Cost Effective Repair Techniques for Turbine Airfoils. Volume I

DTIC Science & Technology

1978-11-01

Turbine blades and vanes in current engines are subjected to the most hostile environment...payoff potential in turbine vanes / blades . The criteria used included: • Incidence of damage - Scrapped or damaged turbine airfoils at the ALC centers...Corporate Author: GENERAL ELECTRIC CO CINCINNATI OHIO AIRCRAFT ENGINE GROUP Unclassified Title: (U) Cost Effective Repair Techniques for Turbine

Implementing a trustworthy cost-accounting model.

PubMed

Spence, Jay; Seargeant, Dan

2015-03-01

Hospitals and health systems can develop an effective cost-accounting model and maximize the effectiveness of their cost-accounting teams by focusing on six key areas: Implementing an enhanced data model. Reconciling data efficiently. Accommodating multiple cost-modeling techniques. Improving transparency of cost allocations. Securing department manager participation. Providing essential education and training to staff members and stakeholders.

Cost Analysis of Cerebrospinal Fluid Leaks and Cerebrospinal Fluid Leak Prevention in Patients Undergoing Cerebellopontine Angle Surgery.

PubMed

Chern, Alexander; Hunter, Jacob B; Bennett, Marc L

2017-01-01

To determine if cranioplasty techniques following translabyrinthine approaches to the cerebellopontine angle are cost-effective. Retrospective case series. One hundred eighty patients with available financial data who underwent translabyrinthine approaches at a single academic referral center between 2005 and 2015. Cranioplasty with a dural substitute, layered fat graft, and a resorbable mesh plate secured with screws Main Outcome Measures: billing data was obtained for each patient's hospital course for translabyrinthine approaches and postoperative cerebrospinal fluid (CSF) leaks. One hundred nineteen patients underwent translabyrinthine approaches with an abdominal fat graft closure, with a median cost of $25759.89 (range, $15885.65-$136433.07). Sixty-one patients underwent translabyrinthine approaches with a dural substitute, abdominal fat graft, and a resorbable mesh for closure, with a median cost of $29314.97 (range, $17674.28-$111404.55). The median cost of a CSF leak was $50401.25 (range, $0-$384761.71). The additional cost of a CSF leak when shared by all patients who underwent translabyrinthine approaches is $6048.15. The addition of a dural substitute and a resorbable mesh plate after translabyrinthine approaches reduced the CSF leak from 12 to 1.9%, an 84.2% reduction, and a median savings per patient of $2932.23. Applying our cohort's billing data to previously published cranioplasty techniques, costs, and leak rate improvements after translabyrinthine approaches, all techniques were found to be cost-effective. Resorbable mesh cranioplasty is cost-effective at reducing CSF leaks after translabyrinthine approaches. Per our billing data and achieving the same CSF leak rate, cranioplasty costs exceeding $5090.53 are not cost-effective.

The cost-effectiveness of quality improvement projects: a conceptual framework, checklist and online tool for considering the costs and consequences of implementation-based quality improvement.

PubMed

Thompson, Carl; Pulleyblank, Ryan; Parrott, Steve; Essex, Holly

2016-02-01

In resource constrained systems, decision makers should be concerned with the efficiency of implementing improvement techniques and technologies. Accordingly, they should consider both the costs and effectiveness of implementation as well as the cost-effectiveness of the innovation to be implemented. An approach to doing this effectively is encapsulated in the 'policy cost-effectiveness' approach. This paper outlines some of the theoretical and practical challenges to assessing policy cost-effectiveness (the cost-effectiveness of implementation projects). A checklist and associated (freely available) online application are also presented to help services develop more cost-effective implementation strategies. © 2015 John Wiley & Sons, Ltd.

A Cost Analysis of Colonoscopy using Microcosting and Time-and-motion Techniques

PubMed Central

Ness, Reid M.; Stiles, Renée A.; Shintani, Ayumi K.; Dittus, Robert S.

2007-01-01

Background The cost of an individual colonoscopy is an important determinant of the overall cost and cost-effectiveness of colorectal cancer screening. Published cost estimates vary widely and typically report institutional costs derived from gross-costing methods. Objective Perform a cost analysis of colonoscopy using micro-costing and time-and-motion techniques to determine the total societal cost of colonoscopy, which includes direct health care costs as well as direct non-health care costs and costs related to patients’ time. The design is prospective cohort. The participants were 276 contacted, eligible patients who underwent colonoscopy between July 2001 and June 2002, at either a Veterans’ Affairs Medical Center or a University Hospital in the Southeastern United States. Major results The median direct health care cost for colonoscopy was $379 (25%, 75%; $343, $433). The median direct non-health care and patient time costs were $226 (25%, 75%; $187, $323) and $274 (25%, 75%; $186, $368), respectively. The median total societal cost of colonoscopy was $923 (25%, 75%; $805, $1047). The median direct health care, direct non-health care, patient time costs, and total costs at the VA were $391, $288, $274, and $958, respectively; analogous costs at the University Hospital were $376, $189, $368, and $905, respectively. Conclusion Microcosting techniques and time-and-motion studies can produce accurate, detailed cost estimates for complex medical interventions. Cost estimates that inform health policy decisions or cost-effectiveness analyses should use total costs from the societal perspective. Societal cost estimates, which include patient and caregiver time costs, may affect colonoscopy screening rates. PMID:17665271

EOS imaging versus current radiography: A health technology assessment study

PubMed Central

Mahboub-Ahari, Alireza; Hajebrahimi, Sakineh; Yusefi, Mahmoud; Velayati, Ashraf

2016-01-01

Background: EOS is a 2D/3D muscle skeletal diagnostic imaging system. The device has been developed to produce a high quality 2D, full body radiographs in standing, sitting and squatting positions. Three dimensional images can be reconstructed via sterEOS software. This Health Technology Assessment study aimed to investigate efficacy, effectiveness and cost-effectiveness of new emerged EOS imaging system in comparison with conventional x-ray radiographic techniques. Methods: All cost and outcome data were assessed from Iran's Ministry of Health Perspective. Data for clinical effectiveness was extracted using a rigorous systematic review. As clinical outcomes the rate of x-ray emission and related quality of life were compared with Computed Radiography (CR) and Digital Radiography (DR). Standard costing method was conducted to find related direct medical costs. In order to examine robustness of the calculated Incremental Cost Effectiveness Ratios (ICERs) we used two-way sensitivity analysis. GDP Per capita of Islamic Republic of Iran (2012) adopted as cost-effectiveness threshold. Results: Review of related literature highlighted the lack of rigorous evidence for clinical outcomes. Ultra low dose EOS imaging device is known as a safe intervention because of FDA, CE and CSA certificates. The rate of emitted X-ray was 2 to 18 fold lower for EOS compared to the conventional techniques (p<0.001). The Incremental Cost Effectiveness Ratio for EOS relative to CR calculated $50706 in baseline analysis (the first scenario) and $50714, $9446 respectively for the second and third scenarios. Considering the value of neither $42146 as upper limit, nor the first neither the second scenario could pass the cost-effectiveness threshold for Iran. Conclusion: EOS imaging technique might not be considered as a cost-effective intervention in routine practice of health system, especially within in-patient wards. Scenario analysis shows that, only in an optimum condition such as lower assembling costs and higher utilization rates, the device can be recruited for research and therapeutic purposes in pediatric orthopedic centers. PMID:27390701

In-hospital cost comparison between the standard lateral and supercapsular percutaneously-assisted total hip surgical techniques for total hip replacement.

PubMed

Gofton, Wade; Fitch, David A

2016-03-01

The purpose of this study was to compare the in-hospital costs associated with the tissue-sparing supercapsular percutaneously-assisted total hip (SuperPath) and traditional Lateral surgical techniques for total hip replacement (THR). Between April 2013 and January 2014, in-hospital costs were reviewed for all THRs performed using the SuperPath technique by a single surgeon and all THRs performed using the Lateral technique by another surgeon at the same institution. Overall, costs were 28.4% higher in the Lateral group. This was largely attributable to increased costs associated with transfusion (+92.5%), patient rooms (+60.4%), patient food (+62.8%), narcotics (+42.5%), physical therapy (+52.5%), occupational therapy (+88.6%), and social work (+92.9%). The only costs noticeably increased for SuperPath were for imaging (+105.9%), and this was because the SuperPath surgeon performed intraoperative radiographs on all patients while the Lateral surgeon did not. The use of the SuperPath technique resulted in in-hospital cost reductions of over 28%, suggesting that this tissue-sparing surgical technique can be cost-effective primarily by facilitating early mobilisation and patient discharge even during a surgeon's initial experience with the approach.

Proposed Reliability/Cost Model

NASA Technical Reports Server (NTRS)

Delionback, L. M.

1982-01-01

New technique estimates cost of improvement in reliability for complex system. Model format/approach is dependent upon use of subsystem cost-estimating relationships (CER's) in devising cost-effective policy. Proposed methodology should have application in broad range of engineering management decisions.

Replacement of Expensive, Disposable Instruments With Old-fashioned Surgical Techniques for Improved Cost-effectiveness in Laparoscopic Hysterectomy

PubMed Central

Morrison, John E.

2004-01-01

Objective: Patients demand that health care and procedures in rural areas be provided by ambulatory surgery centers close to home. However, the reimbursement rate for such procedures in ambulatory centers is extremely low, so a standard classic intrafascial supracervical hysterectomy procedure needs to be more cost effective to be performed there. Instruments and disposable devices can make up ≥50% of hospital costs for this procedure, so any cost reduction has to focus on this aspect. Methods: We identified the 3 most expensive disposable devices: (1) an Endostapler, US $498 and 3 staple reloads, US $179 each; (2) a calibrated uterine resection tool 15 mm for encoring of the endocervical canal, US $853; and (3) a serrated edged macro morcellator for intraabdominal uterus morcellation, US $321, and substituted them using classic conservative surgical techniques. Results: From September 2001 to September 2002, we performed 26 procedures with this modified technique at an ambulatory surgery center with a follow-up of 6.7 (2 to 14) months. This modified operative technique was feasible; no conversions were necessary, and no complications occurred. Cost savings were US $2209 per procedure; additional costs were US $266.33 for suture material and an Endopouch, resulting in an overall savings of US $50 509.42. The disadvantage was an increase in operating room time of about 1 hour 20 minutes per case. Conclusion: These modifications in the classic intrafascial supracervical hysterectomy technique have proven to be feasible, safe, and highly cost effective, especially for a rural ambulatory surgery center. Long-term follow-up is necessary to further evaluate these operative modifications. PMID:15119671

Cost-Effective Stress Management Training.

ERIC Educational Resources Information Center

Shea, Gordon F.

1980-01-01

Stress management training can be a cost effective way to improve productivity and job performance. Among many relaxation techniques, the most effective in terms of teachability, participant motivation, and profitability are self-hypnosis, progressive relaxation, and transcendental meditation. (SK)

The Potential to Forgo Social Welfare Gains through Overrelianceon Cost Effectiveness/Cost Utility Analyses in the Evidence Base for Public Health

PubMed Central

Cohen, D. R.; Patel, N.

2009-01-01

Economic evaluations of clinical treatments most commonly take the form of cost effectiveness or cost utility analyses. This is appropriate since the main—sometimes the only—benefit of such interventions is increased health. The majority of economic evaluations in public health, however, have also been assessed using these techniques when arguably cost benefit analyses would in many cases have been more appropriate, given its ability to take account of nonhealth benefits as well. An examination of the nonhealth benefits from a sample of studies featured in a recent review of economic evaluations in public health illustrates how overfocusing on cost effectiveness/cost utility analyses may lead to forgoing potential social welfare gains from programmes in public health. Prior to evaluation, programmes should be considered in terms of the potential importance of nonhealth benefits and where these are considerable would be better evaluated by more inclusive economic evaluation techniques. PMID:20049165

Cost-effectiveness of manual therapy for the management of musculoskeletal conditions: a systematic review and narrative synthesis of evidence from randomized controlled trials.

PubMed

Tsertsvadze, Alexander; Clar, Christine; Court, Rachel; Clarke, Aileen; Mistry, Hema; Sutcliffe, Paul

2014-01-01

The purpose of this study was to systematically review trial-based economic evaluations of manual therapy relative to other alternative interventions used for the management of musculoskeletal conditions. A comprehensive literature search was undertaken in major medical, health-related, science and health economic electronic databases. Twenty-five publications were included (11 trial-based economic evaluations). The studies compared cost-effectiveness and/or cost-utility of manual therapy interventions to other treatment alternatives in reducing pain (spinal, shoulder, ankle). Manual therapy techniques (e.g., osteopathic spinal manipulation, physiotherapy manipulation and mobilization techniques, and chiropractic manipulation with or without other treatments) were more cost-effective than usual general practitioner (GP) care alone or with exercise, spinal stabilization, GP advice, advice to remain active, or brief pain management for improving low back and shoulder pain/disability. Chiropractic manipulation was found to be less costly and more effective than alternative treatment compared with either physiotherapy or GP care in improving neck pain. Preliminary evidence from this review shows some economic advantage of manual therapy relative to other interventions used for the management of musculoskeletal conditions, indicating that some manual therapy techniques may be more cost-effective than usual GP care, spinal stabilization, GP advice, advice to remain active, or brief pain management for improving low back and shoulder pain/disability. However, at present, there is a paucity of evidence on the cost-effectiveness and/or cost-utility evaluations for manual therapy interventions. Further improvements in the methodological conduct and reporting quality of economic evaluations of manual therapy are warranted in order to facilitate adequate evidence-based decisions among policy makers, health care practitioners, and patients. Copyright © 2014 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

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.

Low-Cost Intra-Articular Distraction Technique Using Kirschner Wires and a Toothed Lamina Spreader.

PubMed

Shymon, Stephen Joseph; Harris, Thomas Gregory

We describe a low-cost (instrument cost) technique for joint distraction using 2 Kirschner wires and a toothed lamina spreader in lieu of a Hintermann distractor. The described technique allows for temporary intra-articular distraction and visualization and preservation of the articular surface with extra-articular instrumentation. The technique can also allow for closed reduction and percutaneous treatment in cases of soft tissue compromise. Additionally, the technique uses common orthopedic surgical instruments, leading to a minimal learning curve for novice surgeons. We have found this distraction technique to be most effective for intra-articular preparation of hindfoot and midfoot arthrodeses and for navicular fracture reduction. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Costing behavioral interventions: a practical guide to enhance translation.

PubMed

Ritzwoller, Debra P; Sukhanova, Anna; Gaglio, Bridget; Glasgow, Russell E

2009-04-01

Cost and cost effectiveness of behavioral interventions are critical parts of dissemination and implementation into non-academic settings. Due to the lack of indicative data and policy makers' increasing demands for both program effectiveness and efficiency, cost analyses can serve as valuable tools in the evaluation process. To stimulate and promote broader use of practical techniques that can be used to efficiently estimate the implementation costs of behavioral interventions, we propose a set of analytic steps that can be employed across a broad range of interventions. Intervention costs must be distinguished from research, development, and recruitment costs. The inclusion of sensitivity analyses is recommended to understand the implications of implementation of the intervention into different settings using different intervention resources. To illustrate these procedures, we use data from a smoking reduction practical clinical trial to describe the techniques and methods used to estimate and evaluate the costs associated with the intervention. Estimated intervention costs per participant were $419, with a range of $276 to $703, depending on the number of participants.

Space system production cost benefits from contemporary philosophies in management and manufacturing

NASA Technical Reports Server (NTRS)

Rosmait, Russell L.

1991-01-01

The cost of manufacturing space system hardware has always been expensive. The Engineering Cost Group of the Program Planning office at Marshall is attempting to account for cost savings that result from new technologies in manufacturing and management. The objective is to identify and define contemporary philosophies in manufacturing and management. The seven broad categories that make up the areas where technological advances can assist in reducing space system costs are illustrated. Included within these broad categories is a list of the processes or techniques that specifically provide the cost savings within todays design, test, production and operations environments. The processes and techniques listed achieve savings in the following manner: increased productivity; reduced down time; reduced scrap; reduced rework; reduced man hours; and reduced material costs. In addition, it should be noted that cost savings from production and processing improvements effect 20 to 40 pct. of production costs whereas savings from management improvements effects 60 to 80 of production cost. This is important because most efforts in reducing costs are spent trying to reduce cost in the production.

Cost-Effectiveness Research in Neurosurgery: We Can and We Must.

PubMed

Stein, Sherman C

2018-01-05

Rapid advancement of medical and surgical therapies, coupled with the recent preoccupation with limiting healthcare costs, makes a collision of the 2 objectives imminent. This article explains the value of cost-effectiveness analysis (CEA) in reconciling the 2 competing goals, and provides a brief introduction to evidence-based CEA techniques. The historical role of CEA in determining whether new neurosurgical strategies provide value for cost is summarized briefly, as are the limitations of the technique. Finally, the unique ability of the neurosurgical community to provide input to the CEA process is emphasized, as are the potential risks of leaving these important decisions in the hands of others. Copyright © 2018 by the Congress of Neurological Surgeons.

The Technique of Special-Effects Cinematography.

ERIC Educational Resources Information Center

Fielding, Raymond

The author describes the many techniques used to produce cinematic effects that would be too costly, too difficult, too time-consuming, too dangerous, or simply impossible to achieve with conventional photographic techniques. He points out that these techniques are available not only for 35 millimeter work but also to the 16 mm. photographer who…

Clinical-outcome-based demand management in health services.

PubMed

Brogan, C; Lawrence, D; Mayhew, L

2008-01-01

THE PROBLEM OF MANAGING DEMAND: Most healthcare systems have 'third-party payers' who face the problem of keeping within budgets despite pressures to increase resources due to the ageing population, new technologies and patient demands to lower thresholds for care. This paper uses the UK National Health Service as a case study to suggest techniques for system-based demand management, which aims to control demand and costs whilst maintaining the cost-effectiveness of the system. The technique for managing demand in primary, elective and urgent care consists of managing treatment thresholds for appropriate care, using a whole-systems approach and costing the care elements in the system. It is important to analyse activity in relation to capacity and demand. Examples of using these techniques in practice are given. The practical effects of using such techniques need evaluation. If these techniques are not used, managing demand and limiting healthcare expenditure will be at the expense of clinical outcomes and unmet need, which will perpetuate financial crises.

THE EFFECT OF THE "EVOKING FREEDOM" TECHNIQUE ON AN UNUSUAL AND DISTURBING REQUEST.

PubMed

Guéguen, Nicolas; Silone, Fabien; David, Mathieu; Pascual, Alexandre

2015-06-01

The "evoking freedom" technique consists in soliciting someone to comply with a request by simply saying that she is free to accept or to refuse the request. However, previous studies used low cost requests. The present study examined the magnitude of this technique associated with a more disturbing and costly request. Sixty men and 60 women aged approximately 20-25 years walking in the street were asked by a male confederate to hold a closed transparent box containing a live trap-door spider while he went into the post office to pick up a package. In the evoking freedom condition, the confederate added in his request that the participant was "free to accept or to refuse." More compliance occurred in the "evoking freedom" condition (53.3%) than in the control condition (36.7%). These results confirm the robustness and the magnitude of the evoking freedom technique on compliance and show that this technique remained effective even when the request was psychologically costly to perform and was associated with fear.

Ageing Mechanisms and Control. Specialists’ Meeting on Life Management Techniques for Ageing Air Vehicles (Les mecanismes vieillissants et le controle) (Reunions des specialistes des techniques de gestion du cycle de vie pour vehicules aeriens vieillissants)

DTIC Science & Technology

2003-02-01

Beam Weld Repair and Qualification of Titanium Fan Blades for Military Gas Turbine Engines”, NATO-RTO-AVT Workshop on Cost Effective Applications of...announced in the Meeting Announcement Research of Extension of the Life Cycle of Helicopter Rotor Blade in Hungary 39 by M. Balaskó, G. Endröczi, J...and Power Systems MP-069(I), February 2003 Low Cost Composite Structures / Cost Effective Application of Titanium Alloys in Military Platforms MP-069

Unobtrusive monitoring of heart rate using a cost-effective speckle-based SI-POF remote sensor

NASA Astrophysics Data System (ADS)

Pinzón, P. J.; Montero, D. S.; Tapetado, A.; Vázquez, C.

2017-03-01

A novel speckle-based sensing technique for cost-effective heart-rate monitoring is demonstrated. This technique detects periodical changes in the spatial distribution of energy on the speckle pattern at the output of a Step-Index Polymer Optical Fiber (SI-POF) lead by using a low-cost webcam. The scheme operates in reflective configuration thus performing a centralized interrogation unit scheme. The prototype has been integrated into a mattress and its functionality has been tested with 5 different patients lying on the mattress in different positions without direct contact with the fiber sensing lead.

Cost-effectiveness analysis of implants versus autologous perforator flaps using the BREAST-Q.

PubMed

Matros, Evan; Albornoz, Claudia R; Razdan, Shantanu N; Mehrara, Babak J; Macadam, Sheina A; Ro, Teresa; McCarthy, Colleen M; Disa, Joseph J; Cordeiro, Peter G; Pusic, Andrea L

2015-04-01

Reimbursement has been recognized as a physician barrier to autologous reconstruction. Autologous reconstructions are more expensive than prosthetic reconstructions, but provide greater health-related quality of life. The authors' hypothesis is that autologous tissue reconstructions are cost-effective compared with prosthetic techniques when considering health-related quality of life and patient satisfaction. A cost-effectiveness analysis from the payer perspective, including patient input, was performed for unilateral and bilateral reconstructions with deep inferior epigastric perforator (DIEP) flaps and implants. The effectiveness measure was derived using the BREAST-Q and interpreted as the cost for obtaining 1 year of perfect breast health-related quality-adjusted life-year. Costs were obtained from the 2010 Nationwide Inpatient Sample. The incremental cost-effectiveness ratio was generated. A sensitivity analysis for age and stage at diagnosis was performed. BREAST-Q scores from 309 patients with implants and 217 DIEP flap reconstructions were included. The additional cost for obtaining 1 year of perfect breast-related health for a unilateral DIEP flap compared with implant reconstruction was $11,941. For bilateral DIEP flaps compared with implant reconstructions, the cost for an additional breast health-related quality-adjusted life-year was $28,017. The sensitivity analysis demonstrated that the cost for an additional breast health-related quality-adjusted life-year for DIEP flaps compared with implants was less for younger patients and earlier stage breast cancer. DIEP flaps are cost-effective compared with implants, especially for unilateral reconstructions. Cost-effectiveness of autologous techniques is maximized in women with longer life expectancy. Patient-reported outcomes findings can be incorporated into cost-effectiveness analyses to demonstrate the relative value of reconstructive procedures.

Cost-effectiveness of a distance lifestyle counselling programme among overweight employees from a company perspective, ALIFE@Work: a randomized controlled trial.

PubMed

Gussenhoven, A H M; van Wier, M F; Bosmans, J E; Dekkers, J C; van Mechelen, W

2013-01-01

The objective of this study was to determine whether a lifestyle intervention with individual counselling was cost-effective for reducing body weight compared with usual care from a company perspective. Overweight employees were recruited and randomly assigned to the intervention groups, either phone or Internet, or the control group. The intervention was based on a cognitive behavioural approach and addressed physical activity and diet. Self-reported body weight was collected at baseline and 12 months follow-up. Intervention costs and costs of sick leave days based on gross and net lost productivity days (GLPDs/NLPDs) obtained from the participating companies were calculated. Missing data were imputed using multiple imputation techniques. Uncertainty surrounding the differences in costs and the incremental cost-effectiveness ratios (ICER) was estimated by bootstrapping techniques, and presented on cost-effectiveness planes and cost-effectiveness acceptability curves. No statistically significant differences in total costs were found between the intervention groups and control group, though mean total costs in both intervention groups tended to be higher than those in the control group. The ICER of the Internet group compared with the control group was €59 per kilogram of weight loss based on GLPD costs. The probability of cost effectiveness of the Internet intervention was 45% at a willingness-to-pay of €0 per extra kilogram weight loss and 75% at a willingness-to-pay of €1500 per extra kilogram body weight loss. Comparable results were found for the phone intervention. The intervention was not cost effective in comparison with usual care from the company perspective. Due to the large amount of missing data, it is not possible to draw firm conclusions.

A comparison of the 'cost per child treated' at a primary care-based sedation referral service, compared to a general anaesthetic in hospital.

PubMed

Jameson, K; Averley, P A; Shackley, P; Steele, J

2007-09-22

To compare the cost-effectiveness of dental sedation techniques used in the treatment of children, focusing on hospital-based dental general anaesthetic (DGA) and advanced conscious sedation in a controlled primary care environment. Data on fees, costs and treatment pathways were obtained from a primary care clinic specialising in advanced sedation techniques. For the hospital-based DGA cohort, data were gathered from hospital trusts in the same area. Comparison was via an average cost per child treated and subsequent sensitivity analysis. Analysing records spanning one year, the average cost per child treated via advanced conscious sedation was pound245.47. As some treatments fail (3.5% of cases attempted), and the technique is not deemed suitable for all patients (4-5%), DGA is still required and has been factored into this cost. DGA has an average cost per case treated of pound359.91, 46.6% more expensive than advanced conscious sedation. These cost savings were robust to plausible variation in all parameters. The costs of advanced conscious sedation techniques, applied in a controlled primary care environment, are substantially lower than the equivalent costs of hospital-based DGA, informing the debate about the optimum way of managing this patient group.

The impact of surgeon choice on the cost of performing laparoscopic appendectomy.

PubMed

Chu, Thomas; Chandhoke, Ryan A; Smith, Paul C; Schwaitzberg, Steven D

2011-04-01

While laparoscopic appendectomy (LA) can be performed using a myriad of techniques, the cost of each method varies. The purpose of this study is to analyze the effects of surgeon choice of technique on the cost of key steps in LA. Surgeon operative notes, hospital invoice lists, and surgeon instrumentation preference sheets were obtained for all LA cases in 2008 at Cambridge Health Alliance (CHA). Only cases (N = 89) performed by fulltime staff general surgeons (N = 8) were analyzed. Disposable costs were calculated for the following components of LA: port access, mesoappendix division, and management of the appendiceal stump. The actual cost of each disposable was determined based on the hospital's materials management database. Actual hospital reimbursements for LA in 2008 were obtained for all payers and compared with the disposable cost per case. Disposable cost per case for the three portions analyzed for 126 theoretical models were calculated and found to range from US $81 to US $873. The surgeon with the most cost-effective preferred method (US $299) utilized one multi-use endoscopic clip applier for mesoappendix division, two commercially available pretied loops for management of the appendiceal stump, and three 5-mm trocars as their preferred technique. The surgeon with the least cost-effective preferred method (US $552) utilized two staple firings for mesoappendix division, one staple firing for management of the appendiceal stump, and 12/5/10-mm trocars for access. The two main payers for LA patients were Medicaid and Health Safety Net, whose total hospital reimbursements ranged from US $264 to US $504 and from US $0 to US $545 per case, respectively, for patients discharged on day 1. Disposable costs frequently exceeded hospital reimbursements. Currently, there is no scientific literature that clearly illustrates a superior surgical method for performing these portions of LA in routine cases. This study suggests that surgeons should review the cost implications of their practice and to find ways to provide the most cost-effective care without jeopardizing clinical outcome.

Cost-Effectiveness Analysis of Intensity Modulated Radiation Therapy Versus 3-Dimensional Conformal Radiation Therapy for Preoperative Treatment of Extremity Soft Tissue Sarcomas

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

Richard, Patrick, E-mail: patrjr@uw.edu; Phillips, Mark; Smith, Wade

Purpose: Create a cost-effectiveness model comparing preoperative intensity modulated radiation therapy (IMRT) versus 3-dimensional conformal radiation therapy (3DCRT) for extremity soft tissue sarcomas. Methods and Materials: Input parameters included 5-year local recurrence rates, rates of acute wound adverse events, and chronic toxicities (edema, fracture, joint stiffness, and fibrosis). Health-state utilities were used to calculate quality-adjusted life years (QALYs). Overall treatment costs per QALY or incremental cost-effectiveness ratio (ICER) were calculated. Roll-back analysis was performed using average costs and utilities to determine the baseline preferred radiation technique. One-way, 2-way, and probabilistic sensitivity analyses (PSA) were performed for input parameters with themore » largest impact on the ICER. Results: Overall treatment costs were $17,515.58 for 3DCRT compared with $22,920.51 for IMRT. The effectiveness was higher for IMRT (3.68 QALYs) than for 3DCRT (3.35 QALYs). The baseline ICER for IMRT was $16,842.75/QALY, making it the preferable treatment. The ICER was most sensitive to the probability of local recurrence, upfront radiation costs, local recurrence costs, certain utilities (no toxicity/no recurrence, grade 1 toxicity/no local recurrence, grade 4 toxicity/no local recurrence), and life expectancy. Dominance patterns emerged when the cost of 3DCRT exceeded $15,532.05 (IMRT dominates) or the life expectancy was under 1.68 years (3DCRT dominates). Furthermore, preference patterns changed based on the rate of local recurrence (threshold: 13%). The PSA results demonstrated that IMRT was the preferred cost-effective technique for 64% of trials compared with 36% for 3DCRT. Conclusions: Based on our model, IMRT is the preferred technique by lowering rates of local recurrence, severe toxicities, and improving QALYs. From a third-party payer perspective, IMRT should be a supported approach for extremity soft tissue sarcomas.« less

New Technologies to Reclaim Arid Lands User's Manual

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

W. K. Ostler

2002-10-01

Approximately 70 percent of all U.S. military training lands are located in arid and semi-arid areas. Training activities in such areas frequently adversely affect vegetation, damaging plants and reducing the resilience of vegetation to recover once disturbed. Fugitive dust resulting from a loss of vegetation creates additional problems for human health, increasing accidents due to decreased visibility, and increasing maintenance costs for roads, vehicles, and equipment. Under conventional technologies to mitigate these impacts, it is estimated that up to 35 percent of revegetation projects in arid areas will fail due to unpredictable natural environmental conditions, such as drought, and reclamationmore » techniques that were inadequate to restore vegetative cover in a timely and cost-effective manner. New reclamation and restoration techniques are needed in desert ranges to help mitigate the adverse effects of military training and other activities to arid-land environments. In 1999, a cooperative effort between the U.S. Department of Energy (DOE), the US. Department of Defense (DoD), and selected university scientists was undertaken to focus on mitigating military impacts in arid lands. As arid lands are impacted due to DoD and DOE activities, biological and soil resources are gradually lost and the habitat is altered. A conceptual model of that change in habitat quality is described for varying levels of disturbance in the Mojave Desert. As the habitat quality degrades and more biological and physical resources are lost from training areas, greater costs are required to return the land to sustainable levels. The purpose of this manual is to assist land managers in recognizing thresholds associated with habitat degradation and provide reclamation planning and techniques that can reduce the costs of mitigation for these impacted lands to ensure sustainable use of these lands. The importance of reclamation planning is described in this manual with suggestions about establishing project objectives, scheduling, budgeting, and selecting cost-effective techniques. Reclamation techniques include sections describing: (1) erosion control (physical, chemical, and biological), (2) site preparation, (3) soil amendments, (4) seeding, (5) planting, (6) grazing and weed control, (7) mulching, (8) irrigation, and (9) site protection. Each section states the objectives of the technique, the principles, an in-depth look at the techniques, and any special considerations as it relates to DoD or DOE lands. The need for monitoring and remediation is described to guide users in monitoring reclamation efforts to evaluate their cost-effectiveness. Costs are provided for the proposed techniques for the major deserts of the southwestern U.S. showing the average and range of costs. A set of decision tools are provided in the form of a flow diagram and table to guide users in selecting effective reclamation techniques to achieve mitigation objectives. Recommendations are provided to help summarize key reclamation principles and to assist users in developing a successful program that contributes to sustainable uses of DoD and DOE lands. The users manual is helpful to managers in communicating to installation management the needs and consequences of training decisions and the costs required to achieve successful levels of sustainable use. This users manual focuses on the development of new reclamation techniques that have been implemented at the National Training Center at Fort Irwin, California, and are applicable to most arid land reclamation efforts.« less

Perioperative Cost Analysis of Minimally Invasive vs Open Resection of Intradural Extramedullary Spinal Cord Tumors.

PubMed

Fontes, Ricardo B V; Wewel, Joshua T; OʼToole, John E

2016-04-01

Minimally invasive spinal surgery (MIS) has emerged as a clinically effective tool but its cost-effectiveness remains unclear. No studies have compared MIS vs open surgical techniques for the treatment of intradural extramedullary (IDEM) tumors. To analyze and compare open and MIS techniques for resection of IDEM tumors, with focus on perioperative costs. Retrospective analysis of a prospectively collected database including 35 IDEM patients (18 open, 17 MIS). Perioperative data, hospital costs, and hospital and physician charges for in-hospital services associated with the index surgical procedure and readmissions within 90 days were compared. Mean estimated blood loss, operative time, preoperative hospital charges, and physician fees were similar between open and MIS techniques. Patient and tumor characteristics were similar between groups. MIS cases were associated with shorter intensive care unit and floor stay. There were 3 complications in the open group, requiring 2 readmissions and 1 reoperation. Hospital costs ($21 307.80 open, $15 015.20 MIS, P < .01), and postoperative ($75 383.48 open, $56 006.88 MIS, P < .01) and total charges ($100 779.38 open, $76 100.92 MIS, P < .01) were significantly lower in the MIS group. There were no tumor recurrences in either group. All patients except for one in the open group maintained or improved their Nurick score. Both MIS and open techniques were able to adequately treat IDEM tumors. Reductions in complication rate and intensive care unit and hospital stay led to a decrease in hospital costs of almost 30% in the MIS group. MIS resection of IDEM tumors is not only an effective and safe option, but allows faster hospital discharge and significant cost savings.

38 CFR 1.921 - Analysis of costs.

Code of Federal Regulations, 2010 CFR

2010-07-01

... effectiveness of alternative collection techniques, establish guidelines with respect to points at which costs... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Analysis of costs. 1.921... Standards for Collection of Claims § 1.921 Analysis of costs. VA collection procedures should provide for...

Approaches to the Analysis of School Costs, an Introduction.

ERIC Educational Resources Information Center

Payzant, Thomas

A review and general discussion of quantitative and qualitative techniques for the analysis of economic problems outside of education is presented to help educators discover new tools for planning, allocating, and evaluating educational resources. The pamphlet covers some major components of cost accounting, cost effectiveness, cost-benefit…

Anatomic Outside-In Reconstruction of the Anterior Cruciate Ligament Using Femoral Fixation with Metallic Interference Screw and Surgical Staples (Agrafe) in the Tibia: An Effective Low-Cost Technique.

PubMed

Diego, Ariel de Lima; Stemberg Martins, de Vasconcelos; Dias, Leite José Alberto; Moreira, Pinto Dilamar; Beltrão, Teixeira Rogério; Coelho, de Léo Álvaro; de Lima, Silveira Leonardo; Krause, Gonçalves Romeu; Carvalho Krause, Gonçalves Marcelo; Carolina Leite, de Vasconcelos Ana; Dias Costa, Filho Carlos Frederico; Lana Lacerda, de Lima

2017-01-01

An anterior cruciate ligament (ACL) rupture is a frequent injury, with short and long-term consequences if left untreated. With a view to benefitting as many patients as possible and preventing future complications, we created a low-cost ligament reconstruction technique. The present article describes an anatomic ACL reconstruction technique. The technique involves single-band reconstruction, using flexors tendon graft, outside-in tunnel perforation, femoral fixation with metal interference screw and surgical staples (Agrafe) in the longitudinal position. We present a simple, easy-to-reproduce technique that, when executed on patients with good bone quality, primarily in the tibia, is effective and inexpensive, favoring its large scale application.

Anatomic Outside-In Reconstruction of the Anterior Cruciate Ligament Using Femoral Fixation with Metallic Interference Screw and Surgical Staples (Agrafe) in the Tibia: An Effective Low-Cost Technique

PubMed Central

Diego, Ariel de Lima; Stemberg Martins, de Vasconcelos,; Dias, Leite, José Alberto; Moreira, Pinto, Dilamar; Beltrão, Teixeira, Rogério; Coelho, de Léo, Álvaro; de Lima, Silveira, Leonardo; Krause, Gonçalves, Romeu; Carvalho Krause, Gonçalves, Marcelo; Carolina Leite, de Vasconcelos, Ana; Dias Costa, Filho, Carlos Frederico; Lana Lacerda, de Lima,

2017-01-01

Background: An anterior cruciate ligament (ACL) rupture is a frequent injury, with short and long-term consequences if left untreated. With a view to benefitting as many patients as possible and preventing future complications, we created a low-cost ligament reconstruction technique. Method: The present article describes an anatomic ACL reconstruction technique. Results: The technique involves single-band reconstruction, using flexors tendon graft, outside-in tunnel perforation, femoral fixation with metal interference screw and surgical staples (Agrafe) in the longitudinal position. Conclusion: We present a simple, easy-to-reproduce technique that, when executed on patients with good bone quality, primarily in the tibia, is effective and inexpensive, favoring its large scale application. PMID:29290851

Techniques for Conducting Effective Concept Design and Design-to-Cost Trade Studies

NASA Technical Reports Server (NTRS)

Di Pietro, David A.

