-1.10) reduction in time spent post-AD diagnosis, additional 38 (95% CI, 2-94) days without AD flare, and an undiscounted gain of 0.041 (95% CI, 0.007-0.103) QALYs. The discounted AD-related 6-year cost estimates when feeding a high-risk infant with PHF-W were MYR 1,758 (US $556) (95% CI, MYR 917-3,033) and with CMF MYR 2,871 (US $909) (95% CI, MYR 1,697-4,278), resulting in a per-child net saving of MYR 1,113 (US $352) (95% CI, MYR 317-1,884) favoring PHF-W. Using PHF-W instead of CMF in this population is expected to result in AD-related costs savings.

Economic value of atopic dermatitis prevention via infant formula use in high-risk Malaysian infants

PubMed Central

Bhanegaonkar, Abhijeet J; Horodniceanu, Erica G; Abdul Latiff, Amir Hamzah; Woodhull, Sanjay; Khoo, Phaik Choo; Detzel, Patrick; Ji, Xiang

2015-01-01

Background Breastfeeding is best for infants and the World Health Organization recommends exclusive breastfeeding for at least the first 6 months of life. For those who are unable to be breastfed, previous studies demonstrate that feeding high-risk infants with hydrolyzed formulas instead of cow's milk formula (CMF) may decrease the risk of atopic dermatitis (AD). Objective To estimate the economic impact of feeding high-risk, not exclusively breastfed, urban Malaysian infants with partiallyhydrolyzed whey-based formula (PHF-W) instead of CMF for the first 17 weeks of life as an AD risk reduction strategy. Methods A cohort Markov model simulated the AD incidence and burden from birth to age 6 years in the target population fed with PHF-W vs. CMF. The model integrated published clinical and epidemiologic data, local cost data, and expert opinion. Modeled outcomes included AD-risk reduction, time spent post AD diagnosis, days without AD flare, quality-adjusted life years (QALYs), and costs (direct and indirect). Outcomes were discounted at 3% per year. Costs are expressed in Malaysian Ringgit (MYR; MYR 1,000 = United States dollar [US $]316.50). Results Feeding a high-risk infant PHF-W vs. CMF resulted in a 14% point reduction in AD risk (95% confidence interval [CI], 3%-23%), a 0.69-year (95% CI, 0.25-1.10) reduction in time spent post-AD diagnosis, additional 38 (95% CI, 2-94) days without AD flare, and an undiscounted gain of 0.041 (95% CI, 0.007-0.103) QALYs. The discounted AD-related 6-year cost estimates when feeding a high-risk infant with PHF-W were MYR 1,758 (US $556) (95% CI, MYR 917-3,033) and with CMF MYR 2,871 (US $909) (95% CI, MYR 1,697-4,278), resulting in a per-child net saving of MYR 1,113 (US $352) (95% CI, MYR 317-1,884) favoring PHF-W. Conclusion Using PHF-W instead of CMF in this population is expected to result in AD-related costs savings. PMID:25938073

Automated volumetry of temporal horn of lateral ventricle for detection of Alzheimer's disease in CT scan

NASA Astrophysics Data System (ADS)

Takahashi, Noriyuki; Kinoshita, Toshibumi; Ohmura, Tomomi; Matsuyama, Eri; Toyoshima, Hideto

2018-02-01

The rapid increase in the incidence of Alzheimer's disease (AD) has become a critical issue in low and middle income countries. In general, MR imaging has become sufficiently suitable in clinical situations, while CT scan might be uncommonly used in the diagnosis of AD due to its low contrast between brain tissues. However, in those countries, CT scan, which is less costly and readily available, will be desired to become useful for the diagnosis of AD. For CT scan, the enlargement of the temporal horn of the lateral ventricle (THLV) is one of few findings for the diagnosis of AD. In this paper, we present an automated volumetry of THLV with segmentation based on Bayes' rule on CT images. In our method, first, all CT data sets are normalized into an atlas by using linear affine transformation and non-linear wrapping techniques. Next, a probability map of THLV is constructed in the normalized data. Then, THLV regions are extracted based on Bayes' rule. Finally, the volume of the THLV is evaluated. This scheme was applied to CT scans from 20 AD patients and 20 controls to evaluate the performance of the method for detecting AD. The estimated THLV volume was markedly increased in the AD group compared with the controls (P < .0001), and the area under the receiver operating characteristic curve (AUC) was 0.921. Therefore, this computerized method may have the potential to accurately detect AD on CT images.

How to Make Money out of RLVs

NASA Astrophysics Data System (ADS)

Parkinson, B.

A successful reusable launch vehicle (RLV) will need to launch payloads at lower prices than competing expendable launch vehicles (ELVs). Existing ELVs have the advantage of written off development costs, and support a range of payload sizes through dual launch and launcher modularity - features not expected to be shared by an RLV. However, the majority of ELV launch costs are expendable hardware, while for RLVs many costs are fixed annual costs. Starting with a per-flight cost below that of competing ELVs, an RLV can support a range of payload sizes at a fixed cost/kg. Since the cost of adding an extra flight to the annual operations (“marginal cost”) is also very much less than the “full recovery” cost, it is possible to extend the range of economic payload sizes downwards. This can provide the customer with a flexible, constant specific cost launcher, while giving the operator a strategy allowing recovery of the development and initial fleet production costs. An estimate for the probability distribution of future payloads (to LEO, GTO and polar orbits) is presented. This can then be used to optimize the vehicle market capture to maximise the operator's profit, or to identify a minimum market size for which an RLV will be profitable.

Decision Support For Digester Algae Integration For Improved Environmental And Economic Sustainability

DOE Office of Scientific and Technical Information (OSTI.GOV)

Guillen, Donna P.; Panike, Katherine R.; Havlovick, Caryn M.

The Idaho National Laboratory (INL) has teamed with University of Idaho and Boise State University to make the use of ADs more attractive by implementing a two-stage AD and coupling additional processes to the system. The addition of a polyhydroxyalkanoate (PHA) reactor, algae cultivation system, and a biomass treatment system such as fast-pyrolysis or hydrothermal liquefaction (HTL) would further sequester carbon and nutrients, as well as add valuable products that can be sold or used on-site to mitigate costs. The Decision-support for Digester-Algae IntegRation for Improved Environmental and Economic Sustainability (DAIRIEES) technoeconomic model will play a key role in evaluatingmore » the effectiveness and viability of this system to achieve economic and environmental sustainability by the dairy industry.« less

Energy management guidelines for rail transit systems : volume I. final report

DOT National Transportation Integrated Search

1986-09-01

The cost of electricity is a significant portion of the operating costs of rail transit systems. The impact of increasing energy costs is felt by those systems presently in operation and will be felt by those in the planning or construction phases. B...

Revisiting the phase transition of AdS-Maxwell-power-Yang-Mills black holes via AdS/CFT tools

NASA Astrophysics Data System (ADS)

El Moumni, H.

2018-01-01

In the present work we investigate the Van der Waals-like phase transition of AdS black hole solution in the Einstein-Maxwell-power-Yang-Mills gravity (EMPYM) via different approaches. After reconsidering this phase structure in the entropy-thermal plane, we recall the nonlocal observables such as holographic entanglement entropy and two point correlation function to show that the both observables exhibit a Van der Waals-like behavior as the case of the thermal entropy. By checking the Maxwell's equal area law and calculating the critical exponent for different values of charge C and nonlinearity parameter q we confirm that the first and the second order phases persist in the holographic framework. Also the validity of the Maxwell law is governed by the proximity to the critical point.

Critical behaviors and phase transitions of black holes in higher order gravities and extended phase spaces

NASA Astrophysics Data System (ADS)

Sherkatghanad, Zeinab; Mirza, Behrouz; Mirzaiyan, Zahra; Mansoori, Seyed Ali Hosseini

We consider the critical behaviors and phase transitions of Gauss-Bonnet-Born-Infeld-AdS black holes (GB-BI-AdS) for d = 5, 6 and the extended phase space. We assume the cosmological constant, Λ, the coupling coefficient α, and the BI parameter β to be thermodynamic pressures of the system. Having made these assumptions, the critical behaviors are then studied in the two canonical and grand canonical ensembles. We find “reentrant and triple point phase transitions” (RPT-TP) and “multiple reentrant phase transitions” (multiple RPT) with increasing pressure of the system for specific values of the coupling coefficient α in the canonical ensemble. Also, we observe a reentrant phase transition (RPT) of GB-BI-AdS black holes in the grand canonical ensemble and for d = 6. These calculations are then expanded to the critical behavior of Born-Infeld-AdS (BI-AdS) black holes in the third-order of Lovelock gravity and in the grand canonical ensemble to find a van der Waals (vdW) behavior for d = 7 and a RPT for d = 8 for specific values of potential ϕ in the grand canonical ensemble. Furthermore, we obtain a similar behavior for the limit of β →∞, i.e. charged-AdS black holes in the third-order of the Lovelock gravity. Thus, it is shown that the critical behaviors of these black holes are independent of the parameter β in the grand canonical ensemble.

A Comparison Study of Offshore Wind Support Structures with Monopiles and Jackets for U.S. Waters: Preprint

DOE Office of Scientific and Technical Information (OSTI.GOV)

Damiani, Rick; Dykes, Katherine; Scott, George

2016-08-01

U.S. experience in offshore wind is limited, and high costs are expected unless innovations are introduced in one or multiple aspects of the project, from the installed technology to the balance of system (BOS). The substructure is the main single component responsible for the BOS capital expenditure (CapEx) and thus one that, if improved, could yield significant levelized cost of energy (LCOE) savings. For projects in U.S. waters, multimember, lattice structures (also known as jackets) can render required stiffness for transitional water depths at potentially lower costs than monopiles (MPs). In this study, we used a systems engineering approach tomore » evaluate the LCOE of prototypical wind power plants at six locations along the eastern seaboard and the Gulf of Mexico for both types of support structures. Using a reference wind turbine and actual metocean conditions for the selected sites, we calculated loads for a parked and an operational situation, and we optimized the MP- and jacket-based support structures to minimize their overall mass. Using a suite of cost models, we then computed their associated LCOE. For all water depths, the MP-based configurations were heavier than their jacket counterparts, but the overall costs for the MPs were less than they were for jackets up to depths of slightly less than 30 m. When the associated manufacturing and installation costs were included, jackets resulted in lower LCOE for depths greater than 40 m. These results can be used by U.S. stakeholders to understand the potential for different technologies at different sites, but the methodology illustrated in this study can be further employed to analyze the effects of innovations and design choices throughout wind power plant systems.« less

Starship Life Support

NASA Technical Reports Server (NTRS)

Jones, Harry W.

2009-01-01

The design and mass cost of a starship and its life support system are investigated. The mission plan for a multi generational interstellar voyage to colonize a new planet is used to describe the starship design, including the crew habitat, accommodations, and life support. Only current technology is assumed. Highly reliable life support systems can be provided with reasonably small additional mass, suggesting that they can support long duration missions. Bioregenerative life support, growing crop plants that provide food, water, and oxygen, has been thought to need less mass than providing stored food for long duration missions. The large initial mass of hydroponics systems is paid for over time by saving the mass of stored food. However, the yearly logistics mass required to support a bioregenerative system exceeds the mass of food solids it produces, so that supplying stored dehydrated food always requires less mass than bioregenerative food production. A mixed system that grows about half the food and supplies the other half dehydrated has advantages that allow it to breakeven with stored dehydrated food in about 66 years. However, moderate increases in the hydroponics system mass to achieve high reliability, such as adding spares that double the system mass and replacing the initial system every 100 years, increase the mass cost of bioregenerative life support. In this case, the high reliability half food growing, half food supplying system does not breakeven for 389 years. An even higher reliability half and half system, with three times original system mass and replacing the system every 50 years, never breaks even. Growing food for starship life support requires more mass than providing dehydrated food, even for multigeneration voyages of hundreds of years. The benefits of growing some food may justify the added mass cost. Much more efficient recycling food production is wanted but may not be possible. A single multigenerational interstellar voyage to colonize a new planet would have cost similar to that of the Apollo program. Cost is reduced if a small crew travels slowly and lands with minimal equipment. We can go to the stars!

Increasing the productivity of the nation's urban transportation infrastructure: Measures to increase transit use and carpooling. Final report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kain, J.F.; Gittell, R.; Daniere, A.

1992-01-01

The report surveys the growing use of bus and carpool priority measures to increase the productivity of the nation's transportation infrastructure. While it identifies a wide variety of priority measures, the report principally focuses on the planning and operation of exclusive and shared busways and high occupancy vehicle (HOV) facilities. It presents a variety of case studies describing the implementation of busways and transitways. The document also compares the cost effectiveness of exclusive busways and bus-HOV facilities with the cost effectiveness of recently completed light and heavy rail lines. It also explores the options and problems in serving large downtownmore » areas.« less

A Framework for Supporting Organizational Transition Processes Towards Sustainable Energy Systems

NASA Astrophysics Data System (ADS)

Buch, Rajesh

Economic development over the last century has driven a tripling of the world's population, a twenty-fold increase in fossil fuel consumption, and a tripling of traditional biomass consumption. The associated broad income and wealth inequities are retaining over 2 billion people in poverty. Adding to this, fossil fuel combustion is impacting the environment across spatial and temporal scales and the cost of energy is outpacing all other variable costs for most industries. With 60% of world energy delivered in 2008 consumed by the commercial and industrial sector, the fragmented and disparate energy-related decision making within organizations are largely responsible for the inefficient and impacting use of energy resources. The global transition towards sustainable development will require the collective efforts of national, regional, and local governments, institutions, the private sector, and a well-informed public. The leadership role in this transition could be provided by private and public sector organizations, by way of sustainability-oriented organizations, cultures, and infrastructure. The diversity in literature exemplifies the developing nature of sustainability science, with most sustainability assessment approaches and frameworks lacking transformational characteristics, tending to focus on analytical methods. In general, some shortfalls in sustainability assessment processes include lack of: · thorough stakeholder participation in systems and stakeholder mapping, · participatory envisioning of future sustainable states, · normative aggregation of results to provide an overall measure of sustainability, and · influence within strategic decision-making processes. Specific to energy sustainability assessments, while some authors aggregate results to provide overall sustainability scores, assessments have focused solely on energy supply scenarios, while including the deficits discussed above. This paper presents a framework for supporting organizational transition processes towards sustainable energy systems, using systems and stakeholder mapping, participatory envisioning, and sustainability assessment to prepare the development of transition strategies towards realizing long-term energy sustainability. The energy system at Arizona State University's Tempe campus (ASU) in 2008 was used as a baseline to evaluate the sustainability of the current system. From interviews and participatory workshops, energy system stakeholders provided information to map the current system and measure its performance. Utilizing operationalized principles of energy sustainability, stakeholders envisioned a future sustainable state of the energy system, and then developed strategies to begin transition of the current system to its potential future sustainable state. Key findings include stakeholders recognizing that the current energy system is unsustainable as measured against principles of energy sustainability and an envisioned future sustainable state of the energy system. Also, insufficient governmental stakeholder engagement upstream within the current system could lead to added risk as regulations affect energy supply. Energy demand behavior and consumption patterns are insufficiently understood by current stakeholders, limiting participation and accountability from consumers. In conclusion, although this research study focused on the Tempe campus, ASU could apply this process to other campuses thereby improving overall ASU energy system sustainability. Expanding stakeholder engagement upstream within the energy system and better understanding energy consumption behavior can also improve long-term energy sustainability. Finally, benchmarking ASU's performance against its peer universities could expand the current climate commitment of participants to broader sustainability goals.

Methane production from wheat straw with anaerobic sludge by heme supplementation.

PubMed

Xi, Yonglan; Chang, Zhizhou; Ye, Xiaomei; Xu, Rong; Du, Jing; Chen, Guangyin

2014-11-01

Wheat straw particles were directly used as substrate for batch anaerobic digestion with anaerobic sludge under 35°C to evaluate the effects of adding heme on methane production. When 1mg/l heme was added to the fermentation process with no agitated speed, a maximum cumulative methane production of 12227.8ml was obtained with cumulative methane yield of wheat straw was 257.4ml/g-TS (total solid), which was increased by 20.6% compared with 213.5ml/g-TS of no heme was added in the reactor. Meanwhile, oxido-reduction potential (ORP) level was decreased, the activity of coenzyme F420 was significantly improved and NADH/NAD(+) ratio were the highest than other experimental groups. These results suggest that heme-supplemented anaerobic sludge with no agitated speed may be providing a more reductive environment, which is a cost-effective method of anaerobic digestion from biomass waste to produce methane with less energy consuming. Copyright © 2014 Elsevier Ltd. All rights reserved.

Low-cost production of 6G-fructofuranosidase with high value-added astaxanthin by Xanthophyllomyces dendrorhous.

PubMed

Ning, Yawei; Li, Qiang; Chen, Feng; Yang, Na; Jin, Zhengyu; Xu, Xueming

2012-01-01

The effects of medium composition and culture conditions on the production of (6)G-fructofuranosidase with value-added astaxanthin were investigated to reduce the capital cost of neo-fructooligosaccharides (neo-FOS) production by Xanthophyllomyces dendrorhous. The sucrose and corn steep liquor (CSL) were found to be the optimal carbon source and nitrogen source, respectively. CSL and initial pH were selected as the critical factors using Plackett-Burman design. Maximum (6)G-fructofuranosidase 242.57 U/mL with 5.23 mg/L value-added astaxanthin was obtained at CSL 52.5 mL/L and pH 7.89 by central composite design. Neo-FOS yield could reach 238.12 g/L under the optimized medium conditions. Cost analysis suggested 66.3% of substrate cost was reduced compared with that before optimization. These results demonstrated that the optimized medium and culture conditions could significantly enhance the production of (6)G-fructofuranosidase with value-added astaxanthin and remarkably decrease the substrate cost, which opened up possibilities to produce neo-FOS industrially. Copyright © 2011 Elsevier Ltd. All rights reserved.

Recruitment to Online Therapies for Depression: Pilot Cluster Randomized Controlled Trial

PubMed Central

Goldsmith, Lesley; Hewson, Paul; Williams, Christopher J

2013-01-01

Background Raising awareness of online cognitive behavioral therapy (CBT) could benefit many people with depression, but we do not know how purchasing online advertising compares to placing free links from relevant local websites in increasing uptake. Objective To pilot a cluster randomized controlled trial (RCT) comparing purchase of Google AdWords with placing free website links in raising awareness of online CBT resources for depression in order to better understand research design issues. Methods We compared two online interventions with a control without intervention. The pilot RCT had 4 arms, each with 4 British postcode areas: (A) geographically targeted AdWords, (B) adverts placed on local websites by contacting website owners and requesting links be added, (C) both interventions, (D) control. Participants were directed to our research project website linking to two freely available online CBT resource sites (Moodgym and Living Life To The Full (LLTTF)) and two other depression support sites. We used data from (1) AdWords, (2) Google Analytics for our project website and for LLTTF, and (3) research project website. We compared two outcomes: (1) numbers with depression accessing the research project website, and then chose an onward link to one of the two CBT websites, and (2) numbers registering with LLTTF. We documented costs, and explored intervention and assessment methods to make general recommendations to inform researchers aiming to use similar methodologies in future studies. Results Trying to place local website links appeared much less cost effective than AdWords and although may prove useful for service delivery, was not worth pursuing in the context of the current study design. Our AdWords intervention was effective in recruiting people to the project website but our location targeting “leaked” and was not as geographically specific as claimed. The impact on online CBT was also diluted by offering participants other choices of destinations. Measuring the impact on LLTTF use was difficult as the total number using LLTTF was less than 5% of all users and record linkage across websites was impossible. Confounding activity may have resulted in some increase in registrations in the control arm. Conclusions Practitioners should consider online advertising to increase uptake of online therapy but need to check its additional value. A cluster RCT using location targeted adverts is feasible and this research design provides the best evidence of cost-effectiveness. Although our British pilot study is limited to online CBT for depression, a cluster RCT with similar design would be appropriate for other online treatments and countries and our recommendations may apply. They include ways of dealing with possible contamination (buffer zones and AdWords techniques), confounding factors (large number of clusters), advertising dose (in proportion to total number of users), record linkage (landing within target website), and length of study (4-6 months). Trial Registration clinicaltrials.gov (Registration No. NCT01469689); http://clinicaltrials.gov/ct2/show/NCT01469689 (Archived by WebCite at http://www.webcitation.org/6EtTthDOp) PMID:23462072

Evaluation of a monorail mine haulage system

DOE Office of Scientific and Technical Information (OSTI.GOV)

Oguz, S.; Stefanko, R.

