Screening blood donors for diabetes: analysis of use, accuracy, and cost.

PubMed

Lenhard, M James; Maser, Raelene E; Kolm, Paul; Healy, Michael J; Seshadri, Prakash

2013-11-01

The objective was to determine if a free, voluntary diabetes screening program as a part of the blood donation process might be cost-effective. During the first 6 months of the program, 26,415 donors were screened using a single random plasma glucose (RPG) level. All donors were asked to eat before donation. Low-, moderate-, and high-risk groups were formed based on RPG levels (<140, 140-200, and >200 mg/dL). Contact with a telephone questionnaire was made with 139 of 178 (78%) of the persons in the high-risk group with 33 new cases of diabetes diagnosed by the donor's physician and 26 donors indicating that they were not diagnosed with diabetes. Sex- and age-matched donors in the low- and moderate-risk groups were contacted and administered the same questionnaire. The three risk groups were similar, except for body mass index (28.1 ± 5.4 kg/m2 vs. 29.9 ± 5.5 kg/m2 vs. 32.7 ± 5.6 kg/m2 , p < 0.001). The discriminative effectiveness of screening was evaluated by the area under the receiver operating characteristics (AROC) curve. The AROC curve was 0.950 (95% confidence interval, 0.920-0.979) for the identification of diabetes. Using a RPG cutoff of 200 mg/dL, sensitivity was 100%, specificity was 82%, and positive predictive value was 56%. Cost analyses showed that the mean cost to screen, per donor, was less than $1. Cost per case identified was estimated to be less than $500 for a RPG cutoff of 200 mg/dL. Screening during the blood donation process appears to be accurate, convenient, and inexpensive. © 2013 American Association of Blood Banks.

Perioperative blood ordering optimization process using information from an anesthesia information management system.

PubMed

Rinehart, Joseph B; Lee, Tiffany C; Kaneshiro, Kayleigh; Tran, Minh-Ha; Sun, Coral; Kain, Zeev N

2016-04-01

As part of ongoing perioperative surgical home implantation process, we applied a previously published algorithm for creation of a maximum surgical blood order schedule (MSBOS) to our operating rooms. We hypothesized that using the MSBOS we could show a reduction in unnecessary preoperative blood testing and associated costs. Data regarding all surgical cases done at UC Irvine Health's operating rooms from January 1, 2011, to January 1, 2014 were extracted from the anesthesia information management systems (AIMS). After the data were organized into surgical specialties and operative sites, blood order recommendations were generated based on five specific case characteristics of the group. Next, we assessed current ordering practices in comparison to actual blood utilization to identify potential areas of wastage and performed a cost analysis comparing the annual hospital costs from preoperative blood orders if the blood order schedule were to be followed to historical practices. Of the 19,138 patients who were categorized by the MSBOS as needing no blood sample, 2694 (14.0%) had a type and screen (T/S) ordered and 1116 (5.8%) had a type and crossmatch ordered. Of the 6073 procedures where MSBOS recommended only a T/S, 2355 (38.8%) had blood crossmatched. The cost analysis demonstrated an annual reduction in actual hospital costs of $57,335 with the MSBOS compared to historical blood ordering practices. We showed that the algorithm for development of a multispecialty blood order schedule is transferable and yielded reductions in preoperative blood product screening at our institution. © 2016 AABB.

Cost-Effectiveness of Intensive versus Standard Blood-Pressure Control.

PubMed

Bress, Adam P; Bellows, Brandon K; King, Jordan B; Hess, Rachel; Beddhu, Srinivasan; Zhang, Zugui; Berlowitz, Dan R; Conroy, Molly B; Fine, Larry; Oparil, Suzanne; Morisky, Donald E; Kazis, Lewis E; Ruiz-Negrón, Natalia; Powell, Jamie; Tamariz, Leonardo; Whittle, Jeff; Wright, Jackson T; Supiano, Mark A; Cheung, Alfred K; Weintraub, William S; Moran, Andrew E

2017-08-24

In the Systolic Blood Pressure Intervention Trial (SPRINT), adults at high risk for cardiovascular disease who received intensive systolic blood-pressure control (target, <120 mm Hg) had significantly lower rates of death and cardiovascular disease events than did those who received standard control (target, <140 mm Hg). On the basis of these data, we wanted to determine the lifetime health benefits and health care costs associated with intensive control versus standard control. We used a microsimulation model to apply SPRINT treatment effects and health care costs from national sources to a hypothetical cohort of SPRINT-eligible adults. The model projected lifetime costs of treatment and monitoring in patients with hypertension, cardiovascular disease events and subsequent treatment costs, treatment-related risks of serious adverse events and subsequent costs, and quality-adjusted life-years (QALYs) for intensive control versus standard control of systolic blood pressure. We determined that the mean number of QALYs would be 0.27 higher among patients who received intensive control than among those who received standard control and would cost approximately $47,000 more per QALY gained if there were a reduction in adherence and treatment effects after 5 years; the cost would be approximately $28,000 more per QALY gained if the treatment effects persisted for the remaining lifetime of the patient. Most simulation results indicated that intensive treatment would be cost-effective (51 to 79% below the willingness-to-pay threshold of $50,000 per QALY and 76 to 93% below the threshold of $100,000 per QALY), regardless of whether treatment effects were reduced after 5 years or persisted for the remaining lifetime. In this simulation study, intensive systolic blood-pressure control prevented cardiovascular disease events and prolonged life and did so at levels below common willingness-to-pay thresholds per QALY, regardless of whether benefits were reduced after 5 years or

Economic burden of malignant blood disorders across Europe: a population-based cost analysis.

PubMed

Burns, Richeal; Leal, Jose; Sullivan, Richard; Luengo-Fernandez, Ramon

2016-08-01

Malignant blood disorders are a leading contributor to cancer incidence and mortality across Europe. Despite their burden, no study has assessed the economic effect of blood cancers in Europe. We aimed to assess the economic burden of malignant blood disorders across the 28 countries in the European Union (EU), Iceland, Norway, and Switzerland. Malignant blood disorder-related costs were estimated for 28 EU countries, Iceland, Norway, and Switzerland for 2012. Country-specific costs were estimated with aggregate data on morbidity, mortality, and health-care resource use obtained from international and national sources. Health-care costs were estimated from expenditure on primary, outpatient, emergency, inpatient care, and drugs. Costs of informal care and productivity losses due to morbidity and early death were also included. For countries in the EU, malignant blood disorders were compared with the economic burden of overall cancer. Malignant blood disorders cost the 31 European countries €12 billion in 2012. Health-care cost €7·3 billion (62% of total costs), productivity losses cost €3·6 billion (30%), and informal care cost €1 billion (8%). For the EU countries, malignant blood disorders cost €6·8 billion (12%) of the total health-care expenditure on cancer (€57 billion), with this proportion being second only to breast cancer. In terms of total cancer costs in the EU (€143 billion), malignant blood disorders cost €12 billion (8%). Malignant blood disorders represent a leading cause of death, health-care service use, and costs, not only to European health-care systems, but to society overall. Our results add to essential public health knowledge needed for effective national cancer-control planning and priorities for public research funding. European Hematology Association. Copyright © 2016 Elsevier Ltd. All rights reserved.

Cost-effective practices in the blood service sector.

PubMed

Katsaliaki, Korina

2008-05-01

The objective of this study is to recommend alternative policies, which are tested on a computer simulation model, towards a more cost-effective management of the blood supply chain in the UK. With the use of primary and secondary data from the National Blood Service (NBS) and the supplied hospitals, statistical analysis is conducted and a detailed discrete event simulation model of a vertical part of the UK supply chain of blood products is developed to test and identify good ordering, inventory and distribution practices. Fewer outdates, group substitutions, shortages and deliveries could be achieved by blood banks: holding stock of rare blood groups of red blood cells (RBC), having a second routine delivery per weekday, exercising a more insensitive ordering point for RBC, reducing the total crossmatch release period to less than 1.5 days, increasing the transfusion-to-crossmatch ratio to 70%, adhering to an age-based issuing of orders, holding RBC stock of a weighted average of approximately 4 days. The blood supply simulation model can offer useful pieces of advice to the stakeholders of the examined system which leads to cost reductions and increased safety. Moreover, it provides a great range of experimental capabilities in a risk-free environment.

[Analysis of productivity, quality and cost of first grade laboratories: blood biometry].

PubMed

Avila, L; Hernández, P; Cruz, A; Zurita, B; Terres, A M; Cruz, C

1999-04-01

Assessment of productivity, quality and production costs and determination of the efficiency of top grade clinical laboratories in Mexico. Ten laboratories were selected from among the total number (52) existing in Mexico City, and the Donabedian model of structure, process and results were applied. Blood count was selected as a tracer. The principal problems found were: inadequate distribution of trained human resources, poor glass material, inadequate analytic process and low productivity. These factors are reflected in the unit costs, which exceed reference laboratory costs by 200%. Only 50% of the laboratories analyzed generate reliable results. Only 20% of the laboratories studied operate efficiently. To solve the problems identified requires integral strategies at different levels. A specific recomendation for the improvement of quality and productivity is an assessment of the cost/benefit of creating a central laboratory and using the remaining sites exclusively for the collection of samples.

[Organization of safe cost-effective blood transfusion: experience APHM-EFSAM].

PubMed

Ferrera-Tourenc, V; Dettori, I; Chiaroni, J; Lassale, B

2013-03-01

Blood transfusion safety depends on strict compliance with each step of a process beginning with the order for labile blood products and related immunohematologic testing and ending with administration and follow-up of the receiver. This process is governed by stringent regulatory texts and guidelines. Despite precautions, processing errors are still reported. Analysis of incident reports shows that the most common cause involves patient identification and that most errors occur at two levels, i.e. the entry of patient information and management of multiple regulatory crosschecks and record-keeping using different systems. The purpose of this report is to describe the collaborative approach implemented by the Établissement français du Sang Alpes-Méditerranée (EFSAM) and the Assistance publique des Hôpitaux de Marseille (APHM) to secure the blood transfusion process and protect interfaces while simplifying and facilitating exchanges. Close cooperation has had a threefold impact with simplification of administration, improvement of experience feedback, and better management of test ordering. The organization implemented between the two institutions has minimized document redundancy and interfaces between immunohematologic testing and delivery. Collaboration based on experience feedback has improved the level of quality and cost control. In the domain of blood transfusion safety, the threshold of 10(-5) has been reached with regard to the risk of ABO errors in the distribution concentrated red cells (CRC). In addition, this collaborative organization has created further opportunity for improvement by deploying new methods to identify simplification measures and by controlling demand and usage. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Economic burden of non-malignant blood disorders across Europe: a population-based cost study.

PubMed

Luengo-Fernandez, Ramon; Burns, Richeal; Leal, Jose

2016-08-01

Blood disorders comprise a wide range of diseases including anaemia, malignant blood disorders, and haemorrhagic disorders. Although they are a common cause of disease, no systematic cost-of-illness studies have been done to assess the economic effect of non-malignant blood disorders in Europe. We aimed to assess the economic burden of non-malignant blood disorders across the 28 countries of the European Union (EU), Iceland, Norway, and Switzerland. Non-malignant blood disorder-related costs (WHO International Classification of Diseases, 10th revision [ICD] D50-89) were estimated for 28 EU countries, Iceland, Norway, and Switzerland for 2012. Country-specific costs were estimated with aggregate data on morbidity, mortality, and health-care resource use obtained from international and national sources. Health-care costs were estimated from expenditure on primary care, outpatient care, emergency care, hospital inpatient care, and drugs. Costs of informal care and productivity losses due to morbidity and early death were also included. To these costs we added those due to malignant blood disorders (ICD-10 C81-96 and D47) as estimated in a Burns and colleagues' companion Article to obtain the total costs of blood disorders. Non-malignant disorders of the blood cost the 31 European countries €11 billion in 2012. Health-care costs accounted for €8 billion (75% of total costs), productivity losses for €2 billion (19%), and informal care for less than €1 billion (6%). Averaged across the European population studied, non-malignant disorders of the blood represented an annual health-care cost of €159 per ten citizens. Combining malignant and non-malignant blood disorders, the total cost of blood disorders was €23 billion in 2012. Our study highlights the economic burden that non-malignant blood disorders place on European health-care systems and societies. Our study also shows that blood disorder costs were evenly distributed between malignant and non

Clinical process cost analysis.

PubMed

Marrin, C A; Johnson, L C; Beggs, V L; Batalden, P B

1997-09-01

New systems of reimbursement are exerting enormous pressure on clinicians and hospitals to reduce costs. Using cheaper supplies or reducing the length of stay may be a satisfactory short-term solution, but the best strategy for long-term success is radical reduction of costs by reengineering the processes of care. However, few clinicians or institutions know the actual costs of medical care; nor do they understand, in detail, the activities involved in the delivery of care. Finally, there is no accepted method for linking the two. Clinical process cost analysis begins with the construction of a detailed flow diagram incorporating each activity in the process of care. The cost of each activity is then calculated, and the two are linked. This technique was applied to Diagnosis Related Group 75 to analyze the real costs of the operative treatment of lung cancer at one institution. Total costs varied between $6,400 and $7,700. The major driver of costs was personnel time, which accounted for 55% of the total. Forty percent of the total cost was incurred in the operating room. The cost of care decreased progressively during hospitalization. Clinical process cost analysis provides detailed information about the costs and processes of care. The insights thus obtained may be used to reduce costs by reengineering the process.

Low-cost, disposable microfluidics device for blood plasma extraction using continuously alternating paramagnetic and diamagnetic capture modes

PubMed Central

Kim, Pilkee; Ong, Eng Hui; Yoon, Yong-Jin; Ng, Sum Huan Gary; Puttachat, Khuntontong

2016-01-01

Blood plasma contains biomarkers and substances that indicate the physiological state of an organism, and it can be used to diagnose various diseases or body condition. To improve the accuracy of diagnostic test, it is required to obtain the high purity of blood plasma. This paper presents a low-cost, disposable microfluidics device for blood plasma extraction using magnetophoretic behaviors of blood cells. This device uses alternating magnetophoretic capture modes to trap and separate paramagnetic and diamagnetic cells away from blood plasma. The device system is composed of two parts, a disposable microfluidics chip and a non-disposable (reusable) magnetic field source. Such modularized device helps the structure of the disposable part dramatically simplified, which is beneficial for low-cost mass production. A series of numerical simulation and parametric study have been performed to describe the mechanism of blood cell separation in the microchannel, and the results are discussed. Furthermore, experimental feasibility test has been carried out in order to demonstrate the blood plasma extraction process of the proposed device. In this experiment, pure blood plasma has been successfully extracted with yield of 21.933% from 75 μl 1:10 dilution of deoxygenated blood. PMID:27042252

Incremental costs associated with physician and pharmacist collaboration to improve blood pressure control.

PubMed

Kulchaitanaroaj, Puttarin; Brooks, John M; Ardery, Gail; Newman, Dana; Carter, Barry L

2012-08-01

To compare costs associated with a physician-pharmacist collaborative intervention with costs of usual care. Cost analysis using health care utilization and outcome data from two prospective, cluster-randomized, controlled clinical trials. Eleven community-based medical offices. A total of 496 patients with hypertension; 244 were in the usual care (control) group and 252 were in the intervention group. To compare the costs, we combined cost data from the two trials. Total costs included costs of provider time, laboratory tests, and antihypertensive drugs. Provider time was calculated based on an online survey of intervention pharmacists and the National Ambulatory Medical Care Survey. Cost parameters were taken from the Bureau of Labor Statistics for average wage rates, the Medicare laboratory fee schedule, and a publicly available Web site for drug prices. Total costs were adjusted for patient characteristics. Adjusted total costs were $774.90 in the intervention group and $445.75 in the control group (difference $329.16, p<0.001). In a sensitivity analysis, the difference in adjusted total costs between the two groups ranged from $224.27-515.56. The intervention cost required to have one additional patient achieve blood pressure control within 6 months was $1338.05, determined by the difference in costs divided by the difference in hypertension control rates between the groups ($329.16/24.6%). The cost over 6 months to lower systolic and diastolic blood pressure 1 mm Hg was $36.25 and $94.32, respectively. The physician-pharmacist collaborative intervention increased not only blood pressure control but also the cost of care. Additional research, such as a cost-benefit or a cost-minimization analysis, is needed to assess whether financial savings related to reduced morbidity and mortality achieved from better blood pressure control outweigh the cost of the intervention. © 2012 Pharmacotherapy Publications, Inc. All rights reserved.

Cost-effectiveness of additional blood screening tests in the Netherlands.

PubMed

Borkent-Raven, Barbara A; Janssen, Mart P; van der Poel, Cees L; Bonsel, Gouke J; van Hout, Ben A

2012-03-01

During the past decade, blood screening tests such as triplex nucleic acid amplification testing (NAT) and human T-cell lymphotropic virus type I or I (HTLV-I/II) antibody testing were added to existing serologic testing for hepatitis B virus (HBV), human immunodeficiency virus (HIV), and hepatitis C virus (HCV). In some low-prevalence regions these additional tests yielded disputable benefits that can be valuated by cost-effectiveness analyses (CEAs). CEAs are used to support decision making on implementation of medical technology. We present CEAs of selected additional screening tests that are not uniformly implemented in the EU. Cost-effectiveness was analyzed of: 1) HBV, HCV, and HIV triplex NAT in addition to serologic testing; 2) HTLV-I/II antibody test for all donors, for first-time donors only, and for pediatric recipients only; and 3) hepatitis A virus (HAV) for all donations. Disease progression of the studied viral infections was described in five Markov models. In the Netherlands, the incremental cost-effectiveness ratio (ICER) of triplex NAT is €5.20 million per quality-adjusted life-year (QALY) for testing minipools of six donation samples and €4.65 million/QALY for individual donation testing. The ICER for anti-HTLV-I/II is €45.2 million/QALY if testing all donations, €2.23 million/QALY if testing new donors only, and €27.0 million/QALY if testing blood products for pediatric patients only. The ICER of HAV NAT is €18.6 million/QALY. The resulting ICERs are very high, especially when compared to other health care interventions. Nevertheless, these screening tests are implemented in the Netherlands and elsewhere. Policy makers should reflect more explicit on the acceptability of costs and effects whenever additional blood screening tests are implemented. © 2011 American Association of Blood Banks.

Blood Donation Process

MedlinePlus

... to donate. All medical equipment used for this test, as well as during the donation process, is sterile, used only once and then disposed. Blood Donation Once the pre-donation screening is finished, you will proceed to ...

Cost-effectiveness of ambulatory blood pressure monitoring in the management of hypertension.

PubMed

Costa, Diogo; Peixoto Lima, Ricardo

2017-02-01

The prevalence of hypertension in Portugal is between 29.1% and 42.2%. International studies show that 13% of individuals have masked hypertension and 13% of diagnoses based on office blood pressure measurements are in fact white coat hypertension. More sensitive and specific blood pressure measuring methods could avoid costs associated with misdiagnosis. The aim of this study was to review the cost-effectiveness of ambulatory blood pressure monitoring (ABPM) compared to other methods in the management of hypertension. We performed a literature search in CMA Infobase, Guidelines Finder, National Guideline Clearinghouse, Bandolier, BMJ Clinical Evidence, the Cochrane Library, DARE, Medline, the Trip Database, SUMSearch and Índex das Revistas Médicas Portuguesas. We researched articles published between January 2005 and August 2015 in Portuguese, English and Spanish, using the MeSH terms "Hypertension", "Blood Pressure Monitoring, Ambulatory" and "Cost-Benefit Analysis" and the Portuguese search terms "Hipertensão", "Monitorização Ambulatorial da Pressão Arterial" and "Análise Custo-Benefício". Levels of evidence and grades of recommendation were attributed according to the Oxford Centre for Evidence-Based Medicine scale. Five hundred and twenty-five articles were identified. We included five original studies and one clinical practice guideline. All of them state that ABPM is the most cost-effective method. Two report better blood pressure control, and a Portuguese study revealed a saving of 23%. The evidence shows that ABPM is cost-effective, avoiding iatrogenic effects and reducing expenditure on treatment (grade of recommendation B). The included studies provide a solid basis, but further evidence of reproducibility is needed in research that is not based mainly on analytical models. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

Cost and effectiveness comparison of two methods for screening potential blood donors for anaemia in Vietnam.

PubMed

Tyrrell, A; Worrall, E; Que, T N; Bates, I

2011-06-01

To compare the cost and effectiveness of Copper Sulphate (CS) and HemoCue (HC) methods for screening blood donors for anaemia. Robust information from developing countries about cost and effectiveness of anaemia screening methods for blood donors is scarce. In such countries there are widespread shortages of blood, so the most cost-effective method should maximise blood supply without compromising donor safety. Economic data (e.g. staff time, equipment and buildings) were collected from direct observation of procedures and purchase data from Hanoi's Central Blood Bank administrative department. A framework for comparing the cost and effectiveness of anaemia screening methods was developed and a cost per effective (i.e. usable and accurate) test was generated for each method. Samples from 100 potential donors from the Hanoi Central Blood Bank (static) and 198 from two mobile units were tested. The mean probability of an ineffective anaemia test was 0·1 (0·05-0·2). The average cost of an HC test was $0·75 (static $0·61 and mobile $0·89) and a CS test was $0·31 (static $0·17 and mobile $0·45). The difference between static and mobile units was predominantly due to transport costs; the difference between the two methods was predominantly due to the HC microcuvettes. In this setting the CS yields greater value for money than the HC method for screening blood donors. The relative cost and effectiveness of CS and HC may be different in places with higher staff turnover, lower test accuracy, higher anaemia prevalence or lower workload than in Vietnam. © 2010 Liverpool School of Tropical Medicine. Transfusion Medicine © 2010 British Blood Transfusion Society.

Cost Models for MMC Manufacturing Processes

NASA Technical Reports Server (NTRS)

Elzey, Dana M.; Wadley, Haydn N. G.

1996-01-01

Processes for the manufacture of advanced metal matrix composites are rapidly approaching maturity in the research laboratory and there is growing interest in their transition to industrial production. However, research conducted to date has almost exclusively focused on overcoming the technical barriers to producing high-quality material and little attention has been given to the economical feasibility of these laboratory approaches and process cost issues. A quantitative cost modeling (QCM) approach was developed to address these issues. QCM are cost analysis tools based on predictive process models relating process conditions to the attributes of the final product. An important attribute, of the QCM approach is the ability to predict the sensitivity of material production costs to product quality and to quantitatively explore trade-offs between cost and quality. Applications of the cost models allow more efficient direction of future MMC process technology development and a more accurate assessment of MMC market potential. Cost models were developed for two state-of-the art metal matrix composite (MMC) manufacturing processes: tape casting and plasma spray deposition. Quality and Cost models are presented for both processes and the resulting predicted quality-cost curves are presented and discussed.

Blood transfusion versus hydroxyurea in beta-thalassemia in Iran: a cost-effectiveness study.

PubMed

Ravangard, Ramin; Mirzaei, Zahra; Keshavarz, Khosro; Haghpanah, Sezaneh; Karimi, Mehran

2017-11-21

Thalassemia intermedia is a type of anemia which has several treatments modalities. We aimed to study the cost effectiveness of two treatments, including blood transfusion and hydroxyurea, in patients with beta-thalassemia intermedia in south of Iran referred to a referral center affiliated to Iran, Shiraz University of Medical Sciences in 2015. This was a cost-effectiveness study which was conducted on 122 patients with beta-thalassemia intermedia. The indicator of effectiveness in this study was the reduction of growth disorder (normal BMI). Data analysis was done using SPSS 21, Excel 2010 and Treeage 2011. Finally, the one-way sensitivity analysis was performed to determine the robustness of the results. The average annual costs of blood transfusion and the use of hydroxyurea in 2015 were 20733.27 purchasing power parity (PPP)$ and 7040.29 PPP$, respectively. The effectiveness of blood transfusion was57.4% while in hydroxyurea group was 60.7%. The results showed that the cost effectiveness of using hydroxyurea was more than that of blood transfusion. Therefore, it is recommended that the use of hydroxyurea in the treatment of patients with beta-thalassemia intermedia would become the first priority, and more basic and supplementary insurance coverage for treating such patients using hydroxyurea should be considered.

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

PubMed

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

2018-04-01

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

Animated-simulation modeling facilitates clinical-process costing.

PubMed

Zelman, W N; Glick, N D; Blackmore, C C

2001-09-01

Traditionally, the finance department has assumed responsibility for assessing process costs in healthcare organizations. To enhance process-improvement efforts, however, many healthcare providers need to include clinical staff in process cost analysis. Although clinical staff often use electronic spreadsheets to model the cost of specific processes, PC-based animated-simulation tools offer two major advantages over spreadsheets: they allow clinicians to interact more easily with the costing model so that it more closely represents the process being modeled, and they represent cost output as a cost range rather than as a single cost estimate, thereby providing more useful information for decision making.

Use of cost-effectiveness analysis to determine inventory size for a national cord blood bank.

PubMed

Howard, David H; Meltzer, David; Kollman, Craig; Maiers, Martin; Logan, Brent; Gragert, Loren; Setterholm, Michelle; Horowitz, Mary M

2008-01-01

Transplantation with stem cells from stored umbilical cord blood units is an alternative to living unrelated bone marrow transplantation. The larger the inventory of stored cord units, the greater the likelihood that transplant candidates will match to a unit, but storing units is costly. The authors present the results of a study, commissioned by the Institute of Medicine, as part of a report on the establishment of a national cord blood bank, examining the optimal inventory level. They emphasize the unique challenges of undertaking cost-effectiveness analysis in this field and the contribution of the analysis to policy. The authors estimate the likelihood that transplant candidates will match to a living unrelated marrow donor or a cord blood unit as a function of cord blood inventory and then calculate the life-years gained for each transplant type by match level using historical data. They develop a model of the cord blood inventory level to estimate total costs as a function of the number of stored units. The cost per life-year gained associated with increasing inventory from 50,000 to 100,000 units is $44,000 to $86,000 and from 100,000 to 150,000 units is $64,000 to $153,000, depending on the assumption about the degree to which survival rates for cord transplants vary by match quality. Expanding the cord blood inventory above current levels is cost-effective by conventional standards. The analysis helped shape the Institute of Medicine's report, but it is difficult to determine the extent to which the analysis influenced subsequent congressional legislation.

Home blood-pressure monitoring in a hypertensive pregnant population: cost minimisation study.

PubMed

Xydopoulos, G; Perry, H; Sheehan, E; Thilaganathan, B; Fordham, R; Khalil, A

2018-03-08

Traditional monitoring of blood pressure in hypertensive pregnant women requires frequent visits to the maternity outpatient services. Home blood-pressure monitoring (HBPM) could offer a cost-saving alternative that is acceptable to patients. The main objective of this study was to undertake a health economic analysis of HBPM compared with traditional monitoring in hypertensive pregnant women. This was a case-control study. Cases were pregnant women with hypertension who had HBPM with or without the adjunct of a smartphone app, via a specially designed pathway. The control group were managed as per existing hospital guidelines. Specific outcome measures were the number of outpatient visits, inpatient bed stays and investigations performed. Maternal, fetal and neonatal adverse outcomes were also recorded. Health economic analysis was performed using two methods: direct cost comparison of the study dataset and process scenario modelling. There were 108 women in the HBPM group, of whom 29 recorded their results on the smartphone app (App-HBPM) and 79 in their notes (Non-app HBPM). The control group comprised of 58 patients. There were significantly more women with chronic hypertension in the HBPM group (49.1% vs 25.9%, P = 0.004). The HBPM group had significantly longer duration of monitoring (9 weeks vs 5 weeks P = 0.004) and started monitoring from an earlier gestation (30 weeks vs 33.6 weeks, P = 0.001). Despite these differences, the mean saving per week for HBPM compared with the control group was £200.69. For the App-HBPM cohort, the saving per week compared with the control group was £286.53. The process modelling method predicted savings of between £98.32 and £245.80 per week using HBPM compared to the traditional monitoring. HBPM in hypertensive pregnancies appears to be cost-saving compared with traditional monitoring, without compromising maternal, fetal or neonatal safety. Larger studies are required to confirm these findings. This article is

Cost-Effectiveness of Blood Donation Screening for Trypanosoma cruzi in Mexico

PubMed Central

Sánchez-González, Gilberto; Figueroa-Lara, Alejandro; Elizondo-Cano, Miguel; Wilson, Leslie; Novelo-Garza, Barbara; Valiente-Banuet, Leopoldo; Ramsey, Janine M.

2016-01-01

An estimated 2 million inhabitants are infected with Chagas disease in Mexico, with highest prevalence coinciding with highest demographic density in the southern half of the country. After vector-borne transmission, Trypanosoma cruzi is principally transmitted to humans via blood transfusion. Despite initiation of serological screening of blood donations or donors for T. cruzi since 1990 in most Latin American countries, Mexico only finally included mandatory serological screening nationwide in official Norms in 2012. Most recent regulatory changes and segmented blood services in Mexico may affect compliance of mandatory screening guidelines. The objective of this study was to calculate the incremental cost-effectiveness ratio for total compliance of current guidelines from both Mexican primary healthcare and regular salaried worker health service institutions: the Secretary of Health and the Mexican Institute for Social Security. We developed a bi-modular model to analyze compliance using a decision tree for the most common screening algorithms for each health institution, and a Markov transition model for the natural history of illness and care. The incremental cost effectiveness ratio based on life-years gained is US$ 383 for the Secretary of Health, while the cost for an additional life-year gained is US$ 463 for the Social Security Institute. The results of the present study suggest that due to incomplete compliance of Mexico’s national legislation during 2013 and 2014, the MoH has failed to confirm 15,162 T. cruzi infections, has not prevented 2,347 avoidable infections, and has lost 333,483 life-years. Although there is a vast difference in T. cruzi prevalence between Bolivia and Mexico, Bolivia established mandatory blood screening for T.cruzi in 1996 and until 2002 detected and discarded 11,489 T. cruzi -infected blood units and prevented 2,879 potential infections with their transfusion blood screening program. In the first two years of Mexico�

Cost-Effectiveness of Blood Donation Screening for Trypanosoma cruzi in Mexico.

PubMed

Sánchez-González, Gilberto; Figueroa-Lara, Alejandro; Elizondo-Cano, Miguel; Wilson, Leslie; Novelo-Garza, Barbara; Valiente-Banuet, Leopoldo; Ramsey, Janine M

2016-03-01

An estimated 2 million inhabitants are infected with Chagas disease in Mexico, with highest prevalence coinciding with highest demographic density in the southern half of the country. After vector-borne transmission, Trypanosoma cruzi is principally transmitted to humans via blood transfusion. Despite initiation of serological screening of blood donations or donors for T. cruzi since 1990 in most Latin American countries, Mexico only finally included mandatory serological screening nationwide in official Norms in 2012. Most recent regulatory changes and segmented blood services in Mexico may affect compliance of mandatory screening guidelines. The objective of this study was to calculate the incremental cost-effectiveness ratio for total compliance of current guidelines from both Mexican primary healthcare and regular salaried worker health service institutions: the Secretary of Health and the Mexican Institute for Social Security. We developed a bi-modular model to analyze compliance using a decision tree for the most common screening algorithms for each health institution, and a Markov transition model for the natural history of illness and care. The incremental cost effectiveness ratio based on life-years gained is US$ 383 for the Secretary of Health, while the cost for an additional life-year gained is US$ 463 for the Social Security Institute. The results of the present study suggest that due to incomplete compliance of Mexico's national legislation during 2013 and 2014, the MoH has failed to confirm 15,162 T. cruzi infections, has not prevented 2,347 avoidable infections, and has lost 333,483 life-years. Although there is a vast difference in T. cruzi prevalence between Bolivia and Mexico, Bolivia established mandatory blood screening for T.cruzi in 1996 and until 2002 detected and discarded 11,489 T. cruzi -infected blood units and prevented 2,879 potential infections with their transfusion blood screening program. In the first two years of Mexico's mandated

A structured blood conservation programme reduces transfusions and costs in cardiac surgery.

PubMed

Ternström, Lisa; Hyllner, Monica; Backlund, Erika; Schersten, Henrik; Jeppsson, Anders

2014-11-01

Transfusions of blood products can be lifesaving, but they are also associated with considerable risks and adverse effects, including immune response and infections. In cardiac surgery, transfusions have also been associated with increased mortality. We prospectively studied the effects of a structured programme to reduce transfusions and transfusion-associated costs in cardiac surgery. The programme included: (i) education of all staff about the risks and benefits of blood transfusions; (ii) revised guidelines for transfusions; and (iii) a transfusion log where indication for transfusion, status of the patient and prescribing physician were registered. Transfusion prevalence, complications and costs for blood products were registered for all acute and elective cardiac operations during a 12-month period before (n = 1128) and after (n = 1034) the programme was started. The two time periods were compared. In addition, the prevalence of transfusions was registered for 2 more years after the programme was initiated. The first year after the programme was initiated the proportion of patients transfused with red blood cell concentrate decreased by 21.8% (from 58.2 to 45.5%, P <0.001), plasma by 37.4% (from 30.8 to 19.3%, P <0.001) and platelets by 21.0% (from 20.5 to 16.2%, P = 0.010). Reoperations for bleeding (5.8 vs 5.0%), early complication rate and 30-day mortality (2.5 vs 2.6%) were not significantly different before and after the start date. Based on the 2009 institutional prices for red blood cell concentrate (102 €/unit), plasma (35 €/unit) and platelets (290 €/unit), the savings on blood products were €161,623 during the first 12 months after the programme was launched. The proportion of patients transfused with any blood product was 60.9% before the programme was started and 48.3, 54.0 and 50.7% 1-3 years after its start (all P <0.001), respectively. A structured blood conservation programme reduces transfusions and costs for blood products in cardiac

Cost Models for MMC Manufacturing Processes

NASA Technical Reports Server (NTRS)

Elzey, Dana M.; Wadley, Haydn N. G.

1996-01-01

The quality cost modeling (QCM) tool is intended to be a relatively simple-to-use device for obtaining a first-order assessment of the quality-cost relationship for a given process-material combination. The QCM curve is a plot of cost versus quality (an index indicating microstructural quality), which is unique for a given process-material combination. The QCM curve indicates the tradeoff between cost and performance, thus enabling one to evaluate affordability. Additionally, the effect of changes in process design, raw materials, and process conditions on the cost-quality relationship can be evaluated. Such results might indicate the most efficient means to obtain improved quality at reduced cost by process design refinements, the implementation of sensors and models for closed loop process control, or improvement in the properties of raw materials being fed into the process. QCM also allows alternative processes for producing the same or similar material to be compared in terms of their potential for producing competitively priced, high quality material. Aside from demonstrating the usefulness of the QCM concept, this is one of the main foci of the present research program, namely to compare processes for making continuous fiber reinforced, metal matrix composites (MMC's). Two processes, low pressure plasma spray deposition and tape casting are considered for QCM development. This document consists of a detailed look at the design of the QCM approach, followed by discussion of the application of QCM to each of the selected MMC manufacturing processes along with results, comparison of processes, and finally, a summary of findings and recommendations.

Process Improvement Project Using Tranexamic Acid Is Cost-Effective in Reducing Blood Loss and Transfusions After Total Hip and Total Knee Arthroplasty.

PubMed

Demos, Harry A; Lin, Zilan X; Barfield, William R; Wilson, Sylvia H; Robertson, Dawn C; Pellegrini, Vincent D

2017-08-01

Tranexamic acid (TXA) has been associated with decreased blood loss and transfusion after total hip arthroplasty (THA) and total knee arthroplasty (TKA). The purpose of this study was to examine both transfusion utilization and the economic impact of a Process Improvement Project implementing TXA for THA and TKA. After standardization of TXA administration in THA and TKA patients, retrospective data were compared from 12 consecutive months before (group A, n = 336 procedures) and after (group B, n = 436 procedures) project initiation. TXA administration increased with project implementation (group A = 3.57%, group B = 86.01%) and was associated with reductions in perioperative hemoglobin decrement (20.2%), patients transfused (45%), and number of units transfused per patient (61.9%). Cost savings were notable per patient ($128) and annually program wide ($55,884) with the primary THA subgroup contributing the most to the savings. No increase in adverse effects was observed. Standardized administration of TXA is an effective and economically favorable blood-reduction strategy for patients undergoing elective THA or TKA. Although reduction in transfusions with TXA may be greater after TKA, the economic and clinical impact of transfusion reduction is more substantial in THA patients. Copyright © 2017 Elsevier Inc. All rights reserved.

Machine Learning Based Single-Frame Super-Resolution Processing for Lensless Blood Cell Counting

PubMed Central

Huang, Xiwei; Jiang, Yu; Liu, Xu; Xu, Hang; Han, Zhi; Rong, Hailong; Yang, Haiping; Yan, Mei; Yu, Hao

2016-01-01

A lensless blood cell counting system integrating microfluidic channel and a complementary metal oxide semiconductor (CMOS) image sensor is a promising technique to miniaturize the conventional optical lens based imaging system for point-of-care testing (POCT). However, such a system has limited resolution, making it imperative to improve resolution from the system-level using super-resolution (SR) processing. Yet, how to improve resolution towards better cell detection and recognition with low cost of processing resources and without degrading system throughput is still a challenge. In this article, two machine learning based single-frame SR processing types are proposed and compared for lensless blood cell counting, namely the Extreme Learning Machine based SR (ELMSR) and Convolutional Neural Network based SR (CNNSR). Moreover, lensless blood cell counting prototypes using commercial CMOS image sensors and custom designed backside-illuminated CMOS image sensors are demonstrated with ELMSR and CNNSR. When one captured low-resolution lensless cell image is input, an improved high-resolution cell image will be output. The experimental results show that the cell resolution is improved by 4×, and CNNSR has 9.5% improvement over the ELMSR on resolution enhancing performance. The cell counting results also match well with a commercial flow cytometer. Such ELMSR and CNNSR therefore have the potential for efficient resolution improvement in lensless blood cell counting systems towards POCT applications. PMID:27827837

Cord blood clinical processing, cryopreservation, and storage.

PubMed

Elmoazzen, Heidi; Holovati, Jelena L

2015-01-01

Allogeneic umbilical cord blood (UCB) hematopoietic stem cell transplantation has become a crucial advancement in the treatment for a variety of diseases including hematopoietic and non-hematopoietic malignancies, BM failure syndromes, hemoglobinopathies, and metabolic and immunodeficiency disorders. It has been well documented that the success of UCB engraftment is tied to UCB banking processes, and now there are established guidelines for standardization of collection, banking, processing, and cryopreservation for unrelated UCB units with purpose of achieving consistent production of high quality placental and UCB units for administration. In 2011, Canada's Ministry of Health has announced Canada's first national, publicly funded umbilical cord blood bank, which aims to provide altruistic donations for unrelated allogeneic hematopoietic stem cell transplant. In this chapter, we describe specific protocols for clinical processing, cryopreservation, and storage of UCB used by the Canadian Blood Services National Public Umbilical Cord Blood Bank.

The cost of post-operative shed blood salvage after total knee arthroplasty: an analysis of 1,093 consecutive procedures

PubMed Central

Muñoz, Manuel; Ariza, Daniel; Campos, Arturo; Martín-Montañez, Elisa; Pavía, José

2013-01-01

Background Requirements for allogeneic red cell transfusion after total knee arthroplasty are still high (20–50%), and salvage and reinfusion of unwashed, filtered post-operative shed blood is an established method for reducing transfusion requirements following this operation. We performed a cost analysis to ascertain whether this alternative is likely to be cost-effective. Materials and methods Data from 1,093 consecutive primary total knee arthroplasties, managed with (reinfusion group, n=763) or without reinfusion of unwashed salvaged blood (control group, n=330), were retrospectively reviewed. The costs of low-vacuum drains, shed blood collection canisters (Bellovac ABT®, Wellspect HealthCare and ConstaVac CBC II®, Stryker), shed blood reinfusion, acquisition and transfusion of allogeneic red cell concentrate, haemoglobin measurements, and prolonged length of hospital stay were used for the blood management cost analysis. Results Patients in the reinfusion group received 152±64 mL of red blood cells from postoperatively salvaged blood, without clinically relevant incidents, and showed a lower allogeneic transfusion rate (24.5% vs 8.5%, for the control and reinfusion groups, respectively; p =0.001). There were no differences in post-operative infection rates. Patients receiving allogeneic transfusions stayed in hospital longer (+1.9 days [95% CI: 1.2 to 2.6]). As reinfusion of unwashed salvaged blood reduced the allogeneic transfusion rate, both reinfusion systems may provide net savings in different cost scenarios (€ 4.6 to € 106/patient for Bellovac ABT, and € −51.9 to € 49.9/patient for ConstaVac CBCII). Discussion Return of unwashed salvaged blood after total knee arthroplasty seems to save costs in patients with pre-operative haemoglobin between 12 and 15 g/dL. It is not cost-saving in patients with a pre-operative haemoglobin >15 g/dL, whereas in those with a pre-operative haemoglobin <12 g/dL, although cost-saving, its efficacy could be

Process-based Cost Estimation for Ramjet/Scramjet Engines

NASA Technical Reports Server (NTRS)

Singh, Brijendra; Torres, Felix; Nesman, Miles; Reynolds, John

2003-01-01

Process-based cost estimation plays a key role in effecting cultural change that integrates distributed science, technology and engineering teams to rapidly create innovative and affordable products. Working together, NASA Glenn Research Center and Boeing Canoga Park have developed a methodology of process-based cost estimation bridging the methodologies of high-level parametric models and detailed bottoms-up estimation. The NASA GRC/Boeing CP process-based cost model provides a probabilistic structure of layered cost drivers. High-level inputs characterize mission requirements, system performance, and relevant economic factors. Design alternatives are extracted from a standard, product-specific work breakdown structure to pre-load lower-level cost driver inputs and generate the cost-risk analysis. As product design progresses and matures the lower level more detailed cost drivers can be re-accessed and the projected variation of input values narrowed, thereby generating a progressively more accurate estimate of cost-risk. Incorporated into the process-based cost model are techniques for decision analysis, specifically, the analytic hierarchy process (AHP) and functional utility analysis. Design alternatives may then be evaluated not just on cost-risk, but also user defined performance and schedule criteria. This implementation of full-trade study support contributes significantly to the realization of the integrated development environment. The process-based cost estimation model generates development and manufacturing cost estimates. The development team plans to expand the manufacturing process base from approximately 80 manufacturing processes to over 250 processes. Operation and support cost modeling is also envisioned. Process-based estimation considers the materials, resources, and processes in establishing cost-risk and rather depending on weight as an input, actually estimates weight along with cost and schedule.

Automated processing of whole blood units: operational value and in vitro quality of final blood components

PubMed Central

Jurado, Marisa; Algora, Manuel; Garcia-Sanchez, Félix; Vico, Santiago; Rodriguez, Eva; Perez, Sonia; Barbolla, Luz

2012-01-01

Background The Community Transfusion Centre in Madrid currently processes whole blood using a conventional procedure (Compomat, Fresenius) followed by automated processing of buffy coats with the OrbiSac system (CaridianBCT). The Atreus 3C system (CaridianBCT) automates the production of red blood cells, plasma and an interim platelet unit from a whole blood unit. Interim platelet unit are pooled to produce a transfusable platelet unit. In this study the Atreus 3C system was evaluated and compared to the routine method with regards to product quality and operational value. Materials and methods Over a 5-week period 810 whole blood units were processed using the Atreus 3C system. The attributes of the automated process were compared to those of the routine method by assessing productivity, space, equipment and staffing requirements. The data obtained were evaluated in order to estimate the impact of implementing the Atreus 3C system in the routine setting of the blood centre. Yield and in vitro quality of the final blood components processed with the two systems were evaluated and compared. Results The Atreus 3C system enabled higher throughput while requiring less space and employee time by decreasing the amount of equipment and processing time per unit of whole blood processed. Whole blood units processed on the Atreus 3C system gave a higher platelet yield, a similar amount of red blood cells and a smaller volume of plasma. Discussion These results support the conclusion that the Atreus 3C system produces blood components meeting quality requirements while providing a high operational efficiency. Implementation of the Atreus 3C system could result in a large organisational improvement. PMID:22044958

Automated processing of whole blood units: operational value and in vitro quality of final blood components.

PubMed

Jurado, Marisa; Algora, Manuel; Garcia-Sanchez, Félix; Vico, Santiago; Rodriguez, Eva; Perez, Sonia; Barbolla, Luz

2012-01-01

The Community Transfusion Centre in Madrid currently processes whole blood using a conventional procedure (Compomat, Fresenius) followed by automated processing of buffy coats with the OrbiSac system (CaridianBCT). The Atreus 3C system (CaridianBCT) automates the production of red blood cells, plasma and an interim platelet unit from a whole blood unit. Interim platelet unit are pooled to produce a transfusable platelet unit. In this study the Atreus 3C system was evaluated and compared to the routine method with regards to product quality and operational value. Over a 5-week period 810 whole blood units were processed using the Atreus 3C system. The attributes of the automated process were compared to those of the routine method by assessing productivity, space, equipment and staffing requirements. The data obtained were evaluated in order to estimate the impact of implementing the Atreus 3C system in the routine setting of the blood centre. Yield and in vitro quality of the final blood components processed with the two systems were evaluated and compared. The Atreus 3C system enabled higher throughput while requiring less space and employee time by decreasing the amount of equipment and processing time per unit of whole blood processed. Whole blood units processed on the Atreus 3C system gave a higher platelet yield, a similar amount of red blood cells and a smaller volume of plasma. These results support the conclusion that the Atreus 3C system produces blood components meeting quality requirements while providing a high operational efficiency. Implementation of the Atreus 3C system could result in a large organisational improvement.

Analysis of economic and social costs of adverse events associated with blood transfusions in Spain.

PubMed

Ribed-Sánchez, Borja; González-Gaya, Cristina; Varea-Díaz, Sara; Corbacho-Fabregat, Carlos; Bule-Farto, Isabel; Pérez de-Oteyza, Jaime

To calculate, for the first time, the direct and social costs of transfusion-related adverse events in order to include them in the National Healthcare System's budget, calculation and studies. In Spain more than 1,500 patients yearly are diagnosed with such adverse events. Blood transfusion-related adverse events recorded yearly in Spanish haemovigilance reports were studied retrospectively (2010-2015). The adverse events were coded according to the classification of Diagnosis-Related Groups. The direct healthcare costs were obtained from public information sources. The productivity loss (social cost) associated with adverse events was calculated using the human capital and hedonic salary methodologies. In 2015, 1,588 patients had adverse events that resulted in direct health care costs (4,568,914€) and social costs due to hospitalization (200,724€). Three adverse reactions resulted in patient death (at a social cost of 1,364,805€). In total, the cost of blood transfusion-related adverse events was 6,134,443€ in Spain. For the period 2010-2015: the trends show a reduction in the total amount of transfusions (2 vs. 1.91M€; -4.4%). The number of adverse events increased (822 vs. 1,588; +93%), as well as their related direct healthcare cost (3.22 vs. 4.57M€; +42%) and the social cost of hospitalization (110 vs 200M€; +83%). Mortality costs decreased (2.65 vs. 1.36M€; -48%). This is the first time that the costs of post-transfusion adverse events have been calculated in Spain. These new figures and trends should be taken into consideration in any cost-effectiveness study or trial of new surgical techniques or sanitary policies that influence blood transfusion activities. Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Modified allocation capacitated planning model in blood supply chain management

NASA Astrophysics Data System (ADS)

Mansur, A.; Vanany, I.; Arvitrida, N. I.

2018-04-01

Blood supply chain management (BSCM) is a complex process management that involves many cooperating stakeholders. BSCM involves four echelon processes, which are blood collection or procurement, production, inventory, and distribution. This research develops an optimization model of blood distribution planning. The efficiency of decentralization and centralization policies in a blood distribution chain are compared, by optimizing the amount of blood delivered from a blood center to a blood bank. This model is developed based on allocation problem of capacitated planning model. At the first stage, the capacity and the cost of transportation are considered to create an initial capacitated planning model. Then, the inventory holding and shortage costs are added to the model. These additional parameters of inventory costs lead the model to be more realistic and accurate.

49 CFR 594.9 - Fee for reimbursement of bond processing costs and costs for processing offers of cash deposits...

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 7 2010-10-01 2010-10-01 false Fee for reimbursement of bond processing costs and costs for processing offers of cash deposits or obligations of the United States in lieu of sureties on... indirect costs the agency incurs for receipt, processing, handling, and disbursement of cash deposits or...

Rotational Thromboelastometry or Conventional Coagulation Tests in Liver Transplantation: Comparing Blood Loss, Transfusions, and Cost.