2015-01-01

Concept design plays a central role in project success as its product effectively locks the majority of system life cycle cost. Such extraordinary leverage presents a business case for conducting concept design in a credible fashion, particularly for first-of-a-kind systems that advance the state of the art and that have high design uncertainty. A key challenge, however, is to know when credible design convergence has been achieved in such systems. Using a space system example, this paper characterizes the level of convergence needed for concept design in the context of technical and programmatic resource margins available in preliminary design and highlights the importance of design and cost evaluation learning curves in determining credible convergence. It also provides techniques for selecting trade study cases that promote objective concept evaluation, help reveal unknowns, and expedite convergence within the trade space and conveys general practices for conducting effective concept design-to-cost studies.

Compensation of the impact of low-cost manufacturing techniques in the design of E-plane multiport waveguide junctions

NASA Astrophysics Data System (ADS)

San-Blas, A. A.; Roca, J. M.; Cogollos, S.; Morro, J. V.; Boria, V. E.; Gimeno, B.

2016-06-01

In this work, a full-wave tool for the accurate analysis and design of compensated E-plane multiport junctions is proposed. The implemented tool is capable of evaluating the undesired effects related to the use of low-cost manufacturing techniques, which are mostly due to the introduction of rounded corners in the cross section of the rectangular waveguides of the device. The obtained results show that, although stringent mechanical effects are imposed, it is possible to compensate for the impact of the cited low-cost manufacturing techniques by redesigning the matching elements considered in the original device. Several new designs concerning a great variety of E-plane components (such as right-angled bends, T-junctions and magic-Ts) are presented, and useful design guidelines are provided. The implemented tool, which is mainly based on the boundary integral-resonant mode expansion technique, has been successfully validated by comparing the obtained results to simulated data provided by a commercial software based on the finite element method.

The cost-effectiveness of single-row compared with double-row arthroscopic rotator cuff repair.

PubMed

Genuario, James W; Donegan, Ryan P; Hamman, Daniel; Bell, John-Erik; Boublik, Martin; Schlegel, Theodore; Tosteson, Anna N A

2012-08-01

Interest in double-row techniques for arthroscopic rotator cuff repair has increased over the last several years, presumably because of a combination of literature demonstrating superior biomechanical characteristics and recent improvements in instrumentation and technique. As a result of the increasing focus on value-based health-care delivery, orthopaedic surgeons must understand the cost implications of this practice. The purpose of this study was to examine the cost-effectiveness of double-row arthroscopic rotator cuff repair compared with traditional single-row repair. A decision-analytic model was constructed to assess the cost-effectiveness of double-row arthroscopic rotator cuff repair compared with single-row repair on the basis of the cost per quality-adjusted life year gained. Two cohorts of patients (one with a tear of <3 cm and the other with a tear of ≥3 cm) were evaluated. Probabilities for retear and persistent symptoms, health utilities for the particular health states, and the direct costs for rotator cuff repair were derived from the orthopaedic literature and institutional data. The incremental cost-effectiveness ratio for double-row compared with single-row arthroscopic rotator cuff repair was $571,500 for rotator cuff tears of <3 cm and $460,200 for rotator cuff tears of ≥3 cm. The rate of radiographic or symptomatic retear alone did not influence cost-effectiveness results. If the increase in the cost of double-row repair was less than $287 for small or moderate tears and less than $352 for large or massive tears compared with the cost of single-row repair, then double-row repair would represent a cost-effective surgical alternative. On the basis of currently available data, double-row rotator cuff repair is not cost-effective for any size rotator cuff tears. However, variability in the values for costs and probability of retear can have a profound effect on the results of the model and may create an environment in which double-row repair becomes the more cost-effective surgical option. The identification of the threshold values in this study may help surgeons to determine the most cost-effective treatment.

An economic evaluation of Alexander Technique lessons or acupuncture sessions for patients with chronic neck pain: A randomized trial (ATLAS).

PubMed

Essex, Holly; Parrott, Steve; Atkin, Karl; Ballard, Kathleen; Bland, Martin; Eldred, Janet; Hewitt, Catherine; Hopton, Ann; Keding, Ada; Lansdown, Harriet; Richmond, Stewart; Tilbrook, Helen; Torgerson, David; Watt, Ian; Wenham, Aniela; Woodman, Julia; MacPherson, Hugh

2017-01-01

To assess the cost-effectiveness of acupuncture and usual care, and Alexander Technique lessons and usual care, compared with usual GP care alone for chronic neck pain patients. An economic evaluation was undertaken alongside the ATLAS trial, taking both NHS and wider societal viewpoints. Participants were offered up to twelve acupuncture sessions or twenty Alexander lessons (equivalent overall contact time). Costs were in pounds sterling. Effectiveness was measured using the generic EQ-5D to calculate quality adjusted life years (QALYs), as well as using a specific neck pain measure-the Northwick Park Neck Pain Questionnaire (NPQ). In the base case analysis, incremental QALY gains were 0.032 and 0.025 in the acupuncture and Alexander groups, respectively, in comparison to usual GP care, indicating moderate health benefits for both interventions. Incremental costs were £451 for acupuncture and £667 for Alexander, mainly driven by intervention costs. Acupuncture was likely to be cost-effective (ICER = £18,767/QALY bootstrapped 95% CI £4,426 to £74,562) and was robust to most sensitivity analyses. Alexander lessons were not cost-effective at the lower NICE threshold of £20,000/QALY (£25,101/QALY bootstrapped 95% CI -£150,208 to £248,697) but may be at £30,000/QALY, however, there was considerable statistical uncertainty in all tested scenarios. In comparison with usual care, acupuncture is likely to be cost-effective for chronic neck pain, whereas, largely due to higher intervention costs, Alexander lessons are unlikely to be cost-effective. However, there were high levels of missing data and further research is needed to assess the long-term cost-effectiveness of these interventions.

An economic evaluation of Alexander Technique lessons or acupuncture sessions for patients with chronic neck pain: A randomized trial (ATLAS)

PubMed Central

Essex, Holly; Parrott, Steve; Atkin, Karl; Ballard, Kathleen; Bland, Martin; Eldred, Janet; Hewitt, Catherine; Hopton, Ann; Keding, Ada; Lansdown, Harriet; Richmond, Stewart; Tilbrook, Helen; Torgerson, David; Watt, Ian; Wenham, Aniela; Woodman, Julia; MacPherson, Hugh

2017-01-01

Objectives To assess the cost-effectiveness of acupuncture and usual care, and Alexander Technique lessons and usual care, compared with usual GP care alone for chronic neck pain patients. Methods An economic evaluation was undertaken alongside the ATLAS trial, taking both NHS and wider societal viewpoints. Participants were offered up to twelve acupuncture sessions or twenty Alexander lessons (equivalent overall contact time). Costs were in pounds sterling. Effectiveness was measured using the generic EQ-5D to calculate quality adjusted life years (QALYs), as well as using a specific neck pain measure–the Northwick Park Neck Pain Questionnaire (NPQ). Results In the base case analysis, incremental QALY gains were 0.032 and 0.025 in the acupuncture and Alexander groups, respectively, in comparison to usual GP care, indicating moderate health benefits for both interventions. Incremental costs were £451 for acupuncture and £667 for Alexander, mainly driven by intervention costs. Acupuncture was likely to be cost-effective (ICER = £18,767/QALY bootstrapped 95% CI £4,426 to £74,562) and was robust to most sensitivity analyses. Alexander lessons were not cost-effective at the lower NICE threshold of £20,000/QALY (£25,101/QALY bootstrapped 95% CI -£150,208 to £248,697) but may be at £30,000/QALY, however, there was considerable statistical uncertainty in all tested scenarios. Conclusions In comparison with usual care, acupuncture is likely to be cost-effective for chronic neck pain, whereas, largely due to higher intervention costs, Alexander lessons are unlikely to be cost-effective. However, there were high levels of missing data and further research is needed to assess the long-term cost-effectiveness of these interventions. PMID:29211741

Cost-effectiveness of electroconvulsive therapy compared to repetitive transcranial magnetic stimulation for treatment-resistant severe depression: a decision model.

PubMed

Vallejo-Torres, L; Castilla, I; González, N; Hunter, R; Serrano-Pérez, P; Perestelo-Pérez, L

2015-05-01

Electroconvulsive therapy (ECT) is widely applied to treat severe depression resistant to standard treatment. Results from previous studies comparing the cost-effectiveness of this technique with treatment alternatives such as repetitive transcranial magnetic stimulation (rTMS) are conflicting. We conducted a cost-effectiveness analysis comparing ECT alone, rTMS alone and rTMS followed by ECT when rTMS fails under the perspective of the Spanish National Health Service. The analysis is based on a Markov model which simulates the costs and health outcomes of individuals treated under these alternatives over a 12-month period. Data to populate this model were extracted and synthesized from a series of randomized controlled trials and other studies that have compared these techniques on the patient group of interest. We measure effectiveness using quality-adjusted life years (QALYs) and characterize the uncertainty using probabilistic sensitivity analyses. ECT alone was found to be less costly and more effective than rTMS alone, while the strategy of providing rTMS followed by ECT when rTMS fails is the most expensive and effective option. The incremental cost per QALY gained of this latter strategy was found to be above the reference willingness-to-pay threshold used in these types of studies in Spain and other countries. The probability that ECT alone is the most cost-effective alternative was estimated to be around 70%. ECT is likely to be the most cost-effective option in the treatment of resistant severe depression for a willingness to pay of €30,000 per QALY.

A Technique to Perfuse Cadavers that Extends the Useful Life of Fresh Tissues: The Duke Experience

ERIC Educational Resources Information Center

Messmer, Caroline; Kellogg, Ryan T.; Zhang, Yixin; Baiak, Andresa; Leiweke, Clinton; Marcus, Jeffrey R.; Levin, L. Scott; Zenn, Michael R.; Erdmann, Detlev

2010-01-01

The demand for laboratory-based teaching and training is increasing worldwide as medical training and education confront the pressures of shorter training time and rising costs. This article presents a cost-effective perfusion technique that extends the useful life of fresh tissue. Refrigerated cadavers are preserved in their natural state for up…

Modeling rheumatoid arthritis using different techniques - a review of model construction and results.

PubMed

Scholz, Stefan; Mittendorf, Thomas

2014-12-01

Rheumatoid arthritis (RA) is a chronic, inflammatory disease with severe effects on the functional ability of patients. Due to the prevalence of 0.5 to 1.0 percent in western countries, new treatment options are a major concern for decision makers with regard to their budget impact. In this context, cost-effectiveness analyses are a helpful tool to evaluate new treatment options for reimbursement schemes. To analyze and compare decision analytic modeling techniques and to explore their use in RA with regard to their advantages and shortcomings. A systematic literature review was conducted in PubMED and 58 studies reporting health economics decision models were analyzed with regard to the modeling technique used. From the 58 reviewed publications, we found 13 reporting decision tree-analysis, 25 (cohort) Markov models, 13 publications on individual sampling methods (ISM) and seven discrete event simulations (DES). Thereby 26 studies were identified as presenting independently developed models and 32 models as adoptions. The modeling techniques used were found to differ in their complexity and in the number of treatment options compared. Methodological features are presented in the article and a comprehensive overview of the cost-effectiveness estimates is given in Additional files 1 and 2. When compared to the other modeling techniques, ISM and DES have advantages in the coverage of patient heterogeneity and, additionally, DES is capable to model more complex treatment sequences and competing risks in RA-patients. Nevertheless, the availability of sufficient data is necessary to avoid assumptions in ISM and DES exercises, thereby enabling biased results. Due to the different settings, time frames and interventions in the reviewed publications, no direct comparison of modeling techniques was applicable. The results from other indications suggest that incremental cost-effective ratios (ICERs) do not differ significantly between Markov and DES models, but DES is able to report more outcome parameters. Given a sufficient data supply, DES is the modeling technique of choice when modeling cost-effectiveness in RA. Otherwise transparency on the data inputs is crucial for valid results and to inform decision makers about possible biases. With regard to ICERs, Markov models might provide similar estimates as more advanced modeling techniques.

Economic Considerations for Moving beyond the Kato-Katz Technique for Diagnosing Intestinal Parasites As We Move Towards Elimination.

PubMed

Turner, Hugo C; Bettis, Alison A; Dunn, Julia C; Whitton, Jane M; Hollingsworth, T Déirdre; Fleming, Fiona M; Anderson, Roy M

2017-06-01

While the need for more sensitive diagnostics for intestinal helminths is well known, the cost of developing and implementing new tests is considered relatively high compared to the Kato-Katz technique. Here, we review the reported costs of performing the Kato-Katz technique. We also outline several economic arguments we believe highlight the need for further investment in alternative diagnostics, and considerations that should be made when comparing their costs. In our opinion, we highlight that, without new diagnostic methods, it will be difficult for policy makers to make the most cost-effective decisions and that the potentially higher unit costs of new methods can be outweighed by the long-term programmatic benefits they have (such as the ability to detect the interruption of transmission). Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Goal-Directed Fluid Therapy Guided by Cardiac Monitoring During High-Risk Abdominal Surgery in Adult Patients: Cost-Effectiveness Analysis of Esophageal Doppler and Arterial Pulse Pressure Waveform Analysis.

PubMed

Legrand, Guillaume; Ruscio, Laura; Benhamou, Dan; Pelletier-Fleury, Nathalie

2015-07-01

Several minimally invasive techniques for cardiac output monitoring such as the esophageal Doppler (ED) and arterial pulse pressure waveform analysis (APPWA) have been shown to improve surgical outcomes compared with conventional clinical assessment (CCA). To evaluate the cost-effectiveness of these techniques in high-risk abdominal surgery from the perspective of the French public health insurance fund. An analytical decision model was constructed to compare the cost-effectiveness of ED, APPWA, and CCA. Effectiveness data were defined from meta-analyses of randomized clinical trials. The clinical end points were avoidance of hospital mortality and avoidance of major complications. Hospital costs were estimated by the cost of corresponding diagnosis-related groups. Both goal-directed therapy strategies evaluated were more effective and less costly than CCA. Perioperative mortality and the rate of major complications were reduced by the use of ED and APPWA. Cost reduction was mainly due to the decrease in the rate of major complications. APPWA was dominant compared with ED in 71.6% and 27.6% and dominated in 23.8% and 20.8% of the cases when the end point considered was "major complications avoided" and "death avoided," respectively. Regarding cost per death avoided, APPWA was more likely to be cost-effective than ED in a wide range of willingness to pay. Cardiac output monitoring during high-risk abdominal surgery is cost-effective and is associated with a reduced rate of hospital mortality and major complications, whatever the device used. The two devices evaluated had negligible costs compared with the observed reduction in hospital costs. Our comparative studies suggest a larger effect with APPWA that needs to be confirmed by further studies. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Processing experiments on non-Czochralski silicon sheet

NASA Technical Reports Server (NTRS)

Pryor, R. A.; Grenon, L. A.; Sakiotis, N. G.; Pastirik, E. M.; Sparks, T. O.; Legge, R. N.

1981-01-01

A program is described which supports and promotes the development of processing techniques which may be successfully and cost-effectively applied to low-cost sheets for solar cell fabrication. Results are reported in the areas of process technology, cell design, cell metallization, and production cost simulation.

Cost-effectiveness of modern radiotherapy techniques in locally advanced pancreatic cancer.

PubMed

Murphy, James D; Chang, Daniel T; Abelson, Jon; Daly, Megan E; Yeung, Heidi N; Nelson, Lorene M; Koong, Albert C

2012-02-15

Radiotherapy may improve the outcome of patients with pancreatic cancer but at an increased cost. In this study, the authors evaluated the cost-effectiveness of modern radiotherapy techniques in the treatment of locally advanced pancreatic cancer. A Markov decision-analytic model was constructed to compare the cost-effectiveness of 4 treatment regimens: gemcitabine alone, gemcitabine plus conventional radiotherapy, gemcitabine plus intensity-modulated radiotherapy (IMRT); and gemcitabine with stereotactic body radiotherapy (SBRT). Patients transitioned between the following 5 health states: stable disease, local progression, distant failure, local and distant failure, and death. Health utility tolls were assessed for radiotherapy and chemotherapy treatments and for radiation toxicity. SBRT increased life expectancy by 0.20 quality-adjusted life years (QALY) at an increased cost of $13,700 compared with gemcitabine alone (incremental cost-effectiveness ratio [ICER] = $69,500 per QALY). SBRT was more effective and less costly than conventional radiotherapy and IMRT. An analysis that excluded SBRT demonstrated that conventional radiotherapy had an ICER of $126,800 per QALY compared with gemcitabine alone, and IMRT had an ICER of $1,584,100 per QALY compared with conventional radiotherapy. A probabilistic sensitivity analysis demonstrated that the probability of cost-effectiveness at a willingness to pay of $50,000 per QALY was 78% for gemcitabine alone, 21% for SBRT, 1.4% for conventional radiotherapy, and 0.01% for IMRT. At a willingness to pay of $200,000 per QALY, the probability of cost-effectiveness was 73% for SBRT, 20% for conventional radiotherapy, 7% for gemcitabine alone, and 0.7% for IMRT. The current results indicated that IMRT in locally advanced pancreatic cancer exceeds what society considers cost-effective. In contrast, combining gemcitabine with SBRT increased clinical effectiveness beyond that of gemcitabine alone at a cost potentially acceptable by today's standards. Copyright © 2011 American Cancer Society.

Bioremediation techniques-classification based on site of application: principles, advantages, limitations and prospects.

PubMed

Azubuike, Christopher Chibueze; Chikere, Chioma Blaise; Okpokwasili, Gideon Chijioke

2016-11-01

Environmental pollution has been on the rise in the past few decades owing to increased human activities on energy reservoirs, unsafe agricultural practices and rapid industrialization. Amongst the pollutants that are of environmental and public health concerns due to their toxicities are: heavy metals, nuclear wastes, pesticides, green house gases, and hydrocarbons. Remediation of polluted sites using microbial process (bioremediation) has proven effective and reliable due to its eco-friendly features. Bioremediation can either be carried out ex situ or in situ, depending on several factors, which include but not limited to cost, site characteristics, type and concentration of pollutants. Generally, ex situ techniques apparently are more expensive compared to in situ techniques as a result of additional cost attributable to excavation. However, cost of on-site installation of equipment, and inability to effectively visualize and control the subsurface of polluted sites are of major concerns when carrying out in situ bioremediation. Therefore, choosing appropriate bioremediation technique, which will effectively reduce pollutant concentrations to an innocuous state, is crucial for a successful bioremediation project. Furthermore, the two major approaches to enhance bioremediation are biostimulation and bioaugmentation provided that environmental factors, which determine the success of bioremediation, are maintained at optimal range. This review provides more insight into the two major bioremediation techniques, their principles, advantages, limitations and prospects.

Cost-Effectiveness Analysis of Bariatric Surgery for Morbid Obesity.

PubMed

Alsumali, Adnan; Eguale, Tewodros; Bairdain, Sigrid; Samnaliev, Mihail

2018-01-15

In the USA, three types of bariatric surgeries are widely performed, including laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-en-Y gastric bypass (LRYGB), and laparoscopic adjustable gastric banding (LAGB). However, few economic evaluations of bariatric surgery are published. There is also scarcity of studies focusing on the LSG alone. Therefore, this study is evaluating the cost-effectiveness of bariatric surgery using LRYGB, LAGB, and LSG as treatment for morbid obesity. A microsimulation model was developed over a lifetime horizon to simulate weight change, health consequences, and costs of bariatric surgery for morbid obesity. US health care prospective was used. A model was propagated based on a report from the first report of the American College of Surgeons. Incremental cost-effectiveness ratios (ICERs) in terms of cost per quality-adjusted life-year (QALY) gained were used in the model. Model parameters were estimated from publicly available databases and published literature. LRYGB was cost-effective with higher QALYs (17.07) and cost ($138,632) than LSG (16.56 QALYs; $138,925), LAGB (16.10 QALYs; $135,923), and no surgery (15.17 QALYs; $128,284). Sensitivity analysis showed initial cost of surgery and weight regain assumption were very sensitive to the variation in overall model parameters. Across patient groups, LRYGB remained the optimal bariatric technique, except that with morbid obesity 1 (BMI 35-39.9 kg/m 2 ) patients, LSG was the optimal choice. LRYGB is the optimal bariatric technique, being the most cost-effective compared to LSG, LAGB, and no surgery options for most subgroups. However, LSG was the most cost-effective choice when initial BMI ranged between 35 and 39.9 kg/m 2 .

A prospective outcome and cost-effectiveness comparison between two ligament reattachment techniques using suture anchors for chronic ankle instability.

PubMed

Cho, Byung-Ki; Kim, Yong-Min; Park, Kyoung-Jin; Park, Ji-Kang; Kim, Do-Kyoon

2015-02-01

There are various ligament reattachment techniques for the modified Brostrom procedure. There have been few comparative studies on recently developed techniques. This prospective study was performed to compare the functional outcomes of 2 different ligament reattachment techniques using suture anchors. We furthermore evaluated the cost-effectiveness of the suture bridge technique. Forty-five amateur athletes under 30 years of age were followed for more than 2 years. Twenty-four procedures with the suture anchor technique and 21 procedures with the suture bridge technique were performed by one surgeon. The functional evaluation consisted of the American Orthopaedic Foot & Ankle Society (AOFAS) score, Foot and Ankle Outcome Score (FAOS), Karlsson score, Sefton grading system, and the period to return to various forms of exercise (jogging, spurt running, jumping, one leg standing for >1 minute, walking on uneven ground, and going down stairs). Measurement of talar tilt angle and anterior talar translation was obtained from stress radiographs to evaluate mechanical stability. There were no significant differences on AOFAS score, FAOS, Karlsson score, Sefton grade, and stress radiographs. There were no significant differences on the return to exercises, except for jumping. As the most common complication, there were 3 cases of skin irritation by suture materials in the suture anchor group and 2 cases of intraoperative breakage of the suture anchor in suture bridge group. Both ligament reattachment techniques using suture anchors showed similar functional outcomes. Considering the additional medical expenses incurred by more suture anchors, the modified Brostrom procedure using the suture bridge technique had low cost-effectiveness. Proper indication and clinical usefulness of suture bridge technique for chronic ankle instability will be addressed in further studies. Level II, prospective comparative study. © The Author(s) 2014.

Effects of a cost-effective surgical workflow on cosmesis and patient's satisfaction in open thyroid surgery.

PubMed

Billmann, Franck; Bokor-Billmann, Therezia; Voigt, Joachim; Kiffner, Erhard

2013-01-01

In thyroid surgery, minimally invasive procedures are thought to improve cosmesis and patient's satisfaction. However, studies using standardized tools are scarce, and results are controversial. Moreover, minimally invasive techniques raise the question of material costs in a context of health spending cuts. The aim of the present study is to test a cost-effective surgical workflow to improve cosmesis in conventional open thyroid surgery. Our study ran between January 2009 and November 2010, and was based on a prospectively maintained thyroid surgery register. Patients operated for benign thyroid diseases were included. Since January 2010, a standardized surgical workflow was used in addition to the reference open procedure to improve the outcome. Two groups were created: (1) G1 group (patients operated with the reference technique), (2) G2 group (patients operated with our workflow in addition to reference technique). Patients were investigated for postoperative outcomes, self-evaluated body image, cosmetic and self-confidence scores. 820 patients were included in the present study. The overall body image and cosmetic scores were significantly better in the G2 group (P < 0.05). No significant difference was noted in terms of surgical outcomes, scar length, and self-confidence. Our surgical workflow in conjunction with the reference technique is safe and shows significant better results in terms of body image and cosmesis than do the reference technique alone. Thus, we recommend its implementation in order to improve outcomes in a cost-effective way. The limitations of the present study should be kept in mind in the elaboration of future studies. Copyright © 2012 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

Laparoscopic tubal reanastomosis versus in vitro fertilization: cost-based decision analysis.

PubMed

Hirshfeld-Cytron, Jennifer; Winter, Jordan

2013-07-01

Regret after tubal ligation continues to be a problem. After tubal ligation, couples have the option of tubal surgery or in vitro fertilization (IVF). Using decision analysis techniques, we compared cost-effectiveness of tubal reanastomosis by tubal type vs tubal surgery or in vitro fertilization (IVF) for 3 separate age groups of women: <35 years of age, 35 to 40 years of age and >40 years of age. Tubal techniques was divided into type A, those with more favorable prognosis because of the likelihood of having a more significant length tube at time of reanastomosis and type B, those with a worse prognosis of success. We incorporated delivery costs to address the impact of high order multiples in IVF. Data were extracted by studies available in the literature. All costs were adjusted to 2012 US dollars. One-way and 2-way sensitivity analyses were performed. The laparoscopic reanastomosis of type A dominated the other groups, because it was more effective and less costly then type B and IVF. However, when women were >40 years old with a history of type B, IVF was favored when its costs were at the lower limit. The most cost-effective choice for a woman desiring pregnancy after tubal ligation is laparoscopic reanastomosis after a prior clip or ring tubal ligation for women ≤40 years old. It is also the most cost-effective for the oldest cohort, assuming IVF costs are greater than $4500. Copyright © 2013 Mosby, Inc. All rights reserved.

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.

Planning for Cost Effectiveness.

ERIC Educational Resources Information Center

Schlaebitz, William D.

1984-01-01

A heat pump life-cycle cost analysis is used to explain the technique. Items suggested for the life-cycle analysis approach include lighting, longer-life batteries, site maintenance, and retaining experts to inspect specific building components. (MLF)

Minimalist fault-tolerance techniques for mitigating single-event effects in non-radiation-hardened microcontrollers

NASA Astrophysics Data System (ADS)

Caldwell, Douglas Wyche

Commercial microcontrollers--monolithic integrated circuits containing microprocessor, memory and various peripheral functions--such as are used in industrial, automotive and military applications, present spacecraft avionics system designers an appealing mix of higher performance and lower power together with faster system-development time and lower unit costs. However, these parts are not radiation-hardened for application in the space environment and Single-Event Effects (SEE) caused by high-energy, ionizing radiation present a significant challenge. Mitigating these effects with techniques which require minimal additional support logic, and thereby preserve the high functional density of these devices, can allow their benefits to be realized. This dissertation uses fault-tolerance to mitigate the transient errors and occasional latchups that non-hardened microcontrollers can experience in the space radiation environment. Space systems requirements and the historical use of fault-tolerant computers in spacecraft provide context. Space radiation and its effects in semiconductors define the fault environment. A reference architecture is presented which uses two or three microcontrollers with a combination of hardware and software voting techniques to mitigate SEE. A prototypical spacecraft function (an inertial measurement unit) is used to illustrate the techniques and to explore how real application requirements impact the fault-tolerance approach. Low-cost approaches which leverage features of existing commercial microcontrollers are analyzed. A high-speed serial bus is used for voting among redundant devices and a novel wire-OR output voting scheme exploits the bidirectional controls of I/O pins. A hardware testbed and prototype software were constructed to evaluate two- and three-processor configurations. Simulated Single-Event Upsets (SEUs) were injected at high rates and the response of the system monitored. The resulting statistics were used to evaluate technical effectiveness. Fault-recovery probabilities (coverages) higher than 99.99% were experimentally demonstrated. The greater than thousand-fold reduction in observed effects provides performance comparable with SEE tolerance of tested, rad-hard devices. Technical results were combined with cost data to assess the cost-effectiveness of the techniques. It was found that a three-processor system was only marginally more effective than a two-device system at detecting and recovering from faults, but consumed substantially more resources, suggesting that simpler configurations are generally more cost-effective.

How Much Can Non-industry Standard Measurement Methodologies Benefit Methane Reduction Programs?

NASA Astrophysics Data System (ADS)

Risk, D. A.; O'Connell, L.; Atherton, E.

2017-12-01

In recent years, energy sector methane emissions have been recorded in large part by applying modern non-industry-standard techniques. Industry may lack the regulatory flexibility to use such techniques, or in some cases may not understand the possible associated economic advantage. As progressive jurisdictions move from estimation and towards routine measurement, the research community should provide guidance to help regulators and companies measure more effectively, and economically if possible. In this study, we outline a modelling experiment in which we explore the integration of non-industry-standard measurement techniques as part of a generalized compliance measurement program. The study was not intended to be exhaustive, or to recommend particular combinations, but instead to explore the inter-relationships between methodologies, development type, compliance practice. We first defined the role, applicable scale, detection limits, working distances, and approximate deployment cost of several measurement methodologies. We then considered a variety of development types differing mainly in footprint, density, and emissions "profile". Using a Monte Carlo approach, we evaluated the effect of these various factors on the cost and confidence of the compliance measurement program. We found that when added individually, some of the research techniques were indeed able to deliver an improvement in cost and/or confidence when used alongside industry-standard Optical Gas Imaging. When applied in combination, the ideal fraction of each measurement technique depended on development type, emission profile, and whether confidence or cost was more important. Results suggest that measurement cost and confidence could be improved if energy companies exploited a wider range of measurement techniques, and in a manner tailored to each development. In the short-term, combining clear scientific guidance with economic information could benefit immediate mitigation efforts over developing new super sensors.

Remediation techniques for heavy metal-contaminated soils: Principles and applicability.

PubMed

Liu, Lianwen; Li, Wei; Song, Weiping; Guo, Mingxin

2018-08-15

Globally there are over 20millionha of land contaminated by the heavy metal(loid)s As, Cd, Cr, Hg, Pb, Co, Cu, Ni, Zn, and Se, with the present soil concentrations higher than the geo-baseline or regulatory levels. In-situ and ex-situ remediation techniques have been developed to rectify the heavy metal-contaminated sites, including surface capping, encapsulation, landfilling, soil flushing, soil washing, electrokinetic extraction, stabilization, solidification, vitrification, phytoremediation, and bioremediation. These remediation techniques employ containment, extraction/removal, and immobilization mechanisms to reduce the contamination effects through physical, chemical, biological, electrical, and thermal remedy processes. These techniques demonstrate specific advantages, disadvantages, and applicability. In general, in-situ soil remediation is more cost-effective than ex-situ treatment, and contaminant removal/extraction is more favorable than immobilization and containment. Among the available soil remediation techniques, electrokinetic extraction, chemical stabilization, and phytoremediation are at the development stage, while the others have been practiced at full, field scales. Comprehensive assessment indicates that chemical stabilization serves as a temporary soil remediation technique, phytoremediation needs improvement in efficiency, surface capping and landfilling are applicable to small, serious-contamination sites, while solidification and vitrification are the last remediation option. The cost and duration of soil remediation are technique-dependent and site-specific, up to $500ton -1 soil (or $1500m -3 soil or $100m -2 land) and 15years. Treatability studies are crucial to selecting feasible techniques for a soil remediation project, with considerations of the type and degree of contamination, remediation goals, site characteristics, cost effectiveness, implementation time, and public acceptability. Copyright © 2018 Elsevier B.V. All rights reserved.

A Primer on the Financial Management of Experiential Learning Assessment Programs.

ERIC Educational Resources Information Center

MacTaggart, Terrence

1983-01-01

The success and failure of experiential learning assessment programs rests not only on their academic quality, but also on their financial management. Types of cost and the meaning of cost-effectiveness are discussed. Break-even analysis, cost-reduction activities, and revenue-enhancement techniques are described. (Author/MLW)

New generation cut-and-seal devices in oral and oropharyngeal cancer resection: clinical and cost-effectiveness study.

PubMed

Tirelli, G; Del Piero, G C; Valentinuz, G; Monte, A; Gatto, A; Rebelli, A; Quatela, E

2018-04-01

To evaluate the clinical efficacy and cost-effectiveness of ultrasonic shears and the electrothermal bipolar vessel sealing system, in comparison to the traditional cold knife and bipolar forceps, in oral and oropharyngeal cancer surgery. Patients who underwent oral or oropharyngeal cancer resection and neck dissection with either ultrasonic shears (n = 36) or electrothermal bipolar vessel sealing (n = 32) were enrolled. Surgical time, intra-operative bleeding, blood drainage, post-operative pain, neck oedema, complications and hospitalisation duration were compared to those of an historical cohort of 36 patients treated using a cold knife and bipolar forceps. Additionally, a cost-effectiveness evaluation was performed. Ultrasonic shears and, in particular, electrothermal bipolar vessel sealing, were advantageous compared to the traditional techniques. The cost of ultrasonic shears and electrothermal bipolar vessel sealing was completely offset by declining time-driven costs for the surgical team and operating theatre. Ultrasonic shears and, in particular, electrothermal bipolar vessel sealing, are more advantageous compared to the traditional techniques, from both a clinical and economic point of view.

Robotics in general surgery: A systematic cost assessment

PubMed Central

Gkegkes, Ioannis D.; Mamais, Ioannis A.; Iavazzo, Christos

2017-01-01

The utilisation of robotic-assisted techniques is a novelty in the field of general surgery. Our intention was to examine the up to date available literature on the cost assessment of robotic surgery of diverse operations in general surgery. PubMed and Scopus databases were searched in a systematic way to retrieve the included studies in our review. Thirty-one studies were retrieved, referring on a vast range of surgical operations. The mean cost for robotic, open and laparoscopic ranged from 2539 to 57,002, 7888 to 16,851 and 1799 to 50,408 Euros, respectively. The mean operative charges ranged from 273.74 to 13,670 Euros. More specifically, for the robotic and laparoscopic gastric fundoplication, the cost ranged from 1534 to 2257 and 657 to 763 Euros, respectively. For the robotic and laparoscopic colectomy, it ranged from 3739 to 17,080 and 3109 to 33,865 Euros, respectively. For the robotic and laparoscopic cholecystectomy, ranged from 1163.75 to 1291 and from 273.74 to 1223 Euros, respectively. The mean non-operative costs ranged from 900 to 48,796 from 8347 to 8800 and from 870 to 42,055 Euros, for robotic, open and laparoscopic technique, respectively. Conversions to laparotomy were present in 34/18,620 (0.18%) cases of laparoscopic and in 22/1488 (1.5%) cases of robotic technique. Duration of surgery robotic, open and laparoscopic ranged from 54.6 to 328.7, 129 to 234, and from 50.2 to 260 min, respectively. The present evidence reveals that robotic surgery, under specific conditions, has the potential to become cost-effective. Large number of cases, presence of industry competition and multidisciplinary team utilisation are some of the factors that could make more reasonable and cost-effective the robotic-assisted technique. PMID:28000648

Robotics in general surgery: A systematic cost assessment.

PubMed

Gkegkes, Ioannis D; Mamais, Ioannis A; Iavazzo, Christos

2017-01-01

The utilisation of robotic-assisted techniques is a novelty in the field of general surgery. Our intention was to examine the up to date available literature on the cost assessment of robotic surgery of diverse operations in general surgery. PubMed and Scopus databases were searched in a systematic way to retrieve the included studies in our review. Thirty-one studies were retrieved, referring on a vast range of surgical operations. The mean cost for robotic, open and laparoscopic ranged from 2539 to 57,002, 7888 to 16,851 and 1799 to 50,408 Euros, respectively. The mean operative charges ranged from 273.74 to 13,670 Euros. More specifically, for the robotic and laparoscopic gastric fundoplication, the cost ranged from 1534 to 2257 and 657 to 763 Euros, respectively. For the robotic and laparoscopic colectomy, it ranged from 3739 to 17,080 and 3109 to 33,865 Euros, respectively. For the robotic and laparoscopic cholecystectomy, ranged from 1163.75 to 1291 and from 273.74 to 1223 Euros, respectively. The mean non-operative costs ranged from 900 to 48,796 from 8347 to 8800 and from 870 to 42,055 Euros, for robotic, open and laparoscopic technique, respectively. Conversions to laparotomy were present in 34/18,620 (0.18%) cases of laparoscopic and in 22/1488 (1.5%) cases of robotic technique. Duration of surgery robotic, open and laparoscopic ranged from 54.6 to 328.7, 129 to 234, and from 50.2 to 260 min, respectively. The present evidence reveals that robotic surgery, under specific conditions, has the potential to become cost-effective. Large number of cases, presence of industry competition and multidisciplinary team utilisation are some of the factors that could make more reasonable and cost-effective the robotic-assisted technique.