1971-02-01

The following advantages accrue to a monorail system compared to track haulage: Derailment is impossible; track and road maintenance is eliminated; higher gradient can be overcome with less power demand; equipment maintenance is reduced drastically; haulage cost per ton-mile is reduced because less power is consumed; it is not affected by a weak floor and back conditions; initial capital cost is much less than track haulage; and it is easily adopted to material and mantrip use. The basic conclusion to be derived from this study is that the monorail system is versatile. Besides its use in material handling and formore » mantrips in Europe and Great Britain, it can be used for ore haulage in small mines. The monorail requires a lower initial capital investment in addition to reduced operational and maintenance costs. Floor maintenance of haulage ways is completely eliminated. Haulage capacity of the system can be increased by eliminating waiting times, speeding up the monorail and adding more containers to the system. These facts establish the superiority of the monorail system over conventional equipment and should strongly be considered. For material handling very little clearance is required above the floor to move material either by hand or by rope hoist or even pushing it with a tractor. Therefore, a low seam is not a handicap to a monorail system in material handling. However, some modifications on the system may be necessary for different applications.« less

Cost-Effectiveness Analysis of Ixekizumab vs Etanercept and Their Manufacturer-Recommended Dosing Regimens in Moderate to Severe Plaque Psoriasis.

PubMed

Udkoff, Jeremy; Eichenfield, Lawrence F

2017-10-01

Biologic therapies have revolutionized the treatment of psoriasis; however, their use is limited by costs. Ixekizumab was more effective than etanercept in the UNCOVER trials, and the Food and Drug Administration (FDA) approved ixekizumab for treating psoriasis. Evaluating the cost-effectiveness of these therapies is crucial for medical decision making and our objective was to determine the cost-effectiveness of various ixekizumab dosing frequencies compared with etanercept. We utilized published data from the UNCOVER comparative efficacy trials, including transitional probabilities and treatment response rates, to create a Markov model simulating the clinical course and cost-effectiveness of three treatment algorithms for patients with moderate to severe plaque psoriasis over 60-weeks: (1) ixekizumab every 2 weeks for 12 weeks then every 4 weeks, (2) ixekizumab every 4 weeks throughout the treatment period, (3) biweekly etanercept for 12 weeks then once weekly. We utilized a standard willingness-to-pay (WTP) threshold of $150,000 per quality adjusted life year (QALY) and Medicaid drug acquisition costs for our calculations. Ixekizumab every 4 weeks was $28,681 (USD) less expensive than biweekly etanercept, and $21,375 less expensive, and 0.006 QALY less effective, than ixekizumab every 2 weeks-- a savings of $28.7 and $21.4 million, respectively, per 1,000 patients. A 95.6% cost reduction to $197.83 per dose is required for ixekizumab every 2 weeks to be more cost-effective than every 4 weeks. Biweekly etanercept requires a 29.5% cost reduction ($743.82 per dose) to be competitive with ixekizumab every 4 weeks. This cost-effectiveness model utilizes strong input data but is a limited approximation of real-life scenarios. Treatment with ixekizumab every 2 weeks is unlikely to be cost-effective compared with ixekizumab every 4 weeks at current U.S. market prices. Yet, the U.S. FDA approval and manufacturer's recommendation are for ixekizumab every 2 weeks. Accordingly, we suggested selecting biologic therapies using cost-effectiveness analyses.

J Drugs Dermatol. 2017;16(10):964-970.

New graduate nurse transition programs and clinical leadership skills in novice RNs.

PubMed

Chappell, Kathy B; Richards, Kathy C; Barnett, Scott D

2014-12-01

The objective of this study was to determine predictors of clinical leadership skill (CLS) for RNs with 24 months of clinical experience or less. New graduate nurse transition programs (NGNTPs) have been proposed as a strategy to increase CLS. CLS is associated with positive patient outcomes. Method used was hierarchical regression modeling to evaluate predictors of CLS among individual characteristics of RNs and characteristics of NGNTPs. Perceived overall quality of an NGNTP was the strongest predictor of CLS (R = 0.041, P < .01). Clinical experience and NGNTP characteristics accounted for 6.9% of the variance in CLS and 12.6% of the variance among RNs with assigned mentors (P < .01). RNs participating in NGNTPs for more than 24 weeks were 21 times more likely to remain employed within the organization when compared with NGNTPs of 12 weeks or less, a significant cost-benefit to the organization. Although perceived overall quality of a NGNTP was the strongest predictor of CLS, much of the variance in CLS remains unexplained.

Soil vapor extraction with dewatering

DOE Office of Scientific and Technical Information (OSTI.GOV)

Thomson, N.R.

1996-08-01

The physical treatment technology of soil vapor extraction (SVE) is reliable, safe, robust, and able to remove significant amounts of mass at a relatively low cost. SVE combined with a pump-and-treat system to create a dewatered zone has the opportunity to remove more mass with the added cost of treating the extracted groundwater. Various limiting processes result in a significant reduction in the overall mass removal rates from a SVE system in porous media. Only pilot scale, limited duration SVE tests conducted in low permeability media have been reported in the literature. It is expected that the presence of amore » fracture network in low permeability media will add another complexity to the limiting conditions surrounding the SVE technology. 20 refs., 4 figs.« less

Cost-effectiveness of heat and moisture exchangers compared to usual care for pulmonary rehabilitation after total laryngectomy in Poland.

PubMed

Retèl, Valesca P; van den Boer, Cindy; Steuten, Lotte M G; Okła, Sławomir; Hilgers, Frans J; van den Brekel, Michiel W

2015-09-01

The beneficial physical and psychosocial effects of heat and moisture exchangers (HMEs) for pulmonary rehabilitation of laryngectomy patients are well evidenced. However, cost-effectiveness in terms of costs per additional quality-adjusted life years (QALYs) has not yet been investigated. Therefore, a model-based cost-effectiveness analysis of using HMEs versus usual care (UC) (including stoma covers, suction system and/or external humidifier) for patients after laryngectomy was performed. Primary outcomes were costs, QALYs and incremental cost-effectiveness ratio (ICER). Secondary outcomes were pulmonary infections, and sleeping problems. The analysis was performed from a health care perspective of Poland, using a time horizon of 10 years and cycle length of 1 year. Transition probabilities were derived from various sources, amongst others a Polish randomized clinical trial. Quality of life data was derived from an Italian study on similar patients. Data on frequencies and mortality-related tracheobronchitis and/or pneumonia were derived from a Europe-wide survey amongst head and neck cancer experts. Substantial differences in quality-adjusted survival between the use of HMEs (3.63 QALYs) versus UC (2.95 QALYs) were observed. Total health care costs/patient were 39,553 PLN (9465 Euro) for the HME strategy and 4889 PLN (1168 Euro) for the UC strategy. HME use resulted in fewer pulmonary infections, and less sleeping problems. We could conclude that given the Polish threshold of 99,000 PLN/QALY, using HMEs is cost-effective compared to UC, resulting in 51,326 PLN/QALY (12,264 Euro/QALY) gained for patients after total laryngectomy. For the hospital period alone (2 weeks), HMEs were cost-saving: less costly and more effective.

A Cost-Effectiveness Analysis of Gemcitabine plus Cisplatin Versus Gemcitabine Alone for Treatment of Advanced Biliary Tract Cancer in Japan.

PubMed

Tsukiyama, Ikuto; Ejiri, Masayuki; Yamamoto, Yoshihiro; Nakao, Haruhisa; Yoneda, Masashi; Matsuura, Katsuhiko; Arakawa, Ichiro; Saito, Hiroko; Inoue, Tadao

2017-12-01

This study assessed the cost-effectiveness of combination treatment with gemcitabine and cisplatin compared to treatment with gemcitabine alone for advanced biliary tract cancer (BTC) in Japan. A monthly transmitted Markov model of three states was constructed based on the Japan BT-22 trial. Transition probabilities among the health states were derived from a trial conducted in Japan and converted to appropriate parameters for our model. The associated cost components, obtained from a receipt-based survey undertaken at the Aichi Medical University Hospital, were those related to inpatient care, outpatient care, and treatment for BTC. Costs for palliative care and treatment of adverse events were obtained from the National Health Insurance price list. We estimated cost-effectiveness per quality-adjusted life year (QALY) at a time horizon of 36 months. An annual discount of 3 % for both cost and outcome was considered. The base case outcomes indicated that combination therapy was less cost-effective than monotherapy when the incremental cost-effectiveness ratio (ICER) was approximately 14 million yen per QALY gained. The deterministic sensitivity analysis of the ICER revealed that the ICER of the base case was robust. A probabilistic analysis conducted with 10,000-time Monte Carlo simulations demonstrated efficacy at the willingness to pay threshold of 6 million yen per QALY gained for approximately 33 % of the population. In Japan, combination therapy is less cost-effective than monotherapy for treating advanced BTC, regardless of the statistical significance of the two therapies. Useful information on the cost-effectiveness of chemotherapy is much needed for the treatment of advanced BTC in Japan.

Comparative Cost-Effectiveness of Conservative or Intensive Blood Pressure Treatment Guidelines in Adults Aged 35-74 Years: The Cardiovascular Disease Policy Model.

PubMed

Moise, Nathalie; Huang, Chen; Rodgers, Anthony; Kohli-Lynch, Ciaran N; Tzong, Keane Y; Coxson, Pamela G; Bibbins-Domingo, Kirsten; Goldman, Lee; Moran, Andrew E

2016-07-01

The population health effect and cost-effectiveness of implementing intensive blood pressure goals in high-cardiovascular disease (CVD) risk adults have not been described. Using the CVD Policy Model, CVD events, treatment costs, quality-adjusted life years, and drug and monitoring costs were simulated over 2016 to 2026 for hypertensive patients aged 35 to 74 years. We projected the effectiveness and costs of hypertension treatment according to the 2003 Joint National Committee (JNC)-7 or 2014 JNC8 guidelines, and then for adults aged ≥50 years, we assessed the cost-effectiveness of adding an intensive goal of systolic blood pressure <120 mm Hg for patients with CVD, chronic kidney disease, or 10-year CVD risk ≥15%. Incremental cost-effectiveness ratios <$50 000 per quality-adjusted life years gained were considered cost-effective. JNC7 strategies treat more patients and are more costly to implement compared with JNC8 strategies. Adding intensive systolic blood pressure goals for high-risk patients prevents an estimated 43 000 and 35 000 annual CVD events incremental to JNC8 and JNC7, respectively. Intensive strategies save costs in men and are cost-effective in women compared with JNC8 alone. At a willingness-to-pay threshold of $50 000 per quality-adjusted life years gained, JNC8+intensive had the highest probability of cost-effectiveness in women (82%) and JNC7+intensive the highest probability of cost-effectiveness in men (100%). Assuming higher drug and monitoring costs, adding intensive goals for high-risk patients remained consistently cost-effective in men, but not always in women. Among patients aged 35 to 74 years, adding intensive blood pressure goals for high-risk groups to current national hypertension treatment guidelines prevents additional CVD deaths while saving costs provided that medication costs are controlled. © 2016 American Heart Association, Inc.

Cost Effectiveness of Childhood Obesity Interventions: Evidence and Methods for CHOICES.

PubMed

Gortmaker, Steven L; Long, Michael W; Resch, Stephen C; Ward, Zachary J; Cradock, Angie L; Barrett, Jessica L; Wright, Davene R; Sonneville, Kendrin R; Giles, Catherine M; Carter, Rob C; Moodie, Marj L; Sacks, Gary; Swinburn, Boyd A; Hsiao, Amber; Vine, Seanna; Barendregt, Jan; Vos, Theo; Wang, Y Claire

2015-07-01

The childhood obesity epidemic continues in the U.S., and fiscal crises are leading policymakers to ask not only whether an intervention works but also whether it offers value for money. However, cost-effectiveness analyses have been limited. This paper discusses methods and outcomes of four childhood obesity interventions: (1) sugar-sweetened beverage excise tax (SSB); (2) eliminating tax subsidy of TV advertising to children (TV AD); (3) early care and education policy change (ECE); and (4) active physical education (Active PE). Cost-effectiveness models of nationwide implementation of interventions were estimated for a simulated cohort representative of the 2015 U.S. population over 10 years (2015-2025). A societal perspective was used; future outcomes were discounted at 3%. Data were analyzed in 2014. Effectiveness, implementation, and equity issues were reviewed. Population reach varied widely, and cost per BMI change ranged from $1.16 (TV AD) to $401 (Active PE). At 10 years, assuming maintenance of the intervention effect, three interventions would save net costs, with SSB and TV AD saving $55 and $38 for every dollar spent. The SSB intervention would avert disability-adjusted life years, and both SSB and TV AD would increase quality-adjusted life years. Both SSB ($12.5 billion) and TV AD ($80 million) would produce yearly tax revenue. The cost effectiveness of these preventive interventions is greater than that seen for published clinical interventions to treat obesity. Cost-effectiveness evaluations of childhood obesity interventions can provide decision makers with information demonstrating best value for the money. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Identifying factors of activities of daily living important for cost and caregiver outcomes in Alzheimer's disease.

PubMed

Reed, Catherine; Belger, Mark; Vellas, Bruno; Andrews, Jeffrey Scott; Argimon, Josep M; Bruno, Giuseppe; Dodel, Richard; Jones, Roy W; Wimo, Anders; Haro, Josep Maria

2016-02-01

We aimed to obtain a better understanding of how different aspects of patient functioning affect key cost and caregiver outcomes in Alzheimer's disease (AD). Baseline data from a prospective observational study of community-living AD patients (GERAS) were used. Functioning was assessed using the Alzheimer's Disease Cooperative Study-Activities of Daily Living Scale. Generalized linear models were conducted to analyze the relationship between scores for total activities of daily living (ADL), basic ADL (BADL), instrumental ADL (IADL), ADL subdomains (confirmed through factor analysis) and individual ADL questions, and total societal costs, patient healthcare and social care costs, total and supervision caregiver time, and caregiver burden. Four distinct ADL subdomains were confirmed: basic activities, domestic/household activities, communication, and outside activities. Higher total societal costs were associated with impairments in all aspects of ADL, including all subdomains; patient costs were associated with total ADL and BADL, and basic activities subdomain scores. Both total and supervision caregiver hours were associated with total ADL and IADL scores, and domestic/household and outside activities subdomain scores (greater hours associated with greater functional impairments). There was no association between caregiver burden and BADL or basic activities subdomain scores. The relationship between total ADL, IADL, and the outside activities subdomain and outcomes differed between patients with mild and moderate-to-severe AD. Identification of ADL subdomains may lead to a better understanding of the association between patient function and costs and caregiver outcomes at different stages of AD, in particular the outside activities subdomain within mild AD.

Preparation of transition metal nanoparticles and surfaces modified with (CO)polymers synthesized by RAFT

DOEpatents

McCormick, III., Charles L.; Lowe, Andrew B.; Sumerlin, Brent S.

2006-11-21

A new, facile, general one-phase method of generating thio-functionalized transition metal nanoparticles and surfaces modified by (co)polymers synthesized by the RAFT method is described. The method includes the stops of forming a (co)polymer in aqueous solution using the RAFT methodology, forming a colloidal transition metal precursor solution from an appropriate transition metal; adding the metal precursor solution or surface to the (co)polymer solution, adding a reducing agent into the solution to reduce the metal colloid in situ to produce the stabilized nanoparticles or surface, and isolating the stabilized nanoparticles or surface in a manner such that aggregation is minimized. The functionalized surfaces generated using these methods can further undergo planar surface modifications, such as functionalization with a variety of different chemical groups, expanding their utility and application.

Preparation of transition metal nanoparticles and surfaces modified with (co)polymers synthesized by RAFT

DOEpatents

McCormick, III, Charles L.; Lowe, Andrew B [Hattiesburg, MS; Sumerlin, Brent S [Pittsburgh, PA

2011-12-27

A new, facile, general one-phase method of generating thiol-functionalized transition metal nanoparticles and surfaces modified by (co)polymers synthesized by the RAFT method is described. The method includes the steps of forming a (co)polymer in aqueous solution using the RAFT methodology, forming a colloidal transition metal precursor solution from an appropriate transition metal; adding the metal precursor solution or surface to the (co)polymer solution, adding a reducing agent into the solution to reduce the metal colloid in situ to produce the stabilized nanoparticles or surface, and isolating the stabilized nanoparticles or surface in a manner such that aggregation is minimized. The functionalized surfaces generated using these methods can further undergo planar surface modifications, such as functionalization with a variety of different chemical groups, expanding their utility and application.

Cost-Effectiveness of Florbetapir-PET in Alzheimer's Disease: A Spanish Societal Perspective.

PubMed

Hornberger, John; Michalopoulos, Steven; Dai, Minghan; Andrade, Paula; Dilla, Tatiana; Happich, Michael

2015-06-01

The rising prevalence of Alzheimer's disease (AD), and other diseases associated with dementia, imposes significant burden to various stakeholders who care for the elderly. Management of AD is complicated by multiple factors including disease-specific features which make it difficult to diagnose accurately during milder stages. Florbetapir F18 positron emission tomography (florbetapir-PET) is an approved imaging tool used to capture beta-amyloid neuritic plaque density in brains of cognitively impaired adults undergoing evaluation for AD and other causes of cognitive impairment. It has the potential to help improve healthcare outcomes as it may help clinicians identify patients with AD early so that treatments are initiated when most effective. Evaluate the potential long-term clinical and economic outcomes of adopting florbetapir-PET--adjunctive to standard clinical evaluation (SCE)--versus SCE alone in the diagnostic assessment of cognitively impaired patients with suspected AD. A decision analysis with a ten-year time horizon was developed in compliance with Good Research Practices and CHEERS guidelines. The target population was comprised of Spanish patients who were undergoing initial assessment for cognitive impairment (Mini-Mental State Examination [MMSE] score=20). Diagnostic accuracy, rate of cognitive decline, effect of drugs on cognition and dwelling status, economic burden (direct and indirect costs), and quality of life (QoL) were based on relevant clinical studies and published literature. Scenario analysis was applied to explore outcomes under different conditions, which included: (i) use of florbetapir-PET earlier in disease progression (MMSE score=22); and (ii) the addition of fluorodeoxyglucose (FDG)-PET to SCE. Adjunctive florbetapir-PET increased quality-adjusted life years (QALYs) by 0.008 years and increased costs by 36 compared to SCE alone (incremental cost-effectiveness ratio [ICER], 4,769). Use of florbetapir-PET was dominant in alternate scenarios. Sensitivity analyses indicated rates of institutionalization (by MMSE) and MMSE score upon initiation of acetylcholinesterase inhibitor (AChEI) treatment most influenced the primary outcome (ICER) in the base case scenario. Over 82% of probabilistic simulations were cost-effective using the Spanish threshold (30,000/QALY). The addition of florbetapir-PET to SCE is expected to improve the accuracy of AD diagnoses for patients experiencing cognitive impairment; it is cost-effective due to decreased healthcare costs and caregiver burden. Prospective studies of the clinical utility of florbetapir-PET are necessary to evaluate the long-term implications of adopting florbetapir-PET on clinical outcomes and costs in real-world settings. Florbetapir-PET is expected to improve decision-making regarding appropriate and sufficient care for cognitively impaired patients with suspected AD, while cost-effective. Earlier and more accurate diagnosis of AD may help to improve patient's health status and reduce treatment costs by effectively allocating healthcare resources and maximizing the benefit of treatments and supportive services. Use of florbetapir-PET may help accurately identify patients with AD. The development of novel therapeutics for use with companion diagnostics may provide additional benefits by slowing or halting progressive cognitive decline with AD, increase QoL and prolong survival.