PubMed

Smart, Laura; Mumtaz, Khalid; Scharpf, Danielle; Gray, Nicole O'Bleness; Traetow, Daniel; Black, Sylvester; Michaels, Anthony J; Elkhammas, Elmahdi; Kirkpatrick, Robert; Hanje, A James

Orthotopic liver transplantation (OLT) can be associated with significant bleeding requiring multiple blood product transfusions. Rotational thromboelastometry (ROTEM) is a point-of-care device that has been used to monitor coagulation during OLT. Whether it reduces blood loss/transfusions during OLT remains controversial. We aim to compare ROTEM with conventional coagulation tests (aPTT, PT, INR, platelet count, fibrinogen) to guide transfusion of platelets, cryoprecipitate, and fresh frozen plasma (FFP) during OLT over 3 years. Thirty-four patients who had transfusions guided by ROTEM were compared to 34 controls who received transfusions guided by conventional coagulation tests (CCT). Intraoperative blood loss, type/ amount of blood products transfused, and direct costs were compared between the two groups. The ROTEM group had significantly less intra-operative blood loss (2.0 vs. 3.0 L, p = 0.04) and fresh frozen plasma (FFP) transfusion (4 units vs. 6.5 units, p = 0.015) compared to the CCT group (2.0L vs. 3.0L, p = 0.04). However, total number of patients transfused cryoprecipitate was increased in ROTEM (n = 25;73%) as compared to CCT (n = 19; 56%), p = 0.033. The direct cost of blood products plus testing was reduced in the ROTEM group ($113,142.89 vs. $127,814.77). In conclusion implementation of a ROTEM-guided transfusion algorithm resulted in a reduction in intra-operative blood loss, FFP transfusion and a decrease in direct cost during OLT. ROTEM is a useful and safe point of care device in OLT setting.

Tracking blood products in blood centres using radio frequency identification: a comprehensive assessment.

PubMed

Davis, Rodeina; Geiger, Bradley; Gutierrez, Alfonso; Heaser, Julie; Veeramani, Dharmaraj

2009-07-01

Radio frequency identification (RFID) can be a key enabler for enhancing productivity and safety of the blood product supply chain. This article describes a systematic approach developed by the RFID Blood Consortium for a comprehensive feasibility and impact assessment of RFID application in blood centre operations. Our comprehensive assessment approach incorporates process-orientated and technological perspectives as well as impact analysis. Assessment of RFID-enabled process redesign is based on generic core processes derived from the three participating blood centres. The technological assessment includes RFID tag readability and performance evaluation, testing of temperature and biological effects of RF energy on blood products, and RFID system architecture design and standards. The scope of this article is limited to blood centre processes (from donation to manufacturing/distribution) for selected mainstream blood products (red blood cells and platelets). Radio frequency identification can help overcome a number of common challenges and process inefficiencies associated with identification and tracking of blood products. High frequency-based RFID technology performs adequately and safely for red blood cell and platelet products. Productivity and quality improvements in RFID-enabled blood centre processes can recoup investment cost in a 4-year payback period. Radio frequency identification application has significant process-orientated and technological implications. It is feasible and economically justifiable to incorporate RFID into blood centre processes.

Cost analysis of advanced turbine blade manufacturing processes

NASA Technical Reports Server (NTRS)

Barth, C. F.; Blake, D. E.; Stelson, T. S.

1977-01-01

A rigorous analysis was conducted to estimate relative manufacturing costs for high technology gas turbine blades prepared by three candidate materials process systems. The manufacturing costs for the same turbine blade configuration of directionally solidified eutectic alloy, an oxide dispersion strengthened superalloy, and a fiber reinforced superalloy were compared on a relative basis to the costs of the same blade currently in production utilizing the directional solidification process. An analytical process cost model was developed to quantitatively perform the cost comparisons. The impact of individual process yield factors on costs was also assessed as well as effects of process parameters, raw materials, labor rates and consumable items.

Blood Donation Process

MedlinePlus

... After What Happens to Donated Blood First Time Blood Donors Hosting a Blood Drive Manage My Blood Drive ... some information about donating blood. Tip: Download the Blood Donor app . After your first donation, use the digital ...

Costs and cost-effectiveness of full implementation of a biennial faecal occult blood test screening program for bowel cancer in Australia.

PubMed

Pignone, Michael P; Flitcroft, Kathy L; Howard, Kirsten; Trevena, Lyndal J; Salkeld, Glenn P; St John, D James B

2011-02-21

To examine the costs and cost-effectiveness of full implementation of biennial bowel cancer screening for Australian residents aged 50-74 years. Identification of existing economic models from 1993 to 2010 through searches of PubMed and economic analysis databases, and by seeking expert advice; and additional modelling to determine the costs and cost-effectiveness of full implementation of biennial faecal occult blood test screening for the five million adults in Australia aged 50-74 years. Estimated number of deaths from bowel cancer prevented, costs, and cost-effectiveness (cost per life-year gained [LYG]) of biennial bowel cancer screening. We identified six relevant economic analyses, all of which found colorectal cancer (CRC) screening to be very cost-effective, with costs per LYG under $55,000 per year in 2010 Australian dollars. Based on our additional modelling, we conservatively estimate that full implementation of biennial screening for people aged 50-74 years would have gross costs of $150 million, reduce CRC mortality by 15%-25%, prevent 300-500 deaths from bowel cancer, and save 3600-6000 life-years annually, for an undiscounted cost per LYG of $25,000-$41,667, compared with no screening, and not taking cost savings as a result of treatment into consideration. The additional expenditure required, after accounting for reductions in CRC incidence, savings in CRC treatment costs, and existing ad-hoc colonoscopy use, is likely to be less than $50 million annually. Full implementation of biennial faecal occult blood test screening in Australia can reduce bowel cancer mortality, and is an efficient use of health resources that would require modest additional government investment.

Cost Evaluation of Dried Blood Spot Home Sampling as Compared to Conventional Sampling for Therapeutic Drug Monitoring in Children

PubMed Central

Martial, Lisa C.; Aarnoutse, Rob E.; Schreuder, Michiel F.; Henriet, Stefanie S.; Brüggemann, Roger J. M.; Joore, Manuela A.

2016-01-01

Dried blood spot (DBS) sampling for the purpose of therapeutic drug monitoring can be an attractive alternative for conventional blood sampling, especially in children. This study aimed to compare all costs involved in conventional sampling versus DBS home sampling in two pediatric populations: renal transplant patients and hemato-oncology patients. Total costs were computed from a societal perspective by adding up healthcare cost, patient related costs and costs related to loss of productivity of the caregiver. Switching to DBS home sampling was associated with a cost reduction of 43% for hemato-oncology patients (€277 to €158) and 61% for nephrology patients (€259 to €102) from a societal perspective (total costs) per blood draw. From a healthcare perspective, costs reduced with 7% for hemato-oncology patients and with 21% for nephrology patients. Total savings depend on the number of hospital visits that can be avoided by using home sampling instead of conventional sampling. PMID:27941974

Cost Evaluation of Dried Blood Spot Home Sampling as Compared to Conventional Sampling for Therapeutic Drug Monitoring in Children.

PubMed

Martial, Lisa C; Aarnoutse, Rob E; Schreuder, Michiel F; Henriet, Stefanie S; Brüggemann, Roger J M; Joore, Manuela A

2016-01-01

Dried blood spot (DBS) sampling for the purpose of therapeutic drug monitoring can be an attractive alternative for conventional blood sampling, especially in children. This study aimed to compare all costs involved in conventional sampling versus DBS home sampling in two pediatric populations: renal transplant patients and hemato-oncology patients. Total costs were computed from a societal perspective by adding up healthcare cost, patient related costs and costs related to loss of productivity of the caregiver. Switching to DBS home sampling was associated with a cost reduction of 43% for hemato-oncology patients (€277 to €158) and 61% for nephrology patients (€259 to €102) from a societal perspective (total costs) per blood draw. From a healthcare perspective, costs reduced with 7% for hemato-oncology patients and with 21% for nephrology patients. Total savings depend on the number of hospital visits that can be avoided by using home sampling instead of conventional sampling.

A cost analysis: processing maple syrup products

Treesearch

Neil K. Huyler; Lawrence D. Garrett

1979-01-01

A cost analysis of processing maple sap to syrup for three fuel types, oil-, wood-, and LP gas-fired evaporators, indicates that: (1) fuel, capital, and labor are the major cost components of processing sap to syrup; (2) wood-fired evaporators show a slight cost advantage over oil- and LP gas-fired evaporators; however, as the cost of wood approaches $50 per cord, wood...

21 CFR 864.9100 - Empty container for the collection and processing of blood and blood components.

Code of Federal Regulations, 2010 CFR

2010-04-01

... of blood and blood components. 864.9100 Section 864.9100 Food and Drugs FOOD AND DRUG ADMINISTRATION... Used In Establishments That Manufacture Blood and Blood Products § 864.9100 Empty container for the collection and processing of blood and blood components. (a) Identification. An empty container for the...

21 CFR 864.9100 - Empty container for the collection and processing of blood and blood components.

Code of Federal Regulations, 2012 CFR

2012-04-01

... of blood and blood components. 864.9100 Section 864.9100 Food and Drugs FOOD AND DRUG ADMINISTRATION... Used In Establishments That Manufacture Blood and Blood Products § 864.9100 Empty container for the collection and processing of blood and blood components. (a) Identification. An empty container for the...

21 CFR 864.9100 - Empty container for the collection and processing of blood and blood components.

Code of Federal Regulations, 2011 CFR

2011-04-01

... of blood and blood components. 864.9100 Section 864.9100 Food and Drugs FOOD AND DRUG ADMINISTRATION... Used In Establishments That Manufacture Blood and Blood Products § 864.9100 Empty container for the collection and processing of blood and blood components. (a) Identification. An empty container for the...

21 CFR 864.9100 - Empty container for the collection and processing of blood and blood components.

Code of Federal Regulations, 2014 CFR

2014-04-01

... of blood and blood components. 864.9100 Section 864.9100 Food and Drugs FOOD AND DRUG ADMINISTRATION... Used In Establishments That Manufacture Blood and Blood Products § 864.9100 Empty container for the collection and processing of blood and blood components. (a) Identification. An empty container for the...

21 CFR 864.9100 - Empty container for the collection and processing of blood and blood components.

Code of Federal Regulations, 2013 CFR

2013-04-01

... of blood and blood components. 864.9100 Section 864.9100 Food and Drugs FOOD AND DRUG ADMINISTRATION... Used In Establishments That Manufacture Blood and Blood Products § 864.9100 Empty container for the collection and processing of blood and blood components. (a) Identification. An empty container for the...

Cost of umbilical cord blood units released for transplantation.

PubMed

Sirchia, G; Rebulla, P; Tibaldi, S; Lecchi, L

1999-06-01

A large number of institutions have started programs banking umbilical cord blood (UCB) for allogeneic unrelated-donor and related-donor transplantation. However, limited information is available on the financial issues surrounding these activities. The aim of this study was to determine the fee per UCB unit released for transplantation that would allow cost recovery after 10 years. Three organizational models were considered suitable to provide units for five UCB transplants per 1 million population per year, a figure that would translate into an annual need for 280 units in Italy. Models A, B, and C included, respectively, seven networked banks, each with an inventory of 1,500 units; two networked banks, each with an inventory of 5,000 units; and one bank with an inventory of 10,000 units. It was estimated that it would take 3 years to develop the cryopreserved inventory and that approximately 3 percent of the inventory could be released and replaced each year during the 7-year interval between the fourth and tenth years of activity. The data on the costs of labor, reagents and diagnostics, disposables, depreciation and maintenance, laboratory tests, and overhead, as well as the operational data used in the analysis were collected at the Milano Cord Blood Bank in 1996. Fees of US $15,061, $12,666, and $11,602 per unit released during the fourth through the tenth years of activity allow full cost recovery (principle and interest) under Models A, B, and C, respectively. Although UCB procurement costs compare favorably with those of other hematopoietic cell sources, these results and the current fee of US $15,300 used in some institutions show that UCB is an expensive resource. Therefore, judicious planning of banking programs with high quality standards is necessary to prevent economic losses. The advantages of lower fees associated with the centralized banking approach of Model C should be balanced with the more flexible collection offered by Model A.

Process-Improvement Cost Model for the Emergency Department.

PubMed

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

2015-01-01

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

The cost-effectiveness of predonation screening for transfusion transmissible infections using rapid test kits in a hospital-based blood transfusion centre.

PubMed

Dosunmu, Adedoyin Owolabi; Akinbami, Akinsegun Abduljaleel; Ismail, Ayobami Kamal; Olaiya, Modupe Adebimpe; Uche, Ebele Ifeyinwa; Aile, Igbinoba Kingsley

2017-01-01

Blood transfusion practice emphasises safety, efficacy and appropriate use. These require cost-effective programme management. This study focused on the cost of screening for transfusion transmissible infections (TTI). This was a 1 year (2016) analysis of screening in a hospital-based transfusion centre. The cost of screening all blood donors by ELISA was compared to the cost of serial screening starting from rapid kit, taking into account, the estimated cost of blood bags prevented from discard after ELISA screening (attributable cost). The cost of voluntary donor drive plus cost of ELISA screening was compared with the present cost of screening. A total of 5591 donors were screened for HIV, hepatitis B and C using the rapid kit, 291 donors were deferred (5.2%). A total of 5300 units were further screened by ELISA. A total of 435 blood units (8.2%) were discarded due to TTI positivity. TTI positivity rate was 12.98%. Only 2.36% were voluntary donors and among these 9.1% were TTI positive. The attributable cost of serial screening was 55,653.5 USD while that of screening by ELISA only was 55,910 USD. The attributable cost of rapid screening for only hepatitis B and then ELISA was 53,313.9 USD taking into consideration that 187 blood units would be prevented from undue discard. This analysis demonstrated that with proper donor selection, rapid screening for hepatitis B virus only before ELISA screening is more cost-effective. This will also reduce the waiting time for donors and counselling if HIV positive.

Cost analysis of strategies to reduce blood culture contamination in the emergency department: sterile collection kits and phlebotomy teams.

PubMed

Self, Wesley H; Talbot, Thomas R; Paul, Barbara R; Collins, Sean P; Ward, Michael J

2014-08-01

Blood culture collection practices that reduce contamination, such as sterile blood culture collection kits and phlebotomy teams, increase up-front costs for collecting cultures but may lead to net savings by eliminating downstream costs associated with contamination. The study objective was to compare overall hospital costs associated with 3 collection strategies: usual care, sterile kits, and phlebotomy teams. Cost analysis. This analysis was conducted from the perspective of a hospital leadership team selecting a blood culture collection strategy for an adult emergency department (ED) with 8,000 cultures drawn annually. Total hospital costs associated with 3 strategies were compared: (1) usual care, with nurses collecting cultures without a standardized protocol; (2) sterile kits, with nurses using a dedicated sterile collection kit; and (3) phlebotomy teams, with cultures collected by laboratory-based phlebotomists. In the base case, contamination rates associated with usual care, sterile kits, and phlebotomy teams were assumed to be 4.34%, 1.68%, and 1.10%, respectively. Total hospital costs included costs of collecting cultures and hospitalization costs according to culture results (negative, true positive, and contaminated). Compared with usual care, annual net savings using the sterile kit and phlebotomy team strategies were $483,219 and $288,980, respectively. Both strategies remained less costly than usual care across a broad range of sensitivity analyses. EDs with high blood culture contamination rates should strongly consider evidence-based strategies to reduce contamination. In addition to improving quality, implementing a sterile collection kit or phlebotomy team strategy is likely to result in net cost savings.

21 CFR 864.9145 - Processing system for frozen blood.

Code of Federal Regulations, 2012 CFR

2012-04-01

... system for frozen blood is a device used to glycerolize red blood cells prior to freezing to minimize... thawing of red blood cells and to deglycerolize and wash thawed cells for subsequent reinfusion. (b... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Processing system for frozen blood. 864.9145...

21 CFR 864.9145 - Processing system for frozen blood.

Code of Federal Regulations, 2014 CFR

2014-04-01

... system for frozen blood is a device used to glycerolize red blood cells prior to freezing to minimize... thawing of red blood cells and to deglycerolize and wash thawed cells for subsequent reinfusion. (b... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Processing system for frozen blood. 864.9145...

21 CFR 864.9145 - Processing system for frozen blood.

Code of Federal Regulations, 2010 CFR

2010-04-01

... system for frozen blood is a device used to glycerolize red blood cells prior to freezing to minimize... thawing of red blood cells and to deglycerolize and wash thawed cells for subsequent reinfusion. (b... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Processing system for frozen blood. 864.9145...

21 CFR 864.9145 - Processing system for frozen blood.

Code of Federal Regulations, 2013 CFR

2013-04-01

... system for frozen blood is a device used to glycerolize red blood cells prior to freezing to minimize... thawing of red blood cells and to deglycerolize and wash thawed cells for subsequent reinfusion. (b... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Processing system for frozen blood. 864.9145...

21 CFR 864.9145 - Processing system for frozen blood.

Code of Federal Regulations, 2011 CFR

2011-04-01

... system for frozen blood is a device used to glycerolize red blood cells prior to freezing to minimize... thawing of red blood cells and to deglycerolize and wash thawed cells for subsequent reinfusion. (b... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Processing system for frozen blood. 864.9145...

Cost analysis of composite fan blade manufacturing processes

NASA Technical Reports Server (NTRS)

Stelson, T. S.; Barth, C. F.

1980-01-01

The relative manufacturing costs were estimated for large high technology fan blades prepared by advanced composite fabrication methods using seven candidate materials/process systems. These systems were identified as laminated resin matrix composite, filament wound resin matrix composite, superhybrid solid laminate, superhybrid spar/shell, metal matrix composite, metal matrix composite with a spar and shell, and hollow titanium. The costs were calculated utilizing analytical process models and all cost data are presented as normalized relative values where 100 was the cost of a conventionally forged solid titanium fan blade whose geometry corresponded to a size typical of 42 blades per disc. Four costs were calculated for each of the seven candidate systems to relate the variation of cost on blade size. Geometries typical of blade designs at 24, 30, 36 and 42 blades per disc were used. The impact of individual process yield factors on costs was also assessed as well as effects of process parameters, raw materials, labor rates and consumable items.

21 CFR 864.9900 - Cord blood processing system and storage container.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cord blood processing system and storage container... Manufacture Human Cells, Tissues, and Cellular and Tissue-Based Products (HCT/Ps) § 864.9900 Cord blood processing system and storage container. (a) Identification. A cord blood processing system and storage...

21 CFR 864.9900 - Cord blood processing system and storage container.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Cord blood processing system and storage container... Manufacture Human Cells, Tissues, and Cellular and Tissue-Based Products (HCT/Ps) § 864.9900 Cord blood processing system and storage container. (a) Identification. A cord blood processing system and storage...

21 CFR 864.9900 - Cord blood processing system and storage container.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Cord blood processing system and storage container... Manufacture Human Cells, Tissues, and Cellular and Tissue-Based Products (HCT/Ps) § 864.9900 Cord blood processing system and storage container. (a) Identification. A cord blood processing system and storage...

21 CFR 864.9900 - Cord blood processing system and storage container.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Cord blood processing system and storage container... Manufacture Human Cells, Tissues, and Cellular and Tissue-Based Products (HCT/Ps) § 864.9900 Cord blood processing system and storage container. (a) Identification. A cord blood processing system and storage...

21 CFR 864.9900 - Cord blood processing system and storage container.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Cord blood processing system and storage container... Manufacture Human Cells, Tissues, and Cellular and Tissue-Based Products (HCT/Ps) § 864.9900 Cord blood processing system and storage container. (a) Identification. A cord blood processing system and storage...

Cost-Effectiveness of a Physician-Pharmacist Collaboration Intervention to Improve Blood Pressure Control.

PubMed

Polgreen, Linnea A; Han, Jayoung; Carter, Barry L; Ardery, Gail P; Coffey, Christopher S; Chrischilles, Elizabeth A; James, Paul A

2015-12-01

Previous studies have demonstrated the cost-effectiveness of physician-pharmacist collaborations to improve hypertension control. However, most studies have limited generalizability, lacking minority and low-income populations. The Collaboration Among Pharmacist and Physicians to Improve Blood Pressure Now (CAPTION) trial randomized 625 patients from 32 medical offices in 15 states. Each office had an existing clinical pharmacist on staff. Pharmacists in intervention offices communicated with patients and made recommendations to physicians about changes in therapy. Demographic information, blood pressure (BP), medications, and physician visits were recorded. In addition, pharmacists tracked time spent with each patient. Costs were assigned to medications and pharmacist and physician time. Cost-effectiveness ratios were calculated based on changes in BP measurements and hypertension control rates. Thirty-eight percent of patients were black, 14% were Hispanic, and 49% had annual income <$25 000. At 9 months, average systolic BP was 6.1 mm Hg lower (±3.5), diastolic was 2.9 mm Hg lower (±1.9), and the percentage of patients with controlled hypertension was 43% in the intervention group and 34% in the control group. Total costs for the intervention group were $1462.87 (±132.51) and $1259.94 (±183.30) for the control group, a difference of $202.93. The cost to lower BP by 1 mm Hg was $33.27 for systolic BP and $69.98 for diastolic BP. The cost to increase the rate of hypertension control by 1 percentage point in the study population was $22.55. Our results highlight the cost-effectiveness of a clinical pharmacy intervention for hypertension control in primary care settings. © 2015 American Heart Association, Inc.

An Improved Effective Cost Review Process for Value Engineering

PubMed Central

Joo, D. S.; Park, J. I.

2014-01-01

Second-look value engineering (VE) is an approach that aims to lower the costs of products for which target costs are not being met during the production stage. Participants in second-look VE typically come up with a variety of ideas for cost cutting, but the outcomes often depend on their levels of experience, and not many good alternatives are available during the production stage. Nonetheless, good ideas have been consistently generated by VE experts. This paper investigates past second-look VE cases and the thinking processes of VE experts and proposes a cost review process as a systematic means of investigating cost-cutting ideas. This cost review process includes the use of an idea checklist and a specification review process. In addition to presenting the process, this paper reports on its feasibility, based on its introduction into a VE training course as part of a pilot study. The results indicate that the cost review process is effective in generating ideas for later analysis. PMID:25580459

An improved effective cost review process for value engineering.

PubMed

Joo, D S; Park, J I

2014-01-01

Second-look value engineering (VE) is an approach that aims to lower the costs of products for which target costs are not being met during the production stage. Participants in second-look VE typically come up with a variety of ideas for cost cutting, but the outcomes often depend on their levels of experience, and not many good alternatives are available during the production stage. Nonetheless, good ideas have been consistently generated by VE experts. This paper investigates past second-look VE cases and the thinking processes of VE experts and proposes a cost review process as a systematic means of investigating cost-cutting ideas. This cost review process includes the use of an idea checklist and a specification review process. In addition to presenting the process, this paper reports on its feasibility, based on its introduction into a VE training course as part of a pilot study. The results indicate that the cost review process is effective in generating ideas for later analysis.

Effect of Cord Blood Processing on Transplant Outcomes after Single Myeloablative Umbilical Cord Blood Transplantation

PubMed Central

Ballen, Karen K.; Logan, Brent R.; Laughlin, Mary J.; He, Wensheng; Ambruso, Daniel R.; Armitage, Susan E.; Beddard, Rachel L.; Bhatla, Deepika; Hwang, William Y.K.; Kiss, Joseph E.; Koegler, Gesine; Kurtzberg, Joanne; Nagler, Arnon; Oh, David; Petz, Lawrence D.; Price, Thomas H.; Quinones, Ralph R.; Ratanatharathorn, Voravit; Rizzo, J. Douglas; Sazama, Kathleen; Scaradavou, Andromachi; Schuster, Michael W.; Sender, Leonard S.; Shpall, Elizabeth J.; Spellman, Stephen R.; Sutton, Millicent; Weitekamp, Lee Ann; Wingard, John R.; Eapen, Mary

2015-01-01

Variations in cord blood manufacturing and administration are common, and the optimal practice, not known. We compared processing and banking practices at 16 public cord blood banks (CBB) in the United States, and assessed transplant outcomes on 530 single umbilical cord blood (UCB) myeloablative transplantations for hematologic malignancies, facilitated by these banks. UCB banking practices were separated into three mutually exclusive groups based on whether processing was automated or manual; units were plasma and red blood cell reduced or buffy coat production method or plasma reduced. Compared to the automated processing system for units, the day-28 neutrophil recovery was significantly lower after transplantation of units that were manually processed and plasma reduced (red cell replete) (odds ratio [OR] 0.19 p=0.001) or plasma and red cell reduced (OR 0.54, p=0.05). Day-100 survival did not differ by CBB. However, day-100 survival was better with units that were thawed with the dextran-albumin wash method compared to the “no wash” or “dilution only” techniques (OR 1.82, p=0.04). In conclusion, CBB processing has no significant effect on early (day 100) survival despite differences in kinetics of neutrophil recovery. PMID:25543094

Process Cost Modeling for Multi-Disciplinary Design Optimization

NASA Technical Reports Server (NTRS)

Bao, Han P.; Freeman, William (Technical Monitor)

2002-01-01

For early design concepts, the conventional approach to cost is normally some kind of parametric weight-based cost model. There is now ample evidence that this approach can be misleading and inaccurate. By the nature of its development, a parametric cost model requires historical data and is valid only if the new design is analogous to those for which the model was derived. Advanced aerospace vehicles have no historical production data and are nowhere near the vehicles of the past. Using an existing weight-based cost model would only lead to errors and distortions of the true production cost. This report outlines the development of a process-based cost model in which the physical elements of the vehicle are costed according to a first-order dynamics model. This theoretical cost model, first advocated by early work at MIT, has been expanded to cover the basic structures of an advanced aerospace vehicle. Elemental costs based on the geometry of the design can be summed up to provide an overall estimation of the total production cost for a design configuration. This capability to directly link any design configuration to realistic cost estimation is a key requirement for high payoff MDO problems. Another important consideration in this report is the handling of part or product complexity. Here the concept of cost modulus is introduced to take into account variability due to different materials, sizes, shapes, precision of fabrication, and equipment requirements. The most important implication of the development of the proposed process-based cost model is that different design configurations can now be quickly related to their cost estimates in a seamless calculation process easily implemented on any spreadsheet tool. In successive sections, the report addresses the issues of cost modeling as follows. First, an introduction is presented to provide the background for the research work. Next, a quick review of cost estimation techniques is made with the intention to

How do I provide leukapheresis products? Blood center experience and evidence for process improvement.

PubMed

Ginzburg, Yelena; Kessler, Debra; Narici, Manlio; Caltabiano, Melinda; Rebosa, Mark; Strauss, Donna; Shaz, Beth

2013-10-01

The past few decades have seen a resurgence of interest in leukapheresis products to improve the survival of infected patients with neutropenia. These products have a short shelf life and require donor stimulation with dexamethasone before collection. Additionally, a system with good communications and logistical support is essential. A recent survey of blood centers in North America revealed that the majority of centers collecting leukapheresis products use steroid-stimulated donors. The survey results suggested that an analysis of the process and potential process improvement would be of interest to the transfusion medicine community. Data from 2008 to 2011 regarding donor selection, donor dexamethasone stimulation, leukapheresis collection, and correlations between potentially pertinent variables for process improvement were analyzed. Results from an analysis of cost are also included. We evaluate 432 leukapheresis donations and demonstrate correlations between 1) pre- and poststimulation white blood cell (WBC) count (p<0.0001), 2) interval (donor stimulation to collection) and poststimulation WBC count (p<0.0001), and 3) poststimulation WBC count and leukapheresis product granulocyte yield (p<0.0001). Significant improvement in granulocyte quality and yield can be accomplished in dexamethasone-stimulated donors, by selecting eligible donors with relatively high normal prestimulation WBC counts and/or previously good responses to dexamethasone, increasing the duration between dexamethasone stimulation and granulocyte collection, and maintaining optimal hematocrit (5%-10%) in granulocyte collections. Because the majority of surveyed blood centers collecting stimulated granulocytes use steroids alone, modifications presented here may prove useful. Further assessment of correlation between granulocyte yield and clinical outcome will await results of additional studies. © 2012 American Association of Blood Banks.

The value to blood establishments of supplier quality audit and of adopting a European Blood Alliance collaborative approach

PubMed Central

Nightingale, Mark J.; Ceulemans, Jan; Ágoston, Stephanie; van Mourik, Peter; Marcou-Cherdel, Céline; Wickens, Betty; Johnstone, Pauline

2014-01-01

Background The assessment of suppliers of critical goods and services to European blood establishments is a regulatory requirement proving difficult to resource. This study was to establish whether European Blood Alliance member blood services could collaborate to reduce the cost of auditing suppliers without diminishing standards. Materials and method Five blood services took part, each contributing a maximum of one qualified auditor per audit (rather than the usual two). Four audits were completed involving eight auditors in total to a European Blood Alliance agreed policy and process using an audit scope agreed with suppliers. Results Audits produced a total of 22 observations, the majority relating to good manufacturing practice and highlighted deficiencies in processes, procedures and quality records including complaints’ handling, product recall, equipment calibration, management of change, facilities’ maintenance and monitoring and business continuity. Auditors reported that audits had been useful to their service and all audits prompted a positive response from suppliers with satisfactory corrective action plans where applicable. Audit costs totalled € 3,438 (average € 860 per audit) which is no more than equivalent traditional audits. The four audit reports have been shared amongst the five participating blood establishments and benefitted 13 recipient departments in total. Previously, 13 separate audits would have been required by the five blood services. Discussion Collaborative supplier audit has proven an effective and efficient initiative that can reduce the resource requirements of both suppliers and individual blood service’s auditing costs. Collaborative supplier audit has since been established within routine European Blood Alliance management practice. PMID:24553596

A RAPID Method for Blood Processing to Increase the Yield of Plasma Peptide Levels in Human Blood.

PubMed

Teuffel, Pauline; Goebel-Stengel, Miriam; Hofmann, Tobias; Prinz, Philip; Scharner, Sophie; Körner, Jan L; Grötzinger, Carsten; Rose, Matthias; Klapp, Burghard F; Stengel, Andreas

2016-04-28

Research in the field of food intake regulation is gaining importance. This often includes the measurement of peptides regulating food intake. For the correct determination of a peptide's concentration, it should be stable during blood processing. However, this is not the case for several peptides which are quickly degraded by endogenous peptidases. Recently, we developed a blood processing method employing Reduced temperatures, Acidification, Protease inhibition, Isotopic exogenous controls and Dilution (RAPID) for the use in rats. Here, we have established this technique for the use in humans and investigated recovery, molecular form and circulating concentration of food intake regulatory hormones. The RAPID method significantly improved the recovery for (125)I-labeled somatostatin-28 (+39%), glucagon-like peptide-1 (+35%), acyl ghrelin and glucagon (+32%), insulin and kisspeptin (+29%), nesfatin-1 (+28%), leptin (+21%) and peptide YY3-36 (+19%) compared to standard processing (EDTA blood on ice, p <0.001). High performance liquid chromatography showed the elution of endogenous acyl ghrelin at the expected position after RAPID processing, while after standard processing 62% of acyl ghrelin were degraded resulting in an earlier peak likely representing desacyl ghrelin. After RAPID processing the acyl/desacyl ghrelin ratio in blood of normal weight subjects was 1:3 compared to 1:23 following standard processing (p = 0.03). Also endogenous kisspeptin levels were higher after RAPID compared to standard processing (+99%, p = 0.02). The RAPID blood processing method can be used in humans, yields higher peptide levels and allows for assessment of the correct molecular form.

77 FR 46096 - Statistical Process Controls for Blood Establishments; Public Workshop

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-02

...] Statistical Process Controls for Blood Establishments; Public Workshop AGENCY: Food and Drug Administration... workshop entitled: ``Statistical Process Controls for Blood Establishments.'' The purpose of this public workshop is to discuss the implementation of statistical process controls to validate and monitor...

A process model to estimate biodiesel production costs.

PubMed

Haas, Michael J; McAloon, Andrew J; Yee, Winnie C; Foglia, Thomas A

2006-03-01

'Biodiesel' is the name given to a renewable diesel fuel that is produced from fats and oils. It consists of the simple alkyl esters of fatty acids, most typically the methyl esters. We have developed a computer model to estimate the capital and operating costs of a moderately-sized industrial biodiesel production facility. The major process operations in the plant were continuous-process vegetable oil transesterification, and ester and glycerol recovery. The model was designed using contemporary process simulation software, and current reagent, equipment and supply costs, following current production practices. Crude, degummed soybean oil was specified as the feedstock. Annual production capacity of the plant was set at 37,854,118 l (10 x 10(6)gal). Facility construction costs were calculated to be US dollar 11.3 million. The largest contributors to the equipment cost, accounting for nearly one third of expenditures, were storage tanks to contain a 25 day capacity of feedstock and product. At a value of US dollar 0.52/kg (dollar 0.236/lb) for feedstock soybean oil, a biodiesel production cost of US dollar 0.53/l (dollar 2.00/gal) was predicted. The single greatest contributor to this value was the cost of the oil feedstock, which accounted for 88% of total estimated production costs. An analysis of the dependence of production costs on the cost of the feedstock indicated a direct linear relationship between the two, with a change of US dollar 0.020/l (dollar 0.075/gal) in product cost per US dollar 0.022/kg (dollar 0.01/lb) change in oil cost. Process economics included the recovery of coproduct glycerol generated during biodiesel production, and its sale into the commercial glycerol market as an 80% w/w aqueous solution, which reduced production costs by approximately 6%. The production cost of biodiesel was found to vary inversely and linearly with variations in the market value of glycerol, increasing by US dollar 0.0022/l (dollar 0.0085/gal) for every US

Laboratory Workflow Analysis of Culture of Periprosthetic Tissues in Blood Culture Bottles.

PubMed

Peel, Trisha N; Sedarski, John A; Dylla, Brenda L; Shannon, Samantha K; Amirahmadi, Fazlollaah; Hughes, John G; Cheng, Allen C; Patel, Robin

2017-09-01

Culture of periprosthetic tissue specimens in blood culture bottles is more sensitive than conventional techniques, but the impact on laboratory workflow has yet to be addressed. Herein, we examined the impact of culture of periprosthetic tissues in blood culture bottles on laboratory workflow and cost. The workflow was process mapped, decision tree models were constructed using probabilities of positive and negative cultures drawn from our published study (T. N. Peel, B. L. Dylla, J. G. Hughes, D. T. Lynch, K. E. Greenwood-Quaintance, A. C. Cheng, J. N. Mandrekar, and R. Patel, mBio 7:e01776-15, 2016, https://doi.org/10.1128/mBio.01776-15), and the processing times and resource costs from the laboratory staff time viewpoint were used to compare periprosthetic tissues culture processes using conventional techniques with culture in blood culture bottles. Sensitivity analysis was performed using various rates of positive cultures. Annualized labor savings were estimated based on salary costs from the U.S. Labor Bureau for Laboratory staff. The model demonstrated a 60.1% reduction in mean total staff time with the adoption of tissue inoculation into blood culture bottles compared to conventional techniques (mean ± standard deviation, 30.7 ± 27.6 versus 77.0 ± 35.3 h per month, respectively; P < 0.001). The estimated annualized labor cost savings of culture using blood culture bottles was $10,876.83 (±$337.16). Sensitivity analysis was performed using various rates of culture positivity (5 to 50%). Culture in blood culture bottles was cost-effective, based on the estimated labor cost savings of $2,132.71 for each percent increase in test accuracy. In conclusion, culture of periprosthetic tissue in blood culture bottles is not only more accurate than but is also cost-saving compared to conventional culture methods. Copyright © 2017 American Society for Microbiology.

Processes of early stroke care and hospital costs.

PubMed

Svendsen, Marie Louise; Ehlers, Lars H; Hundborg, Heidi H; Ingeman, Annette; Johnsen, Søren P

2014-08-01

The relationship between processes of early stroke care and hospital costs remains unclear. We therefore examined the association in a population based cohort study. We identified 5909 stroke patients who were admitted to stroke units in a Danish county between 2005 and 2010.The examined recommended processes of care included early admission to a stroke unit, early initiation of antiplatelet or anticoagulant therapy, early computed tomography/magnetic resonance imaging (CT/MRI) scan, early physiotherapy and occupational therapy, early assessment of nutritional risk, constipation risk and of swallowing function, early mobilization,early catheterization, and early thromboembolism prophylaxis.Hospital costs were assessed for each patient based on the number of days spent in different in-hospital facilities using local hospital charges. The mean costs of hospitalization were $23 352 (standard deviation 27 827). The relationship between receiving more relevant processes of early stroke care and lower hospital costs followed a dose–response relationship. The adjusted costs were $24 566 (95% confidence interval 19 364–29 769) lower for patients who received 75–100% of the relevant processes of care compared with patients receiving 0–24%. All processes of care were associated with potential cost savings, except for early catheterization and early thromboembolism prophylaxis. Early care in agreement with key guidelines recommendations for the management of patients with stroke may be associated with hospital savings.

Potential cost saving of Epoetin alfa in elective hip or knee surgery due to reduction in blood transfusions and their side effects: a discrete-event simulation model.

PubMed

Tomeczkowski, Jörg; Stern, Sean; Müller, Alfred; von Heymann, Christian

2013-01-01

Transfusion of allogeneic blood is still common in orthopedic surgery. This analysis evaluates from the perspective of a German hospital the potential cost savings of Epoetin alfa (EPO) compared to predonated autologous blood transfusions or to a nobloodconservationstrategy (allogeneic blood transfusion strategy)during elective hip and knee replacement surgery. Individual patients (N = 50,000) were simulated based on data from controlled trials, the German DRG institute (InEK) and various publications and entered into a stochastic model (Monte-Carlo) of three treatment arms: EPO, preoperative autologous donation and nobloodconservationstrategy. All three strategies lead to a different risk for an allogeneic blood transfusion. The model focused on the costs and events of the three different procedures. The costs were obtained from clinical trial databases, the German DRG system, patient records and medical publications: transfusion (allogeneic red blood cells: €320/unit and autologous red blood cells: €250/unit), pneumonia treatment (€5,000), and length of stay (€300/day). Probabilistic sensitivity analyses were performed to determine which factors had an influence on the model's clinical and cost outcomes. At acquisition costs of €200/40,000 IU EPO is cost saving compared to autologous blood donation, and cost-effective compared to a nobloodconservationstrategy. The results were most sensitive to the cost of EPO, blood units and hospital days. EPO might become an attractive blood conservation strategy for anemic patients at reasonable costs due to the reduction in allogeneic blood transfusions, in the modeled incidence of transfusion-associated pneumonia andthe prolongedlength of stay.

Cost-effectiveness of cell salvage and alternative methods of minimising perioperative allogeneic blood transfusion: a systematic review and economic model.

PubMed

Davies, L; Brown, T J; Haynes, S; Payne, K; Elliott, R A; McCollum, C

2006-11-01

To compare patient outcomes, resource use and costs to the NHS and NHS Blood Transfusion Authority (BTA) associated with cell salvage and alternative methods of minimising perioperative allogeneic blood transfusion. Electronic databases covering the period 1996-2004 for systematic reviews and 1994-2004 for economic evidence. Existing systematic reviews were updated with data from selected randomised controlled trials (RCTs) that involved adults scheduled for elective non-urgent surgery. Any resource use or cost data were extracted for potential use in populating an economic model. Relative risks or weighted mean difference of each outcome for each intervention were assessed, taking into account the number of RCTs included in each outcome and intervention and the presence of any heterogeneity. This allowed indirect comparison of the relative effectiveness of each intervention when the intervention is compared with allogeneic blood transfusion. A decision analytic model synthesised clinical and economic data from several sources, to estimate the relative cost-effectiveness of cell salvage for people undergoing elective surgery with moderate to major expected blood loss. The perspective of the NHS and patients and a time horizon of 1 month were used. The economic model was developed from reviews of effectiveness and cost-effectiveness and clinical experts. Secondary analysis explored the robustness of the results to changes in the timing and costs of cell salvage equipment, surgical procedure, use of transfusion protocols and time horizon of analysis. Overall, 668 studies were identified electronically for the update of the two systematic reviews. This included five RCTs, of which two were cell salvage and three preoperative autologous donation (PAD). Five published systematic reviews were identified for antifibrinolytics, fibrin sealants and restrictive transfusion triggers, PAD plus erythropoietin, erythropoietin alone and acute normovolaemic haemodilution (ANH

Patient level costing in Ireland: process, challenges and opportunities.

PubMed

Murphy, A; McElroy, B

2015-03-01

In 2013, the Department of Health released their policy paper on hospital financing entitled Money Follows the Patient. A fundamental building block for the proposed financing model is patient level costing. This paper outlines the patient level costing process, identifies the opportunities and considers the challenges associated with the process in the Irish hospital setting. Methods involved a review of the existing literature which was complemented with an interview with health service staff. There are considerable challenges associated with implementing patient level costing including deficits in information and communication technologies and financial expertise as well as timeliness of coding. In addition, greater clinical input into the costing process is needed compared to traditional costing processes. However, there are long-term benefits associated with patient level costing; these include empowerment of clinical staff, improved transparency and price setting and greater fairness, especially in the treatment of outliers. These can help to achieve the Government's Health Strategy. The benefits of patient level costing need to be promoted and a commitment to investment in overcoming the challenges is required.

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 management: the implementation of the activity-based costing method in sterile processing department].

PubMed

Jericó, Marli de Carvalho; Castilho, Valéria

2010-09-01

This exploratory case study was performed aiming at implementing the Activity-based Costing (ABC) method in a sterile processing department (SPD) of a major teaching hospital. Data collection was performed throughout 2006. Documentary research techniques and non participant closed observation were used. The ABC implementation allowed for learning the activity-based costing of both the chemical and physical disinfection cycle/load: (dollar 9.95) and (dollar 12.63), respectively; as well as the cost for sterilization by steam under pressure (autoclave) (dollar 31.37) and low temperature steam and gaseous formaldehyde sterilization (LTSF) (dollar 255.28). The information provided by the ABC method has optimized the overall understanding of the cost driver process and provided the foundation for assessing performance and improvement in the SPD processes.

Low-cost, email-based system for self blood pressure monitoring at home.

PubMed

Nakajima, Kazuki; Nambu, Masayuki; Kiryu, Tohru; Tamura, Toshiyo; Sasaki, Kazuo

2006-01-01

We have developed a low-cost monitoring system, which allows subjects to send blood pressure (BP) data obtained at home to health-care professionals by email. The system consists of a wrist BP monitor and a personal computer (PC) with an Internet connection. The wrist BP monitor includes an advanced positioning sensor to verify that the wrist is placed properly at heart level. Subjects at home can self-measure their BP every day, automatically transfer the BP data to their PC each week, and then send a comma-separated values (CSV) file to their health-care professional by email. In a feasibility study, 10 subjects used the system for a mean period of 207 days (SD 149). The mean percent achievement of measurement in the 10 subjects was 84% (SD 12). There was a seasonal variation in systolic and diastolic BP, which was inversely correlated with temperature. Eight of the 10 subjects evaluated the system favourably. The results of the present study demonstrate the feasibility of our email-based system for self-monitoring of blood pressure. Its low cost means that it may have widespread application in future home telecare studies.

Enzymatic corn wet milling: engineering process and cost model

PubMed Central

Ramírez, Edna C; Johnston, David B; McAloon, Andrew J; Singh, Vijay

2009-01-01

Background Enzymatic corn wet milling (E-milling) is a process derived from conventional wet milling for the recovery and purification of starch and co-products using proteases to eliminate the need for sulfites and decrease the steeping time. In 2006, the total starch production in USA by conventional wet milling equaled 23 billion kilograms, including modified starches and starches used for sweeteners and ethanol production [1]. Process engineering and cost models for an E-milling process have been developed for a processing plant with a capacity of 2.54 million kg of corn per day (100,000 bu/day). These models are based on the previously published models for a traditional wet milling plant with the same capacity. The E-milling process includes grain cleaning, pretreatment, enzymatic treatment, germ separation and recovery, fiber separation and recovery, gluten separation and recovery and starch separation. Information for the development of the conventional models was obtained from a variety of technical sources including commercial wet milling companies, industry experts and equipment suppliers. Additional information for the present models was obtained from our own experience with the development of the E-milling process and trials in the laboratory and at the pilot plant scale. The models were developed using process and cost simulation software (SuperPro Designer®) and include processing information such as composition and flow rates of the various process streams, descriptions of the various unit operations and detailed breakdowns of the operating and capital cost of the facility. Results Based on the information from the model, we can estimate the cost of production per kilogram of starch using the input prices for corn, enzyme and other wet milling co-products. The work presented here describes the E-milling process and compares the process, the operation and costs with the conventional process. Conclusion The E-milling process was found to be cost

Implementation of a patient blood management monitoring and feedback program significantly reduces transfusions and costs.

PubMed

Mehra, Tarun; Seifert, Burkhardt; Bravo-Reiter, Silvina; Wanner, Guido; Dutkowski, Philipp; Holubec, Tomas; Moos, Rudolf M; Volbracht, Jörk; Manz, Markus G; Spahn, Donat R

2015-12-01

Patient blood management (PBM) measures have been shown to be effective in reducing transfusions while maintaining patient outcome. The issuance of transfusion guidelines is seen as being key to the success of PBM programs. As the introduction of guidelines alone did not visibly reduce transfusions in our center, a monitoring and feedback program was established. The aim of our study was to show the effectiveness of such measures in reducing transfusions and cost. We designed a prospective, interventional cohort study with a 3-year time frame (January 1, 2012 to December 31, 2014). In total, 101,794 patients aged 18 years or older were included. The PBM monitoring and feedback program was introduced on January 1, 2014, with the subsequent issuance of quarterly reporting. Within the first year of introduction, transfusion of all allogeneic blood products per 1000 patients was reduced by 27% (red blood cell units, -24%; platelet units, -25%; and fresh-frozen plasma units, -37%; all p < 0.001) leading to direct allogeneic blood product related savings of more than 2 million USD. The number of blood products transfused per case was significantly reduced from 9 ± 19 to 7 ± 14 (p < 0.001). With an odds ratio of 0.86 (95% confidence interval, 0.82-0.91), the introduction of our PBM monitoring and feedback program was a significant independent factor in the reduction of transfusion probability (p < 0.001). Our PBM monitoring and feedback program was highly efficacious in reducing the transfusion of allogeneic blood products and transfusion-related costs. © 2015 AABB.

Pathogen reduction of whole blood: utility and feasibility.

PubMed

Allain, J-P; Goodrich, R

2017-10-01

To collect information on pathogen reduction applied to whole blood. Pathogen reduction (PR) of blood components has been developed over the past two decades, and pathogen-reduced fresh-frozen plasma and platelet concentrates are currently in clinical use. High cost and incomplete coverage of components make PR out of reach for low- and middle-income countries (LMIC). However, should PR become applicable to whole blood (WB), the main product transfused in sub-Saharan Africa, and be compatible with the preparation of clinically suitable components, cost would be minimised, and a range of safety measures in place at high cost in developed areas would become redundant. All articles called with "pathogen reduction", "pathogen inactivation" and "whole blood" were retrieved from Medline. References in articles were utilised. One such PR technology (PRT) applied to WB has been developed and has shown efficacious against viruses, bacteria and parasites in vitro; and has been able to inactivate nucleated blood cells whilst retaining the ability to prepare components with acceptable characteristics. The efficacy of this WB PRT has been demonstrated in vivo using the inactivation of Plasmodium falciparum as a model and showing a high degree of correlation between in vitro and in vivo data. Obtaining further evidence of efficacy on other suitable targets is warranted. Shortening of the process, which is currently around 50 min, or increasing the number of units simultaneously processed would be necessary to make PRT WB conducive to LMIC blood services' needs. Even if not 100% effective against agents that are present in high pathogen load titres, WB PRT could massively impact blood safety in LMIC by providing safer products at an affordable cost. © 2017 British Blood Transfusion Society.

Perceived barriers among physicians for stopping non-cost-effective blood-saving measures in total hip and total knee arthroplasties.

PubMed

Voorn, Veronique M A; Marang-van de Mheen, Perla J; Wentink, Manon M; Kaptein, Ad A; Koopman-van Gemert, Ankie W M M; So-Osman, Cynthia; Vliet Vlieland, Thea P M; Nelissen, Rob G H H; van Bodegom-Vos, Leti

2014-10-01

Despite evidence that the blood-saving measures (BSMs) erythropoietin (EPO) and intra- and postoperative blood salvage are not (cost-)effective in primary elective total hip and knee arthroplasties, they are used frequently in Dutch hospitals. This study aims to assess the impact of barriers associated with the intention of physicians to stop BSMs. A survey among 400 orthopedic surgeons and 400 anesthesiologists within the Netherlands was performed. Multivariate logistic regression was used to identify barriers associated with intention to stop BSMs. A total of 153 (40%) orthopedic surgeons and 100 (27%) anesthesiologists responded. Of all responders 67% used EPO, perioperative blood salvage, or a combination. After reading the evidence on non-cost-effective BSMs, 50% of respondents intended to stop EPO and 53% to stop perioperative blood salvage. In general, barriers perceived most frequently were lack of attention for blood management (90% of respondents), department priority to prevent transfusions (88%), and patient characteristics such as comorbidity (81%). Barriers significantly associated with intention to stop EPO were lack of interest to save money and the impact of other involved parties. Barriers significantly associated with intention to stop perioperative blood salvage were concerns about patient safety, lack of alternatives, losing experience with the technique, and lack of interest to save money. Physicians experience barriers to stop using BSMs, related to their own technical skills, patient safety, current blood management policy, and lack of interest to save money. These barriers should be targeted in strategies to make BSM use cost-effective. © 2014 AABB.