Cost/efficacy evaluation of the technologies applied to video-assisted thoracoscopic surgery lobectomy.

PubMed

Menna, Cecilia; Ibrahim, Mohsen; Rendina, Erino Angelo; Venuta, Federico; Andreetti, Claudio

2017-01-01

Superior outcomes after video-assisted thoracoscopic surgery (VATS) pulmonary lobectomy have been demonstrated, compared with thoracotomy, for patients affected by early-stage non-small cell lung cancer (NSCLC). However, in an era of rising health care costs and controlled resources, the overall medical cost of surgical procedures is measured by the hospitals' marketing offices. Several factors such as surgical technique, conversion rate, length of stay, post-operative complications occurrence and mainly the introduction of new surgical technologies (disposables and devices) could influence the cost-effectiveness of VATS procedures. However, increased operating room costs are counteracted by shorter hospital stay and reduced ward bed stays providing further resources for other patients. Thus, choosing a surgical approach and assessing whether a specific technique is cost-effective is mandatory for a modern thoracic surgeon to justify its expenses. This review tries to reach a conclusion by comparing all recent studies reporting a cost analysis for VATS lobectomy, especially for new technologies used for VATS lobectomy. Nevertheless, no sufficient evidences are published to assess VATS new technologies sustainability and further cost analyses are necessary before VATS lobectomy expense is deemed justified.

Diazo processing of LANDSAT imagery: A low-cost instructional technique

NASA Technical Reports Server (NTRS)

Lusch, D. P.

1981-01-01

Diazo processing of LANDSAT imagery is a relatively simple and cost effective method of producing enhanced renditions of the visual LANDSAT products. This technique is capable of producing a variety of image enhancements which have value in a teaching laboratory environment. Additionally, with the appropriate equipment, applications research which relys on accurate and repeatable results is possible. Exposure and development equipment options, diazo materials, and enhancement routines are discussed.

Costs and effects in lumbar spinal fusion. A follow-up study in 136 consecutive patients with chronic low back pain

PubMed Central

Christensen, Finn Bjarke; Christiansen, Terkel; Bünger, Cody

2006-01-01

Although cost-effectiveness is becoming the foremost evaluative criterion within health service management of spine surgery, scientific knowledge about cost-patterns and cost-effectiveness is limited. The aims of this study were (1) to establish an activity-based method for costing at the patient-level, (2) to investigate the correlation between costs and effects, (3) to investigate the influence of selected patient characteristics on cost-effectiveness and, (4) to investigate the incremental cost-effectiveness ratio of (a) posterior instrumentation and (b) intervertebral anterior support in lumbar spinal fusion. We hypothesized a positive correlation between costs and effects, that determinants of effects would also determine cost-effectiveness, and that posterolateral instrumentation and anterior intervertebral support are cost-effective adjuncts in posterolateral lumbar fusion. A cohort of 136 consecutive patients with chronic low back pain, who were surgically treated from January 2001 through January 2003, was followed until 2 years postoperatively. Operations took place at University Hospital of Aarhus and all patients had either (1) non-instrumented posterolateral lumbar spinal fusion, (2) instrumented posterolateral lumbar spinal fusion, or (3) instrumented posterolateral lumbar spinal fusion + anterior intervertebral support. Analysis of costs was performed at the patient-level, from an administrator’s perspective, by means of Activity-Based-Costing. Clinical effects were measured by means of the Dallas Pain Questionnaire and the Low Back Pain Rating Scale at baseline and 2 years postoperatively. Regression models were used to reveal determinants for costs and effects. Costs and effects were analyzed as a net-benefit measure to reveal determinants for cost-effectiveness, and finally, adjusted analysis (for non-random allocation of patients) was performed in order to reveal the incremental cost-effectiveness ratios of (a) posterior instrumentation and (b) anterior support. The costs of non-instrumented posterolateral spinal fusion were estimated at DKK 88,285(95% CI 81,369;95,546), instrumented posterolateral spinal fusion at DKK 94,396(95% CI 89,865;99,574) and instrumented posterolateral lumbar spinal fusion + anterior intervertebral support at DKK 120,759(95% CI 111,981;133,738). The net-benefit of the regimens was significantly affected by smoking and functional disability in psychosocial life areas. Multi-level fusion and surgical technique significantly affected the net-benefit as well. Surprisingly, no correlation was found between treatment costs and treatment effects. Incremental analysis suggested that the probability of posterior instrumentation being cost-effective was limited, whereas the probability of anterior intervertebral support being cost-effective escalates as willingness-to-pay per effect unit increases. This study reveals useful and hitherto unknown information both about cost-patterns at the patient-level and determinants of cost-effectiveness. The overall conclusion of the present investigation is a recommendation to focus further on determinants of cost-effectiveness. For example, patient characteristics that are modifiable at a relatively low expense may have greater influence on cost-effectiveness than the surgical technique itself—at least from an administrator’s perspective. PMID:16871387

Fertility preservation for social indications: a cost-based decision analysis.

PubMed

Hirshfeld-Cytron, Jennifer; Grobman, William A; Milad, Magdy P

2012-03-01

Age-related infertility remains a problem that assisted reproductive techniques (ART) have limited ability to overcome. Correspondingly, because an increasing number of women are choosing to delay childbearing, fertility preservation strategies, initially intended for patients undergoing gonadotoxic therapies, are being applied to this group of healthy women. Studies supporting the effectiveness of this practice are lacking. Decision analytic techniques. We compared the cost-effectiveness of three strategies for women planning delayed childbearing until age 40: oocyte cryopreservation at age 25, ovarian tissue cryopreservation (OTC) at age 25, and no assisted reproduction until spontaneous conception had been attempted. Not applicable. Not applicable. Cost-effectiveness, which was defined as the cost per live birth. In this analysis, the strategy of foregoing fertility preservation at age 25 and then choosing ART only after not spontaneously conceiving at age 40 was the most cost-effective option. OTC was dominated by the other strategies. Sensitivity analyses demonstrated the robustness of the model; no analysis existed in which OTC was not dominated by oocyte cryopreservation. Increasing the cost of an IVF cycle beyond $22,000 was the only situation in which oocyte cryopreservation was the most preferred strategy. Neither oocyte cryopreservation nor OTC appear to be cost-effective under current circumstances for otherwise healthy women planning delayed childbearing. This analysis should give pause to the current practice of offering fertility preservation based only on the desire for delayed childbearing. Copyright © 2012 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Cost-effectiveness study of the microbiological diagnosis of tuberculosis using geneXpert MTB/RIF®.

PubMed

Herráez, Óscar; Asencio-Egea, María Ángeles; Huertas-Vaquero, María; Carranza-González, Rafael; Castellanos-Monedero, Jesús; Franco-Huerta, María; Barberá-Farré, José Ramón; Tenías-Burillo, José María

To perform a cost-effectiveness analysis of a molecular biology technique for the diagnosis of tuberculosis compared to the classical diagnostic alternative. A cost-effectiveness analysis was performed to evaluate the theoretical implementation of a molecular biology method including two alternative techniques for early detection of Mycobacterium tuberculosis Complex, and resistance to rifampicin (alternative1: one determination in selected patients; alternative2: two determinations in all the patients). Both alternatives were compared with the usual procedure for microbiological diagnosis of tuberculosis (staining and microbiological culture), and was accomplished on 1,972 patients in the period in 2008-2012. The effectiveness was measured in QALYs, and the uncertainty was assessed by univariate, multivariate and probabilistic analysis of sensitivity. A value of €8,588/QALYs was obtained by the usual method. Total expenditure with the alternative1 was €8,487/QALYs, whereas with alternative2, the cost-effectiveness ratio amounted to €2,960/QALYs. Greater diagnostic efficiency was observed by applying the alternative2, reaching a 75% reduction in the number of days that a patient with tuberculosis remains without an adequate treatment, and a 70% reduction in the number of days that a patient without tuberculosis remains in hospital. The implementation of a molecular microbiological technique in the diagnosis of tuberculosis is extremely cost-effective compared to the usual method. Its introduction into the routine diagnostic procedure could lead to an improvement in quality care for patients, given that it would avoid both unnecessary hospitalisations and treatments, and reflected in economic savings to the hospital. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Design and performance evaluation of a dispersion compensation unit using several chirping functions in a tanh apodized FBG and comparison with dispersion compensation fiber.

PubMed

Mohammed, Nazmi A; Solaiman, Mohammad; Aly, Moustafa H

2014-10-10

In this work, various dispersion compensation methods are designed and evaluated to search for a cost-effective technique with remarkable dispersion compensation and a good pulse shape. The techniques consist of different chirp functions applied to a tanh fiber Bragg grating (FBG), a dispersion compensation fiber (DCF), and a DCF merged with an optimized linearly chirped tanh FBG (joint technique). The techniques are evaluated using a standard 10 Gb/s optical link over a 100 km long haul. The linear chirp function is the most appropriate choice of chirping function, with a pulse width reduction percentage (PWRP) of 75.15%, lower price, and poor pulse shape. The DCF yields an enhanced PWRP of 93.34% with a better pulse quality; however, it is the most costly of the evaluated techniques. Finally, the joint technique achieved the optimum PWRP (96.36%) among all the evaluated techniques and exhibited a remarkable pulse shape; it is less costly than the DCF, but more expensive than the chirped tanh FBG.

Perinatal Health Belief Scales: A Cost Effective Technique for Predicting Prenatal Appointment Keeping Rates amongst Pregnant Teenagers.

ERIC Educational Resources Information Center

Wells, Robert D.; And Others

Prenatal appointment keeping is an important predictor of birth outcomes, yet many pregnant adolescents miss an excessive number of appointments. Since effective strategies for increasing appointment keeping require costly staff time, methods to predict relative risk for noncompliance with appointments might help delineate a circumscribed…

Effects of semi-continous peracetic acid dosing on rainbow trout Oncorhynchus mykiss performance, water quality, and off-flavor compounds in recirculation aquaculture systems

USDA-ARS?s Scientific Manuscript database

Water clarifying and disinfection techniques such as ozonation and ultraviolet irradiation are commonly used in recirculation aquaculture systems (RAS); however, the capital and operating costs of these technologies are expensive. Cost-effective treatment options that maintain fish health and simult...

Clinical practice guidelines for the diagnosis and management of osteoporosis. Scientific Advisory Board, Osteoporosis Society of Canada.

PubMed Central

1996-01-01

OBJECTIVE: To recommend clinical practice guidelines for the assessment of people at risk for osteoporosis, and for effective diagnosis and management of the condition. OPTIONS: Screening and diagnostic methods: risk-factor assessment, clinical evaluation, measurement of bone mineral density, laboratory investigations. Prophylactic and corrective therapies: calcium and vitamin D nutritional supplementation, physical activity and fall-avoidance techniques, ovarian hormone therapy, bisphosphonate drugs, other drug therapies. Pain-management medications and techniques. OUTCOMES: Prevention of loss of bone mineral density and fracture; increased bone mass; and improved quality of life. EVIDENCE: Epidemiologic and clinical studies and reports were examined, with emphasis on recent randomized controlled trials. Clinical practice in Canada and elsewhere was surveyed. Availability of treatment products and diagnostic equipment in Canada was considered. VALUES: Cost-effective methods and products that can be adopted across Canada were considered. A high value was given to accurate assessment of fracture risk and osteoporosis, and to increasing bone mineral density, reducing fractures and fracture risk and minimizing side effects of diagnosis and treatment. BENEFITS, HARMS AND COSTS: Proper diagnosis and management of osteoporosis minimize injury and disability, improve quality of life for patients and reduce costs to society. Rationally targeted methods of screening and diagnosis are safe and cost effective. Harmful side effects and costs of recommended therapies are minimal compared with the harms and costs of untreated osteoporosis. Alternative therapies provide a range of choices for physicians and patients. RECOMMENDATIONS: Population sets at high risk should be identified and then the diagnosis confirmed through bone densitometry. Dual-energy x-ray absorptiometry is the preferred measurement technique. Radiography can be adjunct when indicated. Calcium and vitamin D nutritional supplementation should be at currently recommended levels. Patients should be counselled in fall-avoidance techniques and exercises. Immobilization should be avoided. Guidelines for management of acute pain are listed. Ovarian hormone therapy is the therapy of choice for osteoporosis prevention and treatment in postmenopausal women. Bisphosphonates are an alternative therapy for women with established osteoporosis who cannot or prefer not to take ovarian hormone therapy. PMID:8873639

Single-cell RNA-seq of rheumatoid arthritis synovial tissue using low-cost microfluidic instrumentation.

PubMed

Stephenson, William; Donlin, Laura T; Butler, Andrew; Rozo, Cristina; Bracken, Bernadette; Rashidfarrokhi, Ali; Goodman, Susan M; Ivashkiv, Lionel B; Bykerk, Vivian P; Orange, Dana E; Darnell, Robert B; Swerdlow, Harold P; Satija, Rahul

2018-02-23

Droplet-based single-cell RNA-seq has emerged as a powerful technique for massively parallel cellular profiling. While this approach offers the exciting promise to deconvolute cellular heterogeneity in diseased tissues, the lack of cost-effective and user-friendly instrumentation has hindered widespread adoption of droplet microfluidic techniques. To address this, we developed a 3D-printed, low-cost droplet microfluidic control instrument and deploy it in a clinical environment to perform single-cell transcriptome profiling of disaggregated synovial tissue from five rheumatoid arthritis patients. We sequence 20,387 single cells revealing 13 transcriptomically distinct clusters. These encompass an unsupervised draft atlas of the autoimmune infiltrate that contribute to disease biology. Additionally, we identify previously uncharacterized fibroblast subpopulations and discern their spatial location within the synovium. We envision that this instrument will have broad utility in both research and clinical settings, enabling low-cost and routine application of microfluidic techniques.

Stapedectomy technique.

PubMed

House, J W

1993-06-01

This article reviews the evolution of the author's stapedectomy technique from total footplate removal with single loop wire prosthesis and Gelfoam seal to small fenestra stapedectomy with platinum ribbon piston prosthesis and blood seal. The author concludes that the microdrill is effective, safe, and cost effective for performing this procedure. Since using this technique, the author has had no cases of sensorineural hearing loss and few complaints of dizziness or vertigo.

Cost-utility analysis of an advanced pressure ulcer management protocol followed by trained wound, ostomy, and continence nurses.

PubMed

Kaitani, Toshiko; Nakagami, Gojiro; Iizaka, Shinji; Fukuda, Takashi; Oe, Makoto; Igarashi, Ataru; Mori, Taketoshi; Takemura, Yukie; Mizokami, Yuko; Sugama, Junko; Sanada, Hiromi

2015-01-01

The high prevalence of severe pressure ulcers (PUs) is an important issue that requires to be highlighted in Japan. In a previous study, we devised an advanced PU management protocol to enable early detection of and intervention for deep tissue injury and critical colonization. This protocol was effective for preventing more severe PUs. The present study aimed to compare the cost-effectiveness of the care provided using an advanced PU management protocol, from a medical provider's perspective, implemented by trained wound, ostomy, and continence nurses (WOCNs), with that of conventional care provided by a control group of WOCNs. A Markov model was constructed for a 1-year time horizon to determine the incremental cost-effectiveness ratio of advanced PU management compared with conventional care. The number of quality-adjusted life-years gained, and the cost in Japanese yen (¥) ($US1 = ¥120; 2015) was used as the outcome. Model inputs for clinical probabilities and related costs were based on our previous clinical trial results. Univariate sensitivity analyses were performed. Furthermore, a Bayesian multivariate probability sensitivity analysis was performed using Monte Carlo simulations with advanced PU management. Two different models were created for initial cohort distribution. For both models, the expected effectiveness for the intervention group using advanced PU management techniques was high, with a low expected cost value. The sensitivity analyses suggested that the results were robust. Intervention by WOCNs using advanced PU management techniques was more effective and cost-effective than conventional care. © 2015 by the Wound Healing Society.

The Use of Probability Theory as a Basis for Planning and Controlling Overhead Costs in Education and Industry. Final Report.

ERIC Educational Resources Information Center

Vinson, R. B.

In this report, the author suggests changes in the treatment of overhead costs by hypothesizing that "the effectiveness of standard costing in planning and controlling overhead costs can be increased through the use of probability theory and associated statistical techniques." To test the hypothesis, the author (1) presents an overview of the…

Innovative slide repair techniques guidebook for Missouri.

DOT National Transportation Integrated Search

2011-09-01

Soil slides often require immediate action to keep traffic moving safely. This study will : focus on developing newer (innovative) approaches to evaluate slope failures and : provide cost-effective repair and mitigation techniques. Typically slides a...

Cost effectiveness as applied to the Viking Lander systems-level thermal development test program

NASA Technical Reports Server (NTRS)

Buna, T.; Shupert, T. C.

1974-01-01

The economic aspects of thermal testing at the systems-level as applied to the Viking Lander Capsule thermal development program are reviewed. The unique mission profile and pioneering scientific goals of Viking imposed novel requirements on testing, including the development of a simulation technique for the Martian thermal environment. The selected approach included modifications of an existing conventional thermal vacuum facility, and improved test-operational techniques that are applicable to the simulation of the other mission phases as well, thereby contributing significantly to the cost effectiveness of the overall thermal test program.

Improved Evolutionary Programming with Various Crossover Techniques for Optimal Power Flow Problem

NASA Astrophysics Data System (ADS)

Tangpatiphan, Kritsana; Yokoyama, Akihiko

This paper presents an Improved Evolutionary Programming (IEP) for solving the Optimal Power Flow (OPF) problem, which is considered as a non-linear, non-smooth, and multimodal optimization problem in power system operation. The total generator fuel cost is regarded as an objective function to be minimized. The proposed method is an Evolutionary Programming (EP)-based algorithm with making use of various crossover techniques, normally applied in Real Coded Genetic Algorithm (RCGA). The effectiveness of the proposed approach is investigated on the IEEE 30-bus system with three different types of fuel cost functions; namely the quadratic cost curve, the piecewise quadratic cost curve, and the quadratic cost curve superimposed by sine component. These three cost curves represent the generator fuel cost functions with a simplified model and more accurate models of a combined-cycle generating unit and a thermal unit with value-point loading effect respectively. The OPF solutions by the proposed method and Pure Evolutionary Programming (PEP) are observed and compared. The simulation results indicate that IEP requires less computing time than PEP with better solutions in some cases. Moreover, the influences of important IEP parameters on the OPF solution are described in details.

Retinal Imaging Techniques for Diabetic Retinopathy Screening

PubMed Central

Goh, James Kang Hao; Cheung, Carol Y.; Sim, Shaun Sebastian; Tan, Pok Chien; Tan, Gavin Siew Wei; Wong, Tien Yin

2016-01-01

Due to the increasing prevalence of diabetes mellitus, demand for diabetic retinopathy (DR) screening platforms is steeply increasing. Early detection and treatment of DR are key public health interventions that can greatly reduce the likelihood of vision loss. Current DR screening programs typically employ retinal fundus photography, which relies on skilled readers for manual DR assessment. However, this is labor-intensive and suffers from inconsistency across sites. Hence, there has been a recent proliferation of automated retinal image analysis software that may potentially alleviate this burden cost-effectively. Furthermore, current screening programs based on 2-dimensional fundus photography do not effectively screen for diabetic macular edema (DME). Optical coherence tomography is becoming increasingly recognized as the reference standard for DME assessment and can potentially provide a cost-effective solution for improving DME detection in large-scale DR screening programs. Current screening techniques are also unable to image the peripheral retina and require pharmacological pupil dilation; ultra-widefield imaging and confocal scanning laser ophthalmoscopy, which address these drawbacks, possess great potential. In this review, we summarize the current DR screening methods using various retinal imaging techniques, and also outline future possibilities. Advances in retinal imaging techniques can potentially transform the management of patients with diabetes, providing savings in health care costs and resources. PMID:26830491

Retinal Imaging Techniques for Diabetic Retinopathy Screening.

PubMed

Goh, James Kang Hao; Cheung, Carol Y; Sim, Shaun Sebastian; Tan, Pok Chien; Tan, Gavin Siew Wei; Wong, Tien Yin

2016-02-01

Due to the increasing prevalence of diabetes mellitus, demand for diabetic retinopathy (DR) screening platforms is steeply increasing. Early detection and treatment of DR are key public health interventions that can greatly reduce the likelihood of vision loss. Current DR screening programs typically employ retinal fundus photography, which relies on skilled readers for manual DR assessment. However, this is labor-intensive and suffers from inconsistency across sites. Hence, there has been a recent proliferation of automated retinal image analysis software that may potentially alleviate this burden cost-effectively. Furthermore, current screening programs based on 2-dimensional fundus photography do not effectively screen for diabetic macular edema (DME). Optical coherence tomography is becoming increasingly recognized as the reference standard for DME assessment and can potentially provide a cost-effective solution for improving DME detection in large-scale DR screening programs. Current screening techniques are also unable to image the peripheral retina and require pharmacological pupil dilation; ultra-widefield imaging and confocal scanning laser ophthalmoscopy, which address these drawbacks, possess great potential. In this review, we summarize the current DR screening methods using various retinal imaging techniques, and also outline future possibilities. Advances in retinal imaging techniques can potentially transform the management of patients with diabetes, providing savings in health care costs and resources. © 2016 Diabetes Technology Society.

Rapid, cost-effective and accurate quantification of Yucca schidigera Roezl. steroidal saponins using HPLC-ELSD method.

PubMed

Tenon, Mathieu; Feuillère, Nicolas; Roller, Marc; Birtić, Simona

2017-04-15

Yucca GRAS-labelled saponins have been and are increasingly used in food/feed, pharmaceutical or cosmetic industries. Existing techniques presently used for Yucca steroidal saponin quantification remain either inaccurate and misleading or accurate but time consuming and cost prohibitive. The method reported here addresses all of the above challenges. HPLC/ELSD technique is an accurate and reliable method that yields results of appropriate repeatability and reproducibility. This method does not over- or under-estimate levels of steroidal saponins. HPLC/ELSD method does not require each and every pure standard of saponins, to quantify the group of steroidal saponins. The method is a time- and cost-effective technique that is suitable for routine industrial analyses. HPLC/ELSD methods yield a saponin fingerprints specific to the plant species. As the method is capable of distinguishing saponin profiles from taxonomically distant species, it can unravel plant adulteration issues. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Alternative control techniques document: NOx emissions from industrial/commercial/institutional (ICI) boilers

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

Not Available

1994-03-01

Industrial, commercial, and institutional (ICI) boilers have been identified as a category that emits more than 25 tons of oxides of nitrogen (NOx) per year. This alternative control techniques (ACT) document provides technical information for use by State and local agencies to develop and implement regulatory programs to control NOx emissions from ICI boilers. Additional ACT documents are being developed for other stationary source categories. Chapter 2 summarizes the findings of this study. Chapter 3 presents information on the ICI boiler types, fuels, operation, and industry applications. Chapter 4 discusses NOx formation and uncontrolled NOx emission factors. Chapter 5 coversmore » alternative control techniques and achievable controlled emission levels. Chapter 6 presents the cost and cost effectiveness of each control technique. Chapter 7 describes environmental and energy impacts associated with implementing the NOx control techniques. Finally, Appendices A through G provide the detailed data used in this study to evaluate uncontrolled and controlled emissions and the costs of controls for several retrofit scenarios.« less

Cost assessment of robotics in gynecologic surgery: a systematic review.

PubMed

Iavazzo, Christos; Papadopoulou, Eleni K; Gkegkes, Ioannis D

2014-11-01

The application of robotics is an innovation in the field of gynecologic surgery. Our objective was to evaluate the currently available literature on the cost assessment of robotic surgery of various operations in the field of gynecologic surgery. PubMed and Scopus databases were systematically searched in order to retrieve the included studies in our review. We retrieved 23 studies on a variety of gynecologic operations. The mean cost for robotic, open and laparoscopic surgery ranged from 1731 to 48,769, 894 to 20,277 and 411 to 41,836 Euros, respectively. Operative charges, in hysterectomy, for robotic, open and laparoscopic technique ranged from 936 to 33,920, 684 to 25,616 and 858 to 25,578 Euros, respectively. In sacrocolpopexy, these costs ranged from 2067 to 7275, 2904 to 69,792 and 1482 to 2000 Euros, respectively. Non-operative charges ranged from 467 to 39,121 Euros. The mean total costs for myomectomy ranged from 27,342 to 42,497 and 13,709 to 20,277 Euros, respectively, for the robotic and open methods, while the mean total cost of the laparoscopic technique was 26,181 Euros. Conversions to laparotomy were present in 79/36,185 (0.2%) cases of laparoscopic surgery and in 21/3345 (0.62%) cases of robotic technique. Duration of robotic, open and laparoscopic surgery ranged from 50 to 445, 83.7 to 701 and 74 to 330 min, respectively. Robotic surgery has the potential to become cost-effective in centers with many patients while industry competition could reduce the cost of the robotic instrumentation, making robotic technology more affordable and cost-effective. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

A Technique for Choosing Cost-Effective Instructional Delivery Systems

DTIC Science & Technology

1975-04-01

Braby, Ed.D. James M. Henry William F. Parrish, Jr. William M. Swope, Ph.D. Trainino Analysis and Evaluatton Group April 1975 GOVERNMENT RIGHTS IN DATA ...11 Required Reference Materials .... .............. .. 15 -Additional Supporting Data ...... ............... 17 Post Note...Limitations. . 75.. APPENDIX I-Fortran Program of Cost Model ................. 8 ATTACHMENT 1 Cost Data Collection Form .... .............. .113 3

Wavelet Analyses of Oil Prices, USD Variations and Impact on Logistics

NASA Astrophysics Data System (ADS)

Melek, M.; Tokgozlu, A.; Aslan, Z.

2009-07-01

This paper is related with temporal variations of historical oil prices and Dollar and Euro in Turkey. Daily data based on OECD and Central Bank of Turkey records beginning from 1946 has been considered. 1D-continuous wavelets and wavelet packets analysis techniques have been applied on data. Wavelet techniques help to detect abrupt changing's, increasing and decreasing trends of data. Estimation of variables has been presented by using linear regression estimation techniques. The results of this study have been compared with the small and large scale effects. Transportation costs of track show a similar variation with fuel prices. The second part of the paper is related with estimation of imports, exports, costs, total number of vehicles and annual variations by considering temporal variation of oil prices and Dollar currency in Turkey. Wavelet techniques offer a user friendly methodology to interpret some local effects on increasing trend of imports and exports data.

COST-EFFECTIVE SAMPLING FOR SPATIALLY DISTRIBUTED PHENOMENA

EPA Science Inventory

Various measures of sampling plan cost and loss are developed and analyzed as they relate to a variety of multidisciplinary sampling techniques. The sampling choices examined include methods from design-based sampling, model-based sampling, and geostatistics. Graphs and tables ar...

Bibliographic Control at the Crossroads: Do We Get Our Money's Worth?

ERIC Educational Resources Information Center

Koel, Ake I.

1981-01-01

Contrasts traditional objectives for library catalogs with current bibliographic control practices to protest the increasing complexity and cost of cataloging. Research is urged to develop more cost-effective bibliographic control procedures and techniques. Eight references are listed. (RAA)

Assessment of weathering steel bridge performance in Iowa and development of inspection and maintenance techniques.

DOT National Transportation Integrated Search

2013-02-01

Weathering steel is commonly used as a cost-effective alternative for bridge superstructures, as the costs and environmental : impacts associated with the maintenance/replacement of paint coatings are theoretically eliminated. The performance of : we...

In-line charge-trapping characterization of dielectrics for sub-0.5-um CMOS technologies

NASA Astrophysics Data System (ADS)

Roy, Pradip K.; Chacon, Carlos M.; Ma, Yi; Horner, Gregory

1997-09-01

The advent of ultra-large and giga-scale-integration (ULSI/GSI) has placed considerable emphasis on the development of new gate oxides and interlevel dielectrics capable of meeting strict performance and reliability requirements. The costs and demands associated with ULSI fabrication have in turn fueled the need for cost-effective, rapid and accurate in-line characterization techniques for evaluating dielectric quality. The use of non-contact surface photovoltage characterization techniques provides cost-effective rapid feedback on dielectric quality, reducing costs through the reutilization of control wafers and the elimination of processing time. This technology has been applied to characterize most of the relevant C-V parameters, including flatband voltage (Vfb), density of interface traps (Dit), mobile charge density (Qm), oxide thickness (Tox), oxide resistivity (pox) and total charge (Qtot) for gate and interlevel (ILO) oxides. A novel method of measuring tunneling voltage by this technique on various gate oxides is discussed. For ILO, PECVD and high density plasma dielectrics, surface voltage maps are also presented. Measurements of near-surface silicon quality are described, including minority carrier generation lifetime, and examples of their application in diagnosing manufacturing problems.

Can global navigation satellite system signals reveal the ecological attributes of forests?

NASA Astrophysics Data System (ADS)

Liu, Jingbin; Hyyppä, Juha; Yu, Xiaowei; Jaakkola, Anttoni; Liang, Xinlian; Kaartinen, Harri; Kukko, Antero; Zhu, Lingli; Wang, Yunsheng; Hyyppä, Hannu

2016-08-01

Forests have important impacts on the global carbon cycle and climate, and they are also related to a wide range of industrial sectors. Currently, one of the biggest challenges in forestry research is effectively and accurately measuring and monitoring forest variables, as the exploitation potential of forest inventory products largely depends on the accuracy of estimates and on the cost of data collection. A low-cost crowdsourcing solution is needed for forest inventory to collect forest variables. Here, we propose global navigation satellite system (GNSS) signals as a novel type of observables for predicting forest attributes and show the feasibility of utilizing GNSS signals for estimating important attributes of forest plots, including mean tree height, mean diameter at breast height, basal area, stem volume and tree biomass. The prediction accuracies of the proposed technique were better in boreal forest conditions than those of the conventional techniques of 2D remote sensing. More importantly, this technique provides a novel, cost-effective way of collecting large-scale forest measurements in the crowdsourcing context. This technique can be applied by, for example, harvesters or persons hiking or working in forests because GNSS devices are widely used, and the field operation of this technique is simple and does not require professional forestry skills.

Cost-effectiveness of oral phenytoin, intravenous phenytoin, and intravenous fosphenytoin in the emergency department.

PubMed

Rudis, Maria I; Touchette, Daniel R; Swadron, Stuart P; Chiu, Amy P; Orlinsky, Michael

2004-03-01

Oral phenytoin, intravenous phenytoin, and intravenous fosphenytoin are all commonly used for loading phenytoin in the emergency department (ED). The cost-effectiveness of each was compared for patients presenting with seizures and subtherapeutic phenytoin concentrations. A simple decision tree was developed to determine the treatment costs associated with each of 3 loading techniques. We determined effectiveness by comparing adverse event rates and by calculating the time to safe ED discharge. Time to safe ED discharge was defined as the time at which therapeutic concentrations of phenytoin (>or=10 mg/L) were achieved with an absence of any adverse events that precluded discharge. The comparative cost-effectiveness of alternatives to oral phenytoin was determined by combining net costs and number of adverse events, expressed as cost per adverse events avoided. Cost-effectiveness was also determined by comparing the net costs of each loading technique required to achieve the time to safe ED discharge, expressed as cost per hour of ED time saved. The outcomes and costs were primarily derived from a prospective, randomized controlled trial, augmented by time-motion studies and alternate-cost sources. Costs included the cost of drugs, supplies, and personnel. Analyses were also performed in scenarios incorporating labor costs and savings from using a lower-urgency area of the ED. The mean number of adverse events per patient for oral phenytoin, intravenous phenytoin, and intravenous fosphenytoin was 1.06, 1.93, and 2.13, respectively. Mean time to safe ED discharge in the 3 groups was 6.4 hours, 1.7 hours, and 1.3 hours. Cost per patient was 2.83 dollars, 21.16 dollars, and 175.19 dollars, respectively, and did not differ substantially in the Labor and Triage (lower-urgency area of ED) scenarios. When the measure of effectiveness was adverse events, oral phenytoin dominated intravenous phenytoin and intravenous fosphenytoin, with a lower cost and number of adverse events. With time to safe ED discharge as the outcome measure, the incremental cost-effectiveness ratios were 3.90 dollars and 387.27 dollars per hour of ED time saved for oral phenytoin versus intravenous phenytoin and for intravenous fosphenytoin versus intravenous phenytoin, respectively. Oral phenytoin is the most cost-effective loading method in most settings. Intravenous phenytoin is preferred if one is willing to pay an additional 20.65 dollars to 44.25 dollars per patient and willing to have more adverse events for a quicker average time to safe ED discharge. It is unlikely that intravenous fosphenytoin is justifiable in any setting.

Activity-Based Costing in a Service Organization

DTIC Science & Technology

1993-06-01

environments, very little research has been done in service organizations. This thesis is a comparative analysis of a tradional cost accounting system with an...activity-based cost accounting system in a medium-sized mass transit system. The purpose of the analysis was to determine whether activity-based... accounting techniques can effectively be applied in a service industry. In addition, a goal for the thesis was to determine which costing system reports a

Costing bias in economic evaluations.

PubMed

Frappier, Julie; Tremblay, Gabriel; Charny, Mark; Cloutier, L Martin

2015-01-01

Determining the cost-effectiveness of healthcare interventions is key to the decision-making process in healthcare. Cost comparisons are used to demonstrate the economic value of treatment options, to evaluate the impact on the insurer budget, and are often used as a key criterion in treatment comparison and comparative effectiveness; however, little guidance is available to researchers for establishing the costing of clinical events and resource utilization. Different costing methods exist, and the choice of underlying assumptions appears to have a significant impact on the results of the costing analysis. This editorial describes the importance of the choice of the costing technique and it's potential impact on the relative cost of treatment options. This editorial also calls for a more efficient approach to healthcare intervention costing in order to ensure the use of consistent costing in the decision-making process.

Comparison of specimen adequacy and smear quality in oral smears prepared by manual liquid-based cytology and conventional methods

PubMed Central

Shukla, Surabhi; Einstein, A; Shukla, Abhilasha; Mishra, Deepika

2015-01-01

Background: Liquid-based cytology (LBC), recommended in the mass screening of potentially malignant cervical and oral lesions, suffers from high cost owing to the use of expensive automated devices and materials. Considering the need for cost-effective LBC techniques, we evaluated the efficacy of an inexpensive manual LBC (MLBC) technique against conventional cytological technique in terms of specimen adequacy and smear quality of oral smears. Materials and Methods: Cytological samples were collected from 21 patients using a cytobrush device. After preparation of a conventional smear, the brush containing the remaining sample was immersed in the preservative vial. The preserved material was processed by an MLBC technique and subsequently, direct smears were made from the prepared cell button. Both conventional and MLBC smears were stained by routine Papanicolaou technique and evaluated by an independent observer for the thickness of the smear, cellular distribution, resolution/clarity of cells, cellular staining characteristics and the presence of unsatisfactory background/artifacts. Each parameter was graded as satisfactory; or satisfactory, but limited; or unsatisfactory. Chi-square test was used to compare the values obtained (significance set at P ≤ 0.05). Results: MLBC technique produced a significant number of satisfactory smears with regard to cell distribution, clarity/resolution, staining characteristics and background/artifacts compared to conventional methods. Conclusions: MLBC is a cost-effective cytological technique that may produce oral smears with excellent cytomorphology and longer storage life. PMID:26980958

Relationship between implant use, operative time, and costs associated with distal biceps tendon reattachment.

PubMed

Grant, John A; Bissell, Benjamin; Hake, Mark E; Miller, Bruce S; Hughes, Richard E; Carpenter, James E

2012-11-01

The suture anchor and transosseous drill hole techniques for reattachment of the distal biceps tendon to the radius have been found to have similar clinical and biomechanical outcomes. However, a comparison of the cost effectiveness of these techniques is lacking. The purpose of this study was to determine whether the use of suture anchors decreases operative time enough to offset the additional cost of the implants. The records of all patients undergoing a distal biceps tendon reattachment were reviewed to determine the method of fixation, operative time, and associated surgical costs. Two surgeons used a technique of fixing the tendon directly to the bone (transosseous group), whereas 3 surgeons used suture anchors. Given the standard nature of the surgical procedure (other than the fixation technique), only the costs that differed between the 2 groups were included. Surgical center costs were obtained from the local outpatient surgical center in 2011 US dollars. Five surgeons treated 70 men (mean age, 45.9±9.2 years). Mean time from injury to surgery was 14 days. Mean operative times for the transosseous and suture anchor groups were 97.6±14.9 and 95.8±25.8 minutes, respectively (P=.74). Two anchors were used in 79% of the anchor cases. The use of anchors cost $474.33 more per patient. However, this value is sensitive to the cost of the individual anchors, intersurgeon variation in operative time, and per-minute value of saved operative time. No operative time was saved with the use of suture anchors. This cost comparison framework can be used to evaluate the balance in surgical resource use due to implant cost vs savings in operative time. Copyright 2012, SLACK Incorporated.