Semiclassical Monte Carlo: A first principles approach to non-adiabatic molecular dynamics

DOE Office of Scientific and Technical Information (OSTI.GOV)

White, Alexander J.; Center for Nonlinear Studies; Gorshkov, Vyacheslav N.

2014-11-14

Modeling the dynamics of photophysical and (photo)chemical reactions in extended molecular systems is a new frontier for quantum chemistry. Many dynamical phenomena, such as intersystem crossing, non-radiative relaxation, and charge and energy transfer, require a non-adiabatic description which incorporate transitions between electronic states. Additionally, these dynamics are often highly sensitive to quantum coherences and interference effects. Several methods exist to simulate non-adiabatic dynamics; however, they are typically either too expensive to be applied to large molecular systems (10's-100's of atoms), or they are based on ad hoc schemes which may include severe approximations due to inconsistencies in classical and quantummore » mechanics. We present, in detail, an algorithm based on Monte Carlo sampling of the semiclassical time-dependent wavefunction that involves running simple surface hopping dynamics, followed by a post-processing step which adds little cost. The method requires only a few quantities from quantum chemistry calculations, can systematically be improved, and provides excellent agreement with exact quantum mechanical results. Here we show excellent agreement with exact solutions for scattering results of standard test problems. Additionally, we find that convergence of the wavefunction is controlled by complex valued phase factors, the size of the non-adiabatic coupling region, and the choice of sampling function. These results help in determining the range of applicability of the method, and provide a starting point for further improvement.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Semiz, İbrahim; Kazım Çamlıbel, A., E-mail: ibrahim.semiz@boun.edu.tr, E-mail: kazim.camlibel@boun.edu.tr

We try to reconstruct the scale factor a(t) of the universe from the SNe Ia data, i.e. the luminosity distance d{sub L}(z), using only the cosmological principle and the assumption that gravitation is governed by a metric theory. In our hence model-independent, or cosmographic study, we fit functions to d{sub L}(z) rather than a(t), since d{sub L}(z) is what is measured. We find that the acceleration history of the universe cannot be reliably determined in this approach due to the irregularity and parametrization-dependence of the results. However, adding the GRB data to the dataset cures most of the irregularities, atmore » the cost of compromising the model-independent nature of the study slightly. Then we can determine the redshift of transition to cosmic acceleration as z{sub t} ∼ 0.50 ± 0.09 for a flat universe (larger for positive spatial curvature).If Einstein gravity (GR) is assumed, we find a redshift at which the density of the universe predicted from the d{sub L}(z) data is independent of curvature. We use this point to derive an upper limit on matter density, hence a lower limit on the density of dark energy. While these limits do not improve the generally accepted ones, they are derived only using the d{sub L}(z) data.« less

Revealing Optical Components

NASA Technical Reports Server (NTRS)

2002-01-01

The Optical Vector Analyzer (OVA) 1550 significantly reduces the time and cost of testing sophisticated optical components. The technology grew from the research Luna Technologies' Dr. Mark Froggatt conducted on optical fiber strain measurement while working at Langley Research Center. Dr. Froggatt originally developed the technology for non- destructive evaluation testing at Langley. The new technique can provide 10,000 independent strain measurements while adding less than 10 grams to the weight of the vehicle. The OVA is capable of complete linear characterization of single-mode optical components used in high- bit-rate applications. The device can test most components over their full range in less than 30 seconds, compared to the more than 20 minutes required by other testing methods. The dramatically shortened measurement time results in increased efficiency in final acceptance tests of optical devices, and the comprehensive data produced by the instrument adds considerable value for component consumers. The device eliminates manufacturing bottlenecks, while reducing labor costs and wasted materials during production.

Early decline in glucose transport and metabolism precedes shift to ketogenic system in female aging and Alzheimer's mouse brain: implication for bioenergetic intervention.

PubMed

Ding, Fan; Yao, Jia; Rettberg, Jamaica R; Chen, Shuhua; Brinton, Roberta Diaz

2013-01-01

We previously demonstrated that mitochondrial bioenergetic deficits in the female brain accompanied reproductive senescence and was accompanied by a shift from an aerobic glycolytic to a ketogenic phenotype. Herein, we investigated the relationship between systems of fuel supply, transport and mitochondrial metabolic enzyme expression/activity during aging (3-15 months) in the hippocampus of nontransgenic (nonTg) background and 3xTgAD female mice. Results indicate that during female brain aging, both nonTg and 3xTgAD brains undergo significant decline in glucose transport, as detected by FDG-microPET, between 6-9 months of age just prior to the transition into reproductive senescence. The deficit in brain metabolism was sustained thereafter. Decline in glucose transport coincided with significant decline in neuronal glucose transporter expression and hexokinase activity with a concomitant rise in phosphorylated/inactivated pyruvate dehydrogenase. Lactate utilization declined in parallel to the decline in glucose transport suggesting lactate did not serve as an alternative fuel. An adaptive response in the nonTg hippocampus was a shift to transport and utilization of ketone bodies as an alternative fuel. In the 3xTgAD brain, utilization of ketone bodies as an alternative fuel was evident at the earliest age investigated and declined thereafter. The 3xTgAD adaptive response was to substantially increase monocarboxylate transporters in neurons while decreasing their expression at the BBB and in astrocytes. Collectively, these data indicate that the earliest change in the metabolic system of the aging female brain is the decline in neuronal glucose transport and metabolism followed by decline in mitochondrial function. The adaptive shift to the ketogenic system as an alternative fuel coincided with decline in mitochondrial function. Translationally, these data provide insights into the earliest events in bioenergetic aging of the female brain and provide potential targets for preventing shifts to less efficient bioenergetic fuels and transition to the ketogenic phenotype of the Alzheimer's brain.

Introducing auto-disable syringes to the national immunization programme in Madagascar.

PubMed Central

Drain, Paul K.; Ralaivao, Josoa S.; Rakotonandrasana, Alexander; Carnell, Mary A.

2003-01-01

OBJECTIVE: To evaluate the safety and coverage benefits of auto-disable (AD) syringes, weighed against the financial and logis- tical costs, and to create appropriate health policies in Madagascar. METHODS: Fifteen clinics in Madagascar, trained to use AD syringes, were randomized to implement an AD syringe only, mixed (AD syringes used only on non-routine immunization days), or sterilizable syringe only (control) programme. During a five-week period, data on administered vaccinations were collected, interviews were conducted, and observations were recorded. FINDINGS: The use of AD syringes improved coverage rates by significantly increasing the percentage of vaccines administered on non-routine immunization days (AD-only 4.3%, mixed 5.7%, control 1.1% (P<0.05)). AD-only clinics eliminated sterilization sessions for vaccinations, whereas mixed clinics reduced the number of sterilization sessions by 64%. AD syringes were five times more expensive than sterilizable syringes, which increased AD-only and mixed clinics' projected annual injection costs by 365% and 22%, respectively. However, introducing AD syringes for all vaccinations would only increase the national immunization budget by 2%. CONCLUSION: The use of AD syringes improved vaccination coverage rates by providing ready-to-use sterile syringes on non-routine immunization days and decreasing the number of sterilization sessions, thereby improving injection safety. The mixed programme was the most beneficial approach to phasing in AD syringes and diminishing logistical complications, and it had minimal costs. AD syringes, although more expensive, can feasibly be introduced into a developing country's immunization programme to improve vaccination safety and coverage. PMID:14576886

An overview of the etiology, diagnosis, and treatment of Alzheimer disease.

PubMed

Forsyth, E; Ritzline, P D

1998-12-01

Alzheimer disease (AD) is the most common form of dementia affecting elderly people. It is the fourth leading cause of death among adults in the United States, following heart disease, cancer, and stroke. The prevalence of AD increases with increasing age. An estimated 10% of people aged 65 years have this progressive, degenerative disease, and this percentage increases to 47.2% for people aged 85 years and older. An early-onset form of AD can affect individuals who are middle-aged, with the youngest documented case being that of a 28-year-old. In the Framingham cohort, women with AD outnumbered men by a ratio of 2.8:1 for those aged 75 years or older. Undoubtedly, as our population continues to age, the increasing prevalence of AD will have an even greater impact on society than it does today. Approximately 4 million Americans have AD, and it is projected that the number will rise to 14 million by the middle of the next century. The financial impact of AD is staggering, with the average lifetime cost for an individual with AD exceeding $170,000. Although the majority of individuals with AD are cared for by family and friends at home, individuals with AD constitute half of all nursing home residents. The average cost of a year of nursing home care for an individual with AD is $42,000, and this cost can exceed $70,000. The purpose of this article is to provide an overview of the etiology of AD, the tools used in the diagnosis of AD, and the treatment of individuals with AD. In addition, the clinical presentation of the various stages of AD is described, and the psychosocial implications of this disease are discussed.

Deterioration and cost information for bridge management.

DOT National Transportation Integrated Search

2012-05-01

This study applies contract bid tabulations and elementlevel condition records to develop elementlevel actions, : costs for actions, transition probabilities for models of deterioration of bridge elements, and transition probabilities : for imp...

Measures of International Manufacturing and Trade of Clean Energy Technologies

DOE Office of Scientific and Technical Information (OSTI.GOV)

Engel-Cox, Jill; Sandor, Debbie; Keyser, David

The technologies that produce clean energy, such as solar photovoltaic panels and lithium ion batteries for electric vehicles, are globally manufactured and traded. As demand and deployment of these technologies grows exponentially, the innovation to reach significant economies of scale and drive down energy production costs becomes less in the technology and more in the manufacturing of the technology. Manufacturing innovations and other manufacturing decisions can reduce costs of labor, materials, equipment, operating costs, and transportation, across all the links in the supply chain. To better understand the manufacturing aspect of the clean energy economy, we have developed key metricsmore » for systematically measuring and benchmarking international manufacturing of clean energy technologies. The metrics are: trade, market size, manufacturing value-added, and manufacturing capacity and production. These metrics were applied to twelve global economies and four representative technologies: wind turbine components, crystalline silicon solar photovoltaic modules, vehicle lithium ion battery cells, and light emitting diode packages for efficient lighting and other consumer products. The results indicated that clean energy technologies are being developed via complex, dynamic, and global supply chains, with individual economies benefiting from different technologies and links in the supply chain, through both domestic manufacturing and global trade.« less

What do isogamous organisms teach us about sex and the two sexes?

PubMed

Lehtonen, Jussi; Kokko, Hanna; Parker, Geoff A

2016-10-19

Isogamy is a reproductive system where all gametes are morphologically similar, especially in terms of size. Its importance goes beyond specific cases: to this day non-anisogamous systems are common outside of multicellular animals and plants, they can be found in all eukaryotic super-groups, and anisogamous organisms appear to have isogamous ancestors. Furthermore, because maleness is synonymous with the production of small gametes, an explanation for the initial origin of males and females is synonymous with understanding the transition from isogamy to anisogamy. As we show here, this transition may also be crucial for understanding why sex itself remains common even in taxa with high costs of male production (the twofold cost of sex). The transition to anisogamy implies the origin of male and female sexes, kickstarts the subsequent evolution of sex roles, and has a major impact on the costliness of sexual reproduction. Finally, we combine some of the consequences of isogamy and anisogamy in a thought experiment on the maintenance of sexual reproduction. We ask what happens if there is a less than twofold benefit to sex (not an unlikely scenario as large short-term benefits have proved difficult to find), and argue that this could lead to a situation where lineages that evolve anisogamy-and thus the highest costs of sex-end up being associated with constraints that make invasion by asexual reproduction unlikely (the 'anisogamy gateway' hypothesis).This article is part of the themed issue 'Weird sex: the underappreciated diversity of sexual reproduction'. © 2016 The Author(s).

What do isogamous organisms teach us about sex and the two sexes?

PubMed Central

Lehtonen, Jussi; Kokko, Hanna; Parker, Geoff A.

2016-01-01

Isogamy is a reproductive system where all gametes are morphologically similar, especially in terms of size. Its importance goes beyond specific cases: to this day non-anisogamous systems are common outside of multicellular animals and plants, they can be found in all eukaryotic super-groups, and anisogamous organisms appear to have isogamous ancestors. Furthermore, because maleness is synonymous with the production of small gametes, an explanation for the initial origin of males and females is synonymous with understanding the transition from isogamy to anisogamy. As we show here, this transition may also be crucial for understanding why sex itself remains common even in taxa with high costs of male production (the twofold cost of sex). The transition to anisogamy implies the origin of male and female sexes, kickstarts the subsequent evolution of sex roles, and has a major impact on the costliness of sexual reproduction. Finally, we combine some of the consequences of isogamy and anisogamy in a thought experiment on the maintenance of sexual reproduction. We ask what happens if there is a less than twofold benefit to sex (not an unlikely scenario as large short-term benefits have proved difficult to find), and argue that this could lead to a situation where lineages that evolve anisogamy—and thus the highest costs of sex—end up being associated with constraints that make invasion by asexual reproduction unlikely (the ‘anisogamy gateway’ hypothesis). This article is part of the themed issue ‘Weird sex: the underappreciated diversity of sexual reproduction’. PMID:27619696

FACT is a sensor of DNA torsional stress in eukaryotic cells

PubMed Central

Safina, Alfiya; Cheney, Peter; Pal, Mahadeb; Brodsky, Leonid; Ivanov, Alexander; Kirsanov, Kirill; Lesovaya, Ekaterina; Naberezhnov, Denis; Nesher, Elimelech; Koman, Igor; Wang, Dan; Wang, Jianming; Yakubovskaya, Marianna; Winkler, Duane

2017-01-01

Abstract Transitions of B-DNA to alternative DNA structures (ADS) can be triggered by negative torsional strain, which occurs during replication and transcription, and may lead to genomic instability. However, how ADS are recognized in cells is unclear. We found that the binding of candidate anticancer drug, curaxin, to cellular DNA results in uncoiling of nucleosomal DNA, accumulation of negative supercoiling and conversion of multiple regions of genomic DNA into left-handed Z-form. Histone chaperone FACT binds rapidly to the same regions via the SSRP1 subunit in curaxin-treated cells. In vitro binding of purified SSRP1 or its isolated CID domain to a methylated DNA fragment containing alternating purine/pyrimidines, which is prone to Z-DNA transition, is much stronger than to other types of DNA. We propose that FACT can recognize and bind Z-DNA or DNA in transition from a B to Z form. Binding of FACT to these genomic regions triggers a p53 response. Furthermore, FACT has been shown to bind to other types of ADS through a different structural domain, which also leads to p53 activation. Thus, we propose that FACT acts as a sensor of ADS formation in cells. Recognition of ADS by FACT followed by a p53 response may explain the role of FACT in DNA damage prevention. PMID:28082391

46 CFR 296.60 - Applications.

Code of Federal Regulations, 2010 CFR

2010-10-01

... additional vessel maintenance and repair preparation costs, including costs for additional engineering...” for transit to a U.S. shipyard in excess of the transit period to a foreign shipyard on the same trade...

Calculating electronic correlation effects from densities of transitions

NASA Astrophysics Data System (ADS)

Haydock, Roger

Adding a localized electron to a system of interacting electrons induces a density of transitions described by the time-independent Heisenberg equation. Sequences of these transitions generate interacting states whose total energy is the sum of energies of the constituent transitions. A calculation of magnetic moments for itinerant electrons with Ising interactions illustrates this method. supported by the H. V. Snyder Gift to the University of Oregon.

47 CFR 1.1404 - Complaint.

Code of Federal Regulations, 2010 CFR

2010-10-01

... telecommunications carriers for non-recurring costs. (2) Data and information should be based upon historical or... upon historical or original cost methodology, insofar as possible. Data should be derived from ARMIS...) through (n) and adding new paragraphs (g)(12) and (h) through (j). The added text contains information...

Phase-transition Theory of Kerr Black Holes in the Electromagnetic Field

NASA Astrophysics Data System (ADS)

Liao, Yi; Gong, Xiao-Bo; Wu, Jian-Sheng

2017-02-01

For a Kerr black hole (KBH) with spin J and mass M in a steady electromagnetic field, a special Wald vacuum solution (WVS) has been found in the case of the no-source uniform field. For WVS, the Meissner effect (ME) occurs only in the the extreme KBH, where M2/J = 1, in this case, the magnetic field is totally excluded from the event horizon (EH) of KBH. However, WVS does not consider the Hawking radiation (HR) but treats KBH as an absolutely black body. If HR is added , researchers believe that the condition is not so restricted and it is possible for ME to occur in the less-extreme case. How less is the “less-extreme case”? This paper tries to answer this question. Since the Hawking temperature TH of KBH defined by HR is proportional to the surface gravity κ at the EH, this question is actually about the so-called existence/non-existence of ME (ME/NME) or superconducting phase transition. In this paper, we study the connection between the superconductivity of KBH-EH and the existence of Weyl fermion. Using thermodynamic formulas and the KBH state equation, we prove that the inherent-parameter condition for ME to occur is {M}2/J≤slant {ɛ }c=1.5 in force-free fields whether it be in the simple axisymmetric vacuum zero source case or in the non-zero source case, which can be described by the nonlinear Grad-Shafranov equation. We suggest that this is a second-order phase transition and calculate the critical exponents δ = 1 and η = 1/2 for the specific heat diverging at constant J.

Articulated Bus Report

DOT National Transportation Integrated Search

1982-07-01

Escalating transit deficits have led the transit industry to search for methods for improving productivity and reducing operating costs. In seeking these objectives, there has been renewed interest in the cost-saving potential of high-capacity articu...

Self tuning system for industrial surveillance

DOEpatents

Stephan, Wegerich W; Jarman, Kristin K.; Gross, Kenneth C.

2000-01-01

A method and system for automatically establishing operational parameters of a statistical surveillance system. The method and system performs a frequency domain transition on time dependent data, a first Fourier composite is formed, serial correlation is removed, a series of Gaussian whiteness tests are performed along with an autocorrelation test, Fourier coefficients are stored and a second Fourier composite is formed. Pseudorandom noise is added, a Monte Carlo simulation is performed to establish SPRT missed alarm probabilities and tested with a synthesized signal. A false alarm test is then emperically evaluated and if less than a desired target value, then SPRT probabilities are used for performing surveillance.

Enhancing efficiency of production cost on seafood process with activity based management method

NASA Astrophysics Data System (ADS)

Tarigan, U.; Tarigan, U. P. P.

2018-02-01

The efficiency of production costs has an important impact maintaining company presence in the business world, as well as in the face of increasingly sharp global competition. It was done by identifying and reducing non-value-added activities to decrease production costs and increase profits. The study was conducted at a company engaged in the production of squid (seafood). It has a higher product price than the market as Rp 50,000 per kg while the market price of squid is only Rp 35,000 per kg. The price of the product to be more expensive compared with market price, and thereby a lot more consumers choose the lower market price. Based on the discussions conducted, the implementation of Activity Based Management was seen in the reduction of activities that are not added value in the production process. Since each activities consumers cost, the reduction of nonvalue-added activities has effects on the decline of production cost. The production’s decline costs mainly occur in the reduction of material transfer costs. The results showed that there was an increase after the improvement of 2.60%. Increased production cost efficiency causes decreased production costs and increased profits.