30 CFR 251.13 - Reimbursement for the costs of reproducing data and information and certain processing costs.

Code of Federal Regulations, 2010 CFR

2010-07-01

... and information and certain processing costs. 251.13 Section 251.13 Mineral Resources MINERALS... third party for the reasonable costs of processing geophysical information (which does not include cost... OUTER CONTINENTAL SHELF § 251.13 Reimbursement for the costs of reproducing data and information and...

Prospects for reducing the processing cost of lithium ion batteries

DOE PAGES

Wood III, David L.; Li, Jianlin; Daniel, Claus

2014-11-06

A detailed processing cost breakdown is given for lithium-ion battery (LIB) electrodes, which focuses on: elimination of toxic, costly N-methylpyrrolidone (NMP) dispersion chemistry; doubling the thicknesses of the anode and cathode to raise energy density; and, reduction of the anode electrolyte wetting and SEI-layer formation time. These processing cost reduction technologies generically adaptable to any anode or cathode cell chemistry and are being implemented at ORNL. This paper shows step by step how these cost savings can be realized in existing or new LIB manufacturing plants using a baseline case of thin (power) electrodes produced with NMP processing and amore » standard 10-14-day wetting and formation process. In particular, it is shown that aqueous electrode processing can cut the electrode processing cost and energy consumption by an order of magnitude. Doubling the thickness of the electrodes allows for using half of the inactive current collectors and separators, contributing even further to the processing cost savings. Finally wetting and SEI-layer formation cost savings are discussed in the context of a protocol with significantly reduced time. These three benefits collectively offer the possibility of reducing LIB pack cost from $502.8 kWh-1-usable to $370.3 kWh-1-usable, a savings of $132.5/kWh (or 26.4%).« less

Red blood cell transfusion probability and associated costs in neurosurgical procedures.

PubMed

Barth, Martin; Weiss, Christel; Schmieder, Kirsten

2018-03-20

The extent of red blood cell units (RBC) needed for different neurosurgical procedures and the time point of their administration are widely unknown, which results in generously cross-matching prior to surgery. However, RBC are increasingly requested in the aging western populations, and blood donations are significantly reduced. Therefore, the knowledge of the extent and time point of administration of RBC is of major importance. This is a retrospective single center analysis. The incidence of RBC transfusion during surgery or within 48 h after surgery was analyzed for all neurosurgical patients within 3 years. Costs for cross-matched and transfused RBC were calculated and risk factors for RBC transfusion analyzed. The risk of intraoperative RBC administration was low for spinal and intracranial tumor resections (1.87%) and exceeded 10% only in spinal fusion procedures. This was dependent on the number of fused segments with an intraoperative transfusion risk of > 12.5% with fusion of more than three levels. Multiple logistic regression analysis showed a significantly increased risk for RBC transfusion for female gender (p = 0.006; OR 1.655), higher age (N = 4812; p < 0.0001; OR 1.028), and number of fused segments (N = 737; p < 0.0001; OR 1.433). Annual costs for cross-matching were 783,820.88 USD and for intraoperative RBC administration 121,322.13 USD. Neurosurgical procedures are associated with a low number of RBC needed intraoperatively. Only elective spine fusion procedures with ≥ 3 levels involved and AVM resections seem to require cross-matching of RBC. The present data may allow changing the preoperative algorithm of RBC cross-matching in neurosurgical procedures and help to save resources and costs.

High Cost of Hospitalization for Colonic Diverticular Bleeding Depended on Repeated Bleeding and Blood Transfusion: Analysis with Diagnosis Procedure Combination Data in Japan.

PubMed

Ito, Yoichiro; Sakata, Yasuhisa; Yoshida, Hisako; Nonaka, Sayuri; Fujii, Susumu; Tanaka, Yuichiro; Shirai, Shimpei; Takeshita, Eri; Akutagawa, Takashi; Kawakubo, Hiroharu; Yamamoto, Koji; Tsuruoka, Nanae; Shimoda, Ryo; Iwakiri, Ryuichi; Fujimoto, Kazuma

2017-01-01

Bleeding from a colonic diverticulum is serious in aged patients. The aim of this study was to determine the risk factors for high-cost hospitalization of colonic diverticular bleeding using the diagnosis procedure combination (DPC) data. From January 2009 to December 2015, 78 patients with colonic diverticular bleeding were identified by DPC data in Saga Medical School Hospital. All patients underwent colonic endoscopy within 3 days. The patients were divided into 2 groups: the low-cost group (DPC cost of <500,000 yen) and the high-cost group (DPC cost of >500,000 yen). Univariate analysis revealed that aging, hypertension, rebleeding, a low hemoglobin concentration at admission, and blood transfusion were risk factors for high hospitalization cost. Multivariate analysis revealed that rebleeding (OR 5.3; 95% CI 1.3-21.3; p = 0.017) and blood transfusion (OR 3.8; 95% CI 1.01-14.2; p = 0.048) were definite risk factors for high hospitalization cost. Rebleeding and blood transfusion were related to high hospitalization cost for colonic diverticular bleeding. © 2017 S. Karger AG, Basel.

Clinical process analysis and activity-based costing at a heart center.

PubMed

Ridderstolpe, Lisa; Johansson, Andreas; Skau, Tommy; Rutberg, Hans; Ahlfeldt, Hans

2002-08-01

Cost studies, productivity, efficiency, and quality of care measures, the links between resources and patient outcomes, are fundamental issues for hospital management today. This paper describes the implementation of a model for process analysis and activity-based costing (ABC)/management at a Heart Center in Sweden as a tool for administrative cost information, strategic decision-making, quality improvement, and cost reduction. A commercial software package (QPR) containing two interrelated parts, "ProcessGuide and CostControl," was used. All processes at the Heart Center were mapped and graphically outlined. Processes and activities such as health care procedures, research, and education were identified together with their causal relationship to costs and products/services. The construction of the ABC model in CostControl was time-consuming. However, after the ABC/management system was created, it opened the way for new possibilities including process and activity analysis, simulation, and price calculations. Cost analysis showed large variations in the cost obtained for individual patients undergoing coronary artery bypass grafting (CABG) surgery. We conclude that a process-based costing system is applicable and has the potential to be useful in hospital management.

A Predictive Model to Estimate Cost Savings of a Novel Diagnostic Blood Panel for Diagnosis of Diarrhea-predominant Irritable Bowel Syndrome.

PubMed

Pimentel, Mark; Purdy, Chris; Magar, Raf; Rezaie, Ali

2016-07-01

A high incidence of irritable bowel syndrome (IBS) is associated with significant medical costs. Diarrhea-predominant IBS (IBS-D) is diagnosed on the basis of clinical presentation and diagnostic test results and procedures that exclude other conditions. This study was conducted to estimate the potential cost savings of a novel IBS diagnostic blood panel that tests for the presence of antibodies to cytolethal distending toxin B and anti-vinculin associated with IBS-D. A cost-minimization (CM) decision tree model was used to compare the costs of a novel IBS diagnostic blood panel pathway versus an exclusionary diagnostic pathway (ie, standard of care). The probability that patients proceed to treatment was modeled as a function of sensitivity, specificity, and likelihood ratios of the individual biomarker tests. One-way sensitivity analyses were performed for key variables, and a break-even analysis was performed for the pretest probability of IBS-D. Budget impact analysis of the CM model was extrapolated to a health plan with 1 million covered lives. The CM model (base-case) predicted $509 cost savings for the novel IBS diagnostic blood panel versus the exclusionary diagnostic pathway because of the avoidance of downstream testing (eg, colonoscopy, computed tomography scans). Sensitivity analysis indicated that an increase in both positive likelihood ratios modestly increased cost savings. Break-even analysis estimated that the pretest probability of disease would be 0.451 to attain cost neutrality. The budget impact analysis predicted a cost savings of $3,634,006 ($0.30 per member per month). The novel IBS diagnostic blood panel may yield significant cost savings by allowing patients to proceed to treatment earlier, thereby avoiding unnecessary testing. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Blood transfusion safety: a new philosophy.

PubMed

Franklin, I M

2012-12-01

Blood transfusion safety has had a chequered history, and there are current and future challenges. Internationally, there is no clear consensus for many aspects of the provision of safe blood, although pan-national legislation does provide a baseline framework in the European Union. Costs are rising, and new safety measures can appear expensive, especially when tested against some other medical interventions, such as cancer treatment and vaccination programmes. In this article, it is proposed that a comprehensive approach is taken to the issue of blood transfusion safety that considers all aspects of the process rather than considering only new measures. The need for an agreed level of safety for specified and unknown risks is also suggested. The importance of providing care and support for those inadvertently injured as a result of transfusion problems is also made. Given that the current blood safety decision process often uses a utilitarian principle for decision making--through the calculation of Quality Adjusted Life Years--an alternative philosophy is proposed. A social contract for blood safety, based on the principles of 'justice as fairness' developed by John Rawls, is recommended as a means of providing an agreed level of safety, containing costs and providing support for any adverse outcomes. © 2012 The Author. Transfusion Medicine © 2012 British Blood Transfusion Society.

[Process-oriented cost calculation in interventional radiology. A case study].

PubMed

Mahnken, A H; Bruners, P; Günther, R W; Rasche, C

2012-01-01

Currently used costing methods such as cost centre accounting do not sufficiently reflect the process-based resource utilization in medicine. The goal of this study was to establish a process-oriented cost assessment of percutaneous radiofrequency (RF) ablation of liver and lung metastases. In each of 15 patients a detailed task analysis of the primary process of hepatic and pulmonary RF ablation was performed. Based on these data a dedicated cost calculation model was developed for each primary process. The costs of each process were computed and compared with the revenue for in-patients according to the German diagnosis-related groups (DRG) system 2010. The RF ablation of liver metastases in patients without relevant comorbidities and a low patient complexity level results in a loss of EUR 588.44, whereas the treatment of patients with a higher complexity level yields an acceptable profit. The treatment of pulmonary metastases is profitable even in cases of additional expenses due to complications. Process-oriented costing provides relevant information that is needed for understanding the economic impact of treatment decisions. It is well suited as a starting point for economically driven process optimization and reengineering. Under the terms of the German DRG 2010 system percutaneous RF ablation of lung metastases is economically reasonable, while RF ablation of liver metastases in cases of low patient complexity levels does not cover the costs.

Reducing Design Cycle Time and Cost Through Process Resequencing

NASA Technical Reports Server (NTRS)

Rogers, James L.

2004-01-01

In today's competitive environment, companies are under enormous pressure to reduce the time and cost of their design cycle. One method for reducing both time and cost is to develop an understanding of the flow of the design processes and the effects of the iterative subcycles that are found in complex design projects. Once these aspects are understood, the design manager can make decisions that take advantage of decomposition, concurrent engineering, and parallel processing techniques to reduce the total time and the total cost of the design cycle. One software tool that can aid in this decision-making process is the Design Manager's Aid for Intelligent Decomposition (DeMAID). The DeMAID software minimizes the feedback couplings that create iterative subcycles, groups processes into iterative subcycles, and decomposes the subcycles into a hierarchical structure. The real benefits of producing the best design in the least time and at a minimum cost are obtained from sequencing the processes in the subcycles.

Identification of blood culture isolates directly from positive blood cultures by use of matrix-assisted laser desorption ionization-time of flight mass spectrometry and a commercial extraction system: analysis of performance, cost, and turnaround time.

PubMed

Lagacé-Wiens, Philippe R S; Adam, Heather J; Karlowsky, James A; Nichol, Kimberly A; Pang, Paulette F; Guenther, Jodi; Webb, Amanda A; Miller, Crystal; Alfa, Michelle J

2012-10-01

Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry represents a revolution in the rapid identification of bacterial and fungal pathogens in the clinical microbiology laboratory. Recently, MALDI-TOF has been applied directly to positive blood culture bottles for the rapid identification of pathogens, leading to reductions in turnaround time and potentially beneficial patient impacts. The development of a commercially available extraction kit (Bruker Sepsityper) for use with the Bruker MALDI BioTyper has facilitated the processing required for identification of pathogens directly from positive from blood cultures. We report the results of an evaluation of the accuracy, cost, and turnaround time of this method for 61 positive monomicrobial and 2 polymicrobial cultures representing 26 species. The Bruker MALDI BioTyper with the Sepsityper gave a valid (score, >1.7) identification for 85.2% of positive blood cultures with no misidentifications. The mean reduction in turnaround time to identification was 34.3 h (P < 0.0001) in the ideal situation where MALDI-TOF was used for all blood cultures and 26.5 h in a more practical setting where conventional identification or identification from subcultures was required for isolates that could not be directly identified by MALDI-TOF. Implementation of a MALDI-TOF-based identification system for direct identification of pathogens from blood cultures is expected to be associated with a marginal increase in operating costs for most laboratories. However, the use of MALDI-TOF for direct identification is accurate and should result in reduced turnaround time to identification.

Cord blood units collected at a remote site: a collaborative endeavor to collect umbilical cord blood through the Hawaii Cord Blood Bank and store the units at the Puget Sound Blood Center.

PubMed

Wada, Randal K; Bradford, Andrea; Moogk, Margery; Yim, Robyn; Strong, D Michael; Drachman, Jonathan; Reems, Jo Anna

2004-01-01

Umbilical cord blood is a useful source of hematopoietic stem cells, especially because compared to equivalent HLA-matched stem cells from unrelated adult donors. A network of community collection sites targeted at particular ethnic groups and serviced by a central processing and storage facility can maximize the genetic diversity of banked cord blood units (CBUs) in a cost-effective fashion. The present study compared CBUs collected near the Puget Sound Blood Center in Seattle, WA, with those collected in Honolulu, HI, and processed in Seattle. Evaluated variables include collection volume, total nucleated cell count, cellular viability, CD34+ cell count, clonogenic activity, and donor race for a total of 1646 CBUs received from July 1998 through November 2002. CBUs from the two sites did not differ with regard to volume or total nucleated cells. Those from Hawaii had significantly longer transit times (p < 0.001) and lower whole cord blood cell viability. However, the numbers of CFU and viable CD34+ cells were not affected by remote collection. CBUs screened from Seattle were largely from Caucasian donors, whereas over 85 percent of those from Honolulu were from donors of Asian-Pacific Islander or mixed ethnicity. These studies demonstrate the feasibility of long-distance umbilical cord blood banking. Arrangements such as those described here could be used to help target cost-effective collection from minority populations and increase the HLA and ethnic diversity for CBUs.

Low Cost Processing of Commingled Thermoplastic Composites

NASA Astrophysics Data System (ADS)

Chiasson, Matthew Lee

A low cost vacuum consolidation process has been investigated for use with commingled thermoplastic matrix composites. In particular, the vacuum consolidation behaviour of commingled polypropylene/glass fibre and commingled nylon/carbon fibre precursors were studied. Laminates were consolidated in a convection oven under vacuum pressure. During processing, the consolidation of the laminate packs was measured by use of non-contact eddy current sensors. The consolidation curves are then used to tune an empirical consolidation model. The overall quality of the resulting laminates is also discussed. Dynamic mechanical analysis, differential scanning calorimetry and mechanical tensile testing were also performed in order to determine the effects of varying processing parameters on the physical and mechanical properties of the laminates. Through this analysis, it was determined that the nylon/carbon fibre blend was not suitable for vacuum consolidation, while the polypropylene/glass fibre blend is a viable option for vacuum consolidation. The ultimate goal of this work is to provide a foundation from which low cost unmanned aerial vehicle (UAV) components can be designed and manufactured from thermoplastic matrix composites using a low cost processing technique as an alternative to traditional thermoset composite materials.

Influence of the washing program on the blood processing performance of a continuous autotransfusion device.

PubMed

Yoon, Chiyul; Noh, Seungwoo; Lee, Jung Chan; Ko, Sung Ho; Ahn, Wonsik; Kim, Hee Chan

2014-03-01

The continuous autotransfusion system has been widely used in surgical operations. It is known that if oil is added to blood, and this mixture is then processed by an autotransfusion device, the added oil is removed and reinfusion of fat is prevented by the device. However, there is no detailed report on the influence of the particular washing program selected on the levels of blood components including blood fat after continuous autotransfusion using such a system. Fresh bovine blood samples were processed by a commercial continuous autotransfusion device using the "emergency," "quality," and "high-quality" programs, applied in random order. Complete blood count (CBC) and serum chemistry were analyzed to determine how the blood processing performance of the device changes with the washing program applied. There was no significant difference in the CBC results obtained with the three washing programs. Although all of the blood lipids in the processed blood were decreased compared to those in the blood before processing, the levels of triglyceride, phospholipid, and total cholesterol after processing via the emergency program were significantly higher than those present after processing via the quality and high-quality programs. Although the continuous autotransfusion device provided consistent hematocrit quality, the levels of some blood lipid components showed significant differences among the washing programs.

Biological effects of the electrostatic field: red blood cell-related alterations of oxidative processes in blood

NASA Astrophysics Data System (ADS)

Harutyunyan, Hayk A.; Sahakyan, Gohar V.

2016-01-01

The aim of this study was to determine activities of pro-/antioxidant enzymes, reactive oxygen species (ROS) content, and oxidative modification of proteins and lipids in red blood cells (RBCs) and blood plasma of rats exposed to electrostatic field (200 kV/m) during the short (1 h) and the long periods (6 day, 6 h daily). Short-term exposure was characterized by the increase of oxidatively damaged proteins in blood of rats. This was strongly expressed in RBC membranes. After long-term action, RBC content in peripheral blood was higher than in control ( P < 0.01) and the attenuation of prooxidant processes was shown.

Global transcriptomic profiling using small volumes of whole blood: a cost-effective method for translational genomic biomarker identification in small animals.

PubMed

Fricano, Meagan M; Ditewig, Amy C; Jung, Paul M; Liguori, Michael J; Blomme, Eric A G; Yang, Yi

2011-01-01

Blood is an ideal tissue for the identification of novel genomic biomarkers for toxicity or efficacy. However, using blood for transcriptomic profiling presents significant technical challenges due to the transcriptomic changes induced by ex vivo handling and the interference of highly abundant globin mRNA. Most whole blood RNA stabilization and isolation methods also require significant volumes of blood, limiting their effective use in small animal species, such as rodents. To overcome these challenges, a QIAzol-based RNA stabilization and isolation method (QSI) was developed to isolate sufficient amounts of high quality total RNA from 25 to 500 μL of rat whole blood. The method was compared to the standard PAXgene Blood RNA System using blood collected from rats exposed to saline or lipopolysaccharide (LPS). The QSI method yielded an average of 54 ng total RNA per μL of rat whole blood with an average RNA Integrity Number (RIN) of 9, a performance comparable with the standard PAXgene method. Total RNA samples were further processed using the NuGEN Ovation Whole Blood Solution system and cDNA was hybridized to Affymetrix Rat Genome 230 2.0 Arrays. The microarray QC parameters using RNA isolated with the QSI method were within the acceptable range for microarray analysis. The transcriptomic profiles were highly correlated with those using RNA isolated with the PAXgene method and were consistent with expected LPS-induced inflammatory responses. The present study demonstrated that the QSI method coupled with NuGEN Ovation Whole Blood Solution system is cost-effective and particularly suitable for transcriptomic profiling of minimal volumes of whole blood, typical of those obtained with small animal species.

Real-time blood flow visualization using the graphics processing unit

NASA Astrophysics Data System (ADS)

Yang, Owen; Cuccia, David; Choi, Bernard

2011-01-01

Laser speckle imaging (LSI) is a technique in which coherent light incident on a surface produces a reflected speckle pattern that is related to the underlying movement of optical scatterers, such as red blood cells, indicating blood flow. Image-processing algorithms can be applied to produce speckle flow index (SFI) maps of relative blood flow. We present a novel algorithm that employs the NVIDIA Compute Unified Device Architecture (CUDA) platform to perform laser speckle image processing on the graphics processing unit. Software written in C was integrated with CUDA and integrated into a LabVIEW Virtual Instrument (VI) that is interfaced with a monochrome CCD camera able to acquire high-resolution raw speckle images at nearly 10 fps. With the CUDA code integrated into the LabVIEW VI, the processing and display of SFI images were performed also at ~10 fps. We present three video examples depicting real-time flow imaging during a reactive hyperemia maneuver, with fluid flow through an in vitro phantom, and a demonstration of real-time LSI during laser surgery of a port wine stain birthmark.

Real-time blood flow visualization using the graphics processing unit

PubMed Central

Yang, Owen; Cuccia, David; Choi, Bernard

2011-01-01

Laser speckle imaging (LSI) is a technique in which coherent light incident on a surface produces a reflected speckle pattern that is related to the underlying movement of optical scatterers, such as red blood cells, indicating blood flow. Image-processing algorithms can be applied to produce speckle flow index (SFI) maps of relative blood flow. We present a novel algorithm that employs the NVIDIA Compute Unified Device Architecture (CUDA) platform to perform laser speckle image processing on the graphics processing unit. Software written in C was integrated with CUDA and integrated into a LabVIEW Virtual Instrument (VI) that is interfaced with a monochrome CCD camera able to acquire high-resolution raw speckle images at nearly 10 fps. With the CUDA code integrated into the LabVIEW VI, the processing and display of SFI images were performed also at ∼10 fps. We present three video examples depicting real-time flow imaging during a reactive hyperemia maneuver, with fluid flow through an in vitro phantom, and a demonstration of real-time LSI during laser surgery of a port wine stain birthmark. PMID:21280915

Process, cost, and clinical quality: the initial oral contraceptive visit.

PubMed

McMullen, Michael J; Woolford, Samuel W; Moore, Charles L; Berger, Barry M

2013-01-01

To demonstrate how the analysis of clinical process, cost, and outcomes can identify healthcare improvements that reduce cost without sacrificing quality, using the example of the initial visit associated with oral contraceptive pill use. Cross-sectional study using data collected by HealthMETRICS between 1996 and 2009. Using data collected from 106 sites in 24 states, the unintended pregnancy (UIP) rate, effectiveness of patient education, and unit visit cost were calculated. Staff type providing education and placement of education were recorded. Two-way analysis of variance models were created and tested for significance to identify differences between groups. Sites using nonclinical staff to provide education outside the exam were associated with lower cost, higher education scores, and a UIP rate no different from that of sites using clinical staff. Sites also providing patient education during the physical examination were associated with higher cost, lower education scores, and a UIP rate no lower than that of sites providing education outside of the exam. Through analyzing process, cost, and quality, lower-cost processes that did not reduce clinical quality were identified. This methodology is applicable to other clinical services for identifying low-cost processes that do not result in lower clinical quality. By using nonclinical staff educators to provide education outside of the physical examination, sites could save an average of 32% of the total cost of the visit.

Mobile Clinic In Massachusetts Associated With Cost Savings From Lowering Blood Pressure And Emergency Department Use

PubMed Central

Hill, Caterina; Bennet, Jennifer; Vavasis, Anthony; Oriol, Nancy E.

2014-01-01

Mobile health clinics are in increasingly wide use, but evidence of their clinical impact or cost-effectiveness is limited. Using a unique data set of 5,900 patients who made a total of 10,509 visits in 2010–12 to the Family Van, an urban mobile health clinic in Massachusetts, we examined the effect of screenings and counseling provided by the clinic on blood pressure. Patients who presented with high blood pressure during their initial visit experienced average reductions of 10.7 mmHg and 6.2 mmHg in systolic and diastolic blood pressure, respectively, during their follow-up visits. These changes were associated with 32.2 percent and 44.6 percent reductions in the relative risk of myocardial infarction and stroke, respectively, which we converted into savings using estimates of the incidence and costs of these conditions over thirty months. The savings from this reduction in blood pressure and patient-reported avoided emergency department visits produced a positive lower bound for the clinic’s return on investment of 1.3. All other services of the clinic—those aimed at diabetes, obesity, and maternal health, for example—were excluded from this lower-bound estimate. Policy makers should consider mobile clinics as a delivery model for underserved communities with poor health status and high use of emergency departments. PMID:23297269

Mobile clinic in Massachusetts associated with cost savings from lowering blood pressure and emergency department use.

PubMed

Song, Zirui; Hill, Caterina; Bennet, Jennifer; Vavasis, Anthony; Oriol, Nancy E

2013-01-01

Mobile health clinics are in increasingly wide use, but evidence of their clinical impact or cost-effectiveness is limited. Using a unique data set of 5,900 patients who made a total of 10,509 visits in 2010-12 to the Family Van, an urban mobile health clinic in Massachusetts, we examined the effect of screenings and counseling provided by the clinic on blood pressure. Patients who presented with high blood pressure during their initial visit experienced average reductions of 10.7 mmHg and 6.2 mmHg in systolic and diastolic blood pressure, respectively, during their follow-up visits. These changes were associated with 32.2 percent and 44.6 percent reductions in the relative risk of myocardial infarction and stroke, respectively, which we converted into savings using estimates of the incidence and costs of these conditions over thirty months. The savings from this reduction in blood pressure and patient-reported avoided emergency department visits produced a positive lower bound for the clinic's return on investment of 1.3. All other services of the clinic-those aimed at diabetes, obesity, and maternal health, for example-were excluded from this lower-bound estimate. Policy makers should consider mobile clinics as a delivery model for underserved communities with poor health status and high use of emergency departments.

A Framework for Automating Cost Estimates in Assembly Processes

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

Calton, T.L.; Peters, R.R.

1998-12-09

When a product concept emerges, the manufacturing engineer is asked to sketch out a production strategy and estimate its cost. The engineer is given an initial product design, along with a schedule of expected production volumes. The engineer then determines the best approach to manufacturing the product, comparing a variey of alternative production strategies. The engineer must consider capital cost, operating cost, lead-time, and other issues in an attempt to maximize pro$ts. After making these basic choices and sketching the design of overall production, the engineer produces estimates of the required capital, operating costs, and production capacity. 177is process maymore » iterate as the product design is refined in order to improve its pe~ormance or manufacturability. The focus of this paper is on the development of computer tools to aid manufacturing engineers in their decision-making processes. This computer sof~are tool provides aj?amework in which accurate cost estimates can be seamlessly derivedfiom design requirements at the start of any engineering project. Z+e result is faster cycle times through first-pass success; lower ll~e cycie cost due to requirements-driven design and accurate cost estimates derived early in the process.« less

[Logistic and production process in a regional blood center: modeling and analysis].

PubMed

Baesler, Felipe; Martínez, Cristina; Yaksic, Eduardo; Herrera, Claudia

2011-09-01

The blood supply chain is a complex system that considers different interconnected elements that have to be synchronized correctly to satisfy in quality and quantity the final patient requirements. To determine the blood center maximum production capacity, as well as the determination of the necessary changes for a future production capacity expansion. This work was developed in the Blood Center of Concepción, Chile, operations management tools were applied to model it and to propose improvement alternatives for the production process. The use of simulation is highlighted, which permitted the replication of the center behavior and the evaluation of expansion alternatives. It is possible to absorb a 100% increment in blood demand, without making major changes or investments in the production process. Also it was possible to determine the subsequent steps in terms of investments in equipment and human resources for a future expansion of the center coverage. The techniques used to model the production process of the blood center of Concepción, Chile, allowed us to analyze how it operates, to detect "bottle necks", and to support the decision making process for a future expansion of its capacity.

Process and assembly plans for low cost commercial fuselage structure

NASA Technical Reports Server (NTRS)

Willden, Kurtis; Metschan, Stephen; Starkey, Val

1991-01-01

Cost and weight reduction for a composite structure is a result of selecting design concepts that can be built using efficient low cost manufacturing and assembly processes. Since design and manufacturing are inherently cost dependent, concurrent engineering in the form of a Design-Build Team (DBT) is essential for low cost designs. Detailed cost analysis from DBT designs and hardware verification must be performed to identify the cost drivers and relationships between design and manufacturing processes. Results from the global evaluation are used to quantitatively rank design, identify cost centers for higher ranking design concepts, define and prioritize a list of technical/economic issues and barriers, and identify parameters that control concept response. These results are then used for final design optimization.

RTM: Cost-effective processing of composite structures

NASA Technical Reports Server (NTRS)

Hasko, Greg; Dexter, H. Benson

1991-01-01

Resin transfer molding (RTM) is a promising method for cost effective fabrication of high strength, low weight composite structures from textile preforms. In this process, dry fibers are placed in a mold, resin is introduced either by vacuum infusion or pressure, and the part is cured. RTM has been used in many industries, including automotive, recreation, and aerospace. Each of the industries has different requirements of material strength, weight, reliability, environmental resistance, cost, and production rate. These requirements drive the selection of fibers and resins, fiber volume fractions, fiber orientations, mold design, and processing equipment. Research is made into applying RTM to primary aircraft structures which require high strength and stiffness at low density. The material requirements are discussed of various industries, along with methods of orienting and distributing fibers, mold configurations, and processing parameters. Processing and material parameters such as resin viscosity, perform compaction and permeability, and tool design concepts are discussed. Experimental methods to measure preform compaction and permeability are presented.

Cost model for biobanks.

PubMed

Gonzalez-Sanchez, M Beatriz; Lopez-Valeiras, Ernesto; Morente, Manuel M; Fernández Lago, Orlando

2013-10-01

Current economic conditions and budget constraints in publicly funded biomedical research have brought about a renewed interest in analyzing the cost and economic viability of research infrastructures. However, there are no proposals for specific cost accounting models for these types of organizations in the international scientific literature. The aim of this paper is to present the basis of a cost analysis model useful for any biobank regardless of the human biological samples that it stores for biomedical research. The development of a unique cost model for biobanks can be a complicated task due to the diversity of the biological samples they store. Different types of samples (DNA, tumor tissues, blood, serum, etc.) require different production processes. Nonetheless, the common basic steps of the production process can be identified. Thus, the costs incurred in each step can be analyzed in detail to provide cost information. Six stages and four cost objects were obtained by taking the production processes of biobanks belonging to the Spanish National Biobank Network as a starting point. Templates and examples are provided to help managers to identify and classify the costs involved in their own biobanks to implement the model. The application of this methodology will provide accurate information on cost objects, along with useful information to give an economic value to the stored samples, to analyze the efficiency of the production process and to evaluate the viability of some sample collections.

Low-cost laser speckle contrast imaging of blood flow using a webcam.

PubMed

Richards, Lisa M; Kazmi, S M Shams; Davis, Janel L; Olin, Katherine E; Dunn, Andrew K

2013-01-01

Laser speckle contrast imaging has become a widely used tool for dynamic imaging of blood flow, both in animal models and in the clinic. Typically, laser speckle contrast imaging is performed using scientific-grade instrumentation. However, due to recent advances in camera technology, these expensive components may not be necessary to produce accurate images. In this paper, we demonstrate that a consumer-grade webcam can be used to visualize changes in flow, both in a microfluidic flow phantom and in vivo in a mouse model. A two-camera setup was used to simultaneously image with a high performance monochrome CCD camera and the webcam for direct comparison. The webcam was also tested with inexpensive aspheric lenses and a laser pointer for a complete low-cost, compact setup ($90, 5.6 cm length, 25 g). The CCD and webcam showed excellent agreement with the two-camera setup, and the inexpensive setup was used to image dynamic blood flow changes before and after a targeted cerebral occlusion.

Low-cost laser speckle contrast imaging of blood flow using a webcam

PubMed Central

Richards, Lisa M.; Kazmi, S. M. Shams; Davis, Janel L.; Olin, Katherine E.; Dunn, Andrew K.

2013-01-01

Laser speckle contrast imaging has become a widely used tool for dynamic imaging of blood flow, both in animal models and in the clinic. Typically, laser speckle contrast imaging is performed using scientific-grade instrumentation. However, due to recent advances in camera technology, these expensive components may not be necessary to produce accurate images. In this paper, we demonstrate that a consumer-grade webcam can be used to visualize changes in flow, both in a microfluidic flow phantom and in vivo in a mouse model. A two-camera setup was used to simultaneously image with a high performance monochrome CCD camera and the webcam for direct comparison. The webcam was also tested with inexpensive aspheric lenses and a laser pointer for a complete low-cost, compact setup ($90, 5.6 cm length, 25 g). The CCD and webcam showed excellent agreement with the two-camera setup, and the inexpensive setup was used to image dynamic blood flow changes before and after a targeted cerebral occlusion. PMID:24156082

New technologies for solar energy silicon - Cost analysis of dichlorosilane process

NASA Technical Reports Server (NTRS)

Yaws, C. L.; Li, K.-Y.; Chu, T. C. T.; Fang, C. S.; Lutwack, R.; Briglio, A., Jr.

1981-01-01

A reduction in the cost of silicon for solar cells is an important objective in a project concerned with the reduction of the cost of electricity produced with solar cells. The cost goal for the silicon material is about $14 per kg (1980 dollars). The process which is currently employed to produce semiconductor grade silicon from trichlorosilane is not suited for meeting this cost goal. Other processes for producing silicon are, therefore, being investigated. A description is presented of results obtained for the DCS process which involves the production of dichlorosilane as a silicon source material for solar energy silicon. Major benefits of dichlorosilane as a silicon source material include faster reaction rates for chemical vapor deposition of silicon. The DCS process involves the reaction 2SiHCl3 yields reversibly SiH2Cl2 + SiCl4. The results of a cost analysis indicate a total product cost without profit of $1.29/kg of SiH2Cl2.

Reactive control processes contributing to residual switch cost and mixing cost across the adult lifespan.

PubMed

Whitson, Lisa R; Karayanidis, Frini; Fulham, Ross; Provost, Alexander; Michie, Patricia T; Heathcote, Andrew; Hsieh, Shulan

2014-01-01

In task-switching paradigms, performance is better when repeating the same task than when alternating between tasks (switch cost) and when repeating a task alone rather than intermixed with another task (mixing cost). These costs remain even after extensive practice and when task cues enable advanced preparation (residual costs). Moreover, residual reaction time mixing cost has been consistently shown to increase with age. Residual switch and mixing costs modulate the amplitude of the stimulus-locked P3b. This mixing effect is disproportionately larger in older adults who also prepare more for and respond more cautiously on these "mixed" repeat trials (Karayanidis et al., 2011). In this paper, we analyze stimulus-locked and response-locked P3 and lateralized readiness potentials to identify whether residual switch and mixing cost arise from the need to control interference at the level of stimulus processing or response processing. Residual mixing cost was associated with control of stimulus-level interference, whereas residual switch cost was also associated with a delay in response selection. In older adults, the disproportionate increase in mixing cost was associated with greater interference at the level of decision-response mapping and response programming for repeat trials in mixed-task blocks. These findings suggest that older adults strategically recruit greater proactive and reactive control to overcome increased susceptibility to post-stimulus interference. This interpretation is consistent with recruitment of compensatory strategies to compensate for reduced repetition benefit rather than an overall decline on cognitive flexibility.

Reactive control processes contributing to residual switch cost and mixing cost across the adult lifespan

PubMed Central

Whitson, Lisa R.; Karayanidis, Frini; Fulham, Ross; Provost, Alexander; Michie, Patricia T.; Heathcote, Andrew; Hsieh, Shulan

2014-01-01

In task-switching paradigms, performance is better when repeating the same task than when alternating between tasks (switch cost) and when repeating a task alone rather than intermixed with another task (mixing cost). These costs remain even after extensive practice and when task cues enable advanced preparation (residual costs). Moreover, residual reaction time mixing cost has been consistently shown to increase with age. Residual switch and mixing costs modulate the amplitude of the stimulus-locked P3b. This mixing effect is disproportionately larger in older adults who also prepare more for and respond more cautiously on these “mixed” repeat trials (Karayanidis et al., 2011). In this paper, we analyze stimulus-locked and response-locked P3 and lateralized readiness potentials to identify whether residual switch and mixing cost arise from the need to control interference at the level of stimulus processing or response processing. Residual mixing cost was associated with control of stimulus-level interference, whereas residual switch cost was also associated with a delay in response selection. In older adults, the disproportionate increase in mixing cost was associated with greater interference at the level of decision-response mapping and response programming for repeat trials in mixed-task blocks. These findings suggest that older adults strategically recruit greater proactive and reactive control to overcome increased susceptibility to post-stimulus interference. This interpretation is consistent with recruitment of compensatory strategies to compensate for reduced repetition benefit rather than an overall decline on cognitive flexibility. PMID:24817859

Energetic costs of protein synthesis do not differ between red- and white-blooded Antarctic notothenioid fishes.

PubMed

Lewis, Johanne M; Grove, Theresa J; O'Brien, Kristin M

2015-09-01

Antarctic icefishes (Family Channichthyidae) within the suborder Notothenioidei lack the oxygen-binding protein hemoglobin (Hb), and six of the 16 species of icefishes lack myoglobin (Mb) in heart ventricle. As iron-centered proteins, Hb and Mb can promote the formation of reactive oxygen species (ROS) that damage biological macromolecules. Consistent with this, our previous studies have shown that icefishes have lower levels of oxidized proteins and lipids in oxidative muscle compared to red-blooded notothenioids. Because oxidized proteins are usually degraded by the 20S proteasome and must be resynthesized, we hypothesized that rates of protein synthesis would be lower in icefishes compared to red-blooded notothenioids, thereby reducing the energetic costs of protein synthesis and conferring a benefit to the loss of Hb and Mb. Rates of protein synthesis were quantified in hearts, and the fraction of oxygen consumption devoted to protein synthesis was measured in isolated hepatocytes and cardiomyocytes of notothenioids differing in the expression of Hb and cardiac Mb. Neither rates of protein synthesis nor the energetic costs of protein synthesis differed among species, suggesting that red-blooded species do not degrade and replace oxidatively modified proteins at a higher rate compared to icefishes but rather, persist with higher levels of oxidized proteins. Copyright © 2015 Elsevier Inc. All rights reserved.

19 CFR 10.814 - Direct costs of processing operations.

Code of Federal Regulations, 2014 CFR

2014-04-01

... manufacture of the specific good, including fringe benefits, on-the-job training, and the costs of engineering..., design, engineering, and blueprint costs, to the extent that they are allocable to the specific good; (4... 19 Customs Duties 1 2014-04-01 2014-04-01 false Direct costs of processing operations. 10.814...

19 CFR 10.774 - Direct costs of processing operations.

Code of Federal Regulations, 2014 CFR

2014-04-01

... manufacture of the specific good, including fringe benefits, on-the-job training, and the costs of engineering..., design, engineering, and blueprint costs, to the extent that they are allocable to the specific good; (4... 19 Customs Duties 1 2014-04-01 2014-04-01 false Direct costs of processing operations. 10.774...

Effectiveness and cost-effectiveness of blood pressure screening in adolescents in the United States.

PubMed

Wang, Y Claire; Cheung, Angela M; Bibbins-Domingo, Kirsten; Prosser, Lisa A; Cook, Nancy R; Goldman, Lee; Gillman, Matthew W

2011-02-01

To compare the long-term effectiveness and cost-effectiveness of 3 approaches to managing elevated blood pressure (BP) in adolescents in the United States: no intervention, "screen-and-treat," and population-wide strategies to lower the entire BP distribution. We used a simulation model to combine several data sources to project the lifetime costs and cardiovascular outcomes for a cohort of 15-year-old U.S. adolescents under different BP approaches and conducted cost-effectiveness analysis. We obtained BP distributions from the National Health and Nutrition Examination Survey 1999-2004 and used childhood-to-adult longitudinal correlation analyses to simulate the tracking of BP. We then used the coronary heart disease policy model to estimate lifetime coronary heart disease events, costs, and quality-adjusted life years (QALY). Among screen-and-treat strategies, finding and treating the adolescents at highest risk (eg, left ventricular hypertrophy) was most cost-effective ($18000/QALY [boys] and $47000/QALY [girls]). However, all screen-and-treat strategies were dominated by population-wide strategies such as salt reduction (cost-saving [boys] and $650/QALY [girls]) and increasing physical education ($11000/QALY [boys] and $35000/QALY [girls]). Routine adolescents BP screening is moderately effective, but population-based BP interventions with broader reach could potentially be less costly and more effective for early cardiovascular disease prevention and should be implemented in parallel. Copyright © 2011 Mosby, Inc. All rights reserved.

30 CFR 250.196 - Reimbursements for reproduction and processing costs.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 2 2011-07-01 2011-07-01 false Reimbursements for reproduction and processing... SHELF General Information and Reporting Requirements § 250.196 Reimbursements for reproduction and... reproduction and processing costs separately from acquisition costs. (d) MMS will not reimburse you for data...

Field performance of a low-cost and fully-automated blood counting system operated by trained and untrained users (Conference Presentation)

NASA Astrophysics Data System (ADS)

Xie, Dengling; Xie, Yanjun; Liu, Peng; Tong, Lieshu; Chu, Kaiqin; Smith, Zachary J.

2017-02-01

Current flow-based blood counting devices require expensive and centralized medical infrastructure and are not appropriate for field use. In this paper we report a method to count red blood cells, white blood cells as well as platelets through a low-cost and fully-automated blood counting system. The approach consists of using a compact, custom-built microscope with large field-of-view to record bright-field and fluorescence images of samples that are diluted with a single, stable reagent mixture and counted using automatic algorithms. Sample collection is performed manually using a spring loaded lancet, and volume-metering capillary tubes. The capillaries are then dropped into a tube of pre-measured reagents and gently shaken for 10-30 seconds. The sample is loaded into a measurement chamber and placed on a custom 3D printed platform. Sample translation and focusing is fully automated, and a user has only to press a button for the measurement and analysis to commence. Cost of the system is minimized through the use of custom-designed motorized components. We performed a series of comparative experiments by trained and untrained users on blood from adults and children. We compare the performance of our system, as operated by trained and untrained users, to the clinical gold standard using a Bland-Altman analysis, demonstrating good agreement of our system to the clinical standard. The system's low cost, complete automation, and good field performance indicate that it can be successfully translated for use in low-resource settings where central hematology laboratories are not accessible.

Cost of Purchased Versus Produced Plasma from Donor Recruitment Through Transfusion.

PubMed

Prioli, Katherine M; Pizzi, Laura T; Karp, Julie Katz; Galanis, Taki; Herman, Jay H

2016-10-01

Plasma is used to treat acquired coagulopathy or thrombotic thrombocytopenic purpura, or to reverse warfarin effect. Scant data are available, however, about its costs. To estimate total costs of plasma from production through administration, from the perspective of a US hospital blood donor center (BDC). Six sequential decision analytic models were constructed and informed by primary and secondary data on time, tasks, personnel, and supplies for donation, processing, and administration. Expected values of the models were summed to yield the BDC's total cost of producing, preparing, and transfusing plasma. Costs ($US 2015) are reported for a typical patient using three units of plasma. Models assume plasma was obtained from whole blood donation and transfused in an inpatient setting. Univariate sensitivity analyses were performed to test the impact of changing inputs for personnel costs and adverse event (AE) rates and costs. BDC production cost of plasma was $91.24/patient ($30.41/unit), a $30.16/patient savings versus purchased plasma. Administration and monitoring costs totaled $194.64/patient. Sensitivity analyses indicated that modifying BDC personnel costs during donation and processing has little impact on total plasma costs. However, the probability and cost of transfusion-associated circulatory overload (TACO) have a significant impact on costs. Plasma produced by our BDC may be less costly than purchased plasma. Though plasma processes have multiple tasks involving staff time, these are not the largest cost driver. Major plasma-related AEs are uncommon, but are the biggest driver of total plasma costs.

A portable system for processing donated whole blood into high quality components without centrifugation.

PubMed

Gifford, Sean C; Strachan, Briony C; Xia, Hui; Vörös, Eszter; Torabian, Kian; Tomasino, Taylor A; Griffin, Gary D; Lichtiger, Benjamin; Aung, Fleur M; Shevkoplyas, Sergey S

2018-01-01

The use of centrifugation-based approaches for processing donated blood into components is routine in the industrialized world, as disparate storage conditions require the rapid separation of 'whole blood' into distinct red blood cell (RBC), platelet, and plasma products. However, the logistical complications and potential cellular damage associated with centrifugation/apheresis manufacturing of blood products are well documented. The objective of this study was to evaluate a proof-of-concept system for whole blood processing, which does not employ electromechanical parts, is easily portable, and can be operated immediately after donation with minimal human labor. In a split-unit study (n = 6), full (~500mL) units of freshly-donated whole blood were divided, with one half processed by conventional centrifugation techniques and the other with the new blood separation system. Each of these processes took 2-3 hours to complete and were performed in parallel. Blood products generated by the two approaches were compared using an extensive panel of cellular and plasma quality metrics. Comparison of nearly all RBC parameters showed no significant differences between the two approaches, although the portable system generated RBC units with a slight but statistically significant improvement in 2,3-diphosphoglyceric acid concentration (p < 0.05). More notably, several markers of platelet damage were significantly and meaningfully higher in products generated with conventional centrifugation: the increase in platelet activation (assessed via P-selectin expression in platelets before and after blood processing) was nearly 4-fold higher for platelet units produced via centrifugation, and the release of pro-inflammatory mediators (soluble CD40-ligand, thromboxane B2) was significantly higher for centrifuged platelets as well (p < 0.01). This study demonstrated that a simple, passive system for separating donated blood into components may be a viable alternative to centrifugation

Hair sheep blood, citrated or defibrinated, fulfills all requirements of blood agar for diagnostic microbiology laboratory tests.

PubMed

Yeh, Ellen; Pinsky, Benjamin A; Banaei, Niaz; Baron, Ellen Jo

2009-07-03

Blood agar is used for the identification and antibiotic susceptibility testing of many bacterial pathogens. In the developing world, microbiologists use human blood agar because of the high cost and inhospitable conditions for raising wool sheep or horses to supply blood. Many pathogens either fail to grow entirely or exhibit morphologies and hemolytic patterns on human blood agar that confound colony recognition. Furthermore, human blood can be hazardous to handle due to HIV and hepatitis. This study investigated whether blood from hair sheep, a hardy, low-maintenance variety of sheep adapted for hot climates, was suitable for routine clinical microbiology studies. Hair sheep blood obtained by jugular venipuncture was anticoagulated by either manual defibrination or collection in human blood bank bags containing citrate-phosphate-dextrose. Trypticase soy 5% blood agar was made from both forms of hair sheep blood and commercial defibrinated wool sheep blood. Growth characteristics, colony morphologies, and hemolytic patterns of selected human pathogens, including several streptococcal species, were evaluated. Specialized identification tests, including CAMP test, reverse CAMP test, and satellite colony formation with Haemophilus influenzae and Abiotrophia defectiva were also performed. Mueller-Hinton blood agar plates prepared from the three blood types were compared in antibiotic susceptibility tests by disk diffusion and E-test. The results of all studies showed that blood agar prepared from citrated hair sheep blood is suitable for microbiological tests used in routine identification and susceptibility profiling of human pathogens. The validation of citrated hair sheep blood eliminates the labor-intensive and equipment-requiring process of manual defibrination. Use of hair sheep blood, in lieu of human blood currently used by many developing world laboratories and as an alternative to cost-prohibitive commercial sheep blood, offers the opportunity to

Pooled HIV-1 viral load testing using dried blood spots to reduce the cost of monitoring antiretroviral treatment in a resource-limited setting.

PubMed

Pannus, Pieter; Fajardo, Emmanuel; Metcalf, Carol; Coulborn, Rebecca M; Durán, Laura T; Bygrave, Helen; Ellman, Tom; Garone, Daniela; Murowa, Michael; Mwenda, Reuben; Reid, Tony; Preiser, Wolfgang

2013-10-01

Rollout of routine HIV-1 viral load monitoring is hampered by high costs and logistical difficulties associated with sample collection and transport. New strategies are needed to overcome these constraints. Dried blood spots from finger pricks have been shown to be more practical than the use of plasma specimens, and pooling strategies using plasma specimens have been demonstrated to be an efficient method to reduce costs. This study found that combination of finger-prick dried blood spots and a pooling strategy is a feasible and efficient option to reduce costs, while maintaining accuracy in the context of a district hospital in Malawi.

Novel cost controlled materials and processing for primary structures

NASA Technical Reports Server (NTRS)

Dastin, S. J.

1993-01-01

Textile laminates, developed a number of years ago, have recently been shown to be applicable to primary aircraft structures for both small and large components. Such structures have the potential to reduce acquisition costs but require advanced automated processing to keep costs controlled while verifying product reliability and assuring structural integrity, durability and affordable life-cycle costs. Recently, resin systems and graphite-reinforced woven shapes have been developed that have the potential for improved RTM processes for aircraft structures. Ciba-Geigy, Brochier Division has registered an RTM prepreg reinforcement called 'Injectex' that has shown effectivity for aircraft components. Other novel approaches discussed are thermotropic resins producing components by injection molding and ceramic polymers for long-duration hot structures. The potential of such materials and processing will be reviewed along with initial information/data available to date.