A simple technique of laparoscopic port closure.

PubMed

Aziz, Homayara Haque

2013-01-01

Laparoscopic and robotic surgery is widely practiced in modern medicine. The operative procedure is not complete until the port sites are closed with a fascial suture. We report a simple new technique that is easy, cost-effective, and quick to apply using 2 S-retractors for suture placement under direct visualization to secure the abdominal wall fascia and peritoneum. As a prospective consecutive case series, this technique was used for fascial closure after laparoscopy ports > 8 mm using 2 S-retractors. One S-retractor is used as a barrier protecting the contents of the abdominal cavity, reducing the risk of visceral injuries. The second S-retractor allows us to directly visualize the different layers, exposing the needle tip during its course through the fascia. This method was used in 100 patients with no intraoperative incidents, additional operative time, or need to access costly instruments. Currently, this technique is also used by many surgeons in our institution without any difficulty. No bowel injuries or port-site hernias were reported during a mean follow-up of 6 wk postoperation and 12-mo annual follow-up. The procedure is simple, easy, cost-effective, and quick to apply.

Quantification of moving target cyber defenses

NASA Astrophysics Data System (ADS)

Farris, Katheryn A.; Cybenko, George

2015-05-01

Current network and information systems are static, making it simple for attackers to maintain an advantage. Adaptive defenses, such as Moving Target Defenses (MTD) have been developed as potential "game-changers" in an effort to increase the attacker's workload. With many new methods being developed, it is difficult to accurately quantify and compare their overall costs and effectiveness. This paper compares the tradeoffs between current approaches to the quantification of MTDs. We present results from an expert opinion survey on quantifying the overall effectiveness, upfront and operating costs of a select set of MTD techniques. We find that gathering informed scientific opinions can be advantageous for evaluating such new technologies as it offers a more comprehensive assessment. We end by presenting a coarse ordering of a set of MTD techniques from most to least dominant. We found that seven out of 23 methods rank as the more dominant techniques. Five of which are techniques of either address space layout randomization or instruction set randomization. The remaining two techniques are applicable to software and computer platforms. Among the techniques that performed the worst are those primarily aimed at network randomization.

Computerized systems analysis and optimization of aircraft engine performance, weight, and life cycle costs

NASA Technical Reports Server (NTRS)

Fishbach, L. H.

1980-01-01

The computational techniques are described which are utilized at Lewis Research Center to determine the optimum propulsion systems for future aircraft applications and to identify system tradeoffs and technology requirements. Cycle performance, and engine weight can be calculated along with costs and installation effects as opposed to fuel consumption alone. Almost any conceivable turbine engine cycle can be studied. These computer codes are: NNEP, WATE, LIFCYC, INSTAL, and POD DRG. Examples are given to illustrate how these computer techniques can be applied to analyze and optimize propulsion system fuel consumption, weight and cost for representative types of aircraft and missions.

Training Effectiveness and Cost Iterative Technique (TECIT). Volume 2. Cost Effectiveness Analysis

DTIC Science & Technology

1988-07-01

Moving Tank in a Field Exercise A The task cluster identified as tank commander’s station/tank gunnery and the sub-task of firing an M250 grenade launcher...Firing Procedures, Task Number 171-126-1028. I OBJECTIVE: Given an Ml tank with crew, loaded M250 I grenade launcher, the commander’s station powered up

Space shuttle solid rocket booster cost-per-flight analysis technique

NASA Technical Reports Server (NTRS)

Forney, J. A.

1979-01-01

A cost per flight computer model is described which considers: traffic model, component attrition, hardware useful life, turnaround time for refurbishment, manufacturing rates, learning curves on the time to perform tasks, cost improvement curves on quantity hardware buys, inflation, spares philosophy, long lead, hardware funding requirements, and other logistics and scheduling constraints. Additional uses of the model include assessing the cost per flight impact of changing major space shuttle program parameters and searching for opportunities to make cost effective management decisions.

Value Engineering. "A Working Tool for Cost Control in the Design of Educational Facilities."

ERIC Educational Resources Information Center

Lawrence, Jerry

Value Engineering (VE) is a cost optimizing technique used to analyze design quality and cost-effectiveness. The application of VE procedures to the design and construction of school facilities has been adopted by the state of Washington. By using VE, the optimum value for every life cycle dollar spent on a facility is obtained by identifying not…

Black light photography

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

Lisin, M.A.

1996-11-01

Black light photography of fluorescent penetrant and wet fluorescent magnetic particle indications can yield spectacular and useful results. The technique provides a lasting record of a flaw`s severity and location, as well as its physical relation to other components and important features. The procedures are easily learned and do not require sophisticated apparatus. In fact, equipment costs can often be justified on the basis of a single application. Using the techniques described in this article, black light photography can be a cost-effective, informative NDT tool.

INFLUENCE OF AGING AND PH ON DISSOLUTION KINETICS AND STABILITY OF PHROMORPHITE

EPA Science Inventory

In-situ, immobilization of metal contaminates in soil systems shows great potential as a cost-effective and environmemtally sound remediation technique. Pb contaminated soils are typically removed from site and replaced with clean soil at great costs. However, innovative techno...

Economic evaluation of the practical approach to lung health and informal provider interventions for improving the detection of tuberculosis and chronic airways disease at primary care level in Malawi: study protocol for cost-effectiveness analysis.

PubMed

Gama, Elvis; Madan, Jason; Banda, Hastings; Squire, Bertie; Thomson, Rachael; Namakhoma, Ireen

2015-01-08

Chronic airway diseases pose a big challenge to health systems in most developing countries, particularly in Sub-Saharan Africa. A diagnosis for people with chronic or persistent cough is usually delayed because of individual and health system barriers. However, delayed diagnosis and treatment facilitates further transmission, severity of disease with complications and mortality. The objective of this study is to assess the cost-effectiveness of the practical approach to lung health strategy, a patient-centred approach for diagnosis and treatment of common respiratory illnesses in primary healthcare settings, as a means of strengthening health systems to improve the quality of management of respiratory diseases. Economic evaluation nested in a cluster randomised controlled trial with three arms will be performed. Measures of effectiveness and costs for all arms of the study will be obtained from the cluster randomised controlled clinical trial. The main outcome measures are a combined rate of major respiratory diseases milestones and process indicators extracted from the practical approach to lung health strategy. For analysis, descriptive as well as regression techniques will be used. A cost-effectiveness analysis will be performed according to intention-to-treat principle and from a societal perspective. Cost-effectiveness ratios will be calculated using bootstrapping techniques. We hope to demonstrate the cost-effectiveness of the practical approach to lung health and informal healthcare providers, see an improvement in patients' quality of life, achieve a reduction in the duration and occurrence of episodes and the chronicity of respiratory diseases, and are able to report a decrease in the social cost. If the practical approach to lung health and informal healthcare provider's interventions are cost-effective, they could be scaled up to all primary healthcare centres. PACTR: PACTR201411000910192.

A case report on the remodelling technique for the earlobe using a soft splint.

PubMed

Vaiude, Partha N; Anthony, Edwin T; Syed, Mobin; Ilyas, Syed

2008-01-01

Correcting earlobe deformities often presents an aesthetic challenge to the surgeon. The described technique presents a simple, accurate and cost effective method of remodelling soft tissue defects of the earlobe using a soft splint.

Approaches to answering critical CER questions.

PubMed

Kinnier, Christine V; Chung, Jeanette W; Bilimoria, Karl Y

2015-01-01

While randomized controlled trials (RCTs) are the gold standard for research, many research questions cannot be ethically and practically answered using an RCT. Comparative effectiveness research (CER) techniques are often better suited than RCTs to address the effects of an intervention under routine care conditions, an outcome otherwise known as effectiveness. CER research techniques covered in this section include: effectiveness-oriented experimental studies such as pragmatic trials and cluster randomized trials, treatment response heterogeneity, observational and database studies including adjustment techniques such as sensitivity analysis and propensity score analysis, systematic reviews and meta-analysis, decision analysis, and cost effectiveness analysis. Each section describes the technique and covers the strengths and weaknesses of the approach.

Standard cost elements for technology programs

NASA Technical Reports Server (NTRS)

Christensen, Carisa B.; Wagenfuehrer, Carl

1992-01-01

The suitable structure for an effective and accurate cost estimate for general purposes is discussed in the context of a NASA technology program. Cost elements are defined for research, management, and facility-construction portions of technology programs. Attention is given to the mechanisms for insuring the viability of spending programs, and the need for program managers is established for effecting timely fund disbursement. Formal, structures, and intuitive techniques are discussed for cost-estimate development, and cost-estimate defensibility can be improved with increased documentation. NASA policies for cash management are examined to demonstrate the importance of the ability to obligate funds and the ability to cost contracted funds. The NASA approach to consistent cost justification is set forth with a list of standard cost-element definitions. The cost elements reflect the three primary concerns of cost estimates: the identification of major assumptions, the specification of secondary analytic assumptions, and the status of program factors.

Surgical management for displaced pediatric proximal humeral fractures: a cost analysis.

PubMed

Shore, Benjamin J; Hedequist, Daniel J; Miller, Patricia E; Waters, Peter M; Bae, Donald S

2015-02-01

The purpose of this investigation was to determine which of the following methods of fixation, percutaneous pinning (PP) or intramedullary nailing (IMN), was more cost-effective in the treatment of displaced pediatric proximal humeral fractures (PPHF). A retrospective cohort of surgically treated PPHF over a 12-year period at a single institution was performed. A decision analysis model was constructed to compare three surgical strategies: IMN versus percutaneous pinning leaving the pins exposed (PPE) versus leaving the pins buried (PPB). Finally, sensitivity analyses were performed, assessing the cost-effectiveness of each technique when infection rates and cost of deep infections were varied. A total of 84 patients with displaced PPHF underwent surgical stabilization. A total of 35 cases were treated with IMN, 32 with PPE, and 17 with PPB. The age, sex, and preoperative fracture angulation were similar across all groups. A greater percentage of open reduction was seen in the IMN and PPB groups (p = 0.03), while a higher proportion of physeal injury was seen in the PPE group (p = 0.02). Surgical time and estimated blood loss was higher in the IMN group (p < 0.001 and p = 0.01, respectively). The decision analysis revealed that the PPE technique resulted in an average cost saving of $4,502 per patient compared to IMN and $2,066 compared to PPB. This strategy remained cost-effective even when the complication rates with exposed implants approached 55 %. Leaving pins exposed after surgical fixation of PPHF is more cost-effective than either burying pins or using intramedullary fixation.

GREAT I: A Study of the Upper Mississippi River. Volume 3. Material and Equipment Needs, Commercial Transportation.

DTIC Science & Technology

1980-09-01

Needs 75 DEVELOPMENT OF DREDGING COST ESTIMATES 76 IMPLEMENTATION OF SELECTED PLAN 77 EVALUATION OF SELECTED PLAN 78 NATIONAL ECONOMIC DEVELOPMENT EFFECTS ...78 ENVIRONMENTAL QUALITY EFFECTS 78 TABLE OF CONTENTS (CONT) ITEM PAGE RECOMM*ENDATIONS 79 THE DREDGE WILLIAM A. THOMPSON 79 MECHANICAL DREDGING...and cost effective for implementing a recommended channel maintenance plan. 3. Suggesting which types of equipment and techniques are best suited for

Cost-effectiveness analysis comparing epidural, patient-controlled intravenous morphine, and continuous wound infiltration for postoperative pain management after open abdominal surgery.

PubMed

Tilleul, P; Aissou, M; Bocquet, F; Thiriat, N; le Grelle, O; Burke, M J; Hutton, J; Beaussier, M

2012-06-01

Continuous wound infiltration (CWI), i.v. patient-controlled analgesia (i.v.-PCA), and epidural analgesia (EDA) are analgesic techniques commonly used for pain relief after open abdominal surgery. The aim of this study was to evaluate the cost-effectiveness of these techniques. A decision analytic model was developed, including values retrieved from clinical trials and from an observational prospective cohort of 85 patients. Efficacy criteria were based on pain at rest (VAS ≤ 30/100 mm at 24 h). Resource use and costs were evaluated from medical record measurements and published data. Probabilistic sensitivity analysis (PSA) was performed. When taking into account all resources consumed, the CWI arm (€ 6460) is economically dominant when compared with i.v.-PCA (€ 7273) and EDA (€ 7500). The proportion of patients successfully controlled for their postoperative pain management are 77.4%, 53.9%, and 72.9% for CWI, i.v.-PCA, and EDA, respectively, demonstrating the CWI procedure to be both economically and clinically dominant. PSA reported that CWI remains cost saving in 70.4% of cases in comparison with EDA and in 59.2% of cases when compared with PCA. Device-related costs of using CWI for pain management after abdominal laparotomy are partly counterbalanced by a reduction in resource consumption. The cost-effectiveness analysis suggests that CWI is the dominant treatment strategy for managing postoperative pain (i.e. more effective and less costly) in comparison with i.v.-PCA. When compared with EDA, CWI is less costly with almost equivalent efficacy. This economic evaluation may be useful for clinicians to design algorithms for pain management after major abdominal surgery.

What is the perceived impact of Alexander technique lessons on health status, costs and pain management in the real life setting of an English hospital? The results of a mixed methods evaluation of an Alexander technique service for those with chronic back pain.

PubMed

McClean, Stuart; Brilleman, Sam; Wye, Lesley

2015-07-28

Randomised controlled trial evidence indicates that Alexander Technique is clinically and cost effective for chronic back pain. The aim of this mixed methods evaluation was to explore the role and perceived impact of Alexander Technique lessons in the naturalistic setting of an acute hospital Pain Management Clinic in England. To capture changes in health status and resource use amongst service users, 43 service users were administered three widely used questionnaires (Brief Pain Inventory, MYMOP and Client Service Resource Inventory) at three time points: baseline, six weeks and three months after baseline. We also carried out 27 telephone interviews with service users and seven face-to-face interviews with pain clinic staff and Alexander Technique teachers. Quantitative data were analysed using descriptive statistics and qualitative data were analysed thematically. Those taking Alexander Technique lessons reported small improvements in health outcomes, and condition-related costs fell. However, due to the non-randomised, uncontrolled nature of the study design, changes cannot be attributed to the Alexander Technique lessons. Service users stated that their relationship to pain and pain management had changed, especially those who were more committed to practising the techniques regularly. These changes may explain the reported reduction in pain-related service use and the corresponding lower associated costs. Alexander Technique lessons may be used as another approach to pain management. The findings suggests that Alexander Technique lessons can help improve self-efficacy for those who are sufficiently motivated, which in turn may have an impact on service utilisation levels.

Societal costs in displaced transverse olecranon fractures: using decision analysis tools to find the most cost-effective strategy between tension band wiring and locked plating.

PubMed

Francis, Tittu; Washington, Travis; Srivastava, Karan; Moutzouros, Vasilios; Makhni, Eric C; Hakeos, William

2017-11-01

Tension band wiring (TBW) and locked plating are common treatment options for Mayo IIA olecranon fractures. Clinical trials have shown excellent functional outcomes with both techniques. Although TBW implants are significantly less expensive than a locked olecranon plate, TBW often requires an additional operation for implant removal. To choose the most cost-effective treatment strategy, surgeons must understand how implant costs and return to the operating room influence the most cost-effective strategy. This cost-effective analysis study explored the optimal treatment strategies by using decision analysis tools. An expected-value decision tree was constructed to estimate costs based on the 2 implant choices. Values for critical variables, such as implant removal rate, were obtained from the literature. A Monte Carlo simulation consisting of 100,000 trials was used to incorporate variability in medical costs and implant removal rates. Sensitivity analysis and strategy tables were used to show how different variables influence the most cost-effective strategy. TBW was the most cost-effective strategy, with a cost savings of approximately $1300. TBW was also the dominant strategy by being the most cost-effective solution in 63% of the Monte Carlo trials. Sensitivity analysis identified implant costs for plate fixation and surgical costs for implant removal as the most sensitive parameters influencing the cost-effective strategy. Strategy tables showed the most cost-effective solution as 2 parameters vary simultaneously. TBW is the most cost-effective strategy in treating Mayo IIA olecranon fractures despite a higher rate of return to the operating room. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Low cost MATLAB-based pulse oximeter for deployment in research and development applications.

PubMed

Shokouhian, M; Morling, R C S; Kale, I

2013-01-01

Problems such as motion artifact and effects of ambient lights have forced developers to design different signal processing techniques and algorithms to increase the reliability and accuracy of the conventional pulse oximeter device. To evaluate the robustness of these techniques, they are applied either to recorded data or are implemented on chip to be applied to real-time data. Recorded data is the most common method of evaluating however it is not as reliable as real-time measurements. On the other hand, hardware implementation can be both expensive and time consuming. This paper presents a low cost MATLAB-based pulse oximeter that can be used for rapid evaluation of newly developed signal processing techniques and algorithms. Flexibility to apply different signal processing techniques, providing both processed and unprocessed data along with low implementation cost are the important features of this design which makes it ideal for research and development purposes, as well as commercial, hospital and healthcare application.

FINANCIAL ANALYSIS OF CURRENT OPERATIONS OF COLLEGES AND UNIVERSITIES.

ERIC Educational Resources Information Center

SWANSON, JOHN E.; AND OTHERS

TECHNIQUES FOR DEVELOPING FINANCIAL AND RELATED COST-EFFECTIVENESS DATA FOR PUBLIC AND PRIVATELY SUPPORTED AMERICAN COLLEGES AND UNIVERSITIES WERE STUDIED TO FORMULATE PRINCIPLES, PROCEDURES, AND STANDARDS FOR THE ACCUMULATION AND ANALYSES OF CURRENT OPERATING COSTS. AFTER SEPARATE ANALYSES OF INSTITUTIONAL PROCEDURES AND REPORTS, ANALYTIC UNITS…

REDUCED COST SEWER PIPE RELINING USING ULTRASONIC TAPE LAMINATION - PHASE II

EPA Science Inventory

During the Phase I program, Foster-Miller developed techniques based on Ultrasonic Tape Lamination (UTL) for joining of plasticized PVC sewer pipe liner. This effort was undertaken in response to a need for environmentally sound and cost-effective methods for rehabilitation of...

45 CFR 74.91 - Alternative dispute resolution.

Code of Federal Regulations, 2010 CFR

2010-10-01

... resolution (ADR) techniques. ADR often is effective in reducing the cost, delay and contentiousness involved in appeals and other traditional ways of handling disputes. ADR techniques include mediation, neutral evaluation and other consensual methods. Information about ADR is available from the HHS Dispute Resolution...

45 CFR 74.91 - Alternative dispute resolution.

Code of Federal Regulations, 2011 CFR

2011-10-01

... resolution (ADR) techniques. ADR often is effective in reducing the cost, delay and contentiousness involved in appeals and other traditional ways of handling disputes. ADR techniques include mediation, neutral evaluation and other consensual methods. Information about ADR is available from the HHS Dispute Resolution...

Introduction (PSW-GTR-246)

Treesearch

James Halperin; David Ganz

2013-01-01

Globally, approximately two-thirds of the world's forests are considered degraded, but practical, cost-effective tools for monitoring forest quality remain elusive. Techniques for monitoring deforestation and changes to forest carbon stocks are widespread and well published. However, techniques for monitoring forest degradation are relatively untested in...

Resin transfer molding of textile preforms for aircraft structural applications

NASA Technical Reports Server (NTRS)

Hasko, Gregory H.; Dexter, H. Benson; Weideman, Mark H.

1992-01-01

The NASA LaRC is conducting and supporting research to develop cost-effective fabrication methods that are applicable to primary composite aircraft structures. One of the most promising fabrication methods that has evolved is resin transfer molding (RTM) of dry textile material forms. RTM has been used for many years for secondary structures, but has received increased emphasis because it is an excellent method for applying resin to damage-tolerant textile preforms at low cost. Textile preforms based on processes such as weaving, braiding, knitting, stitching, and combinations of these have been shown to offer significant improvements in damage tolerance compared to laminated tape composites. The use of low-cost resins combined with textile preforms could provide a major breakthrough in achieving cost-effective composite aircraft structures. RTM uses resin in its lowest cost form, and storage and spoilage costs are minimal. Near net shape textile preforms are expected to be cost-effective because automated machines can be used to produce the preforms, post-cure operations such as machining and fastening are minimized, and material scrap rate may be reduced in comparison with traditional prepreg molding. The purpose of this paper is to discuss experimental and analytical techniques that are under development at NASA Langley to aid the engineer in developing RTM processes for airframe structural elements. Included are experimental techniques to characterize preform and resin behavior and analytical methods that were developed to predict resin flow and cure kinetics.

Improving inhaler adherence in patients with chronic obstructive pulmonary disease: a cost-effectiveness analysis.

PubMed

van Boven, Job Fm; Tommelein, Eline; Boussery, Koen; Mehuys, Els; Vegter, Stefan; Brusselle, Guy Go; Rutten-van Mölken, Maureen Pmh; Postma, Maarten J

2014-06-14

The PHARMACOP-intervention significantly improved medication adherence and inhalation technique for patients with COPD compared with usual care. This study aimed to evaluate its cost-effectiveness. An economic analysis was performed from the Belgian healthcare payer's perspective. A Markov model was constructed in which a representative group of patients with COPD (mean age of 70 years, 66% male, 43% current smokers and mean Forced Expiratory Volume in 1 second of % predicted of 50), was followed for either receiving the 3-month PHARMACOP-intervention or usual care. Three types of costs were calculated: intervention costs, medication costs and exacerbation costs. Outcome measures included the number of hospital-treated exacerbations, cost per prevented hospital-treated exacerbation and cost per Quality Adjusted Life-Year. Follow-up was 1 year in the basecase analysis. Sensitivity and scenario analyses (including long-term follow-up) were performed to assess uncertainty. In the basecase analysis, the average overall costs per patient for the PHARMACOP-intervention and usual care were €2,221 and €2,448, respectively within the 1-year time horizon. This reflects cost savings of €227 for the PHARMACOP-intervention. The PHARMACOP-intervention resulted in the prevention of 0.07 hospital-treated exacerbations per patient (0.177 for PHARMACOP versus 0.244 for usual care). Results showed robust cost-savings in various sensitivity analyses. Optimization of current pharmacotherapy (e.g. close monitoring of inhalation technique and medication adherence) has been shown to be cost-saving and should be considered before adding new therapies.

Improving inhaler adherence in patients with Chronic Obstructive Pulmonary Disease: a cost-effectiveness analysis

PubMed Central

2014-01-01

Background The PHARMACOP-intervention significantly improved medication adherence and inhalation technique for patients with COPD compared with usual care. This study aimed to evaluate its cost-effectiveness. Methods An economic analysis was performed from the Belgian healthcare payer’s perspective. A Markov model was constructed in which a representative group of patients with COPD (mean age of 70 years, 66% male, 43% current smokers and mean Forced Expiratory Volume in 1 second of % predicted of 50), was followed for either receiving the 3-month PHARMACOP-intervention or usual care. Three types of costs were calculated: intervention costs, medication costs and exacerbation costs. Outcome measures included the number of hospital-treated exacerbations, cost per prevented hospital-treated exacerbation and cost per Quality Adjusted Life-Year. Follow-up was 1 year in the basecase analysis. Sensitivity and scenario analyses (including long-term follow-up) were performed to assess uncertainty. Results In the basecase analysis, the average overall costs per patient for the PHARMACOP-intervention and usual care were €2,221 and €2,448, respectively within the 1-year time horizon. This reflects cost savings of €227 for the PHARMACOP-intervention. The PHARMACOP-intervention resulted in the prevention of 0.07 hospital-treated exacerbations per patient (0.177 for PHARMACOP versus 0.244 for usual care). Results showed robust cost-savings in various sensitivity analyses. Conclusions Optimization of current pharmacotherapy (e.g. close monitoring of inhalation technique and medication adherence) has been shown to be cost-saving and should be considered before adding new therapies. PMID:24929799

An Advanced Programming Technique for a Cost-Effective Hardware-Independent Realization of Naval Software Systems. Final Technical Report, Part II.

ERIC Educational Resources Information Center

Computer Symbolic, Inc., Washington, DC.

A pseudo assembly language, PAL, was developed and specified for use as the lowest level in a general, multilevel programing system for the realization of cost-effective, hardware-independent Naval software. The language was developed as part of the system called FIRMS (Fast Iterative Recursive Macro System) and is sufficiently general to allow…

Life Cycle Costing: A Working Level Approach

DTIC Science & Technology

1981-06-01

Effects Analysis ( FMEA ) ...... ................ .. 59 Logistics Performance Factors (LPFs) 60 Planning the Use of Life Cycle Cost in the Demonstration...form. Failure Mode and Effects Analysis ( FMEA ). Description. FMEA is a technique that attempts to improve the design of any particular unit. The FMEA ...failure modes and also eliminate extra parts or ones that are used to achieve more performance than is necessary (16:5-14]. Advantages. FMEA forces

Passive solar design strategies: Remodeling guidelines for conserving energy at home

NASA Astrophysics Data System (ADS)

The idea of passive solar is simple, but applying it effectively does require information and attention to the details of design and construction. Some passive solar techniques are modest and low-cost, and require only small changes in remodeler's typical practice. At the other end of the spectrum, some passive solar systems can almost eliminate a house's need for purchased heating (and in some cases, cooling) energy - but probably at a relatively high first cost. In between are a broad range of energy-conserving passive solar techniques. Whether or not they are cost-effective, practical, and attractive enough to offer a market advantage to any individual remodeler depends on very specific factors such as local costs, climate, and market characteristics. Passive Solar Design Strategies: Remodeling Guidelines For Conserving Energy At Home is written to help give remodelers the information they need to make these decisions. Passive Solar Design Strategies is a package in three basic parts: the guidelines contain information about passive solar techniques and how they work, and provides specific examples of systems which will save various percentages of energy; the worksheets offer a simple, fill-in-the-blank method to pre-evaluate the performance of a specific design; and the worked example demonstrates how to complete the worksheets for a typical residence.

Laparoscopic appendectomy: quality care and cost-effectiveness for today’s economy

PubMed Central

2013-01-01

Background Open appendectomy (OA) has traditionally been the treatment for acute appendicitis (AA). Beneficial effects of laparoscopic appendectomy (LA) for the treatment of AA are still controversial. Aim To present our technique for LA and to determine whether LA should be the technique of choice of any case of AA instead of OA. Material and methods All cases operated for AA (February 2011 through February 2012) by means of LA or OA were prospectively evaluated. Data regarding length of stay, complications, emergency department consultation after discharge or readmission were collected. Patients were classified into four groups depending on the severity of the appendicitis. Economic data were obtained based on the cost of the disposable material. Cost of hospital stay was calculated based on the Ley de Tasas of the Generalitat Valenciana according to the DRG and the length of stay. Results One hundred and forty-two cases were included. Ninety-nine patients underwent OA and 43 LA. Average length of stay for LA group was 2,6 days and 3,8 for OA. Average cost of the stay for OA was 1.799 euros and 1.081 euros for LA. Global morbidity rate was 16%, 5% for LA and 20% for OA. Conclusions LA is nowadays the technique of choice for the treatment of AA. PMID:24180475

New Technique of Applying Topical Oxygen Therapy as a Cost-Effective Procedure.

PubMed

Agarwal, Vivek; Aroor, Shashank; Gupta, Nikhil; Gupta, Arun; Agarwal, Nitin; Kaur, Navneet

2015-12-01

To describe the newly designed technique of applying topical oxygen therapy for large wounds. C arm sterile disposable cover is used for covering the wound. For abdominal and pelvis wounds, two artificial holes are created at one end of the cover for the inclusion of the limb. Free end of the cover is secured with adhesive, and a hole is created for the insertion of the suction catheter. Oxygen cylinder is connected to the suction catheter, and oxygen is supplied at the rate of 10 L/min. Three patients were treated with topical oxygen therapy. These patients were cases of necrotizing soft tissue infections and large post traumatic wounds. There were less requirements of debridement and granulation tissue appeared earlier. The cost of one cycle of the therapy is less than 500 INR. Topical oxygen therapy is the recent modality for improved wound healing. The novel method of applying topical oxygen devised by us is effective, feasible, and cost-effective as compared to standard devices.

Economic impact of minimally invasive lumbar surgery.

PubMed

Hofstetter, Christoph P; Hofer, Anna S; Wang, Michael Y

2015-03-18

Cost effectiveness has been demonstrated for traditional lumbar discectomy, lumbar laminectomy as well as for instrumented and noninstrumented arthrodesis. While emerging evidence suggests that minimally invasive spine surgery reduces morbidity, duration of hospitalization, and accelerates return to activites of daily living, data regarding cost effectiveness of these novel techniques is limited. The current study analyzes all available data on minimally invasive techniques for lumbar discectomy, decompression, short-segment fusion and deformity surgery. In general, minimally invasive spine procedures appear to hold promise in quicker patient recovery times and earlier return to work. Thus, minimally invasive lumbar spine surgery appears to have the potential to be a cost-effective intervention. Moreover, novel less invasive procedures are less destabilizing and may therefore be utilized in certain indications that traditionally required arthrodesis procedures. However, there is a lack of studies analyzing the economic impact of minimally invasive spine surgery. Future studies are necessary to confirm the durability and further define indications for minimally invasive lumbar spine procedures.

A cost-effectiveness comparison of the use of antimicrobial agents for treatment or prophylaxis of travelers' diarrhea.

PubMed

Reves, R R; Johnson, P C; Ericsson, C D; DuPont, H L

1988-11-01

We conducted a decision analysis to compare the cost-effectiveness of antimicrobial agents used for treatment with their use for prophylaxis of travelers' diarrhea. Estimates of the likelihood and the cost of various outcomes were obtained from a panel of experts using the Delphi group opinion technique. Treatment with sulfamethoxazole-trimethoprim for three days was compared with daily prophylaxis with sulfamethoxazole-trimethoprim or doxycycline. The cost-effectiveness of prophylaxis with either agent (75% to 83%) was greater than that of treatment (38%). Treatment would become more cost-effective than prophylaxis when the cumulative risk of acquiring travelers' diarrhea was less than 0.05 episodes per person per week or if the effectiveness of prophylaxis fell below 35% for doxycycline and 46% for sulfamethoxazole-trimethoprim. The most important contributor to the mean cost of travelers' diarrhea in this analysis was the cost associated with a day of incapacitation due to illness. On the basis of the results of this decision analysis, we conclude that prophylaxis of travelers' diarrhea is an option that should be considered for individual situations and recommend further studies of its cost-effectiveness.

Cost-of-illness studies: concepts, scopes, and methods

PubMed Central

2014-01-01

Liver diseases are one of the main causes of death, and their ever-increasing prevalence is threatening to cause significant damage both to individuals and society as a whole. This damage is especially serious for the economically active population in Korea. From the societal perspective, it is therefore necessary to consider the economic impacts associated with liver diseases, and identify interventions that can reduce the burden of these diseases. The cost-of-illness study is considered to be an essential evaluation technique in health care. By measuring and comparing the economic burdens of diseases to society, such studies can help health-care decision-makers to set up and prioritize health-care policies and interventions. Using economic theories, this paper introduces various study methods that are generally applicable to most disease cases for estimating the costs of illness associated with mortality, morbidity, disability, and other disease characteristics. It also presents concepts and scopes of costs along with different cost categories from different research perspectives in cost estimations. By discussing the epidemiological and economic grounds of the cost-of-illness study, the reported results represent useful information about several evaluation techniques at an advanced level, such as cost-benefit analysis, cost-effectiveness analysis, and cost-utility analysis. PMID:25548737

Cost-of-illness studies: concepts, scopes, and methods.

PubMed

Jo, Changik

2014-12-01

Liver diseases are one of the main causes of death, and their ever-increasing prevalence is threatening to cause significant damage both to individuals and society as a whole. This damage is especially serious for the economically active population in Korea. From the societal perspective, it is therefore necessary to consider the economic impacts associated with liver diseases, and identify interventions that can reduce the burden of these diseases. The cost-of-illness study is considered to be an essential evaluation technique in health care. By measuring and comparing the economic burdens of diseases to society, such studies can help health-care decision-makers to set up and prioritize health-care policies and interventions. Using economic theories, this paper introduces various study methods that are generally applicable to most disease cases for estimating the costs of illness associated with mortality, morbidity, disability, and other disease characteristics. It also presents concepts and scopes of costs along with different cost categories from different research perspectives in cost estimations. By discussing the epidemiological and economic grounds of the cost-of-illness study, the reported results represent useful information about several evaluation techniques at an advanced level, such as cost-benefit analysis, cost-effectiveness analysis, and cost-utility analysis.

Protocol for the Hall Technique study: A trial to measure clinical effectiveness and cost-effectiveness of stainless steel crowns for dental caries restoration in primary molars in young children.

PubMed

Tonmukayakul, Utsana; Martin, Rachel; Clark, Richard; Brownbill, John; Manton, David; Hall, Martin; Armfield, Jason; Smith, Michael; Shankumar, Ramini; Sivasithamparam, Kavitha; Martin-Kerry, Jacqueline; Calache, Hanny

2015-09-01

The Hall Technique (HT) is a carious primary molar treatment that does not require local analgesia, carious tissue removal or tooth preparation. The carious lesions in carefully selected teeth are sealed with a stainless steel crown (preformed metal crown). The study aims are to determine the clinical effectiveness, acceptability and cost-effectiveness of the HT for management of carious lesions in young dental patients. Children, aged 3-7years, with a primary molar tooth with a carious lesion extending no further than the middle third of dentine, with no signs or symptoms of pulp inflammation or infection, and attending one of three community agencies are recruited. Target sample size is 220. A control tooth with an intra-coronal restoration is sourced from the same mouth. The primary outcome is the period of time free from further treatment. The assessments are scheduled at 6, 12 and 24months. In addition to the clinical assessment, acceptability of the HT will be assessed via questionnaires among patients and their primary carers at baseline, 6, 12 and 24months. Cost-outcome description and cost-effectiveness analysis from healthcare provider and societal perspective will be conducted. The clinical effectiveness, acceptability and cost-effectiveness of the HT in the community dental setting will be evaluated. The results of this study will determine the implementation of HT in the management of dental caries in young children. Copyright © 2015 Elsevier Inc. All rights reserved.

A participatory approach for selecting cost-effective measures in the WFD context: the Mar Menor (SE Spain).

PubMed

Perni, Angel; Martínez-Paz, José M

2013-08-01

Achieving a good ecological status in water bodies by 2015 is one of the objectives established in the European Water Framework Directive. Cost-effective analysis (CEA) has been applied for selecting measures to achieve this goal, but this appraisal technique requires technical and economic information that is not always available. In addition, there are often local insights that can only be identified by engaging multiple stakeholders in a participatory process. This paper proposes to combine CEA with the active involvement of stakeholders for selecting cost-effective measures. This approach has been applied to the case study of one of the main coastal lagoons in the European Mediterranean Sea, the Mar Menor, which presents eutrophication problems. Firstly, face-to-face interviews were conducted to estimate relative effectiveness and relative impacts of a set of measures by means of the pairwise comparison technique. Secondly, relative effectiveness was used to estimate cost-effectiveness ratios. The most cost-effective measures were the restoration of watercourses that drain into the lagoon and the treatment of polluted groundwater. Although in general the stakeholders approved the former, most of them stated that the latter involved some uncertainties, which must be addressed before implementing it. Stakeholders pointed out that the PoM would have a positive impact not only on water quality, but also on fishing, agriculture and tourism in the area. This approach can be useful to evaluate other programmes, plans or projects related to other European environmental strategies. Copyright © 2013 Elsevier B.V. All rights reserved.

Carpal tunnel syndrome, the search for a cost-effective surgical intervention: a randomised controlled trial.

PubMed Central

Lorgelly, Paula K.; Dias, Joseph J.; Bradley, Mary J.; Burke, Frank D.