An Application of Cost-Effectiveness Analysis in a Major Defense Acquisition Program: the Decision by the U.S. Department of Defense to Retain the C-17 Transport Aircraft

DTIC Science & Technology

2010-12-01

adding hush kits to dampen the sound of the engines and adding extra material to the fuselage. The cost to restart the C-5 line was estimated at $750...include adding hush kits to dampen the sound of the engines and extra material to the fuselage. A recently completed SAB had recommended that the weep

Protecting child health and nutrition status with ready-to-use food in addition to food assistance in urban Chad: a cost-effectiveness analysis

PubMed Central

2013-01-01

Background Despite growing interest in use of lipid nutrient supplements for preventing child malnutrition and morbidity, there is inconclusive evidence on the effectiveness, and no evidence on the cost-effectiveness of this strategy. Methods A cost effectiveness analysis was conducted comparing costs and outcomes of two arms of a cluster randomized controlled trial implemented in eastern Chad during the 2010 hunger gap by Action contre la Faim France and Ghent University. This trial assessed the effect on child malnutrition and morbidity of a 5-month general distribution of staple rations, or staple rations plus a ready-to-use supplementary food (RUSF). RUSF was distributed to households with a child aged 6–36 months who was not acutely malnourished (weight-for-height > = 80% of the NCHS reference median, and absence of bilateral pitting edema), to prevent acute malnutrition in these children. While the addition of RUSF to a staple ration did not result in significant reduction in wasting rates, cost-effectiveness was assessed using successful secondary outcomes of cases of diarrhea and anemia (hemoglobin <110 g/L) averted among children receiving RUSF. Total costs of the program and incremental costs of RUSF and related management and logistics were estimated using accounting records and key informant interviews, and include costs to institutions and communities. An activity-based costing methodology was applied and incremental costs were calculated per episode of diarrhea and case of anemia averted. Results Adding RUSF to a general food distribution increased total costs by 23%, resulting in an additional cost per child of 374 EUR, and an incremental cost per episode of diarrhea averted of 1,083 EUR and per case of anemia averted of 3,627 EUR. Conclusions Adding RUSF to a staple ration was less cost-effective than other standard intervention options for averting diarrhea and anemia. This strategy holds potential to address a broad array of health and nutrition outcomes in emergency settings where infrastructure is weak and other intervention options are infeasible in the short-term. However, further research is needed to establish the contexts in which RUSF is most effective and cost-effective in preventing acute malnutrition and morbidity among vulnerable children, compared to other options. PMID:24210058

2009 Alzheimer's disease facts and figures.

PubMed

2009-05-01

Alzheimer's disease (AD) is the sixth leading cause of all deaths in the United States, and the fifth leading cause of death in Americans aged 65 and older. Whereas other major causes of death have been on the decrease, deaths attributable to AD have been rising dramatically. Between 2000 and 2006, heart-disease deaths decreased nearly 12%, stroke deaths decreased 18%, and prostate cancer-related deaths decreased 14%, whereas deaths attributable to AD increased 47%. An estimated 5.3 million Americans have AD; the approximately 200,000 persons under age 65 years with AD comprise the younger-onset AD population. Every 70 seconds, someone in America develops AD; by 2050, this time is expected to decrease to every 33 seconds. Over the coming decades, the "baby-boom" population is projected to add 10 million people to these numbers. In 2050, the incidence of AD is expected to approach nearly a million people per year, with a total estimated prevalence of 11 to 16 million people. Significant cost implications related to AD and other dementias include an estimated $148 billion annually in direct (Medicare/Medicaid) and indirect (e.g., decreased business productivity) costs. Not included in these figures is the $94 billion in unpaid services to individuals with AD provided annually by an estimated 10 million caregivers. Mild cognitive impairment (MCI) is an important component in the continuum from healthy cognition to dementia. Understanding which individuals with MCI are at highest risk for eventually developing AD is key to our ultimate goal of preventing AD. This report provides information meant to increase an understanding of the public-health impact of AD, including incidence and prevalence, mortality, lifetime risks, costs, and impact on family caregivers. This report also sets the stage for a better understanding of the relationship between MCI and AD.

Sociality and health: impacts of sociality on disease susceptibility and transmission in animal and human societies

PubMed Central

Kappeler, Peter M.; Cremer, Sylvia; Nunn, Charles L.

2015-01-01

This paper introduces a theme issue presenting the latest developments in research on the impacts of sociality on health and fitness. The articles that follow cover research on societies ranging from insects to humans. Variation in measures of fitness (i.e. survival and reproduction) has been linked to various aspects of sociality in humans and animals alike, and variability in individual health and condition has been recognized as a key mediator of these relationships. Viewed from a broad evolutionary perspective, the evolutionary transitions from a solitary lifestyle to group living have resulted in several new health-related costs and benefits of sociality. Social transmission of parasites within groups represents a major cost of group living, but some behavioural mechanisms, such as grooming, have evolved repeatedly to reduce this cost. Group living also has created novel costs in terms of altered susceptibility to infectious and non-infectious disease as a result of the unavoidable physiological consequences of social competition and integration, which are partly alleviated by social buffering in some vertebrates. Here, we define the relevant aspects of sociality, summarize their health-related costs and benefits, and discuss possible fitness measures in different study systems. Given the pervasive effects of social factors on health and fitness, we propose a synthesis of existing conceptual approaches in disease ecology, ecological immunology and behavioural neurosciences by adding sociality as a key factor, with the goal to generate a broader framework for organismal integration of health-related research. PMID:25870402

Rates of transition between amyloid and neurodegeneration biomarker states and to dementia among non-demented individuals: a population-based cohort study

PubMed Central

Jack, Clifford R.; Therneau, Terry M.; Wiste, Heather J.; Weigand, Stephen D.; Knopman, David S.; Lowe, Val J.; Mielke, Michelle M.; Vemuri, Prashanthi; Roberts, Rosebud O.; Machulda, Mary M.; Senjem, Matthew L.; Gunter, Jeffrey L.; Rocca, Walter A.; Petersen, Ronald C.

2016-01-01

Summary Background We previously observed in a cross-sectional analysis that frequencies of amyloid and neurodegeneration biomarker states varied greatly by age among cognitively non-impaired participants, suggesting dynamic within-person processes. Our objective in this longitudinal study was to estimate rates of transitioning from a less- to a more-abnormal biomarker state by age among non-demented individuals, as well as rates of transitioning to dementia by biomarker state. Methods All participants (n=4049) were non-demented at baseline. A subset of 1541 underwent multi-modality imaging. Amyloid PET was used to classify individuals as amyloid positive (A+) or negative (A−). FDG PET and MRI were used to classify individuals as neurodegeneration positive (N+) or negative (N−). All observations from the 4049 individuals were used in a multi-state model to estimate four different age-specific biomarker state transition rates among non-demented individuals: A−N− to A+N−; A−N− to A−N+ (suspected non-Alzheimer pathology, SNAP); A+N− to A+N+; A−N+ (SNAP) to A+N+. We also estimated two age-specific rates to dementia: A+N+ to dementia; and A−N+ (SNAP) to dementia. Using these state-to-state transition rates, we estimated biomarker state frequencies by age. Findings All transition rates were low at age 50 and (with one exception) were well-characterized by an exponential increase with age. The rates per 100-person years at ages 65 versus 85 were 1.6 versus 17.2 for A−N− to A−N+, 6.1 versus 20.8 for A+N− to A+N+, 2.6 versus 13.2 for A−N+ to A+N+, 0.8 versus 7.0 for A+N+ to dementia, and 0.6 versus 1.7 for A−N+ to dementia. The one exception to an exponential increase with age was the transition rate from A−N− to A+N− which increased from 4.0 transitions per 100 person-years at age 65 to approximately 7 transitions per 100 person-years in the 70s and then plateaued beyond that age. Estimated biomarker frequencies by age from the multistate model were similar to cross-sectional biomarker frequencies. Interpretation Dynamic state-to-state transition rates illustrate important measurable aspects of the changing biology underlying brain aging. The biomarker states we describe relate to both AD and non-AD processes. Our transition rates suggest that brain aging can be conceptualized as a nearly inevitable acceleration toward worse biomarker and clinical states. The one exception was that transition to amyloidosis without neurodegeneration was most dynamic from age 60 to 70 and then plateaued beyond that age. We found that simple transition rates can explain complex, highly interdependent biomarker state frequencies in our sample. PMID:26597325

Measure Guideline: Transitioning to a Tankless Water Heater

DOE Office of Scientific and Technical Information (OSTI.GOV)

Brozyna, K.; Rapport, A.

2012-09-01

This Measure Guideline provides information to help residential builders and retrofitters with the design, specification, selection, implementation, installation, and maintenance issues of transitioning from tank-type water heaters to tankless water heaters. The report compares the differences between tankless and tank-type water heaters, highlighting the energy savings that can be realized by adopting tankless water heaters over tank-type water heaters. Selection criteria and risks discussed include unit sizing and location, water distribution system, plumbing line length and diameter, water quality, electrical backup, and code issues. Cost and performance data are provided for various types of tankless and tank-type water heaters, bothmore » natural gas fired and electric. Also considered are interactions between the tankless water heater and other functional elements of a house, such as cold water supply and low-flow devices. Operating costs and energy use of water distribution systems for single- and two-story houses are provided, along with discussion of the various types of distribution systems that can be used with tankless water heaters. Finally, details to prepare for proper installation of a tankless water heater are described.« less

Genomic stability of adipogenic human adenovirus 36.

PubMed

Nam, J-H; Na, H-N; Atkinson, R L; Dhurandhar, N V

2014-02-01

Human adenovirus Ad36 increases adiposity in several animal models, including rodents and non-human primates. Importantly, Ad36 is associated with human obesity, which has prompted research to understand its epidemiology and to develop a vaccine to prevent a subgroup of obesity. For this purpose, understanding the genomic stability of Ad36 in vivo and in vitro infections is critical. Here, we examined whether in vitro cell passaging over a 14-year period introduced any genetic variation in Ad36. We sequenced the whole genome of Ad36-which was plaque purified in 1998 from the original strain obtained from American Type Culture Collection, and passaged approximately 12 times over the past 14 years (Ad36-2012). This DNA sequence was compared with a previously published sequence of Ad36 likely obtained from the same source (Ad36-1988). Compared with Ad36-1988, only two nucleotides were altered in Ad36-2012: a T insertion at nucleotide 1862, which may induce early termination of the E1B viral protein, and a T➝C transition at nucleotide 26 136. Virus with the T insertion (designated Ad36-2012-T6) was mixed with wild-type virus lacking the T insertion (designated Ad36-2012-T5) in the viral stock. The transition at nucleotide 26 136 does not change the encoded amino acid (aspartic acid) in the pVIII viral protein. The rate of genetic variation in Ad36 is ∼2.37 × 10(-6) mutations/nucleotide/passage. Of particular importance, there were no mutations in the E4orf1 gene, the critical gene for producing obesity. This very-low-variation rate should reduce concerns about genetic variability when developing Ad36 vaccines or developing assays for detecting Ad36 infection in populations.

On the reversibility of transitions between closed and open cellular convection

DOE PAGES

Feingold, G.; Koren, I.; Yamaguchi, T.; ...

2015-07-08

The two-way transition between closed and open cellular convection is addressed in an idealized cloud-resolving modeling framework. A series of cloud-resolving simulations shows that the transition between closed and open cellular states is asymmetrical and characterized by a rapid ("runaway") transition from the closed- to the open-cell state but slower recovery to the closed-cell state. Given that precipitation initiates the closed–open cell transition and that the recovery requires a suppression of the precipitation, we apply an ad hoc time-varying drop concentration to initiate and suppress precipitation. We show that the asymmetry in the two-way transition occurs even for very rapidmore » drop concentration replenishment. The primary barrier to recovery is the loss in turbulence kinetic energy (TKE) associated with the loss in cloud water (and associated radiative cooling) and the vertical stratification of the boundary layer during the open-cell period. In transitioning from the open to the closed state, the system faces the task of replenishing cloud water fast enough to counter precipitation losses, such that it can generate radiative cooling and TKE. It is hampered by a stable layer below cloud base that has to be overcome before water vapor can be transported more efficiently into the cloud layer. Recovery to the closed-cell state is slower when radiative cooling is inefficient such as in the presence of free tropospheric clouds or after sunrise, when it is hampered by the absorption of shortwave radiation. Tests suggest that recovery to the closed-cell state is faster when the drizzle is smaller in amount and of shorter duration, i.e., when the precipitation causes less boundary layer stratification. Cloud-resolving model results on recovery rates are supported by simulations with a simple predator–prey dynamical system analogue. It is suggested that the observed closing of open cells by ship effluent likely occurs when aerosol intrusions are large, when contact comes prior to the heaviest drizzle in the early morning hours, and when the free troposphere is cloud free.« less

SU-E-T-228: The Beauty and the Beast: Transition from Film/paper Charts to Paperless Environment with a New TrueBeam/ARIA System in a Small Community Hospital on a Tight Budget.

PubMed

Chu, K; Rasmussen, B

2012-06-01

To review the issues a physicist may encounter in a community hospital during the transition from film/paper charts to a paperless environment with ARIA and a TrueBeam LINAC. With a lean budget, it was necessary for the physics group to take on the project management responsibilities in order save costs. This work highlights the lessons learned during the planning and execution of our project. Like many hospitals around the county, our hospital was caught in the economic downturn and was unable to provide all of the capital necessary to upgrade to the radiation oncology department. However, with the support of the hospital foundation, a total of $6M was secured for new LINAC, ARIA and CT simulator. To save costs on facilities and computers, it was necessary for the physics group to be involved in creating architectural drawings for shielding calculations, finding a vendor to remove the old linac, assisting the foundation to raise money, submission of the 'Certificate of Need' approval with the state, negotiation with vendors, IT infrastructure, reviews with the general contractor and vendor's project team, and ultimately writing the commissioning reports for the new systems as well as developing new policies and procedures. During a period of 4 months, the old LINAC was removed, facility renovations made, the TrueBeam linac was installed, accepted, and commissioned and first patients were treated. In addition, we transitioned from a film/paper environment to a paperless environment. However, this was very stressful for staff and it may be advisable to stage such a project over a longer period of time. There was also significant lost revenue (∼$2M) during downtime of construction, installation, and commissioning. The radiation oncology department was upgraded (The Beauty) on a tight budget but at the cost of added stress (The Beast) to the staff. © 2012 American Association of Physicists in Medicine.

How Confounder Strength Can Affect Allocation of Resources in Electronic Health Records.

PubMed

Lynch, Kristine E; Whitcomb, Brian W; DuVall, Scott L

2018-01-01

When electronic health record (EHR) data are used, multiple approaches may be available for measuring the same variable, introducing potentially confounding factors. While additional information may be gleaned and residual confounding reduced through resource-intensive assessment methods such as natural language processing (NLP), whether the added benefits offset the added cost of the additional resources is not straightforward. We evaluated the implications of misclassification of a confounder when using EHRs. Using a combination of simulations and real data surrounding hospital readmission, we considered smoking as a potential confounder. We compared ICD-9 diagnostic code assignment, which is an easily available measure but has the possibility of substantial misclassification of smoking status, with NLP, a method of determining smoking status that more expensive and time-consuming than ICD-9 code assignment but has less potential for misclassification. Classification of smoking status with NLP consistently produced less residual confounding than the use of ICD-9 codes; however, when minimal confounding was present, differences between the approaches were small. When considerable confounding is present, investing in a superior measurement tool becomes advantageous.

More frequent, more costly? Health economic modelling aspects of monitoring glaucoma patients in England.

PubMed

Boodhna, Trishal; Crabb, David P

2016-10-22

Chronic open angle glaucoma (COAG) is an age-related eye disease causing irreversible loss of visual field (VF). Health service delivery for COAG is challenging given the large number of diagnosed patients requiring lifelong periodic monitoring by hospital eye services. Yet frequent examination better determines disease worsening and speed of VF loss under treatment. We examine the cost-effectiveness of increasing frequency of VF examinations during follow-up using a health economic model. Two different VF monitoring schemes defined as current practice (annual VF testing) and proposed practice (three VF tests per year in the first 2 years after diagnosis) were examined. A purpose written health economic Markov model is used to test the hypothesis that cost effectiveness improves by implementing proposed practice on groups of patients stratified by age and severity of COAG. Further, a new component of the model, estimating costs of visual impairment, was added. Results were derived from a simulated cohort of 10000 patients with quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) used as main outcome measures. An ICER of £21,392 per QALY was derived for proposed practice improving to a value of £11,382 once savings for prevented visual impairment was added to the model. Proposed practice was more cost-effective in younger patients. Proposed practice for patients with advanced disease at diagnosis generated ICERs > £60,000 per QALY; these cases would likely be on the most intensive treatment pathway making clinical information on speed of VF loss redundant. Sensitivity analysis indicated results to be robust in relation to hypothetical willingness to pay threshold identified by national guidelines, although greatest uncertainty was allied to estimates of implementation and visual impairment costs. Increasing VF monitoring at the earliest stages of follow-up for COAG appears to be cost-effective depending on reasonable assumptions about implementation costs. Our health economic model highlights benefits of stratifying patients to more or less monitoring based on age and stage of disease at diagnosis; a prospective study is needed to prove these findings. Further, this works highlights gaps in knowledge about long term costs of visual impairment.

An Experimental Investigation of Computer Program Development Approaches and Computer Programming Metrics.

DTIC Science & Technology

1979-12-01

team progranming in reducing software dleveloup- ment costs relative to ad hoc approaches and improving software product quality relative to...are interpreted as demonstrating the advantages of disciplined team programming in reducing software development costs relative to ad hoc approaches...is due oartialty to the cost and imoracticality of a valiI experimental setup within a oroauct ion environment. Thus the question remains, are

Impact on Medical Cost, Cumulative Survival, and Cost-Effectiveness of Adding Rituximab to First-Line Chemotherapy for Follicular Lymphoma in Elderly Patients: An Observational Cohort Study Based on SEER-Medicare

PubMed Central

Griffiths, Robert I.; Gleeson, Michelle L.; Mikhael, Joseph; Danese, Mark D.

2012-01-01

Rituximab improves survival in follicular lymphoma (FL), but is considerably more expensive than conventional chemotherapy. We estimated the total direct medical costs, cumulative survival, and cost-effectiveness of adding rituximab to first-line chemotherapy for FL, based on a single source of data representing routine practice in the elderly. Using surveillance, epidemiology, and end results (SEER) registry data plus Medicare claims, we identified 1,117 FL patients who received first-line CHOP (cyclophosphamide (C), doxorubicin, vincristine (V), and prednisone (P)) or CVP +/− rituximab. Multivariate regression was used to estimate adjusted cumulative cost and survival differences between the two groups over four years after beginning treatment. The median age was 73 years (minimum 66 years), 56% had stage III-IV disease, and 67% received rituximab. Adding rituximab to first-line chemotherapy was associated with higher adjusted incremental total cost ($18,695; 95% Confidence Interval (CI) $9,302–$28,643) and longer adjusted cumulative survival (0.18 years; 95% CI 0.10–0.27) over four years of followup. The expected cost-effectiveness was $102,142 (95% CI $34,531–296,337) per life-year gained. In routine clinical practice, adding rituximab to first-line chemotherapy for elderly patients with FL results in higher direct medical costs to Medicare and longer cumulative survival after four years. PMID:22969803

Rural Policy in a New Century.