Promoting health and reducing costs: a role for reform of self-monitoring of blood glucose provision within the National Health Service.

PubMed

Leigh, S; Idris, I; Collins, B; Granby, P; Noble, M; Parker, M

2016-05-01

To determine the cost-effectiveness of all options for the self-monitoring of blood glucose funded by the National Health Service, providing guidance for disinvestment and testing the hypothesis that advanced meter features may justify higher prices. Using data from the Health and Social Care Information Centre concerning all 8 340 700 self-monitoring of blood glucose-related prescriptions during 2013/2014, we conducted a cost-minimization analysis, considering both strip and lancet costs, including all clinically equivalent technologies for self-monitoring of blood glucose, as determined by the ability to meet ISO-15197:2013 guidelines for meter accuracy. A total of 56 glucose monitor, test strip and lancet combinations were identified, of which 38 met the required accuracy standards. Of these, the mean (range) net ingredient costs for test strips and lancets were £0.27 (£0.14-£0.32) and £0.04 (£0.02-£0.05), respectively, resulting in a weighted average of £0.28 (£0.18-£0.37) per test. Systems providing four or more advanced features were priced equal to those providing just one feature. A total of £12 m was invested in providing 42 million self-monitoring of blood glucose tests with systems that fail to meet acceptable accuracy standards, and efficiency savings of £23.2 m per annum are achievable if the National Health Service were to disinvest from technologies providing lesser functionality than available alternatives, but at a much higher price. The study uncovered considerable variation in the price paid by the National Health Service for self-monitoring of blood glucose, which could not be explained by the availability of advanced meter features. A standardized approach to self-monitoring of blood glucose prescribing could achieve significant efficiency savings for the National Health Service, whilst increasing overall utilisation and improving safety for those currently using systems that fail to meet acceptable standards for measurement accuracy

Low-cost exterior insulation process and structure

DOEpatents

Vohra, A.

1999-03-02

A low-cost exterior insulation process of stacking bags of insulating material against a wall and covering them with wire mesh and stucco provides a durable structure with good insulating value. 2 figs.

Optics based signal processing methods for intraoperative blood vessel detection and quantification in real time (Conference Presentation)

NASA Astrophysics Data System (ADS)

Chaturvedi, Amal; Shukair, Shetha A.; Le Rolland, Paul; Vijayvergia, Mayank; Subramanian, Hariharan; Gunn, Jonathan W.

2016-03-01

Minimally invasive operations require surgeons to make difficult cuts to blood vessels and other tissues with impaired tactile and visual feedback. This leads to inadvertent cuts to blood vessels hidden beneath tissue, causing serious health risks to patients and a non-reimbursable financial burden to hospitals. Intraoperative imaging technologies have been developed, but these expensive systems can be cumbersome and provide only a high-level view of blood vessel networks. In this research, we propose a lean reflectance-based system, comprised of a dual wavelength LED, photodiode, and novel signal processing algorithms for rapid vessel characterization. Since this system takes advantage of the inherent pulsatile light absorption characteristics of blood vessels, no contrast agent is required for its ability to detect the presence of a blood vessel buried deep inside any tissue type (up to a cm) in real time. Once a vessel is detected, the system is able to estimate the distance of the vessel from the probe and the diameter size of the vessel (with a resolution of ~2mm), as well as delineate the type of tissue surrounding the vessel. The system is low-cost, functions in real-time, and could be mounted on already existing surgical tools, such as Kittner dissectors or laparoscopic suction irrigation cannulae. Having been successfully validated ex vivo, this technology will next be tested in a live porcine study and eventually in clinical trials.

Effectiveness and Cost-Effectiveness of Blood Pressure Screening in Adolescents in the United States

PubMed Central

Wang, Y. Claire; Cheung, Angela M.; Bibbins-Domingo, Kirsten; Prosser, Lisa A.; Cook, Nancy R.; Goldman, Lee; Gillman, Matthew W.

2014-01-01

Objective To compare the long-term effectiveness and cost-effectiveness of 3 approaches to managing elevated blood pressure (BP) in adolescents in the United States: no intervention, “screen-and-treat,” and population-wide strategies to lower the entire BP distribution. Study design We used a simulation model to combine several data sources to project the lifetime costs and cardiovascular outcomes for a cohort of 15-year-old U.S. adolescents under different BP approaches and conducted cost-effectiveness analysis. We obtained BP distributions from the National Health and Nutrition Examination Survey 1999–2004 and used childhood-to-adult longitudinal correlation analyses to simulate the tracking of BP. We then used the coronary heart disease policy model to estimate lifetime coronary heart disease events, costs, and quality-adjusted life years (QALY). Results Among screen-and-treat strategies, finding and treating the adolescents at highest risk (eg, left ventricular hypertrophy) was most cost-effective ($18 000/QALY [boys] and $47 000/QALY [girls]). However, all screen-and-treat strategies were dominated by population-wide strategies such as salt reduction (cost-saving [boys] and $650/ QALY [girls]) and increasing physical education ($11 000/QALY [boys] and $35 000/QALY [girls]). Conclusions Routine adolescents BP screening is moderately effective, but population-based BP interventions with broader reach could potentially be less costly and more effective for early cardiovascular disease prevention and should be implemented in parallel. PMID:20850759

Prophylactic platelet transfusions in patients with blood malignancies: cost analysis of a randomized trial.

PubMed

Campbell, Helen E; Estcourt, Lise J; Stokes, Elizabeth A; Llewelyn, Charlotte A; Murphy, Michael F; Wood, Erica M; Stanworth, Simon J

2014-10-01

This cost analysis uses data from a randomized trial comparing a no prophylaxis versus prophylactic platelet (PLT) transfusion policy (counts <10 × 10(9) /L) in adult patients with hematologic malignancies. Results are presented for all patients and separately for autologous hematopoietic stem cell transplantation (HSCT) (autoHSCT) and chemotherapy/allogeneic HSCT (chemo/alloHSCT) patients. Data were collected to 30 days on PLT and red blood cell (RBC) transfusions, major bleeds, serious adverse events, critical care, and hematology ward stay. Data were costed using 2011 to 2012 UK unit costs and converted into US$. Sensitivity analyses were performed on uncertain cost variables. Across the whole trial no prophylaxis saved costs compared to prophylaxis: -$1760 per patient (95% confidence interval [CI], -$3250 to -$249; p < 0.05). For autoHSCT patients there was no cost difference between arms: -$110 per patient (95% CI, -$1648 to $1565; p = 0.89). For chemo/alloHSCT patients no prophylaxis cost significantly less than prophylaxis: -$5686 per patient (95% CI, -$8580 to -$2853; p < 0.01). The cost impact of no prophylaxis differed significantly between subgroups. Sensitivity analyses varying daily treatment costs and ward stay for chemo/alloHSCT patients reduced cost differences to -$941 per patient (p = 0.21) across the whole trial and -$2927 per patient (p < 0.05) in chemo/alloHSCT subgroup. It is unclear whether a no-prophylaxis policy saves costs overall. In chemo/alloHSCT patients cost savings are apparent but their magnitude is sensitive to a number of variables and must be considered alongside clinical data showing increased bleeding rates. In autoHSCT patients savings generated through lower PLT use in no-prophylaxis arm were offset by cost increases elsewhere, for example, additional RBC transfusions. Cost-effectiveness analyses of alternative PLT transfusion policies simultaneously considering costs and patient

Intraoperative blood salvage.

PubMed

Pineda, A A; Valbonesi, M

1990-04-01

Interest in and use of IBS have increased recently. This form of haemotherapy involves the retrieval of blood shed perioperatively. IBS, together with other forms of ABT, has gained a prominent role in transfusion medicine, largely due to an increased awareness of the risks associated with transfusion of homologous blood. In addition to conserving erythrocytes, IBS prevents disease transmission, other adverse transfusion reactions, and alloimmunization to antigens in blood cells and plasma which may result from homologous blood use. An array of IBS devices is presently available, ranging from disposable canisters to complete processing systems. The devices are capable of recovering, filtering, washing and reinfusing shed erythrocytes. They can be divided into slow-flow and rapid-flow systems based on the rapidity of blood processing. Most systems use a dual channel aspiration cannula through which shed blood is aspirated and mixed with anticoagulant solution. The salvage procedure requires operator control at every step, even for the highly automated instruments. Various health care personnel have been trained to operate IBS equipment; a transfusion service nurse with blood bank expertise has proved to be a highly reliable operator in our practice. Extensive clinical observation has shown that salvaged erythrocytes function and survive normally. IBS has been applied in many surgical fields; it has two relative contraindications: its use in areas affected by infection or malignancy. Operative procedures characterized by large blood losses provide a cost-efficient application of IBS, including cardiac surgery, orthopaedic procedures, trauma, vascular surgery, and liver transplantation. New, highly efficient technology is emerging that is capable of recovering other blood components. Consequently, what presently amounts to erythrocyte recovery will be expanded shortly to include platelets and plasma, with its many constituents.

COST ESTIMATION MODELS FOR DRINKING WATER TREATMENT UNIT PROCESSES

EPA Science Inventory

Cost models for unit processes typically utilized in a conventional water treatment plant and in package treatment plant technology are compiled in this paper. The cost curves are represented as a function of specified design parameters and are categorized into four major catego...

Radiofrequency bipolar hemostatic sealer reduces blood loss, transfusion requirements, and cost for patients undergoing multilevel spinal fusion surgery: a case control study.

PubMed

Frank, Steven M; Wasey, Jack O; Dwyer, Ian M; Gokaslan, Ziya L; Ness, Paul M; Kebaish, Khaled M

2014-07-05

A relatively new method of electrocautery, the radiofrequency bipolar hemostatic sealer (RBHS), uses saline-cooled delivery of energy, which seals blood vessels rather than burning them. We assessed the benefits of RBHS as a blood conservation strategy in adult patients undergoing multilevel spinal fusion surgery. In a retrospective cohort study, we compared blood utilization in 36 patients undergoing multilevel spinal fusion surgery with RBHS (Aquamantys, Medtronic, Minneapolis, MN, USA) to that of a historical control group (n = 38) matched for variables related to blood loss. Transfusion-related costs were calculated by two methods. Patient characteristics in the two groups were similar. Intraoperatively, blood loss was 55% less in the RBHS group than in the control group (810 ± 530 vs. 1,800 ± 1,600 mL; p = 0.002), and over the entire hospital stay, red cell utilization was 51% less (2.4 ± 3.4 vs. 4.9 ± 4.5 units/patient; p = 0.01) and plasma use was 56% less (1.1 ± 2.4 vs. 2.5 ± 3.4 units/patient; p = 0.03) in the RBHS group. Platelet use was 0.1 ± 0.5 and 0.3 ± 0.6 units/patient in the RBHS and control groups, respectively (p = 0.07). The perioperative decrease in hemoglobin was less in the RBHS group than in the control group (-2.0 ± 2.2 vs. -3.2 ± 2.1 g/dL; p = 0.04), and hemoglobin at discharge was higher in the RBHS group (10.5 ± 1.4 vs. 9.7 ± 0.9 g/dL; p = 0.01). The estimated transfusion-related cost savings were $745/case by acquisition cost and approximately 3- to 5-fold this amount by activity-based cost. The use of RBHS in patients undergoing multilevel spine fusion surgery can conserve blood, promote higher hemoglobin levels, and reduce transfusion-related costs.

An assessment of differences in costs and health benefits of serology and NAT screening of donations for blood transfusion in different Western countries.

PubMed

Janssen, M P; van Hulst, M; Custer, B

2017-08-01

The cost-utility of safety interventions is becoming increasingly important as a driver of implementation decisions. The aim of this study was to compare the cost-utility of different blood screening strategies in various settings, and to analyse the extent and cause of differences in health economic results. For eight Western countries (Australia, Canada, Denmark, Finland, France, The Netherlands, UK and the United States of America), data were collected on donor and recipient populations, blood products, screening tests, and on patient treatment practices and costs. An existing ISBT web-tool model was used to assess the cost-utility of various strategies for HIV, HCV and HBV screening. The cost-utility ratio of serology screening for these eight countries ranges between -11 000 and 92 000 US$ per QALY, and for NAT between -12 000 and 113 000 US$ per QALY when compared to no screening. Combined serology and NAT ranges between 600 and 217 000 US$ per QALY. The incremental cost-utility of NAT after implementation of serology screening ranges from 2 231 000 to 15 778 000 US$ per QALY. There are substantial differences in costs per QALY between countries for various HIV, HBV and HCV screening strategies. These differences are primarily caused by costs of screening tests and infection rates in the donor population. Within each country, similar cost per QALY results for serology and NAT compared to no screening, coupled with evidence of limited value of serology and NAT together prompts the need for further discussion on the acceptability of parallel testing by serology and NAT. © 2017 International Society of Blood Transfusion.

Mechanical impedance measurements for improved cost-effective process monitoring

NASA Astrophysics Data System (ADS)

Clopet, Caroline R.; Pullen, Deborah A.; Badcock, Rodney A.; Ralph, Brian; Fernando, Gerard F.; Mahon, Steve W.

1999-06-01

The aerospace industry has seen a considerably growth in composite usage over the past ten years, especially with the development of cost effective manufacturing techniques such as Resin Transfer Molding and Resin Infusion under Flexible Tooling. The relatively high cost of raw material and conservative processing schedules has limited their growth further in non-aerospace technologies. In-situ process monitoring has been explored for some time as a means to improving the cost efficiency of manufacturing with dielectric spectroscopy and optical fiber sensors being the two primary techniques developed to date. A new emerging technique is discussed here making use of piezoelectric wafers with the ability to sense not only aspects of resin flow but also to detect the change in properties of the resin as it cures. Experimental investigations to date have shown a correlation between mechanical impedance measurements and the mechanical properties of cured epoxy systems with potential for full process monitoring.

HYBRID SULFUR PROCESS REFERENCE DESIGN AND COST ANALYSIS

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

Gorensek, M.; Summers, W.; Boltrunis, C.

2009-05-12

This report documents a detailed study to determine the expected efficiency and product costs for producing hydrogen via water-splitting using energy from an advanced nuclear reactor. It was determined that the overall efficiency from nuclear heat to hydrogen is high, and the cost of hydrogen is competitive under a high energy cost scenario. It would require over 40% more nuclear energy to generate an equivalent amount of hydrogen using conventional water-cooled nuclear reactors combined with water electrolysis compared to the proposed plant design described herein. There is a great deal of interest worldwide in reducing dependence on fossil fuels, whilemore » also minimizing the impact of the energy sector on global climate change. One potential opportunity to contribute to this effort is to replace the use of fossil fuels for hydrogen production by the use of water-splitting powered by nuclear energy. Hydrogen production is required for fertilizer (e.g. ammonia) production, oil refining, synfuels production, and other important industrial applications. It is typically produced by reacting natural gas, naphtha or coal with steam, which consumes significant amounts of energy and produces carbon dioxide as a byproduct. In the future, hydrogen could also be used as a transportation fuel, replacing petroleum. New processes are being developed that would permit hydrogen to be produced from water using only heat or a combination of heat and electricity produced by advanced, high temperature nuclear reactors. The U.S. Department of Energy (DOE) is developing these processes under a program known as the Nuclear Hydrogen Initiative (NHI). The Republic of South Africa (RSA) also is interested in developing advanced high temperature nuclear reactors and related chemical processes that could produce hydrogen fuel via water-splitting. This report focuses on the analysis of a nuclear hydrogen production system that combines the Pebble Bed Modular Reactor (PBMR), under

Transfusion safety: is this the business of blood centers?

PubMed

Slapak, Colleen; Fredrich, Nanci; Wagner, Jeffrey

2011-12-01

ATSO is in a unique position to break down organizational silos between hospitals and blood centers through the development of a collaborative relationship between the two entities. Use of the TSO as blood center staff centralizes the role into a consultative position thereby retaining the independence of the hospitals. The TSO position then becomes a value-added service offered by the blood center designed to supplement processes within the hospital.Whether the TSO is based in the hospital or the blood center, improvements are gained through appropriate utilization of blood components, reductions in hospital costs, ongoing education of hospital staff involved in transfusion practice, and increased availability of blood products within the community. Implementation and standardization of best practice processes for ordering and administration of blood products developed by TSOs leads to improved patient outcomes. As a liaison between hospitals and blood centers, the TSO integrates the mutual goal of transfusion safety: the provision of the safest blood product to the right patient at the right time for the right reason.

Strengthening the service continuum between transfusion providers and suppliers: enhancing the blood services network.

PubMed

Sime, Stacy L

2005-10-01

As the cost of health care increases, the focus on cost containment grows. The pressure to reduce costs comes at the same time the public focus is on ensuring a zero-risk blood supply. The blood supply has never been safer or more expensive. With the relative vanquishing of transfusion-transmitted diseases, noninfectious risks now exceed infectious risks. This has resulted in a call to refocus blood safety efforts on interconnected processes that link a unit of blood from its volunteer blood donor to the patient. Additional costs in the blood supply chain will create new pressures on an already taxed system that gets little additional reimbursement with each new safety initiative. Opposing interests have created a tenuous relationship between the blood supplier and the transfusion provider. This adversarial relationship does not benefit the ultimate stakeholder, the patient. It is time to create a service partnership that is built on access, cost, and quality. Initiatives must be undertaken at a local, regional, and national level. Locally, blood suppliers and transfusion providers must reevaluate policies that are focused on individual gain and reinvent policies that will reward improvements in the overall system and expand cooperative services. Regionally, both blood suppliers and transfusion providers need to consolidate services to gain cost and quality benefits without compromising the competitive nature of the industry. Nationally, the creation of a strategic plan will help ensure that a mutually beneficial relationship focused on the patient is created between the blood supplier and transfusion provider at all levels. Development of such a plan would benefit the transfusing and supplying parties by identifying areas of common interest and how each may facilitate the achievement of shared benefits.

Low cost 3D scanning process using digital image processing

NASA Astrophysics Data System (ADS)

Aguilar, David; Romero, Carlos; Martínez, Fernando

2017-02-01

This paper shows the design and building of a low cost 3D scanner, able to digitize solid objects through contactless data acquisition, using active object reflection. 3D scanners are used in different applications such as: science, engineering, entertainment, etc; these are classified in: contact scanners and contactless ones, where the last ones are often the most used but they are expensive. This low-cost prototype is done through a vertical scanning of the object using a fixed camera and a mobile horizontal laser light, which is deformed depending on the 3-dimensional surface of the solid. Using digital image processing an analysis of the deformation detected by the camera was done; it allows determining the 3D coordinates using triangulation. The obtained information is processed by a Matlab script, which gives to the user a point cloud corresponding to each horizontal scanning done. The obtained results show an acceptable quality and significant details of digitalized objects, making this prototype (built on LEGO Mindstorms NXT kit) a versatile and cheap tool, which can be used for many applications, mainly by engineering students.

Pretreatment of whole blood using hydrogen peroxide and UV irradiation. Design of the advanced oxidation process.

PubMed

Bragg, Stefanie A; Armstrong, Kristie C; Xue, Zi-Ling

2012-08-15

A new process to pretreat blood samples has been developed. This process combines the Advanced Oxidation Process (AOP) treatment (using H(2)O(2) and UV irradiation) with acid deactivation of the enzyme catalase in blood. A four-cell reactor has been designed and built in house. The effect of pH on the AOP process has been investigated. The kinetics of the pretreatment process shows that at high C(H(2)O(2),t=0), the reaction is zeroth order with respect to C(H(2)O(2)) and first order with respect to C(blood). The rate limiting process is photon flux from the UV lamp. Degradation of whole blood has been compared with that of pure hemoglobin samples. The AOP pretreatment of the blood samples has led to the subsequent determination of chromium and zinc concentrations in the samples using electrochemical methods. Copyright © 2012 Elsevier B.V. All rights reserved.

Cost model relationships between textile manufacturing processes and design details for transport fuselage elements

NASA Technical Reports Server (NTRS)

Metschan, Stephen L.; Wilden, Kurtis S.; Sharpless, Garrett C.; Andelman, Rich M.

1993-01-01

Textile manufacturing processes offer potential cost and weight advantages over traditional composite materials and processes for transport fuselage elements. In the current study, design cost modeling relationships between textile processes and element design details were developed. Such relationships are expected to help future aircraft designers to make timely decisions on the effect of design details and overall configurations on textile fabrication costs. The fundamental advantage of a design cost model is to insure that the element design is cost effective for the intended process. Trade studies on the effects of processing parameters also help to optimize the manufacturing steps for a particular structural element. Two methods of analyzing design detail/process cost relationships developed for the design cost model were pursued in the current study. The first makes use of existing databases and alternative cost modeling methods (e.g. detailed estimating). The second compares design cost model predictions with data collected during the fabrication of seven foot circumferential frames for ATCAS crown test panels. The process used in this case involves 2D dry braiding and resin transfer molding of curved 'J' cross section frame members having design details characteristic of the baseline ATCAS crown design.

Process-Based Governance in Public Administrations Using Activity-Based Costing

NASA Astrophysics Data System (ADS)

Becker, Jörg; Bergener, Philipp; Räckers, Michael

Decision- and policy-makers in public administrations currently lack on missing relevant information for sufficient governance. In Germany the introduction of New Public Management and double-entry accounting enable public administrations to get the opportunity to use cost-centered accounting mechanisms to establish new governance mechanisms. Process modelling in this case can be a useful instrument to help the public administrations decision- and policy-makers to structure their activities and capture relevant information. In combination with approaches like Activity-Based Costing, higher management level can be supported with a reasonable data base for fruitful and reasonable governance approaches. Therefore, the aim of this article is combining the public sector domain specific process modelling method PICTURE and concept of activity-based costing for supporting Public Administrations in process-based Governance.

Feasibility of using continuous chromatography in downstream processing: Comparison of costs and product quality for a hybrid process vs. a conventional batch process.

PubMed

Ötes, Ozan; Flato, Hendrik; Winderl, Johannes; Hubbuch, Jürgen; Capito, Florian

2017-10-10

The protein A capture step is the main cost-driver in downstream processing, with high attrition costs especially when using protein A resin not until end of resin lifetime. Here we describe a feasibility study, transferring a batch downstream process to a hybrid process, aimed at replacing batch protein A capture chromatography with a continuous capture step, while leaving the polishing steps unchanged to minimize required process adaptations compared to a batch process. 35g of antibody were purified using the hybrid approach, resulting in comparable product quality and step yield compared to the batch process. Productivity for the protein A step could be increased up to 420%, reducing buffer amounts by 30-40% and showing robustness for at least 48h continuous run time. Additionally, to enable its potential application in a clinical trial manufacturing environment cost of goods were compared for the protein A step between hybrid process and batch process, showing a 300% cost reduction, depending on processed volumes and batch cycles. Copyright © 2017 Elsevier B.V. All rights reserved.

Shaped Charge Liner Materials: Resources, Processes, Properties, Costs, and Applications

DTIC Science & Technology

1991-02-01

SUBTITLE 5. FUNDING NUMBERS Shaped Charge Liner Materials: Resources, Processes, Properties, Costs, and Applications 2 6. AUTHOC Steven M. Buc 7...summaries of the mineral availability, Cq prmarymetal refinement processeb, material costs in raw form and as finished shaped charge liners , relevant... liner materials. 94-11479 gI 14, SUBJECT TERMS iSt NUMBER OF PAGIS 13chrg wrhad :xplosively formed penetrators material R. PRCE COEV" processing

Producing optical (contact) lenses by a novel low cost process

NASA Astrophysics Data System (ADS)

Skipper, Richard S.; Spencer, Ian D.

2005-09-01

The rapid and impressive growth of China has been achieved on the back of highly labour intensive industries, often in manufacturing, and at the cost of companies and jobs in Europe and America. Approaches that worked well in the 1990's to reduce production costs in the developed countries are no longer effective when confronted with the low labour costs of China and India. We have looked at contact lenses as a product that has become highly available to consumers here but as an industry that has reduced costs by moving to low labour cost countries. The question to be answered was, "Do we have the skill to still make the product in the UK, and can we make it cheap enough to export to China?" if we do not, then contact lens manufacture will move to China sooner or later. The challenge to enter the markets of the BRIC (Brazil, Russia, India and China) countries is extremely exciting as here is the new money, high growth and here is a product that sells to those with disposable incomes. To succeed we knew we had to be radical in our approach; the radical step was very simple: to devise a process in which each step added value to the customer and not cost to the product. The presentation examines the processes used by the major producers and how, by applying good manufacturing practice sound scientific principles to them, the opportunity to design a new low cost patented process was identified.

From blood transfusion to patient blood management: a new paradigm for patient care and cost assessment of blood transfusion practice.

PubMed

Leahy, M F; Mukhtar, S A

2012-03-01

The ageing population in developed countries, including Australia, is putting increasing demands on blood transfusion services. With a falling donor pool there is likely to be a shortage of blood and blood products in the next 20 to 30 years unless there are significant changes in medical practice. The National Health and Medical Research Council/Australasian Society of Blood Transfusion Clinical Practice Guidelines on the Use of Blood Components from 2001 are being redeveloped by the National Health and Medical Research Council/Australian and New Zealand Society of Blood Transfusion as evidence-based patient-focused Patient Blood Management guidelines with the aim of improving patient outcomes by reducing inappropriate blood and blood product use and targeting therapies for improving the management of anaemia and coagulopathies. © 2012 The Authors. Internal Medicine Journal © 2012 Royal Australasian College of Physicians.

Point-of-care, portable microfluidic blood analyzer system

NASA Astrophysics Data System (ADS)

Maleki, Teimour; Fricke, Todd; Quesenberry, J. T.; Todd, Paul W.; Leary, James F.

2012-03-01

Recent advances in MEMS technology have provided an opportunity to develop microfluidic devices with enormous potential for portable, point-of-care, low-cost medical diagnostic tools. Hand-held flow cytometers will soon be used in disease diagnosis and monitoring. Despite much interest in miniaturizing commercially available cytometers, they remain costly, bulky, and require expert operation. In this article, we report progress on the development of a battery-powered handheld blood analyzer that will quickly and automatically process a drop of whole human blood by real-time, on-chip magnetic separation of white blood cells (WBCs), fluorescence analysis of labeled WBC subsets, and counting a reproducible fraction of the red blood cells (RBCs) by light scattering. The whole blood (WB) analyzer is composed of a micro-mixer, a special branching/separation system, an optical detection system, and electronic readout circuitry. A droplet of un-processed blood is mixed with the reagents, i.e. magnetic beads and fluorescent stain in the micro-mixer. Valve-less sorting is achieved by magnetic deflection of magnetic microparticle-labeled WBC. LED excitation in combination with an avalanche photodiode (APD) detection system is used for counting fluorescent WBC subsets using several colors of immune-Qdots, while counting a reproducible fraction of red blood cells (RBC) is performed using a laser light scatting measurement with a photodiode. Optimized branching/channel width is achieved using Comsol Multi-Physics™ simulation. To accommodate full portability, all required power supplies (40v, +/-10V, and +3V) are provided via step-up voltage converters from one battery. A simple onboard lock-in amplifier is used to increase the sensitivity/resolution of the pulse counting circuitry.

Evaluation of canine red blood cell quality after processing with an automated cell salvage device.

PubMed

Hofbauer, Nina; Windberger, Ursula; Schwendenwein, Ilse; Tichy, Alexander; Eberspächer, Eva

2016-05-01

To evaluate the properties of RBC concentrate harvested after processing fresh whole blood units from healthy dogs with an automated cell salvage device. Prospective, in vitro, experimental study. University teaching hospital. Sixteen healthy, privately owned dogs of various breeds. Fresh canine whole blood collected in bags with citrate phosphate dextrose adenine solution was processed with an automated cell salvage device and analyzed in vitro. Laboratory values determined before (baseline, from a catheter sample) and after processing RBCs (procRBCs) included a complete blood count, selected blood chemistry analytes, erythrocyte osmotic resistance, whole blood viscosity, RBC aggregation, and RBC deformability. Total recovery of RBCs was 80% ± 12%. Hematocrit of the procRBCs yielded by the device was 77% ± 3.7% (mean ± standard deviation). Gross morphology of the RBCs remained unchanged. The mean corpuscular volume, erythrocyte osmotic resistance, RBC deformability, RBC aggregation, and the activity of lactate dehydrogenase showed minor but statistically significant changes from baseline. No differences in the concentrations of free hemoglobin were observed. Whole blood viscosity was less in the procRBCs. Seventy-seven percent (mean) of the platelets were washed out, while a mean of 57% of the leukocytes remained in the procRBCs. Although processing canine blood with this automated cell salvage device leads to slight changes in some properties of RBCs, most of these changes are comparable to changes seen in human blood after processing. Present data indicate that the use of this cell salvage device does not induce changes in canine RBC concentrate that would preclude its use for transfusion. © Veterinary Emergency and Critical Care Society 2016.

The hand surgery fellowship application process: expectations, logistics, and costs.

PubMed

Meals, Clifton; Osterman, Meredith

2015-04-01

To investigate expectations, logistics, and costs relevant to the hand surgery fellowship application process. We sought to discover (1) what both applicants and program directors are seeking, (2) what both parties have to offer, (3) how both parties collect information about each other, and (4) the costs incurred in arranging each match. We conducted on-line surveys of hand surgery fellowship applicants for appointment in 2015 and of current fellowship program directors. Sixty-two applicants and 41 program directors completed the survey. Results revealed applicants' demographic characteristics, qualifications, method of ranking hand fellowship programs, costs incurred (both monetary and opportunity) during the application process, ultimate match status, and suggestions for change. Results also revealed program directors' program demographics, rationale for offering interviews and favorably ranking applicants, application-related logistical details, costs incurred (both monetary and opportunity) during the application process, and suggestions for change. Applicants for hand surgery fellowship training are primarily interested in a potential program's academic reputation, emphasis on orthopedic surgery, and location. The typical, successfully matched applicant was a 30-year-old male orthopedic resident with 3 publications to his credit. Applicants rely on peers and Web sites for information about fellowships. Fellowship directors are primarily seeking applicants recommended by other experienced surgeons and with positive personality traits. The typical fellowship director offers a single year of orthopedic-based fellowship training to 2 fellows per year and relies on a common application and in-person interviews to collect information about applicants. Applicants appear to be more concerned than directors about the current state of the match process. Applicants and directors alike incur heavy costs, in both dollars and opportunity, to arrange each match. A nuanced

Comparison between cylindrical and prismatic lithium-ion cell costs using a process based cost model

NASA Astrophysics Data System (ADS)

Ciez, Rebecca E.; Whitacre, J. F.

2017-02-01

The relative size and age of the US electric vehicle market means that a few vehicles are able to drive market-wide trends in the battery chemistries and cell formats on the road today. Three lithium-ion chemistries account for nearly all of the storage capacity, and half of the cells are cylindrical. However, no specific model exists to examine the costs of manufacturing these cylindrical cells. Here we present a process-based cost model tailored to the cylindrical lithium-ion cells currently used in the EV market. We examine the costs for varied cell dimensions, electrode thicknesses, chemistries, and production volumes. Although cost savings are possible from increasing cell dimensions and electrode thicknesses, economies of scale have already been reached, and future cost reductions from increased production volumes are minimal. Prismatic cells, which are able to further capitalize on the cost reduction from larger formats, can offer further reductions than those possible for cylindrical cells.

Assessment of low-cost manufacturing process sequences. [photovoltaic solar arrays

NASA Technical Reports Server (NTRS)

Chamberlain, R. G.

1979-01-01

An extensive research and development activity to reduce the cost of manufacturing photovoltaic solar arrays by a factor of approximately one hundred is discussed. Proposed and actual manufacturing process descriptions were compared to manufacturing costs. An overview of this methodology is presented.

Real-Time Electrical Impedimetric Monitoring of Blood Coagulation Process under Temperature and Hematocrit Variations Conducted in a Microfluidic Chip

PubMed Central

Lei, Kin Fong; Chen, Kuan-Hao; Tsui, Po-Hsiang; Tsang, Ngan-Ming

2013-01-01

Blood coagulation is an extremely complicated and dynamic physiological process. Monitoring of blood coagulation is essential to predict the risk of hemorrhage and thrombosis during cardiac surgical procedures. In this study, a high throughput microfluidic chip has been developed for the investigation of the blood coagulation process under temperature and hematocrit variations. Electrical impedance of the whole blood was continuously recorded by on-chip electrodes in contact with the blood sample during coagulation. Analysis of the impedance change of the blood was conducted to investigate the characteristics of blood coagulation process and the starting time of blood coagulation was defined. The study of blood coagulation time under temperature and hematocrit variations was shown a good agreement with results in the previous clinical reports. The electrical impedance measurement for the definition of blood coagulation process provides a fast and easy measurement technique. The microfluidic chip was shown to be a sensitive and promising device for monitoring blood coagulation process even in a variety of conditions. It is found valuable for the development of point-of-care coagulation testing devices that utilizes whole blood sample in microliter quantity. PMID:24116099

Cost effectiveness of an intensive blood glucose control policy in patients with type 2 diabetes: economic analysis alongside randomised controlled trial (UKPDS 41)

PubMed Central

Gray, Alastair; Raikou, Maria; McGuire, Alistair; Fenn, Paul; Stevens, Richard; Cull, Carole; Stratton, Irene; Adler, Amanda; Holman, Rury; Turner, Robert

2000-01-01

Objective To estimate the cost effectiveness of conventional versus intensive blood glucose control in patients with type 2 diabetes. Design Incremental cost effectiveness analysis alongside randomised controlled trial. Setting 23 UK hospital clinic based study centres. Participants 3867 patients with newly diagnosed type 2 diabetes (mean age 53 years). Interventions Conventional (primarily diet) glucose control policy versus intensive control policy with a sulphonylurea or insulin. Main outcome measures Incremental cost per event-free year gained within the trial period. Results Intensive glucose control increased trial treatment costs by £695 (95% confidence interval £555 to £836) per patient but reduced the cost of complications by £957 (£233 to £1681) compared with conventional management. If standard practice visit patterns were assumed rather than trial conditions, the incremental cost of intensive management was £478 (−£275 to £1232) per patient. The within trial event-free time gained in the intensive group was 0.60 (0.12 to 1.10) years and the lifetime gain 1.14 (0.69 to 1.61) years. The incremental cost per event-free year gained was £1166 (costs and effects discounted at 6% a year) and £563 (costs discounted at 6% a year and effects not discounted). Conclusions Intensive blood glucose control in patients with type 2 diabetes significantly increased treatment costs but substantially reduced the cost of complications and increased the time free of complications. PMID:10818026

Processing of Cells' Trajectories Data for Blood Flow Simulation Model*

NASA Astrophysics Data System (ADS)

Slavík, Martin; Kovalčíková, Kristína; Bachratý, Hynek; Bachratá, Katarína; Smiešková, Monika

2018-06-01

Simulations of the red blood cells (RBCs) flow as a movement of elastic objects in a fluid, are developed to optimize microfluidic devices used for a blood sample analysis for diagnostic purposes in the medicine. Tracking cell behaviour during simulation helps to improve the model and adjust its parameters. For the optimization of the microfluidic devices, it is also necessary to analyse cell trajectories as well as likelihood and frequency of their occurrence in a particular device area, especially in the parts, where they can affect circulating tumour cells capture. In this article, we propose and verify several ways of processing and analysing the typology and trajectory stability in simulations with single or with a large number of red blood cells (RBCs) in devices with different topologies containing cylindrical obstacles.

Half a decade of mini-pool nucleic acid testing: Cost-effective way for improving blood safety in India

PubMed Central

Chandrashekar, Shivaram

2014-01-01

Background and Objectives: It is well established that Nucleic acid testing (NAT) reduces window phase of transfusion transmissible infections (TTI) and helps improve blood safety. NAT testing can be done individually or in pools. The objectives of this study were to determine the utility, feasibility and cost effectiveness of an in-house minipool-NAT(MP-NAT). Materials and Methods: Blood donors were screened by history, tested by ELISA and sero-negative samples were subjected to an in-house NAT by using reverse transcriptase-polymerase chain reaction (RT-PCR). Testing was done in mini-pools of size eight (8). Positive pools were repeated with individual samples. Results: During the study period of Oct 2005-Sept 2010 (5 years) all blood donors (n=53729) were screened by ELISA. Of which 469 (0.87%) were positive for HIV-1, HBV or HCV. Sero-negative samples (n=53260) were screened by in-house MP-NAT. HIV-NAT yield was 1/53260 (n=1) and HBV NAT yield (n=2) was 1/26630. Conclusion: NAT yield was lower than other India studies possibly due to the lower sero-reactivity amongst our donors. Nevertheless it intercepted 9 lives including the components prepared. The in-house assay met our objective of improving blood safety at nominal cost and showed that it is feasible to set up small molecular biology units in medium-large sized blood banks and deliver blood within 24-48 hours. The utility of NAT (NAT yield) will vary based on the donor population, the type of serological test used, the nature of kit employed and the sensitivity of NAT test used. The limitations of our in-house MP-NAT consisted of stringent sample preparation requirements, with labor and time involved. The benefits of our MP-NAT were that it acted as a second level of check for ELISA tests, was relatively inexpensive compared to ID-NAT and did not need sophisticated equipment. PMID:24678172

Comparison of human umbilical cord blood processing with or without hydroxyethyl starch.

PubMed

Souri, Milad; Nikougoftar Zarif, Mahin; Rasouli, Mahboobeh; Golzadeh, Khadijeh; Nakhlestani Hagh, Mozhdeh; Ezzati, Nasim; Atarodi, Kamran

2017-11-01

Umbilical cord blood (UCB) processing with hydroxyethyl starch (HES) is the most common protocol in the cord blood banks. The quality of UCB volume reduction was guaranteed by minimum manipulation of cord blood samples in the closed system. This study aimed to analyze and compare cell recovery and viability of UCB processed using the Sepax automated system in the presence and absence of HES. Thirty UCB bags with a total nucleated cell (TNC) count of more than 2.5 × 10 9 were divided in two bags with equal volume. HES solution was added to one bag and another was intact. Both bags were processed with the Sepax. To determine cell recovery, viability, and potential of colony-forming cells (CFCs), preprocessing, postprocessing, and thawing samples were analyzed. The mean TNC recovery after processing and after thaw was significantly better with the HES method (p < 0.01 for the postprocessing step and p < 0.05 for the postthaw step). There were no significant differences to mononucleated cells (MNCs) and CD34+ cell recovery between the two methods after processing and after thaw. TNC and MNC viability was significantly higher without HES after processing and after thaw (p < 0.01). The results of the CFC assay were similar for both methods after processing and after thaw. These results showed that processing of UCB using the Sepax system with the without-HES protocol due to the lower manipulation of samples could be used as an eligible protocol to reduce the volume of UCB. © 2017 AABB.

New technologies for solar energy silicon - Cost analysis of BCL process

NASA Technical Reports Server (NTRS)

Yaws, C. L.; Li, K.-Y.; Fang, C. S.; Lutwack, R.; Hsu, G.; Leven, H.

1980-01-01

New technologies for producing polysilicon are being developed to provide lower cost material for solar cells which convert sunlight into electricity. This article presents results for the BCL Process, which produces the solar-cell silicon by reduction of silicon tetrachloride with zinc vapor. Cost, sensitivity, and profitability analysis results are presented based on a preliminary process design of a plant to produce 1000 metric tons/year of silicon by the BCL Process. Profitability analysis indicates a sales price of $12.1-19.4 per kg of silicon (1980 dollars) at a 0-25 per cent DCF rate of return on investment after taxes. These results indicate good potential for meeting the goal of providing lower cost material for silicon solar cells.

Differences in metabolite profiles caused by pre-analytical blood processing procedures.

PubMed

Nishiumi, Shin; Suzuki, Makoto; Kobayashi, Takashi; Yoshida, Masaru

2018-05-01

Recently, the use of metabolomic analysis of human serum and plasma for biomarker discovery and disease diagnosis in clinical studies has been increasing. The feasibility of using a metabolite biomarker for disease diagnosis is strongly dependent on the metabolite's stability during pre-analytical blood processing procedures, such as serum or plasma sampling and sample storage prior to centrifugation. However, the influence of blood processing procedures on the stability of metabolites has not been fully characterized. In the present study, we compared the levels of metabolites in matched human serum and plasma samples using gas chromatography coupled with mass spectrometry and liquid chromatography coupled with mass spectrometry. In addition, we evaluated the changes in plasma metabolite levels induced by storage at room temperature or at a cold temperature prior to centrifugation. As a result, it was found that 76 metabolites exhibited significant differences between their serum and plasma levels. Furthermore, the pre-centrifugation storage conditions significantly affected the plasma levels of 45 metabolites. These results highlight the importance of blood processing procedures during metabolome analysis, which should be considered during biomarker discovery and the subsequent use of biomarkers for disease diagnosis. Copyright © 2017 The Society for Biotechnology, Japan. Published by Elsevier B.V. All rights reserved.

Cost effectiveness of universal umbilical cord blood gas and lactate analysis in a tertiary level maternity unit.

PubMed

White, Christopher R H; Doherty, Dorota A; Cannon, Jeffrey W; Kohan, Rolland; Newnham, John P; Pennell, Craig E

2016-07-01

There is an increasing body of literature supporting universal umbilical cord blood gas analysis (UCBGA) into all maternity units. A significant impediment to UCBGA's introduction is the perceived expense of the introduction and associated ongoing costs. Consequently, this study set out to conduct the first cost-effectiveness analysis of introducing universal UCBGA. Analysis was based on 42,100 consecutive deliveries ≥23 weeks of gestation at a single tertiary obstetric unit. Within 4 years of UCBGA's introduction there was a 45% reduction in term special care nursery (SCN) admissions >2499 g. Incurred costs included initial and ongoing costs associated with universal UCBGA. Averted costs were based on local diagnosis-related grouping costs for reduction in term SCN admissions. Incremental cost-effectiveness ratio (ICER) and sensitivity analysis results were reported. Under the base-case scenario, the adoption of universal UCBGA was less costly and more effective than selective UCBGA over 4 years and resulted in saving of AU$641,532 while adverting 376 SCN admissions. Sensitivity analysis showed that UCBGA was cost-effective in 51.8%, 83.3%, 99.6% and 100% of simulations in years 1, 2, 3 and 4. These conclusions were not sensitive to wide, clinically possible variations in parameter values for neonatal intensive care unit and SCN admissions, magnitude of averted SCN admissions, cumulative delivery numbers, and SCN admission costs. Universal UCBGA is associated with significant initial and ongoing costs; however, potential averted costs (due to reduced SCN admissions) exceed incurred costs in most scenarios.

A low-cost photovoltaic cell process based on thick film techniques

NASA Technical Reports Server (NTRS)

Mardesich, N.; Pepe, A.; Bunyan, S.; Edwards, B.; Olson, C.

1980-01-01

The low-cost, easily automated processing for solar cell fabrication being developed at Spectrolab for the DOE LSA program is described. These processes include plasma-etching, spray-on diffusion sources and antireflective coating, thick film metallization, aluminum back contacts, laser scribing and ultrasonic soldering. The process sequence has been shown to produce solar cells having 15% conversion efficiency at AM1 which meet the cell fabrication budget required for the DOE 1986 cost goal of $0.70 per peak watt in 1980.

Are lower levels of red blood cell transfusion more cost-effective than liberal levels after cardiac surgery? Findings from the TITRe2 randomised controlled trial

PubMed Central

Stokes, E A; Wordsworth, S; Bargo, D; Pike, K; Rogers, C A; Brierley, R C M; Angelini, G D; Murphy, G J; Reeves, B C

2016-01-01

Objective To assess the incremental cost and cost-effectiveness of a restrictive versus a liberal red blood cell transfusion threshold after cardiac surgery. Design A within-trial cost-effectiveness analysis with a 3-month time horizon, based on a multicentre superiority randomised controlled trial from the perspective of the National Health Service (NHS) and personal social services in the UK. Setting 17 specialist cardiac surgery centres in UK NHS hospitals. Participants 2003 patients aged >16 years undergoing non-emergency cardiac surgery with a postoperative haemoglobin of <9 g/dL. Interventions Restrictive (transfuse if haemoglobin <7.5 g/dL) or liberal (transfuse if haemoglobin <9 g/dL) threshold during hospitalisation after surgery. Main outcome measures Health-related quality of life measured using the EQ-5D-3L to calculate quality-adjusted life years (QALYs). Results The total costs from surgery up to 3 months were £17 945 and £18 127 in the restrictive and liberal groups (mean difference is −£182, 95% CI −£1108 to £744). The cost difference was largely attributable to the difference in the cost of red blood cells. Mean QALYs to 3 months were 0.18 in both groups (restrictive minus liberal difference is 0.0004, 95% CI −0.0037 to 0.0045). The point estimate for the base-case cost-effectiveness analysis suggested that the restrictive group was slightly more effective and slightly less costly than the liberal group and, therefore, cost-effective. However, there is great uncertainty around these results partly due to the negligible differences in QALYs gained. Conclusions We conclude that there is no clear difference in the cost-effectiveness of restrictive and liberal thresholds for red blood cell transfusion after cardiac surgery. Trial registration number ISRCTN70923932; Results. PMID:27481621

Contribution of blood oxygen and carbon dioxide sensing to the energetic optimization of human walking.

PubMed

Wong, Jeremy D; O'Connor, Shawn M; Selinger, Jessica C; Donelan, J Maxwell

2017-08-01

People can adapt their gait to minimize energetic cost, indicating that walking's neural control has access to ongoing measurements of the body's energy use. In this study we tested the hypothesis that an important source of energetic cost measurements arises from blood gas receptors that are sensitive to O 2 and CO 2 concentrations. These receptors are known to play a role in regulating other physiological processes related to energy consumption, such as ventilation rate. Given the role of O 2 and CO 2 in oxidative metabolism, sensing their levels can provide an accurate estimate of the body's total energy use. To test our hypothesis, we simulated an added energetic cost for blood gas receptors that depended on a subject's step frequency and determined if subjects changed their behavior in response to this simulated cost. These energetic costs were simulated by controlling inspired gas concentrations to decrease the circulating levels of O 2 and increase CO 2 We found this blood gas control to be effective at shifting the step frequency that minimized the ventilation rate and perceived exertion away from the normally preferred frequency, indicating that these receptors provide the nervous system with strong physiological and psychological signals. However, rather than adapt their preferred step frequency toward these lower simulated costs, subjects persevered at their normally preferred frequency even after extensive experience with the new simulated costs. These results suggest that blood gas receptors play a negligible role in sensing energetic cost for the purpose of optimizing gait. NEW & NOTEWORTHY Human gait adaptation implies that the nervous system senses energetic cost, yet this signal is unknown. We tested the hypothesis that the blood gas receptors sense cost for gait optimization by controlling blood O 2 and CO 2 with step frequency as people walked. At the simulated energetic minimum, ventilation and perceived exertion were lowest, yet subjects

30 CFR 250.196 - Reimbursements for reproduction and processing costs.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Reimbursements for reproduction and processing... Reporting Requirements § 250.196 Reimbursements for reproduction and processing costs. (a) MMS will... retains the information. (c) When you request reimbursement, you must identify reproduction and processing...

Benefits to blood banks of a sales and operations planning process.

PubMed

Keal, Donald A; Hebert, Phil

2010-12-01

A formal sales and operations planning (S&OP) process is a decision making and communication process that balances supply and demand while integrating all business operational components with customer-focused business plans that links high level strategic plans to day-to-day operations. Furthermore, S&OP can assist in managing change across the organization as it provides the opportunity to be proactive in the face of problems and opportunities while establishing a plan for everyone to follow. Some of the key outcomes from a robust S&OP process in blood banking would include: higher customer satisfaction (donors and health care providers), balanced inventory across product lines and customers, more stable production rates and higher productivity, more cooperation across the entire operation, and timely updates to the business plan resulting in better forecasting and fewer surprises that negatively impact the bottom line. © 2010 American Association of Blood Banks.

The consequence of biologic graft processing on blood interface biocompatibility and mechanics.

PubMed

Van de Walle, Aurore B; Uzarski, Joseph S; McFetridge, Peter S

2015-09-01

Processing ex vivo derived tissues to reduce immunogenicity is an effective approach to create biologically complex materials for vascular reconstruction. Due to the sensitivity of small diameter vascular grafts to occlusive events, the effect of graft processing on critical parameters for graft patency, such as peripheral cell adhesion and wall mechanics, requires detailed analysis. Isolated human umbilical vein sections were used as model allogenic vascular scaffolds that were processed with either: 1. sodium dodecyl sulfate (SDS), 2. ethanol/acetone (EtAc), or 3. glutaraldehyde (Glu). Changes in material mechanics were assessed via uniaxial tensile testing. Peripheral cell adhesion to the opaque grafting material was evaluated using an innovative flow chamber that allows direct observation of the blood-graft interface under physiological shear conditions. All treatments modified the grafts tensile strain and stiffness properties, with physiological modulus values decreasing from Glu 240±12 kPa to SDS 210±6 kPa and EtAc 140±3 kPa, P<.001. Relative to glutaraldehyde treatments, neutrophil adhesion to the decellularized grafts increased, with no statistical difference observed between SDS or EtAc treatments. Early platelet adhesion (% surface coverage) showed no statistical difference between the three treatments; however, quantification of platelet aggregates was significantly higher on SDS scaffolds compared to EtAc or Glu. Tissue processing strategies applied to the umbilical vein scaffold were shown to modify structural mechanics and cell adhesion properties, with the EtAc treatment reducing thrombotic events relative to SDS treated samples. This approach allows time and cost effective prescreening of clinically relevant grafting materials to assess initial cell reactivity.