2005-01-01

OBJECTIVE: There is insufficient evidence regarding the clinical and cost-effectiveness of surgical interventions for carpal tunnel syndrome. This study evaluates the cost, effectiveness and cost-effectiveness of minimally invasive surgery compared with conventional open surgery. PATIENTS AND METHODS: 194 sufferers (208 hands) of carpal tunnel syndrome were randomly assigned to each treatment option. A self-administered questionnaire assessed the severity of patients' symptoms and functional status pre- and postoperatively. Treatment costs were estimated from resource use and hospital financial data. RESULTS: Minimally invasive carpal tunnel decompression is marginally more effective than open surgery in terms of functional status, but not significantly so. Little improvement in symptom severity was recorded for either intervention. Minimally invasive surgery was found to be significantly more costly than open surgery. The incremental cost effectiveness ratio for functional status was estimated to be 197 UK pounds, such that a one percentage point improvement in functioning costs 197 UK pounds when using the minimally invasive technique. CONCLUSIONS: Minimally invasive carpal tunnel decompression appears to be more effective but more costly. Initial analysis suggests that the additional expense for such a small improvement in function and no improvement in symptoms would not be regarded as value-for-money, such that minimally invasive carpal tunnel release is unlikely to be considered a cost-effective alternative to the traditional open surgery procedure. PMID:15720906

Impact of robotic technique and surgical volume on the cost of radical prostatectomy.

PubMed

Hyams, Elias S; Mullins, Jeffrey K; Pierorazio, Phillip M; Partin, Alan W; Allaf, Mohamad E; Matlaga, Brian R

2013-03-01

Our present understanding of the effect of robotic surgery and surgical volume on the cost of radical prostatectomy (RP) is limited. Given the increasing pressures placed on healthcare resource utilization, such determinations of healthcare value are becoming increasingly important. Therefore, we performed a study to define the effect of robotic technology and surgical volume on the cost of RP. The state of Maryland mandates that all acute-care hospitals report encounter-level and hospital discharge data to the Health Service Cost Review Commission (HSCRC). The HSCRC was queried for men undergoing RP between 2008 and 2011 (the period during which robot-assisted laparoscopic radical prostatectomy [RALRP] was coded separately). High-volume hospitals were defined as >60 cases per year, and high-volume surgeons were defined as >40 cases per year. Multivariate regression analysis was performed to evaluate whether robotic technique and high surgical volume impacted the cost of RP. There were 1499 patients who underwent RALRP and 2565 who underwent radical retropubic prostatectomy (RRP) during the study period. The total cost for RALRP was higher than for RRP ($14,000 vs 10,100; P<0.001) based primarily on operating room charges and supply charges. Multivariate regression demonstrated that RALRP was associated with a significantly higher cost (β coeff 4.1; P<0.001), even within high-volume hospitals (β coeff 3.3; P<0.001). High-volume surgeons and high-volume hospitals, however, were associated with a significantly lower cost for RP overall. High surgeon volume was associated with lower cost for RALRP and RRP, while high institutional volume was associated with lower cost for RALRP only. High surgical volume was associated with lower cost of RP. Even at high surgical volume, however, the cost of RALRP still exceeded that of RRP. As robotic surgery has come to dominate the healthcare marketplace, strategies to increase the role of high-volume providers may be needed to improve the cost-effectiveness of prostate cancer surgical therapy.

Time transfer techniques: Historical overview, current practices and future capabilities

NASA Technical Reports Server (NTRS)

Klepczynski, W. J.

1984-01-01

A brief historical review of time transfer techniques used during the last twenty years is presented. Methods currently used are discussed in terms of cost effectiveness as a function of accuracy achievable. Future trends are also discussed in terms of projected timekeeping capabilities.

Investigation of automated and interactive crack measurement systems : final report, May 27, 2008 [summary].

DOT National Transportation Integrated Search

2008-05-01

The use of imaging techniques to evaluate roadway pavements for crack damage has proven to be a safe, rapid, and cost- : effective alternative to traditional highway survey techniques. The Multi-Purpose Survey Vehicle (MPSV) developed by FDOT capture...

Development of a mix design process for cold-in-place rehabilitation using foamed asphalt.

DOT National Transportation Integrated Search

2003-12-01

This study evaluates one of the recycling techniques used to rehabilitate pavement, called Cold In-Place Recycling (CIR). CIR is one of the fastest growing road rehabilitation techniques because it is quick and cost-effective. The document reports on...

A cost-effective methodology for the design of massively-parallel VLSI functional units

NASA Technical Reports Server (NTRS)

Venkateswaran, N.; Sriram, G.; Desouza, J.

1993-01-01

In this paper we propose a generalized methodology for the design of cost-effective massively-parallel VLSI Functional Units. This methodology is based on a technique of generating and reducing a massive bit-array on the mask-programmable PAcube VLSI array. This methodology unifies (maintains identical data flow and control) the execution of complex arithmetic functions on PAcube arrays. It is highly regular, expandable and uniform with respect to problem-size and wordlength, thereby reducing the communication complexity. The memory-functional unit interface is regular and expandable. Using this technique functional units of dedicated processors can be mask-programmed on the naked PAcube arrays, reducing the turn-around time. The production cost of such dedicated processors can be drastically reduced since the naked PAcube arrays can be mass-produced. Analysis of the the performance of functional units designed by our method yields promising results.

Cogestion and recreation site demand: a model of demand-induced quality effects

USGS Publications Warehouse

Douglas, Aaron J.; Johnson, Richard L.

1993-01-01

This analysis focuses on problems of estimating site-specific dollar benefits conferred by outdoor recreation sites in the face of congestion costs. Encounters, crowding effects and congestion costs have often been treated by natural resource economists in a piecemeal fashion. In the current paper, encounters and crowding effects are treated systematically. We emphasize the quantitative impact of congestion costs on site-specific estimates of benefits conferred by improvements in outdoor recreation sites. The principal analytic conclusion is that techniques that streamline on data requirements produce biased estimates of benefits conferred by site improvements at facilities with significant crowding effects. The principal policy recommendation is that the Federal and state agencies should collect and store information on visitation rates, encounter levels and congestion costs at various outdoor recreation sites.

Novel Trocarless, Scarless Technique for Left Lobe Liver Retraction in Laparoscopic Upper Gastrointestinal Surgeries: Simple, Cost-effective and with Better Cosmesis.

PubMed

Madnani, Manish A; Patel, Tejas J; Gupta, Alankar K; Mistry, Jitendra H; Soni, Harshad N; Shah, Atul J; Patel, Kantilal S; Haribhakti, Sanjiv P

2015-12-01

Surgeons always look for ways to reduce the size and number of ports in laparoscopy, where in today's era, we have single-incision laparoscopic surgery (SILS). While doing so, principal 'adequate exposure' should not be compromised. For upper gastrointestinal laparoscopic surgeries, we have adopted a novel technique for retraction of the left lobe of liver, which is described here. Device can be made both single sling and double sling, with help of an infant feeding tube and any routinely used suture material. Placement of device does not require any incision, special energy source, or instrument. It can help in SILS. Detailed technique is described in the text. Operative times did not change significantly. Exposure was excellent. No special instruments or energy devices are required; thus, it is cost-effective. Reducing one port for liver retraction gives better cosmetic results. No liver injury due to the device was noticed in any of the cases. This technique is simpler and cheaper and also gives reasonable cosmetic results compared to other techniques described in the literature.

Evaluation of techniques for handling missing cost-to-charge ratios in the USA Nationwide Inpatient Sample: a simulation study.

PubMed

Yu, Tzy-Chyi; Zhou, Huanxue

2015-09-01

Evaluate performance of techniques used to handle missing cost-to-charge ratio (CCR) data in the USA Healthcare Cost and Utilization Project's Nationwide Inpatient Sample. Four techniques to replace missing CCR data were evaluated: deleting discharges with missing CCRs (complete case analysis), reweighting as recommended by Healthcare Cost and Utilization Project, reweighting by adjustment cells and hot deck imputation by adjustment cells. Bias and root mean squared error of these techniques on hospital cost were evaluated in five disease cohorts. Similar mean cost estimates would be obtained with any of the four techniques when the percentage of missing data is low (<10%). When total cost is the outcome of interest, a reweighting technique to avoid underestimation from dropping observations with missing data should be adopted.

Overview on Techniques to Construct Tissue Arrays with Special Emphasis on Tissue Microarrays

PubMed Central

Vogel, Ulrich

2014-01-01

With the advent of new histopathological staining techniques (histochemistry, immunohistochemistry, in situ hybridization) and the discovery of thousands of new genes, mRNA, and proteins by molecular biology, the need grew for a technique to compare many different cells or tissues on one slide in a cost effective manner and with the possibility to easily track the identity of each specimen: the tissue array (TA). Basically, a TA consists of at least two different specimens per slide. TAs differ in the kind of specimens, the number of specimens installed, the dimension of the specimens, the arrangement of the specimens, the embedding medium, the technique to prepare the specimens to be installed, and the technique to construct the TA itself. A TA can be constructed by arranging the tissue specimens in a mold and subsequently pouring the mold with the embedding medium of choice. In contrast, preformed so-called recipient blocks consisting of the embedding medium of choice have punched, drilled, or poured holes of different diameters and distances in which the cells or tissue biopsies will be deployed manually, semi-automatically, or automatically. The costs of constructing a TA differ from a few to thousands of Euros depending on the technique/equipment used. Remarkably high quality TAs can be also achieved by low cost techniques. PMID:27600339

A low cost technique to evaluate usable product for small manufacturing companies: a case study on Garcia robot.

PubMed

An, Vatana; Soares, Marcelo

2012-01-01

A usability evaluation technique to evaluate user interfaces is introduces. The technique is effective and affordable for small manufacturing companies. By using this technique, an integration of users' feedbacks and some usability concepts, a product can be 3 times easier to use among potential users and more than 5 times easier to use among motivated users. In addition, the technique can be implemented with the company's employees as participants.

Health economics of hysterectomy.

PubMed

Garry, Ray

2005-06-01

Health resources are finite, and it is increasingly necessary to practise medicine within defined budgets. Hysterectomy is recognized as one of the most frequently performed of all major surgical operations and is of great economic as well as medical and social importance. A full assessment of the value of an intervention requires consideration of both economic and clinical outcomes. New alternative therapies to uterine excision have been introduced, and new ways of performing hysterectomy have been developed. Cost-effectiveness analysis enables each of these approaches to be meaningfully compared. Using such analytic techniques, hysterectomy can be shown to be an effective and cost-effective intervention across a variety of indications. The vaginal route is the most cost-effective approach. There seems to be no obvious advantage in conserving or retaining the cervix, but there is as yet no evidence about the cost-effectiveness of concomitant oophorectomy.

Today's minimal requirements for a practical dental office infection control and exposure control program.

PubMed

Terezhalmy, G T; Gitto, C A

1998-10-01

The current climate in society regarding infectious diseases in general, and herpes, hepatitis, and HIV infections in particular, dictates that today's dental practices must use effective infection control techniques. The Occupational Safety and Health Administration continues to inspect, cite, and fine health care facilities. More states are implementing regulations concerning the operation of health care facilities. Patients are becoming more sophisticated in their scrutinizing of the dental and medical professions' approach to asepsis. Media coverage of exposure incidents is becoming more intense. All these factors leave dentists no choice; they must implement appropriate infection control techniques. The life-time cost of effective infection control is far less than one malpractice settlement. Implementation of an effective infection control program to promote dental asepsis can be cost-effective. In addition, it can be a practice builder.

A novel methodology for estimating upper limits of major cost drivers for profitable conceptual launch system architectures

NASA Astrophysics Data System (ADS)

Rhodes, Russel E.; Byrd, Raymond J.

1998-01-01

This paper presents a ``back of the envelope'' technique for fast, timely, on-the-spot, assessment of affordability (profitability) of commercial space transportation architectural concepts. The tool presented here is not intended to replace conventional, detailed costing methodology. The process described enables ``quick look'' estimations and assumptions to effectively determine whether an initial concept (with its attendant cost estimating line items) provides focus for major leapfrog improvement. The Cost Charts Users Guide provides a generic sample tutorial, building an approximate understanding of the basic launch system cost factors and their representative magnitudes. This process will enable the user to develop a net ``cost (and price) per payload-mass unit to orbit'' incorporating a variety of significant cost drivers, supplemental to basic vehicle cost estimates. If acquisition cost and recurring cost factors (as a function of cost per payload-mass unit to orbit) do not meet the predetermined system-profitability goal, the concept in question will be clearly seen as non-competitive. Multiple analytical approaches, and applications of a variety of interrelated assumptions, can be examined in a quick, (on-the-spot) cost approximation analysis as this tool has inherent flexibility. The technique will allow determination of concept conformance to system objectives.

Assessing the quality of cost management

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

Fayne, V.; McAllister, A.; Weiner, S.B.

1995-12-31

Managing environmental programs can be effective only when good cost and cost-related management practices are developed and implemented. The Department of Energy`s Office of Environmental Management (EM), recognizing this key role of cost management, initiated several cost and cost-related management activities including the Cost Quality Management (CQM) Program. The CQM Program includes an assessment activity, Cost Quality Management Assessments (CQMAs), and a technical assistance effort to improve program/project cost effectiveness. CQMAs provide a tool for establishing a baseline of cost-management practices and for measuring improvement in those practices. The result of the CQMA program is an organization that has anmore » increasing cost-consciousness, improved cost-management skills and abilities, and a commitment to respond to the public`s concerns for both a safe environment and prudent budget outlays. The CQMA program is part of the foundation of quality management practices in DOE. The CQMA process has contributed to better cost and cost-related management practices by providing measurements and feedback; defining the components of a quality cost-management system; and helping sites develop/improve specific cost-management techniques and methods.« less

Design issues of a low cost lock-in amplifier readout circuit for an infrared detector

NASA Astrophysics Data System (ADS)

Scheepers, L.; Schoeman, J.

2014-06-01

In the past, high resolution thermal sensors required expensive cooling techniques making the early thermal imagers expensive to operate and cumbersome to transport, limiting them mainly to military applications. However, the introduction of uncooled microbolometers has overcome many of earlier problems and now shows great potential for commercial optoelectric applications. The structure of uncooled microbolometer sensors, especially their smaller size, makes them attractive in low cost commercial applications requiring high production numbers with relatively low performance requirements. However, the biasing requirements of these microbolometers cause these sensors to generate a substantial amount of noise on the output measurements due to self-heating. Different techniques to reduce this noise component have been attempted, such as pulsed biasing currents and the use of blind bolometers as common mode reference. These techniques proved to either limit the performance of the microbolometer or increase the cost of their implementation. The development of a low cost lock-in amplifier provides a readout technique to potentially overcome these challenges. High performance commercial lock-in amplifiers are very expensive. Using this as a readout circuit for a microbolometer will take away from the low manufacturing cost of the detector array. Thus, the purpose of this work was to develop a low cost readout circuit using the technique of phase sensitive detection and customizing this as a readout circuit for microbolometers. The hardware and software of the readout circuit was designed and tested for improvement of the signal-to-noise ratio (SNR) of the microbolometer signal. An optical modulation system was also developed in order to effectively identify the desired signal from the noise with the use of the readout circuit. A data acquisition and graphical user interface sub system was added in order to display the signal recovered by the readout circuit. The readout circuit was able to enhance the SNR of the microbolometer signal significantly. It was shown that the quality of the phase sensitive detector plays a significant role in the effectiveness of the readout circuit to improve the SNR.

Ultra-Low-Cost Room Temperature SiC Thin Films

NASA Technical Reports Server (NTRS)

Faur, Maria

1997-01-01

The research group at CSU has conducted theoretical and experimental research on 'Ultra-Low-Cost Room Temperature SiC Thin Films. The effectiveness of a ultra-low-cost room temperature thin film SiC growth technique on Silicon and Germanium substrates and structures with applications to space solar sells, ThermoPhotoVoltaic (TPV) cells and microelectronic and optoelectronic devices was investigated and the main result of this effort are summarized.

Fault Tolerant Considerations and Methods for Guidance and Control Systems

DTIC Science & Technology

1987-07-01

multifunction devices such as microprocessors with software. In striving toward the economic goal, however, a cost is incurred in a different coin, i.e...therefore been developed which reduces the software risk to acceptable proportions. Several of the techniques thus developed incur no significant cost ...complex that their design and implementation need computerized tools in order to be cost -effective (in a broad sense, including the capability of

Present-value analysis: A systems approach to public decisionmaking for cost effectiveness

NASA Technical Reports Server (NTRS)

Herbert, T. T.

1971-01-01

Decision makers within Governmental agencies and Congress must evaluate competing (and sometimes conflicting) proposals which seek funding and implementation. Present value analysis can be an effective decision making tool by enabling the formal evaluation of the effects of competing proposals on efficient national resource utilization. A project's costs are not only its direct disbursements, but its social costs as well. How much does it cost to have those funds diverted from their use and economic benefit by the private sector to the public project? Comparisons of competing projects' social costs allow decision makers to expand their decision bases by quantifying the projects' impacts upon the economy and the efficient utilization of the country's limited national resources. A conceptual model is established for the choosing of the appropriate discount rate to be used in evaluation decisions through the technique.

Microalgae harvesting techniques: A review.

PubMed

Singh, Gulab; Patidar, S K

2018-07-01

Microalgae with wide range of commercial applications have attracted a lot of attention of the researchers in the last few decades. However, microalgae utilization is not economically sustainable due to high cost of harvesting. A wide range of solid - liquid separation techniques are available for microalgae harvesting. The techniques include coagulation and flocculation, flotation, centrifugation and filtration or a combination of various techniques. Despite the importance of harvesting to the economics and energy balance, there is no universal harvesting technique for microalgae. Therefore, this review focuses on assessing technical, economical and application potential of various harvesting techniques so as to allow selection of an appropriate technology for cost effectively harvesting of microalgae from their culture medium. Various harvesting and concentrating techniques of microalgae were reviewed to suggest order of suitability of the techniques for four main microalgae applications i.e biofuel, human and animal food, high valued products, and water quality restoration. For deciding the order of suitability, a comparative analysis of various harvesting techniques based on the six common criterions (i.e biomass quality, cost, biomass quantity, processing time, species specific and toxicity) has been done. Based on the order of various techniques vis-a-vis various criteria and preferred order of criteria for various applications, order of suitability of harvesting techniques for various applications has been decided. Among various harvesting techniques, coagulation and flocculation, centrifugation and filtration were found to be most suitable for considered applications. These techniques may be used alone or in combination for increasing the harvesting efficiency. Copyright © 2018 Elsevier Ltd. All rights reserved.

Low-Cost Quality Control and Nondestructive Evaluation Technologies for General Aviation Structures

NASA Technical Reports Server (NTRS)

Cramer, K. Elliott; Gavinsky, Bob; Semanskee, Grant

1998-01-01

NASA's Advanced General Aviation Transport Experiments (AGATE) Program has as a goal to reduce the overall cost of producing private aviation aircraft while maintaining the safety of these aircraft. In order to successfully meet this goal, it is necessary to develop nondestructive inspection techniques which will facilitate the production of the materials used in these aircraft and assure the quality necessary to maintain airworthiness. This paper will discuss a particular class of general aviation materials and several nondestructive inspection techniques that have proven effective for making these inspections. Additionally, this paper will discuss the investigation and application of other commercially available quality control techniques applicable to these structures.

[An evaluation of costs in nephrology by means of analytical accounting system].

PubMed

Hernández-Jaras, J; García Pérez, H; Pons, R; Calvo, C

2005-01-01

The analytical accounting is a countable technique directed to the evaluation, by means of pre-established criteria of distribution, of the internal economy of the hospital, in order to know the effectiveness and efficiency of Clinical Units. The aim of this study was to analyze the activity and costs of the Nephrology Department of General Hospital of Castellón. Activity of Hospitalization and Ambulatory Care, during 2003 was analysed. Hospitalization discharges were grouped in DGR and the costs per DGR were determinated. Total costs Hospitalisation and Ambulatory Care were 560.434,9 and 146.317,8 Euros, respectively. And the costs of one stay, one first outpatient visit and maintenance visit were 200, 63, and 31,6 Euros, respectively. Eighty per cent of the discharges were grouped in 9 DGR and DRG number 316 (Renal Failure) represented 30% of the total productivity. Costs of DGR 316 were 3.178,2 Euros and 16% represented laboratory cost and costs of diagnostic or therapeutic procedures. With introduction of analytical accounting and DGR system, the Nephrology Departments can acquire more full information on the results and costs of treatment. These techniques permits to improve the financial and economic performance.

Impact of gene patents on the cost-effective delivery of care: the case of BRCA1 genetic testing.

PubMed

Sevilla, Christine; Julian-Reynier, Claire; Eisinger, François; Stoppa-Lyonnet, Dominique; Bressac-de Paillerets, Brigitte; Sobol, Hagay; Moatti, Jean-Paul

2003-01-01

In 1994/95, two genes, BRCA1/2, associated with a predisposition to breast or ovarian cancer were identified. Genetic testing of deleterious BRCA1/2 mutations consequently can be proposed to individuals with a family history of breast or ovarian cancer to identify who is at risk. The granting of U.S. patents on BRCA1/2 to a privately owned company has led to the monopoly use of a unique technique (Direct Sequencing of the gene, DS) for BRCA1/2 testing in this country. Alternative strategies using prescreening techniques, however, have been experienced worldwide. On the basis of data collected at three laboratories of French public hospitals, we carried out a cost-effectiveness study comparing DS to 19 alternative strategies with the number of deleterious BRCA1 mutations detected as the outcome. Results show that the DS strategy presents the highest average cost per mutation detected (9,882.5 Euro) and that there exist strategies using prescreening techniques that can reach similar effectiveness while reducing total costs. Moreover, other strategies can obtain a four- to sevenfold reduction in the average cost per mutation detected as soon as some rates of false negatives (2% to 13%) are deemed to be acceptable. Results suggest that gene patents with a very broad scope, covering all potential medical applications, may prevent health care systems from identifying and adopting the most efficient genetic testing strategies due to the monopoly granted for the exploitation of the gene. Policy implications for regulatory authorities, in the current context of the extension of BRCA1/2 patents in other countries, are discussed.

Motorcyclists safety system to avoid rear end collisions based on acoustic signatures

NASA Astrophysics Data System (ADS)

Muzammel, M.; Yusoff, M. Zuki; Malik, A. Saeed; Mohamad Saad, M. Naufal; Meriaudeau, F.

2017-03-01

In many Asian countries, motorcyclists have a higher fatality rate as compared to other vehicles. Among many other factors, rear end collisions are also contributing for these fatalities. Collision detection systems can be useful to minimize these accidents. However, the designing of efficient and cost effective collision detection system for motorcyclist is still a major challenge. In this paper, an acoustic information based, cost effective and efficient collision detection system is proposed for motorcycle applications. The proposed technique uses the Short time Fourier Transform (STFT) to extract the features from the audio signal and Principal component analysis (PCA) has been used to reduce the feature vector length. The reduction of feature length, further increases the performance of this technique. The proposed technique has been tested on self recorded dataset and gives accuracy of 97.87%. We believe that this method can help to reduce a significant number of motorcycle accidents.

Magnetic induction tomography of objects for security applications

NASA Astrophysics Data System (ADS)

Ward, Rob; Joseph, Max; Langley, Abbi; Taylor, Stuart; Watson, Joe C.

2017-10-01

A coil array imaging system has been further developed from previous investigations, focusing on designing its application for fast screening of small bags or parcels, with a view to the production of a compact instrument for security applications. In addition to reducing image acquisition times, work was directed toward exploring potential cost effective manufacturing routes. Based on magnetic induction tomography and eddy-current principles, the instrument captured images of conductive targets using a lock-in amplifier, individually multiplexing signals between a primary driver coil and a 20 by 21 imaging array of secondary passive coils constructed using a reproducible multiple tile design. The design was based on additive manufacturing techniques and provided 2 orthogonal imaging planes with an ability to reconstruct images in less than 10 seconds. An assessment of one of the imaging planes is presented. This technique potentially provides a cost effective threat evaluation technique that may compliment conventional radiographic approaches.

Embolization of the Internal Iliac Artery: Cost-Effectiveness of Two Different Techniques

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

Pellerin, Olivier, E-mail: olivier.pellerin@egp.aphp.f; Caruba, Thibaud; Kandounakis, Yanis

2008-11-15

The purpose of this study was to compare the cost-effectiveness of coils versus the Amplatzer Vascular Plug (AVP) for occlusion of the internal iliac artery (IAA). Between 2002 and January 2006, 13 patients (mean age 73 {+-} 13 years) were referred for stent-grafting of abdominal aortic aneurysm (n = 6); type I distal endoleak (n = 3), isolated iliac aneurysm (n = 3), or rupture of a common iliac aneurysm (n = 1). In all patients, extension of the stent-graft was needed because the distal neck was absent. Two different techniques were used to occlude the IIA: AVP in sevenmore » patients (group A) and coil embolization in six patients (group C). Immediate results and direct material costs were assessed retrospectively. Immediate success was achieved in all patients, and simultaneous stent-grafting was successfully performed in two of six patients in group C versus five of seven patients in group A. In all group A patients, a single AVP was sufficient to achieve occlusion of the IIA, accounting for a mean cost of 485 Euro , whereas in group C patients, an average of 7 {+-} 3 coils were used, accounting for a mean cost of 1,745 Euro . Mean average cost savings using the AVP was 1,239 Euro . When IIA occlusion is needed, the AVP allows a single-step procedure at significant cost savings.« less

A Cost-Effectiveness Analysis of the Swedish Universal Parenting Program All Children in Focus.

PubMed

Ulfsdotter, Malin; Lindberg, Lene; Månsdotter, Anna

2015-01-01

There are few health economic evaluations of parenting programs with quality-adjusted life-years (QALYs) as the outcome measure. The objective of this study was, therefore, to conduct a cost-effectiveness analysis of the universal parenting program All Children in Focus (ABC). The goals were to estimate the costs of program implementation, investigate the health effects of the program, and examine its cost-effectiveness. A cost-effectiveness analysis was conducted. Costs included setup costs and operating costs. A parent proxy Visual Analog Scale was used to measure QALYs in children, whereas the General Health Questionnaire-12 was used for parents. A societal perspective was adopted, and the incremental cost-effectiveness ratio was calculated. To account for uncertainty in the estimate, the probability of cost-effectiveness was investigated, and sensitivity analyses were used to account for the uncertainty in cost data. The cost was € 326.3 per parent, of which € 53.7 represented setup costs under the assumption that group leaders on average run 10 groups, and € 272.6 was the operating costs. For health effects, the QALY gain was 0.0042 per child and 0.0027 per parent. These gains resulted in an incremental cost-effectiveness ratio for the base case of € 47 290 per gained QALY. The sensitivity analyses resulted in ratios from € 41 739 to € 55 072. With the common Swedish threshold value of € 55 000 per QALY, the probability of the ABC program being cost-effective was 50.8 percent. Our analysis of the ABC program demonstrates cost-effectiveness ratios below or just above the QALY threshold in Sweden. However, due to great uncertainty about the data, the health economic rationale for implementation should be further studied considering a longer time perspective, effects on siblings, and validated measuring techniques, before full scale implementation.

A Cost-Effectiveness Analysis of the Swedish Universal Parenting Program All Children in Focus

PubMed Central

Ulfsdotter, Malin

2015-01-01

Objective There are few health economic evaluations of parenting programs with quality-adjusted life-years (QALYs) as the outcome measure. The objective of this study was, therefore, to conduct a cost-effectiveness analysis of the universal parenting program All Children in Focus (ABC). The goals were to estimate the costs of program implementation, investigate the health effects of the program, and examine its cost-effectiveness. Methods A cost-effectiveness analysis was conducted. Costs included setup costs and operating costs. A parent proxy Visual Analog Scale was used to measure QALYs in children, whereas the General Health Questionnaire-12 was used for parents. A societal perspective was adopted, and the incremental cost-effectiveness ratio was calculated. To account for uncertainty in the estimate, the probability of cost-effectiveness was investigated, and sensitivity analyses were used to account for the uncertainty in cost data. Results The cost was €326.3 per parent, of which €53.7 represented setup costs under the assumption that group leaders on average run 10 groups, and €272.6 was the operating costs. For health effects, the QALY gain was 0.0042 per child and 0.0027 per parent. These gains resulted in an incremental cost-effectiveness ratio for the base case of €47 290 per gained QALY. The sensitivity analyses resulted in ratios from €41 739 to €55 072. With the common Swedish threshold value of €55 000 per QALY, the probability of the ABC program being cost-effective was 50.8 percent. Conclusion Our analysis of the ABC program demonstrates cost-effectiveness ratios below or just above the QALY threshold in Sweden. However, due to great uncertainty about the data, the health economic rationale for implementation should be further studied considering a longer time perspective, effects on siblings, and validated measuring techniques, before full scale implementation. PMID:26681349

Cost-effectiveness Analysis with Influence Diagrams.

PubMed

Arias, M; Díez, F J

2015-01-01

Cost-effectiveness analysis (CEA) is used increasingly in medicine to determine whether the health benefit of an intervention is worth the economic cost. Decision trees, the standard decision modeling technique for non-temporal domains, can only perform CEA for very small problems. To develop a method for CEA in problems involving several dozen variables. We explain how to build influence diagrams (IDs) that explicitly represent cost and effectiveness. We propose an algorithm for evaluating cost-effectiveness IDs directly, i.e., without expanding an equivalent decision tree. The evaluation of an ID returns a set of intervals for the willingness to pay - separated by cost-effectiveness thresholds - and, for each interval, the cost, the effectiveness, and the optimal intervention. The algorithm that evaluates the ID directly is in general much more efficient than the brute-force method, which is in turn more efficient than the expansion of an equivalent decision tree. Using OpenMarkov, an open-source software tool that implements this algorithm, we have been able to perform CEAs on several IDs whose equivalent decision trees contain millions of branches. IDs can perform CEA on large problems that cannot be analyzed with decision trees.

Induction motor broken rotor bar fault location detection through envelope analysis of start-up current using Hilbert transform

NASA Astrophysics Data System (ADS)

Abd-el-Malek, Mina; Abdelsalam, Ahmed K.; Hassan, Ola E.

2017-09-01

Robustness, low running cost and reduced maintenance lead Induction Motors (IMs) to pioneerly penetrate the industrial drive system fields. Broken rotor bars (BRBs) can be considered as an important fault that needs to be early assessed to minimize the maintenance cost and labor time. The majority of recent BRBs' fault diagnostic techniques focus on differentiating between healthy and faulty rotor cage. In this paper, a new technique is proposed for detecting the location of the broken bar in the rotor. The proposed technique relies on monitoring certain statistical parameters estimated from the analysis of the start-up stator current envelope. The envelope of the signal is obtained using Hilbert Transformation (HT). The proposed technique offers non-invasive, fast computational and accurate location diagnostic process. Various simulation scenarios are presented that validate the effectiveness of the proposed technique.

Is transcatheter aortic valve implantation (TAVI) a cost-effective treatment in patients who are ineligible for surgical aortic valve replacement? A systematic review of economic evaluations.

PubMed

Eaton, James; Mealing, Stuart; Thompson, Juliette; Moat, Neil; Kappetein, Pieter; Piazza, Nicolo; Busca, Rachele; Osnabrugge, Ruben

2014-05-01

Health Technology Assessment (HTA) agencies often undertake a review of economic evaluations of an intervention during an appraisal in order to identify published estimates of cost-effectiveness, to elicit comparisons with the results of their own model, and to support local reimbursement decision-making. The aim of this research is to determine whether Transcatheter Aortic Valve Implantation (TAVI) compared to medical management (MM) is cost-effective in patients ineligible for surgical aortic valve replacement (SAVR), across different jurisdictions and country-specific evaluations. A systematic review of the literature from 2007-2012 was performed in the MEDLINE, MEDLINE in-process, EMBASE, and UK NHS EED databases according to standard methods, supplemented by a search of published HTA models. All identified publications were reviewed independently by two health economists. The British Medical Journal (BMJ) 35-point checklist for economic evaluations was used to assess study reporting. To compare results, incremental cost effectiveness ratios (ICERs) were converted to 2012 dollars using purchasing power parity (PPP) techniques. Six studies were identified representing five reimbursement jurisdictions (England/Wales, Scotland, the US, Canada, and Belgium) and different modeling techniques. The identified economic evaluations represent different willingness-to-pay thresholds, discount rates, medical costs, and healthcare systems. In addition, the model structures, time horizons, and cycle lengths varied. When adjusting for differences in currencies, the ICERs ranged from $27K-$65K per QALY gained. Despite notable differences in modeling approach, under the thresholds defined by using either the local threshold value or that recommended by the World Health Organization (WHO) threshold value, each study showed that TAVI was likely to be a cost-effective intervention for patients ineligible for SAVR.

Value Engineering. Technical Manual. School Facilities Development Procedures Manual.

ERIC Educational Resources Information Center

Washington Office of the State Superintendent of Public Instruction, Olympia.

Value Engineering (VE) is a cost-optimizing technique used to analyze design quality and cost-effectiveness. The application of VE procedures to the design and construction of school facilities has been adopted by the state of Washington. This technical manual provides guidance in developing the scope and applicability of VE to school projects; in…

Safety belts : the uncollected dividends : a manual for use by state legislators and state officials on techniques to increase safety belt usage.

DOT National Transportation Integrated Search

1977-09-01

Recognizing that increased safety belt usage is by far the most cost-effective I highway safety measure that can be undertaken by any State, this project describes how. States can initiate action to collect major dividends in cost and human welfare.

Cost-Effective Magnetoencephalography Based on Time Encoded Optical Fiber Interferometry for Epilepsy and Tinnitus

DTIC Science & Technology

2016-09-01

Thanks to the elegant reciprocal geometry of the Sagnac interferometer, many sources of drift that would present in other polarimetry techniques were...interferometers. And is 2 orders of magnitude better than competing polarimetry -based Faraday techniques. Couple a Rb Vapor cell to the Sagnac interferometer

Trained standardized patients can train their peers to provide well-rated, cost-effective physical exam skills training to first-year medical students.

PubMed

Aamodt, Carla B; Virtue, David W; Dobbie, Alison E

2006-05-01

Teaching physical examination skills effectively, consistently, and cost-effectively is challenging. Faculty time is the most expensive resource. One solution is to train medical students using lay physical examination teaching associates. In this study, we investigated the feasibility, acceptability, and cost-effectiveness of training medical students using teaching associates trained by a lay expert instead of a clinician. We used teaching associates to instruct students about techniques of physical examination. We measured students' satisfaction with this teaching approach. We also monitored the financial cost of this approach compared to the previously used approach in which faculty physicians taught physical examination skills. Our program proved practical to accomplish and acceptable to students. Students rated the program highly, and we saved approximately $9,100, compared with our previous faculty-intensive teaching program. We believe that our program is popular with students, cost-effective, and generalizable to other institutions.

Economic analysis of human papillomavirus triage, repeat cytology, and immediate colposcopy in management of women with minor cytological abnormalities in Sweden.

PubMed

Ostensson, Ellinor; Fröberg, Maria; Hjerpe, Anders; Zethraeus, Niklas; Andersson, Sonia

2010-10-01

To assess the cost-effectiveness of using human papillomavirus testing (HPV triage) in the management of women with minor cytological abnormalities in Sweden. An economic analysis based on a clinical trial, complemented with data from published meta-analyses on accuracy of HPV triage. The study takes perspective of the Swedish healthcare system. The Swedish population-based cervical cancer screening program. A decision analytic model was constructed to evaluate cost-effectiveness of HPV triage compared to repeat cytology and immediate colposcopy with biopsy, stratifying by index cytology (ASCUS = atypical squamous cells of undetermined significance, and LSIL = low-grade squamous intraepithelial lesion) and age (23-60 years, <30 years and ≥30 years). Costs, incremental cost, incremental effectiveness and incremental cost per additional high-grade lesion (CIN2+) detected. For women with ASCUS ≥30 years, HPV triage is the least costly alternative, whereas immediate colposcopy with biopsy provides the most effective option at an incremental cost-effectiveness ratio (ICER) of SEK 2,056 per additional case of CIN2+ detected. For LSIL (all age groups) and ASCUS (23-60 years and <30 years), HPV triage is dominated by immediate colposcopy and biopsy. Model results were sensitive to HPV test cost changes. With improved HPV testing techniques at lower costs, HPV triage can become a cost-effective alternative for follow-up of minor cytological abnormalities. Today, immediate colposcopy with biopsy is a cost-effective alternative compared to HPV triage and repeat cytology.

Comparison of cost-effectiveness and postoperative outcome of device closure and open surgery closure techniques for treatment of patent ductus arteriosus.