ERIC Educational Resources Information Center

Marshall, Ray

Past rural policies are reviewed, noting the effects of globalization and information technology. Rural business profits can be maximized by direct cost or value-added competition, but cost competition limits the development of productive capacity and leads to unequal income distribution. In contrast, value-added competition could create steep…

Inverse probability weighted least squares regression in the analysis of time-censored cost data: an evaluation of the approach using SEER-Medicare.

PubMed

Griffiths, Robert I; Gleeson, Michelle L; Danese, Mark D; O'Hagan, Anthony

2012-01-01

To assess the accuracy and precision of inverse probability weighted (IPW) least squares regression analysis for censored cost data. By using Surveillance, Epidemiology, and End Results-Medicare, we identified 1500 breast cancer patients who died and had complete cost information within the database. Patients were followed for up to 48 months (partitions) after diagnosis, and their actual total cost was calculated in each partition. We then simulated patterns of administrative and dropout censoring and also added censoring to patients receiving chemotherapy to simulate comparing a newer to older intervention. For each censoring simulation, we performed 1000 IPW regression analyses (bootstrap, sampling with replacement), calculated the average value of each coefficient in each partition, and summed the coefficients for each regression parameter to obtain the cumulative values from 1 to 48 months. The cumulative, 48-month, average cost was $67,796 (95% confidence interval [CI] $58,454-$78,291) with no censoring, $66,313 (95% CI $54,975-$80,074) with administrative censoring, and $66,765 (95% CI $54,510-$81,843) with administrative plus dropout censoring. In multivariate analysis, chemotherapy was associated with increased cost of $25,325 (95% CI $17,549-$32,827) compared with $28,937 (95% CI $20,510-$37,088) with administrative censoring and $29,593 ($20,564-$39,399) with administrative plus dropout censoring. Adding censoring to the chemotherapy group resulted in less accurate IPW estimates. This was ameliorated, however, by applying IPW within treatment groups. IPW is a consistent estimator of population mean costs if the weight is correctly specified. If the censoring distribution depends on some covariates, a model that accommodates this dependency must be correctly specified in IPW to obtain accurate estimates. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Constrained Optimization of Average Arrival Time via a Probabilistic Approach to Transport Reliability

PubMed Central

Namazi-Rad, Mohammad-Reza; Dunbar, Michelle; Ghaderi, Hadi; Mokhtarian, Payam

2015-01-01

To achieve greater transit-time reduction and improvement in reliability of transport services, there is an increasing need to assist transport planners in understanding the value of punctuality; i.e. the potential improvements, not only to service quality and the consumer but also to the actual profitability of the service. In order for this to be achieved, it is important to understand the network-specific aspects that affect both the ability to decrease transit-time, and the associated cost-benefit of doing so. In this paper, we outline a framework for evaluating the effectiveness of proposed changes to average transit-time, so as to determine the optimal choice of average arrival time subject to desired punctuality levels whilst simultaneously minimizing operational costs. We model the service transit-time variability using a truncated probability density function, and simultaneously compare the trade-off between potential gains and increased service costs, for several commonly employed cost-benefit functions of general form. We formulate this problem as a constrained optimization problem to determine the optimal choice of average transit time, so as to increase the level of service punctuality, whilst simultaneously ensuring a minimum level of cost-benefit to the service operator. PMID:25992902

Assessing the economic burden of Alzheimer's disease patients first diagnosed by specialists.

PubMed

Kirson, Noam Y; Desai, Urvi; Ristovska, Ljubica; Cummings, Alice Kate G; Birnbaum, Howard G; Ye, Wenyu; Andrews, J Scott; Ball, Daniel; Kahle-Wrobleski, Kristin

2016-07-11

It is not known if there is a differential impact on Alzheimer's disease (AD) diagnosis and outcomes if/when patients are diagnosed with cognitive decline by specialists versus non-specialists. This study examined the cost trajectories of Medicare beneficiaries initially diagnosed by specialists compared to similar patients who received their diagnosis in primary care settings. Patients with ≥2 claims for AD were selected from de-identified administrative claims data for US Medicare beneficiaries (5 % random sample). The earliest observed diagnosis of cognitive decline served as the index date. Patients were required to have continuous Medicare coverage for ≥12 months pre-index (baseline) and ≥12 months following the first AD diagnosis, allowing for up to 3 years from index to AD diagnosis. Time from index date to AD diagnosis was compared between those diagnosed by specialists (i.e., neurologist, psychiatrist, or geriatrician) versus non-specialists using Kaplan-Meier analyses with log-rank tests. Patient demographics, Charlson Comorbidity Index (CCI) during baseline, and annual all-cause medical costs (reimbursed by Medicare) in baseline and follow-up periods were compared across propensity-score matched cohorts. Patients first diagnosed with cognitive decline by specialists (n = 2593) were younger (78.8 versus 80.8 years old), more likely to be male (40 % versus 34 %), and had higher CCI scores and higher medical costs at baseline than those diagnosed by non-specialists (n = 13,961). However, patients diagnosed by specialists had a significantly shorter time to AD diagnosis, both before and after matching (mean [after matching]: 3.5 versus 4.6 months, p < 0.0001). In addition, patients diagnosed by specialists had significantly lower average total all-cause medical costs in the first 12 months after their index date, a finding that persisted after matching ($19,824 versus $25,863, p < 0.0001). Total per-patient annual medical costs were similar for the two groups starting in the second year post-index. Before and after matching, patients diagnosed by a specialist had a shorter time to AD diagnosis and incurred lower costs in the year following the initial cognitive decline diagnosis. Differences in costs converged during subsequent years. This suggests that seeking care from specialists may yield more timely diagnosis, appropriate care and reduced costs among those with cognitive decline.

Cost-effectiveness and population outcomes of general population screening for hepatitis C.

PubMed

Coffin, Phillip O; Scott, John D; Golden, Matthew R; Sullivan, Sean D

2012-05-01

Current US guidelines recommend limiting hepatitis C virus (HCV) screening to high-risk individuals, and 50%-75% of infected persons remain unaware of their status. To estimate the cost-effectiveness and population-level impact of adding one-time HCV screening of US population aged 20-69 years to current guidelines, we developed a decision analytic model for the screening intervention and Markov model with annual transitions to estimate natural history. Subanalyses included protease inhibitor therapy and screening those at highest risk of infection (birth year 1945-1965). We relied on published literature and took a lifetime, societal perspective. Compared to current guidelines, incremental cost per quality-adjusted life year gained (ICER) was $7900 for general population screening and $4200 for screening by birth year, which dominated general population screening if cost, clinician uptake, and median age of diagnoses were assumed equivalent. General population screening remained cost-effective in all one-way sensitivity analyses, 30 000 Monte Carlo simulations, and scenarios in which background mortality was doubled, all genotype 1 patients were treated with protease inhibitors, and most parameters were set unfavorable to increased screening. ICER was lowest if screening was applied to a population with liver fibrosis similar to 2010 estimates. Approximately 1% of liver-related deaths would be averted per 15% of the general population screened; the impact would be greater with improved referral, treatment uptake, and cure. Broader screening for HCV would likely be cost-effective, but significantly reducing HCV-related morbidity and mortality would also require improved rates of referral, treatment, and cure.

A cost-effective process to prepare VO{sub 2} (M) powder and films with superior thermochromic properties

DOE Office of Scientific and Technical Information (OSTI.GOV)

Xiao, Xiudi; Zhang, Hua; Chai, Guanqi

2014-03-01

Graphical abstract: Combining codeposition and short time post annealing, VO{sub 2} (M) with high quality and excellent phase transition performance is obtained. After mixing the VO{sub 2} powder with acrylic resin, the composite films deposited on glass show superior visible transmission and solar modulation, which can be used as an excellent candidate of low cost smart window in energy saving field. - Highlights: • The VO{sub 2} powder obtained by short time thermolysis method is high purity and crystallinity with superior phase transition performance. • The maximum decreasing efficiency of phase transition temperature is about −30 K/at% with w =more » 0.4 at%. • After mixing VO{sub 2} powder with acrylic resin, the maximal visible transmission of the composite films is 48% and the transmission modulation at 2000 nm is 37.3% with phase transition temperature of 66.2 °C. • Though the phase transition performance is weakened by tungsten doping, the film prepared by 1.3 at% tungsten doped VO{sub 2} still show superior transmission modulation about 26.4%, which means that it is a potential candidate as smart windows. - Abstract: VO{sub 2} powder with superior phase transition performance was prepared by convenient thermolysis method. The results illustrated that VO{sub 2} powder show high purity and crystallinity. VO{sub 2} particles are transformed from cluster to quasi-sphere with the increase of annealing temperature. The DSC analysis proves that VO{sub 2} show superior phase transition performance around 68 °C. The phase transition temperature can be reduced to 33.5 °C by 1.8 at% tungsten doping. The maximum decreasing efficiency of phase transition temperature is about −30 K/at% with w = 0.4 at%. After mixing VO{sub 2} powder with acrylic resin, the maximal visible transmission of the composite thin films on glass is 48% and the transmission modulation at 2000 nm is 37.3% with phase transition temperature of 66.2 °C. Though the phase transition performance is weakened by tungsten doping, the film prepared by 1.3 at% tungsten doped VO{sub 2} still show superior transmission modulation about 26.4% at 2000 nm, which means that it is a potential candidate as smart windows.« less

Maxwell's equal area law for black holes in power Maxwell invariant

NASA Astrophysics Data System (ADS)

Li, Huai-Fan; Guo, Xiong-ying; Zhao, Hui-Hua; Zhao, Ren

2017-08-01

In this paper, we consider the phase transition of black hole in power Maxwell invariant by means of Maxwell's equal area law. First, we review and study the analogy of nonlinear charged black hole solutions with the Van der Waals gas-liquid system in the extended phase space, and obtain isothermal P- v diagram. Then, using the Maxwell's equal area law we study the phase transition of AdS black hole with different temperatures. Finally, we extend the method to the black hole in the canonical (grand canonical) ensemble in which charge (potential) is fixed at infinity. Interestingly, we find the phase transition occurs in the both ensembles. We also study the effect of the parameters of the black hole on the two-phase coexistence. The results show that the black hole may go through a small-large phase transition similar to those of usual non-gravity thermodynamic systems.

Gravitational waves from non-Abelian gauge fields at a tachyonic transition

NASA Astrophysics Data System (ADS)

Tranberg, Anders; Tähtinen, Sara; Weir, David J.

2018-04-01

We compute the gravitational wave spectrum from a tachyonic preheating transition of a Standard Model-like SU(2)-Higgs system. Tachyonic preheating involves exponentially growing IR modes, at scales as large as the horizon. Such a transition at the electroweak scale could be detectable by LISA, if these non-perturbatively large modes translate into non-linear dynamics sourcing gravitational waves. Through large-scale numerical simulations, we find that the spectrum of gravitational waves does not exhibit such IR features. Instead, we find two peaks corresponding to the Higgs and gauge field mass, respectively. We find that the gravitational wave production is reduced when adding non-Abelian gauge fields to a scalar-only theory, but increases when adding Abelian gauge fields. In particular, gauge fields suppress the gravitational wave spectrum in the IR. A tachyonic transition in the early Universe will therefore not be detectable by LISA, even if it involves non-Abelian gauge fields.

Societal consequences of Title II of Public Law 92-513: Motor Vehicle Information and Cost Savings Act. Final report, May 1974--Mar 1975

DOE Office of Scientific and Technical Information (OSTI.GOV)

Northrop, G.M.

1975-06-01

Societal consequences of the availability, under Title II, Public Law 92-513, of information on crashworthiness, crash repair cost, routine maintenance and repair cost, and insurance cost are investigated. Surveys of small groups of private passenger car buyers and fleet buyers were conducted, and the results were analyzed. Three simple computer models were prepared: (1) an Accident Model to compare the number of occupants suffering fatal or serious injuries under assumed car-buying behavior with and without the availability of Title II information and changes made by car manufacturers that modify crashworthiness and car weight; (2) a New Car Sales Model tomore » determine the impact of car-buying behavior on 22 societal elements involving consumer expenditures and employment, sales margin, and value added for dealers, car manufacturers, and industrial suppliers; and (3) a Car Operations Model to determine the impact of car-buying behavior on the total gasoline consumption cost, crash repair cost, routine maintenance, repair cost, and insurance cost. Projections of car-buying behavior over a 10-year period (1976-1985) were made and results presented in the form of 10-year average values of the percent difference between results under 'With Title II' and 'Without Title II' information.« less

Cost-effectiveness of a barrier-strengthening moisturizing cream as maintenance therapy vs. no treatment after an initial steroid course in patients with atopic dermatitis in Sweden--with model applications for Denmark, Norway and Finland.

PubMed

Hjalte, F; Asseburg, C; Tennvall, G R

2010-04-01

Atopic dermatitis (AD) affects health and quality of life and it has great impact on both health-care costs and costs to the society. The objective of this study was to develop a model to analyse the cost-effectiveness of a barrier-strengthening moisturizing cream as maintenance therapy compared with no treatment after initial treatment with betamethasone valerate in adult patients with AD in Sweden. A further aim was to apply a similar health-economic analysis for Denmark, Norway and Finland. A Markov simulation model was developed including data from three sources: (i) efficacy data from a randomized controlled trial including patients with moderate AD treated with either a moisturizing cream or no treatment, (ii) resource utilization and quality of life data, and (iii) unit prices from official price lists. A societal perspective was used and the analysis was performed according to treatment practice in Sweden. The model simulation was also applied for Denmark, Norway and Finland with inclusion of country-specific unit costs. Sensitivity analyses were performed to test the robustness of the results. The results from the present analyses of treatment for patients with moderate AD indicate that maintenance treatment with a moisturizing cream during eczema-free periods could be cost-effective in a societal perspective. Similar results were obtained for Sweden, Denmark, Norway and Finland. According to the analysis, treatment with a moisturizing cream was found to be a cost-effective option compared with no treatment in eczema-free periods in adult patients with AD in the four Nordic countries.

Probabilistic Cost-Effectiveness Analysis of Vaccination for Mild or Moderate Alzheimer's Disease.

PubMed

Yang, Kuen-Cheh; Chen, Hsiu-Hsi

2016-01-01

Studies on the immunotherapy for Alzheimer's disease (AD) have increasingly gained attention since 1990s. However, there are pros (preventing of AD) and cons (incurred cost and side effects) regarding the administration of immunotherapy. Up to date, there has been lacking of economic evaluation for immunotherapy of AD. We aimed to assess the cost-effectiveness analysis of the vaccination for AD. A meta-analysis of randomized control trials after systemic review was conducted to evaluate the efficacy of the vaccine. A Markov decision model was constructed and applied to a 120,000-Taiwanese cohort aged ≥65 years. Person years and quality-adjusted life years (QALY) were computed between the vaccinated group and the the unvaccinated group. Economic evaluation was performed to calculate the incremental cost-effectiveness ratio (ICER) and cost-effectiveness acceptability curve (CEAC). Vaccinated group gained an additional 0.84 life years and 0.56 QALYs over 10-years and an additional 0.35 life years and 0.282 QALYs over 5-years of follow-up. The vaccinated group dominated the unvaccinated group by ICER over 5-years of follow-up. The ICERs of 10-year follow-up for the vaccinated group against the unvaccinated group were $13,850 per QALY and $9,038 per life year gained. Given the threshold of $20,000 of willingness to pay (WTP), the CEAC showed the probability of being cost-effective for vaccination with QALY was 70.7% and 92% for life years gained after 10-years of follow-up. The corresponding figures were 87.3% for QALY and 93.5% for life years gained over 5-years follow-up. The vaccination for AD was cost-effective in gaining QALY and life years compared with no vaccination, under the condition of a reasonable threshold of WTP.

Post-Bariatric Body-Contouring Surgery: Fewer Procedures, Less Demand, and Lower Costs.

PubMed

Felberbauer, Franz X; Shakeri-Leidenmühler, Soheila; Langer, Felix B; Kitzinger, Hugo; Bohdjalian, Arthur; Kefurt, Ronald; Prager, Gerhard

2015-07-01

Paralleling the growth of bariatric surgery, the demand for post-bariatric body-contouring surgery is increasing and placing additional burdens on already strained health care systems. In Austria, medically necessary body contouring is covered by public health care. In a sample of 622 women, we assessed the proportion of patients that underwent post-bariatric surgery at least 2 years after gastric bypass. Former bariatric patients were asked whether they had undergone post-bariatric surgery or were planning to do so by structured telephone interviews. For patients who had undergone body contouring, the degree of satisfaction with the results was inquired. Costs for bariatric and post-bariatric procedures were assessed. Of 622 patients, 93 (14.9 %) had undergone body contouring and 68 (10.9 %) considered a procedure, while 454 (73 %) definitely stated that they did not want plastic surgery. Cost coverage was declined in 7 patients (1.1 %). Plastic procedures (n = 101) included 65 abdominoplasties, 25 lower body lifts without thigh lifts, 7 brachioplasties, and 4 minor procedures. Forty-nine patients were very satisfied with the results, 28 were fairly satisfied, and 16 were not satisfied. Body contouring added about 6 % to the costs of surgical treatment for morbid obesity. Fewer patients than in other studies expressed a desire for post-bariatric surgery, 15 % actually proceeded to this step. The low demand was neither due to denied coverage nor to unfavourable results of plastic surgery. Additional costs for body contouring were less than expected.

Space suit bioenergetics: framework and analysis of unsuited and suited activity.

PubMed

Carr, Christopher E; Newman, Dava J

2007-11-01

Metabolic costs limit the duration and intensity of extravehicular activity (EVA), an essential component of future human missions to the Moon and Mars. Energetics Framework: We present a framework for comparison of energetics data across and between studies. This framework, applied to locomotion, differentiates between muscle efficiency and energy recovery, two concepts often confused in the literature. The human run-walk transition in Earth gravity occurs at the point for which energy recovery is approximately the same for walking and running, suggesting a possible role for recovery in gait transitions. Muscular Energetics: Muscle physiology limits the overall efficiency by which chemical energy is converted through metabolism to useful work. Unsuited Locomotion: Walking and running use different methods of energy storage and release. These differences contribute to the relative changes in the metabolic cost of walking and running as gravity is varied, with the metabolic cost of locomoting at a given velocity changing in proportion to gravity for running and less than in proportion for walking. Space Suits: Major factors affecting the energetic cost of suited movement include suit pressurization, gravity, velocity, surface slope, and space suit configuration. Apollo lunar surface EVA traverse metabolic rates, while unexpectedly low, were higher than other activity categories. The Lunar Roving Vehicle facilitated even lower metabolic rates, thus longer duration EVAs. Muscles and tendons act like springs during running; similarly, longitudinal pressure forces in gas pressure space suits allow spring-like storage and release of energy when suits are self-supporting.

Cost-efficacy in interventional cardiology; results from the EPISTENT study. Evaluation of Platelet IIb/IIIa Inhibitor For Stenting Trial.

PubMed

Zwart-van Rijkom, J E; van Hout, B A

2001-08-01

The EPISTENT study has demonstrated that the combined use of abciximab and stenting as an adjunct to PTCA leads to increased event-free survival compared to either using abciximab or stenting alone. However, this combined strategy may be costly and the additional costs have to be weighted against the additional effects. The 6-months efficacy data from the EPISTENT study are combined with Dutch estimates of unit costs. Adding a stent to a procedure with abciximab further decreases the number of revascularizations at an extra cost of Euros 12,000 (95% upper limit (u.l.) Euros 31,000) per additional major adverse cardiac event-free survivor. Adding abciximab to a stenting procedure decreases the incidence of myocardial infarctions at an extra cost of Euros 13,000 (95% u.l. Euros 27,000) per additional myocardial infarction-free survivor. In the subgroup of diabetics, adding abciximab improves revascularization rates as well, resulting in a cost-efficacy rate of Euros 2000 (95% u.l. Euros 25,000) per additional MACE-free survivor, with uncertainty regions indicating potential costs savings. The combination of stenting and abciximab costs about Euros 13,000 to avoid one event after PTCA. In diabetic patients the strategy may be cost-saving. Copyright 2001 The European Society of Cardiology.