19 CFR 10.178 - Direct costs of processing operations performed in the beneficiary developing country.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 19 Customs Duties 1 2011-04-01 2011-04-01 false Direct costs of processing operations performed in... processing operations performed in the beneficiary developing country. (a) Items included in the direct costs of processing operations. As used in § 10.176, the words “direct costs of processing operations...

Quantitative assessment of anthrax vaccine immunogenicity using the dried blood spot matrix.

PubMed

Schiffer, Jarad M; Maniatis, Panagiotis; Garza, Ilana; Steward-Clark, Evelene; Korman, Lawrence T; Pittman, Phillip R; Mei, Joanne V; Quinn, Conrad P

2013-03-01

The collection, processing and transportation to a testing laboratory of large numbers of clinical samples during an emergency response situation present significant cost and logistical issues. Blood and serum are common clinical samples for diagnosis of disease. Serum preparation requires significant on-site equipment and facilities for immediate processing and cold storage, and significant costs for cold-chain transport to testing facilities. The dried blood spot (DBS) matrix offers an alternative to serum for rapid and efficient sample collection with fewer on-site equipment requirements and considerably lower storage and transport costs. We have developed and validated assay methods for using DBS in the quantitative anti-protective antigen IgG enzyme-linked immunosorbent assay (ELISA), one of the primary assays for assessing immunogenicity of anthrax vaccine and for confirmatory diagnosis of Bacillus anthracis infection in humans. We have also developed and validated high-throughput data analysis software to facilitate data handling for large clinical trials and emergency response. Published by Elsevier Ltd.

Activity-based costs of plasma transfusions in medical and surgical inpatients at a US hospital.

PubMed

Shander, A; Ozawa, S; Hofmann, A

2016-07-01

Fresh frozen plasma (FFP) usage has significantly increased over the last decade leading to elevated healthcare costs. Although FFP is used in several clinical settings, it is often inappropriately transfused and evidence for its clinical efficacy is poor. Here, we describe plasma usage and transfusion costs in a real-world US inpatient setting to determine the cost-effectiveness of FFP transfusion and for comparison to various patient blood management (PBM) options to treat coagulopathies. All activities related to plasma transfusion recorded at a single US hospital over one calendar year were collected in a stepwise manner using an activity-based costing (ABC) methodology. This model maps all technical, administrative and clinical processes inherent to the cost of plasma. Of 18 200 inpatients recorded, 849 were charged for blood products. In total, 136 medical and surgical inpatients were charged for 577 units of FFP, receiving a total of 534 units; 43 units were charged but not transfused. The total cost per unit of FFP transfused was $409·62 and $1,608·37 per patient transfused with FFP. Wasted products, in-hospital processes and overhead costs were found to account for 89·8% of the total cost of FFP transfusions. This study is the first to use ABC methodology to determine the full cost of plasma transfusion in a US inpatient setting. These data reveal the true cost of plasma, providing a useful reference point to compare with the cost of other PBM options to manage coagulation disorders. © 2016 International Society of Blood Transfusion.

INTEGRATION OF COST MODELS AND PROCESS SIMULATION TOOLS FOR OPTIMUM COMPOSITE MANUFACTURING PROCESS

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

Pack, Seongchan; Wilson, Daniel; Aitharaju, Venkat

Manufacturing cost of resin transfer molded composite parts is significantly influenced by the cycle time, which is strongly related to the time for both filling and curing of the resin in the mold. The time for filling can be optimized by various injection strategies, and by suitably reducing the length of the resin flow distance during the injection. The curing time can be reduced by the usage of faster curing resins, but it requires a high pressure injection equipment, which is capital intensive. Predictive manufacturing simulation tools that are being developed recently for composite materials are able to provide variousmore » scenarios of processing conditions virtually well in advance of manufacturing the parts. In the present study, we integrate the cost models with process simulation tools to study the influence of various parameters such as injection strategies, injection pressure, compression control to minimize high pressure injection, resin curing rate, and demold time on the manufacturing cost as affected by the annual part volume. A representative automotive component was selected for the study and the results are presented in this paper« less

Cost effectiveness of adding nucleic acid testing to hepatitis B, hepatitis C, and human immunodeficiency virus screening of blood donations in Zimbabwe.

PubMed

Mafirakureva, Nyashadzaishe; Mapako, Tonderai; Khoza, Star; Emmanuel, Jean C; Marowa, Lucy; Mvere, David; Postma, Maarten J; van Hulst, Marinus

2016-12-01

The aim of this study was to assess the cost effectiveness of introducing individual-donation nucleic acid testing (ID-NAT), in addition to serologic tests, compared with the exclusive use of serologic tests for the identification of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) I and II among blood donors in Zimbabwe. The costs, health consequences, and cost effectiveness of adding ID-NAT to serologic tests, compared with serologic testing alone, were estimated from a health care perspective using a decision-analytic model. The introduction of ID-NAT in addition to serologic tests would lower the risk of HBV, HCV, and HIV transmission to 46.9, 0.3, and 2.7 per 100,000 donations, respectively. ID-NAT would prevent an estimated 25, 6, and 9 HBV, HCV, and HIV transfusion-transmitted infections per 100,000 donations, respectively. The introduction of this intervention would result in an estimated 212 quality-adjusted life-years (QALYs) gained. The incremental cost-effectiveness ratio is estimated at US$17,774/QALY, a value far more than three times the gross national income per capita for Zimbabwe. Although the introduction of NAT could further improve the safety of the blood supply, current evidence suggests that it cannot be considered cost effective. Reducing the test costs for NAT through efficient donor recruitment, negotiating the price of reagents, and the efficient use of technology will improve cost effectiveness. © 2016 AABB.

Laser doppler blood flow imaging using a CMOS imaging sensor with on-chip signal processing.

PubMed

He, Diwei; Nguyen, Hoang C; Hayes-Gill, Barrie R; Zhu, Yiqun; Crowe, John A; Gill, Cally; Clough, Geraldine F; Morgan, Stephen P

2013-09-18

The first fully integrated 2D CMOS imaging sensor with on-chip signal processing for applications in laser Doppler blood flow (LDBF) imaging has been designed and tested. To obtain a space efficient design over 64 × 64 pixels means that standard processing electronics used off-chip cannot be implemented. Therefore the analog signal processing at each pixel is a tailored design for LDBF signals with balanced optimization for signal-to-noise ratio and silicon area. This custom made sensor offers key advantages over conventional sensors, viz. the analog signal processing at the pixel level carries out signal normalization; the AC amplification in combination with an anti-aliasing filter allows analog-to-digital conversion with a low number of bits; low resource implementation of the digital processor enables on-chip processing and the data bottleneck that exists between the detector and processing electronics has been overcome. The sensor demonstrates good agreement with simulation at each design stage. The measured optical performance of the sensor is demonstrated using modulated light signals and in vivo blood flow experiments. Images showing blood flow changes with arterial occlusion and an inflammatory response to a histamine skin-prick demonstrate that the sensor array is capable of detecting blood flow signals from tissue.

Digitizing dissertations for an institutional repository: a process and cost analysis.

PubMed

Piorun, Mary; Palmer, Lisa A

2008-07-01

This paper describes the Lamar Soutter Library's process and costs associated with digitizing 300 doctoral dissertations for a newly implemented institutional repository at the University of Massachusetts Medical School. Project tasks included identifying metadata elements, obtaining and tracking permissions, converting the dissertations to an electronic format, and coordinating workflow between library departments. Each dissertation was scanned, reviewed for quality control, enhanced with a table of contents, processed through an optical character recognition function, and added to the institutional repository. Three hundred and twenty dissertations were digitized and added to the repository for a cost of $23,562, or $0.28 per page. Seventy-four percent of the authors who were contacted (n = 282) granted permission to digitize their dissertations. Processing time per title was 170 minutes, for a total processing time of 906 hours. In the first 17 months, full-text dissertations in the collection were downloaded 17,555 times. Locally digitizing dissertations or other scholarly works for inclusion in institutional repositories can be cost effective, especially if small, defined projects are chosen. A successful project serves as an excellent recruitment strategy for the institutional repository and helps libraries build new relationships. Challenges include workflow, cost, policy development, and copyright permissions.

Digitizing Dissertations for an Institutional Repository: A Process and Cost Analysis*

PubMed Central

Piorun, Mary; Palmer, Lisa A.

2008-01-01

Objective: This paper describes the Lamar Soutter Library's process and costs associated with digitizing 300 doctoral dissertations for a newly implemented institutional repository at the University of Massachusetts Medical School. Methodology: Project tasks included identifying metadata elements, obtaining and tracking permissions, converting the dissertations to an electronic format, and coordinating workflow between library departments. Each dissertation was scanned, reviewed for quality control, enhanced with a table of contents, processed through an optical character recognition function, and added to the institutional repository. Results: Three hundred and twenty dissertations were digitized and added to the repository for a cost of $23,562, or $0.28 per page. Seventy-four percent of the authors who were contacted (n = 282) granted permission to digitize their dissertations. Processing time per title was 170 minutes, for a total processing time of 906 hours. In the first 17 months, full-text dissertations in the collection were downloaded 17,555 times. Conclusion: Locally digitizing dissertations or other scholarly works for inclusion in institutional repositories can be cost effective, especially if small, defined projects are chosen. A successful project serves as an excellent recruitment strategy for the institutional repository and helps libraries build new relationships. Challenges include workflow, cost, policy development, and copyright permissions. PMID:18654648

Effect of liberal blood transfusion on clinical outcomes and cost in spine surgery patients.

PubMed

Purvis, Taylor E; Goodwin, C Rory; De la Garza-Ramos, Rafael; Ahmed, A Karim; Lafage, Virginie; Neuman, Brian J; Passias, Peter G; Kebaish, Khaled M; Frank, Steven M; Sciubba, Daniel M

2017-09-01

Blood transfusions in spine surgery are shown to be associated with increased patient morbidity. The association between transfusion performed using a liberal hemoglobin (Hb) trigger-defined as an intraoperative Hb level of ≥10 g/dL, a postoperative level of ≥8 g/dL, or a whole hospital nadir between 8 and 10 g/dL-and perioperative morbidity and cost in spine surgery patients is unknown and thus was investigated in this study. This study aimed to describe the perioperative outcomes and economic cost associated with liberal Hb trigger transfusion among spine surgery patients. This is a retrospective study. The surgical billing database at our institution was queried for inpatients discharged between 2008 and 2015 after the following procedures: atlantoaxial fusion, anterior cervical fusion, posterior cervical fusion, anterior lumbar fusion, posterior lumbar fusion, lateral lumbar fusion, other procedures, and tumor-related surgeries. In total, 6,931 patients were included for analysis. The primary outcome was composite morbidity, which was composed of (1) infection (sepsis, surgical-site infection, Clostridium difficile infection, or drug-resistant infection); (2) thrombotic event (pulmonary embolus, deep venous thrombosis, or disseminated intravascular coagulation); (3) kidney injury; (4) respiratory event; and (5) ischemic event (transient ischemic attack, myocardial infarction, or cerebrovascular accident). Data on intraoperative transfusion were obtained from an automated, prospectively collected anesthesia data management system. Data on postoperative hospital transfusion were obtained through a Web-based intelligence portal. Based on previous research, we analyzed the data using three definitions of a liberal transfusion trigger in patients who underwent red blood cell transfusion: a liberal intraoperative Hb trigger as a nadir Hb level of 10 g/dL or greater, a liberal postoperative Hb trigger as a nadir Hb level of 8 g/dL or greater, or a whole

On the costs of parallel processing in dual-task performance: The case of lexical processing in word production.

PubMed

Paucke, Madlen; Oppermann, Frank; Koch, Iring; Jescheniak, Jörg D

2015-12-01

Previous dual-task picture-naming studies suggest that lexical processes require capacity-limited processes and prevent other tasks to be carried out in parallel. However, studies involving the processing of multiple pictures suggest that parallel lexical processing is possible. The present study investigated the specific costs that may arise when such parallel processing occurs. We used a novel dual-task paradigm by presenting 2 visual objects associated with different tasks and manipulating between-task similarity. With high similarity, a picture-naming task (T1) was combined with a phoneme-decision task (T2), so that lexical processes were shared across tasks. With low similarity, picture-naming was combined with a size-decision T2 (nonshared lexical processes). In Experiment 1, we found that a manipulation of lexical processes (lexical frequency of T1 object name) showed an additive propagation with low between-task similarity and an overadditive propagation with high between-task similarity. Experiment 2 replicated this differential forward propagation of the lexical effect and showed that it disappeared with longer stimulus onset asynchronies. Moreover, both experiments showed backward crosstalk, indexed as worse T1 performance with high between-task similarity compared with low similarity. Together, these findings suggest that conditions of high between-task similarity can lead to parallel lexical processing in both tasks, which, however, does not result in benefits but rather in extra performance costs. These costs can be attributed to crosstalk based on the dual-task binding problem arising from parallel processing. Hence, the present study reveals that capacity-limited lexical processing can run in parallel across dual tasks but only at the expense of extraordinary high costs. (c) 2015 APA, all rights reserved).

A primer on the cost of quality for improvement of laboratory and pathology specimen processes.

PubMed

Carlson, Richard O; Amirahmadi, Fazlollaah; Hernandez, James S

2012-09-01

In today's environment, many laboratories and pathology practices are challenged to maintain or increase their quality while simultaneously lowering their overall costs. The cost of improving specimen processes is related to quality, and we demonstrate that actual costs can be reduced by designing "quality at the source" into the processes. Various costs are hidden along the total testing process, and we suggest ways to identify opportunities to reduce cost by improving quality in laboratories and pathology practices through the use of Lean, Six Sigma, and industrial engineering.

Autologous blood transfusion during emergency trauma operations.

PubMed

Brown, Carlos V R; Foulkrod, Kelli H; Sadler, Holli T; Richards, E Kalem; Biggan, Dennis P; Czysz, Clea; Manuel, Tony

2010-07-01

Intraoperative cell salvage (CS) of shed blood during emergency surgical procedures provides an effective and cost-efficient resuscitation alternative to allogeneic blood transfusion, which is associated with increased morbidity and mortality in trauma patients. Retrospective matched cohort study. Level I trauma center. All adult trauma patients who underwent an emergency operation and received CS as part of their intraoperative resuscitation. The CS group was matched to a no-CS group for age, sex, Injury Severity Score, mechanism of injury, and operation performed. Amount and cost of allogeneic transfusion of packed red blood cells and plasma. The 47 patients in the CS group were similar to the 47 in the no-CS group for all matched variables. Patients in the CS group received an average of 819 mL of autologous CS blood. The CS group received fewer intraoperative (2 vs 4 U; P = .002) and total (4 vs 8 U; P < .001) units of allogeneic packed red blood cells. The CS group also received fewer total units of plasma (3 vs 5 U; P = .03). The cost of blood product transfusion (including the total cost of CS) was less in the CS group ($1616 vs $2584 per patient; P = .004). Intraoperative CS provides an effective and cost-efficient resuscitation strategy as an alternative to allogeneic blood transfusion in trauma patients undergoing emergency operative procedures.

Improved cost-effectiveness of the block co-polymer anneal process for DSA

NASA Astrophysics Data System (ADS)

Pathangi, Hari; Stokhof, Maarten; Knaepen, Werner; Vaid, Varun; Mallik, Arindam; Chan, Boon Teik; Vandenbroeck, Nadia; Maes, Jan Willem; Gronheid, Roel

2016-04-01

This manuscript first presents a cost model to compare the cost of ownership of DSA and SAQP for a typical front end of line (FEoL) line patterning exercise. Then, we proceed to a feasibility study of using a vertical furnace to batch anneal the block co-polymer for DSA applications. We show that the defect performance of such a batch anneal process is comparable to the process of record anneal methods. This helps in increasing the cost benefit for DSA compared to the conventional multiple patterning approaches.

GMP in blood collection and processing.

PubMed

Wagstaff, W

1998-01-01

The principles of Good Manufacturing Practice have, in the main, been universally developed for the guidance of the pharmaceutical industry rather than for transfusion services. However, these rules and guides are increasingly being adapted for use in blood centres, in the production of labile blood components and of plasma for fractionation. The guide for pharmaceutical industries produced by the commission of the European Communities is used as a model here, the nine basic requirements being those applicable to Quality Management, personnel, premises and equipment, document, production, Quality Control, contract manufacture and analysis, complaints and product recall, and self-inspection. Though having more direct application to the production laboratory preparing blood components, the majority of these requirements and principles are also directly applicable to all of the activities involved in blood collection.

[Improving blood safety: errors management in transfusion medicine].

PubMed

Bujandrić, Nevenka; Grujić, Jasmina; Krga-Milanović, Mirjana

2014-01-01

The concept of blood safety includes the entire transfusion chain starting with the collection of blood from the blood donor, and ending with blood transfusion to the patient. The concept involves quality management system as the systematic monitoring of adverse reactions and incidents regarding the blood donor or patient. Monitoring of near-miss errors show the critical points in the working process and increase transfusion safety. The aim of the study was to present the analysis results of adverse and unexpected events in transfusion practice with a potential risk to the health of blood donors and patients. One-year retrospective study was based on the collection, analysis and interpretation of written reports on medical errors in the Blood Transfusion Institute of Vojvodina. Errors were distributed according to the type, frequency and part of the working process where they occurred. Possible causes and corrective actions were described for each error. The study showed that there were not errors with potential health consequences for the blood donor/patient. Errors with potentially damaging consequences for patients were detected throughout the entire transfusion chain. Most of the errors were identified in the preanalytical phase. The human factor was responsible for the largest number of errors. Error reporting system has an important role in the error management and the reduction of transfusion-related risk of adverse events and incidents. The ongoing analysis reveals the strengths and weaknesses of the entire process and indicates the necessary changes. Errors in transfusion medicine can be avoided in a large percentage and prevention is cost-effective, systematic and applicable.

High resolution image processing on low-cost microcomputers

NASA Technical Reports Server (NTRS)

Miller, R. L.

1993-01-01

Recent advances in microcomputer technology have resulted in systems that rival the speed, storage, and display capabilities of traditionally larger machines. Low-cost microcomputers can provide a powerful environment for image processing. A new software program which offers sophisticated image display and analysis on IBM-based systems is presented. Designed specifically for a microcomputer, this program provides a wide-range of functions normally found only on dedicated graphics systems, and therefore can provide most students, universities and research groups with an affordable computer platform for processing digital images. The processing of AVHRR images within this environment is presented as an example.

The principles of quality-associated costing: derivation from clinical transfusion practice.

PubMed

Trenchard, P M; Dixon, R

1997-01-01

As clinical transfusion practice works towards achieving cost-effectiveness, prescribers of blood and its derivatives must be certain that the prices of such products are based on real manufacturing costs and not market forces. Using clinical cost-benefit analysis as the context for the costing and pricing of blood products, this article identifies the following two principles: (1) the product price must equal the product cost (the "price = cost" rule) and (2) the product cost must equal the real cost of product manufacture. In addition, the article describes a new method of blood product costing, quality-associated costing (QAC), that will enable valid cost-benefit analysis of blood products.

Seroprevalence, cost per donation and reduction in blood supply due to positive and indeterminate results for infectious markers in a blood bank in Lima, Peru.

PubMed

Moya-Salazar, Jeel; Ubidia-Incio, Roberto; Incio-Grande, Maritza; Blejer, Jorgelina L; Gonzalez, Carlos A

Safety in Transfusion Medicine is subject to regulations and government legislation within a total quality framework. The aim of this study was to evaluate the impact of seroprevalence and indeterminate results on lost units and cost per donation. A prospective cross-sectional study was performed in the Blood Bank and Transfusion Therapy Department of the Hospital Central de la Policia Nacional del Perú in Lima, Peru. All completed donations (replacement/voluntary) without complications were included in this study. Every donation met the institutional requirements and quality criteria of Programa Nacional de Hemoterapia y Bancos de Sangre (PRONAHEBAS). Data analysis was achieved using the Statistical Package for the Social Sciences. A total of 7723 donations were evaluated during 2014 and 2015 with 493 being seropositive (overall prevalence 5.25%) and 502 having indeterminate results (overall prevalence 5.35%). Thus total loss was 995units, 437.8L of blood and 49,750 US dollars. The most common seropositive infectious markers were the core antibody of hepatitis B virus (2.82%) and syphilis (1.02%), and the most common indeterminate results were Chagas disease (1.27%) and the core antibody of hepatitis B virus (1.26%). There was no significant change in the prevalence of seropositivity (p-value=0.243) or indeterminate results (p-value=0.227) over the two-year period of the study. A statistical correlation was found between the cost per lost donation and the most prevalent markers (rho=0.848; p-value=<0.001). Seroprevalence was lower than the regional mean, but the prevalence of indeterminate results was elevated causing a great impact on blood supply and economic losses to this institution. Copyright © 2017 Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular. Published by Elsevier Editora Ltda. All rights reserved.

Improving appropriateness of blood utilization through prospective review of requests for blood products: the role of pathology residents as consultants.

PubMed

Haldiman, Lindsey; Zia, Hamid; Singh, Gurmukh

2014-01-01

To evaluate the effectiveness of prospective review of orders for fresh-frozen plasma (FFP) and platelets in reducing blood-product use, and of the effectiveness of preparing pathology residents to serve as clinical consultants. At our 572-bed tertiary-care hospital, we developed guidelines for the use of blood products in collaboration with a variety of departments. For patients whose condition(s) met generally accepted criteria, we identified trigger points to allow for quick release by blood bank staff of blood products. For patients whose condition(s) did not meet the applicable criteria, the on-call pathology resident reviewed the medical record of that patient to determine whether there were any extenuating circumstances; consulted with the ordering physician and attending pathologist, as needed; and advised the house staff on appropriate use of blood products. We evaluated the change in use of blood products between the years 2009 and 2012 to assess the effectiveness of the program. We observed a decrease of 38.8% and 31.4% in the use of FFP and platelets, respectively (29.7% and 21.1%, respectively, when normalized for the number of discharges). If projected to the national level, this improvement would translate to an annual cost reduction of approximately $130 million. Prospective review of orders for blood products can significantly improve use of these products, thereby reducing risk to patients and avoiding unnecessary healthcare costs. The involvement of pathology residents in the prospective review process provides an excellent opportunity for their training as laboratory consultants. Copyright© by the American Society for Clinical Pathology (ASCP).

Method of evaluation of process of red blood cell sedimentation based on photometry of droplet samples.

PubMed

Aristov, Alexander; Nosova, Ekaterina

2017-04-01

The paper focuses on research aimed at creating and testing a new approach to evaluate the processes of aggregation and sedimentation of red blood cells for purpose of its use in clinical laboratory diagnostics. The proposed method is based on photometric analysis of blood sample formed as a sessile drop. The results of clinical approbation of this method are given in the paper. Analysis of the processes occurring in the sample in the form of sessile drop during the process of blood cells sedimentation is described. The results of experimental studies to evaluate the effect of the droplet sample focusing properties on light radiation transmittance are presented. It is shown that this method significantly reduces the sample volume and provides sufficiently high sensitivity to the studied processes.

Rapid Diagnosis of Staphylococcal Catheter-Related Bacteraemia in Direct Blood Samples by Real-Time PCR

PubMed Central

Soto, Marcelo; Sampietro-Colom, Laura; Soriano, Alex; Alvarez-Martínez, Míriam José; Almela, Manel; Marco, Francesc; Arjona, Ruth; Cobos-Trigueros, Nazaret; Morata, Laura; Mensa, José; Martínez, José Antonio; Mira, Aurea

2016-01-01

Catheter-related bacteremia (CRB) is an important cause of morbidity and mortality among hospitalized patients, being staphylococci the main etiologic agents. The objective of this study was to assess the use of a PCR-based assay for detection of staphylococci directly from blood obtained through the catheter to diagnose CRB caused by these microorganisms and to perform a cost-effectiveness analysis. A total of 92 patients with suspected CRB were included in the study. Samples were obtained through the catheter. Paired blood cultures were processed by standard culture methods and 4 ml blood samples were processed by GeneXpert-MRSA assay for the detection of methicillin-susceptible (MSSA) or methicillin-resistant (MRSA) Staphylococcus aureus, and methicillin-resistant coagulase-negative staphylococci (MR-CoNS). Sixteen CRB caused by staphylococci were diagnosed among 92 suspected patients. GeneXpert detected 14 out of 16 cases (87.5%), including 4 MSSA and 10 MR-CoNS in approximately 1 hour after specimen receipt. The sensitivity and specificity of GeneXpert were 87.5% (CI 95%: 60.4–97.8) and 92.1% (CI 95%: 83–96.7), respectively, compared with standard culture methods. The sensitivity of GeneXpert for S. aureus was 100%. Regarding a cost-effectiveness analysis, the incremental cost of using GeneXpert was of 31.1€ per patient while the incremental cost-effectiveness ratio of GeneXpert compared with blood culture alones was about 180€ per life year gained. In conclusion, GeneXpert can be used directly with blood samples obtained through infected catheters to detect S. aureus and MR-CoNS in approximately 1h after sampling. In addition, it is cost-effective especially in areas with high prevalence of staphylococcal CRB. PMID:27571200

The minimal work cost of information processing

NASA Astrophysics Data System (ADS)

Faist, Philippe; Dupuis, Frédéric; Oppenheim, Jonathan; Renner, Renato

2015-07-01

Irreversible information processing cannot be carried out without some inevitable thermodynamical work cost. This fundamental restriction, known as Landauer's principle, is increasingly relevant today, as the energy dissipation of computing devices impedes the development of their performance. Here we determine the minimal work required to carry out any logical process, for instance a computation. It is given by the entropy of the discarded information conditional to the output of the computation. Our formula takes precisely into account the statistically fluctuating work requirement of the logical process. It enables the explicit calculation of practical scenarios, such as computational circuits or quantum measurements. On the conceptual level, our result gives a precise and operational connection between thermodynamic and information entropy, and explains the emergence of the entropy state function in macroscopic thermodynamics.

An examination of blood center structure and hospital customer satisfaction: what can centralized and decentralized blood centers learn from each other?

PubMed

Carden, Robert; DelliFraine, Jami L

2005-01-01

The cost of blood and blood products has increased rapidly over the last several years while the supply of available blood donors has simultaneously decreased. Higher blood costs and donor shortages have put a strain on the relationship between blood suppliers and their hospital customers. This study examines the association between blood center centralization or decentralization and several aspects of hospital satisfaction. Centralized and decentralized blood centers have significant differences in various aspects of hospital customer satisfaction. Advantages and disadvantages of the two structures are discussed, as well as areas for future research.

Low-Cost HIV-1 Diagnosis and Quantification in Dried Blood Spots by Real Time PCR

PubMed Central

Mehta, Nishaki; Trzmielina, Sonia; Nonyane, Bareng A. S.; Eliot, Melissa N.; Lin, Rongheng; Foulkes, Andrea S.; McNeal, Kristina; Ammann, Arthur; Eulalievyolo, Vindu; Sullivan, John L.; Luzuriaga, Katherine; Somasundaran, Mohan

2009-01-01

Background Rapid and cost-effective methods for HIV-1 diagnosis and viral load monitoring would greatly enhance the clinical management of HIV-1 infected adults and children in limited-resource settings. Recent recommendations to treat perinatally infected infants within the first year of life are feasible only if early diagnosis is routinely available. Dried blood spots (DBS) on filter paper are an easy and convenient way to collect and transport blood samples. A rapid and cost effective method to diagnose and quantify HIV-1 from DBS is urgently needed to facilitate early diagnosis of HIV-1 infection and monitoring of antiretroviral therapy. Methods and Findings We have developed a real-time LightCycler (rtLC) PCR assay to detect and quantify HIV-1 from DBS. HIV-1 RNA extracted from DBS was amplified in a one-step, single-tube system using primers specific for long-terminal repeat sequences that are conserved across all HIV-1 clades. SYBR Green dye was used to quantify PCR amplicons and HIV-1 RNA copy numbers were determined from a standard curve generated using serially diluted known copies of HIV-1 RNA. This assay detected samples across clades, has a dynamic range of 5 log10, and %CV <8% up to 4 log10 dilution. Plasma HIV-1 RNA copy numbers obtained using this method correlated well with the Roche Ultrasensitive (r = 0.91) and branched DNA (r = 0.89) assays. The lower limit of detection (95%) was estimated to be 136 copies. The rtLC DBS assay was 2.5 fold rapid as well as 40-fold cheaper when compared to commercial assays. Adaptation of the assay into other real-time systems demonstrated similar performance. Conclusions The accuracy, reliability, genotype inclusivity and affordability, along with the small volumes of blood required for the assay suggest that the rtLC DBS assay will be useful for early diagnosis and monitoring of pediatric HIV-1 infection in resource-limited settings. PMID:19503790

Low-cost HIV-1 diagnosis and quantification in dried blood spots by real time PCR.

PubMed

Mehta, Nishaki; Trzmielina, Sonia; Nonyane, Bareng A S; Eliot, Melissa N; Lin, Rongheng; Foulkes, Andrea S; McNeal, Kristina; Ammann, Arthur; Eulalievyolo, Vindu; Sullivan, John L; Luzuriaga, Katherine; Somasundaran, Mohan

2009-06-05

Rapid and cost-effective methods for HIV-1 diagnosis and viral load monitoring would greatly enhance the clinical management of HIV-1 infected adults and children in limited-resource settings. Recent recommendations to treat perinatally infected infants within the first year of life are feasible only if early diagnosis is routinely available. Dried blood spots (DBS) on filter paper are an easy and convenient way to collect and transport blood samples. A rapid and cost effective method to diagnose and quantify HIV-1 from DBS is urgently needed to facilitate early diagnosis of HIV-1 infection and monitoring of antiretroviral therapy. We have developed a real-time LightCycler (rtLC) PCR assay to detect and quantify HIV-1 from DBS. HIV-1 RNA extracted from DBS was amplified in a one-step, single-tube system using primers specific for long-terminal repeat sequences that are conserved across all HIV-1 clades. SYBR Green dye was used to quantify PCR amplicons and HIV-1 RNA copy numbers were determined from a standard curve generated using serially diluted known copies of HIV-1 RNA. This assay detected samples across clades, has a dynamic range of 5 log(10), and %CV <8% up to 4 log(10) dilution. Plasma HIV-1 RNA copy numbers obtained using this method correlated well with the Roche Ultrasensitive (r = 0.91) and branched DNA (r = 0.89) assays. The lower limit of detection (95%) was estimated to be 136 copies. The rtLC DBS assay was 2.5 fold rapid as well as 40-fold cheaper when compared to commercial assays. Adaptation of the assay into other real-time systems demonstrated similar performance. The accuracy, reliability, genotype inclusivity and affordability, along with the small volumes of blood required for the assay suggest that the rtLC DBS assay will be useful for early diagnosis and monitoring of pediatric HIV-1 infection in resource-limited settings.

Cutting costs without drawing blood.

PubMed

Copeland, T

2000-01-01

When looking for ways to cut costs, most managers reach for the head-count hatchet, and the markets usually roar with approval. But a company can almost always create far more sustainable value by rigorously evaluating the small-ticket capital items that often get rubber-stamped. Drawing on his experience as a consultant and providing numerous anecdotes, the author contends that those "little" requests often prove to be gold plated or unnecessary. A disciplined evaluation involves asking only eight questions and conducting postmortems--regular audits of units' capital spending. But the payoff is enormous. Because cutting the capital budget increases cash flow, the author argues that a permanent cut of just 15% in the planned level of capital spending could boost some companies' market capitalization by as much as 30%. The first three questions--Is this your investment to make? Does it really have to be new? How are our competitors meeting compliance needs?--are asked of operating managers as they assemble capital project requests. The next three are asked by senior managers of themselves and their colleagues as they examine proposals: Is the left hand duplicating investments made by the right? Are trade-offs between profit and capital spending well understood? Are there signs of budget massage? At the end of the review process, senior managers ask: Are we fully using shared assets? How fine-grained are our capacity measures? The author's suggestions for the postmortem include searching for systematic problems with whole classes of expenditures and making sure audit teams come up with specific recommendations for change.

Improving data collection processes for routine evaluation of treatment cost-effectiveness.

PubMed

Monto, Sari; Penttilä, Riku; Kärri, Timo; Puolakka, Kari; Valpas, Antti; Talonpoika, Anna-Maria

2016-04-01

The healthcare system in Finland has begun routine collection of health-related quality of life (HRQoL) information for patients in hospitals to support more systematic cost-effectiveness analysis (CEA). This article describes the systematic collection of HRQoL survey data, and addresses challenges in the implementation of patient surveys and acquisition of cost data in the case hospital. Challenges include problems with incomplete data and undefined management processes. In order to support CEA of hospital treatments, improvements are sought from the process management literature and in the observation of healthcare professionals. The article has been written from an information system and process management perspective, concluding that process ownership, automation of data collection and better staff training are keys to generating more reliable data.

A low-cost vector processor boosting compute-intensive image processing operations

NASA Technical Reports Server (NTRS)

Adorf, Hans-Martin

1992-01-01

Low-cost vector processing (VP) is within reach of everyone seriously engaged in scientific computing. The advent of affordable add-on VP-boards for standard workstations complemented by mathematical/statistical libraries is beginning to impact compute-intensive tasks such as image processing. A case in point in the restoration of distorted images from the Hubble Space Telescope. A low-cost implementation is presented of the standard Tarasko-Richardson-Lucy restoration algorithm on an Intel i860-based VP-board which is seamlessly interfaced to a commercial, interactive image processing system. First experience is reported (including some benchmarks for standalone FFT's) and some conclusions are drawn.

Economic Impact of Blood Transfusions: Balancing Cost and Benefits

PubMed Central

Oge, Tufan; Kilic, Cemil Hakan; Kilic, Gokhan Sami

2014-01-01

Blood transfusions may be lifesaving, but they inherit their own risks. Risk of transfusion to benefit is a delicate balance. In addition, blood product transfusions purchases are one of the largest line items among the hospital and laboratory charges. In this review, we aimed to discuss the transfusion strategies and share our transfusion protocol as well as the steps for hospitals to build-up a blood management program while all these factors weight in. Moreover, we evaluate the financial burden to the health care system. PMID:25610294

Are central institutional review boards the solution? The National Heart, Lung, and Blood Institute Working Group's report on optimizing the IRB process.

PubMed

Mascette, Alice M; Bernard, Gordon R; Dimichele, Donna; Goldner, Jesse A; Harrington, Robert; Harris, Paul A; Leeds, Hilary S; Pearson, Thomas A; Ramsey, Bonnie; Wagner, Todd H

2012-12-01

The National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health convened a working group in June 2011 to examine alternative institutional review board (IRB) models. The working group was held in response to proposed changes in the regulations for government-supported research and the proliferation of multicenter clinical trials where multiple individual reviews may be inefficient. Group members included experts in heart, lung, and blood research, research oversight, bioethics, health economics, regulations, and information technology (IT). The group discussed alternative IRB models, ethical concerns, metrics for evaluating IRBs, IT needs, and economic considerations. Participants noted research gaps in IRB best practices and in metrics. The group arrived at recommendations for process changes, such as defining specific IRB performance requirements in funding announcements, requiring funded researchers to use more efficient alternative IRB models, and developing IT systems to facilitate information sharing and collaboration among IRBs. Despite the success of the National Cancer Institute's central IRB (CIRB), the working group, concerned about the creation costs and unknown cost-efficiency of a new CIRB, and about the risk of shifting the burden of dealing with multiple IRBs from sponsors to research institutions, did not recommend the creation of an NHLBI-funded CIRB.

Financial and educational costs of the residency interview process for urology applicants.

PubMed

Kerfoot, B Price; Asher, Kevin P; McCullough, David L

2008-06-01

To investigate the financial and educational costs of the urology residency interview process, we performed a survey of the applicants to the 2006 urology match. All applicants registered for the 2006 urology match were invited to participate. In January 2006 prior to the match, an anonymous online survey containing 8 questions on the financial and educational costs of the interview process was distributed via email. Survey response rate was 61% (287/468). The median educational debt of the applicants was $125,000 (IQR 65,000 to 160,000). Respondents reported having a median 12 interviews (IQR 8 to 15) with urology residencies and spending a median 20 days (IQR 14 to 30) on the interview trail. The total cost of the interview process was a median $4000 (IQR 2000 to 5200) with a median expense per interview of $330 (IQR 211 to 455). Applicants reported that travel expenses accounted for a median 60% of overall interview expenses, whereas the remainder of the expense was accounted for by lodging (25%), food (10%) and clothing (5%). The money to cover these interview-related expenses was obtained primarily by loans. Forty-six percent of the applicants reported that skipping medical school clerkships and classes for urology interviews was "not at all detrimental" to their medical education, whereas 1% reported that it was "greatly detrimental." The financial cost of the interview process for urology applicants is substantial, although the educational cost appears to be limited. Efforts to reduce the financial impact of the interview process should be initiated at both a regional and national level.

Simulation Based Low-Cost Composite Process Development at the US Air Force Research Laboratory

NASA Technical Reports Server (NTRS)

Rice, Brian P.; Lee, C. William; Curliss, David B.

2003-01-01

Low-cost composite research in the US Air Force Research Laboratory, Materials and Manufacturing Directorate, Organic Matrix Composites Branch has focused on the theme of affordable performance. Practically, this means that we use a very broad view when considering the affordability of composites. Factors such as material costs, labor costs, recurring and nonrecurring manufacturing costs are balanced against performance to arrive at the relative affordability vs. performance measure of merit. The research efforts discussed here are two projects focused on affordable processing of composites. The first topic is the use of a neural network scheme to model cure reaction kinetics, then utilize the kinetics coupled with simple heat transport models to predict, in real-time, future exotherms and control them. The neural network scheme is demonstrated to be very robust and a much more efficient method that mechanistic cure modeling approach. This enables very practical low-cost processing of thick composite parts. The second project is liquid composite molding (LCM) process simulation. LCM processing of large 3D integrated composite parts has been demonstrated to be a very cost effective way to produce large integrated aerospace components specific examples of LCM processes are resin transfer molding (RTM), vacuum assisted resin transfer molding (VARTM), and other similar approaches. LCM process simulation is a critical part of developing an LCM process approach. Flow simulation enables the development of the most robust approach to introducing resin into complex preforms. Furthermore, LCM simulation can be used in conjunction with flow front sensors to control the LCM process in real-time to account for preform or resin variability.

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

PubMed Central

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

2016-01-01

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

Surface-enhanced Raman scattering of whole human blood, blood plasma, and red blood cells: cellular processes and bioanalytical sensing.

PubMed

Premasiri, W R; Lee, J C; Ziegler, L D

2012-08-09

SERS spectra of whole human blood, blood plasma, and red blood cells on Au nanoparticle SiO(2) substrates excited at 785 nm have been observed. For the sample preparation procedure employed here, the SERS spectrum of whole blood arises from the blood plasma component only. This is in contrast to the normal Raman spectrum of whole blood excited at 785 nm and open to ambient air, which is exclusively due to the scattering of oxyhemoglobin. The SERS spectrum of whole blood shows a storage time dependence that is not evident in the non-SERS Raman spectrum of whole blood. Hypoxanthine, a product of purine degradation, dominates the SERS spectrum of blood after ~10-20 h of storage at 8 °C. The corresponding SERS spectrum of plasma isolated from the stored blood shows the same temporal release of hypoxanthine. Thus, blood cellular components (red blood cells, white blood cells, and/or platelets) are releasing hypoxanthine into the plasma over this time interval. The SERS spectrum of red blood cells (RBCs) excited at 785 nm is reported for the first time and exhibits well-known heme group marker bands as well as other bands that may be attributed to cell membrane components or protein denaturation contributions. SERS, as well as normal Raman spectra, of oxy- and met-RBCs are reported and compared. These SERS results can have significant impact in the area of clinical diagnostics, blood supply management, and forensics.

Surface Enhanced Raman Scattering of Whole Human Blood, Blood Plasma and Red Blood Cells: Cellular Processes and Bioanalytical Sensing

PubMed Central

Premasiri, W. R.; Lee, J. C.; Ziegler, L. D.

2013-01-01

SERS spectra of whole human blood, blood plasma and red blood cells on Au nanoparticle SiO2 substrates excited at 785 nm have been observed. For the sample preparation procedure employed here, the SERS spectrum of whole blood arises from the blood plasma component only. This is in contrast to the normal Raman spectrum of whole blood excited at 785 nm and open to ambient air, which is exclusively due to the scattering of oxyhemoglobin. The SERS spectrum of whole blood shows a storage time dependence that is not evident in the non-SERS Raman spectrum of whole blood. Hypoxanthine, a product of purine degradation, dominates the SERS spectrum of blood after ~10 – 20 hours of storage at 8 °C. The corresponding SERS spectrum of plasma isolated from the stored blood shows the same temporal release of hypoxanthine. Thus, blood cellular components (red blood cells, white blood cells and/or platelets) are releasing hypoxanthine into the plasma over this time interval. The SERS spectrum of red blood cells (RBCs) excited at 785 nm is reported for the first time and exhibits well known heme group marker bands, as well as other bands that may be attributed to cell membrane components or protein denaturation contributions. SERS, as well as normal Raman spectra, of oxy- and met-RBCs are reported and compared. These SERS results can have significant impact in the area of clinical diagnostics, blood supply management and forensics. PMID:22780445

48 CFR 30.604 - Processing changes to disclosed or established cost accounting practices.

Code of Federal Regulations, 2010 CFR

2010-10-01

... disclosed or established cost accounting practices. 30.604 Section 30.604 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION GENERAL CONTRACTING REQUIREMENTS COST ACCOUNTING STANDARDS ADMINISTRATION CAS Administration 30.604 Processing changes to disclosed or established cost accounting practices...

48 CFR 30.604 - Processing changes to disclosed or established cost accounting practices.

Code of Federal Regulations, 2011 CFR

2011-10-01

... disclosed or established cost accounting practices. 30.604 Section 30.604 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION GENERAL CONTRACTING REQUIREMENTS COST ACCOUNTING STANDARDS ADMINISTRATION CAS Administration 30.604 Processing changes to disclosed or established cost accounting practices...

Novel Automated Blood Separations Validate Whole Cell Biomarkers

PubMed Central

Burger, Douglas E.; Wang, Limei; Ban, Liqin; Okubo, Yoshiaki; Kühtreiber, Willem M.; Leichliter, Ashley K.; Faustman, Denise L.

2011-01-01

Background Progress in clinical trials in infectious disease, autoimmunity, and cancer is stymied by a dearth of successful whole cell biomarkers for peripheral blood lymphocytes (PBLs). Successful biomarkers could help to track drug effects at early time points in clinical trials to prevent costly trial failures late in development. One major obstacle is the inaccuracy of Ficoll density centrifugation, the decades-old method of separating PBLs from the abundant red blood cells (RBCs) of fresh blood samples. Methods and Findings To replace the Ficoll method, we developed and studied a novel blood-based magnetic separation method. The magnetic method strikingly surpassed Ficoll in viability, purity and yield of PBLs. To reduce labor, we developed an automated platform and compared two magnet configurations for cell separations. These more accurate and labor-saving magnet configurations allowed the lymphocytes to be tested in bioassays for rare antigen-specific T cells. The automated method succeeded at identifying 79% of patients with the rare PBLs of interest as compared with Ficoll's uniform failure. We validated improved upfront blood processing and show accurate detection of rare antigen-specific lymphocytes. Conclusions Improving, automating and standardizing lymphocyte detections from whole blood may facilitate development of new cell-based biomarkers for human diseases. Improved upfront blood processes may lead to broad improvements in monitoring early trial outcome measurements in human clinical trials. PMID:21799852

[Hospital processes and costs in neurology. A study of a referral hospital].

PubMed

Canto-Torán, Esther; Vivas-Consuelo, David; Barrachina-Martinez, Isabel; Escudero-Torrella, Joaquín

2011-11-16

The steady growth of spending on healthcare and the limited availability of resources make it necessary to include cost analysis among the tools used for hospital management. AIMS. To obtain the hospitalisation operating statement of a neurology service and to analyse the differences with regard to costs per process. The study involved an analysis of costs per process in the neurology service of a referral hospital in the Valencian Community (400,000 inhabitants). The data used were those concerning health care activity in 2008 according to the information registered by the Economic Information System of the Valencian Regional Ministry of Health; ABC and top-down methods were applied to calculate the cost per process. The results thus obtained were compared with the fees established for hospital production in the Valencian Regional Government's Law on Fees. For a production of 1092 hospital discharges, with a case-mix index of 0.96 and a mean length of stay of 9.2 days with a case mix of 1.91, hospitalisation costs came to 4,411,643.45 euros, with a mean cost per process of 2,111.46 euros. Taking into account the fees that were applied, the difference between income and expenditure was -12,770.39 euros. The diagnosis-related groups with the greatest difference were numbers 14 (-246,392.49 euros), 533 (-90,292.49 euros) and 15 (-55,139.66 euros). The hospitalisation profit and loss account obtained is negative due to the fact that the mean length of stay in the service is longer than expected, above all in diagnosis-related groups 14, 533 and 15, which are the most inefficient.

Impact of Capital and Current Costs Changes of the Incineration Process of the Medical Waste on System Management Cost

NASA Astrophysics Data System (ADS)

Jolanta Walery, Maria

2017-12-01

The article describes optimization studies aimed at analysing the impact of capital and current costs changes of medical waste incineration on the cost of the system management and its structure. The study was conducted on the example of an analysis of the system of medical waste management in the Podlaskie Province, in north-eastern Poland. The scope of operational research carried out under the optimization study was divided into two stages of optimization calculations with assumed technical and economic parameters of the system. In the first stage, the lowest cost of functioning of the analysed system was generated, whereas in the second one the influence of the input parameter of the system, i.e. capital and current costs of medical waste incineration on economic efficiency index (E) and the spatial structure of the system was determined. Optimization studies were conducted for the following cases: with a 25% increase in capital and current costs of incineration process, followed by 50%, 75% and 100% increase. As a result of the calculations, the highest cost of system operation was achieved at the level of 3143.70 PLN/t with the assumption of 100% increase in capital and current costs of incineration process. There was an increase in the economic efficiency index (E) by about 97% in relation to run 1.

Assessment of Rheumatoid Arthritis Quality Process Measures and Associated Costs.

PubMed

Brady, Brenna L; Tkacz, Joseph; Meyer, Roxanne; Bolge, Susan C; Ruetsch, Charles

2017-02-01

The objective was to examine the relationship between health care costs and quality in rheumatoid arthritis (RA). Administrative claims were used to calculate 8 process measures for the treatment of RA. Associated health care costs were calculated for members who achieved or did not achieve each of the measures. Medical, pharmacy, and laboratory claims for RA patients (International Classification of Diseases, Ninth Revision, Clinical Modification 714.x) were extracted from the Optum Clinformatics Datamart database for 2011. Individuals were predominately female and in their mid-fifties. Measure achievement ranged from 55.9% to 80.8%. The mean cost of care for members meeting the measure was $18,644; members who did not meet the measures had a mean cost of $14,973. Primary cost drivers were pharmacy and office expenses, accounting for 42.4% and 26.3% of total costs, respectively. Regression analyses revealed statistically significant associations between biologic usage, which was more prevalent in groups attaining measures, and total expenditure across all measures (Ps < 0.001). Pharmacy costs were similar between both groups. Individuals meeting the measures had a higher proportion of costs accounted for by office visits; those not meeting the measures had a higher proportion of costs from inpatient and outpatient visits. These findings suggest that increased quality may lead to lower inpatient and outpatient hospital costs. Yet, the overall cost of RA care is likely to remain high because of intensive pharmacotherapy regimens.