PubMed

Ahmadi, Alireza; Sabri, Mohammadreza; Bigdelian, Hamid; Dehghan, Bahar; Gharipour, Mojgan

2014-01-01

Various devices have been recently employed for percutaneous closure of the patent ductus arteriosus (PDA). Although the high effectiveness of device closure techniques has been clearly determined, a few studies have focused on the cost-effectiveness and also postoperative complications of these procedures in comparison with open surgery. The present study aimed to evaluate the clinical outcome and cost-effectiveness of PDA occlusion by Amplatzer and coil device in comparisong with open surgery. In this cross-sectional study, a randomized sample of 201 patients aged 1 month to 16 years (105 patients with device closure and 96 patients with surgical closure) was selected. The ratio of total pulmonary blood flow to total systemic blood flow, the Qp/Qs ratio, was measured using a pulmonary artery catheter. The cost analysis included direct medical care costs associated with device implantation and open surgery, as well as professional fees. All costs were calculated in Iranian Rials and then converted to US dollars. There was no statistical difference in mean Qp/Qs ratio before the procedure between the device closure group and the open surgery group (2.1 ± 0.7 versus 1.7 ± 0.6, P = 0.090). The mean measured costs were overall higher in the device closure group than in open closure group (948.87 ± 548.76 US$ versus 743.70 ± 696.91 US$, P < 0.001). This difference remained significant after adjustment for age and gender (Standardized Beta = 0.160, P = 0.031). PDA closure with the Amplatzer ductal occluder (1053.05 ± 525.73 US$) or with Nit-Occlud coils (PFM) (912.73 ± 565.94 US$, P < 0.001) was more expensive than that via open surgery. However, the Cook detachable spring coils device closure (605.65 ± 194.62 US$, P = 0.650) had a non-significant cost difference with open surgery. No event was observed in the device closure group regarding in-hospital mortality or morbidity; however, in another group, 2 in-hospital deaths occurred, two patients experienced pneumonia and seizure, and one suffered electrolyte abnormalities including hyponatremia and hypocalcemia. Although open surgery seems to be less expensive than device closure technique, because of lower mortality and morbidity, the latter group is more preferable.

Cost-Effectiveness Comparison of Imaging-Guided Prostate Biopsy Techniques: Systematic Transrectal Ultrasound, Direct In-Bore MRI, and Image Fusion.

PubMed

Venderink, Wulphert; Govers, Tim M; de Rooij, Maarten; Fütterer, Jurgen J; Sedelaar, J P Michiel

2017-05-01

Three commonly used prostate biopsy approaches are systematic transrectal ultrasound guided, direct in-bore MRI guided, and image fusion guided. The aim of this study was to calculate which strategy is most cost-effective. A decision tree and Markov model were developed to compare cost-effectiveness. Literature review and expert opinion were used as input. A strategy was deemed cost-effective if the costs of gaining one quality-adjusted life year (incremental cost-effectiveness ratio) did not exceed the willingness-to-pay threshold of €80,000 (≈$85,000 in January 2017). A base case analysis was performed to compare systematic transrectal ultrasound- and image fusion-guided biopsies. Because of a lack of appropriate literature regarding the accuracy of direct in-bore MRI-guided biopsy, a threshold analysis was performed. The incremental cost-effectiveness ratio for fusion-guided biopsy compared with systematic transrectal ultrasound-guided biopsy was €1386 ($1470) per quality-adjusted life year gained, which was below the willingness-to-pay threshold and thus assumed cost-effective. If MRI findings are normal in a patient with clinically significant prostate cancer, the sensitivity of direct in-bore MRI-guided biopsy has to be at least 88.8%. If that is the case, the incremental cost-effectiveness ratio is €80,000 per quality-adjusted life year gained and thus cost-effective. Fusion-guided biopsy seems to be cost-effective compared with systematic transrectal ultrasound-guided biopsy. Future research is needed to determine whether direct in-bore MRI-guided biopsy is the best pathway; in this study a threshold was calculated at which it would be cost-effective.

Cost-effectiveness analysis: adding value to assessment of animal health welfare and production.

PubMed

Babo Martins, S; Rushton, J

2014-12-01

Cost-effectiveness analysis (CEA) has been extensively used in economic assessments in fields related to animal health, namely in human health where it provides a decision-making framework for choices about the allocation of healthcare resources. Conversely, in animal health, cost-benefit analysis has been the preferred tool for economic analysis. In this paper, the use of CEA in related areas and the role of this technique in assessments of animal health, welfare and production are reviewed. Cost-effectiveness analysis can add further value to these assessments, particularly in programmes targeting animal welfare or animal diseases with an impact on human health, where outcomes are best valued in natural effects rather than in monetary units. Importantly, CEA can be performed during programme implementation stages to assess alternative courses of action in real time.

The contribution of Raman spectroscopy to the analytical quality control of cytotoxic drugs in a hospital environment: eliminating the exposure risks for staff members and their work environment.

PubMed

Bourget, Philippe; Amin, Alexandre; Vidal, Fabrice; Merlette, Christophe; Troude, Pénélope; Baillet-Guffroy, Arlette

2014-08-15

The purpose of the study was to perform a comparative analysis of the technical performance, respective costs and environmental effect of two invasive analytical methods (HPLC and UV/visible-FTIR) as compared to a new non-invasive analytical technique (Raman spectroscopy). Three pharmacotherapeutic models were used to compare the analytical performances of the three analytical techniques. Statistical inter-method correlation analysis was performed using non-parametric correlation rank tests. The study's economic component combined calculations relative to the depreciation of the equipment and the estimated cost of an AQC unit of work. In any case, analytical validation parameters of the three techniques were satisfactory, and strong correlations between the two spectroscopic techniques vs. HPLC were found. In addition, Raman spectroscopy was found to be superior as compared to the other techniques for numerous key criteria including a complete safety for operators and their occupational environment, a non-invasive procedure, no need for consumables, and a low operating cost. Finally, Raman spectroscopy appears superior for technical, economic and environmental objectives, as compared with the other invasive analytical methods. Copyright © 2014 Elsevier B.V. All rights reserved.

Development of Low Cost Satellite Communications System for Helicopters and General Aviation

NASA Technical Reports Server (NTRS)

Farazian, K.; Abbe, B.; Divsalar, D.; Raphaeli, D.; Tulintseff, A.; Wu, T.; Hinedi, S.

1994-01-01

In this paper, the development of low-cost satellite communications (SATCOM) system for helicopters and General Aviation (GA) aircrafts is described. System design and standards analysis have been conducted to meet the low-cost, light-weight, small-size and low-power system requirements for helicopters and GA aircraft environments. Other specific issues investigated include coding schemes, spatial diversity, and antenna arraying techniques. Coding schemes employing Channel State Information (CSI) and inverleaving have been studied in order to mitigate severe banking angle fading and the periodic RF signal blockage due to the helicopter rotor blades. In addition, space diversity and antenna arraying techniques have been investigated to further reduce the fading effects and increase the link margin.

Biosimilar medicines and cost-effectiveness

PubMed Central

Simoens, Steven

2011-01-01

Given that biosimilars are agents that are similar but not identical to the reference biopharmaceutical, this study aims to introduce and describe specific issues related to the economic evaluation of biosimilars by focusing on the relative costs, relative effectiveness, and cost-effectiveness of biosimilars. Economic evaluation assesses the cost-effectiveness of a medicine by comparing the costs and outcomes of a medicine with those of a relevant comparator. The assessment of cost-effectiveness of a biosimilar is complicated by the fact that evidence needed to obtain marketing authorization from a registration authority does not always correspond to the data requirements of a reimbursement authority. In particular, this relates to the availability of adequately powered equivalence or noninferiority studies, the need for comparative data about the effectiveness in a real-world setting rather than the efficacy in a structured setting, and the use of health outcome measures instead of surrogate endpoints. As a biosimilar is likely to be less expensive than the comparator (eg, the reference biopharmaceutical), the assessment of the cost-effectiveness of a biosimilar depends on the relative effectiveness. If appropriately designed and powered clinical studies demonstrate equivalent effectiveness between a biosimilar and the comparator, then a cost-minimization analysis identifies the least expensive medicine. If there are differences in the effectiveness of a biosimilar and the comparator, other techniques of economic evaluation need to be employed, such as cost-effectiveness analysis or cost-utility analysis. Given that there may be uncertainty surrounding the long-term safety (ie, risk of immunogenicity and rare adverse events) and effectiveness of a biosimilar, the cost-effectiveness of a biosimilar needs to be calculated at multiple time points throughout the life cycle of the product. PMID:21935330

Enhancing managerial effectiveness in dietetics.

PubMed

Hoover, L W

1983-01-01

Environmental pressures from such sources as economic conditions, the government, third-party payers, and inter-institutional competition create managerial challenges. Although cost-containment has received considerable attention, long-term cost-effectiveness is probably the significant issue. Dietitians must become more cost-conscious and effective in resource management to attain desired performance outcomes. Some of the skills and characteristics essential to managerial effectiveness are a marketing orientation, systems design skill, quantitative operations management techniques, financial expertise, and leadership. These abilities facilitate decision-making and achievement of long-term cost-effectiveness. Curriculum enhancement and continuing education are two strategies for improving managerial competency in the dietetics profession. In dietetics education, study of management topics should be enhanced to provide more advanced coverage of management theories and quantitative models so that managerial performance can be at a higher level of sophistication and competency. To assure the viability of the dietetics profession, the emphasis on management must be more comprehensive and rigorous.

New Researches and Application Progress of Commonly Used Optical Molecular Imaging Technology

PubMed Central

Chen, Zhi-Yi; Yang, Feng; Lin, Yan; Zhou, Qiu-Lan; Liao, Yang-Ying

2014-01-01

Optical molecular imaging, a new medical imaging technique, is developed based on genomics, proteomics and modern optical imaging technique, characterized by non-invasiveness, non-radiativity, high cost-effectiveness, high resolution, high sensitivity and simple operation in comparison with conventional imaging modalities. Currently, it has become one of the most widely used molecular imaging techniques and has been applied in gene expression regulation and activity detection, biological development and cytological detection, drug research and development, pathogenesis research, pharmaceutical effect evaluation and therapeutic effect evaluation, and so forth, This paper will review the latest researches and application progresses of commonly used optical molecular imaging techniques such as bioluminescence imaging and fluorescence molecular imaging. PMID:24696850

A methodology for the quantification of doctrine and materiel approaches in a capability-based assessment

NASA Astrophysics Data System (ADS)

Tangen, Steven Anthony

Due to the complexities of modern military operations and the technologies employed on today's military systems, acquisition costs and development times are becoming increasingly large. Meanwhile, the transformation of the global security environment is driving the U.S. military's own transformation. In order to meet the required capabilities of the next generation without buying prohibitively costly new systems, it is necessary for the military to evolve across the spectrum of doctrine, organization, training, materiel, leadership and education, personnel, and facilities (DOTMLPF). However, the methods for analyzing DOTMLPF approaches within the early acquisition phase of a capability-based assessment (CBA) are not as well established as the traditional technology design techniques. This makes it difficult for decision makers to decide if investments should be made in materiel or non-materiel solutions. This research develops an agent-based constructive simulation to quantitatively assess doctrine alongside materiel approaches. Additionally, life-cycle cost techniques are provided to enable a cost-effectiveness trade. These techniques are wrapped together in a decision-making environment that brings crucial information forward so informed and appropriate acquisition choices can be made. The methodology is tested on a future unmanned aerial vehicle design problem. Through the implementation of this quantitative methodology on the proof-of-concept study, it is shown that doctrinal changes including fleet composition, asset allocation, and patrol pattern were capable of dramatic improvements in system effectiveness at a much lower cost than the incorporation of candidate technologies. Additionally, this methodology was able to quantify the precise nature of strong doctrine-doctrine and doctrine-technology interactions which have been observed only qualitatively throughout military history. This dissertation outlines the methodology and demonstrates how potential approaches to capability-gaps can be identified with respect to effectiveness, cost, and time. When implemented, this methodology offers the opportunity to achieve system capabilities in a new way, improve the design of acquisition programs, and field the right combination of ways and means to address future challenges to national security.

Results of FM-TV threshold reduction investigation for the ATS F trust experiment

NASA Technical Reports Server (NTRS)

Brown, J. P.

1972-01-01

An investigation of threshold effects in FM TV was initiated to determine if any simple, low cost techniques were available which can reduce the subjective video threshold, applicable to low cost community TV reception via satellite. Two methods of eliminating these effects were examined: the use of standard video pre-emphasis, and the use of an additional circuit to blank the picture tube during the retrace period.

[Cost of assisted reproduction technology in a public hospital].

PubMed

Navarro Espigares, José Luis; Martínez Navarro, Luis; Castilla Alcalá, José Antonio; Hernández Torres, Elisa

2006-01-01

Most studies on the costs of assisted reproductive technologies (ART) identify the total cost of the procedure with the direct cost, without considering important items such as overhead or intermediate costs. The objective of this study was to determine the cost per ART procedure in a public hospital in 2003 and to compare the results with those in the same hospital in 1998. Data from the Human Reproduction Unit of the Virgen de las Nieves University Hospital in Granada (Spain) from 1998 and 2003 were analyzed. Since the total costs of the unit were known, the cost of the distinct ART procedures performed in the hospital was calculated by means of a methodology for cost distribution. Between 1998 and 2003, the activity and costs of the Human Reproduction Unit analyzed evolved differently. Analysis of activity showed that some techniques, such as intracytoplasmic sperm injection, were consolidated while others, such as stimulation without assisted reproduction or intracervical insemination were abandoned. In all procedures, unit costs per cycle and per delivery decreased in the period analyzed. Important changes took place in the structure of costs of ART in the Human Reproduction Unit of the Virgen de las Nieves University Hospital between 1998 and 2003. Some techniques were discontinued, while others gained importance. Technological advances and structural innovations, together with a "learning effect," modified the structure of ART-related costs.

Cost Accounting in Higher Education. Simplified Macro- and Micro-Costing Techniques.

ERIC Educational Resources Information Center

Jenny, Hans H.

This manual covers cost accounting applications and techniques as they apply to institutions of higher education, focusing mainly on the different methods of allocating costs. The manual covers four major costing topics: aggregate institution and systemwide costs; major academic and administrative program costs; academic and administrative…

A cost-effectiveness analysis of hormone replacement therapy in the menopause.

PubMed

Cheung, A P; Wren, B G

1992-03-02

To evaluate the cost-effectiveness of hormone replacement therapy in the menopause with particular reference to osteoporotic fracture and myocardial infarction. The multiple-decrement form of the life table was the mathematical model used to follow women of age 50 through their lifetime under the "no hormone replacement" and "hormone replacement" assumptions. Standard demographic and health economic techniques were used to calculate the corresponding lifetime differences in direct health care costs (net costs in dollars) and health effects ("net effectiveness" in terms of life expectancy and quality, in "quality-adjusted life-years"). This was then expressed as a cost-effectiveness ratio or the cost ($) per quality-adjusted life-year (QALY) for each of the chosen hormone replacement regimens. All women of age 50 in New South Wales, Australia (n = 27,021). The analysis showed that the lifetime net increments in direct medical care costs were largely contributed by hormone drug and consultation costs. Hormone replacement was associated with increased quality-adjusted life expectancy, a large percentage of which was attributed to a relief of menopausal symptoms. Cost-effectiveness ratios ranged from under 10,000 to over a million dollars per QALY. Factors associated with improved cost-effectiveness were prolonged treatment duration, the presence of menopausal symptoms, minimum progestogen side effects (in the case of oestrogen with progestogen regimens), oestrogen use after hysterectomy and the inclusion of cardiac benefits in addition to fracture prevention. Hormone replacement therapy for symptomatic women is cost-effective when factors that enhance its efficiency are considered. Short-term treatment of asymptomatic women for prevention of osteoporotic fractures and myocardial infarction is an inefficient use of health resources. Cost-effectiveness of hormone replacement in asymptomatic women is dependent on the magnitude of cardiac benefits associated with hormone use and the treatment duration.

[Optimizing the financial impact of transitioning to transconjunctival vitrectomy and microincisional phacoemulsification].

PubMed

Cornut, P-L; Soldermann, Y; Robin, C; Barranco, R; Kerhoas, A; Burillon, C

2013-12-01

To report the financial impact of using modern lens and vitreoretinal surgical techniques. Bottom-up sterilization and consumables costs for new surgical techniques (microincisional coaxial phacoemulsification and transconjunctival sutureless vitrectomy) and the corresponding former techniques (phacoemulsification with 3.2-mm incision and 20G vitrectomy) were determined. These costs were compared to each other and to the target costs of the Diagnosis Related Groups for public hospitals (Groupes Homogènes de Séjours [GHS]) concerned, extracted from the analytic accounting data of the French National Cost Study (Étude Nationale des Coûts [ENC]) for 2009 (target=sum of sterilization costs posted under medical logistics, consumables, implantable medical devices, and special pharmaceuticals posted as direct expenses). For outpatient lens surgery with or without vitrectomy (GHS code: 02C05J): the ENC's target cost for 2009 was 339€ out of a total of 1432€. The cost detailed in this study was 4 % higher than the target cost when the procedure was performed using the former technique (3.2mm sutured incision) and 12 % lower when the procedure was performed using the new technique (1.8mm sutureless) after removing now unnecessary consumables and optimization of the technique. For level I retinal detachment surgeries (GHS code: 02C021): the ENC's 2009 target cost was 641€ out of a total of 3091€. The cost specified in this study was 1 % lower than the target cost when the procedure was done using the former technique (20-G vitrectomy) and 16 % less when the procedure was performed using the new technique (transconjunctival vitrectomy) after removal of now unnecessary consumables and optimization of the technique. Contrary to generally accepted ideas, implementing modern techniques in ocular surgery can result in direct cost and sterilization savings when the operator takes advantage of the possibilities these techniques offer in terms of simplification of the procedures to do away with consumables that are no longer necessary. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

CPR: Key to Cardiac Consciousness?

ERIC Educational Resources Information Center

Hyner, Gerald C.; Box, Colin E.

1980-01-01

Recommendations are made for improving certification standards for programs providing training in cardiopulmonary resuscitation (CPR). Training techniques, cost effectiveness, and teachers for CPR programs are discussed. (JD)

A review of phytoremediation technology: heavy metals uptake by plants

NASA Astrophysics Data System (ADS)

Sumiahadi, A.; Acar, R.

2018-03-01

Heavy metal is one of the serious environmental pollutions for now days as impact of industrial development in several countries. Heavy metals give toxic effects on human health and cause several serious diseases. Several techniques have been using for removing heavy metal contaminants from the environmental but these techniques have limitations such as high cost, long time, logistical problems and mechanical complexity. Phytoremediation can be used as an alternative solution for heavy metal remediation process because of its advantages as a cost-effective, efficient, environment- and eco-friendly technology based on the use of metal-accumulating plants. According to previous studies, several plants have a high potential as heavy metals bioaccumulator and can be used for phytoremediation process of heavy metals.

Is minimal access spine surgery more cost-effective than conventional spine surgery?

PubMed

Lubelski, Daniel; Mihalovich, Kathryn E; Skelly, Andrea C; Fehlings, Michael G; Harrop, James S; Mummaneni, Praveen V; Wang, Michael Y; Steinmetz, Michael P

2014-10-15

Systematic review. To summarize and critically review the economic literature evaluating the cost-effectiveness of minimal access surgery (MAS) compared with conventional open procedures for the cervical and lumbar spine. MAS techniques may improve perioperative parameters (length of hospital stay and extent of blood loss) compared with conventional open approaches. However, some have questioned the clinical efficacy of these differences and the associated cost-effectiveness implications. When considering the long-term outcomes, there seem to be no significant differences between MAS and open surgery. PubMed, EMBASE, the Cochrane Collaboration database, University of York, Centre for Reviews and Dissemination (NHS-EED and HTA), and the Tufts CEA Registry were reviewed to identify full economic studies comparing MAS with open techniques prior to December 24, 2013, based on the key questions established a priori. Only economic studies that evaluated and synthesized the costs and consequences of MAS compared with conventional open procedures (i.e., cost-minimization, cost-benefit, cost-effectiveness, or cost-utility) were considered for inclusion. Full text of the articles meeting inclusion criteria were reviewed by 2 independent investigators to obtain the final collection of included studies. The Quality of Health Economic Studies instrument was scored by 2 independent reviewers to provide an initial basis for critical appraisal of included economic studies. The search strategy yielded 198 potentially relevant citations, and 6 studies met the inclusion criteria, evaluating the costs and consequences of MAS versus conventional open procedures performed for the lumbar spine; no studies for the cervical spine met the inclusion criteria. Studies compared MAS tubular discectomy with conventional microdiscectomy, minimal access transforaminal lumbar interbody fusion versus open transforaminal lumbar interbody fusion, and multilevel hemilaminectomy via MAS versus open approach. Overall, the included cost-effectiveness studies generally supported no significant differences between open surgery and MAS lumbar approaches. However, these conclusions are preliminary because there was a paucity of high-quality evidence. Much of the evidence lacked details on methodology for modeling, related assumptions, justification of economic model chosen, and sources and types of included costs and consequences. The follow-up periods were highly variable, indirect costs were not frequently analyzed or reported, and many of the studies were conducted by a single group, thereby limiting generalizability. Prospective studies are needed to define differences and optimal treatment algorithms. 3.

Performance-based, cost- and time-effective pcb analytical methodology.

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

Alvarado, J. S.

1998-06-11

Laboratory applications for the analysis of PCBs (polychlorinated biphenyls) in environmental matrices such as soil/sediment/sludge and oil/waste oil were evaluated for potential reduction in waste, source reduction, and alternative techniques for final determination. As a consequence, new procedures were studied for solvent substitution, miniaturization of extraction and cleanups, minimization of reagent consumption, reduction of cost per analysis, and reduction of time. These new procedures provide adequate data that meet all the performance requirements for the determination of PCBs. Use of the new procedures reduced costs for all sample preparation techniques. Time and cost were also reduced by combining the newmore » sample preparation procedures with the power of fast gas chromatography. Separation of Aroclor 1254 was achieved in less than 6 min by using DB-1 and SPB-608 columns. With the greatly shortened run times, reproducibility can be tested quickly and consequently with low cost. With performance-based methodology, the applications presented here can be applied now, without waiting for regulatory approval.« less

Kinetic Super-Resolution Long-Wave Infrared (KSR LWIR) Thermography Diagnostic for Building Envelopes: Camp Lejeune, NC

DTIC Science & Technology

2015-08-18

of Defense (DoD) to achieve cost-effective energy efficiency at much greater scale than other commercially available techniques of measuring energy...recommends specific energy conservation measures (ECMs), and quantifies significant potential return on investment. ERDC/CERL TR-15-18 iii...effective energy efficiency at much greater scale than other commercially available techniques of measuring energy loss due to envelope inefficien- cies

Evaluation of a cost-effective loads approach. [shock spectra/impedance method for Viking Orbiter

NASA Technical Reports Server (NTRS)

Garba, J. A.; Wada, B. K.; Bamford, R.; Trubert, M. R.

1976-01-01

A shock spectra/impedance method for loads predictions is used to estimate member loads for the Viking Orbiter, a 7800-lb interplanetary spacecraft that has been designed using transient loads analysis techniques. The transient loads analysis approach leads to a lightweight structure but requires complex and costly analyses. To reduce complexity and cost, a shock spectra/impedance method is currently being used to design the Mariner Jupiter Saturn spacecraft. This method has the advantage of using low-cost in-house loads analysis techniques and typically results in more conservative structural loads. The method is evaluated by comparing the increase in Viking member loads to the loads obtained by the transient loads analysis approach. An estimate of the weight penalty incurred by using this method is presented. The paper also compares the calculated flight loads from the transient loads analyses and the shock spectra/impedance method to measured flight data.

Evaluation of a cost-effective loads approach. [for Viking Orbiter light weight structural design

NASA Technical Reports Server (NTRS)

Garba, J. A.; Wada, B. K.; Bamford, R.; Trubert, M. R.

1976-01-01

A shock spectra/impedance method for loads prediction is used to estimate member loads for the Viking Orbiter, a 7800-lb interplanetary spacecraft that has been designed using transient loads analysis techniques. The transient loads analysis approach leads to a lightweight structure but requires complex and costly analyses. To reduce complexity and cost a shock spectra/impedance method is currently being used to design the Mariner Jupiter Saturn spacecraft. This method has the advantage of using low-cost in-house loads analysis techniques and typically results in more conservative structural loads. The method is evaluated by comparing the increase in Viking member loads to the loads obtained by the transient loads analysis approach. An estimate of the weight penalty incurred by using this method is presented. The paper also compares the calculated flight loads from the transient loads analyses and the shock spectra/impedance method to measured flight data.

Evaluation of trade-offs in costs and environmental impacts for returnable packaging implementation

NASA Astrophysics Data System (ADS)

Jarupan, Lerpong; Kamarthi, Sagar V.; Gupta, Surendra M.

2004-02-01

The main thrust of returnable packaging these days is to provide logistical services through transportation and distribution of products and be environmentally friendly. Returnable packaging and reverse logistics concepts have converged to mitigate the adverse effect of packaging materials entering the solid waste stream. Returnable packaging must be designed by considering the trade-offs between costs and environmental impact to satisfy manufacturers and environmentalists alike. The cost of returnable packaging entails such items as materials, manufacturing, collection, storage and disposal. Environmental impacts are explicitly linked with solid waste, air pollution, and water pollution. This paper presents a multi-criteria evaluation technique to assist decision-makers for evaluating the trade-offs in costs and environmental impact during the returnable packaging design process. The proposed evaluation technique involves a combination of multiple objective integer linear programming and analytic hierarchy process. A numerical example is used to illustrate the methodology.

Cost-Effectiveness of Procedures for Treatment of Ostium Secundum Atrial Septal Defects Occlusion Comparing Conventional Surgery and Septal Percutaneous Implant

PubMed Central

da Costa, Márcia Gisele Santos; Santos, Marisa da Silva; Sarti, Flávia Mori; Senna, Kátia Marie Simões e.; Tura, Bernardo Rangel; Goulart, Marcelo Correia

2014-01-01

Objectives The study performs a cost-effectiveness analysis of procedures for atrial septal defects occlusion, comparing conventional surgery to septal percutaneous implant. Methods A model of analytical decision was structured with symmetric branches to estimate cost-effectiveness ratio between the procedures. The decision tree model was based on evidences gathered through meta-analysis of literature, and validated by a panel of specialists. The lower number of surgical procedures performed for atrial septal defects occlusion at each branch was considered as the effectiveness outcome. Direct medical costs and probabilities for each event were inserted in the model using data available from Brazilian public sector database system and information extracted from the literature review, using micro-costing technique. Sensitivity analysis included price variations of percutaneous implant. Results The results obtained from the decision model demonstrated that the percutaneous implant was more cost effective in cost-effectiveness analysis at a cost of US$8,936.34 with a reduction in the probability of surgery occurrence in 93% of the cases. Probability of atrial septal communication occlusion and cost of the implant are the determinant factors of cost-effectiveness ratio. Conclusions The proposal of a decision model seeks to fill a void in the academic literature. The decision model proposed includes the outcomes that present major impact in relation to the overall costs of the procedure. The atrial septal defects occlusion using percutaneous implant reduces the physical and psychological distress to the patients in relation to the conventional surgery, which represent intangible costs in the context of economic evaluation. PMID:25302806

Cost-effectiveness of procedures for treatment of ostium secundum atrial septal defects occlusion comparing conventional surgery and septal percutaneous implant.

PubMed

da Costa, Márcia Gisele Santos; Santos, Marisa da Silva; Sarti, Flávia Mori; Simões e Senna, Kátia Marie; Tura, Bernardo Rangel; Correia, Marcelo Goulart; Goulart, Marcelo Correia

2014-01-01

The study performs a cost-effectiveness analysis of procedures for atrial septal defects occlusion, comparing conventional surgery to septal percutaneous implant. A model of analytical decision was structured with symmetric branches to estimate cost-effectiveness ratio between the procedures. The decision tree model was based on evidences gathered through meta-analysis of literature, and validated by a panel of specialists. The lower number of surgical procedures performed for atrial septal defects occlusion at each branch was considered as the effectiveness outcome. Direct medical costs and probabilities for each event were inserted in the model using data available from Brazilian public sector database system and information extracted from the literature review, using micro-costing technique. Sensitivity analysis included price variations of percutaneous implant. The results obtained from the decision model demonstrated that the percutaneous implant was more cost effective in cost-effectiveness analysis at a cost of US$8,936.34 with a reduction in the probability of surgery occurrence in 93% of the cases. Probability of atrial septal communication occlusion and cost of the implant are the determinant factors of cost-effectiveness ratio. The proposal of a decision model seeks to fill a void in the academic literature. The decision model proposed includes the outcomes that present major impact in relation to the overall costs of the procedure. The atrial septal defects occlusion using percutaneous implant reduces the physical and psychological distress to the patients in relation to the conventional surgery, which represent intangible costs in the context of economic evaluation.

Data on electrical energy conservation using high efficiency motors for the confidence bounds using statistical techniques.

PubMed

Shaikh, Muhammad Mujtaba; Memon, Abdul Jabbar; Hussain, Manzoor

2016-09-01

In this article, we describe details of the data used in the research paper "Confidence bounds for energy conservation in electric motors: An economical solution using statistical techniques" [1]. The data presented in this paper is intended to show benefits of high efficiency electric motors over the standard efficiency motors of similar rating in the industrial sector of Pakistan. We explain how the data was collected and then processed by means of formulas to show cost effectiveness of energy efficient motors in terms of three important parameters: annual energy saving, cost saving and payback periods. This data can be further used to construct confidence bounds for the parameters using statistical techniques as described in [1].

Marginal cost curves for water footprint reduction in irrigated agriculture: guiding a cost-effective reduction of crop water consumption to a permit or benchmark level

NASA Astrophysics Data System (ADS)

Chukalla, Abebe D.; Krol, Maarten S.; Hoekstra, Arjen Y.

2017-07-01

Reducing the water footprint (WF) of the process of growing irrigated crops is an indispensable element in water management, particularly in water-scarce areas. To achieve this, information on marginal cost curves (MCCs) that rank management packages according to their cost-effectiveness to reduce the WF need to support the decision making. MCCs enable the estimation of the cost associated with a certain WF reduction target, e.g. towards a given WF permit (expressed in m3  ha-1 per season) or to a certain WF benchmark (expressed in m3  t-1 of crop). This paper aims to develop MCCs for WF reduction for a range of selected cases. AquaCrop, a soil-water-balance and crop-growth model, is used to estimate the effect of different management packages on evapotranspiration and crop yield and thus the WF of crop production. A management package is defined as a specific combination of management practices: irrigation technique (furrow, sprinkler, drip or subsurface drip); irrigation strategy (full or deficit irrigation); and mulching practice (no, organic or synthetic mulching). The annual average cost for each management package is estimated as the annualized capital cost plus the annual costs of maintenance and operations (i.e. costs of water, energy and labour). Different cases are considered, including three crops (maize, tomato and potato); four types of environment (humid in UK, sub-humid in Italy, semi-arid in Spain and arid in Israel); three hydrologic years (wet, normal and dry years) and three soil types (loam, silty clay loam and sandy loam). For each crop, alternative WF reduction pathways were developed, after which the most cost-effective pathway was selected to develop the MCC for WF reduction. When aiming at WF reduction one can best improve the irrigation strategy first, next the mulching practice and finally the irrigation technique. Moving from a full to deficit irrigation strategy is found to be a no-regret measure: it reduces the WF by reducing water consumption at negligible yield reduction while reducing the cost for irrigation water and the associated costs for energy and labour. Next, moving from no to organic mulching has a high cost-effectiveness, reducing the WF significantly at low cost. Finally, changing from sprinkler or furrow to drip or subsurface drip irrigation reduces the WF, but at a significant cost.

The threshold rate of oral atypical anti-psychotic adherence at which paliperidone palmitate is cost saving.

PubMed

Edwards, Natalie C; Muser, Erik; Doshi, Dilesh; Fastenau, John

2012-01-01

To identify, estimate, and compare 'real world' costs and outcomes associated with paliperidone palmitate compared with branded oral atypical anti-psychotics, and to estimate the threshold rate of oral atypical adherence at which paliperidone palmitate is cost saving. Decision analytic modeling techniques developed by Glazer and Ereshefsky have previously been used to estimate the cost-effectiveness of depot haloperidol, LAI risperidone, and, more recently, LAI olanzapine. This study used those same techniques, along with updated comparative published clinical data, to evaluate paliperidone palmitate. Adherence rates were based on strict Medication Event Monitoring System (MEMS) criteria. The evaluation was conducted from the perspective of US healthcare payers. Paliperidone palmitate patients had fewer mean annual days of relapse (8.7 days; 6.0 requiring hospitalization, 2.7 not requiring hospitalization vs 17.8 days; 12.4 requiring hospitalization, 5.4 not requiring hospitalization), and lower annual total cost ($20,995) compared to oral atypicals (mean $22,481). Because paliperidone palmitate was both more effective and less costly, it is considered economically dominant. Paliperidone palmitate saved costs when the rate of adherence of oral atypical anti-psychotics was below 44.9% using strict MEMS criteria. Sensitivity analyses showed results were robust to changes in parameter values. For patients receiving 156 mg paliperidone palmitate, the annual incremental cost was $1216 per patient (ICER = $191 per day of relapse averted). Inclusion of generic risperidone (market share 18.6%) also resulted in net incremental cost for paliperidone palmitate ($120; ICER = $13). Limitations of this evaluation include use of simplifying assumptions, data from multiple sources, and generalizability of results. Although uptake of LAIs in the US has not been as rapid as elsewhere, many thought leaders emphasize their importance in optimizing outcomes in patients with adherence problems. The findings of this analysis support the cost-effectiveness of paliperidone palmitate in these patients.

Optimal systems of geoscience surveying A preliminary discussion

NASA Astrophysics Data System (ADS)

Shoji, Tetsuya

2006-10-01

In any geoscience survey, each survey technique must be effectively applied, and many techniques are often combined optimally. An important task is to get necessary and sufficient information to meet the requirement of the survey. A prize-penalty function quantifies effectiveness of the survey, and hence can be used to determine the best survey technique. On the other hand, an information-cost function can be used to determine the optimal combination of survey techniques on the basis of the geoinformation obtained. Entropy is available to evaluate geoinformation. A simple model suggests the possibility that low-resolvability techniques are generally applied at early stages of survey, and that higher-resolvability techniques should alternate with lower-resolvability ones with the progress of the survey.

Myocardial perfusion scintigraphy: the evidence

PubMed Central

Anagnostopoulos, C.; Cerqueira, M.; Ell, P. J.; Flint, E. J.; Harbinson, M.; Kelion, A. D.; Al-Mohammad, A.; Prvulovich, E. M.; Shaw, L. J.; Tweddel, A. C.

2003-01-01

This review summarises the evidence for the role of myocardial perfusion scintigraphy (MPS) in patients with known or suspected coronary artery disease. It is the product of a consensus conference organised by the British Cardiac Society, the British Nuclear Cardiology Society and the British Nuclear Medicine Society and is endorsed by the Royal College of Physicians of London and the Royal College of Radiologists. It was used to inform the UK National Institute of Clinical Excellence in their appraisal of MPS in patients with chest pain and myocardial infarction. MPS is a well-established, non-invasive imaging technique with a large body of evidence to support its effectiveness in the diagnosis and management of angina and myocardial infarction. It is more accurate than the exercise ECG in detecting myocardial ischaemia and it is the single most powerful technique for predicting future coronary events. The high diagnostic accuracy of MPS allows reliable risk stratification and guides the selection of patients for further interventions, such as revascularisation. This in turn allows more appropriate utilisation of resources, with the potential for both improved clinical outcomes and greater cost-effectiveness. Evidence from modelling and observational studies supports the enhanced cost-effectiveness associated with MPS use. In patients presenting with stable or acute chest pain, strategies of investigation involving MPS are more cost-effective than those not using the technique. MPS also has particular advantages over alternative techniques in the management of a number of patient subgroups, including women, the elderly and those with diabetes, and its use will have a favourable impact on cost-effectiveness in these groups. MPS is already an integral part of many clinical guidelines for the investigation and management of angina and myocardial infarction. However, the technique is underutilised in the UK, as judged by the inappropriately long waiting times and by comparison with the numbers of revascularisations and coronary angiograms performed. Furthermore, MPS activity levels in this country fall far short of those in comparable European countries, with about half as many scans being undertaken per year. Currently, the number of MPS studies performed annually in the UK is 1,200/million population/year. We estimate the real need to be 4,000/million/year. The current average waiting time is 20 weeks and we recommend that clinically appropriate upper limits of waiting time are 6 weeks for routine studies and 1 week for urgent studies. PMID:15129710

A cost-effectiveness analysis of propofol versus midazolam for procedural sedation in the emergency department.