Using a Media Campaign to Increase Engagement With a Mobile-Based Youth Smoking Cessation Program.

PubMed

Sanders, Amy; Robinson, Cendrine; Taylor, Shani C; Post, Samantha D; Goldfarb, Jeffrey; Shi, Rui; Hunt, Yvonne M; Augustson, Erik M

2018-06-01

To describe the impact of the National Cancer Institute's promotion of its youth smoking cessation program, Smokefree Teen (SFT). We provide a description of campaign strategies and outcomes as a means to engage a teen audience in cessation resources using a cost-effective approach. The campaign occurred nationally, using traditional (TV and radio), online, and social media outreach. Ads targeted adolescent smokers (aged 14-17). The baseline population was 42 586 and increased to 464 357 during the campaign. Metrics used to assess outcomes include (1) visits to SFT website from traditional and online ads, (2) cost to get an online ad clicked (cost-per-click), and (3) SmokefreeTXT program enrollments during the 8-week campaign period. We conducted a quantitative performance review of all tactics. The SFT campaign achieved an online ad click-through rate of 0.33%, exceeding industry averages of 0.15%. Overall, web traffic to teen.smokefree.gov increased by 980%, and the online cost-per-click for ads, including social media actions, was approximately $1 as compared with $107 for traditional ads. Additionally, the campaign increased the SmokefreeTXT program teen sign-ups by 1334%. The campaign increased engagement with evidence-informed cessation resources for teen smokers. Results show the potential of using multiple, online channels to help increase engagement with core resources.

Cost-Effectiveness Analysis of Diagnostic Options for Pneumocystis Pneumonia (PCP)

PubMed Central

Harris, Julie R.; Marston, Barbara J.; Sangrujee, Nalinee; DuPlessis, Desiree; Park, Benjamin

2011-01-01

Background Diagnosis of Pneumocystis jirovecii pneumonia (PCP) is challenging, particularly in developing countries. Highly sensitive diagnostic methods are costly, while less expensive methods often lack sensitivity or specificity. Cost-effectiveness comparisons of the various diagnostic options have not been presented. Methods and Findings We compared cost-effectiveness, as measured by cost per life-years gained and proportion of patients successfully diagnosed and treated, of 33 PCP diagnostic options, involving combinations of specimen collection methods [oral washes, induced and expectorated sputum, and bronchoalveolar lavage (BAL)] and laboratory diagnostic procedures [various staining procedures or polymerase chain reactions (PCR)], or clinical diagnosis with chest x-ray alone. Our analyses were conducted from the perspective of the government payer among ambulatory, HIV-infected patients with symptoms of pneumonia presenting to HIV clinics and hospitals in South Africa. Costing data were obtained from the National Institutes of Communicable Diseases in South Africa. At 50% disease prevalence, diagnostic procedures involving expectorated sputum with any PCR method, or induced sputum with nested or real-time PCR, were all highly cost-effective, successfully treating 77–90% of patients at $26–51 per life-year gained. Procedures using BAL specimens were significantly more expensive without added benefit, successfully treating 68–90% of patients at costs of $189–232 per life-year gained. A relatively cost-effective diagnostic procedure that did not require PCR was Toluidine Blue O staining of induced sputum ($25 per life-year gained, successfully treating 68% of patients). Diagnosis using chest x-rays alone resulted in successful treatment of 77% of patients, though cost-effectiveness was reduced ($109 per life-year gained) compared with several molecular diagnostic options. Conclusions For diagnosis of PCP, use of PCR technologies, when combined with less-invasive patient specimens such as expectorated or induced sputum, represent more cost-effective options than any diagnostic procedure using BAL, or chest x-ray alone. PMID:21858013

[Retrospection and reflection on international progress of sugar-sweetened beverages tax policies].

PubMed

Liu, D; Zhai, Y; Zhao, W H

2017-12-06

Since the invention of sugar, added sugars bring us enjoyment. As consumption continues to rise, especially the advent of sugary drinks makes it easier for people to consume added sugars, less sugars and reduced sugars have also become a of concern around the world. In recent years, in WHO and several countries, tax on sugary beverages has been designed to reduce the intake of sugar and prevent the economic costs of obesity and other diseases. This paper reviews the WHO's proposal on sugary drinks tax and the progress of sugary drinks tax in Hungary, Finland, France, Mexico, the United States, South Africa and other countries and regions. The effect of policy on sugary drinks tax was analyzed and considered. Suggestion and support for the progress of China's reduced sugars was provided in the last.

Cost effectiveness of adding 7-valent pneumococcal conjugate (PCV-7) vaccine to the Norwegian childhood vaccination program.

PubMed

Wisløff, Torbjørn; Abrahamsen, Tore G; Bergsaker, Marianne A Riise; Løvoll, Øistein; Møller, Per; Pedersen, Maren Kristine; Kristiansen, Ivar Sønbø

2006-07-17

Streptococcus pneumoniae is a frequent bacterial cause of serious infections that may cause permanent sequelae and death. A 7-valent conjugate vaccine may reduce the incidence of pneumococcal disease, but some previous studies have questioned the cost-effectiveness of the vaccine. The aim of this study was to estimate costs and health consequences of adding this pneumococcal vaccine to the Norwegian childhood vaccination programme, taking the possibility of herd immunity into account. We developed a simulation model (Markov-model) using data on the risk of pneumococcal disease in Norway, the efficacy of the vaccine as observed in clinical trials from other countries and adjusted for serotype differences, the cost of the vaccine and quality of life for patients with sequelae from pneumococcal disease. The results were expressed as incremental (additional) costs (in euros; euro1.00 approximately NOK8.37), incremental life years and incremental quality adjusted life years. Four different sets of main results are presented: costs and (quality adjusted) life years, with and without indirect costs (the value of lost production due to work absenteeism) and with and without potential herd immunity (i.e. childhood vaccination protects adults against pneumococcal disease). When indirect costs were disregarded, and four vaccine doses used, the incremental cost per life year gained was euro153,000 when herd immunity was included, and euro311,000 when it was not. When accounting for indirect costs as well, the cost per life year gained was euro58,000 and euro124,000, respectively. Assuming that three vaccine doses provide the same protection as four, the cost per life year gained with this regimen was euro90,000 with herd immunity and euro184,000 without (when indirect costs are disregarded). If indirect costs are also included, vaccination both saves costs and gains life years. In Norway, governmental guidelines indicate that only interventions with cost per life year of less than euro54,000 should be implemented. This implies that four dose vaccination is not cost-effective even if decision makers includes both herd immunity and indirect costs in their decisions. If three doses offer the same protection as four doses, however, vaccination would be cost-saving when indirect costs are included, but not with only herd immunity. In the autumn of 2005, the Norwegian Government decided to include PCV-7 in the vaccination program. This analysis was used by the Ministry of Health and Ministry of Finance during the decision process.

Analytical studies on holographic superconductor in the probe limit

NASA Astrophysics Data System (ADS)

Peng, Yan; Liu, Guohua

2017-09-01

We investigate the holographic superconductor model constructed in the (2+1)-dimensional AdS soliton background in the probe limit. With analytical methods, we obtain the formula of critical phase transition points with respect to the scalar mass. We also generalize this formula to higher-dimensional space-time. We mention that these formulas are precise compared to numerical results. In addition, we find a correspondence between the value of the charged scalar field at the tip and the scalar operator at infinity around the phase transition points.

A soft-wall dilaton

DOE PAGES

Cox, Peter; Gherghetta, Tony

2015-02-02

Here, we study the properties of the dilaton in a soft-wall background using two solutions of the Einstein equations. These solutions contain an asymptotically AdS metric with a nontrivial scalar profile that causes both the spontaneous breaking of conformal invariance and the generation of a mass gap in the particle spectrum. We first present an analytic solution, using the superpotential method, that describes a CFT spontaneously broken by a finite dimensional operator in which a light dilaton mode appears in the spectrum. This represents a tuning in the vanishing of the quartic coupling in the effective potential that could bemore » naturally realised from an underlying supersymmetry. Instead, by considering a generalised analytic scalar bulk potential that quickly transitions at the condensate scale from a walking coupling in the UV to an order-one β-function in the IR, we obtain a naturally light dilaton. This provides a simple example for obtaining a naturally light dilaton from nearly-marginal CFT deformations in the more realistic case of a soft-wall background.« less

Semiclassical S-matrix for black holes

DOE PAGES

Bezrukov, Fedor; Levkov, Dmitry; Sibiryakov, Sergey

2015-12-01

In this study, we propose a semiclassical method to calculate S-matrix elements for two-stage gravitational transitions involving matter collapse into a black hole and evaporation of the latter. The method consistently incorporates back-reaction of the collapsing and emitted quanta on the metric. We illustrate the method in several toy models describing spherical self-gravitating shells in asymptotically flat and AdS space-times. We find that electrically neutral shells reflect via the above collapse-evaporation process with probability exp(–B), where B is the Bekenstein-Hawking entropy of the intermediate black hole. This is consistent with interpretation of exp(B) as the number of black hole states.more » The same expression for the probability is obtained in the case of charged shells if one takes into account instability of the Cauchy horizon of the intermediate Reissner-Nordström black hole. As a result, our semiclassical method opens a new systematic approach to the gravitational S-matrix in the non-perturbative regime.« less

Cost-effectiveness of the Adjuvanted Herpes Zoster Subunit Vaccine in Older Adults.

PubMed

Le, Phuc; Rothberg, Michael B

2018-02-01

The live attenuated herpes zoster vaccine (ZVL) is recommended for immunocompetent adults 60 years or older, but the efficacy wanes with age and over time. A new adjuvanted herpes zoster subunit vaccine (HZ/su) has higher efficacy but might be more expensive. The choice of vaccines depends on their relative values. To assess the cost-effectiveness of HZ/su. Markov decision model with transition probabilities based on the US medical literature. Participants were immunocompetent adults 60 years or older. Data were derived from participant groups ranging in number from less than 100 to more than 30 000 depending on the variable assessed. The study dates were July 1 to 31, 2017. No vaccination, ZVL (single dose), and HZ/su (2-dose series) vaccine administered at different ages. Total costs and quality-adjusted life-years (QALYs) were estimated. Based on randomized clinical trial data, at a price of $280 per series ($140 per dose), HZ/su was more effective and less expensive than ZVL at all ages. The incremental cost-effectiveness ratios compared with no vaccination ranged from $20 038 to $30 084 per QALY, depending on vaccination age. The finding was insensitive to variations in most model inputs other than the vaccine price and certain combinations of low adherence rate with a second dose and low efficacy of a single dose of HZ/su. At the current ZVL price ($213 per dose), HZ/su had lower overall costs than ZVL up to a price of $350 per 2-dose series. In probabilistic sensitivity analysis, HZ/su had 73% probability of being cost-effective for 60-year-olds at $50 000 per QALY. Under conservative assumptions, at a price of $280 per series ($140 per dose), HZ/su would cost less than ZVL and has a high probability of offering good value.

Bio-methane from an-aerobic digestion using activated carbon adsorption.

PubMed

Farooq, Muhammad; Bell, Alexandra H; Almustapha, M N; Andresen, John M

2017-08-01

There is an increasing global demand for carbon-neutral bio-methane from an-aerobic digestion (AD) to be injected into national gas grids. Bio-gas, a methane -rich energy gas, is produced by microbial decomposition of organic matter through an-aerobic conditions where the presence of carbon dioxide and hydrogen sulphide affects its performance. Although the microbiological process in the AD can be tailored to enhance the bio-gas composition, physical treatment is needed to convert the bio-gas into bio-methane. Water washing is the most common method for upgrading bio-gas for bio-methane production, but its large use of water is challenging towards industrial scale-up. Hence, the present study focuses on scale-up comparison of water washing with activated-carbon adsorption using HYSYS and Aspen Process Economic Analyzer. The models show that for plants processing less than 500 m 3 /h water scrubbing was cost effective compared with activated carbon. However, against current fossil natural-gas cost of about 1 p/kWh in the UK both relied heavily on governmental subsidies to become economically feasible. For plants operating at 1000 m 3 /hr, the treatment costs were reduced to below 1.5 p/kWh for water scrubbing and 0.9 p/kWh for activated carbon where the main benefits of activated carbon were lower capital and operating costs and virtually no water losses. It is envisioned that this method can significantly aid the production of sustainable bio-methane. Copyright © 2017 Elsevier Ltd. All rights reserved.

Residential building codes, affordability, and health protection: a risk-tradeoff approach.

PubMed

Hammitt, J K; Belsky, E S; Levy, J I; Graham, J D

1999-12-01

Residential building codes intended to promote health and safety may produce unintended countervailing risks by adding to the cost of construction. Higher construction costs increase the price of new homes and may increase health and safety risks through "income" and "stock" effects. The income effect arises because households that purchase a new home have less income remaining for spending on other goods that contribute to health and safety. The stock effect arises because suppression of new-home construction leads to slower replacement of less safe housing units. These countervailing risks are not presently considered in code debates. We demonstrate the feasibility of estimating the approximate magnitude of countervailing risks by combining the income effect with three relatively well understood and significant home-health risks. We estimate that a code change that increases the nationwide cost of constructing and maintaining homes by $150 (0.1% of the average cost to build a single-family home) would induce offsetting risks yielding between 2 and 60 premature fatalities or, including morbidity effects, between 20 and 800 lost quality-adjusted life years (both discounted at 3%) each year the code provision remains in effect. To provide a net health benefit, the code change would need to reduce risk by at least this amount. Future research should refine these estimates, incorporate quantitative uncertainty analysis, and apply a full risk-tradeoff approach to real-world case studies of proposed code changes.

Recommended emergency preparedness guidelines for elderly and disabled rail-transit passengers. Final report, November 1987-March 1989

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hathaway, W.T.; Markos, S.H.; Balog, J.N.

1989-08-01

Rail transit has become an important source of transportation for many elderly and disabled persons. The principal reasons for the increased use are improved accessibility, low cost, and expanded areas of service. For the purposes of the report, 'elderly' is defined as any member of the population who is 60 years of age or older, and 'disabled' is defined as any person who has some type of disability. The Urban Mass Transportation Administration (UMTA) has recognized the need to consider the unique characteristics of elderly and disabled passengers in rail-transit emergency response planning. The needs of these passengers can bemore » addressed through carefully planned emergency response procedures, proper training of transit and emergency-response personnel, and effective use of equipment. The recommendations contained herein are therefore intended to assist rail-transit and emergency response organization personnel in evaluating their emergency response plans in terms of the needs of elderly and disabled passengers and, if necessary, to modify or supplement those plans accordingly. The report is intended to supplement the UMTA publication Recommended Emergency Preparedness Guidelines for Rail Transit Systems. That report contains general guidelines designed to assist rail-transit systems in assessing, developing, documenting, and improving their capabilities for responding to emergencies and in coordinating those efforts with emergency response organizations.« less

Preface for small-molecule activation: Carbon-containing fuels

DOE PAGES

Fujita, Etsuko; Goldman, Alan S.

2015-06-01

For millennia, human transportation was fueled largely through the consumption of biomass (by humans or domestic animals) and to a lesser extent by wind. The 19th century saw a major shift to coal-fueled transportation, with trains and ships powered by steam engines. A second major shift in the fueling of transportation occurred in the 20th century, this time to petroleum. Thus, this transition was not driven by the cost or ease of obtaining energy from oil wells vs. coal mines – indeed, the cost of petroleum has always been higher than coal on a per-unit-energy basis – but rather bymore » the tremendous technical advantages of powering engines with liquids, specifically liquid hydrocarbons.« less

Brake Lining for Transit Buses - Bonded vs. Bolted

DOT National Transportation Integrated Search

1985-06-01

This report points out an often cited complaint from urban transit agencies concerning the Advanced Design Bus: the relatively short brake lining life. Despite design improvements made by the equipment supply industry since the introduction of the AD...

Facebook Recruitment of Young Adult Smokers for a Cessation Trial: Methods, Metrics, and Lessons Learned

PubMed Central

Ramo, Danielle E.; Rodriguez, Theresa M.S.; Chavez, Kathryn; Sommer, Markus J.; Prochaska, Judith J.

2014-01-01

Further understanding is needed of the functionalities and efficiency of social media for health intervention research recruitment. Facebook was examined as a mechanism to recruit young adults for a smoking cessation intervention. An ad campaign targeting young adult smokers tested specific messaging based on market theory and successful strategies used to recruit smokers in previous clinical trials (i.e. informative, call to action, scarcity, social norms), previously successful ads, and general messaging. Images were selected to target smokers (e.g., lit cigarette), appeal to the target age, vary demographically, and vary graphically (cartoon, photo, logo). Facebook’s Ads Manager was used over 7 weeks (6/10/13 – 7/29/13), targeted by age (18–25), location (U.S.), and language (English), and employed multiple ad types (newsfeed, standard, promoted posts, sponsored stories) and keywords. Ads linked to the online screening survey or study Facebook page. The 36 different ads generated 3,198,373 impressions, 5,895 unique clicks, at an overall cost of $2,024 ($0.34/click). Images of smoking and newsfeed ads had the greatest reach and clicks at the lowest cost. Of 5,895 unique clicks, 586 (10%) were study eligible and 230 (39%) consented. Advertising costs averaged $8.80 per eligible, consented participant. The final study sample (n=79) was largely Caucasian (77%) and male (69%), averaging 11 cigarettes/day (SD=8.3) and 2.7 years smoking (SD=0.7). Facebook is a useful, cost-effective recruitment source for young adult smokers. Ads posted via newsfeed posts were particularly successful, likely because they were viewable via mobile phone. Efforts to engage more ethnic minorities, young women, and smokers motivated to quit are needed. PMID:25045624

Facebook Recruitment of Young Adult Smokers for a Cessation Trial: Methods, Metrics, and Lessons Learned.

PubMed

Ramo, Danielle E; Rodriguez, Theresa M S; Chavez, Kathryn; Sommer, Markus J; Prochaska, Judith J

2014-04-01

Further understanding is needed of the functionalities and efficiency of social media for health intervention research recruitment. Facebook was examined as a mechanism to recruit young adults for a smoking cessation intervention. An ad campaign targeting young adult smokers tested specific messaging based on market theory and successful strategies used to recruit smokers in previous clinical trials (i.e. informative, call to action, scarcity, social norms), previously successful ads, and general messaging. Images were selected to target smokers (e.g., lit cigarette), appeal to the target age, vary demographically, and vary graphically (cartoon, photo, logo). Facebook's Ads Manager was used over 7 weeks (6/10/13 - 7/29/13), targeted by age (18-25), location (U.S.), and language (English), and employed multiple ad types (newsfeed, standard, promoted posts, sponsored stories) and keywords. Ads linked to the online screening survey or study Facebook page. The 36 different ads generated 3,198,373 impressions, 5,895 unique clicks, at an overall cost of $2,024 ($0.34/click). Images of smoking and newsfeed ads had the greatest reach and clicks at the lowest cost. Of 5,895 unique clicks, 586 (10%) were study eligible and 230 (39%) consented. Advertising costs averaged $8.80 per eligible, consented participant. The final study sample (n=79) was largely Caucasian (77%) and male (69%), averaging 11 cigarettes/day (SD=8.3) and 2.7 years smoking (SD=0.7). Facebook is a useful, cost-effective recruitment source for young adult smokers. Ads posted via newsfeed posts were particularly successful, likely because they were viewable via mobile phone. Efforts to engage more ethnic minorities, young women, and smokers motivated to quit are needed.