Assessment of Rheumatoid Arthritis Quality Process Measures and Associated Costs

PubMed Central

Tkacz, Joseph; Meyer, Roxanne; Bolge, Susan C.; Ruetsch, Charles

2017-01-01

Abstract The objective was to examine the relationship between health care costs and quality in rheumatoid arthritis (RA). Administrative claims were used to calculate 8 process measures for the treatment of RA. Associated health care costs were calculated for members who achieved or did not achieve each of the measures. Medical, pharmacy, and laboratory claims for RA patients (International Classification of Diseases, Ninth Revision, Clinical Modification 714.x) were extracted from the Optum Clinformatics Datamart database for 2011. Individuals were predominately female and in their mid-fifties. Measure achievement ranged from 55.9% to 80.8%. The mean cost of care for members meeting the measure was $18,644; members who did not meet the measures had a mean cost of $14,973. Primary cost drivers were pharmacy and office expenses, accounting for 42.4% and 26.3% of total costs, respectively. Regression analyses revealed statistically significant associations between biologic usage, which was more prevalent in groups attaining measures, and total expenditure across all measures (Ps < 0.001). Pharmacy costs were similar between both groups. Individuals meeting the measures had a higher proportion of costs accounted for by office visits; those not meeting the measures had a higher proportion of costs from inpatient and outpatient visits. These findings suggest that increased quality may lead to lower inpatient and outpatient hospital costs. Yet, the overall cost of RA care is likely to remain high because of intensive pharmacotherapy regimens. PMID:27031517

Health economics and outcomes methods in risk-based decision-making for blood safety.

PubMed

Custer, Brian; Janssen, Mart P

2015-08-01

Analytical methods appropriate for health economic assessments of transfusion safety interventions have not previously been described in ways that facilitate their use. Within the context of risk-based decision-making (RBDM), health economics can be important for optimizing decisions among competing interventions. The objective of this review is to address key considerations and limitations of current methods as they apply to blood safety. Because a voluntary blood supply is an example of a public good, analyses should be conducted from the societal perspective when possible. Two primary study designs are recommended for most blood safety intervention assessments: budget impact analysis (BIA), which measures the cost to implement an intervention both to the blood operator but also in a broader context, and cost-utility analysis (CUA), which measures the ratio between costs and health gain achieved, in terms of reduced morbidity and mortality, by use of an intervention. These analyses often have important limitations because data that reflect specific aspects, for example, blood recipient population characteristics or complication rates, are not available. Sensitivity analyses play an important role. The impact of various uncertain factors can be studied conjointly in probabilistic sensitivity analyses. The use of BIA and CUA together provides a comprehensive assessment of the costs and benefits from implementing (or not) specific interventions. RBDM is multifaceted and impacts a broad spectrum of stakeholders. Gathering and analyzing health economic evidence as part of the RBDM process enhances the quality, completeness, and transparency of decision-making. © 2015 AABB.

Process development and exergy cost sensitivity analysis of a hybrid molten carbonate fuel cell power plant and carbon dioxide capturing process

NASA Astrophysics Data System (ADS)

Mehrpooya, Mehdi; Ansarinasab, Hojat; Moftakhari Sharifzadeh, Mohammad Mehdi; Rosen, Marc A.

2017-10-01

An integrated power plant with a net electrical power output of 3.71 × 105 kW is developed and investigated. The electrical efficiency of the process is found to be 60.1%. The process includes three main sub-systems: molten carbonate fuel cell system, heat recovery section and cryogenic carbon dioxide capturing process. Conventional and advanced exergoeconomic methods are used for analyzing the process. Advanced exergoeconomic analysis is a comprehensive evaluation tool which combines an exergetic approach with economic analysis procedures. With this method, investment and exergy destruction costs of the process components are divided into endogenous/exogenous and avoidable/unavoidable parts. Results of the conventional exergoeconomic analyses demonstrate that the combustion chamber has the largest exergy destruction rate (182 MW) and cost rate (13,100 /h). Also, the total process cost rate can be decreased by reducing the cost rate of the fuel cell and improving the efficiency of the combustion chamber and heat recovery steam generator. Based on the total avoidable endogenous cost rate, the priority for modification is the heat recovery steam generator, a compressor and a turbine of the power plant, in rank order. A sensitivity analysis is done to investigate the exergoeconomic factor parameters through changing the effective parameter variations.

Cost Factors in Scaling in SfM Collections and Processing Solutions

NASA Astrophysics Data System (ADS)

Cherry, J. E.

2015-12-01

In this talk I will discuss the economics of scaling Structure from Motion (SfM)-style collections from 1 km2 and below to 100's and 1000's of square kilometers. Considerations include the costs of the technical equipment: comparisons of small, medium, and large-format camera systems, as well as various GPS-INS systems and their impact on processing accuracy for various Ground Sampling Distances. Tradeoffs between camera formats and flight time are central. Weather conditions and planning high altitude versus low altitude flights are another economic factor, particularly in areas of persistently bad weather and in areas where ground logistics (i.e. hotel rooms and pilot incidentals) are expensive. Unique costs associated with UAS collections and experimental payloads will be discussed. Finally, the costs of equipment and labor differs in SfM processing than in conventional orthomosaic and LiDAR processing. There are opportunities for 'economies of scale' in SfM collections under certain circumstances but whether the accuracy specifications are firm/fixed or 'best effort' makes a difference.

Pointo - a Low Cost Solution to Point Cloud Processing

NASA Astrophysics Data System (ADS)

Houshiar, H.; Winkler, S.

2017-11-01

With advance in technology access to data especially 3D point cloud data becomes more and more an everyday task. 3D point clouds are usually captured with very expensive tools such as 3D laser scanners or very time consuming methods such as photogrammetry. Most of the available softwares for 3D point cloud processing are designed for experts and specialists in this field and are usually very large software packages containing variety of methods and tools. This results in softwares that are usually very expensive to acquire and also very difficult to use. Difficulty of use is caused by complicated user interfaces that is required to accommodate a large list of features. The aim of these complex softwares is to provide a powerful tool for a specific group of specialist. However they are not necessary required by the majority of the up coming average users of point clouds. In addition to complexity and high costs of these softwares they generally rely on expensive and modern hardware and only compatible with one specific operating system. Many point cloud customers are not point cloud processing experts or willing to spend the high acquisition costs of these expensive softwares and hardwares. In this paper we introduce a solution for low cost point cloud processing. Our approach is designed to accommodate the needs of the average point cloud user. To reduce the cost and complexity of software our approach focuses on one functionality at a time in contrast with most available softwares and tools that aim to solve as many problems as possible at the same time. Our simple and user oriented design improve the user experience and empower us to optimize our methods for creation of an efficient software. In this paper we introduce Pointo family as a series of connected softwares to provide easy to use tools with simple design for different point cloud processing requirements. PointoVIEWER and PointoCAD are introduced as the first components of the Pointo family to provide a

Recent advancements in low cost solar cell processing

NASA Technical Reports Server (NTRS)

Ralph, E. L.

1975-01-01

A proof-of-concept solar cell process has been developed that is adaptable to automation. This involved the development of a new contact system, a new antireflection coating system, a drift field cell design and a new contoured surface treatment. All these processes are performed without the use of vacuum chambers and expensive masking techniques, thus providing the possibility of reduced costs by automation using conventional semiconductor processing machinery. The contacts were printed on the cells by conventional silk screen machinery. The P(+) back field was formed by diffusing in aluminum from a printed aluminum back contact. The antireflection coating was formed by spinning on and baking a TiO2-SiO2 glass film. Air-mass-zero efficiencies of over 10% were achieved using this completely vacuum-free process.

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

PubMed

Tsagkari, Mirela; Couturier, Jean-Luc; Kokossis, Antonis; Dubois, Jean-Luc

2016-09-08

Biorefineries offer a promising alternative to fossil-based processing industries and have undergone rapid development in recent years. Limited financial resources and stringent company budgets necessitate quick capital estimation of pioneering biorefinery projects at the early stages of their conception to screen process alternatives, decide on project viability, and allocate resources to the most promising cases. Biorefineries are capital-intensive projects that involve state-of-the-art technologies for which there is no prior experience or sufficient historical data. This work reviews existing rapid cost estimation practices, which can be used by researchers with no previous cost estimating experience. It also comprises a comparative study of six cost methods on three well-documented biorefinery processes to evaluate their accuracy and precision. The results illustrate discrepancies among the methods because their extrapolation on biorefinery data often violates inherent assumptions. This study recommends the most appropriate rapid cost methods and urges the development of an improved early-stage capital cost estimation tool suitable for biorefinery processes. © 2015 The Authors. Published by Wiley-VCH Verlag GmbH & Co. KGaA.

Automated processing of whole blood samples into microliter aliquots of plasma.

PubMed

Burtis, C A; Johnson, W W; Walker, W A

1988-01-01

A rotor that accepts and automatically processes a bulk aliquot of a single blood sample into multiple aliquots of plasma has been designed and built. The rotor consists of a central processing unit, which includes a disk containing eight precision-bore capillaries. By varying the internal diameters of the capillaries, aliquot volumes ranging 1 to 10 mul can be prepared. In practice, an unmeasured volume of blood is placed in a centre well, and, as the rotor begins to spin, is moved radially into a central annular ring where it is distributed into a series of processing chambers. The rotor is then spun at 3000 rpm for 10 min. When the centrifugal field is removed by slowly decreasing the rotor speed, an aliquot of plasma is withdrawn by capillary action into each of the capillary tubes. The disk containing the eight measured aliquots of plasma is subsequently removed and placed in a modifed rotor for conventional centrifugal analysis. Initial evaluation of the new rotor indicates that it is capable of producing discrete, microliter volumes of plasma with a degree of accuracy and precision approaching that of mechanical pipettes.

19 CFR 10.197 - Direct costs of processing operations performed in a beneficiary country or countries.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 19 Customs Duties 1 2011-04-01 2011-04-01 false Direct costs of processing operations performed in... TO A REDUCED RATE, ETC. Caribbean Basin Initiative § 10.197 Direct costs of processing operations... operations. As used in § 10.195 and § 10.198, the words “direct costs of processing operations” mean those...

Solar energy for process heat: Design/cost studies of four industrial retrofit applications

NASA Technical Reports Server (NTRS)

French, R. L.; Bartera, R. E.

1978-01-01

Five specific California plants with potentially attractive solar applications were identified in a process heat survey. These five plants were visited, process requirements evaluated, and conceptual solar system designs were generated. Four DOE (ERDA) sponsored solar energy system demonstration projects were also reviewed and compared to the design/cost cases included in this report. In four of the five cases investigated, retrofit installations providing significant amounts of thermal energy were found to be feasible. The fifth was rejected because of the condition of the building involved, but the process (soap making) appears to be an attractive potential solar application. Costs, however, tend to be high. Several potential areas for cost reduction were identified including larger collector modules and higher duty cycles.

Hot forming and quenching pilot process development for low cost and low environmental impact manufacturing.

NASA Astrophysics Data System (ADS)

Hall, Roger W.; Foster, Alistair; Herrmann Praturlon, Anja

2017-09-01

The Hot Forming and in-tool Quenching (HFQ®) process is a proven technique to enable complex shaped stampings to be manufactured from high strength aluminium. Its widespread uptake for high volume production will be maximised if it is able to wholly amortise the additional investment cost of this process compared to conventional deep drawing techniques. This paper discusses the use of three techniques to guide some of the development decisions taken during upscaling of the HFQ® process. Modelling of Process timing, Cost and Life-cycle impact were found to be effective tools to identify where development budget could be focused in order to be able to manufacture low cost panels of different sizes from many different alloys in a sustainable way. The results confirm that raw material cost, panel trimming, and artificial ageing were some of the highest contributing factors to final component cost. Additionally, heat treatment and lubricant removal stages played a significant role in the overall life-cycle assessment of the final products. These findings confirmed development priorities as novel furnace design, fast artificial ageing and low-cost alloy development.

Autologous blood donation in a small general acute-care hospital.

PubMed Central

Mott, L. S.; Jones, M. J.

1995-01-01

Increased public concerns about infectious risk associated with homologous blood transfusions have led to a significant increase in autologous blood collections. In response, blood banks and large hospitals have implemented autologous blood donation programs (ABDPs). Small hospitals lack the technical resources and patient case loads to effectively institute ABDPs. A preoperative ABDP designed to increase availability and patient convenience--and, therefore, utilization--is described. The program created in a rural 90-bed general acute-care hospital processed 105 donors and collected 197 units over a 38-month period. The percentage of the collected units that were transfused was 44.7%, and only 6.1% of participating patients required homologous transfusions. Comparisons of hematological and clinical data with previously published results indicate that small-scale preoperative ABDPs are clinically effective, safe, and provide cost-efficient utilization of the safest blood supply available. PMID:7674344

Process cost and facility considerations in the selection of primary cell culture clarification technology.

PubMed

Felo, Michael; Christensen, Brandon; Higgins, John

2013-01-01

The bioreactor volume delineating the selection of primary clarification technology is not always easily defined. Development of a commercial scale process for the manufacture of therapeutic proteins requires scale-up from a few liters to thousands of liters. While the separation techniques used for protein purification are largely conserved across scales, the separation techniques for primary cell culture clarification vary with scale. Process models were developed to compare monoclonal antibody production costs using two cell culture clarification technologies. One process model was created for cell culture clarification by disc stack centrifugation with depth filtration. A second process model was created for clarification by multi-stage depth filtration. Analyses were performed to examine the influence of bioreactor volume, product titer, depth filter capacity, and facility utilization on overall operating costs. At bioreactor volumes <1,000 L, clarification using multi-stage depth filtration offers cost savings compared to clarification using centrifugation. For bioreactor volumes >5,000 L, clarification using centrifugation followed by depth filtration offers significant cost savings. For bioreactor volumes of ∼ 2,000 L, clarification costs are similar between depth filtration and centrifugation. At this scale, factors including facility utilization, available capital, ease of process development, implementation timelines, and process performance characterization play an important role in clarification technology selection. In the case study presented, a multi-product facility selected multi-stage depth filtration for cell culture clarification at the 500 and 2,000 L scales of operation. Facility implementation timelines, process development activities, equipment commissioning and validation, scale-up effects, and process robustness are examined. © 2013 American Institute of Chemical Engineers.

Cell Saver for Adult Spinal Deformity Surgery Reduces Cost.

PubMed

Gum, Jeffrey L; Carreon, Leah Yacat; Kelly, Michael P; Hostin, Richard; Robinson, Chessie; Burton, Douglas C; Polly, David W; Shaffrey, Christopher I; LaFage, Virginie; Schwab, Frank J; Ames, Christopher P; Kim, Han Jo; Smith, Justin S; Bess, R Shay

2017-07-01

Retrospective cohort. To determine if the use of cell saver reduces overall blood costs in adult spinal deformity (ASD) surgery. Recent studies have questioned the clinical value of cell saver during spine procedures. ASD patients enrolled in a prospective, multicenter surgical database who had complete preoperative and surgical data were identified. Patients were stratified into (1) cell saver available during surgery, but no intraoperative autologous infusion (No Infusion group), or (2) cell saver available and received autologous infusion (Infusion group). There were 427 patients in the Infusion group and 153 in the No infusion group. Patients in both groups had similar demographics. Mean autologous infusion volume was 698 mL. The Infusion group had a higher percentage of EBL relative to the estimated blood volume (42.2%) than the No Infusion group (19.6%, p < .000). Allogeneic transfusion was more common in the Infusion group (255/427, 60%) than the No Infusion group (67/153, 44%, p = .001). The number of allogeneic blood units transfused was also higher in the Infusion group (2.4) than the No Infusion group (1.7, p = .009). Total blood costs ranged from $396 to $2,146 in the No Infusion group and from $1,262 to $5,088 in the Infusion group. If the cost of cell saver blood was transformed into costs of allogeneic blood, total blood costs for the Infusion group would range from $840 to $5,418. Thus, cell saver use yielded a mean cost savings ranging from $330 to $422 (allogeneic blood averted). Linear regression showed that after an EBL of 614 mL, cell saver becomes cost-efficient. Compared to transfusing allogeneic blood, cell saver autologous infusion did not reduce the proportion or the volume of allogeneic transfusion for patients undergoing surgery for adult spinal deformity. The use of cell saver becomes cost-efficient above an EBL of 614 mL, producing a cost savings of $330 to $422. Level III. Copyright © 2017 Scoliosis Research Society. Published by

Cost comparative study of autologous peripheral blood progenitor cells (PBPC) and bone marrow (ABM) transplantations for non-Hodgkin's lymphoma patients.

PubMed

Woronoff-Lemsi, M C; Arveux, P; Limat, S; Deconinck, E; Morel, P; Cahn, J Y

1997-12-01

Intensive high-dose chemotherapy with autologous stem-cell support has become a common treatment strategy for non-Hodgkin's lymphomas. A cost-identification analysis was conducted comparing 10 patients autografted with PBSC to 10 others autografted with BM. The analysis included harvest and graft until graft day +100 and was carried out from the point of view of the hospital setting. Resources used, logistic and direct medical costs per patient were identified, and sensitivity analyses performed. The cost distribution was different. Stem cell harvest was more expensive for PBPC ($9030) and BM ($4745); on the other hand, hospitalization from graft to discharge from hospital cost savings with PBSC were about $10666. After discharge from hospital, costs were similar and cheaper in both groups. For the overall study the PBPC procedure was less expensive than ABMT, $35381 and $41759 respectively, with cost savings of $6378. The number of days spent in hospital and blood bank costs were the major cost factors. This study was based on a single pathology, non-Hodgkin's lymphoma, and the actual hospital records for each patient situation as opposed to a clinical trial, and our results were consistent with different previous studies carried out in different health care systems.

Modelling the energy costs of the wastewater treatment process: The influence of the aging factor.

PubMed

Castellet-Viciano, Lledó; Hernández-Chover, Vicent; Hernández-Sancho, Francesc

2018-06-01

Wastewater treatment plants (WWTPs) are aging and its effects on the process are more evident as time goes by. Due to the deterioration of the facilities, the efficiency of the treatment process decreases gradually. Within this framework, this paper proves the increase in the energy consumption of the WWTPs with time, and finds differences among facilities size. Accordingly, the paper aims to develop a dynamic energy cost function capable of predicting the energy cost of the process in the future. The time variable is used to introduce the aging effects on the energy cost estimation in order to increase the accuracy of the estimation. For this purpose, the evolution of energy costs will be assessed and modelled for a group of WWTPs using the methodology of cost functions. The results will be useful for the managers of the facilities in the decision making process. Copyright © 2017 Elsevier B.V. All rights reserved.

19 CFR 10.877 - Direct costs of processing operations.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 19 Customs Duties 1 2014-04-01 2014-04-01 false Direct costs of processing operations. 10.877 Section 10.877 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF THE TREASURY ARTICLES CONDITIONALLY FREE, SUBJECT TO A REDUCED RATE, ETC. United States-Oman...

19 CFR 10.877 - Direct costs of processing operations.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 19 Customs Duties 1 2012-04-01 2012-04-01 false Direct costs of processing operations. 10.877 Section 10.877 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF THE TREASURY ARTICLES CONDITIONALLY FREE, SUBJECT TO A REDUCED RATE, ETC. United States-Oman...

19 CFR 10.877 - Direct costs of processing operations.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 19 Customs Duties 1 2013-04-01 2013-04-01 false Direct costs of processing operations. 10.877 Section 10.877 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF THE TREASURY ARTICLES CONDITIONALLY FREE, SUBJECT TO A REDUCED RATE, ETC. United States-Oman...

Cost Risk Analysis Based on Perception of the Engineering Process

NASA Technical Reports Server (NTRS)

Dean, Edwin B.; Wood, Darrell A.; Moore, Arlene A.; Bogart, Edward H.

1986-01-01

process parameters are elicited from the engineer/expert on the project and are based on that expert's technical knowledge. These are converted by a parametric cost model into a cost estimate. The method discussed makes no assumptions about the distribution underlying the distribution of possible costs, and is not tied to the analysis of previous projects, except through the expert calibrations performed by the parametric cost analyst.

Cost Effectiveness of Community Based Strategies for Blood Pressure Control in a Low income Developing Country: Findings from A Cluster Randomized Factorial Controlled Trial

PubMed Central

Jafar, Tazeen H; Islam, Muhammad; Bux, Rasool; Poulter, Neil; Hatcher, Juanita; Chaturvedi, Nish; Ebrahim, Shah; Cosgrove, Peter

2011-01-01

Background Evidence on economically efficient strategies to lower blood pressure (BP) from low- and middle-income countries remains scarce. The Control of Blood Pressure and Risk Attenuation (COBRA) trial randomized 1341 hypertensive subjects in 12 randomly selected communities in Karachi, Pakistan, to three intervention programs: combined home health education (HHE) plus trained general practitioner (GP); 2) HHE only; 3) trained GP only. The comparator was no intervention (or usual care). The reduction in BP was most pronounced in the combined group. The present study examined the cost-effectiveness of these strategies. Methods and Results Total costs were assessed at baseline and 2 years to estimate incremental cost effectiveness ratios (ICER) based on (a) intervention cost; b) cost of physician consultation, medications and diagnostics, changes in lifestyle, and productivity loss and (c) change in systolic BP. Precision of the ICER estimates was assessed by 1000 bootstrapping replications. Bayesian probabilistic sensitivity analysis was also performed. The annual per participant cost associated with the combined HHE plus trained GP, HHE alone, and trained GP alone were $3.99, $3.34, and $0.65, respectively. HHE plus trained GP was the most cost effective intervention with an ICER of $ 23 (6 to 99) per mm Hg reduction in systolic BP compared to usual care and remained so in 97.7% of 1000 bootstrapped replications. Conclusions The combined intervention of HHE plus trained GP is potentially affordable and more cost effective for BP control than usual care or either strategy alone in some communities in Pakistan, and possibly other countries in Indo-China with similar healthcare infrastructure. PMID:21931077

Solidifying agent and processing of blood used for the larval diet affect screwworm (Diptera: Calliphoridae) life-history parameters.

PubMed

Chaudhury, M F; Skoda, S R; Sagel, A

2011-06-01

Spray-dried whole bovine blood and a sodium polyacrylate polymer gel as a bulking and solidifying agent are among the constituents of the current larval diet for mass rearing screwworm, Cochliomyia hominivorax (Coquerel) (Diptera: Calliphoridae). Locally available, inexpensive dietary materials could reduce rearing cost and address an uncertain commercial supply of spray-dried blood. We compared efficacy of diet prepared from fresh bovine blood after decoagulation with sodium citrate or ethylenediaminetetraacetic acid (EDTA) or after mechanical defibrination, with the diet containing spray-dried blood using either gel or cellulose fiber as the bulking and solidifying agent. Several life-history parameters were compared among insects reared on each of the blood and bulking agent diets combination. Diets containing citrated blood yielded the lightest larval and pupal weights and fewest pupae. EDTA-treated blood with the gel also caused reductions. EDTA-treated blood with fiber yielded screwworms that were heavier and more numerous than those from the diet with citrated blood but lighter than those from the control diet using spray-dried blood. A reduction in percentage of adults emerging from pupae occurred from diets with both bulking agents using citrated blood and the diet using EDTA mixed with the gel bulking agent. As a group, the cellulose-fiber diets performed better than the gel diets. Larval diet did not affect adult longevity, weight of the eggs deposited by the females that emerged or subsequent egg hatch. Parameter measurements of insects from both defibrinated blood diets were similar to those from the spray-dried blood diets, indicating that fresh, defibrinated bovine blood can successfully replace the dry blood in the screwworm rearing medium.

Evaluation of selected chemical processes for production of low-cost silicon

NASA Technical Reports Server (NTRS)

Blocher, J. M., Jr.; Browning, M. F.; Wilson, W. J.; Carmichael, D. C.

1976-01-01

Plant construction costs and manufacturing costs were estimated for the production of solar-grade silicon by the reduction of silicon tetrachloride in a fluidized bed of seed particles, and several modifications of the iodide process using either thermal decomposition on heated filaments (rods) or hydrogen reduction in a fluidized bed of seed particles. Energy consumption data for the zinc reduction process and each of the iodide process options are given and all appear to be acceptable from the standpoint of energy pay back. Information is presented on the experimental zinc reduction of SiCl4 and electrolytic recovery of zinc from ZnCl2. All of the experimental work performed thus far has supported the initial assumption as to technical feasibility of producing semiconductor silicon by the zinc reduction or iodide processes proposed. The results of a more thorough thermodynamic evaluation of the iodination of silicon oxide/carbon mixtures are presented which explain apparent inconsistencies in an earlier cursory examination of the system.

Effects of self-blood on the molding process of polymethyl methacrylate bone cement.

PubMed

Guo, Ying-Jun; Nie, Lin; Zhang, Wen; Mu, Qing

2014-01-01

To evaluate whether the self-blood has influence on the molding process of polymethyl methacrylate (PMMA) bone cement, and to make sure whether it is valuable for the clinical practice. An in vitro study was performed to evaluate the prolonging-effect of self-blood on PMMA bone cement. The effect of prolonging was evaluated by the dough time (TD) and operable time (TO). Moreover, hardness test, squeezing value test and peak temperature test were also conducted to complete the evaluation of this program. The self-blood, especially the plasma, could greatly prolong the handling time of PMMA bone cement without affecting its basic characteristics including hardness, leakage level and peak temperature. On the other hand, we found that in some abnormal conditions, for example with hyperlipemia, self-blood though can also prolong the handling time, would cause some side-effects. We report a new effective way to prolong the handling time of PMMA bone cement by adding moderate amount of self-blood. But "individualized medicine" should be noticed because some abnormal conditions like hyperlipemia would cause undesired side-effects.

What are the critical steps in processing blood cultures? A prospective audit evaluating current practice of reporting blood cultures in a centralised laboratory serving secondary care hospitals.

PubMed

Meda, Manjula; Clayton, James; Varghese, Reela; Rangaiah, Jayakeerthi; Grundy, Clive; Dashti, Farnaz; Garner, David; Groves, Katherine; Fitzmaurice, Karen; Hutley, E

2017-04-01

To assess current procedures of processing positive blood cultures against national standards with an aim to evaluate its clinical impact and to determine the utility of currently available rapid identification and susceptibility tests in processing of blood cultures. Blood cultures from three secondary care hospitals, processed at a centralised laboratory, were prospectively audited. Data regarding processing times, communication with prescribers, changes to patient management and mortality within 30 days of a significant blood culture were collected in a preplanned pro forma for a 4-week period. Of 2206 blood cultures, 211 positive blood cultures flagged positive. Sixty-nine (3.1%) of all cultures were considered to be contaminated. Fifty per cent of blood cultures that flagged positive had a Gram stain reported within 2 hours. Two (0.99%) patients with a significant bacteraemia had escalation of antimicrobial treatment at the point of reporting the Gram stain that was subsequently deemed necessary once sensitivity results were known. Most common intervention was de-escalation of therapy for Gram-positive organisms at the point of availability of pathogen identification (25.6% in Gram positive vs 10% in Gram negative; p=0.012). For Gram-negative organisms, the most common intervention was de-escalation of therapy at the point of availability of sensitivity results (43% in Gram negatives vs 17.9% in Gram positive; p=0.0097). Overall mortality within 30 days of a positive blood culture was 10.9% (23/211). Antibiotic resistance may have contributed to mortality in four of these patients (three Gram negative and one Gram positive). Gram stain result had the least impact on antibiotic treatment interventions (escalation or de-escalation). Tests that improve identification time for Gram-positive pathogens and sensitivity time for Gram-negative pathogens had the greatest impact in making significant changes to antimicrobial treatment. Published by the BMJ

Estimating costs and performance of systems for machine processing of remotely sensed data

NASA Technical Reports Server (NTRS)

Ballard, R. J.; Eastwood, L. F., Jr.

1977-01-01

This paper outlines a method for estimating computer processing times and costs incurred in producing information products from digital remotely sensed data. The method accounts for both computation and overhead, and may be applied to any serial computer. The method is applied to estimate the cost and computer time involved in producing Level II Land Use and Vegetative Cover Maps for a five-state midwestern region. The results show that the amount of data to be processed overloads some example computer systems, but that the processing is feasible on others.

Process Simulation and Cost Analysis for Removing Inorganics from Wood Chips using Combined Mechanical and Chemical Preprocessing

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

Hu, Hongqiang; Westover, Tyler L.; Cherry, Robert

Naturally occurring and introduced inorganic species (ash) in biomass feedstocks negatively impact thermochemical energy conversion processes such as pyrolysis, hydrothermal liquefaction, gasification and combustion to biopower. As such, it is desirable to better understand the cost:benefit ratios of various ash reduction processes. Here, a novel process simulation model was developed using AspenPlus to reduce the ash content of Loblolly logging residues using both air classification and a dilute-acid leaching process. For costing purposes, a throughput of 25 tons/hour was selected. At this scale, the process cost for a standalone air classification process was $3 per ton for a biomass feedstock.more » Ash reduction via dilute –acid leaching was simulated based on experimentally determined kinetics of ion diffusion at an acid concentration of 0.5% H2SO4 and temperature of 75°F. The total estimated processing cost for leaching at these conditions was approximately $14/ton of dry biomass. Sensitivity analysis of three parameters on mineral reduction in the leaching process revealed that increasing leaching temperature was not economically feasible, while it was viable to apply a longer retention time in leaching for higher ash removal or achieve a lower water content in final products with reasonable extra costs. In addition, scenarios combining air classification with leaching were examined. A whole process cost of approximately $16/ton of biomass at a biomass feedstock rate of 25 ton/hour considering a 9% of biomass classified as light fraction to be leached. The leaching operating costs constituted 75% of this amount, of which the heating costs of dryer was 44%. This suggests that the process costs would be substantially reduced if more efficient drying methods are applied in future.« less

Affordable Design: A Methodolgy to Implement Process-Based Manufacturing Cost into the Traditional Performance-Focused Multidisciplinary Design Optimization

NASA Technical Reports Server (NTRS)

Bao, Han P.; Samareh, J. A.

2000-01-01

The primary objective of this paper is to demonstrate the use of process-based manufacturing and assembly cost models in a traditional performance-focused multidisciplinary design and optimization process. The use of automated cost-performance analysis is an enabling technology that could bring realistic processbased manufacturing and assembly cost into multidisciplinary design and optimization. In this paper, we present a new methodology for incorporating process costing into a standard multidisciplinary design optimization process. Material, manufacturing processes, and assembly processes costs then could be used as the objective function for the optimization method. A case study involving forty-six different configurations of a simple wing is presented, indicating that a design based on performance criteria alone may not necessarily be the most affordable as far as manufacturing and assembly cost is concerned.

Development of a Cost Estimation Process for Human Systems Integration Practitioners During the Analysis of Alternatives

DTIC Science & Technology

2010-12-01

processes. Novice estimators must often use of these complicated cost estimation tools (e.g., ACEIT , SEER-H, SEER-S, PRICE-H, PRICE-S, etc.) until...However, the thesis will leverage the processes embedded in cost estimation tools such as the Automated Cost Estimating Integration Tool ( ACEIT ) and the

Feasibility of hospital-based blood banking: a Tanzanian case study.

PubMed

Jacobs, B; Mercer, A

1999-12-01

The demand for blood transfusion is high in sub-Saharan Africa because of the high prevalence of anaemia and pregnancy related complications, but the practice is estimated to account for 10% of HIV infections in some regions. The main response to this problem by the international donor community is to establish vertically implemented blood transfusion services producing suitable (safe) blood at a cost of US$25-40 per unit. However, the economic sustainability of such interventions is questionable and it is argued here that hospital-based blood transfusion services operating at a basic adequate level are sufficient for low-income African countries. The results of a project aimed at improving such services in Tanzania are presented. The main findings are: (1) the cost per suitable blood unit produced was US$12.4; (2) at an HIV test sensitivity of 93.5% during the study period, discounted financial benefits of the interventions exceeded costs by a factor of between 17.2 and 37.1; (3) the cost per undiscounted year of life saved by use of these interventions was US$2.7-2.8; and (4) safe blood transfusion practices can be assured at an annual cost of US$0.07 per capita. Recommendations are made to ensure safe blood transfusion practices at hospital-based blood banks in Tanzania.

Profiling mild steel welding processes to reduce fume emissions and costs in the workplace.

PubMed

Keane, Michael J; Siert, Arlen; Chen, Bean T; Stone, Samuel G

2014-05-01

To provide quantitative information to choose the best welding processes for minimizing workplace emissions, nine gas metal arc welding (GMAW) processes for mild steel were assessed for fume generation rates, normalized fume generation rates (milligram fume per gram of electrode consumed), and normalized generation rates for elemental manganese, nickel, and iron. Shielded metal arc welding (SMAW) and flux-cored arc-welding (FCAW) processes were also profiled. The fumes were collected quantitatively in an American Welding Society-type fume chamber and weighed, recovered, homogenized, and analyzed by inductively coupled atomic emission spectroscopy for total metals. The processes included GMAW with short circuit, globular transfer, axial spray, pulsed spray, Surface Tension Transfer™, Regulated Metal Deposition™, and Cold Metal Transfer™ (CMT) modes. Flux-cored welding was gas shielded, and SMAW was a single rod type. Results indicate a wide range of fume emission factors for the process variations studied. Fume emission rates per gram of electrode consumed were highest for SMAW (~13 mg fume g(-1) electrode) and lowest for GMAW processes such as pulsed spray (~1.5mg g(-1)) and CMT (~1mg g(-1)). Manganese emission rates per gram of electrode consumed ranged from 0.45 mg g(-1) (SMAW) to 0.08 mg g(-1) (CMT). Nickel emission rates were generally low and ranged from ~0.09 (GMAW short circuit) to 0.004 mg g(-1) (CMT). Iron emission rates ranged from 3.7 (spray-mode GMAW) to 0.49 mg g(-1) (CMT). The processes studied have significantly different costs, and cost factors are presented based on a case study to allow comparisons between processes in specific cost categories. Costs per linear meter of weld were $31.07 (SMAW), $12.37 (GMAW short circuit), and $10.89 (FCAW). Although no single process is the best for minimizing fume emissions and costs while satisfying the weld requirements, there are several processes that can minimize emissions. This study provides

Profiling Mild Steel Welding Processes to Reduce Fume Emissions and Costs in the Workplace

PubMed Central

Keane, Michael J.; Siert, Arlen; Chen, Bean T.; Stone, Samuel G.

2015-01-01

To provide quantitative information to choose the best welding processes for minimizing workplace emissions, nine gas metal arc welding (GMAW) processes for mild steel were assessed for fume generation rates, normalized fume generation rates (milligram fume per gram of electrode consumed), and normalized generation rates for elemental manganese, nickel, and iron. Shielded metal arc welding (SMAW) and flux-cored arc-welding (FCAW) processes were also profiled. The fumes were collected quantitatively in an American Welding Society-type fume chamber and weighed, recovered, homogenized, and analyzed by inductively coupled atomic emission spectroscopy for total metals. The processes included GMAW with short circuit, globular transfer, axial spray, pulsed spray, Surface Tension Transfer™, Regulated Metal Deposition™, and Cold Metal Transfer™ (CMT) modes. Flux-cored welding was gas shielded, and SMAW was a single rod type. Results indicate a wide range of fume emission factors for the process variations studied. Fume emission rates per gram of electrode consumed were highest for SMAW (~13 mg fume g−1 electrode) and lowest for GMAW processes such as pulsed spray (~1.5 mg g−1) and CMT (~1 mg g−1). Manganese emission rates per gram of electrode consumed ranged from 0.45 mg g−1 (SMAW) to 0.08 mg g−1 (CMT). Nickel emission rates were generally low and ranged from ~0.09 (GMAW short circuit) to 0.004 mg g−1 (CMT). Iron emission rates ranged from 3.7 (spray-mode GMAW) to 0.49 mg g−1 (CMT). The processes studied have significantly different costs, and cost factors are presented based on a case study to allow comparisons between processes in specific cost categories. Costs per linear meter of weld were $31.07 (SMAW), $12.37 (GMAW short circuit), and $10.89 (FCAW). Although no single process is the best for minimizing fume emissions and costs while satisfying the weld requirements, there are several processes that can minimize emissions. This study provides

Blood biomarkers in Alzheimer's disease.

PubMed

Altuna-Azkargorta, M; Mendioroz-Iriarte, M

2018-05-08

The early diagnosis of Alzheimer's disease (AD) via the use of biomarkers could facilitate the implementation and monitoring of early therapeutic interventions with the potential capacity to significantly modify the course of the disease. Classic cerebrospinal fluid biomarkers and approved structural and functional neuroimaging have a limited clinical application given their invasive nature and/or high cost. The identification of more accessible and less costly biomarkers, such as blood biomarkers, would facilitate application in clinical practice. We present a literature review of the main blood biochemical biomarkers with potential use for diagnosing Alzheimer's disease. Blood biomarkers are cost and time effective with regard to cerebrospinal fluid biomarkers. However, the immediate applicability of blood biochemical biomarkers in clinical practice is not very likely. The main limitations come from the difficulties in measuring and standardising thresholds between different laboratories and in failures to replicate results. Among all the molecules studied, apoptosis and neurodegeneration biomarkers and the biomarker panels obtained through omics approaches, such as isolated or combined metabolomics, offer the most promising results. Copyright © 2018 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

Multi objective optimization model for minimizing production cost and environmental impact in CNC turning process

NASA Astrophysics Data System (ADS)

Widhiarso, Wahyu; Rosyidi, Cucuk Nur

2018-02-01

Minimizing production cost in a manufacturing company will increase the profit of the company. The cutting parameters will affect total processing time which then will affect the production cost of machining process. Besides affecting the production cost and processing time, the cutting parameters will also affect the environment. An optimization model is needed to determine the optimum cutting parameters. In this paper, we develop an optimization model to minimize the production cost and the environmental impact in CNC turning process. The model is used a multi objective optimization. Cutting speed and feed rate are served as the decision variables. Constraints considered are cutting speed, feed rate, cutting force, output power, and surface roughness. The environmental impact is converted from the environmental burden by using eco-indicator 99. Numerical example is given to show the implementation of the model and solved using OptQuest of Oracle Crystal Ball software. The results of optimization indicate that the model can be used to optimize the cutting parameters to minimize the production cost and the environmental impact.

A Systems Approach to Costing in the Blood Bank

PubMed Central

Delon, Gerald L.; Smalley, Harold E.

1969-01-01

A macroscopic approach to departmental cost finding is combined with a microscopic approach to the weighting of laboratory tests in a mathematical model which, when incorporated into a relative unit value format, yields unit costs for such tests under a wide variety of operational conditions. The task of updating such costs to reflect changing conditions can be facilitated by a computer program incorporating the capability of pricing the various tests to achieve any desired profit or loss or to break even. Among other potential uses of such a technique, the effects on unit cost per test caused by increasing or decreasing the number of technicians or the volume of tests can be systematically examined, and pricing can be updated each year as hospital costs change. PMID:5799486

Assessment of a new silicone tri-leaflet valve seamlessly assembled with blood chamber for a low-cost ventricular assist device.

PubMed

Hirai, S; Fukunaga, S; Sueshiro, M; Watari, M; Sueda, T; Matsuura, Y

1998-06-01

We have developed a practical, low-cost ventricular assist device (VAD) comprising a newly designed blood chamber with a silicone lenticular sac and two silicone tri-leaflet valves (STV), made en bloc. This new VAD is seamless, can be made cost-effectively and assembled with the blood chamber and valve as one body. This novel design should reduce the incident of thrombus formation because of the absence of a junction at the connecting ring and because of the use of flexible silicone materials which have both antithrombogenecity and biocompatibility. In in vitro hemodynamics testing, a batch of 3 consecutively manufactured VADs with STVs underwent hydrodynamic functional testing. These showed less regurgitation, a lower value of water hammer phenomenon, and a slightly greater pressure gradient across the valves than a mechanical valve (MV) [Björk-Shiley monostrut valve]. The flow and pulsatile efficiency were adequate and similar to that of a VAD with MVs. In in vitro durability and hemolysis tests, a VAD with STV functioned well for 54 days and showed similar hemolytic profiles to a VAD with MVs. In an in vivo acute experiment using an adult sheep, our device was problem-free providing sufficient output as a left ventricular assist device (LVAD). Although it will be necessary to decrease the pressure gradient across this STV in the future, our device showed efficient performance as a practical land cost-effective VAD for short term use.

Implementation of a new blood cooler insert and tracking technology with educational initiatives and its effect on reducing red blood cell wastage.

PubMed

Fadeyi, Emmanuel A; Emery, Wanda; Simmons, Julie H; Jones, Mary Rose; Pomper, Gregory J

2017-10-01

The objective was to report a successful implementation of a blood cooler insert and tracking technology with educational initiatives and its effect on reducing red blood cell (RBC) wastage. The blood bank database was used to quantify and categorize total RBC units issued in blood coolers from January 2010 to December 2015 with and without the new inserts throughout the hospital. Radiofrequency identification tags were used with special software to monitor blood cooler tracking. An educational policy on how to handle the coolers was initiated. Data were gathered from the software that provided a real-time location monitoring of the blood coolers with inserts throughout the institution. The implementation of the blood cooler with inserts and tracking device reduced mean yearly RBC wastage by fourfold from 0.64% to 0.17% between 2010 and 2015. The conserved RBCs corresponded to a total cost savings of $167,844 during the 3-year postimplementation period. The implementation of new blood cooler inserts, tracking system, and educational initiatives substantially reduced the mean annual total RBC wastage. The cost to implement this initiative may be small if there is an existing institutional infrastructure to monitor and track hospital equipment into which the blood bank intervention can be adapted when compared to the cost of blood wastage. © 2017 AABB.

Investigation of low cost material processes for liquid rocket engines

NASA Technical Reports Server (NTRS)

Nguyentat, Thinh; Kawashige, Chester M.; Scala, James G.; Horn, Ronald M.

1993-01-01

The development of low cost material processes is essential to the achievement of economical liquid rocket propulsion systems in the next century. This paper will present the results of the evaluation of some promising material processes including powder metallurgy, vacuum plasma spray, metal spray forming, and bulge forming. The physical and mechanical test results from the samples and subscale hardware fabricated from high strength copper alloys and superalloys will be discussed.

Image processing and machine learning in the morphological analysis of blood cells.

PubMed

Rodellar, J; Alférez, S; Acevedo, A; Molina, A; Merino, A

2018-05-01

This review focuses on how image processing and machine learning can be useful for the morphological characterization and automatic recognition of cell images captured from peripheral blood smears. The basics of the 3 core elements (segmentation, quantitative features, and classification) are outlined, and recent literature is discussed. Although red blood cells are a significant part of this context, this study focuses on malignant lymphoid cells and blast cells. There is no doubt that these technologies may help the cytologist to perform efficient, objective, and fast morphological analysis of blood cells. They may also help in the interpretation of some morphological features and may serve as learning and survey tools. Although research is still needed, it is important to define screening strategies to exploit the potential of image-based automatic recognition systems integrated in the daily routine of laboratories along with other analysis methodologies. © 2018 John Wiley & Sons Ltd.

Blood Thinners

MedlinePlus

Blood thinners are medicines that prevent blood clots from forming. They also keep existing blood clots from getting larger. Clots in your arteries, ... down your body's process of making clots. Antiplatelet drugs, such as aspirin, prevent blood cells called platelets ...

An Out-of-Pocket Cost Removal Intervention on Fecal Occult Blood Test Attendance.

PubMed

Tabuchi, Takahiro; Murayama, Hiroshi; Hoshino, Takahiro; Nakayama, Tomio

2017-08-01

To date, no comparative study has assessed the impact of a cost-removal intervention on fecal occult blood testing (FOBT). In 2012, the Japanese government introduced a nationwide project to remove out-of-pocket costs for FOBT. The study objective was to evaluate the differential impact of the intervention on FOBT attendance in the total population and various subgroups. This study analyzed 309,103 people in national, repeated cross-sectional studies, observed pre- and post-intervention (2010 and 2013), using covariate-adjusted difference-in-differences estimates to compare intervention and no-intervention groups. The outcome measure was uptake of FOBT attendance resulting from the intervention. Stratified analyses were conducted according to sociodemographic and health-related characteristics. The intervention was associated with significantly positive uptake of FOBT in both genders, but the impact was greater in women than men: 6.7% (95% CI=5.2, 8.1) for women and 2.7% (95% CI=1.1, 4.3) for men in the covariate-adjusted models. Post-intervention, attendance increased in almost all subgroups in women. However, among men, some socially advantaged subgroups, such as high expenditure, high education, and public officers, showed no effect. Some subgroups such as current smokers and less than high school education were identified as hard-to-reach populations that may be less sensitive to the intervention, irrespective of gender. This is the first comparative study of cost-removal intervention for uptake of FOBT. The intervention may increase FOBT attendance. However, the size of the effect is not great, especially in men, and differential effects occurred across subgroups including gender and socioeconomic differences. Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

[Estimating the microcosts of blood transfusion for hemato-oncological patients].

PubMed

Brilhante, Dialina; Macedo, Ana; Santos, Ana

2008-01-01

There are several ways of treating and preventing chemotherapy-associated anaemia, namely with erythropoiesis stimulating agents and blood transfusion, that remains an option. Since erythropoiesis stimulating agents have a high unitary cost, it is crucial to evaluate their cost-effectiveness, namely versus transfusion. The objective of this study is to calculate the cost of a blood transfusion, carried out at the Immunohemotherapy Outward of Instituto Português de Oncologia, Francisco Gentil, in Lisbon as treatment for neoplasia-associated anaemia. Cross sectional, observational study from the perspective of the Hospital and the National Health Service, which evaluates the resources and direct costs, associated with a blood transfusion of two erythrocyte concentrate (EC) units in hemato-oncology patients. Data regarding consumables, human resources, laboratory analysis and occupation of facilities was collected for a period of seven consecutive days, regarding both blood donation and transfusion procedures in the Immunohemotherapy Outward of Instituto Português de Oncologia, Francisco Gentil, in Lisbon. The total cost of a two EC unit transfusion was estimated at euro 676.2, with the greatest part of this cost being attributed to blood preparation, analysis and storage. Determining reliable costs in relation to medical actions and procedures is essential in analysing the cost-effectiveness of new drugs. This study evaluated the cost for the transfusion of two EC units and the results presented are similar to those obtained in other European countries by several authors.

Colorectal cancer screening comparing no screening, immunochemical and guaiac fecal occult blood tests: a cost-effectiveness analysis.

PubMed

van Rossum, Leo G M; van Rijn, Anne F; Verbeek, Andre L M; van Oijen, Martijn G H; Laheij, Robert J F; Fockens, Paul; Jansen, Jan B M J; Adang, Eddy M M; Dekker, Evelien

2011-04-15

Comparability of cost-effectiveness of colorectal cancer (CRC) screening strategies is limited if heterogeneous study data are combined. We analyzed prospective empirical data from a randomized-controlled trial to compare cost-effectiveness of screening with either one round of immunochemical fecal occult blood testing (I-FOBT; OC-Sensor®), one round of guaiac FOBT (G-FOBT; Hemoccult-II®) or no screening in Dutch aged 50 to 75 years, completed with cancer registry and literature data, from a third-party payer perspective in a Markov model with first- and second-order Monte Carlo simulation. Costs were measured in Euros (€), effects in life-years gained, and both were discounted with 3%. Uncertainty surrounding important parameters was analyzed. I-FOBT dominated the alternatives: after one round of I-FOBT screening, a hypothetical person would on average gain 0.003 life-years and save the health care system €27 compared with G-FOBT and 0.003 life years and €72 compared with no screening. Overall, in 4,460,265 Dutch aged 50-75 years, after one round I-FOBT screening, 13,400 life-years and €320 million would have been saved compared with no screening. I-FOBT also dominated in sensitivity analyses, varying uncertainty surrounding important effect and cost parameters. CRC screening with I-FOBT dominated G-FOBT and no screening with or without accounting for uncertainty. Copyright © 2010 UICC.

The health regionalization process from the perspective of the transation cost theory.

PubMed

Sancho, Leyla Gomes; Geremia, Daniela Savi; Dain, Sulamis; Geremia, Fabiano; Leão, Cláudio José Silva

2017-04-01

This study analyzes the incidence of transaction costs in the regionalization process of health policies in the Brazilian federal system. In this work, regionalized health actions contracted and agreed between federal agencies have assumed a transactional nature. A conceptual theoretical essay of reflective nature was prepared with the purpose of questioning and proposing new approaches to improve the health regionalization process. The main considerations suggest that institutional management tools proposed by the standards and regulations of the Unified Health System have a low potential to reduce transaction costs, especially due to hardships in reconciling common goals among the entities, environment surrounded by uncertainty, asymmetries and incomplete information, bounded rationality and conflict of interest. However, regionalization can reduce the incidence of social and/or operational costs, through improved access to health and the construction of more efficient governance models.

Low Cost Coherent Doppler Lidar Data Acquisition and Processing

NASA Technical Reports Server (NTRS)

Barnes, Bruce W.; Koch, Grady J.

2003-01-01

The work described in this paper details the development of a low-cost, short-development time data acquisition and processing system for a coherent Doppler lidar. This was done using common laboratory equipment and a small software investment. This system provides near real-time wind profile measurements. Coding flexibility created a very useful test bed for new techniques.