PubMed

Hohl, Corinne Michèle; Nosyk, Bohdan; Sadatsafavi, Mohsen; Anis, Aslam Hayat

2008-01-01

To determine the incremental cost-effectiveness of using propofol versus midazolam for procedural sedation (PS) in adults in the emergency department (ED). The authors conducted a cost-effectiveness analysis from the perspective of the health care provider. The primary outcome was the incremental cost (or savings) to achieve one additional successful sedation with propofol compared to midazolam. A decision model was developed in which the clinical effectiveness and cost of a PS strategy using either agent was estimated. The authors derived estimates of clinical effectiveness and risk of adverse events (AEs) from a systematic review. The cost of each clinical outcome was determined by incorporating the baseline cost of the ED visit, the cost of the drug, the cost of labor of physicians and nurses, the cost and probability of an AE, and the cost and probability of a PS failure. A standard meta-analytic technique was used to calculate the weighted mean difference in recovery times and obtain mean drug doses from patient-level data from a randomized controlled trial. Probabilistic sensitivity analyses were conducted to examine the uncertainty around the estimated incremental cost-effectiveness ratio using Monte Carlo simulation. Choosing a sedation strategy with propofol resulted in average savings of $17.33 (95% confidence interval [CI] = $24.13 to $10.44) per sedation performed. This resulted in an incremental cost-effectiveness ratio of -$597.03 (95% credibility interval -$6,434.03 to $6,113.57) indicating savings of $597.03 per additional successful sedation performed with propofol. This result was driven by shorter recovery times and was robust to all sensitivity analyses performed. These results indicate that using propofol for PS in the ED is a cost-saving strategy.

Use of ground-penetrating radar techniques in archaeological investigations

NASA Technical Reports Server (NTRS)

Doolittle, James A.; Miller, W. Frank

1991-01-01

Ground-penetrating radar (GPR) techniques are increasingly being used to aid reconnaissance and pre-excavation surveys at many archaeological sites. As a 'remote sensing' tool, GPR provides a high resolution graphic profile of the subsurface. Radar profiles are used to detect, identify, and locate buried artifacts. Ground-penetrating radar provides a rapid, cost effective, and nondestructive method for identification and location analyses. The GPR can be used to facilitate excavation strategies, provide greater areal coverage per unit time and cost, minimize the number of unsuccessful exploratory excavations, and reduce unnecessary or unproductive expenditures of time and effort.

Identification of cost effective energy conservation measures

NASA Technical Reports Server (NTRS)

Bierenbaum, H. S.; Boggs, W. H.

1978-01-01

In addition to a successful program of readily implemented conservation actions for reducing building energy consumption at Kennedy Space Center, recent detailed analyses have identified further substantial savings for buildings representative of technical facilities designed when energy costs were low. The techniques employed for determination of these energy savings consisted of facility configuration analysis, power and lighting measurements, detailed computer simulations and simulation verifications. Use of these methods resulted in identification of projected energy savings as large as $330,000 a year (approximately two year break-even period) in a single building. Application of these techniques to other commercial buildings is discussed

Taking ART to Scale: Determinants of the Cost and Cost-Effectiveness of Antiretroviral Therapy in 45 Clinical Sites in Zambia

PubMed Central

Marseille, Elliot; Giganti, Mark J.; Mwango, Albert; Chisembele-Taylor, Angela; Mulenga, Lloyd; Over, Mead; Kahn, James G.; Stringer, Jeffrey S. A.

2012-01-01

Background We estimated the unit costs and cost-effectiveness of a government ART program in 45 sites in Zambia supported by the Centre for Infectious Disease Research Zambia (CIDRZ). Methods We estimated per person-year costs at the facility level, and support costs incurred above the facility level and used multiple regression to estimate variation in these costs. To estimate ART effectiveness, we compared mortality in this Zambian population to that of a cohort of rural Ugandan HIV patients receiving co-trimoxazole (CTX) prophylaxis. We used micro-costing techniques to estimate incremental unit costs, and calculated cost-effectiveness ratios with a computer model which projected results to 10 years. Results The program cost $69.7 million for 125,436 person-years of ART, or $556 per ART-year. Compared to CTX prophylaxis alone, the program averted 33.3 deaths or 244.5 disability adjusted life-years (DALYs) per 100 person-years of ART. In the base-case analysis, the net cost per DALY averted was $833 compared to CTX alone. More than two-thirds of the variation in average incremental total and on-site cost per patient-year of treatment is explained by eight determinants, including the complexity of the patient-case load, the degree of adherence among the patients, and institutional characteristics including, experience, scale, scope, setting and sector. Conclusions and Significance The 45 sites exhibited substantial variation in unit costs and cost-effectiveness and are in the mid-range of cost-effectiveness when compared to other ART programs studied in southern Africa. Early treatment initiation, large scale, and hospital setting, are associated with statistically significantly lower costs, while others (rural location, private sector) are associated with shifting cost from on- to off-site. This study shows that ART programs can be significantly less costly or more cost-effective when they exploit economies of scale and scope, and initiate patients at higher CD4 counts. PMID:23284843

Taking ART to scale: determinants of the cost and cost-effectiveness of antiretroviral therapy in 45 clinical sites in Zambia.

PubMed

Marseille, Elliot; Giganti, Mark J; Mwango, Albert; Chisembele-Taylor, Angela; Mulenga, Lloyd; Over, Mead; Kahn, James G; Stringer, Jeffrey S A

2012-01-01

We estimated the unit costs and cost-effectiveness of a government ART program in 45 sites in Zambia supported by the Centre for Infectious Disease Research Zambia (CIDRZ). We estimated per person-year costs at the facility level, and support costs incurred above the facility level and used multiple regression to estimate variation in these costs. To estimate ART effectiveness, we compared mortality in this Zambian population to that of a cohort of rural Ugandan HIV patients receiving co-trimoxazole (CTX) prophylaxis. We used micro-costing techniques to estimate incremental unit costs, and calculated cost-effectiveness ratios with a computer model which projected results to 10 years. The program cost $69.7 million for 125,436 person-years of ART, or $556 per ART-year. Compared to CTX prophylaxis alone, the program averted 33.3 deaths or 244.5 disability adjusted life-years (DALYs) per 100 person-years of ART. In the base-case analysis, the net cost per DALY averted was $833 compared to CTX alone. More than two-thirds of the variation in average incremental total and on-site cost per patient-year of treatment is explained by eight determinants, including the complexity of the patient-case load, the degree of adherence among the patients, and institutional characteristics including, experience, scale, scope, setting and sector. The 45 sites exhibited substantial variation in unit costs and cost-effectiveness and are in the mid-range of cost-effectiveness when compared to other ART programs studied in southern Africa. Early treatment initiation, large scale, and hospital setting, are associated with statistically significantly lower costs, while others (rural location, private sector) are associated with shifting cost from on- to off-site. This study shows that ART programs can be significantly less costly or more cost-effective when they exploit economies of scale and scope, and initiate patients at higher CD4 counts.

A cost-effectiveness analysis of school-based suicide prevention programmes.

PubMed

Ahern, Susan; Burke, Lee-Ann; McElroy, Brendan; Corcoran, Paul; McMahon, Elaine M; Keeley, Helen; Carli, Vladimir; Wasserman, Camilla; Hoven, Christina W; Sarchiapone, Marco; Apter, Alan; Balazs, Judit; Banzer, Raphaela; Bobes, Julio; Brunner, Romuald; Cosman, Doina; Haring, Christian; Kaess, Michael; Kahn, Jean-Pierre; Kereszteny, Agnes; Postuvan, Vita; Sáiz, Pilar A; Varnik, Peeter; Wasserman, Danuta

2018-02-14

Suicide is one of the leading causes of death among young people globally. In light of emerging evidence supporting the effectiveness of school-based suicide prevention programmes, an analysis of cost-effectiveness is required. We aimed to conduct a full cost-effectiveness analysis (CEA) of the large pan-European school-based RCT, Saving and Empowering Young Lives in Europe (SEYLE). The health outcomes of interest were suicide attempt and severe suicidal ideation with suicide plans. Adopting a payer's perspective, three suicide prevention interventions were modelled with a Control over a 12-month time period. Incremental cost-effectiveness ratios (ICERs) indicate that the Youth Aware of Mental Health (YAM) programme has the lowest incremental cost per 1% point reduction in incident for both outcomes and per quality adjusted life year (QALY) gained versus the Control. The ICERs reported for YAM were €34.83 and €45.42 per 1% point reduction in incident suicide attempt and incident severe suicidal ideation, respectively, and a cost per QALY gained of €47,017 for suicide attempt and €48,216 for severe suicidal ideation. Cost-effectiveness acceptability curves were used to examine uncertainty in the QALY analysis, where cost-effectiveness probabilities were calculated using net monetary benefit analysis incorporating a two-stage bootstrapping technique. For suicide attempt, the probability that YAM was cost-effective at a willingness to pay of €47,000 was 39%. For severe suicidal ideation, the probability that YAM was cost-effective at a willingness to pay of €48,000 was 43%. This CEA supports YAM as the most cost-effective of the SEYLE interventions in preventing both a suicide attempt and severe suicidal ideation.Trial registration number DRKS00000214.

Fabricating Structural Stiffeners By Superplastic Forming

NASA Technical Reports Server (NTRS)

Bales, Thomas T.; Shinn, Joseph M., Jr.; Hales, Stephen J.; James, William F.

1994-01-01

Superplastic forming (SPF) of aluminum alloys effective technique for making strong, lightweight structural components conforming to close dimensional tolerances. Technique applied in experimental fabrication of prototypes of stiffening ribs for cylindrical tanks. When making structural panel, stiffening ribs spot-welded to metal skin. Use of discrete eliminates machining waste, and use of SPF. Cost of fabrication reduced.

Techniques for assessing extramarket values

Treesearch

Donald F. Dennis

1995-01-01

Central to effective policy development and management of natural resources is an understanding of the trade-offs stakeholders are willing to accept and the values they hold. Although market prices reflect society's preferences to some degree, they clearly do not encompass all values or costs. Conjoint techniques offer a means to estimate and analyze stakeholder...

Occupational Analysis Technology: Expanded Role in Development of Cost-Effective Maintenance Systems. Final Report.

ERIC Educational Resources Information Center

Foley, John P., Jr.

A study was conducted to refine and coordinate occupational analysis, job performance aids, and elements of the instructional systems development process for task specific Air Force maintenance training. Techniques for task identification and analysis (TI & A) and data gathering techniques for occupational analysis were related. While TI &…

Asphalt Pavements Session 2E-3 : Warm Mix Asphalt : Laboratory Evaluation and Pavement Design [SD .WMV (720x480/29fps/218.0 MB)

DOT National Transportation Integrated Search

2003-12-01

This study evaluates one of the recycling techniques used to rehabilitate pavement, called Cold In-Place Recycling (CIR). CIR is one of the fastest growing road rehabilitation techniques because it is quick and cost-effective. The document reports on...

UMEL: a new regression tool to identify measurement peaks in LIDAR/DIAL systems for environmental physics applications.

PubMed

Gelfusa, M; Gaudio, P; Malizia, A; Murari, A; Vega, J; Richetta, M; Gonzalez, S

2014-06-01

Recently, surveying large areas in an automatic way, for early detection of both harmful chemical agents and forest fires, has become a strategic objective of defence and public health organisations. The Lidar and Dial techniques are widely recognized as a cost-effective alternative to monitor large portions of the atmosphere. To maximize the effectiveness of the measurements and to guarantee reliable monitoring of large areas, new data analysis techniques are required. In this paper, an original tool, the Universal Multi Event Locator, is applied to the problem of automatically identifying the time location of peaks in Lidar and Dial measurements for environmental physics applications. This analysis technique improves various aspects of the measurements, ranging from the resilience to drift in the laser sources to the increase of the system sensitivity. The method is also fully general, purely software, and can therefore be applied to a large variety of problems without any additional cost. The potential of the proposed technique is exemplified with the help of data of various instruments acquired during several experimental campaigns in the field.

Near-Neighbor Algorithms for Processing Bearing Data

DTIC Science & Technology

1989-05-10

neighbor algorithms need not be universally more cost -effective than brute force methods. While the data access time of near-neighbor techniques scales with...the number of objects N better than brute force, the cost of setting up the data structure could scale worse than (Continues) 20...for the near neighbors NN2 1 (i). Depending on the particular NN algorithm, the cost of accessing near neighbors for each ai E S1 scales as either N

Cost analysis of hospital material management systems.

PubMed

Egbelu, P J; Harmonosky, C M; Ventura, J A; O'Brien, W E; Sommer, H J

1998-01-01

Integrated healthcare material management begins with manufactures of medical/surgical supplies, uses distributors and ends at the point of use at hospitals. Recent material management philosophies in the healthcare industry, such as just-in-time and stockless systems, are yet to be fully evaluated. In order to evaluate the cost effectiveness of each type of material management technique, a cost model for hospital materials management has been designed. Several case scenarios are analyzed and results are reported.

Remote Sensing of Aquatic Plants.

DTIC Science & Technology

1979-10-01

remote sensing methods for identification and assessment of expanses of aquatic plants. Both materials and techniques are examined for cost effectiveness and capability to sense aquatic plants on both the local and regional scales. Computer simulation of photographic responses was employed; Landsat, high-altitude photography, side-looking airborne radar, and low-altitude photography were examined to determine the capabilities of each for identifying and assessing aquatic plants. Results of the study revealed Landsat to be the most cost effective for regional surveys,

[Cost-effectiveness analysis of renal replacement therapies: how should we design research on these interventions in Brazil?].

PubMed

Sancho, Leyla Gomes; Dain, Sulamis

2008-06-01

This study aims to contribute to the discussion on the possibility of applying health economics assessment, specifically the cost-effectiveness technique, to renal replacement therapies for end-stage renal failure. A review was conducted on the interventions and their alternative courses from the perspective of the various methodological proposals in the literature, considering the availability of data and information in Brazil to back this type of research.

Smear plus Detect-TB for a sensitive diagnosis of pulmonary tuberculosis: a cost-effectiveness analysis in an incarcerated population.

PubMed

Schmid, Karen Barros; Scherer, Luciene; Barcellos, Regina Bones; Kuhleis, Daniele; Prestes, Isaías Valente; Steffen, Ricardo Ewbank; Dalla Costa, Elis Regina; Rossetti, Maria Lucia Rosa

2014-12-16

Prison conditions can favor the spread of tuberculosis (TB). This study aimed to evaluate in a Brazilian prison: the performance and accuracy of smear, culture and Detect-TB; performance of smear plus culture and smear plus Detect-TB, according to different TB prevalence rates; and the cost-effectiveness of these procedures for pulmonary tuberculosis (PTB) diagnosis. This paper describes a cost-effectiveness study. A decision analytic model was developed to estimate the costs and cost-effectiveness of five routine diagnostic procedures for diagnosis of PTB using sputum specimens: a) Smear alone, b) Culture alone, c) Detect-TB alone, d) Smear plus culture and e) Smear plus Detect-TB. The cost-effectiveness ratio of costs were evaluated per correctly diagnosed TB case and all procedures costs were attributed based on the procedure costs adopted by the Brazilian Public Health System. A total of 294 spontaneous sputum specimens from patients suspected of having TB were analyzed. The sensibility and specificity were calculated to be 47% and 100% for smear; 93% and 100%, for culture; 74% and 95%, for Detect-TB; 96% and 100%, for smear plus culture; and 86% and 95%, for smear plus Detect-TB. The negative and positive predictive values for smear plus Detect-TB, according to different TB prevalence rates, ranged from 83 to 99% and 48 to 96%, respectively. In a cost-effectiveness analysis, smear was both less costly and less effective than the other strategies. Culture and smear plus culture were more effective but more costly than the other strategies. Smear plus Detect-TB was the most cost-effective method. The Detect-TB evinced to be sensitive and effective for the PTB diagnosis when applied with smear microscopy. Diagnostic methods should be improved to increase TB case detection. To support rational decisions about the implementation of such techniques, cost-effectiveness studies are essential, including in prisons, which are known for health care assessment problems.

Plasmonic SERS nanochips and nanoprobes for medical diagnostics and bio-energy applications

NASA Astrophysics Data System (ADS)

Ngo, Hoan T.; Wang, Hsin-Neng; Crawford, Bridget M.; Fales, Andrew M.; Vo-Dinh, Tuan

2017-02-01

The development of rapid, easy-to-use, cost-effective, high accuracy, and high sensitive DNA detection methods for molecular diagnostics has been receiving increasing interest. Over the last five years, our laboratory has developed several chip-based DNA detection techniques including the molecular sentinel-on-chip (MSC), the multiplex MSC, and the inverse molecular sentinel-on-chip (iMS-on-Chip). In these techniques, plasmonic surface-enhanced Raman scattering (SERS) Nanowave chips were functionalized with DNA probes for single-step DNA detection. Sensing mechanisms were based on hybridization of target sequences and DNA probes, resulting in a distance change between SERS reporters and the Nanowave chip's gold surface. This distance change resulted in change in SERS intensity, thus indicating the presence and capture of the target sequences. Our techniques were single-step DNA detection techniques. Target sequences were detected by simple delivery of sample solutions onto DNA probe-functionalized Nanowave chips and SERS signals were measured after 1h - 2h incubation. Target sequence labeling or washing to remove unreacted components was not required, making the techniques simple, easy-to-use, and cost effective. The usefulness of the techniques for medical diagnostics was illustrated by the detection of genetic biomarkers for respiratory viral infection and of dengue virus 4 DNA.

Impact of pig insemination technique and semen preparation on profitability.

PubMed

Gonzalez-Peña, D; Knox, R V; Pettigrew, J; Rodriguez-Zas, S L

2014-01-01

Artificial insemination technique and semen preparation impact boar utilization efficiency, genetic dissemination, and biosecurity. Intrauterine (IUI) and deep intrauterine (DUI) AI techniques require lower number of spermatozoa per dose compared to conventional (CON) AI. Frozen semen (FRO) has been associated with lower reproductive performance compared to fresh semen (FRE) preparation. The combined effects of 3 AI techniques (CON, IUI, and DUI) and 2 semen preparations (FRE and FRO) on the financial indicators of a pig crossbreeding system were studied. A 3-tier system was simulated in ZPLAN and the genetic improvement in a representative scenario was characterized. The cross of nucleus lines B and A generated 200,000 BA sows at the multiplier level. The BA sows were inseminated (CON, IUI, or DUI) with FRE or FRO from line C boars at the commercial level. Semen preparation and AI technique were represented by distinct sow:boar ratios in the C × BA cross. A range of farrowing rates (60 to 90%) and litter sizes (8 to 14 liveborn pigs) were tested. Genetic improvement per year for number born alive, adjusted 21-d litter weight, days to 113.5 kg, backfat, and ADG were 0.01 pigs per litter, 0.06 kg, -0.09 d, -0.29 mm, and 0.88 g, respectively. On average, the net profit for FRE (FRO) increased (P-value < 0.0001) from CON to IUI and DUI by 2.2 (3.2%) and 2.6% (4%), respectively. The differences in profit between techniques were driven by differences in costs. Differences in fixed costs between IUI and DUI relative to CON were -2.4 (-5.2%) and -3.4% (-7.4%), respectively. The differences in total costs between FRE and FRO were lower than -5%. The difference in variable costs between FRE and FRO ranged from -5.3 (CON) to -24.7% (DUI). Overall, insemination technique and semen preparation had a nonlinear effect on profit. The average relative difference in profit between FRE and FRO was less than 3% for the scenarios studied.

Economic Evaluation of Frequent Home Nocturnal Hemodialysis Based on a Randomized Controlled Trial

PubMed Central

Tonelli, Marcello; Pauly, Robert; Walsh, Michael; Culleton, Bruce; So, Helen; Hemmelgarn, Brenda; Manns, Braden

2014-01-01

Provider and patient enthusiasm for frequent home nocturnal hemodialysis (FHNHD) has been renewed; however, the cost-effectiveness of this technique is unknown. We performed a cost-utility analysis of FHNHD compared with conventional hemodialysis (CvHD; 4 hours three times per week) from a health payer perspective over a lifetime horizon using patient information from the Alberta NHD randomized controlled trial. Costs, including training costs, were obtained using microcosting and administrative data (CAN$2012). We determined the incremental cost per quality-adjusted life year (QALY) gained. Robustness was assessed using scenario, sensitivity, and probabilistic sensitivity analyses. Compared with CvHD (61% in-center, 14% satellite, and 25% home dialysis), FHNHD led to incremental cost savings (−$6700) and an additional 0.38 QALYs. In sensitivity analyses, when the annual probability of technique failure with FHNHD increased from 7.6% (reference case) to ≥19%, FHNHD became unattractive (>$75,000/QALY). The cost/QALY gained became $13,000 if average training time for FHNHD increased from 3.7 to 6 weeks. In scenarios with alternate comparator modalities, FHNHD remained dominant compared with in-center CvHD; cost/QALYs gained were $18,500, $198,000, and $423,000 compared with satellite CvHD, home CvHD, and peritoneal dialysis, respectively. In summary, FHNHD is attractive compared with in-center CvHD in this cohort. However, the attractiveness of FHNHD varies by technique failure rate, training time, and dialysis modalities from which patients are drawn, and these variables should be considered when establishing FHNHD programs. PMID:24231665

Immediate costs of mini-open versus arthroscopic rotator cuff repair in an Asian population.

PubMed

Hui, Yik Jing; Teo, Alex Quok An; Sharma, Siddharth; Tan, Bryan Hsi Ming; Kumar, V Prem

2017-01-01

While there has been increasing interest in minimally invasive surgery, the expenses incurred by patients undergoing this form of surgery have not been comprehensively studied. The authors compared the costs borne by patients undergoing arthroscopic rotator cuff repair with the standard mini-open repair at a tertiary hospital in an Asian population. This was a retrospective cohort study. The authors studied the inpatient hospital bills of patients following rotator cuff tear repair between January 2010 and October 2014 via the hospital electronic medical records system. 148 patients had arthroscopic repair and 78 had mini-open repair. The cost of implants, consumables, and the total cost of hospitalization were analyzed. Operative times and length of stay for both procedures were also studied. Constant scores and American Shoulder Elbow Scores (ASES) were recorded preoperatively and at 1 year postoperatively. Three fellowship-trained surgeons performed arthroscopic repairs and one performed the mini-open repair. The cost of implants and consumables was significantly higher with arthroscopic repair. The duration of surgery was also significantly longer with that technique. There was no difference in length of stay between the two techniques. There was also no difference in Constant scores or ASES scores, both preoperatively and at 1 year postoperatively. The immediate costs of mini-open repair of rotator cuff tears are significantly less than that of arthroscopic repair. Most of the difference arises from the cost of implants and consumables. Equivalent functional outcomes from both techniques suggest that mini-open repair may be more cost-effective.

Application of Rosenbrock search technique to reduce the drilling cost of a well in Bai-Hassan oil field

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

Aswad, Z.A.R.; Al-Hadad, S.M.S.

1983-03-01

The powerful Rosenbrock search technique, which optimizes both the search directions using the Gram-Schmidt procedure and the step size using the Fibonacci line search method, has been used to optimize the drilling program of an oil well drilled in Bai-Hassan oil field in Kirkuk, Iran, using the twodimensional drilling model of Galle and Woods. This model shows the effect of the two major controllable variables, weight on bit and rotary speed, on the drilling rate, while considering other controllable variables such as the mud properties, hydrostatic pressure, hydraulic design, and bit selection. The effect of tooth dullness on the drillingmore » rate is also considered. Increasing the weight on the drill bit with a small increase or decrease in ratary speed resulted in a significant decrease in the drilling cost for most bit runs. It was found that a 48% reduction in this cost and a 97-hour savings in the total drilling time was possible under certain conditions.« less

Proceedings: 1990 EPRI gas turbine procurement seminar

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

McDonald, B.L.; Miller, M.N.

1991-06-01

This seminar presents information that enables utilities to implement more cost-effective procurements for gas turbine and combined-cycle power generation equipment. A systematic approach to specification and permitting procedures can lower unit life-cycle cost. APPROACH. Thirty-two staff members from 25 utilities met in Danvers, Massachusetts, October 9--11, 1990. Speakers representing utilities, vendors, and EPRI contractors presented material on recent procurement and startup experiences, permitting considerations, specification strategy, bid evaluation techniques, and a vendor's perspective of utility procurements. KEY POINTS. The seminar focused on specification features, procurement procedures, and bid evaluation techniques designed to implement life-cycle cost-effective procurement consistent with the plantmore » mission. Speakers highlighted the following issues: Experiential case histories of recent procurements and startups, emphasizing how to design procurement procedures that improve plant operating economics; Current trends in permitting for NO{sub x} compliance and recent permitting experience; Quantifiable evaluations of vendors' bids for RAM-related characteristics; The means to obtain specifically desired but nonstandard equipment features.« less

Optimal design of solidification processes

NASA Technical Reports Server (NTRS)

Dantzig, Jonathan A.; Tortorelli, Daniel A.

1991-01-01

An optimal design algorithm is presented for the analysis of general solidification processes, and is demonstrated for the growth of GaAs crystals in a Bridgman furnace. The system is optimal in the sense that the prespecified temperature distribution in the solidifying materials is obtained to maximize product quality. The optimization uses traditional numerical programming techniques which require the evaluation of cost and constraint functions and their sensitivities. The finite element method is incorporated to analyze the crystal solidification problem, evaluate the cost and constraint functions, and compute the sensitivities. These techniques are demonstrated in the crystal growth application by determining an optimal furnace wall temperature distribution to obtain the desired temperature profile in the crystal, and hence to maximize the crystal's quality. Several numerical optimization algorithms are studied to determine the proper convergence criteria, effective 1-D search strategies, appropriate forms of the cost and constraint functions, etc. In particular, we incorporate the conjugate gradient and quasi-Newton methods for unconstrained problems. The efficiency and effectiveness of each algorithm is presented in the example problem.

Preoperative paravertebral blocks for the management of acute pain following mastectomy: a cost-effectiveness analysis.

PubMed

Offodile, Anaeze C; Sheckter, Clifford C; Tucker, Austin; Watzker, Anna; Ottino, Kevin; Zammert, Martin; Padula, William V

2017-10-01

Preoperative paravertebral blocks (PPVBs) are routinely used for treating post-mastectomy pain, yet uncertainties remain about the cost-effectiveness of this modality. We aim to evaluate the cost-effectiveness of PPVBs at common willingness-to-pay (WTP) thresholds. A decision analytic model compared two strategies: general anesthesia (GA) alone versus GA with multilevel PPVB. For the GA plus PPVB limb, patients were subjected to successful block placement versus varying severity of complications based on literature-derived probabilities. The need for rescue pain medication was the terminal node for all postoperative scenarios. Patient-reported pain scores sourced from published meta-analyses measured treatment effectiveness. Costing was derived from wholesale acquisition costs, the Medicare fee schedule, and publicly available hospital charge masters. Charges were converted to costs and adjusted for 2016 US dollars. A commercial payer perspective was adopted. Incremental cost-effectiveness ratios (ICERs) were evaluated against WTP thresholds of $500 and $50,000 for postoperative pain control. The ICER for preoperative paravertebral blocks was $154.49 per point reduction in pain score. 15% variation in inpatient costs resulted in ICER values ranging from $124.40-$180.66 per pain point score reduction. Altering the probability of block success by 5% generated ICER values of $144.71-$163.81 per pain score reduction. Probabilistic sensitivity analysis yielded cost-effective trials 69.43% of the time at $500 WTP thresholds. Over a broad range of probabilities, PPVB in mastectomy reduces postoperative pain at an acceptable incremental cost compared to GA. Commercial payers should be persuaded to reimburse this technique based on convincing evidence of cost-effectiveness.

A low cost technique for synthesis of gold nanoparticles using microwave heating and its application in signal amplification for detecting Escherichia Coli O157:H7 bacteria

NASA Astrophysics Data System (ADS)

Thanh Ngo, Vo Ke; Giang Nguyen, Dang; Phat Huynh, Trong; Lam, Quang Vinh

2016-09-01

In the present work a low cost technique for preparation of gold nanoparticles (AuNPs) using microwave heating was developed. The effect of different elements (precursor reagents, irradiation time, and microwave radiation power) on the final morphology of AuNPs obtained through the microwave assisted technique has been investigated. The characterization of the samples has been carried out by transmission electron microscopy, UV-vis absorption spectroscopy, Fourier transform infrared spectroscopy, and powder x-ray diffraction. The results showed that to some extent the above-mentioned characterizations influenced the size of synthetized nanoparticles and application of microwave heating has many advantages such as low cost, rapid preparation and highly uniform particles. As an application in quartz crystal microbalance (QCM) immunosensor, AuNPs are conjugated with the Escherichia coli (E.coli) O157:H7 antibodies for signal amplification to detect E.coli O157:H7 bacteria residual in QCM system.

48 CFR 9905.505-50 - Techniques for application.

Code of Federal Regulations, 2010 CFR

2010-10-01

... this cost accounting principle does not require that allocation of unallowable costs to final cost.... 9905.505-50 Section 9905.505-50 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD... ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS FOR EDUCATIONAL INSTITUTIONS 9905.505-50 Techniques for...

BMP analysis system for watershed-based stormwater management.

PubMed

Zhen, Jenny; Shoemaker, Leslie; Riverson, John; Alvi, Khalid; Cheng, Mow-Soung

2006-01-01

Best Management Practices (BMPs) are measures for mitigating nonpoint source (NPS) pollution caused mainly by stormwater runoff. Established urban and newly developing areas must develop cost effective means for restoring or minimizing impacts, and planning future growth. Prince George's County in Maryland, USA, a fast-growing region in the Washington, DC metropolitan area, has developed a number of tools to support analysis and decision making for stormwater management planning and design at the watershed level. These tools support watershed analysis, innovative BMPs, and optimization. Application of these tools can help achieve environmental goals and lead to significant cost savings. This project includes software development that utilizes GIS information and technology, integrates BMP processes simulation models, and applies system optimization techniques for BMP planning and selection. The system employs the ESRI ArcGIS as the platform, and provides GIS-based visualization and support for developing networks including sequences of land uses, BMPs, and stream reaches. The system also provides interfaces for BMP placement, BMP attribute data input, and decision optimization management. The system includes a stand-alone BMP simulation and evaluation module, which complements both research and regulatory nonpoint source control assessment efforts, and allows flexibility in the examining various BMP design alternatives. Process based simulation of BMPs provides a technique that is sensitive to local climate and rainfall patterns. The system incorporates a meta-heuristic optimization technique to find the most cost-effective BMP placement and implementation plan given a control target, or a fixed cost. A case study is presented to demonstrate the application of the Prince George's County system. The case study involves a highly urbanized area in the Anacostia River (a tributary to Potomac River) watershed southeast of Washington, DC. An innovative system of management practices is proposed to minimize runoff, improve water quality, and provide water reuse opportunities. Proposed management techniques include bioretention, green roof, and rooftop runoff collection (rain barrel) systems. The modeling system was used to identify the most cost-effective combinations of management practices to help minimize frequency and size of runoff events and resulting combined sewer overflows to the Anacostia River.

The potential of imaging techniques as a screening tool for colorectal cancer: a cost-effectiveness analysis.

PubMed

Greuter, Marjolein J E; Berkhof, Johannes; Fijneman, Remond J A; Demirel, Erhan; Lew, Jie-Bin; Meijer, Gerrit A; Stoker, Jaap; Coupé, Veerle M H

2016-07-01

Imaging may be promising for colorectal cancer (CRC) screening, since it has test characteristics comparable with colonoscopy but is less invasive. We aimed to assess the potential of CT colonography (CTC) and MR colonography (MRC) in terms of (cost-effectiveness) using the Adenoma and Serrated pathway to Colorectal CAncer model. We compared several CTC and MRC strategies with 5- or 10-yearly screening intervals with no screening, 10-yearly colonoscopy screening and biennial faecal immunochemical test (FIT) screening. We assumed trial-based participation rates in the base-case analyses and varied the rates in sensitivity analyses. Incremental lifetime costs and health effects were estimated from a healthcare perspective. The health gain of CTC and MRC was similar and ranged from 0.031 to 0.048 life-year gained compared with no screening, for 2-5 screening rounds. Lifetime costs per person for MRC strategies were €60-110 higher than those for CTC strategies with an equal number of screening rounds. All imaging-based strategies were cost-effective compared with no screening. FIT screening was the dominant screening strategy, leading to most LYG and highest cost-savings. Compared with three rounds of colonoscopy screening, CTC with five rounds was found to be cost-effective in an incremental analysis of imaging strategies. Assumptions on screening participation have a major influence on the ordering of strategies in terms of costs and effects. CTC and MRC have potential for CRC screening, compared with no screening and compared with three rounds of 10-yearly colonoscopy screening. When taking FIT screening as the reference, imaging is not cost-effective. Participation is an important driver of effectiveness and cost estimates. This is the first study to assess the cost-effectiveness of MRC screening for CRC.

COTSAT Small Spacecraft Cost Optimization for Government and Commercial Use

NASA Technical Reports Server (NTRS)

Swank, Aaron J.; Bui, David; Dallara, Christopher; Ghassemieh, Shakib; Hanratty, James; Jackson, Evan; Klupar, Pete; Lindsay, Michael; Ling, Kuok; Mattei, Nicholas;

Cost effectiveness of bisphosphonates in the management of breast cancer patients with bone metastases.

PubMed

Botteman, M; Barghout, V; Stephens, J; Hay, J; Brandman, J; Aapro, M

2006-07-01

Bisphosphonates are recommended to prevent skeletal related events (SREs) in patients with breast cancer and bone metastases (BCBM). However, their clinical and economic profiles vary from one agent to the other. Using modeling techniques, we simulated from the perspective of the UK's National Health Service (NHS) the cost and quality adjusted survival (QALY) associated with five commonly-used bisphosphonates or no therapy in this patient population. The simulation followed patients into several health states (i.e. alive or dead, experiencing an SRE or no SRE, and receiving first or second line therapy). Drugs costs, infusion costs, SREs costs, and utility values were estimated from published sources. Utilities were applied to time with and without SREs to capture the impact on quality of life. Compared to no therapy, all bisphosphonates are either cost saving or highly cost-effective (with a cost per QALY < or = 6126 pounds sterlings). Within this evaluation, zoledronic acid was more effective and less expensive than all other options. Based on our model, the use of bisphosphonates in breast cancer patients with bone metastases should lead to improved patient outcomes and cost savings to the NHS and possibly other similar entities.

An evaluation of the PCR-RFLP technique to aid molecular-based monitoring of felids and canids in India

PubMed Central

2010-01-01

Background The order Carnivora is well represented in India, with 58 of the 250 species found globally, occurring here. However, small carnivores figure very poorly in research and conservation policies in India. This is mainly due to the dearth of tested and standardized techniques that are both cost effective and conducive to small carnivore studies in the field. In this paper we present a non-invasive genetic technique standardized for the study of Indian felids and canids with the use of PCR amplification and restriction enzyme digestion of scat collected in the field. Findings Using existing sequences of felids and canids from GenBank, we designed primers from the 16S rRNA region of the mitochondrial genome and tested these on ten species of felids and five canids. We selected restriction enzymes that would cut the selected region differentially for various species within each family. We produced a restriction digestion profile for the potential differentiation of species based on fragment patterns. To test our technique, we used felid PCR primers on scats collected from various habitats in India, representing varied environmental conditions. Amplification success with field collected scats was 52%, while 86% of the products used for restriction digestion could be accurately assigned to species. We verified this through sequencing. A comparison of costs across the various techniques currently used for scat assignment showed that this technique was the most practical and cost effective. Conclusions The species-specific key developed in this paper provides a means for detailed investigations in the future that focus on elusive carnivores in India and this approach provides a model for other studies in areas of Asia where many small carnivores co-occur. PMID:20525407

3D memory: etch is the new litho

NASA Astrophysics Data System (ADS)

Petti, Christopher

2018-03-01

This paper discusses the process challenges and limitations for 3D NAND processes, focusing on vertical 3D architectures. The effect of deep memory hole etches on die cost is calculated, with die cost showing a minimum at a given number of layers because of aspect-ratio dependent etch effects. Techniques to mitigate these etch effects are summarized, as are other etch issues, such as bowing and twisting. Metal replacement gate processes and their challenges are also described. Lastly, future directions of vertical 3D NAND technologies are explored.