Measuring the hemodynamic response to primary pharmacoprophylaxis of variceal bleeding: a cost-effectiveness analysis.

PubMed

Imperiale, Thomas F; Chalasani, Naga; Klein, Robert W

2003-12-01

The hemodynamic response to ss-blockers alone or with nitrates is highly predictive of efficacy in prevention of variceal bleeding. Hemodynamic monitoring (HDM) requires catheterization of the hepatic vein and measurement of the hepatic venous pressure gradient, the difference between wedged and free hepatic venous pressure. The aim of this study was to compare HDM with no HDM in patients considered for primary pharmacoprophylaxis of esophageal variceal bleeding. A decision model was constructed to compare HDM with no HDM in cirrhotic patients with moderate to large esophageal varices. Patients intolerant to beta-blocker therapy would undergo endoscopic variceal ligation; those with an inadequate hemodynamic response (HDR) to beta-blocker therapy could have nitrates added before ligation was considered. Variceal bleeding was treated with ligation, with transjugular intrahepatic portosystemic shunt (TIPS) reserved for refractory bleeding. Probabilities of treatment responses as well as risks of bleeding and mortality were based on published literature. Only direct costs were considered during the 5-yr time horizon. Outcomes were cost in United States dollars, survival length in life-years, and proportions of patients who experienced variceal bleeding, TIPS insertion, and mortality from any cause. In the base case analysis, HDM was either cost-saving ($2,523 US dollars /life-year gained) or cost-effective (incremental cost-effectiveness ratio of $5,200 US dollars/life-year saved) compared with no HDM, depending on whether nitrates were added to beta-blocker therapy. HDM reduced variceal bleeding by nearly 60% and had a small effect on all-cause mortality. In the sensitivity analysis, HDM was sensitive to the time horizon, as it was not cost-effective for a time horizon of <22 months and was not cost-saving before 49 months. The cost-effectiveness of HDM was not sensitive to reasonable variation in the probability of HDR to beta-blocker therapy, risk of bleeding, risk reduction with pharmacotherapy, or to the costs of HDM, bleeding, ligation, or TIPS. Probabilistic sensitivity analysis indicated that HDM was more effective and less costly 100% and 57% of the time, respectively. Compared with the current standard of no HDM, measuring the hemodynamic response of primary pharmacoprophylaxis substantially reduces the number of bleeding episodes and is cost-effective or cost-saving over a wide range of sensitivity analyses. A randomized trial of HDM is needed to verify its efficacy in clinical practice.

A cost-utility analysis of cervical cancer screening and human papillomavirus vaccination in the Philippines.

PubMed

Guerrero, Anna Melissa; Genuino, Anne Julienne; Santillan, Melanie; Praditsitthikorn, Naiyana; Chantarastapornchit, Varit; Teerawattananon, Yot; Alejandria, Marissa; Toral, Jean Anne

2015-07-30

Cervical cancer is the second leading cause of cancer cases and deaths among Filipino women because of inadequate access to screening and treatment services. This study aims to evaluate the health and economic benefits of HPV vaccination and its combination with different screening strategies to find the most optimal preventive strategy in the Philippines. A cost-utility analysis was conducted using an existing semi-Markov model to evaluate different screening (i.e., Pap smear, visual inspection with acetic acid) and vaccination strategies against HPV infection implemented alone or as part of a combination strategy at different coverage scenarios. The model was run using country-specific epidemiologic, cost and clinical parameters from a health system perspective. Sensitivity analysis was performed for vaccine efficacy, duration of protection and costs of vaccination, screening and treatment. Across all coverage scenarios, VIA has been shown to be a dominant and cost-saving screening strategy with incremental cost-effectiveness ratio (ICER) ranging from dominant to Php 61,059 (1443 USD) per QALY gained. VIA can reduce cervical cancer cases and deaths by 25%. Pap smear screening was found to be not cost-effective due to its high cost in the Philippines. Adding HPV vaccination at a cost of 54 USD per vaccinated girl on top of VIA screening was found to be potentially cost-effective using a threshold of 1 GDP per capita (i.e., Php 120,000 or 2835 USD/ QALY) with the most favorable assumption of providing lifelong immunity against high-risk oncogenic HPV types 16/18. The highest incremental QALY gain was achieved with 80% coverage of the combined strategy of VIA at 35 to 45 years old done every five years following vaccination at 11 years of age with an ICER of Php 33,126 (783 USD). This strategy may result in a two-thirds reduction in cervical cancer burden. HPV vaccination is not cost-effective when vaccine protection lasts for less than 20 years. High VIA coverage targeting women aged 35-45 years old at five-year intervals is the most efficient and cost-saving strategy in reducing cervical cancer burden in the Philippines. Adding a vaccination program at high coverage among 11-year-old girls is potentially cost-effective in the Philippines assuming a life-long duration of vaccine efficacy.

A comparison of hospital administrative costs in eight nations: US costs exceed all others by far.

PubMed

Himmelstein, David U; Jun, Miraya; Busse, Reinhard; Chevreul, Karine; Geissler, Alexander; Jeurissen, Patrick; Thomson, Sarah; Vinet, Marie-Amelie; Woolhandler, Steffie

2014-09-01

A few studies have noted the outsize administrative costs of US hospitals, but no research has compared these costs across multiple nations with various types of health care systems. We assembled a team of international health policy experts to conduct just such a challenging analysis of hospital administrative costs across eight nations: Canada, England, Scotland, Wales, France, Germany, the Netherlands, and the United States. We found that administrative costs accounted for 25.3 percent of total US hospital expenditures--a percentage that is increasing. Next highest were the Netherlands (19.8 percent) and England (15.5 percent), both of which are transitioning to market-oriented payment systems. Scotland and Canada, whose single-payer systems pay hospitals global operating budgets, with separate grants for capital, had the lowest administrative costs. Costs were intermediate in France and Germany (which bill per patient but pay separately for capital projects) and in Wales. Reducing US per capita spending for hospital administration to Scottish or Canadian levels would have saved more than $150 billion in 2011. This study suggests that the reduction of US administrative costs would best be accomplished through the use of a simpler and less market-oriented payment scheme. Project HOPE—The People-to-People Health Foundation, Inc.

Cost-Effectiveness of Proton Pump Inhibitor Co-Therapy in Patients Taking Aspirin for Secondary Prevention of Ischemic Stroke.

PubMed

Takabayashi, Nobuyoshi; Murata, Kyoko; Tanaka, Shiro; Kawakami, Koji

2015-10-01

Low-dose aspirin (ASA) is effective for secondary prevention of ischemic stroke but can increase the risks of hemorrhagic stroke, upper gastrointestinal bleeding (UGIB), and dyspepsia. Prophylactic administration of proton pump inhibitors (PPIs) reduces the risks of these digestive symptoms. We investigated the cost effectiveness of adding a PPI to ASA therapy for ischemic stroke patients in Japan. A Markov state-transition model was developed to compare the cost effectiveness of ASA monotherapy with ASA plus PPI co-therapy in patients with histories of upper gastrointestinal ulcers and ischemic stroke. The model takes into account ASA adherence rate and adverse effects due to ASA, including hemorrhagic stroke and UGIB. The analysis was performed from the perspective of healthcare payers in 2013. In the base case, total life-years by PPI co-therapy and monotherapy were 16.005 and 15.932, respectively. The difference in duration of no therapy (no ASA or PPI) between the therapies was 558.5 days, which would prevent 30.3 recurrences of ischemic stroke per 1000 person-years. The incremental cost-effectiveness ratio of PPI co-therapy relative to monotherapy was ¥1,191,665 (US$11,458) per life-year gained. In a one-way sensitivity analysis, PPI co-therapy was consistently cost effective at a willingness to pay of ¥5,000,000 (US$48,077) per life-year gained. In a probabilistic sensitivity analysis, the probability that PPI co-therapy was cost effective was 89.74% at the willingness to pay. Co-therapy with ASA plus PPI appears to be cost-effective compared with ASA monotherapy. The addition of PPI also appeared to prolong the duration of ASA therapy, thereby reducing the risk of ischemic stroke.

Incremental costs of introducing jet injection technology for delivery of routine childhood vaccinations: comparative analysis from Brazil, India, and South Africa.

PubMed

Griffiths, Ulla K; Santos, Andreia C; Nundy, Neeti; Jacoby, Erica; Matthias, Dipika

2011-01-29

Disposable-syringe jet injectors (DSJIs) have the potential to deliver vaccines safely and affordably to millions of children around the world. We estimated the incremental costs of transitioning from needles and syringes to delivering childhood vaccines with DSJIs in Brazil, India, and South Africa. Two scenarios were assessed: (1) DSJI delivery of all vaccines at current dose and depth; (2) a change to intradermal (ID) delivery with DSJIs for hepatitis B and yellow fever vaccines, while the other vaccines are delivered by DSJIs at current dose and depth. The main advantage of ID delivery is that only a small fraction of the standard dose may be needed to obtain an immune response similar to that of subcutaneous or intramuscular injection. Cost categories included were vaccines, injection equipment, waste management, and vaccine transport. Some delivery cost items, such as training and personnel were excluded as were treatment cost savings caused by a reduction in diseases transmitted due to unsafe injections. In the standard dose and depth scenario, the incremental costs of introducing DSJIs per fully vaccinated child amount to US$ 0.57 in Brazil, US$ 0.65 in India and US$ 1.24 in South Africa. In the ID scenario, there are cost savings of US$ 0.11 per child in Brazil, and added costs of US$ 0.45 and US$ 0.76 per child in India and South Africa, respectively. The most important incremental cost item is jet injector disposable syringes. The incremental costs should be evaluated against other vaccine delivery technologies that can deliver the same benefits to patients, health care workers, and the community. DSJIs deserve consideration by global and national decision-makers as a means to expand access to ID delivery and to enhance safety at marginal additional cost. Copyright © 2010 Elsevier Ltd. All rights reserved.

Method for reducing the sulfur content of a sulfur-containing hydrocarbon stream

DOEpatents

Mahajan, Devinder

2004-12-28

The sulfur content of a liquid hydrocarbon stream is reduced under mild conditions by contracting a sulfur-containing liquid hydrocarbon stream with transition metal particles containing the transition metal in a zero oxidation state under conditions sufficient to provide a hydrocarbon product having a reduced sulfur content and metal sulfide particles. The transition metal particles can be produced in situ by adding a transition metal precursor, e.g., a transition metal carbonyl compound, to the sulfur-containing liquid feed stream and sonicating the feed steam/transition metal precursor combination under conditions sufficient to produce the transition metal particles.

Nuclear electric generation: Political, social, and economic cost and benefit to Indonesia. Master`s thesis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Waliyo

Indonesia, the largest archipelagic country with a population the fourth biggest in the world, is now in the process of development. It needs a large quantity of energy electricity to meet the industrial and household demands. The currently available generating capacity is not sufficient to meet the electricity demand for the rapidly growing industries and the increasing population. In order to meet the future demand for electricity, new generating capacity is required to be added to the current capacity. Nuclear electricity generation is one possible alternative to supplement Indonesia`s future demand of electricity. This thesis investigates the possibility of developingmore » nuclear electricity generation in Indonesia, considering the political, social, and economic cost and benefit to Indonesia.« less

Test plan for the soils facility demonstration: A petroleum contaminated soil bioremediation facility

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lombard, K.H.

1994-08-01

The objectives of this test plan are to show the value added by using bioremediation as an effective and environmentally sound method to remediate petroleum contaminated soils (PCS) by: demonstrating bioremediation as a permanent method for remediating soils contaminated with petroleum products; establishing the best operating conditions for maximizing bioremediation and minimizing volatilization for SRS PCS during different seasons; determining the minimum set of analyses and sampling frequency to allow efficient and cost-effective operation; determining best use of existing site equipment and personnel to optimize facility operations and conserve SRS resources; and as an ancillary objective, demonstrating and optimizing newmore » and innovative analytical techniques that will lower cost, decrease time, and decrease secondary waste streams for required PCS assays.« less

Doing more with less in the lab.

PubMed

Craig, Elinore

2003-12-01

Automation offers laboratories the ability to improve patient care, enhance client and employee satisfaction, and increase workload capacity while maintaining a cost-effective department. "The overall objective of any organization's automation project is simple--to do more with less, better," states Davis. "We know our future is on the information systems side," Clarke states. "Vendors' investment in the development and creativity of automation is what is going to drive the future of the laboratory." "Implementing the automation solution was absolutely the right thing to do for Sacred Heart Health," says Wright. "With the transition complete, we are pleased with the results. All we want now is more automation that will enable us to do even more with what we have."

Steering a new course

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gordon, D.

1991-01-01

This book offers for the first time a comprehensive survey and analysis of America's transportation system - how it contributes to our environmental problems, and how we could make it safer, more efficient, and less costly. The book includes a history of modern American transportation, an overview of the U.S. transportation sector, and an in-depth discussion of the strategies that hold the most promise for the future. The book provides a wealth of information about innovative transportation options such as: alternative fuels, advances in mass transit, ultra- fuel-efficient vehicles, high-occupancy vehicle facilities, and telecommuting and alternative work schedules. Deborah Gordonmore » is a transportation and energy analyst for the Union of Concerned Scientists.« less

Jahn–Teller Assisted Na Diffusion for High Performance Na Ion Batteries

DOE Office of Scientific and Technical Information (OSTI.GOV)

Li, Xin; Wang, Yan; Wu, Di

2016-08-30

Na energy storage technology is strategically attractive for large scale applications such as grid energy storage. Here, we show in this paper that there is a clear relation between the Jahn$-$Teller activity of a transition metal ion at the end of charge and the mobility of Na in a cathode material. This is particularly important as mobility at the end of charge limits the capacity of current materials. Consequently, by using this classical piece of physics in the battery world, it is possible to create higher capacity Na-cathode materials. Even more exciting is that the ideal element to impart thismore » effect on cathodes is Fe, which is the least expensive of the transition metal oxides and can therefore enable low cost cathode materials.« less

Air quality impacts of transit improvement, preferential lane, and carpool/vanpool programs. Final report

DOE Office of Scientific and Technical Information (OSTI.GOV)

DiRenzo, J.F.; Rubin, R.B.

1978-03-01

The report was prepared in accordance with Section 108(f) of the Clean Air Act, as amended, August 1977. It is intended to assist urban areas in developing State Implementation Plans and integrating their transportation system management and air quality planning programs as required by FHWA, UMTA, and EPA. The report analyzes the air quality, travel, energy consumption, economic, and cost impacts of three types of transportation programs: priority treatment for high occupancy vehicles on freeways and arterials; areawide carpool and vanpool programs; and transit fare reductions and service improvements. Important factors (e.g., meteorological conditions, traffic volumes and speeds, and changesmore » in modal choice) likely to influence air quality and emissions for the above programs are also analyzed.« less

Adding smoking to the Fardal model of cost-effectiveness for the life-time treatment of periodontal diseases.

PubMed

Fardal, Øystein; Grytten, Jostein; Martin, John; Ellingsen, Stig; Fardal, Patrick; Heasman, Peter; Linden, Gerard J

2018-05-16

Little is known about the financial costs that smoking adds to the life-time treatment of periodontal disease. The total life-time cost of periodontal treatment was modelled using data from private periodontal practice. The costs of initial and supportive therapy, re-treatment and tooth replacements (with bridgework or implants) were identified using average dental charges from the American Dental Association survey. Smoking costs at $6 and $10 for 20 cigarettes were compared to the costs of life-time periodontal treatment for stable and unstable compliant patients. Smoking added 8.8% to the financial cost of the life-time cost of periodontal therapy in stable maintenance patients, 40.1% in patients who needed one extra maintenance visit and 71.4% in patients who needed two extra maintenance visits per year in addition to added re-treatment. The cost of smoking far exceeded the cost of periodontal treatment; For patients who smoked 10 to 40 cigarettes per day at the cost of $6 or $10 a pack, the cost of smoking exceeded the cost of life-time periodontal treatment by between 2.7 and 17.9 times. Smoking 40 cigarettes at $10 a packet for 3.4 years would pay for the entire life-time cost of periodontal treatment. Smoking adds considerable extra financial costs to the life-time treatment of periodontal diseases. The cost of smoking itself exceeds the cost of periodontal therapy. This article is protected by copyright. All rights reserved. © 2018 American Academy of Periodontology.

Comparison of 4 recruiting strategies in a smoking cessation trial.

PubMed

Buller, David B; Meenan, Richard; Severson, Herb; Halperin, Abigail; Edwards, Erika; Magnusson, Brooke

2012-09-01

To compare 4 online and off-line recruiting methods. Young adult smokers (n=3353) were recruited to a trial comparing smoking cessation services with an online health risk assessment (HRA), online ads, offline materials, and quit-line screening. Online ads (n=1426; $41.35) and off-line materials recruited the most smokers (n=1341; $56.23) for the lowest cost. Quitline screening was more expensive (n=189; $132.22), but enrollees used cessation services the most (34%-82%). Online HRA was least successful and most costly (n=397; $630.85) but had the highest follow-up (45%-55%). Online ads and off-line materials were most effective and cost-effective methods.

Benefit-Cost Analysis of Integrated Paratransit Systems : Volume 1. Executive Summary.

DOT National Transportation Integrated Search

1979-09-01

Integrated Paratransit (IP) is a concept which involves the integration of conventional fixed-route transit with flexibly routed paratransit services to provide the most effective area-wide transit coverage. The report estimates the benefits and cost...

DNS of Supersonic Turbulent Flows in a DLR Scramjet Intake

NASA Astrophysics Data System (ADS)

Li, Xinliang; Yu, Changping

2014-11-01

Direct numerical simulation (DNS) of supersonic/hypersonic flow through a DLR scramjet intake GK01 is performed. The free stream Mach numbers are 3, 5 and 7, and the angle of attack is zero degree. The DNS cases are performed by using an optimized MP scheme with adaptive dissipation (OMP-AD) developed by the authors, and the blow-and-suction perturbations near the leading edge are used to trigger the transition. To stabilize the simulation, locally non-linear flittering is used in high-Mach-number case. The transition, separation, and shock-turbulent boundary layer interaction are studied by using both flow visualization and statistical analysis. A new method, OMP-AD, is also addressed in this paper. The OMP-AD scheme is developed by using joint MP method and optimized technique, and the coefficients in the scheme are flexible to show low dissipation in the smoothing region, and to show high robust (but high dissipation) in the large gradient region. Numerical tests show that the OMP-AD is more robust than the original MP schemes, and the numerical dissipation of OMP-AD is very low.

Cost-effectiveness and Budget Impact of Routine Use of Fractional Exhaled Nitric Oxide Monitoring for the Management of Adult Asthma Patients in Spain.

PubMed

Sabatelli, L; Seppälä, U; Sastre, J; Crater, G

Fractional exhaled nitric oxide (FeNO) is a marker for type 2 airway inflammation. The objective of this study was to evaluate the cost-effectiveness and budget impact of FeNO monitoring for management of adult asthma in Spain. A cost-effectiveness analysis model was used to evaluate the effect on costs of adding FeNO monitoring to asthma management. Over a 1-year period, the model estimated the incremental cost per quality-adjusted life year and incremental number of exacerbations avoided when FeNO monitoring was added to standard guideline-driven asthma care compared with standard care alone. Univariate and multivariate sensitivity analyses were applied to explore uncertainty in the model. A budget impact model was used to examine the impact of FeNO monitoring on primary care costs across the Spanish health system. The results showed that adding FeNO to standard asthma care saved €62.53 per patient-year in the adult population and improved quality-adjusted life years by 0.026 per patient-year. The budget impact analysis revealed a potential net yearly saving of €129 million if FeNO monitoring had been used in primary care settings in Spain. The present economic model shows that adding FeNO to the treatment algorithm can considerably reduce costs and improve quality of life when used to manage asthma in combination with current treatment guidelines.