Low-Cost Bio-Based Carbon Fibers for High Temperature Processing

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

Paul, Ryan Michael; Naskar, Amit

GrafTech International Holdings Inc. (GTI), under Award No. DE-EE0005779, worked with Oak Ridge National Laboratory (ORNL) under CRADA No. NFE-15-05807 to develop lignin-based carbon fiber (LBCF) technology and to demonstrate LBCF performance in high-temperature products and applications. This work was unique and different from other reported LBCF work in that this study was application-focused and scalability-focused. Accordingly, the executed work was based on meeting criteria based on technology development, cost, and application suitability. High-temperature carbon fiber based insulation is used in energy intensive industries, such as metal heat treating and ceramic and semiconductor material production. Insulation plays a critical rolemore » in achieving high thermal and process efficiency, which is directly related to energy usage, cost, and product competitiveness. Current high temperature insulation is made with petroleum based carbon fibers, and one goal of this protect was to develop and demonstrate an alternative lignin (biomass) based carbon fiber that would achieve lower cost, CO2 emissions, and energy consumption and result in insulation that met or exceeded the thermal efficiency of current commercial insulation. In addition, other products were targeted to be evaluated with LBCF. As the project was designed to proceed in stages, the initial focus of this work was to demonstrate lab-scale LBCF from at least 4 different lignin precursor feedstock sources that could meet the estimated production cost of $5.00/pound and have ash level of less than 500 ppm in the carbonized insulation-grade fiber. Accordingly, a preliminary cost model was developed based on publicly available information. The team demonstrated that 4 lignin samples met the cost criteria. In addition, the ash level for the 4 carbonized lignin samples was below 500 ppm. Processing as-received lignin to produce a high purity lignin fiber was a significant accomplishment in that most

[Cost-effectiveness analysis in type 2 diabetes patients without hypertension].

PubMed

Villarreal-Ríos, Enrique; Vargas-Daza, Emma Rosa; Galicia-Rodríguez, Liliana; Martínez-González, Lidia; Neri-Calero, Claudia; Hernández-Centeno, María Guadalupe

2010-01-01

To determine SOHDi program cost-effectiveness (S = overweight, O = obesity, H = hypertension, Di = diabetes) in type 2 diabetes patients (DM2) without hypertension. Sample included 32 patients. The effectiveness was measured by the blood glucose values. The SOHDi intervention cost included physician medical attention cost (PMAC), laboratory cost (LC), education group cost and individual evaluation cost. The cost of the traditional alternative medical attention (TAMA) contemplated PMAC and LC. The analysis cost-effectiveness included different intervals measurements, equal or smaller than 140 mg/dL blood glucose levels. The percentage of population with equal or smaller than 140 mg/dL blood glucose (effectiveness) in SOHDi was 23.3%, in TAMA was 44.8%. The average cost in SOHDi was $2202.22; in TAMA $1930.79. In the cases with blood glucose equal or smaller to 140 mg/dL the cost of effectiveness of 50% was $4726 in SOHDi and $2155 in TAMA. In this same situation the effectiveness by $1000 was 10.58% in SOHDi and 23.20% in TAMA. The SOHDi group is not the best alternative, at least not in the present operational conditions.

Proactive risk assessment of blood transfusion process, in pediatric emergency, using the Health Care Failure Mode and Effects Analysis (HFMEA).

PubMed

Dehnavieh, Reza; Ebrahimipour, Hossein; Molavi-Taleghani, Yasamin; Vafaee-Najar, Ali; Noori Hekmat, Somayeh; Esmailzdeh, Hamid

2014-12-25

Pediatric emergency has been considered as a high risk area, and blood transfusion is known as a unique clinical measure, therefore this study was conducted with the purpose of assessing the proactive risk assessment of blood transfusion process in Pediatric Emergency of Qaem education- treatment center in Mashhad, by the Healthcare Failure Mode and Effects Analysis (HFMEA) methodology. This cross-sectional study analyzed the failure mode and effects of blood transfusion process by a mixture of quantitative-qualitative method. The proactive HFMEA was used to identify and analyze the potential failures of the process. The information of the items in HFMEA forms was collected after obtaining a consensus of experts' panel views via the interview and focus group discussion sessions. The Number of 77 failure modes were identified for 24 sub-processes enlisted in 8 processes of blood transfusion. Totally 13 failure modes were identified as non-acceptable risk (a hazard score above 8) in the blood transfusion process and were transferred to the decision tree. Root causes of high risk modes were discussed in cause-effect meetings and were classified based on the UK national health system (NHS) approved classifications model. Action types were classified in the form of acceptance (11.6%), control (74.2%) and elimination (14.2%). Recommendations were placed in 7 categories using TRIZ ("Theory of Inventive Problem Solving.") The re-engineering process for the required changes, standardizing and updating the blood transfusion procedure, root cause analysis of blood transfusion catastrophic events, patient identification bracelet, training classes and educational pamphlets for raising awareness of personnel, and monthly gathering of transfusion medicine committee have all been considered as executive strategies in work agenda in pediatric emergency.

Low cost labeling with highlighter ink efficiently visualizes developing blood vessels in avian and mouse embryos.

PubMed

Takase, Yuta; Tadokoro, Ryosuke; Takahashi, Yoshiko

2013-12-01

To understand how blood vessels form to establish the intricate network during vertebrate development, it is helpful if one can visualize the vasculature in embryos. We here describe a novel labeling method using highlighter ink, easily obtained in stationery stores with a low cost, to visualize embryo-wide vasculatures in avian and mice. We tested 50 different highlighters for fluorescent microscopy with filter sets equipped in a standard fluorescent microscope. The yellow and violet inks yielded fluorescent signals specifically detected by the filters used for green fluorescent protein (GFP) and red fluorescent protein (RFP) detections, respectively. When the ink solution was infused into chicken/quail and mouse embryos, vasculatures including large vessels and capillaries were labeled both in living and fixed embryos. Ink-infused embryos were further subjected to histological sections, and double stained with antibodies including QH-1 (quail), α smooth muscle actin (αSMA), and PECAM-1 (mouse), revealing that the endothelial cells were specifically labeled by the infused highlighter ink. Highlighter-labeled signals were detected with a resolution comparable to or higher than signals of fluorescein isothiocyanate (FITC)-lectin and Rhodamine-dextran, conventionally used for angiography. Furthermore, macroconfocal microscopic analyses with ink-infused embryos visualized fine vascular structures of both embryo proper and extra-embryonic plexus in a Z-stack image of 2400 μm thick with a markedly high resolution. Together, the low cost highlighter ink serves as an alternative reagent useful for visualization of blood vessels in developing avian and mouse embryos and possibly in other animals. © 2013 The Authors Development, Growth & Differentiation © 2013 Japanese Society of Developmental Biologists.

Cost-effectiveness of secondary screening modalities for hypertension.

PubMed

Wang, Y Claire; Koval, Alisa M; Nakamura, Miyabi; Newman, Jonathan D; Schwartz, Joseph E; Stone, Patricia W

2013-02-01

Clinic-based blood pressure (CBP) has been the default approach for the diagnosis of hypertension, but patients may be misclassified because of masked hypertension (false negative) or 'white coat' hypertension (false positive). The incorporation of other diagnostic modalities, such as home blood pressure monitoring (HBPM) and ambulatory blood pressure monitoring (ABPM), holds promise to improve diagnostic accuracy and subsequent treatment decisions. We reviewed the literature on the costs and cost-effectiveness of adding HBPM and ABPM to routine blood pressure screening in adults. We excluded letters, editorials, and studies of pregnant and/or pre-eclamptic patients, children, and patients with specific conditions (e.g. diabetes). We identified 14 original, English language studies that included cost outcomes and compared two or more modalities. ABPM was found to be cost saving for diagnostic confirmation following an elevated CBP in six studies. Three of four studies found that adding HBPM to an elevated CBP was also cost-effective. Existing evidence supports the cost-effectiveness of incorporating HBPM or ABPM after an initial CBP-based diagnosis of hypertension. Future research should focus on their implementation in clinical practice, long-term economic values, and potential roles in identifying masked hypertension.

Blood conservation: the CEO perspective.

PubMed

Morgan, Timothy O

2004-08-01

Hospital CEOs are concerned about more than just cost of services to their patients. The advancement of patient car along with maintaining or improving patient safety are also key elements to the CEO, to limit patient risks, hospital liability, and negative public relations. The CEO is accountable to the hospital staff, the patients, and the general public. Establishing programs such as blood management or bloodless medicine can be implemented by using a team approach. A physician champion with a clear business plan that addresses all issues and challenges is critical for successful implementation. As blood and blood product costs rise and supply decreases, alternatives such as cell saving techniques and the use of pharmacologic interventions can have a significant impact on net hospital expenditures.

Cost comparison of methods for preparation of neonatal red cell aliquots.

PubMed

Lechuga, Diana; Thompson, Christina

2007-01-01

The purpose of this study was to compare the preparation costs of two common methods used for neonatal red blood cell transfusion aliquots. Three months of data from a Level 2 and Level 3 neonatal intensive care unit (NICU) were used to determine the comparative cost for red cell aliquot transfusions using an eight bag aliquot/transfer system or the syringe set system. Using leuko-poor red blood cell blood collected in Adsol and containing approximately 320 ml of red blood cells and supernatant solution, the average cost of neonatal transfusion aliquots was determined using the Charter Medical syringe set and the Charter Medical eight bag aliquot/transfer system. A total of 126 red blood cell transfusion aliquots were used over the three month period. The amount transfused with each aliquot ranged from 5.0 ml - 55.0 ml with an average of 24.0 ml per aliquot. The cost per aliquot using the eight aliquot/transfer set was calculated as $36.25 and the cost per aliquot using the syringe set cost was calculated as $30.71. Additional benefits observed with the syringe set included decreased blood waste. When comparing Charter Medical multiple aliquot bag sets and the Charter Medical syringe aliquot system to provide neonatal transfusions, the use of the syringe system decreased blood waste and proved more cost effective.

The costs of HIV prevention strategies in developing countries.

PubMed Central

Söderlund, N.; Lavis, J.; Broomberg, J.; Mills, A.

1993-01-01

Since many evaluations of HIV (human immunodeficiency virus) prevention programmes do not include data on costs, a preliminary analysis of the costs and outputs of a sample of HIV prevention projects was attempted. Case studies, representing six broad HIV prevention strategies in developing countries with differing levels of per capita gross domestic product, were sought on the basis of availability of data and potential generalizability. The six prevention strategies studied were mass media campaigns, peer education programmes, sexually transmitted disease treatment, condom social marketing, safe blood provision, and needle exchange/bleach provision programmes. Financial cost data were abstracted from published studies or were obtained directly from project coordinators. Although estimates of cost-effectiveness were not made, calculations of the relative cost per common process measure of output were compared. Condom distribution costs ranged from US$ 0.02 to 0.70 per condom distributed, and costs of strategies involving personal educational input ranged from US$ 0.15 to 12.59 per contact. PMID:8261563

Impact of processes of care aimed at complication reduction on the cost of complex cancer surgery

PubMed Central

Ho, Vivian; Aloia, Thomas A.

2015-01-01

Background and Objectives Health care providers add multiple processes to the care of complex cancer patients, believing they prevent and/or ameliorate complications. However, the relationship between these processes, complication remediation, and expenditures is unknown. Methods Data for patients with cancer diagnoses undergoing colectomy, rectal resection, pulmonary lobectomy, pneumonectomy, esophagectomy, and pancreatic resection were obtained from hospital and inpatient physician Medicare claims for the years 2005–2009. Risk‐adjusted regression analyses measured the association between hospitalization costs and processes presumed to prevent and/or remedy complications common to high‐risk procedures. Results After controlling for comorbidities, analysis identified associations between increased costs and use of multiple processes, including arterial lines (4–12% higher; P < 0.001) and pulmonary artery catheters (23–33% higher; P < 0.001). Epidural analgesia was not associated with higher costs. Consultations were associated with 24‐44% (P < 0.001) higher costs, and total parenteral nutrition was associated with 13–31% higher costs (P < 0.001). Conclusions Many frequently utilized processes and services presumed to avoid and/or ameliorate complications are associated with increased surgical oncology costs. This suggests that the patient‐centered value of each process should be measured on a procedure‐specific basis. Likewise, further attention should be focused on defining the efficacy of each of these costly, but frequently unproven, additions to perioperative care. J. Surg. Oncol. 2015;112:610–615. © 2015 The Authors. Journal of Surgical Oncology Published by Wiley Periodicals, Inc. PMID:26391328

The National Blood Service. Supporting better blood transfusion.

PubMed

Gerrard, Rebecca

2004-05-01

The National Blood Service (NBS) is an integral part of the National Health Service that provides blood, blood components, blood products and tissues from fifteen blood centres to England and North Wales. Each year, the NBS collects tests, processes, stores and issues approximately 2.3 million blood donations. The service also undertakes research into blood safety, provides clinical advice to hospital staff and supports hospital transfusion practitioners. Rebecca Gerrard describes some of the initiatives to improve blood transfusion practices, including monitoring of the serious hazards of transfusion, bench marking schemes and the roles of blood transfusion liaison (BTL) nurses.

Financing blood transfusion services in sub-Saharan Africa: a role for user fees?

PubMed

Hensher, M; Jefferys, E

2000-09-01

The provision of a secure and safe blood supply has taken on new importance in sub-Saharan Africa with the onset of the AIDS epidemic. Blood transfusion services capable of providing safe blood are not cheap, however, and there has been some debate on the desirability and sustainability of different financing mechanisms for blood transfusion services. This paper examines patterns of financing blood transfusion in three countries--Côte d'Ivoire, Zimbabwe and Mozambique. It goes on to consider the conceptual options for financing safe blood, and to examine in detail the possible role of user fees for blood transfusion in Africa, developing a simple model of their likely burden to patients based on data from Côte d'Ivoire. The model indicates that, at best, there can only be a limited role for user fees in the financing of safe blood transfusion services, due mainly to the relatively high cost of producing a unit of safe blood. Charging individuals for the blood they receive is likely to be administratively complex and costly, could realistically recover only a fraction of the production costs involved, and is further complicated by the fact that the main recipients of blood transfusion in sub-Saharan Africa are children and pregnant women. If cost-recovery for safe blood is to be attempted, the most viable option appears to be that of charging a collective fee, levied upon all inpatients, not just on those who receive blood. Such a mechanism is not without problems, not least in its failure to offer incentives for more appropriate blood use, and it is still likely to recover only a portion of the costs of producing safe blood. Whether or not cost-recovery is instituted, there will remain an important role for public funding of blood transfusion services, and, by implication, an important role for foreign donor support.

A Novel Macroscale Acoustic Device for Blood Filtration.

PubMed

Dutra, Brian; Carmen Mora, Maria; Gerhardson, Tyler I; Sporbert, Brianna; Dufresne, Alexandre; Bittner, Katharine R; Lovewell, Carolanne; Rust, Michael J; Tirabassi, Michael V; Masi, Louis; Lipkens, Bart; Kennedy, Daniel R

2018-03-01

Retransfusion of a patient's own shed blood during cardiac surgery is attractive since it reduces the need for allogeneic transfusion, minimizes cost, and decreases transfusion related morbidity. Evidence suggests that lipid micro-emboli associated with the retransfusion of the shed blood are the predominant causes of the neurocognitive disorders. We have developed a novel acoustophoretic filtration system that can remove lipids from blood at clinically relevant flow rates. Unlike other acoustophoretic separation systems, this ultrasound technology works at the macroscale, and is therefore able to process larger flow rates than typical micro-electromechanical system (MEMS) scale acoustophoretic separation devices. In this work, we have first demonstrated the systematic design of the acoustic device and its optimization, followed by examining the feasibility of the device to filter lipids from the system. Then, we demonstrate the effects of the acoustic waves on the shed blood; examining hemolysis using both haptoglobin formation and lactate dehydrogenase release, as well as the potential of platelet aggregation or inflammatory cascade activation. Finally, in a porcine surgical model, we determined the potential viability of acoustic trapping as a blood filtration technology, as the animal responded to redelivered blood by increasing both systemic and mean arterial blood pressure.

Pyrimethanil degradation by photo-Fenton process: Influence of iron and irradiance level on treatment cost.

PubMed

Cabrera Reina, A; Miralles-Cuevas, S; Casas López, J L; Sánchez Pérez, J A

2017-12-15

This study evaluates the combined effect of photo-catalyst concentration and irradiance level on photo-Fenton efficiency when this treatment is applied to industrial wastewater decontamination. Three levels of irradiance (18, 32 and 46W/m 2 ) and three iron concentrations (8, 20 and 32mg/L) were selected and their influence over the process studied using a raceway pond reactor placed inside a solar box. For 8mg/L, it was found that there was a lack of catalyst to make use of all the available photons. For 20mg/L, the treatment always improved with irradiance indicating that the process was photo-limited. For 32mg/L, the excess of iron caused an excess of radicals production which proved to be counter-productive for the overall process efficiency. The economic assessment showed that acquisition and maintenance costs represent the lowest relative values. The highest cost was found to be the cost of the reagents consumed. Both sulfuric acid and sodium hydroxide are negligible in terms of costs. Iron cost percentages were also very low and never higher than 10.5% while the highest cost was always that of hydrogen peroxide, representing at least 85% of the reagent costs. Thus, the total costs were between 0.76 and 1.39€/m 3 . Copyright © 2017 Elsevier B.V. All rights reserved.

Production of Low Cost Carbon-Fiber through Energy Optimization of Stabilization Process.

PubMed

Golkarnarenji, Gelayol; Naebe, Minoo; Badii, Khashayar; Milani, Abbas S; Jazar, Reza N; Khayyam, Hamid

2018-03-05

To produce high quality and low cost carbon fiber-based composites, the optimization of the production process of carbon fiber and its properties is one of the main keys. The stabilization process is the most important step in carbon fiber production that consumes a large amount of energy and its optimization can reduce the cost to a large extent. In this study, two intelligent optimization techniques, namely Support Vector Regression (SVR) and Artificial Neural Network (ANN), were studied and compared, with a limited dataset obtained to predict physical property (density) of oxidative stabilized PAN fiber (OPF) in the second zone of a stabilization oven within a carbon fiber production line. The results were then used to optimize the energy consumption in the process. The case study can be beneficial to chemical industries involving carbon fiber manufacturing, for assessing and optimizing different stabilization process conditions at large.

Production of Low Cost Carbon-Fiber through Energy Optimization of Stabilization Process

PubMed Central

Golkarnarenji, Gelayol; Naebe, Minoo; Badii, Khashayar; Milani, Abbas S.; Jazar, Reza N.; Khayyam, Hamid

2018-01-01

To produce high quality and low cost carbon fiber-based composites, the optimization of the production process of carbon fiber and its properties is one of the main keys. The stabilization process is the most important step in carbon fiber production that consumes a large amount of energy and its optimization can reduce the cost to a large extent. In this study, two intelligent optimization techniques, namely Support Vector Regression (SVR) and Artificial Neural Network (ANN), were studied and compared, with a limited dataset obtained to predict physical property (density) of oxidative stabilized PAN fiber (OPF) in the second zone of a stabilization oven within a carbon fiber production line. The results were then used to optimize the energy consumption in the process. The case study can be beneficial to chemical industries involving carbon fiber manufacturing, for assessing and optimizing different stabilization process conditions at large. PMID:29510592

The Age of BLood Evaluation (ABLE) randomised controlled trial: description of the UK-funded arm of the international trial, the UK cost-utility analysis and secondary analyses exploring factors associated with health-related quality of life and health-care costs during the 12-month follow-up.

PubMed

Walsh, Timothy S; Stanworth, Simon; Boyd, Julia; Hope, David; Hemmatapour, Sue; Burrows, Helen; Campbell, Helen; Pizzo, Elena; Swart, Nicholas; Morris, Stephen

2017-10-01

At present, red blood cells (RBCs) are stored for up to 42 days prior to transfusion. The relative effectiveness and safety of different RBC storage times prior to transfusion is uncertain. To assess the clinical effectiveness and cost-effectiveness of transfusing fresher RBCs (stored for ≤ 7 days) compared with current standard-aged RBCs in critically ill patients requiring blood transfusions. The international Age of BLood Evaluation (ABLE) trial was a multicentre, randomised, blinded trial undertaken in Canada, the UK, the Netherlands and France. The UK trial was funded to contribute patients to the international trial and undertake a UK-specific health economic evaluation. Twenty intensive care units (ICUs) in the UK, as part of 64 international centres. Critically ill patients aged ≥ 18 years (≥ 16 years in Scotland) expected to require mechanical ventilation for ≥ 48 hours and requiring a first RBC transfusion during the first 7 days in the ICU. All decisions to transfuse RBCs were made by clinicians. One patient group received exclusively fresh RBCs stored for ≤ 7 days whenever transfusion was required from randomisation until hospital discharge. The other group received standard-issue RBCs throughout their hospital stay. The primary outcome was 90-day mortality. Secondary outcomes included development of organ dysfunction, new thrombosis, infections and transfusion reactions. The primary economic evaluation was a cost-utility analysis. The international trial took place between March 2009 and October 2014 (UK recruitment took place between January 2012 and October 2014). In total, 1211 patients were assigned to receive fresh blood and 1219 patients to receive standard-aged blood. RBCs were stored for a mean of 6.1 days [standard deviation (SD) ± 4.9 days] in the group allocated to receive fresh blood and 22.0 days (SD ± 8.4 days) in the group allocated to receive standard-aged blood. Patients received a mean of 4.3 RBC units

Prediction of healthy blood with data mining classification by using Decision Tree, Naive Baysian and SVM approaches

NASA Astrophysics Data System (ADS)

Khalilinezhad, Mahdieh; Minaei, Behrooz; Vernazza, Gianni; Dellepiane, Silvana

2015-03-01

Data mining (DM) is the process of discovery knowledge from large databases. Applications of data mining in Blood Transfusion Organizations could be useful for improving the performance of blood donation service. The aim of this research is the prediction of healthiness of blood donors in Blood Transfusion Organization (BTO). For this goal, three famous algorithms such as Decision Tree C4.5, Naïve Bayesian classifier, and Support Vector Machine have been chosen and applied to a real database made of 11006 donors. Seven fields such as sex, age, job, education, marital status, type of donor, results of blood tests (doctors' comments and lab results about healthy or unhealthy blood donors) have been selected as input to these algorithms. The results of the three algorithms have been compared and an error cost analysis has been performed. According to this research and the obtained results, the best algorithm with low error cost and high accuracy is SVM. This research helps BTO to realize a model from blood donors in each area in order to predict the healthy blood or unhealthy blood of donors. This research could be useful if used in parallel with laboratory tests to better separate unhealthy blood.

A fiber optic probe coupled low-cost CMOS-camera-based system for simultaneous measurement of oxy-, deoxyhemoglobin, and blood flow

NASA Astrophysics Data System (ADS)

Seong, Myeongsu; Phillips, Zephaniah; Mai, Phuong M.; Yeo, Chaebeom; Song, Cheol; Lee, Kijoon; Kim, Jae G.

2015-07-01

Appropriate oxygen supply and blood flow are important in coordination of body functions and maintaining a life. To measure both oxygen supply and blood flow simultaneously, we developed a system that combined near-infrared spectroscopy (NIRS) and diffuse speckle contrast analysis (DSCA). Our system is more cost effective and compact than such combined systems as diffuse correlation spectroscopy(DCS)-NIRS or DCS flow oximeter, and also offers the same quantitative information. In this article, we present the configuration of DSCA-NIRS and preliminary data from an arm cuff occlusion and a repeated gripping exercise. With further investigation, we believe that DSCA-NIRS can be a useful tool for the field of neuroscience, muscle physiology and metabolic diseases such as diabetes.

[Innovative technology and blood safety].

PubMed

Begue, S; Morel, P; Djoudi, R

2016-11-01

If technological innovations are not enough alone to improve blood safety, their contributions for several decades in blood transfusion are major. The improvement of blood donation (new apheresis devices, RFID) or blood components (additive solutions, pathogen reduction technology, automated processing of platelets concentrates) or manufacturing process of these products (by automated processing of whole blood), all these steps where technological innovations were implemented, lead us to better traceability, more efficient processes, quality improvement of blood products and therefore increased blood safety for blood donors and patients. If we are on the threshold of a great change with the progress of pathogen reduction technology (for whole blood and red blood cells), we hope to see production of ex vivo red blood cells or platelets who are real and who open new conceptual paths on blood safety. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Laser cutting eliminates nucleic acid cross-contamination in dried-blood-spot processing.

PubMed

Murphy, Sean C; Daza, Glenda; Chang, Ming; Coombs, Robert

2012-12-01

Dried blood spots (DBS) are useful for molecular assays but are prone to false positives from cross-contamination. In our malaria DBS assay, cross-contamination was encountered despite cleaning techniques suitable for HIV-1. We therefore developed a contact-free laser cutting system that effectively eliminated cross-contamination during DBS processing.

Proactive Risk Assessment of Blood Transfusion Process, in Pediatric Emergency, Using the Health Care Failure Mode and Effects Analysis (HFMEA)

PubMed Central

Dehnavieh, Reza; Ebrahimipour, Hossein; Molavi-Taleghani, Yasamin; Vafaee-Najar, Ali; Hekmat, Somayeh Noori; Esmailzdeh, Hamid

2015-01-01

Introduction: Pediatric emergency has been considered as a high risk area, and blood transfusion is known as a unique clinical measure, therefore this study was conducted with the purpose of assessing the proactive risk assessment of blood transfusion process in Pediatric Emergency of Qaem education- treatment center in Mashhad, by the Healthcare Failure Mode and Effects Analysis (HFMEA) methodology. Methodology: This cross-sectional study analyzed the failure mode and effects of blood transfusion process by a mixture of quantitative-qualitative method. The proactive HFMEA was used to identify and analyze the potential failures of the process. The information of the items in HFMEA forms was collected after obtaining a consensus of experts’ panel views via the interview and focus group discussion sessions. Results: The Number of 77 failure modes were identified for 24 sub-processes enlisted in 8 processes of blood transfusion. Totally 13 failure modes were identified as non-acceptable risk (a hazard score above 8) in the blood transfusion process and were transferred to the decision tree. Root causes of high risk modes were discussed in cause-effect meetings and were classified based on the UK national health system (NHS) approved classifications model. Action types were classified in the form of acceptance (11.6%), control (74.2%) and elimination (14.2%). Recommendations were placed in 7 categories using TRIZ (“Theory of Inventive Problem Solving.”) Conclusion: The re-engineering process for the required changes, standardizing and updating the blood transfusion procedure, root cause analysis of blood transfusion catastrophic events, patient identification bracelet, training classes and educational pamphlets for raising awareness of personnel, and monthly gathering of transfusion medicine committee have all been considered as executive strategies in work agenda in pediatric emergency. PMID:25560332

Attentive processes, blood lactate and CrossFit®.

PubMed

Perciavalle, Valentina; Marchetta, Nunzio Salvatore; Giustiniani, Salvatore; Borbone, Carlo; Perciavalle, Vincenzo; Petralia, Maria Cristina; Buscemi, Andrea; Coco, Marinella

2016-11-01

To analyze the influences of blood lactate produced during a specific session of CrossFit® on intensity and selectivity of attention. The first was evaluated by measuring the reaction time and the second by analyzing divided attention with a dual task. Fifteen male professionals of CrossFit® volunteered in the study. The training session was the Workout Of the Day (WOD) called 15.5, marked as: 27-21-15-9 repetitions (without recovery) in term of calories measured by using a rowing ergometer (e.g. 27 rowed calories) and in term of barbell full squats (raising a weight of 43 kg for men and of 29.5 kg for women). Blood lactate, blood glucose, reaction time, execution time of a dual task, number of errors and number of omissions were measured at rest, at the conclusion of the session and 15 minutes after its end. The levels of the blood lactate before the start of the session were considerably higher than those which normally occur at rest (<2 mmol /L), with a mean value of 4.5 mmol /l (± 1.99 SD). At the end of the workout session the blood lactate exhibited a significant increase, reaching a mean value of 13.8 mmol /l (± 1.18 SD) and then returning to values similar to the initial ones after 15 minutes. Blood glucose did not exhibit any statistically significant differences during the session. Reaction time, execution time, number of errors and number of omissions exhibited a significant worsening concomitantly with the increase in blood lactate. Athletes practicing CrossFit®, with high levels of blood lactate even at rest, should consequently have attentional performances somewhat limited.

Evaluation of overnight hold of whole blood at room temperature before component processing: effect of red blood cell (RBC) additive solutions on in vitro RBC measures.

PubMed

van der Meer, Pieter F; Cancelas, Jose A; Cardigan, Rebecca; Devine, Dana V; Gulliksson, Hans; Sparrow, Rosemary L; Vassallo, Ralph R; de Wildt-Eggen, Janny; Baumann-Baretti, Bärbel; Hess, John R

2011-01-01

Whole blood (WB) can be held at room temperature (18-25°C) up to 8 hours after collection; thereafter the unit must be refrigerated, rendering it unsuitable for platelet (PLT) production. Overnight hold at room temperature before processing has logistic advantages, and we evaluated this process in an international multicenter study for both buffy coat (BC)- and PLT-rich plasma (PRP)-based blood components and compared three red blood cell (RBC) additive solutions (ASs) for their ability to offset effects of overnight hold. Nine centers participated; seven used the BC method, and two used the PRP method. Four WB units were pooled and split; 1 unit was processed less than 8 hours from collection (Group A), and the other three (Groups B, C, and D) were held at room temperature and processed after 24 to 26 hours. RBCs in Groups A and B were resuspended in saline-adenine-glucose-mannitol, Group C in phosphate-adenine-guanosine-glucose-saline-mannitol, and Group D in ErythroSol-4 RBCs were stored at 2 to 6°C for 49 days. RBCs from overnight-held WB had lower 2,3-diphosphoglycerate (2,3-DPG) and higher adenosine triphosphate (ATP). At the end of storage there were no differences between groups, apart from a slightly higher hemolysis in Group B. ErythroSol-4 showed a slightly higher initial ATP and 2,3-DPG content, but at the end of storage no differences were found. Overnight hold of WB before processing has no lasting deleterious effects on in vitro quality of subsequently prepared components. The use of different RBC ASs did not appear to offer significant advantages in terms of RBC quality at the end, regardless of the processing method. © 2010 American Association of Blood Banks.

Comparing the Costs and Benefits of Re-Accreditation Processes. AIR 2002 Forum Paper.

ERIC Educational Resources Information Center

Shibley, Lisa R.; Volkwein, J. Fredericks

This study examined the costs and benefits of reaccredidation processes at a public research university. A case study approach was used to examining the costs and benefits of reaccredidation activities by Middle States Association (MSA), American Assembly of Collegiate Schools of Business-International Association for Management Education (AACSB),…

A high volume cost efficient production macrostructuring process. [for silicon solar cell surface treatment

NASA Technical Reports Server (NTRS)

Chitre, S. R.

1978-01-01

The paper presents an experimentally developed surface macro-structuring process suitable for high volume production of silicon solar cells. The process lends itself easily to automation for high throughput to meet low-cost solar array goals. The tetrahedron structure observed is 0.5 - 12 micron high. The surface has minimal pitting with virtually no or very few undeveloped areas across the surface. This process has been developed for (100) oriented as cut silicon. Chemi-etched, hydrophobic and lapped surfaces were successfully texturized. A cost analysis as per Samics is presented.

Effect of an imaging-based streamlined electronic healthcare process on quality and costs.

PubMed

Bui, Alex A T; Taira, Ricky K; Goldman, Dana; Dionisio, John David N; Aberle, Denise R; El-Saden, Suzie; Sayre, James; Rice, Thomas; Kangarloo, Hooshang

2004-01-01

A streamlined process of care supported by technology and imaging may be effective in managing the overall healthcare process and costs. This study examined the effect of an imaging-based electronic process of care on costs and rates of hospitalization, emergency room (ER) visits, specialist diagnostic referrals, and patient satisfaction. A healthcare process was implemented for an employer group, highlighting improved patient access to primary care plus routine use of imaging and teleconsultation with diagnostic specialists. An electronic infrastructure supported patient access to physicians and communication among healthcare providers. The employer group, a self-insured company, manages a healthcare plan for its employees and their dependents: 4,072 employees were enrolled in the test group, and 7,639 in the control group. Outcome measures for expenses and frequency of hospitalizations, ER visits, traditional specialist referrals, primary care visits, and imaging utilization rates were measured using claims data over 1 year. Homogeneity tests of proportions were performed with a chi-square statistic, mean differences were tested by two-sample t-tests. Patient satisfaction with access to healthcare was gauged using results from an independent firm. Overall per member/per month costs post-implementation were lower in the enrolled population (126 dollars vs 160 dollars), even though occurrence of chronic/expensive diseases was higher in the enrolled group (18.8% vs 12.2%). Lower per member/per month costs were seen for inpatient (33.29 dollars vs 35.59 dollars); specialist referrals (21.36 dollars vs 26.84 dollars); and ER visits (3.68 dollars vs 5.22 dollars). Moreover, the utilization rate for hospital admissions, ER visits, and traditional specialist referrals were significantly lower in the enrolled group, although primary care and imaging utilization were higher. Comparison to similar employer groups showed that the company's costs were lower than national

Laser Cutting Eliminates Nucleic Acid Cross-Contamination in Dried-Blood-Spot Processing

PubMed Central

Daza, Glenda; Chang, Ming; Coombs, Robert

2012-01-01

Dried blood spots (DBS) are useful for molecular assays but are prone to false positives from cross-contamination. In our malaria DBS assay, cross-contamination was encountered despite cleaning techniques suitable for HIV-1. We therefore developed a contact-free laser cutting system that effectively eliminated cross-contamination during DBS processing. PMID:23052309

[Liability for hepatitis after blood transfusion (author's transl)].

PubMed

Fiedler, H; Hackethal, B

1980-01-01

1) Only a very limited amount of all cases of so-called "post-transfusion-hepatitis" (pth) is really due to infectivity of the transfused blood. Regardless of the mostly unknown true source of the infection, the occurrence of "pth" for itself does not qualify the recipient and/or his illness-insurance company for a legitimate action for damages against the blood bank under current West Germany Federal Law. 2) All West German blood banks are obliged by Federal Law to insure themselves against strictly defined damage claims. Their damage-insurance companies are not entitled to pay compensations to the illness-insurance companies of any victim of "pth" without meticulous investigation of the exact circumstances if expenses exceeding the legally defined limitations are included in the premium of damage-insurance charged to the blood banks. 3)Since nearly all inhabitants of West Germany are legally or voluntarily insured against illness, compensations paid by damage-insurance companies to illness-insurance companies are no appropriate means for any cost containment of the latter: The blood banks have no other choice than to calculate the additional premium costs into the costs of the blood units to be debitted to the illness-insurance companies.

Cost-Effectiveness Analysis of Different Testing Strategies that Use Antibody Levels to Detect Chronic Hepatitis C in Blood Donors.

PubMed

Granados-García, Víctor; Contreras, Ana M; García-Peña, Carmen; Salinas-Escudero, Guillermo; Thein, Hla-Hla; Flores, Yvonne N

2016-01-01

We conducted a cost-effectiveness analysis of seven hepatitis C virus (HCV) testing strategies in blood donors. Three of the seven strategies were based on HCV diagnosis and reporting guidelines in Mexico and four were from previous and current recommendations outlined by the CDC. The strategies that were evaluated determine antibody levels according to the signal-to-cut-off (S/CO) ratio and use reflex Immunoblot (IMB) or HCV RNA tests to confirm true positive (TP) cases of chronic HCV infection. Costs were calculated from the perspective of the Mexican Institute of Social Security (IMSS). A decision tree model was developed to estimate the expected number of true positive cases and costs for the base-case scenarios and for the sensitivity analyses. Base-case findings indicate an extended dominance of the CDC-USA2 and CDC-USA4 options by the IMSS Mexico3 and IMSS-Mexico1 alternatives. The probabilistic sensitivity analyses results suggest that for a willingness-to-pay (WTP) range of $0-9,000 USD the IMSS-Mexico1 strategy is the most cost-effective of all strategies ($5,000 USD per TP). The IMSS-Mexico3, IMSS-Mexico2, and CDC-USA3 strategies are also cost-effective strategies that cost between $7,800 and $8,800 USD per TP case detected. The CDC-USA1 strategy was very expensive and not cost-effective. HCV antibody testing strategies based on the classification of two or three levels of the S/CO are cost-effective procedures to identify patients who require reflex IMB or HCV RNA testing to confirm chronic HCV infection.

Noninvasive blood pressure measurement scheme based on optical fiber sensor

NASA Astrophysics Data System (ADS)

Liu, Xianxuan; Yuan, Xueguang; Zhang, Yangan

2016-10-01

Optical fiber sensing has many advantages, such as volume small, light quality, low loss, strong in anti-jamming. Since the invention of the optical fiber sensing technology in 1977, optical fiber sensing technology has been applied in the military, national defense, aerospace, industrial, medical and other fields in recent years, and made a great contribution to parameter measurement in the environment under the limited condition .With the rapid development of computer, network system, the intelligent optical fiber sensing technology, the sensor technology, the combination of computer and communication technology , the detection, diagnosis and analysis can be automatically and efficiently completed. In this work, we proposed a noninvasive blood pressure detection and analysis scheme which uses optical fiber sensor. Optical fiber sensing system mainly includes the light source, optical fiber, optical detector, optical modulator, the signal processing module and so on. wavelength optical signals were led into the optical fiber sensor and the signals reflected by the human body surface were detected. By comparing actual testing data with the data got by traditional way to measure the blood pressure we can establish models for predicting the blood pressure and achieve noninvasive blood pressure measurement by using spectrum analysis technology. Blood pressure measurement method based on optical fiber sensing system is faster and more convenient than traditional way, and it can get accurate analysis results in a shorter period of time than before, so it can efficiently reduce the time cost and manpower cost.

Perceptual decision processes flexibly adapt to avoid change-of-mind motor costs

PubMed Central

Moher, Jeff; Song, Joo-Hyun

2014-01-01

The motor system is tightly linked with perception and cognition. Recent studies have shown that even anticipated biophysical action costs associated with competing response options can be incorporated into decision-making processes. As a result, choices associated with high energy costs are less likely to be selected. However, some action costs may be harder to predict. For example, a person choosing among apples at a grocery store may change his or her mind suddenly about which apple to put into the cart. This change of mind may be reflected in motor output as the initial decision triggers a motor response toward a Granny Smith that is subsequently redirected toward a Red Delicious. In the present study, to examine how motor costs associated with changes of mind affect perceptual decision making, participants performed a difficult random dot–motion discrimination task in which they had to indicate the direction of motion by reaching to one of two response options. Although each response box was always equidistant from the starting position, the physical distance between the two response options was varied. We found that when the boxes were far apart from one another, and thus changes of mind incurred greater redirection motor costs, change-of-mind frequency decreased while latency to initiate movement increased. This occurred even when response box distance varied randomly from trial to trial and was cued only 1 s before each trial began. Thus, we demonstrated that observers can dynamically adjust perceptual decision-making processes to avoid high motor costs incurred by a change of mind. PMID:24986186

Review of cost versus scale: water and wastewater treatment and reuse processes.

PubMed

Guo, Tianjiao; Englehardt, James; Wu, Tingting

2014-01-01

The US National Research Council recently recommended direct potable water reuse (DPR), or potable water reuse without environmental buffer, for consideration to address US water demand. However, conveyance of wastewater and water to and from centralized treatment plants consumes on average four times the energy of treatment in the USA, and centralized DPR would further require upgradient distribution of treated water. Therefore, information on the cost of unit treatment processes potentially useful for DPR versus system capacity was reviewed, converted to constant 2012 US dollars, and synthesized in this work. A logarithmic variant of the Williams Law cost function was found applicable over orders of magnitude of system capacity, for the subject processes: activated sludge, membrane bioreactor, coagulation/flocculation, reverse osmosis, ultrafiltration, peroxone and granular activated carbon. Results are demonstrated versus 10 DPR case studies. Because economies of scale found for capital equipment are counterbalanced by distribution/collection network costs, further study of the optimal scale of distributed DPR systems is suggested.

An evaluation of welding processes to reduce hexavalent chromium exposures and reduce costs by using better welding techniques.

PubMed

Keane, Michael J

2014-01-01

A group of stainless steel arc welding processes was compared for emission rates of fume and hexavalent chromium, and costs per meter length of weld. The objective was to identify those with minimal emissions and also compare relative labor and consumables costs. The selection included flux-cored arc welding (FCAW), shielded-metal arc welding (SMAW), and multiple gas metal arc welding (GMAW) processes. Using a conical chamber, fumes were collected, and fume generation rates and hexavalent chromium (Cr(6+)) were measured. GMAW processes used were short-circuit (SC) and pulsed-spray modes. Flux-cored welding used gas shielding. Costs were estimated per meter of a 6.3-mm thick horizontal butt weld. Emission rates of Cr(6+) were lowest for GMAW processes and highest for SMAW; several GMAW processes had less than 2% of the SMAW generation rate. Labor and consumable costs for the processes studied were again highest for SMAW, with those of several GMAW types about half that cost. The results show that use of any of the GMAW processes (and flux-cored welding) could substantially reduce fume and Cr(6+) emissions, and greatly reduce costs relative to SMAW.

An Evaluation of Welding Processes to Reduce Hexavalent Chromium Exposures and Reduce Costs by Using Better Welding Techniques

PubMed Central

Keane, Michael J

2014-01-01

A group of stainless steel arc welding processes was compared for emission rates of fume and hexavalent chromium, and costs per meter length of weld. The objective was to identify those with minimal emissions and also compare relative labor and consumables costs. The selection included flux-cored arc welding (FCAW), shielded-metal arc welding (SMAW), and multiple gas metal arc welding (GMAW) processes. Using a conical chamber, fumes were collected, and fume generation rates and hexavalent chromium (Cr6+) were measured. GMAW processes used were short-circuit (SC) and pulsed-spray modes. Flux-cored welding used gas shielding. Costs were estimated per meter of a 6.3-mm thick horizontal butt weld. Emission rates of Cr6+ were lowest for GMAW processes and highest for SMAW; several GMAW processes had less than 2% of the SMAW generation rate. Labor and consumable costs for the processes studied were again highest for SMAW, with those of several GMAW types about half that cost. The results show that use of any of the GMAW processes (and flux-cored welding) could substantially reduce fume and Cr6+ emissions, and greatly reduce costs relative to SMAW. PMID:25574138

Development of a web-based application and multicountry analysis framework for assessing interdicted infections and cost-utility of screening donated blood for HIV, HCV and HBV.

PubMed

Custer, B; Janssen, M P; Hubben, G; Vermeulen, M; van Hulst, M

2017-08-01

Most countries test donations for HIV, HCV and HBV using serology with or without nucleic acid testing (NAT). Cost-utility analyses provide information on the relative value of different screening options. The aim of this project was to develop an open access risk assessment and cost-utility analysis web-tool for assessing HIV, HCV and HBV screening options (http://www.isbtweb.org/working-parties/transfusion-transmitted-infectious-diseases/). An analysis for six countries (Brazil, Ghana, the Netherlands, South Africa, Thailand and USA) was conducted. Four strategies; (1) antibody assays (Abs) for HIV and HCV + HBsAg, (2) antibody assays that include antigens for HIV and HCV (Combo) + HBsAg, (3) NAT in minipools of variable size (MP NAT) and (4) individual donation (ID) NAT can be evaluated using the tool. Country-specific data on donors, donation testing results, recipient outcomes and costs are entered using the online interface. Results obtained include the number infections interdicted using each screening options, and the (incremental and average) cost-utility of the options. In each of the six countries evaluated, the use of antibody assays is cost effective or even cost saving. NAT has varying cost-utility depending on the setting, and where adopted, the incremental cost-utility exceeds any previously defined or proposed threshold in each country. The web-tool allows an assessment of infectious units interdicted and value for money of different testing strategies. Regardless of gross national income (GNI) per capita, countries appear willing to dedicate healthcare resources to blood supply safety in excess of that for other sectors of health care. © 2017 International Society of Blood Transfusion.

Process for measuring low cadmium levels in blood and other biological specimens

DOEpatents

Peterson, David P.; Huff, Edmund A.; Bhattacharyya, Maryka H.

1994-01-01

A process for measuring low levels of cadmium in blood and other biological specimens is provided without interference from high levels of alkali metal contaminants by forming an aqueous solution and without contamination by environmental cadmium absent the proteins from the specimen, selectively removing cadmium from the aqueous solution on an anion exchange resin, thereby removing the alkali metal contaminants, resolubilizing cadmium from the resin to form a second solution and analyzing the second solution for cadmium, the process being carried out in a cadmium-free environment.

Process for measuring low cadmium levels in blood and other biological specimens

DOEpatents

Peterson, David P.; Huff, Edmund A.; Bhattacharyya, Maryka H.

1994-05-03

A process for measuring low levels of cadmium in blood and other biological specimens is provided without interference from high levels of alkali metal contaminants by forming an aqueous solution and without contamination by environmental cadmium absent the proteins from the specimen, selectively removing cadmium from the aqueous solution on an anion exchange resin, thereby removing the alkali metal contaminants, resolubilizing cadmium from the resin to form a second solution and analyzing the second solution for cadmium, the process being carried out in a cadmium-free environment.

Optimizing preoperative blood ordering with data acquired from an anesthesia information management system.

PubMed

Frank, Steven M; Rothschild, James A; Masear, Courtney G; Rivers, Richard J; Merritt, William T; Savage, Will J; Ness, Paul M

2013-06-01

The maximum surgical blood order schedule (MSBOS) is used to determine preoperative blood orders for specific surgical procedures. Because the list was developed in the late 1970s, many new surgical procedures have been introduced and others improved upon, making the original MSBOS obsolete. The authors describe methods to create an updated, institution-specific MSBOS to guide preoperative blood ordering. Blood utilization data for 53,526 patients undergoing 1,632 different surgical procedures were gathered from an anesthesia information management system. A novel algorithm based on previously defined criteria was used to create an MSBOS for each surgical specialty. The economic implications were calculated based on the number of blood orders placed, but not indicated, according to the MSBOS. Among 27,825 surgical cases that did not require preoperative blood orders as determined by the MSBOS, 9,099 (32.7%) had a type and screen, and 2,643 (9.5%) had a crossmatch ordered. Of 4,644 cases determined to require only a type and screen, 1,509 (32.5%) had a type and crossmatch ordered. By using the MSBOS to eliminate unnecessary blood orders, the authors calculated a potential reduction in hospital charges and actual costs of $211,448 and $43,135 per year, respectively, or $8.89 and $1.81 per surgical patient, respectively. An institution-specific MSBOS can be created, using blood utilization data extracted from an anesthesia information management system along with our proposed algorithm. Using these methods to optimize the process of preoperative blood ordering can potentially improve operating room efficiency, increase patient safety, and decrease costs.

The Processing Cost of Reference Set Computation: Acquisition of Stress Shift and Focus

ERIC Educational Resources Information Center

Reinhart, Tanya

2004-01-01

Reference set computation -- the construction of a (global) comparison set to determine whether a given derivation is appropriate in context -- comes with a processing cost. I argue that this cost is directly visible at the acquisition stage: In those linguistic areas in which it has been independently established that such computation is indeed…

A low cost Doppler system for vascular dialysis access surveillance.

PubMed

Molina, P S C; Moraes, R; Baggio, J F R; Tognon, E A

2004-01-01

The National Kidney Foundation guidelines for vascular access recommend access surveillance to avoid morbidity among patients undergoing hemodialysis. Methods to detect access failure based on CW Doppler system are being proposed to implement surveillance programs at lower cost. This work describes a low cost Doppler system implemented in a PC notebook designed to carry out this task. A Doppler board samples the blood flow velocity and delivers demodulated quadrature Doppler signals. These signals are sampled by a notebook sound card. Software for Windows OS (running at the notebook) applies CFFT to consecutive 11.6 ms intervals of Doppler signals. The sonogram is presented on the screen in real time. The software also calculates the maximum and the intensity weighted mean frequency envelopes. Since similar systems employ DSP boards to process the Doppler signals, cost reduction was achieved. The Doppler board electronic circuits and routines to process the Doppler signals are presented.

Process simulation and cost analysis for removing inorganics from wood chips using combined mechanical and chemical preprocessing

DOE PAGES

Hu, Hongqiang; Westover, Tyler L.; Cherry, Robert; ...

2016-10-03

Inorganic species (ash) in biomass feedstocks negatively impact thermochemical and biochemical energy conversion processes. In this work, a process simulation model is developed to model the reduction in ash content of loblolly logging residues using a combination of air classification and dilute-acid leaching. Various scenarios are considered, and it is found that costs associated with discarding high-ash material from air classification are substantial. The costs of material loss can be reduced by chemical leaching the high-ash fraction obtained from air classification. The optimal leaching condition is found to be approximately 0.1 wt% sulfuric acid at 24°C. In example scenarios, totalmore » process costs in the range of $10-12/dry tonnes of product are projected that result in a removal of 11, 66, 53 and 86% of organics, total ash (inorganics), alkaline earth metals and phosphorus (AAEMS+P), and silicon, respectively. Here, sensitivity analyses indicate that costs associated with loss of organic material during processing (yield losses), brine disposal, and labor have the greatest potential to impact the total processing cost.« less

Commercial Crew Cost Estimating - A Look at Estimating Processes, Challenges and Lessons Learned

NASA Technical Reports Server (NTRS)

Battle, Rick; Cole, Lance

2015-01-01

To support annual PPBE budgets and NASA HQ requests for cost information for commercial crew transportation to the International Space Station (ISS), the NASA ISS ACES team developed system development and per flight cost estimates for the potential providers for each annual PPBE submit from 2009-2014. This paper describes the cost estimating processes used, challenges and lessons learned to develop estimates for this key NASA project that diverted from the traditional procurement approach and used a new way of doing business

Greenhouse gas emissions and production cost of ethanol produced from biosyngas fermentation process.

PubMed

Roy, Poritosh; Dutta, Animesh; Deen, Bill

2015-09-01

Life cycle (LC) of ethanol has been evaluated to determine the environmental and economical viability of ethanol that was derived from biosyngas fermentation process (gasification-biosynthesis). Four scenarios [S1: untreated (raw), S2: treated (torrefied); S3: untreated-chemical looping gasification (CLG), S4: treated-CLG] were considered. The simulated biosyngas composition was used in this evaluation process. The GHG emissions and production cost varied from 1.19 to 1.32 kg-CO2 e/L and 0.78 to 0.90$/L, respectively, which were found to be dependent on the scenarios. The environmental and economical viability was found be improved when untreated feedstock was used instead of treated feedstock. Although the GHG emissions slightly reduced in the case of CLG process, production cost was nominally increased because of the cost incurred by the use of CaO. This study revealed that miscanthus is a promising feedstock for the ethanol industry, even if it is grown on marginal land, which can help abate GHG emissions. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

Development of a low-cost cellulase production process using Trichoderma reesei for Brazilian biorefineries.

PubMed

Ellilä, Simo; Fonseca, Lucas; Uchima, Cristiane; Cota, Junio; Goldman, Gustavo Henrique; Saloheimo, Markku; Sacon, Vera; Siika-Aho, Matti

2017-01-01

During the past few years, the first industrial-scale cellulosic ethanol plants have been inaugurated. Although the performance of the commercial cellulase enzymes used in this process has greatly improved over the past decade, cellulases still represent a very significant operational cost. Depending on the region, transport of cellulases from a central production facility to a biorefinery may significantly add to enzyme cost. The aim of the present study was to develop a simple, cost-efficient cellulase production process that could be employed locally at a Brazilian sugarcane biorefinery. Our work focused on two main topics: growth medium formulation and strain improvement. We evaluated several Brazilian low-cost industrial residues for their potential in cellulase production. Among the solid residues evaluated, soybean hulls were found to display clearly the most desirable characteristics. We engineered a Trichoderma reesei strain to secrete cellulase in the presence of repressing sugars, enabling the use of sugarcane molasses as an additional carbon source. In addition, we added a heterologous β-glucosidase to improve the performance of the produced enzymes in hydrolysis. Finally, the addition of an invertase gene from Aspegillus niger into our strain allowed it to consume sucrose from sugarcane molasses directly. Preliminary cost analysis showed that the overall process can provide for very low-cost enzyme with good hydrolysis performance on industrially pre-treated sugarcane straw. In this study, we showed that with relatively few genetic modifications and the right growth medium it is possible to produce considerable amounts of well-performing cellulase at very low cost in Brazil using T. reesei . With further enhancements and optimization, such a system could provide a viable alternative to delivered commercial cellulases.

Thermodynamic Costs of Information Processing in Sensory Adaptation

PubMed Central

Sartori, Pablo; Granger, Léo; Lee, Chiu Fan; Horowitz, Jordan M.

2014-01-01

Biological sensory systems react to changes in their surroundings. They are characterized by fast response and slow adaptation to varying environmental cues. Insofar as sensory adaptive systems map environmental changes to changes of their internal degrees of freedom, they can be regarded as computational devices manipulating information. Landauer established that information is ultimately physical, and its manipulation subject to the entropic and energetic bounds of thermodynamics. Thus the fundamental costs of biological sensory adaptation can be elucidated by tracking how the information the system has about its environment is altered. These bounds are particularly relevant for small organisms, which unlike everyday computers, operate at very low energies. In this paper, we establish a general framework for the thermodynamics of information processing in sensing. With it, we quantify how during sensory adaptation information about the past is erased, while information about the present is gathered. This process produces entropy larger than the amount of old information erased and has an energetic cost bounded by the amount of new information written to memory. We apply these principles to the E. coli's chemotaxis pathway during binary ligand concentration changes. In this regime, we quantify the amount of information stored by each methyl group and show that receptors consume energy in the range of the information-theoretic minimum. Our work provides a basis for further inquiries into more complex phenomena, such as gradient sensing and frequency response. PMID:25503948

Lower operational costs in heat treatment and process engineering through improved temperature measurement

NASA Astrophysics Data System (ADS)

Furniss, C. P.

New metal-sheathed thermocouple systems are described which have lowered operational heat treatment costs and process engineering. The improvements which these thermocouples represent over conventional ones with regard to chemical composition, thermomechanical properties, oxidation resistance, weldability, and coefficient of linear expansion are pointed out. Experimentally determined cost savings for a variety of applications are reported.

Assessing the blood pressure waveform of the carotid artery using an ultrasound image processing method

PubMed Central

Fatouraee, Nasser; Saberi, Hazhir

2017-01-01

Purpose The aim of this study was to introduce and implement a noninvasive method to derive the carotid artery pressure waveform directly by processing diagnostic sonograms of the carotid artery. Methods Ultrasound image sequences of 20 healthy male subjects (age, 36±9 years) were recorded during three cardiac cycles. The internal diameter and blood velocity waveforms were extracted from consecutive sonograms over the cardiac cycles by using custom analysis programs written in MATLAB. Finally, the application of a mathematical equation resulted in time changes of the arterial pressure. The resulting pressures were calibrated using the mean and the diastolic pressure of the radial artery. Results A good correlation was found between the mean carotid blood pressure obtained from the ultrasound image processing and the mean radial blood pressure obtained using a standard digital sphygmomanometer (R=0.91). The mean absolute difference between the carotid calibrated pulse pressures and those measured clinically was -1.333±6.548 mm Hg. Conclusion The results of this study suggest that consecutive sonograms of the carotid artery can be used for estimating a blood pressure waveform. We believe that our results promote a noninvasive technique for clinical applications that overcomes the reproducibility problems of common carotid artery tonometry with technical and anatomical causes. PMID:27776401

Red Blood Cell Agglutination for Blood Typing Within Passive Microfluidic Biochips.

PubMed

Huet, Maxime; Cubizolles, Myriam; Buhot, Arnaud

2018-04-19

Pre-transfusion bedside compatibility test is mandatory to check that the donor and the recipient present compatible groups before any transfusion is performed. Although blood typing devices are present on the market, they still suffer from various drawbacks, like results that are based on naked-eye observation or difficulties in blood handling and process automation. In this study, we addressed the development of a red blood cells (RBC) agglutination assay for point-of-care blood typing. An injection molded microfluidic chip that is designed to enhance capillary flow contained anti-A or anti-B dried reagents inside its microchannel. The only blood handling step in the assay protocol consisted in the deposit of a blood drop at the tip of the biochip, and imaging was then achieved. The embedded reagents were able to trigger RBC agglutination in situ, allowing for us to monitor in real time the whole process. An image processing algorithm was developed on diluted bloods to compute real-time agglutination indicator and was further validated on undiluted blood. Through this proof of concept, we achieved efficient, automated, real time, and quantitative measurement of agglutination inside a passive biochip for blood typing which could be further generalized to blood biomarker detection and quantification.

Process-Based Cost Modeling of Photonics Manufacture: The Cost Competitiveness of Monolithic Integration of a 1550-nm DFB Laser and an Electroabsorptive Modulator on an InP Platform

NASA Astrophysics Data System (ADS)

Fuchs, Erica R. H.; Bruce, E. J.; Ram, R. J.; Kirchain, Randolph E.

2006-08-01

The monolithic integration of components holds promise to increase network functionality and reduce packaging expense. Integration also drives down yield due to manufacturing complexity and the compounding of failures across devices. Consensus is lacking on the economically preferred extent of integration. Previous studies on the cost feasibility of integration have used high-level estimation methods. This study instead focuses on accurate-to-industry detail, basing a process-based cost model of device manufacture on data collected from 20 firms across the optoelectronics supply chain. The model presented allows for the definition of process organization, including testing, as well as processing conditions, operational characteristics, and level of automation at each step. This study focuses on the cost implications of integration of a 1550-nm DFB laser with an electroabsorptive modulator on an InP platform. Results show the monolithically integrated design to be more cost competitive over discrete component options regardless of production scale. Dominant cost drivers are packaging, testing, and assembly. Leveraging the technical detail underlying model projections, component alignment, bonding, and metal-organic chemical vapor deposition (MOCVD) are identified as processes where technical improvements are most critical to lowering costs. Such results should encourage exploration of the cost advantages of further integration and focus cost-driven technology development.

Blood flow and blood cell interactions and migration in microvessels

NASA Astrophysics Data System (ADS)

Fedosov, Dmitry; Fornleitner, Julia; Gompper, Gerhard

2011-11-01

Blood flow in microcirculation plays a fundamental role in a wide range of physiological processes and pathologies in the organism. To understand and, if necessary, manipulate the course of these processes it is essential to investigate blood flow under realistic conditions including deformability of blood cells, their interactions, and behavior in the complex microvascular network which is characteristic for the microcirculation. We employ the Dissipative Particle Dynamics method to model blood as a suspension of deformable cells represented by a viscoelastic spring-network which incorporates appropriate mechanical and rheological cell-membrane properties. Blood flow is investigated in idealized geometries. In particular, migration of blood cells and their distribution in blood flow are studied with respect to various conditions such as hematocrit, flow rate, red blood cell aggregation. Physical mechanisms which govern cell migration in microcirculation and, in particular, margination of white blood cells towards the vessel wall, will be discussed. In addition, we characterize blood flow dynamics and quantify hemodynamic resistance. D.F. acknowledges the Humboldt Foundation for financial support.

19 CFR 10.197 - Direct costs of processing operations performed in a beneficiary country or countries.

Code of Federal Regulations, 2013 CFR

2013-04-01

... specific merchandise, including fringe benefits, on-the-job training, and the cost of engineering..., engineering, and blueprint costs insofar as they are allocable to the specific merchandise and; (4) Costs of... 19 Customs Duties 1 2013-04-01 2013-04-01 false Direct costs of processing operations performed in...

19 CFR 10.197 - Direct costs of processing operations performed in a beneficiary country or countries.

Code of Federal Regulations, 2014 CFR

2014-04-01

... specific merchandise, including fringe benefits, on-the-job training, and the cost of engineering..., engineering, and blueprint costs insofar as they are allocable to the specific merchandise and; (4) Costs of... 19 Customs Duties 1 2014-04-01 2014-04-01 false Direct costs of processing operations performed in...

Fractionation of Whey Protein Isolate with Supercritical Carbon Dioxide—Process Modeling and Cost Estimation

PubMed Central

Yver, Alexandra L.; Bonnaillie, Laetitia M.; Yee, Winnie; McAloon, Andrew; Tomasula, Peggy M.

2012-01-01

An economical and environmentally friendly whey protein fractionation process was developed using supercritical carbon dioxide (sCO2) as an acid to produce enriched fractions of α-lactalbumin (α-LA) and β-lactoglobulin (β-LG) from a commercial whey protein isolate (WPI) containing 20% α-LA and 55% β-LG, through selective precipitation of α-LA. Pilot-scale experiments were performed around the optimal parameter range (T = 60 to 65 °C, P = 8 to 31 MPa, C = 5 to 15% (w/w) WPI) to quantify the recovery rates of the individual proteins and the compositions of both fractions as a function of processing conditions. Mass balances were calculated in a process flow-sheet to design a large-scale, semi-continuous process model using SuperproDesigner® software. Total startup and production costs were estimated as a function of processing parameters, product yield and purity. Temperature, T, pressure, P, and concentration, C, showed conflicting effects on equipment costs and the individual precipitation rates of the two proteins, affecting the quantity, quality, and production cost of the fractions considerably. The highest α-LA purity, 61%, with 80% α-LA recovery in the solid fraction, was obtained at T = 60 °C, C = 5% WPI, P = 8.3 MPa, with a production cost of $8.65 per kilogram of WPI treated. The most profitable conditions resulted in 57%-pure α-LA, with 71% α-LA recovery in the solid fraction and 89% β-LG recovery in the soluble fraction, and production cost of $5.43 per kilogram of WPI treated at T = 62 °C, C = 10% WPI and P = 5.5 MPa. The two fractions are ready-to-use, new food ingredients with a pH of 6.7 and contain no residual acid or chemical contaminants. PMID:22312250

19 CFR 10.178 - Direct costs of processing operations performed in the beneficiary developing country.

Code of Federal Regulations, 2013 CFR

2013-04-01

..., design, engineering, and blueprint costs insofar as they are allocable to the specific merchandise; and... 19 Customs Duties 1 2013-04-01 2013-04-01 false Direct costs of processing operations performed in... TO A REDUCED RATE, ETC. General Provisions Generalized System of Preferences § 10.178 Direct costs of...

19 CFR 10.178 - Direct costs of processing operations performed in the beneficiary developing country.

Code of Federal Regulations, 2014 CFR

2014-04-01

..., design, engineering, and blueprint costs insofar as they are allocable to the specific merchandise; and... 19 Customs Duties 1 2014-04-01 2014-04-01 false Direct costs of processing operations performed in... TO A REDUCED RATE, ETC. General Provisions Generalized System of Preferences § 10.178 Direct costs of...

19 CFR 10.178 - Direct costs of processing operations performed in the beneficiary developing country.

Code of Federal Regulations, 2012 CFR

2012-04-01

..., design, engineering, and blueprint costs insofar as they are allocable to the specific merchandise; and... 19 Customs Duties 1 2012-04-01 2012-04-01 false Direct costs of processing operations performed in... TO A REDUCED RATE, ETC. General Provisions Generalized System of Preferences § 10.178 Direct costs of...

Economics of Team-based Care in Controlling Blood Pressure: A Community Guide Systematic Review

PubMed Central

Jacob, Verughese; Chattopadhyay, Sajal K.; Thota, Anilkrishna B.; Proia, Krista K.; Njie, Gibril; Hopkins, David P.; Finnie, Ramona K.C.; Pronk, Nicolaas P.; Kottke, Thomas E.

2015-01-01

Context High blood pressure is an important risk factor for cardiovascular disease (CVD) and stroke, the leading cause of death in the U.S. and a substantial national burden through lost productivity and medical care. A recent Community Guide systematic review found strong evidence of effectiveness of team-based care in improving blood pressure control. The objective of the present review was to determine from the economic literature whether team-based care for blood pressure control is cost-beneficial and/or cost-effective. Evidence acquisition Electronic databases of papers published January 1980 – May 2012 were searched to find economic evaluations of team-based care interventions to improve blood pressure outcomes, yielding 31 studies for inclusion. Evidence synthesis In analyses conducted in 2012, intervention cost, healthcare cost averted, benefit-to-cost ratios, and cost-effectiveness were abstracted from the studies. The quality of estimates for intervention and healthcare cost from each study were assessed using three elements: intervention focus on blood pressure control; incremental estimates in the intervention group relative to a control group; and inclusion of major cost-driving elements in estimates. Intervention cost per unit reduction in systolic blood pressure was converted to lifetime intervention cost per quality-adjusted life-year (QALY) saved using algorithms from published trials. Conclusion Team-based care to improve blood pressure control is cost-effective based on evidence that 26 of 28 estimates of $/QALY gained from 10 studies were below a conservative threshold of $50,000. This finding is salient to recent health care reforms in the U.S. and coordinated patient-centered care through formation of Accountable Care Organizations (ACOs). PMID:26477804

Economic evaluation of a combined photo-Fenton/MBR process using pesticides as model pollutant. Factors affecting costs.

PubMed

Sánchez Pérez, José Antonio; Román Sánchez, Isabel María; Carra, Irene; Cabrera Reina, Alejandro; Casas López, José Luis; Malato, Sixto

2013-01-15

The aim of this paper is to carry out an economic assessment on a solar photo-Fenton/MBR combined process to treat industrial ecotoxic wastewater. This study focuses on the impact of the contamination present in wastewater, the photochemical oxidation, the use of an MBR as biological process and the plant size on operating and amortization costs. As example of ecotoxic pollutant, a mixture of five commercial pesticides commonly used in the Mediterranean area has been used, ranging from 500 mg/L to 50mg/L, expressed as dissolved organic carbon concentration. The economic evaluation shows that (i) the increase in pollution load does not always involve an increase in photo-Fenton costs because they also depend on organic matter mineralization; (ii) the use of an MBR process permits lower photochemical oxidation requirements than other biological treatments, resulting in approximately 20% photo-Fenton cost reduction for highly polluted wastewater; (iii) when pollution load decreases, the contribution of reactant consumption to the photo-Fenton process costs increase with regard to amortization costs; (iv) 30% total cost reduction can be gained treating higher daily volumes, obtaining competitive costs that vary from 1.1-1.9 €/m(3), depending on the pollution load. Copyright © 2012 Elsevier B.V. All rights reserved.

Profiling stainless steel welding processes to reduce fume emissions, hexavalent chromium emissions and operating costs in the workplace

PubMed Central

Keane, Michael; Siert, Arlen; Stone, Samuel; Chen, Bean T.

2016-01-01

Nine gas metal arc welding (GMAW) processes for stainless steel were assessed for fume generation rates, fume generation rates per g of electrode consumed, and emission rates for hexavalent chromium (Cr6+). Elemental manganese, nickel, chromium, iron emissions per unit length of weld and labor plus consumables costs were similarly measured. Flux-cored arc welding and shielded metal arc (SMAW) processes were also studied. The objective was to identify the best welding processes for reducing workplace exposures, and estimate costs for all processes. Using a conical chamber, fumes were collected, weighed, recovered and analyzed by inductively-coupled atomic emission spectroscopy for metals, and by ion chromatography for Cr6+. GMAW processes used were Surface Tension Transfer™, Regulated Metal Deposition™, Cold Metal Transfer™, short-circuit, axial spray, and pulsed spray modes. Flux-cored welding used gas shielding; SMAW used E308 rods. Costs were estimated as dollars per m length of a ¼ in (6.3 mm) thick horizontal butt weld; equipment costs were estimated as ratios of new equipment costs to a 250 ampere capacity SMAW welding machine. Results indicate a broad range of fume emission factors for the processes studied. Fume emission rates per g of electrode were lowest for GMAW processes such as pulsed-spray mode (0.2 mg/g), and highest for SMAW (8 mg fume/g electrode). Emission rates of Cr6+ ranged from 50 to 7800 μg/min, and Cr6+ generation rates per g electrode ranged from 1 to 270μg/g. Elemental Cr generation rates spanned 13 to 330μg/g. Manganese emission rates ranged from 50 to 300μg/g. Nickel emission rates ranged from 4 to140 μg/g. Labor and consumables costs ranged from $3.15 (GMAW pulsed spray) to $7.40 (SMAW) per meter of finished weld, and were measured or estimated for all 11 processes tested. Equipment costs for some processes may be as much as 5 times the cost of a typical SMAW welding machine. The results show that all of the GMAW processes

Profiling stainless steel welding processes to reduce fume emissions, hexavalent chromium emissions and operating costs in the workplace.

PubMed

Keane, Michael; Siert, Arlen; Stone, Samuel; Chen, Bean T

2016-01-01

Nine gas metal arc welding (GMAW) processes for stainless steel were assessed for fume generation rates, fume generation rates per g of electrode consumed, and emission rates for hexavalent chromium (Cr(6+)). Elemental manganese, nickel, chromium, iron emissions per unit length of weld, and labor plus consumables costs were similarly measured. Flux-cored arc welding and shielded metal arc (SMAW) processes were also studied. The objective was to identify the best welding processes for reducing workplace exposures, and estimate costs for all processes. Using a conical chamber, fumes were collected, weighed, recovered, and analyzed by inductively coupled atomic emission spectroscopy for metals, and by ion chromatography for Cr(6+). GMAW processes used were Surface Tension Transfer, Regulated Metal Deposition, Cold Metal Transfer, short-circuit, axial spray, and pulsed spray modes. Flux-cored welding used gas shielding; SMAW used E308 rods. Costs were estimated as dollars per m length of a ¼ in (6.3 mm) thick horizontal butt weld; equipment costs were estimated as ratios of new equipment costs to a 250 ampere capacity SMAW welding machine. Results indicate a broad range of fume emission factors for the processes studied. Fume emission rates per g of electrode were lowest for GMAW processes such as pulsed-spray mode (0.2 mg/g), and highest for SMAW (8 mg fume/g electrode). Emission rates of Cr(6+) ranged from 50-7800 µg/min, and Cr(6+) generation rates per g electrode ranged from 1-270 µg/g. Elemental Cr generation rates spanned 13-330 µg/g. Manganese emission rates ranged from 50-300 µg/g. Nickel emission rates ranged from 4-140 µg/g. Labor and consumables costs ranged from $3.15 (GMAW pulsed spray) to $7.40 (SMAW) per meter of finished weld, and were measured or estimated for all 11 processes tested. Equipment costs for some processes may be as much as five times the cost of a typical SMAW welding machine. The results show that all of the GMAW processes in this

The importance of cost considerations in the systems engineering process

NASA Technical Reports Server (NTRS)

Hodge, John D.

1993-01-01

This paper examines the question of cost, from the birth of a program to its conclusion, particularly from the point of view of large multi-center programs, and suggests how to avoid some of the traps and pitfalls. Emphasis is given to cost in the systems engineering process, but there is an inevitable overlap with program management. (These terms, systems engineering and program management, have never been clearly defined.) In these days of vast Federal budget deficits and increasing overseas competition, it is imperative that we get more for each research and development dollar. This is the only way we will retain our leadership in high technology and, in the long run, our way of life.

Low-cost digital image processing at the University of Oklahoma

NASA Technical Reports Server (NTRS)

Harrington, J. A., Jr.

1981-01-01

Computer assisted instruction in remote sensing at the University of Oklahoma involves two separate approaches and is dependent upon initial preprocessing of a LANDSAT computer compatible tape using software developed for an IBM 370/158 computer. In-house generated preprocessing algorithms permits students or researchers to select a subset of a LANDSAT scene for subsequent analysis using either general purpose statistical packages or color graphic image processing software developed for Apple II microcomputers. Procedures for preprocessing the data and image analysis using either of the two approaches for low-cost LANDSAT data processing are described.

Low cost solar array project production process and equipment task. A Module Experimental Process System Development Unit (MEPSDU)

NASA Technical Reports Server (NTRS)

1981-01-01

Technical readiness for the production of photovoltaic modules using single crystal silicon dendritic web sheet material is demonstrated by: (1) selection, design and implementation of solar cell and photovoltaic module process sequence in a Module Experimental Process System Development Unit; (2) demonstration runs; (3) passing of acceptance and qualification tests; and (4) achievement of a cost effective module.

Health economic potential of early nutrition programming: a model calculation of long-term reduction in blood pressure and related morbidity costs by use of long-chain polyunsaturated fatty acid-supplemented formula.

PubMed

Straub, Niels; Grunert, Philipp; von Kries, Rüdiger; Koletzko, Berthold

2011-12-01

The reported effect sizes of early nutrition programming on long-term health outcomes are often small, and it has been questioned whether early interventions would be worthwhile in enhancing public health. We explored the possible health economic consequences of early nutrition programming by performing a model calculation, based on the only published study currently available for analysis, to evaluate the effects of supplementing infant formula with long-chain polyunsaturated fatty acids (LC-PUFAs) on lowering blood pressure and lowering the risk of hypertension-related diseases in later life. The costs and health effects of LC-PUFA-enriched and standard infant formulas were compared by using a Markov model, including all relevant direct and indirect costs based on German statistics. We assessed the effect size of blood pressure reduction from LC-PUFA-supplemented formula, the long-term persistence of the effect, and the effect of lowered blood pressure on hypertension-related morbidity. The cost-effectiveness analysis showed an increased life expectancy of 1.2 quality-adjusted life-years and an incremental cost-effectiveness ratio of -630 Euros (discounted to present value) for the LC-PUFA formula in comparison with standard formula. LC-PUFA nutrition was the superior strategy even when the blood pressure-lowering effect was reduced to the lower 95% CI. Breastfeeding is the recommended feeding practice, but infants who are not breastfed should receive an appropriate infant formula. Following this model calculation, LC-PUFA supplementation of infant formula represents an economically worthwhile prevention strategy, based on the costs derived from hypertension-linked diseases in later life. However, because our analysis was based on a single randomized controlled trial, further studies are required to verify the validity of this thesis.

[Economic analysis versus the principle of guaranteed safety in blood transfusion].

PubMed

Moatti, J P; Loubière, S; Rotily, M

2000-06-01

This article shows that policies aimed at reducing risks of infectious agents transmissible through blood unfortunately follow a law of 'diminishing returns': increasing marginal costs have to be devoted for limited reductions in the risks of contamination through blood donations. Therefore, the economic cost-effectiveness analysis is appropriate to identify screening strategies which may minimize costs to reach a certain level of safety. Moreover, economic analysis can contribute to public debates about the level of residual risk that society is willing to accept. Empirical results from French studies about screening for hepatitis C virus (HCV) in individuals who have received blood transfusions and in blood donations are presented to illustrate these points.

Complete blood counts, liver function tests, and chest x-rays as routine screening in early-stage breast cancer: value added or just cost?

PubMed

Louie, Raphael J; Tonneson, Jennifer E; Gowarty, Minda; Goodney, Philip P; Barth, Richard J; Rosenkranz, Kari M

2015-11-01

Current National Comprehensive Cancer Network guidelines for breast cancer staging include pre-treatment complete blood count (CBC) and liver function tests (LFT) to screen for occult metastatic disease. To date, the relevance of these tests in detecting metastatic disease in asymptomatic women with early-stage breast cancer (Stage I/II) has not been demonstrated. Although chest x-rays are no longer recommended in the NCCN guidelines, many centers continue to include this imaging as part of their screening process. We aim to determine the clinical and financial impact of these labs and x-rays in the evaluation of early-stage breast cancer patients. A single institution IRB-approved retrospective chart review was conducted of patients with biopsy-proven invasive breast cancer treated from January 1, 2005–December 31, 2009. We collected patient demographics, clinical and pathologic staging, chest x-ray, CBC, and LFT results at the time of referral. Patients were stratified according to radiographic stage at the time of diagnosis. We obtained Medicare reimbursement fees for cost analysis. From 2005 to 2009, 1609 patients with biopsy-proven invasive breast cancer were treated at our institution. Of the 1082 patients with radiographic stage I/II disease, 27.3 % of patients had abnormal CBCs. No additional testing was performed to evaluate these abnormalities. In the early-stage population, 24.7 % of patients had elevated LFTs, resulting in 84 additional imaging studies. No metastatic disease was detected. The cost of CBC, LFTs and chest x-rays was $110.20 per patient, totaling $106,410.99. Additional tests prompted by abnormal results cost $58,143.30 over the five-year period. We found that pre-treatment CBCs, LFTs, and chest x-rays did not improve detection of occult metastatic disease but resulted in additional financial costs. Avoiding routine ordering of these tests would save the US healthcare system $25.7 million annually.

Power density measurements to optimize AC plasma jet operation in blood coagulation.

PubMed

Ahmed, Kamal M; Eldeighdye, Shaimaa M; Allam, Tarek M; Hassanin, Walaa F

2018-06-14

In this paper, the plasma power density and corresponding plasma dose of a low-cost air non-thermal plasma jet (ANPJ) device are estimated at different axial distances from the nozzle. This estimation is achieved by measuring the voltage and current at the substrate using diagnostic techniques that can be easily made in laboratory; thin wire and dielectric probe, respectively. This device uses a compressed air as input gas instead of the relatively-expensive, large-sized and heavy weighed tanks of Ar or He gases. The calculated plasma dose is found to be very low and allows the presented device to be used in biomedical applications (especially blood coagulation). While plasma active species and charged-particles are found to be the most effective on blood coagulation formation, both air flow and UV, individually, do not have any effect. Moreover, optimal conditions for accelerating blood coagulation are studied. Results showed that, the power density at the substrate is shown to be decreased with increasing the distance from the nozzle. In addition, both distances from nozzle and air flow rate play an important role in accelerating blood coagulation process. Finally, this device is efficient, small-sized, safe enough, of low cost and, hence, has its chances to be wide spread as a first aid and in ambulance.

Design the price signal mechanism of suppliers' cost in the commercial procurement process

NASA Astrophysics Data System (ADS)

Jinming, Huang; Wenjing, Li; Huazhen, Zhu

2016-06-01

In the process of commercial procurement, there exists information asymmetry between purchasers and suppliers in terms of commodity cost. The strike price is what purchasers care about, while the focus of suppliers is only the sales revenue. In order to achieve the relatively lower strike price, purchasers need to design a price signal mechanism, explicating the commodity cost of suppliers. In this article, we have designed a mechanism that purchasers can explicit the commodity cost price based on suppliers' choices by providing a variety of purchase contracts to suppliers.

Preoperative autologous blood donation: clinical, economic, and ethical issues.

PubMed

Domen, R E

1996-09-01

Many patients are donating their own blood before surgery to avoid blood-borne infections, often on the advice of their physicians. But autologous blood transfusion, while safer than allogeneic transfusion, is not completely risk-free. It is also expensive, its benefits are difficult to assess, and its increasing popularity raises many difficult ethical issues, such as whether the benefit of allogeneic transfusion supports its additional expense. Record-keeping, collection, and transfusion errors are occasional risks of autologous transfusions. In addition, risks associated with blood donation, from mild dizziness to precipitation of angina, should be considered when high-risk patients are referred for autologous collection. Only approximately half of autologous units collected are actually used, and the cost per quality-adjusted year of life saved may be as high as $1 million, depending on the type of surgical procedure. Although recombinant human erythropoietin can stimulate red blood cell production before autologous donation and decrease the need for transfusion, it is not clear whether this strategy, which can cost thousands of dollars per patient, will be cost-effective. Perioperative hemodilution may become an important component in efforts to reduce patient exposure to allogeneic blood, but its use remains controversial.

Postoperative blood salvage versus allogeneic blood transfusion in total knee and hip arthroplasty: a literature review.

PubMed

Leigheb, Massimiliano; Pogliacomi, Francesco; Bosetti, Michela; Boccafoschi, Francesca; Sabbatini, Maurizio; Cannas, Mario; Grassi, Federico

2016-04-15

We aimed to compare Postoperative Blood Salvage (PBS) with Allogeneic Blood Transfusion (ABT) in patients undergoing Total Hip and Knee Arthroplasty (THA, TKA).  A bibliographic research was carried out in order to review the literature dedicated to postoperative blood salvage in major orthopaedic surgery, excluding papers dealing exclusively with preoperative autologous donation, intraoperative blood salvage and ABT. PBS and ABT were compared according to complications, costs and duration of hospitalization. PBS effectiveness in reducing ABT was also assessed. PBS system is useful for reducing the complication rate and the length of hospital stay if compared to ABT. Costs for the reinfusion of unwashed shed blood, washed blood, and allogeneic transfusion are controversial among the different authors. Several papers demonstrate that PBS significantly reduces the need of postoperative ABT in both THA and TKA, while there is low evidence that PBS does not affect the risk of surgical wound complications. To reduce potential risks related to PBS, including non-hemolytic febrile reaction, the reinfusion of saved blood should begin within 4-6 hours after the start of collection through the wound drainage. According to literature, PBS appears to be a valid alternative to ABT, which is the standard treatment for postoperative anemia in THA and TKA. Contraindications to PBS must be ruled out before recommending it to patients undergoing major orthopaedic procedures.

Current and historical perspectives on methodological flaws in processing umbilical cord blood.

PubMed

Mehrishi, J N

2013-11-01

Umbilical cord blood (UCB) hematopoietic stem cells (HSC-CD34+) are valuable for treating malignant or nonmalignant disease. Processing UCB by HESPAN-6% and anti-CD34-Miltenyi particles provides insufficient cells for treating adults. Physicochemical-electrokinetic studies on UCB-mononuclear cells (MNCs) under conditions of delayed processing, ice or very low temperatures, and some cell separation media identified artifacts introduced by procedures. Adsorption of biomaterials from cell damage by temperature, degradation products after using enzymes, harsh reagents, dithiothreitol, and HESPAN affect cell properties and distribution. Miltenyi particles internalized by cells could release iron that accumulating in liver or spleen would then risk toxicity. Summary topics included the effects of temperature, HESPAN (fast sedimenting agent), glycoproteases, DNase, and dithiothreitol risk affecting cell receptors in recognition, "homing," leading to possible unintended iatrogenic bioeffects should such cells be transfused into humans. The loss of undetectable and uncaptured low CD34 antigen-bearing cells by Miltenyi particles seems to occur when the current methods of isolation of CD34+ cells and other cells are critically assessed. The purpose here is to highlight and suggest avoiding the procedural flaws involved. Preventing ice temperatures avoids ice-damaged platelets releasing biomaterials that are adsorbed on cells altering UBC-MNCs/HSC properties and cell loss. Omitting the positive selection with antibody-linked Miltenyi particles obviates the use of harsh reagents to release the cells. Internalized Miltenyi particles are a toxicity hazard that needs investigations. Achieving approximately 5% yields of CD34+ cells (153 × 10(5) /110 mL cord-placenta blood) is a major advance holding great promise, for the first time increasing the prospect of stem cell therapy of 70-kg adults, using a single UCB donation (with dose of 1.5 × 10(5) cells/kg) and

Harms, benefits and costs of fecal immunochemical testing versus guaiac fecal occult blood testing for colorectal cancer screening.

PubMed

Goede, S Lucas; Rabeneck, Linda; van Ballegooijen, Marjolein; Zauber, Ann G; Paszat, Lawrence F; Hoch, Jeffrey S; Yong, Jean H E; Kroep, Sonja; Tinmouth, Jill; Lansdorp-Vogelaar, Iris

2017-01-01

The ColonCancerCheck screening program for colorectal cancer (CRC) in Ontario, Canada, is considering switching from biennial guaiac fecal occult blood test (gFOBT) screening between age 50-74 years to the more sensitive, but also less specific fecal immunochemical test (FIT). The aim of this study is to estimate whether the additional benefits of FIT screening compared to gFOBT outweigh the additional costs and harms. We used microsimulation modeling to estimate quality adjusted life years (QALYs) gained and costs of gFOBT and FIT, compared to no screening, in a cohort of screening participants. We compared strategies with various age ranges, screening intervals, and cut-off levels for FIT. Cost-efficient strategies were determined for various levels of available colonoscopy capacity. Compared to no screening, biennial gFOBT screening between age 50-74 years provided 20 QALYs at a cost of CAN$200,900 per 1,000 participants, and required 17 colonoscopies per 1,000 participants per year. FIT screening was more effective and less costly. For the same level of colonoscopy requirement, biennial FIT (with a high cut-off level of 200 ng Hb/ml) between age 50-74 years provided 11 extra QALYs gained while saving CAN$333,300 per 1000 participants, compared to gFOBT. Without restrictions in colonoscopy capacity, FIT (with a low cut-off level of 50 ng Hb/ml) every year between age 45-80 years was the most cost-effective strategy providing 27 extra QALYs gained per 1000 participants, while saving CAN$448,300. Compared to gFOBT screening, switching to FIT at a high cut-off level could increase the health benefits of a CRC screening program without considerably increasing colonoscopy demand.

Reducing intraoperative red blood cell unit wastage in a large academic medical center.

PubMed

Whitney, Gina M; Woods, Marcella C; France, Daniel J; Austin, Thomas M; Deegan, Robert J; Paroskie, Allison; Booth, Garrett S; Young, Pampee P; Dmochowski, Roger R; Sandberg, Warren S; Pilla, Michael A

2015-11-01

The wastage of red blood cell (RBC) units within the operative setting results in significant direct costs to health care organizations. Previous education-based efforts to reduce wastage were unsuccessful at our institution. We hypothesized that a quality and process improvement approach would result in sustained reductions in intraoperative RBC wastage in a large academic medical center. Utilizing a failure mode and effects analysis supplemented with time and temperature data, key drivers of perioperative RBC wastage were identified and targeted for process improvement. Multiple contributing factors, including improper storage and transport and lack of accurate, locally relevant RBC wastage event data were identified as significant contributors to ongoing intraoperative RBC unit wastage. Testing and implementation of improvements to the process of transport and storage of RBC units occurred in liver transplant and adult cardiac surgical areas due to their history of disproportionately high RBC wastage rates. Process interventions targeting local drivers of RBC wastage resulted in a significant reduction in RBC wastage (p < 0.0001; adjusted odds ratio, 0.24; 95% confidence interval, 0.15-0.39), despite an increase in operative case volume over the period of the study. Studied process interventions were then introduced incrementally in the remainder of the perioperative areas. These results show that a multidisciplinary team focused on the process of blood product ordering, transport, and storage was able to significantly reduce operative RBC wastage and its associated costs using quality and process improvement methods. © 2015 AABB.

Reducing robotic prostatectomy costs by minimizing instrumentation.

PubMed

Delto, Joan C; Wayne, George; Yanes, Rafael; Nieder, Alan M; Bhandari, Akshay

2015-05-01

Since the introduction of robotic surgery for radical prostatectomy, the cost-benefit of this technology has been under scrutiny. While robotic surgery professes to offer multiple advantages, including reduced blood loss, reduced length of stay, and expedient recovery, the associated costs tend to be significantly higher, secondary to the fixed cost of the robot as well as the variable costs associated with instrumentation. This study provides a simple framework for the careful consideration of costs during the selection of equipment and materials. Two experienced robotic surgeons at our institution as well as several at other institutions were queried about their preferred instrument usage for robot-assisted prostatectomy. Costs of instruments and materials were obtained and clustered by type and price. A minimal set of instruments was identified and compared against alternative instrumentation. A retrospective review of 125 patients who underwent robotically assisted laparoscopic prostatectomy for prostate cancer at our institution was performed to compare estimated blood loss (EBL), operative times, and intraoperative complications for both surgeons. Our surgeons now conceptualize instrument costs as proportional changes to the cost of the baseline minimal combination. Robotic costs at our institution were reduced by eliminating an energy source like the Ligasure or vessel sealer, exploiting instrument versatility, and utilizing inexpensive tools such as Hem-o-lok clips. Such modifications reduced surgeon 1's cost of instrumentation to ∼40% less compared with surgeon 2 and up to 32% less than instrumentation used by surgeons at other institutions. Surgeon 1's combination may not be optimal for all robotic surgeons; however, it establishes a minimally viable toolbox for our institution through a rudimentary cost analysis. A similar analysis may aid others in better conceptualizing long-term costs not as nominal, often unwieldy prices, but as percent changes in

30 CFR 206.181 - How do I establish processing costs for dual accounting purposes when I do not process the gas?

Code of Federal Regulations, 2010 CFR

2010-07-01

... accounting purposes when I do not process the gas? 206.181 Section 206.181 Mineral Resources MINERALS... Processing Allowances § 206.181 How do I establish processing costs for dual accounting purposes when I do not process the gas? Where accounting for comparison (dual accounting) is required for gas production...

Detection of antileishmanial antibodies in blood sampled from blood bank donors in Istanbul.

PubMed

Ates, Sezen Canim; Bagirova, Malahat; Allahverdiyev, Adil M; Baydar, Serap Yesilkir; Koc, Rabia Cakir; Elcicek, Serhat; Abamor, Emrah Sefik; Oztel, Olga Nehir

2012-06-01

According to the WHO, only 5-20% of the total cases of leishmaniasis are symptomatic leishmaniasis; the other cases are identified as asymptomatic leishmaniasis. In recent studies, it has been demonstrated that donor blood plays an important role in the epidemiology of asymptomatic leishmaniasis. However, the number of the studies on this subject is still insufficient. Additionally, donor blood samples obtained from Istanbul, which is the biggest metropolitan area in Turkey, have not been investigated with regard to Leishmania. Moreover, there is no information about the sensitivity of noninvasive serological methods that are used in the detection of leishmaniasis donor blood samples. Accordingly, this study aimed to investigate the presence of antileishmanial antibodies in blood samples obtained from blood bank donors in Istanbul, by using different serologic methods, and to determine the most sensitive detection method. Blood samples were taken from 188 healthy blood bank donors to the Capa Turkish Red Crescent Blood Bank (Istanbul, Turkey), and the presence of antileishmanial antibodies was measured by indirect immunofluorescent antibody test (IFAT), ELISA, immunochromatographic dipstick rapid test, and western blot (WB). Antileishmanial antibodies were determined in 12 out of 188 samples by IFAT (6.4%), and six out of these 12 donors were found to be positive at diagnostic titer 1:128 (3.2%). One hundred and eighty eight samples were investigated by ELISA and one (0.5%) of them gave a positive result. None of 188 samples provided a positive result by immunochromatographic test. WB applied to the 12 seroreactive donors showed that three out of 12 donors were positive. In this study, the presence of antileishmanial antibodies in blood samples of blood bank donors from Istanbul has been demonstrated by using feasible and low-cost serological methods. Additionally, in comparison with other simple and low-cost detection methods, WB was used for confirmation. IFAT

From Physical Process to Economic Cost - Integrated Approaches of Landslide Risk Assessment

NASA Astrophysics Data System (ADS)

Klose, M.; Damm, B.

2014-12-01

The nature of landslides is complex in many respects, with landslide hazard and impact being dependent on a variety of factors. This obviously requires an integrated assessment for fundamental understanding of landslide risk. Integrated risk assessment, according to the approach presented in this contribution, implies combining prediction of future landslide occurrence with analysis of landslide impact in the past. A critical step for assessing landslide risk in integrated perspective is to analyze what types of landslide damage affected people and property in which way and how people contributed and responded to these damage types. In integrated risk assessment, the focus is on systematic identification and monetization of landslide damage, and analytical tools that allow deriving economic costs from physical landslide processes are at the heart of this approach. The broad spectrum of landslide types and process mechanisms as well as nonlinearity between landslide magnitude, damage intensity, and direct costs are some main factors explaining recent challenges in risk assessment. The two prevailing approaches for assessing the impact of landslides in economic terms are cost survey (ex-post) and risk analysis (ex-ante). Both approaches are able to complement each other, but yet a combination of them has not been realized so far. It is common practice today to derive landslide risk without considering landslide process-based cause-effect relationships, since integrated concepts or new modeling tools expanding conventional methods are still widely missing. The approach introduced in this contribution is based on a systematic framework that combines cost survey and GIS-based tools for hazard or cost modeling with methods to assess interactions between land use practices and landslides in historical perspective. Fundamental understanding of landslide risk also requires knowledge about the economic and fiscal relevance of landslide losses, wherefore analysis of their

Modern banking, collection, compatibility testing and storage of blood and blood components.

PubMed

Green, L; Allard, S; Cardigan, R

2015-01-01

The clinical practice of blood transfusion has changed considerably over the last few decades. The potential risk of transfusion transmissible diseases has directed efforts towards the production of safe and high quality blood. All transfusion services now operate in an environment of ever-increasing regulatory controls encompassing all aspects of blood collection, processing and storage. Stringent donor selection, identification of pathogens that can be transmitted through blood, and development of technologies that can enhance the quality of blood, have all led to a substantial reduction in potential risks and complications associated with blood transfusion. In this article, we will discuss the current standards required for the manufacture of blood, starting from blood collection, through processing and on to storage. © 2014 The Association of Anaesthetists of Great Britain and Ireland.

Virtual blood bank

PubMed Central

Wong, Kit Fai

2011-01-01

Virtual blood bank is the computer-controlled, electronically linked information management system that allows online ordering and real-time, remote delivery of blood for transfusion. It connects the site of testing to the point of care at a remote site in a real-time fashion with networked computers thus maintaining the integrity of immunohematology test results. It has taken the advantages of information and communication technologies to ensure the accuracy of patient, specimen and blood component identification and to enhance personnel traceability and system security. The built-in logics and process constraints in the design of the virtual blood bank can guide the selection of appropriate blood and minimize transfusion risk. The quality of blood inventory is ascertained and monitored, and an audit trail for critical procedures in the transfusion process is provided by the paperless system. Thus, the virtual blood bank can help ensure that the right patient receives the right amount of the right blood component at the right time. PMID:21383930

Outcomes and costs of implementing a community-based intervention for hypertension in an urban slum in Kenya

PubMed Central

van de Vijver, Steven; Gomez, Gabriela B; Agyemang, Charles; Egondi, Thaddaeus; Kyobutungi, Catherine; Stronks, Karien

2016-01-01

Abstract Objective To describe the processes, outcomes and costs of implementing a multi-component, community-based intervention for hypertension among adults aged > 35 years in a large slum in Nairobi, Kenya. Methods The intervention in 2012–2013 was based on four components: awareness-raising; improved access to screening; standardized clinical management of hypertension; and long-term retention in care. Using multiple sources of data, including administrative records and surveys, we described the inputs and outputs of each intervention activity and estimated the outcomes of each component and the impact of the intervention. We also estimated the costs associated with implementation, using a top-down costing approach. Findings The intervention reached 60% of the target population (4049/6780 people), at a cost of 17 United States dollars (US$) per person screened and provided access to treatment for 68% (660/976) of people referred, at a cost of US$ 123 per person with hypertension who attended the clinic. Of the 660 people who attended the clinic, 27% (178) were retained in care, at a cost of US$ 194 per person retained; and of those patients, 33% (58/178) achieved blood pressure control. The total intervention cost per patient with blood pressure controlled was US$ 3205. Conclusion With moderate implementation costs, it was possible to achieve hypertension awareness and treatment levels comparable to those in high-income settings. However, retention in care and blood pressure control were challenges in this slum setting. For patients, the costs and lack of time or forgetfulness were barriers to retention in care. PMID:27429489

Reducing blood testing in pediatric patients after heart surgery: a quality improvement project.

PubMed

Delgado-Corcoran, Claudia; Bodily, Stephanie; Frank, Deborah U; Witte, Madolin K; Castillo, Ramon; Bratton, Susan L

2014-10-01

To safely optimize blood testing and costs for pediatric cardiac surgical patients without adversely impacting patient outcomes. This is a quality improvement cohort project with pre- and postintervention groups. University-affiliated pediatric cardiac ICU in a tertiary care children's hospital. All patients were surgical patients for whom Risk Adjustment for Congenital Heart Surgery categories allowed for stratification by complexity. The preintervention group was treated in 2010 and the postintervention group in 2011. Laboratory ordering processes were analyzed, and practice changed to limit standing blood test orders and requires individualized ordering. Three hundred nineteen patients were studied in 2010 and 345 in 2011. Groups were similar in median age, weight, length of stay (ICU length of stay), and Risk Adjustment for Congenital Heart Surgery category. There was a reduction in the total blood tests per patient (24 vs 38; p < 0.0001) and length of stay adjusted tests per patient-day (10.4 vs 14.4; p = 0.0001) in the postintervention group. The largest test reductions were blood gases and single electrolytes. Adverse outcomes, such as extubation failure (6.4% vs 5.6%), central catheter-associated bloodstream infection (2.2 vs 1.5), and hospital mortality (0.6% vs 0.6%), were not significantly different between the groups. Cost analysis demonstrated an overall laboratory cost savings of 32%. In addition, the volume of packed RBC transfusions was also significantly decreased in the postintervention group among the most complex patients (Risk Adjustment for Congenital Heart Surgery, 6). Blood testing rates were safely decreased in postoperative pediatric cardiac patients by changing laboratory ordering practices. In addition, packed RBC transfusion was decreased among the most complex patients.

A low-cost solid–liquid separation process for enzymatically hydrolyzed corn stover slurries

DOE PAGES

Sievers, David A.; Lischeske, James J.; Biddy, Mary J.; ...

2015-07-01

Solid-liquid separation of intermediate process slurries is required in some process configurations for the conversion of lignocellulosic biomass to transportation fuels. Thermochemically pretreated and enzymatically hydrolyzed corn stover slurries have proven difficult to filter due to formation of very low permeability cakes that are rich in lignin. Treatment of two different slurries with polyelectrolyte flocculant was demonstrated to increase mean particle size and filterability. Filtration flux was greatly improved, and thus scaled filter unit capacity was increased approximately 40-fold compared with unflocculated slurry. Although additional costs were accrued using polyelectrolyte, techno-economic analysis revealed that the increase in filter capacity significantlymore » reduced overall production costs. Fuel production cost at 95% sugar recovery was reduced by $1.35 US per gallon gasoline equivalent for dilute-acid pretreated and enzymatically hydrolyzed slurries and $3.40 for slurries produced using an additional alkaline de-acetylation preprocessing step that is even more difficult to natively filter.« less