The Future of Electricity Resource Planning

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kahrl, Fredrich; Mills, Andrew; Lavin, Luke

Electricity resource planning is the process of identifying longer-term investments to meet electricity reliability requirements and public policy goals at a reasonable cost. Resource planning processes provide a forum for regulators, electric utilities, and electricity industry stakeholders to evaluate the economic, environmental, and social benefits and costs of different investment options. By facilitating a discussion on future goals, challenges and strategies, resource planning processes often play an important role in shaping utility business decisions. Resource planning emerged more than three decades ago in an era of transition, where declining electricity demand and rising costs spurred fundamental changes in electricity industrymore » regulation and structure. Despite significant changes in the industry, resource planning continues to play an important role in supporting investment decision making. Over the next two decades, the electricity industry will again undergo a period of transition, driven by technological change, shifting customer preferences and public policy goals. This transition will bring about a gradual paradigm shift in resource planning, requiring changes in scope, approaches and methods. Even as it changes, resource planning will continue to be a central feature of the electricity industry. Its functions — ensuring the reliability of high voltage (“bulk”) power systems, enabling oversight of regulated utilities and facilitating low-cost compliance with public policy goals — are likely to grow in importance as the electricity industry enters a new period of technological, economic and regulatory change. This report examines the future of electricity resource planning in the context of a changing electricity industry. The report examines emerging issues and evolving practices in five key areas that will shape the future of resource planning: (1) central-scale generation, (2) distributed generation, (3) demand-side resources, (4) transmission and (5) uncertainty and risk management. The analysis draws on a review of recent resource plans for 10 utilities that reflect some of the U.S. electricity industry’s extensive diversity.« less

Influence of reactive gas admixture on transition metal cluster nucleation in a gas aggregation cluster source

NASA Astrophysics Data System (ADS)

Peter, Tilo; Polonskyi, Oleksandr; Gojdka, Björn; Mohammad Ahadi, Amir; Strunskus, Thomas; Zaporojtchenko, Vladimir; Biederman, Hynek; Faupel, Franz

2012-12-01

We quantitatively assessed the influence of reactive gases on the formation processes of transition metal clusters in a gas aggregation cluster source. A cluster source based on a 2 in. magnetron is used to study the production rate of titanium and cobalt clusters. Argon served as working gas for the DC magnetron discharge, and a small amount of reactive gas (oxygen and nitrogen) is added to promote reactive cluster formation. We found that the cluster production rate depends strongly on the reactive gas concentration for very small amounts of reactive gas (less than 0.1% of total working gas), and no cluster formation takes place in the absence of reactive species. The influence of discharge power, reactive gas concentration, and working gas pressure are investigated using a quartz micro balance in a time resolved manner. The strong influence of reactive gas is explained by a more efficient formation of nucleation seeds for metal-oxide or nitride than for pure metal.

Feasibility of a Networked Air Traffic Infrastructure Validation Environment for Advanced NextGen Concepts

NASA Technical Reports Server (NTRS)

McCormack, Michael J.; Gibson, Alec K.; Dennis, Noah E.; Underwood, Matthew C.; Miller,Lana B.; Ballin, Mark G.

2013-01-01

Abstract-Next Generation Air Transportation System (NextGen) applications reliant upon aircraft data links such as Automatic Dependent Surveillance-Broadcast (ADS-B) offer a sweeping modernization of the National Airspace System (NAS), but the aviation stakeholder community has not yet established a positive business case for equipage and message content standards remain in flux. It is necessary to transition promising Air Traffic Management (ATM) Concepts of Operations (ConOps) from simulation environments to full-scale flight tests in order to validate user benefits and solidify message standards. However, flight tests are prohibitively expensive and message standards for Commercial-off-the-Shelf (COTS) systems cannot support many advanced ConOps. It is therefore proposed to simulate future aircraft surveillance and communications equipage and employ an existing commercial data link to exchange data during dedicated flight tests. This capability, referred to as the Networked Air Traffic Infrastructure Validation Environment (NATIVE), would emulate aircraft data links such as ADS-B using in-flight Internet and easily-installed test equipment. By utilizing low-cost equipment that is easy to install and certify for testing, advanced ATM ConOps can be validated, message content standards can be solidified, and new standards can be established through full-scale flight trials without necessary or expensive equipage or extensive flight test preparation. This paper presents results of a feasibility study of the NATIVE concept. To determine requirements, six NATIVE design configurations were developed for two NASA ConOps that rely on ADS-B. The performance characteristics of three existing in-flight Internet services were investigated to determine whether performance is adequate to support the concept. Next, a study of requisite hardware and software was conducted to examine whether and how the NATIVE concept might be realized. Finally, to determine a business case, economic factors were evaluated and a preliminary cost-benefit analysis was performed.

78 FR 66254 - Airworthiness Directives; The Boeing Company Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-05

... AD. Costs of Compliance We estimate that this AD affects 84 airplanes of U.S. registry. We estimate... inspection cycle. We have received no definitive data that would enable us to provide a cost estimate for the... 2 of paragraph 1.E., ``Compliance,'' of Boeing Service Bulletin 747-53A2688, Revision 1, dated...

78 FR 49229 - Airworthiness Directives; The Boeing Company Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-13

... add airplanes to the applicability of AD 2009-24-07. We are proposing this AD to prevent stress... prevent stress corrosion cracking of the forward trunnion pins, which could result in fracture of the pins... Number of Average U.S.- Action Work hours labor rate Parts Cost per product registered Fleet cost per...

Metamorphosing reef fishes avoid predator scent when choosing a home.

PubMed

Vail, Alexander L; McCormick, Mark I

2011-12-23

Most organisms possess anti-predator adaptations to reduce their risk of being consumed, but little is known of the adaptations prey employ during vulnerable life-history transitions when predation pressures can be extreme. We demonstrate the use of a transition-specific anti-predator adaptation by coral reef fishes as they metamorphose from pelagic larvae to benthic juveniles, when over half are consumed within 48 h. Our field experiment shows that naturally settling damselfish use olfactory, and most likely innate, predator recognition to avoid settling to habitat patches manipulated to emit predator odour. Settlement to patches emitting predator odour was on average 24-43% less than to control patches. Evidence strongly suggests that this avoidance of sedentary and patchily distributed predators by nocturnal settlers will gain them a survival advantage, but also lead to non-lethal predator effects: the costs of exhibiting anti-predator adaptations. Transition-specific anti-predator adaptations, such as demonstrated here, may be widespread among organisms with complex life cycles and play an important role in prey population dynamics.

Peruvian perovskite Between Transition-metal to PGM/PlatinumGroupMetal Catalytic Fusion

NASA Astrophysics Data System (ADS)

Maksoed, Wh-

2016-11-01

Strongly correlated electronic materials made of simple building blocks, such as a transition-metal ion in an octahedral oxygen cage forming a perovskite structure- Dagotto & Tokura for examples are the high-temperature superconductivity & the CMR/Colossal Magnetoresistance . Helium-4 denotes from LC Case,ScD: "Catalytic Fusion of Deuterium into Helium-4"- 1998 dealt with gaseous D2- "contacted with a supported metallic catalyst at superatmospheric pressure". The catalyst is a platinum-group metal, at about 0.5% - 1% by weight, on activated C. Accompanies Stephen J Geier, 2010 quotes "transition metal complexes", the Energy thus produced is enormous, and because the deuterium is very cheap in the form of heavy water (less than US 1/g), the fuel cost is very low (<<1 %/KwH). "The oceans contain enough deuterium to satisfy the Earth's energy needs for many millions of year" to keep "maria"/Latin name of seas &Deuteronomy to be eternally preserves. Heartfelt Gratitudes to HE. Mr. Prof. Ir. HANDOJO.

Between Scylla and Charybdis: Delayed mitigation narrows the passage between large-scale CDR and high costs

NASA Astrophysics Data System (ADS)

Strefler, Jessica; Bauer, Nico; Kriegler, Elmar; Popp, Alexander; Giannousakis, Anastasis; Edenhofer, Ottmar

2018-04-01

There are major concerns about the sustainability of large-scale deployment of carbon dioxide removal (CDR) technologies. It is therefore an urgent question to what extent CDR will be needed to implement the long term ambition of the Paris Agreement. Here we show that ambitious near term mitigation significantly decreases CDR requirements to keep the Paris climate targets within reach. Following the nationally determined contributions (NDCs) until 2030 makes 2 °C unachievable without CDR. Reducing 2030 emissions by 20% below NDC levels alleviates the trade-off between high transitional challenges and high CDR deployment. Nevertheless, transitional challenges increase significantly if CDR is constrained to less than 5 Gt CO2 a‑1 in any year. At least 8 Gt CO2 a‑1 CDR are necessary in the long term to achieve 1.5 °C and more than 15 Gt CO2 a‑1 to keep transitional challenges in bounds.

Error estimation for CFD aeroheating prediction under rarefied flow condition

NASA Astrophysics Data System (ADS)

Jiang, Yazhong; Gao, Zhenxun; Jiang, Chongwen; Lee, Chunhian

2014-12-01

Both direct simulation Monte Carlo (DSMC) and Computational Fluid Dynamics (CFD) methods have become widely used for aerodynamic prediction when reentry vehicles experience different flow regimes during flight. The implementation of slip boundary conditions in the traditional CFD method under Navier-Stokes-Fourier (NSF) framework can extend the validity of this approach further into transitional regime, with the benefit that much less computational cost is demanded compared to DSMC simulation. Correspondingly, an increasing error arises in aeroheating calculation as the flow becomes more rarefied. To estimate the relative error of heat flux when applying this method for a rarefied flow in transitional regime, theoretical derivation is conducted and a dimensionless parameter ɛ is proposed by approximately analyzing the ratio of the second order term to first order term in the heat flux expression in Burnett equation. DSMC simulation for hypersonic flow over a cylinder in transitional regime is performed to test the performance of parameter ɛ, compared with two other parameters, Knρ and MaṡKnρ.

Developing health insurance in transitional Asia.

PubMed

Ensor, T

1999-04-01

Many European and Asian economies are currently undergoing a process of economic transition away from state based command systems to market led economies. The impact of transition, such as a decline in public expenditure, break up of state enterprises and economic recession, has affected levels of funding available for social sectors. In the health sector, health insurance is being introduced as a way of alleviating the decline in funding arising from these processes. Most of the Former Soviet Union and a number of other Asian transition economies are currently introducing, extending or considering payroll based systems of health insurance. Comparisons with many Latin American countries, where social security based insurance has been encouraged since the first World War, can be illuminating. Experience suggests that, various factors have impeded or permitted development in these countries. General processes of economic change (transition factors) tend to affect all economies attempting to change the basis for public funding of services. Structural factors, such as urbanisation and the level of state or industrial employment, act as longer term inhibitors to the extension of coverage. These factors vary considerably across transition economies. This suggests that while a social security base for insurance may be a viable option for smaller industrialised European transitional economies, this is not the case for many of larger less industrialised economies. It is unclear how insurance will develop in the future. If a separate insurance fund is maintained it is important that its' purchasing function is developed. Otherwise it is not clear what value is added to the current health system. If entitlement is to be based on contribution, with the fund based on geographic or employment groups, systems for ensuring access for those not in employment and not classified as socially protected must be developed.

Transit car demonstration test program on the roll dynamics unit. Volume 2. Demonstration of a transit car performance test on the roll dynamic unit. Final report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Arnold, G.; Nelson, S.; Cooperrider, N.K.

1982-02-11

This report, Volume II, contains the results, conclusions, and recommendations of the first performance test of a transit care on the RDU. This report is limited to performance tests. The objective is to identify advantages and disadvantages of performance testing on the rollers of the RDU as highlighted by the SOAC test. The report involved separate testing, done by TTC personnel, in such traditional performance areas of transit vehicle operation ass traction, acceleration/deceleration, energy consumption, and spin/slide performance. The results of the successful performance test of a transit car on a roller unit is presented and the advantages of thismore » method of testing is discussed. Acceleration, deceleration, spin/slide, and power consumption tests, although of limited scope in comparison to the track tests performed on the same transit car, did show the feasibility of roller testing. It is concluded that the RDU is most suited for developmental testing of transit car systems particularly for power consumption and for cars with non-standard wheel gage. Tests should be of such scope as to justify the cost of car setup on the RDU. The following two test are recommended: (1) a power consumption study for a standard/non-standard gage transit car which investigates methods of reducing power consumption and (2) a non-standard gage full performance test.« less

Lessons learned in transit efficiencies, revenue generation and cost reductions

DOT National Transportation Integrated Search

1997-01-01

The purpose of this research project was to gather and redistribute information : on how transit agencies are finding ways to either generate new revenues or : reduce costs without harming the best interests of their passengers. This : research proje...

Assessing the costs for hybrid versus regular transit buses : [technical brief].

DOT National Transportation Integrated Search

2012-10-01

This technical brief summarizes : information about the costs and benefits : that have been attributed to use of : hybrid transit buses as found in the : literature. Results from a demonstration : project that compared fuel economy : and emissions fo...

Proximity Effects and Nonequilibrium Superconductivity in Transition-Edge Sensors

NASA Technical Reports Server (NTRS)

Sadleir, John E.; Smith, Stephen J.; Robinson, Ian K.; Finkbeiner, Fred M.; Chervenak, James A.; Bandler, Simon R.; Eckart, Megan E.; Kilbourne, Caroline A.

2011-01-01

We have recently shown that normal-metal/superconductor (N/S) bilayer TESs (superconducting Transition-Edge Sensors) exhibit weak-link behavior.l Here we extend our understanding to include TESs with added noise-mitigating normal-metal structures (N structures). We find TESs with added Au structures also exhibit weak-link behavior as evidenced by exponential temperature dependence of the critical current and Josephson-like oscillations of the critical current with applied magnetic field. We explain our results in terms of an effect converse to the longitudinal proximity effect (LoPE) 1, the lateral inverse proximity effect (LaiPE), for which the order parameter in the N/S bilayer is reduced due to the neighboring N structures. Resistance and critical current measurements are presented as a function of temperature and magnetic field taken on square Mol Au bilayer TESs with lengths ranging from 8 to 130 {\\mu}m with and without added N structures. We observe the inverse proximity effect on the bilayer over in-plane distances many tens of microns and find the transition shifts to lower temperatures scale approximately as the inverse square of the in- plane N-structure separation distance, without appreciable broadening of the transition width. We also present evidence for nonequilbrium superconductivity and estimate a quasiparticle lifetime of 1.8 \\times 10-10 s for the bilayer. The LoPE model is also used to explain the increased conductivity at temperatures above the bilayer's steep resistive transition.

Fuzzy multi-objective optimization case study based on an anaerobic co-digestion process of food waste leachate and piggery wastewater.

PubMed

Choi, Angelo Earvin Sy; Park, Hung Suck

2018-06-20

This paper presents the development and evaluation of fuzzy multi-objective optimization for decision-making that includes the process optimization of anaerobic digestion (AD) process. The operating cost criteria which is a fundamental research gap in previous AD analysis was integrated for the case study in this research. In this study, the mixing ratio of food waste leachate (FWL) and piggery wastewater (PWW), calcium carbonate (CaCO 3 ) and sodium chloride (NaCl) concentrations were optimized to enhance methane production while minimizing operating cost. The results indicated a maximum of 63.3% satisfaction for both methane production and operating cost under the following optimal conditions: mixing ratio (FWL: PWW) - 1.4, CaCO 3 - 2970.5 mg/L and NaCl - 2.7 g/L. In multi-objective optimization, the specific methane yield (SMY) was 239.0 mL CH 4 /g VS added , while 41.2% volatile solids reduction (VSR) was obtained at an operating cost of 56.9 US$/ton. In comparison with the previous optimization study that utilized the response surface methodology, the SMY, VSR and operating cost of the AD process were 310 mL/g, 54% and 83.2 US$/ton, respectively. The results from multi-objective fuzzy optimization proves to show the potential application of this technique for practical decision-making in the process optimization of AD process. Copyright © 2018 Elsevier Ltd. All rights reserved.

Getting to the Core of Transition: A Re-Assessment of Old Wine in New Bottles.

ERIC Educational Resources Information Center

Stodden, Robert A.; Leake, David W.

1994-01-01

The core of the education system must be transformed to make it supportive of exceptional students in transition. Attempts to improve the system by adding on programs rather than instituting core changes have not been effective. A "teaming" process that promotes school-community and interagency collaboration and infuses transition into the core of…

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

PubMed

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.

[Direct and indirect costs of luteinising hormone-releasing hormone analogues in the treatment of locally advanced or metastatic prostate cancer in Italy].

PubMed

Fadda, Valeria; Maratea, Dario

2015-12-01

When analyzing the use of luteinizing hormone-releasing hormone (LHRH) analogues for different clinical indications, current available evidence does not support a presumed drug class effect among the various LHRH in the treatment of prostate cancer. The following search key words were entered in the PubMed database and the NICE and FDA websites: “LHRH agonist AND prostatic cancer”, “androgen deprivation therapy”, “androgen suppression”, “buserelin”, “leuprorelin”, “goserelin”,“triptorelin”, “degarelix”. The direct costs included the following items: follow-up visits, diagnostic exams (e.g. prostate-specific antigen PSA) and drug costs. The indirect costs included working days lost by the patient. With intermittent therapy as a reference, leuprorelin injectable solution of 22,25 mg was associated with the lowest cost and degarelix with the highest cost. However, given the mandatory presence of a nurse for drug injection, the buserelin depot formulation was associated with the lowest cost. If the costs for hospital visits were added to drug costs, differences between the various therapeutic strategies were less remarkable. Our study showed how various factors (e.g. route of administration, frequency of administration, presence of a nurse for drug reconstitution and injection) should be taken into account by decision makers in addition to the price of drugs.

The cost of a large-scale hollow fibre MBR.

PubMed

Verrecht, Bart; Maere, Thomas; Nopens, Ingmar; Brepols, Christoph; Judd, Simon

2010-10-01

A cost sensitivity analysis was carried out for a full-scale hollow fibre membrane bioreactor to quantify the effect of design choices and operational parameters on cost. Different options were subjected to a long term dynamic influent profile and evaluated using ASM1 for effluent quality, aeration requirements and sludge production. The results were used to calculate a net present value (NPV), incorporating both capital expenditure (capex), based on costs obtained from equipment manufacturers and full-scale plants, and operating expenditure (opex), accounting for energy demand, sludge production and chemical cleaning costs. Results show that the amount of contingency built in to cope with changes in feedwater flow has a large impact on NPV. Deviation from a constant daily flow increases NPV as mean plant utilisation decreases. Conversely, adding a buffer tank reduces NPV, since less membrane surface is required when average plant utilisation increases. Membrane cost and lifetime is decisive in determining NPV: an increased membrane replacement interval from 5 to 10 years reduces NPV by 19%. Operation at higher SRT increases the NPV, since the reduced costs for sludge treatment are offset by correspondingly higher aeration costs at higher MLSS levels, though the analysis is very sensitive to sludge treatment costs. A higher sustainable flux demands greater membrane aeration, but the subsequent opex increase is offset by the reduced membrane area and the corresponding lower capex. Copyright © 2010 Elsevier Ltd. All rights reserved.