Direct cost comparison of minimally invasive punch technique versus traditional approaches for percutaneous bone anchored hearing devices.

PubMed

Sardiwalla, Yaeesh; Jufas, Nicholas; Morris, David P

2017-06-12

Minimally Invasive Ponto Surgery (MIPS) was recently described as a new technique to facilitate the placement of percutaneous bone anchored hearing devices. The procedure has resulted in a simplification of the surgical steps and a dramatic reduction in surgical time while maintaining excellent patient outcomes. Given these developments, our group sought to move the procedure from the main operating suite where they have traditionally been performed. This study aims to test the null hypothesis that MIPS and open approaches have the same direct costs for the implantation of percutaneous bone anchored hearing devices in a Canadian public hospital setting. A retrospective direct cost comparison of MIPS and open approaches for the implantation of bone conduction implants was conducted. Indirect and future costs were not included in the fiscal analysis. A simple cost comparison of the two approaches was made considering time, staff and equipment needs. All 12 operations were performed on adult patients from 2013 to 2016 by the same surgeon at a single hospital site. MIPS has a total mean reduction in cost of CAD$456.83 per operation from the hospital perspective when compared to open approaches. The average duration of the MIPS operation was 7 min, which is on average 61 min shorter compared with open approaches. The MIPS technique was more cost effective than traditional open approaches. This primarily reflects a direct consequence of a reduction in surgical time, with further contributions from reduced staffing and equipment costs. This simple, quick intervention proved to be feasible when performed outside the main operating room. A blister pack of required equipment could prove convenient and further reduce costs.

Using the Delphi technique in economic evaluation: time to revisit the oracle?

PubMed

Simoens, S

2006-12-01

Although the Delphi technique has been commonly used as a data source in medical and health services research, its application in economic evaluation of medicines has been more limited. The aim of this study was to describe the methodology of the Delphi technique, to present a case for using the technique in economic evaluation, and to provide recommendations to improve such use. The literature was accessed through MEDLINE focusing on studies discussing the methodology of the Delphi technique and economic evaluations of medicines using the Delphi technique. The Delphi technique can be used to provide estimates of health care resources required and to modify such estimates when making inter-country comparisons. The Delphi technique can also contribute to mapping the treatment process under investigation, to identifying the appropriate comparator to be used, and to ensuring that the economic evaluation estimates cost-effectiveness rather than cost-efficacy. Ideally, economic evaluations of medicines should be based on real-patient data. In the absence of such data, evaluations need to incorporate the best evidence available by employing approaches such as the Delphi technique. Evaluations based on this approach should state the limitations, and explore the impact of the associated uncertainty in the results.

Cost-Effectiveness Analysis of Primary Arthrodesis Versus Open Reduction Internal Fixation for Primarily Ligamentous Lisfranc Injuries.

PubMed

Albright, Rachel H; Haller, Sarah; Klein, Erin; Baker, Jeffrey R; Weil, Lowell; Weil, Lowell S; Fleischer, Adam E

The purpose of the present study was to determine whether surgical intervention with open reduction internal fixation (ORIF) or primary arthrodesis (PA) for Lisfranc injuries is more cost effective. We conducted a formal cost-effectiveness analysis using a Markov model and decision tree to explore the healthcare costs and health outcomes associated with a scenario of ORIF versus PA for 45 years postoperatively. The outcomes assessed included long-term costs, quality-adjusted life-years (QALYs), and incremental cost per QALY gained. The costs were evaluated from the healthcare system perspective and are expressed in U.S. dollars at a 2017 price base. ORIF was always associated with greater costs compared with PA and was less effective in the long term. When calculating the cost required to gain 1 additional QALY, the PA group cost $1429/QALY and the ORIF group cost $3958/QALY. The group undergoing PA overall spent, on average, $43,192 less than the ORIF group, and PA was overall a more effective technique. Strong dominance compared with ORIF was demonstrated in multiple scenarios, and the model's conclusions were unchanged in the sensitivity analysis even after varying the key assumptions. ORIF failed to show functional or financial benefits. In conclusion, from a healthcare system's standpoint, PA would clearly be the preferred treatment strategy for predominantly ligamentous Lisfranc injuries and dislocations. Copyright © 2017 The American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Cost-effectiveness of open versus arthroscopic rotator cuff repair.

PubMed

Adla, Deepthi N; Rowsell, Mark; Pandey, Radhakant

2010-03-01

Economic evaluation of surgical procedures is necessary in view of more expensive newer techniques emerging in an increasingly cost-conscious health care environment. This study compares the cost-effectiveness of open rotator cuff repair with arthroscopic repair for moderately size tears. This was a prospective study of 30 consecutive patients, of whom 15 had an arthroscopic repair and 15 had an open procedure. Clinical effectiveness was assessed using Oxford and Constant shoulder scores. Costs were estimated from departmental and hospital financial data. At last follow-up, no difference Oxford and Constant shoulder scores was noted between the 2 methods of repair. There was no significant difference between the groups in the cost of time in the operating theater, inpatient time, amount of postoperative analgesia, number of postoperative outpatient visits, physiotherapy costs, and time off work. The incremental cost of each arthroscopic rotator cuff repair was pound675 ($1248.75) more than the open procedure. This was mainly in the area of direct health care costs, instrumentation in particular. Health care policy makers are increasingly demanding evidence of cost-effectiveness of a procedure. This study showed both methods of repair provide equivalent clinical results. Open cuff repair is more cost-effective than arthroscopic repair and is likely to have lower cost-utility ratio. In addition, the tariff for the arthroscopic procedure in some health care systems is same as open repair. Copyright 2010 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

[An object-oriented intelligent engineering design approach for lake pollution control].

PubMed

Zou, Rui; Zhou, Jing; Liu, Yong; Zhu, Xiang; Zhao, Lei; Yang, Ping-Jian; Guo, Huai-Cheng

2013-03-01

Regarding the shortage and deficiency of traditional lake pollution control engineering techniques, a new lake pollution control engineering approach was proposed in this study, based on object-oriented intelligent design (OOID) from the perspective of intelligence. It can provide a new methodology and framework for effectively controlling lake pollution and improving water quality. The differences between the traditional engineering techniques and the OOID approach were compared. The key points for OOID were described as object perspective, cause and effect foundation, set points into surface, and temporal and spatial optimization. The blue algae control in lake was taken as an example in this study. The effect of algae control and water quality improvement were analyzed in details from the perspective of object-oriented intelligent design based on two engineering techniques (vertical hydrodynamic mixer and pumping algaecide recharge). The modeling results showed that the traditional engineering design paradigm cannot provide scientific and effective guidance for engineering design and decision-making regarding lake pollution. Intelligent design approach is based on the object perspective and quantitative causal analysis in this case. This approach identified that the efficiency of mixers was much higher than pumps in achieving the goal of low to moderate water quality improvement. However, when the objective of water quality exceeded a certain value (such as the control objective of peak Chla concentration exceeded 100 microg x L(-1) in this experimental water), the mixer cannot achieve this goal. The pump technique can achieve the goal but with higher cost. The efficiency of combining the two techniques was higher than using one of the two techniques alone. Moreover, the quantitative scale control of the two engineering techniques has a significant impact on the actual project benefits and costs.

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

PubMed

Savitz, Lucy A; Savitz, Samuel T

2016-01-01

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

Recent patents of nanopore DNA sequencing technology: progress and challenges.

PubMed

Zhou, Jianfeng; Xu, Bingqian

2010-11-01

DNA sequencing techniques witnessed fast development in the last decades, primarily driven by the Human Genome Project. Among the proposed new techniques, Nanopore was considered as a suitable candidate for the single DNA sequencing with ultrahigh speed and very low cost. Several fabrication and modification techniques have been developed to produce robust and well-defined nanopore devices. Many efforts have also been done to apply nanopore to analyze the properties of DNA molecules. By comparing with traditional sequencing techniques, nanopore has demonstrated its distinctive superiorities in main practical issues, such as sample preparation, sequencing speed, cost-effective and read-length. Although challenges still remain, recent researches in improving the capabilities of nanopore have shed a light to achieve its ultimate goal: Sequence individual DNA strand at single nucleotide level. This patent review briefly highlights recent developments and technological achievements for DNA analysis and sequencing at single molecule level, focusing on nanopore based methods.

Optimal control of malaria: combining vector interventions and drug therapies.

PubMed

Khamis, Doran; El Mouden, Claire; Kura, Klodeta; Bonsall, Michael B

2018-04-24

The sterile insect technique and transgenic equivalents are considered promising tools for controlling vector-borne disease in an age of increasing insecticide and drug-resistance. Combining vector interventions with artemisinin-based therapies may achieve the twin goals of suppressing malaria endemicity while managing artemisinin resistance. While the cost-effectiveness of these controls has been investigated independently, their combined usage has not been dynamically optimized in response to ecological and epidemiological processes. An optimal control framework based on coupled models of mosquito population dynamics and malaria epidemiology is used to investigate the cost-effectiveness of combining vector control with drug therapies in homogeneous environments with and without vector migration. The costs of endemic malaria are weighed against the costs of administering artemisinin therapies and releasing modified mosquitoes using various cost structures. Larval density dependence is shown to reduce the cost-effectiveness of conventional sterile insect releases compared with transgenic mosquitoes with a late-acting lethal gene. Using drug treatments can reduce the critical vector control release ratio necessary to cause disease fadeout. Combining vector control and drug therapies is the most effective and efficient use of resources, and using optimized implementation strategies can substantially reduce costs.

Valuing innovative endoscopic techniques: per-oral endoscopic myotomy for the management of achalasia.

PubMed

Shah, Eric D; Chang, Andrew C; Law, Ryan

2018-04-20

Unclear reimbursement for new and innovative endoscopic procedures can limit adoption in clinical practice despite effectiveness in clinical trials. The aim of this study was to determine maximum cost-effective reimbursement for per-oral endoscopic myotomy (POEM) in treating achalasia. We constructed a decision analytic model assessing POEM versus laparoscopic Heller myotomy with Dor fundoplication (LHM) in managing achalasia from a payer perspective over a 1-year time horizon. Reimbursement data were derived from 2017 Medicare data. Responder rates were based on clinically meaningful improvement in validated Eckardt scores. Validated health utility values were assigned to terminal health states based on data previously derived with a standard gamble technique. Contemporary willingness-to-pay (WTP) levels per quality-adjusted life year (QALY) were used to estimate maximum reimbursement for POEM using threshold analysis. Effectiveness of POEM and LHM was similar at one year of follow-up (0.91 QALY). Maximum cost-effective reimbursement for POEM was $1,200.07 to $1,389.85 (33.4-38.7 total 2017 RVUs). This compares to contemporary total reimbursement of 10-15 total RVU for advanced endoscopic procedures. The model was most sensitive to the probability of GERD after procedure. The rate of conversion to open laparotomy due to perforation or bleeding was infrequent in published clinical practice experience, thus did not significantly affect reimbursement. POEM is an example of an innovative and potentially disruptive endoscopic technique offering greater cost-effective value and similar outcomes to the established surgical standard at contemporary reimbursement levels. Copyright © 2018 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

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

Wike, L.D.

Environmental impact can be difficult to assess, especially at the ecosystem level. Any impact assessment methodology that can give cost effective and timely results is highly desirable. Rapid bioassessment (RBA) is cost effective and produces timely results. Several types of RBA have been used at the Savannah River Site (SRS) to assess stream conditions, including the Index of Biotic Integrity (IBI) based on fish community characteristics, and various techniques using aquatic macroinvertebrate species diversity and abundance. In an attempt to broaden the applicability of the RBA concept, we have also begun to develop RBA techniques for seep-fed wetlands and terrestrialmore » habitats. These techniques will focus on vertebrate and macroinvertebrate assemblages for seep-fed wetlands and arthropod assemblages for terrestrial habitats. In situ bioassay is another technique that could be used for rapid and economical assessment of the effects of anthropogenic disturbance. We propose the development of two methods of in situ bioassay that can address bioavailability of constituents of concern. The use of caged bioassay organisms can be applied to terrestrial systems such as capped or existing waste sites using the common house cricket. Another proposed bioassay could use a resident species, such as the imported red fire ant, which is found in disturbed habitats and open areas such as waste sites. Combining in situ techniques with RBA methodologies has the potential to provide a comprehensive assessment of chemical and physical impacts to a wide range of ecosystem types.« less

Integrated pest management and allocation of control efforts for vector-borne diseases

USGS Publications Warehouse

Ginsberg, H.S.

2001-01-01

Applications of various control methods were evaluated to determine how to integrate methods so as to minimize the number of human cases of vector-borne diseases. These diseases can be controlled by lowering the number of vector-human contacts (e.g., by pesticide applications or use of repellents), or by lowering the proportion of vectors infected with pathogens (e.g., by lowering or vaccinating reservoir host populations). Control methods should be combined in such a way as to most efficiently lower the probability of human encounter with an infected vector. Simulations using a simple probabilistic model of pathogen transmission suggest that the most efficient way to integrate different control methods is to combine methods that have the same effect (e.g., combine treatments that lower the vector population; or combine treatments that lower pathogen prevalence in vectors). Combining techniques that have different effects (e.g., a technique that lowers vector populations with a technique that lowers pathogen prevalence in vectors) will be less efficient than combining two techniques that both lower vector populations or combining two techniques that both lower pathogen prevalence, costs being the same. Costs of alternative control methods generally differ, so the efficiency of various combinations at lowering human contact with infected vectors should be estimated at available funding levels. Data should be collected from initial trials to improve the effects of subsequent interventions on the number of human cases.

Cost-effective and monitoring-active technique for TDM-passive optical networks

NASA Astrophysics Data System (ADS)

Chi, Chang-Chia; Lin, Hong-Mao; Tarn, Chen-Wen; Lin, Huang-Liang

2014-08-01

A reliable, detection-active and cost-effective method which employs the hello and heartbeat signals for branched node distinguishing to monitor fiber fault in any branch of distribution fibers of a time division multiplexing passive optical network (TDM-PON) is proposed. With this method, the material cost of building an optical network monitor system for a TDM-PON with 168 ONUs and the time of identifying a multiple branch faults is significantly reduced in a TDM-PON system of any scale. A fault location in a 1 × 32 TDM-PON system using this method to identify the fault branch is demonstrated.

A review of costing methodologies in critical care studies.

PubMed

Pines, Jesse M; Fager, Samuel S; Milzman, David P

2002-09-01

Clinical decision making in critical care has traditionally been based on clinical outcome measures such as mortality and morbidity. Over the past few decades, however, increasing competition in the health care marketplace has made it necessary to consider costs when making clinical and managerial decisions in critical care. Sophisticated costing methodologies have been developed to aid this decision-making process. We performed a narrative review of published costing studies in critical care during the past 6 years. A total of 282 articles were found, of which 68 met our search criteria. They involved a mean of 508 patients (range, 20-13,907). A total of 92.6% of the studies (63 of 68) used traditional cost analysis, whereas the remaining 7.4% (5 of 68) used cost-effectiveness analysis. None (0 of 68) used cost-benefit analysis or cost-utility analysis. A total of 36.7% (25 of 68) used hospital charges as a surrogate for actual costs. Of the 43 articles that actually counted costs, 37.2% (16 of 43) counted physician costs, 27.9% (12 of 43) counted facility costs, 34.9% (15 of 43) counted nursing costs, 9.3% (4 of 43) counted societal costs, and 90.7% (39 of 43) counted laboratory, equipment, and pharmacy costs. Our conclusion is that despite considerable progress in costing methodologies, critical care studies have not adequately implemented these techniques. Given the importance of financial implications in medicine, it would be prudent for critical care studies to use these more advanced techniques. Copyright 2002, Elsevier Science (USA). All rights reserved.

Modeled cost-effectiveness of transforaminal lumbar interbody fusion compared with posterolateral fusion for spondylolisthesis using N(2)QOD data.

PubMed

Carreon, Leah Y; Glassman, Steven D; Ghogawala, Zoher; Mummaneni, Praveen V; McGirt, Matthew J; Asher, Anthony L

2016-06-01

OBJECTIVE Transforaminal lumbar interbody fusion (TLIF) has become the most commonly used fusion technique for lumbar degenerative disorders. This suggests an expectation of better clinical outcomes with this technique, but this has not been validated consistently. How surgical variables and choice of health utility measures drive the cost-effectiveness of TLIF relative to posterolateral fusion (PSF) has not been established. The authors used health utility values derived from Short Form-6D (SF-6D) and EQ-5D and different cost-effectiveness thresholds to evaluate the relative cost-effectiveness of TLIF compared with PSF. METHODS From the National Neurosurgery Quality and Outcomes Database (N(2)QOD), 101 patients with spondylolisthesis who underwent PSF were propensity matched to patients who underwent TLIF. Health-related quality of life measures and perioperative parameters were compared. Because health utility values derived from the SF-6D and EQ-5D questionnaires have been shown to vary in patients with low-back pain, quality-adjusted life years (QALYs) were derived from both measures. On the basis of these matched cases, a sensitivity analysis for the relative cost per QALY of TLIF versus PSF was performed in a series of cost-assumption models. RESULTS Operative time, blood loss, hospital stay, and 30-day and 90-day readmission rates were similar for the TLIF and PSF groups. Both TLIF and PSF significantly improved back and leg pain, Oswestry Disability Index (ODI) scores, and EQ-5D and SF-6D scores at 3 and 12 months postoperatively. At 12 months postoperatively, patients who had undergone TLIF had greater improvements in mean ODI scores (30.4 vs 21.1, p = 0.001) and mean SF-6D scores (0.16 vs 0.11, p = 0.001) but similar improvements in mean EQ-5D scores (0.25 vs 0.22, p = 0.415) as patients treated with PSF. At a cost per QALY threshold of $100,000 and using SF-6D-based QALYs, the authors found that TLIF would be cost-prohibitive compared with PSF at a surgical cost of $4830 above that of PSF. However, with EQ-5D-based QALYs, TLIF would become cost-prohibitive at an increased surgical cost of $2960 relative to that of PSF. With the 2014 US per capita gross domestic product of $53,042 as a more stringent cost-effectiveness threshold, TLIF would become cost-prohibitive at surgical costs $2562 above that of PSF with SF-6D-based QALYs or at a surgical cost exceeding that of PSF by $1570 with EQ-5D-derived QALYs. CONCLUSIONS As with all cost-effectiveness studies, cost per QALY depended on the measure of health utility selected, durability of the intervention, readmission rates, and the accuracy of the cost assumptions.

Economic impact of rapid diagnostic methods in Clinical Microbiology: Price of the test or overall clinical impact.

PubMed

Cantón, Rafael; Gómez G de la Pedrosa, Elia

2017-12-01

The need to reduce the time it takes to establish a microbiological diagnosis and the emergence of new molecular microbiology and proteomic technologies has fuelled the development of rapid and point-of-care techniques, as well as the so-called point-of-care laboratories. These laboratories are responsible for conducting both techniques partially to response to the outsourcing of the conventional hospital laboratories. Their introduction has not always been accompanied with economic studies that address their cost-effectiveness, cost-benefit and cost-utility, but rather tend to be limited to the unit price of the test. The latter, influenced by the purchase procedure, does not usually have a regulated reference value in the same way that medicines do. The cost-effectiveness studies that have recently been conducted on mass spectrometry in the diagnosis of bacteraemia and the use of antimicrobials have had the greatest clinical impact and may act as a model for future economic studies on rapid and point-of-care tests. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

One hospital, one appendectomy: The cost effectiveness of a standardized doctor's preference card.

PubMed

Skarda, David E; Rollins, Michael; Andrews, Seth; McFadden, Molly; Barnhart, Doug; Meyers, Rebecka; Scaife, Eric

2015-06-01

Appendicitis in children provides a unique opportunity to explore changes that reduce variation, reduce cost, and improve value. In this study we sought to evaluate the effectiveness of standardization of surgical technique and intraoperative disposable device utilization for laparoscopic appendectomy among all surgeons at a tertiary children's hospital. All 6 surgeons at our tertiary children's hospital agreed to standardize to a single technique of performing a laparoscopic appendectomy. We collected data on all pediatric patients who had a laparoscopic appendectomy following implementation of the uniform doctor's preference card (DPC) (March 1, 2013 to February 28, 2014) and compared them to a historical control group. Implementation of the uniform DPC decreased the device cost per appendectomy from $844.11 to $305.32. Operative times (skin incision to skin closure) were 34.8 minutes prior to the uniform DPC and 37.0 minutes using the uniform DPC. There were no significant differences in postappendectomy outcomes. We have demonstrated that implementation of a uniform DPC and technical standardization for laparoscopic appendectomy can significantly reduce cost. Furthermore, this can occur without dramatically increasing operative times, length of stay, or postoperative complications. Copyright © 2015 Elsevier Inc. All rights reserved.

A novel eco-friendly technique for efficient control of lime water softening process.

PubMed

Ostovar, Mohamad; Amiri, Mohamad

2013-12-01

Lime softening is an established type of water treatment used for water softening. The performance of this process is highly dependent on lime dosage. Currently, lime dosage is adjusted manually based on chemical tests, aimed at maintaining the phenolphthalein (P) and total (M) alkalinities within a certain range (2 P - M > or = 5). In this paper, a critical study of the softening process has been presented. It has been shown that the current method is frequently incorrect. Furthermore, electrical conductivity (EC) has been introduced as a novel indicator for effectively characterizing the lime softening process.This novel technique has several advantages over the current alkalinities method. Because no chemical reagents are needed for titration, which is a simple test, there is a considerable reduction in test costs. Additionally, there is a reduction in the treated water hardness and generated sludge during the lime softening process. Therefore, it is highly eco-friendly, and is a very cost effective alternative technique for efficient control of the lime softening process.

Development of a standardized laparoscopic caecum resection model to simulate laparoscopic appendectomy in rats

PubMed Central

2014-01-01

Background Laparoscopic appendectomy (LA) has become one of the most common surgical procedures to date. To improve and standardize this technique further, cost-effective and reliable animal models are needed. Methods In a pilot study, 30 Wistar rats underwent laparoscopic caecum resection (as rats do not have an appendix vermiformis), to optimize the instrumental and surgical parameters. A subsequent test study was performed in another 30 rats to compare three different techniques for caecum resection and bowel closure. Results Bipolar coagulation led to an insufficiency of caecal stump closure in all operated rats (Group 1, n = 10). Endoloop ligation followed by bipolar coagulation and resection (Group 2, n = 10) or resection with a LigaSure™ device (Group 3, n = 10) resulted in sufficient caecal stump closure. Conclusions We developed a LA model enabling us to compare three different caecum resection techniques in rats. In conclusion, only endoloop closure followed by bipolar coagulation proved to be a secure and cost-effective surgical approach. PMID:24934381

All-Dielectric Colored Metasurfaces with Silicon Mie Resonators.

PubMed

Proust, Julien; Bedu, Frédéric; Gallas, Bruno; Ozerov, Igor; Bonod, Nicolas

2016-08-23

The photonic resonances hosted by nanostructures provide vivid colors that can be used as color filters instead of organic colors and pigments in photodetectors and printing technology. Metallic nanostructures have been widely studied due to their ability to sustain surface plasmons that resonantly interact with light. Most of the metallic nanoparticles behave as point-like electric multipoles. However, the needs of an another degree of freedom to tune the color of the photonic nanostructure together with the use of a reliable and cost-effective material are growing. Here, we report a technique to imprint colored images based on silicon nanoparticles that host low-order electric and magnetic Mie resonances. The interplay between the electric and magnetic resonances leads to a large palette of colors. This all-dielectric fabrication technique offers the advantage to use cost-effective, reliable, and sustainable materials to provide vivid color spanning the whole visible spectrum. The interest and potential of this all-dielectric printing technique are highlighted by reproducing at a micrometer scale a Mondrian painting.

Economic Analyses in Anterior Cruciate Ligament Reconstruction: A Qualitative and Systematic Review.

PubMed

Saltzman, Bryan M; Cvetanovich, Gregory L; Nwachukwu, Benedict U; Mall, Nathan A; Bush-Joseph, Charles A; Bach, Bernard R

2016-05-01

As the health care system in the United States (US) transitions toward value-based care, there is an increased emphasis on understanding the cost drivers and high-value procedures within orthopaedics. To date, there has been no systematic review of the economic literature on anterior cruciate ligament reconstruction (ACLR). To evaluate the overall evidence base for economic studies published on ACLR in the orthopaedic literature. Data available on the economics of ACLR are summarized and cost drivers associated with the procedure are identified. Systematic review. All economic studies (including US-based and non-US-based) published between inception of the MEDLINE database and October 3, 2014, were identified. Given the heterogeneity of the existing evidence base, a qualitative, descriptive approach was used to assess the collective results from the economic studies on ACLR. When applicable, comparisons were made for the following cost-related variables associated with the procedure for economic implications: outpatient versus inpatient surgery (or outpatient vs overnight hospital stay vs >1-night stay); bone-patellar tendon-bone (BPTB) graft versus hamstring (HS) graft source; autograft versus allograft source; staged unilateral ACLR versus bilateral ACLR in a single setting; single- versus double-bundle technique; ACLR versus nonoperative treatment; and other unique comparisons reported in single studies, including computer-assisted navigation surgery (CANS) versus traditional surgery, early versus delayed ACLR, single- versus double-incision technique, and finally the costs of ACLR without comparison of variables. A total of 24 studies were identified and included; of these, 17 included studies were cost identification studies. The remaining 7 studies were cost utility analyses that used economic models to investigate the effect of variables such as the cost of allograft tissue, fixation devices, and physical therapy, the percentage and timing of revision surgery, and the cost of revision surgery. Of the 24 studies, there were 3 studies with level 1 evidence, 8 with level 2 evidence, 6 with level 3 evidence, and 7 with level 4 evidence. The following economic comparisons were demonstrated: (1) ACLR is more cost-effective than nonoperative treatment with rehabilitation only (per 3 cost utility analyses); (2) autograft use had lower total costs than allograft use, with operating room supply costs and allograft costs most significant (per 5 cost identification studies and 1 cost utility analysis); (3) results on hamstring versus BPTB graft source are conflicting (per 2 cost identification studies); (4) there is significant cost reduction with an outpatient versus inpatient setting (per 5 studies using cost identification analyses); (5) bilateral ACLR is more cost efficient than 2 unilateral ACLRs in separate settings (per 2 cost identification studies); (6) there are lower costs with similarly successful outcomes between single- and double-bundle technique (per 3 cost identification studies and 2 cost utility analyses). Results from this review suggest that early single-bundle, single (endoscopic)-incision outpatient ACLR using either BPTB or HS autograft provides the most value. In the setting of bilateral ACL rupture, single-setting bilateral ACLR is more cost-effective than staged unilateral ACLR. Procedures using CANS technology do not yet yield results that are superior to the results of a standard surgical procedure, and CANS has substantially greater costs. © 2015 The Author(s).

Practical thoughts on cost-benefit analysis and health services.

PubMed

Burchell, A; Weeden, R

1982-08-01

Cost-benefit analysis is fast becoming--if it is not already--an essential tool in decision making. It is, however, a complex subject, and one in which few doctors have been trained. This paper offers practical thoughts on the art of cost-benefit analysis, and is written for clinicians and other medical specialists who, though inexpert in the techniques of accountancy, nevertheless wish to carry out their own simple analyses in a manner that will enable them, and others, to take effective decisions.

Alternative Models for Small Samples in Psychological Research: Applying Linear Mixed Effects Models and Generalized Estimating Equations to Repeated Measures Data

ERIC Educational Resources Information Center

Muth, Chelsea; Bales, Karen L.; Hinde, Katie; Maninger, Nicole; Mendoza, Sally P.; Ferrer, Emilio

2016-01-01

Unavoidable sample size issues beset psychological research that involves scarce populations or costly laboratory procedures. When incorporating longitudinal designs these samples are further reduced by traditional modeling techniques, which perform listwise deletion for any instance of missing data. Moreover, these techniques are limited in their…

Asphalt Pavements Session 2E-1 : Development of Mix Design Process for Cold-In-Place Recycling [SD .WMV (720x480/29fps/203.0 MB)

DOT National Transportation Integrated Search

2003-12-01

This study evaluates one of the recycling techniques used to rehabilitate pavement, called Cold In-Place Recycling (CIR). CIR is one of the fastest growing road rehabilitation techniques because it is quick and cost-effective. The document reports on...

Asphalt Pavements Session 2E-2 : Missouri's Use of Recycled Asphalt Shingles in Hot Asphalt [SD .WMV (720x480/29fps/289.0 MB)

DOT National Transportation Integrated Search

2003-12-01

This study evaluates one of the recycling techniques used to rehabilitate pavement, called Cold In-Place Recycling (CIR). CIR is one of the fastest growing road rehabilitation techniques because it is quick and cost-effective. The document reports on...

Colorado Department of Transportation hot-mix asphalt crack sealing and filling best practices guidelines.

DOT National Transportation Integrated Search

2014-10-01

Crack sealing and filling on hot mix asphalt (HMA) pavements are cost-effective pavement preservation techniques that improve pavement performance and : extend the life of existing pavements. If performed in a timely and effective manner, crack seali...

Hospital costs associated with laparoscopic and open inguinal herniorrhaphy.

PubMed

Spencer Netto, Fernando; Quereshy, Fayez; Camilotti, Bruna G; Pitzul, Kristen; Kwong, Josephine; Jackson, Timothy; Penner, Todd; Okrainec, Allan

2014-01-01

The purpose of this study was to compare the total hospital costs associated with elective laparoscopic and open inguinal herniorrhaphy. A prospectively maintained database was used to identify patients who underwent elective inguinal herniorrhaphy from April 2009 to March 2011. A retrospective review of electronic patient records was performed along with a standardized case-costing analysis using data from the Ontario Case Costing Initiative. The main outcomes were operating room (OR) and total hospital costs. Two hundred eleven patients underwent elective unilateral inguinal herniorrhaphy (117 open and 94 laparoscopic), and 33 patients underwent elective bilateral inguinal herniorrhaphy (9 open and 24 laparoscopic). OR and total hospital costs for open unilateral inguinal hernia repair were significantly lower than for the laparoscopic approach (median total cost, $3207.15 vs $3723.66; P < .001). OR and total hospital costs for repair of elective bilateral inguinal hernias were similar between the open and laparoscopic approaches (median total cost, $4574.02 vs $4662.89; P = .827). In the setting of a Canadian academic hospital, when considering the repair of an elective unilateral inguinal hernia, the OR and total hospital costs of open surgery were significantly lower than for the laparoscopic techniques. There was no statistical difference between OR and total hospital costs when comparing open surgery and laparoscopic techniques for the repair of bilateral inguinal hernias. Given the perioperative benefits of laparoscopy, further studies incorporating hernia-specific outcomes are necessary to determine the cost-effectiveness of each approach and to define the optimal treatment strategy.

COST Action TU1208 "Civil Engineering Applications of Ground Penetrating Radar": ongoing research activities and third-year results

NASA Astrophysics Data System (ADS)

Pajewski, Lara; Benedetto, Andrea; Loizos, Andreas; Tosti, Fabio

2016-04-01

This work aims at disseminating the ongoing research activities and third-year results of the COST (European COoperation in Science and Technology) Action TU1208 "Civil Engineering Applications of Ground Penetrating Radar." About 350 experts are participating to the Action, from 28 COST Countries (Austria, Belgium, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Ireland, Italy, Latvia, Malta, Macedonia, The Netherlands, Norway, Poland, Portugal, Romania, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Turkey, United Kingdom), and from Albania, Armenia, Australia, Colombia, Egypt, Hong Kong, Jordan, Israel, Philippines, Russia, Rwanda, Ukraine, and United States of America. In September 2014, TU1208 has been recognised among the running Actions as "COST Success Story" ("The Cities of Tomorrow: The Challenges of Horizon 2020," September 17-19, 2014, Torino, IT - A COST strategic workshop on the development and needs of the European cities). The principal goal of the COST Action TU1208 is to exchange and increase scientific-technical knowledge and experience of GPR techniques in civil engineering, whilst simultaneously promoting throughout Europe the effective use of this safe and non-destructive technique in the monitoring of infrastructures and structures. Moreover, the Action is oriented to the following specific objectives and expected deliverables: (i) coordinating European scientists to highlight problems, merits and limits of current GPR systems; (ii) developing innovative protocols and guidelines, which will be published in a handbook and constitute a basis for European standards, for an effective GPR application in civil- engineering tasks; safety, economic and financial criteria will be integrated within the protocols; (iii) integrating competences for the improvement and merging of electromagnetic scattering techniques and of data- processing techniques; this will lead to a novel freeware tool for the localization of buried objects, shape-reconstruction and estimation of geophysical parameters useful for civil engineering needs; (iv) networking for the design, realization and optimization of innovative GPR equipment; (v) comparing GPR with different NDT techniques, such as ultrasonic, radiographic, liquid-penetrant, magnetic-particle, acoustic-emission and eddy-current testing; (vi) comparing GPR technology and methodology used in civil engineering with those used in other fields; (vii) promotion of a more widespread, advanced and efficient use of GPR in civil engineering; and (viii) organization of a high-level modular training program for GPR European users. Four Working Groups (WGs) carry out the research activities. WG 1 focuses on the design of innovative GPR equipment, on the building of prototypes and on the testing and optimisation of new systems. WG 2 focuses on the GPR surveying of pavement, bridges, tunnels and buildings, as well as on the sensing of underground utilities and voids. WG 3 deals with the development of electromagnetic forward and inverse scattering methods, for the characterization of GPR scenarios, as well as with data-processing algorithms for the elaboration of the data collected during GPR surveys. WG 4 works on the use of GPR in fields different from the civil engineering, as well as on the integration of GPR with other non-destructive testing techniques. Each WG includes several Projects. COST Action TU1208 is active through a range of networking tools: meetings, workshops, conferences, training schools, short-term scientific missions, dissemination activities. For more information on COST Action TU1208, please visit www.GPRadar.eu and www.cost.eu. Acknowledgement The Authors wish to thank COST, for funding the COST Action TU1208 "Civil engineering applications of Ground Penetrating Radar."

Comparing five alternative methods of breast reconstruction surgery: a cost-effectiveness analysis.

PubMed

Grover, Ritwik; Padula, William V; Van Vliet, Michael; Ridgway, Emily B

2013-11-01

The purpose of this study was to assess the cost-effectiveness of five standardized procedures for breast reconstruction to delineate the best reconstructive approach in postmastectomy patients in the settings of nonirradiated and irradiated chest walls. A decision tree was used to model five breast reconstruction procedures from the provider perspective to evaluate cost-effectiveness. Procedures included autologous flaps with pedicled tissue, autologous flaps with free tissue, latissimus dorsi flaps with breast implants, expanders with implant exchange, and immediate implant placement. All methods were compared with a "do-nothing" alternative. Data for model parameters were collected through a systematic review, and patient health utilities were calculated from an ad hoc survey of reconstructive surgeons. Results were measured in cost (2011 U.S. dollars) per quality-adjusted life-year. Univariate sensitivity analyses and Bayesian multivariate probabilistic sensitivity analysis were conducted. Pedicled autologous tissue and free autologous tissue reconstruction were cost-effective compared with the do-nothing alternative. Pedicled autologous tissue was the slightly more cost-effective of the two. The other procedures were not found to be cost-effective. The results were robust to a number of sensitivity analyses, although the margin between pedicled and free autologous tissue reconstruction is small and affected by some parameter values. Autologous pedicled tissue was slightly more cost-effective than free tissue reconstruction in irradiated and nonirradiated patients. Implant-based techniques were not cost-effective. This is in agreement with the growing trend at academic institutions to encourage autologous tissue reconstruction because of its natural recreation of the breast contour, suppleness, and resiliency in the setting of irradiated recipient beds.

Cost-effectiveness of wound management in France: pressure ulcers and venous leg ulcers.

PubMed

Meaume, S; Gemmen, E

2002-06-01

This study set out to define realistic protocols of care for the treatment of chronic venous leg ulcers and pressure ulcers in France and, by developing cost-effectiveness models, to compare the different protocols of care for the two ulcer groups, enabling a calculation of direct medical costs per ulcer healed in a typical French health insurance plan. Clinical outcomes and some treatment patterns were obtained from published literature. Validations of different treatment patterns were developed using an expert consensus panel similar to the Delphi approach. Costs were calculated based on national averages and estimates from the UK and Germany. The models were used to measure costs per healed ulcer over a 12-week period. For both the pressure ulcer and venous leg ulcer models, three protocols of care were identified. For pressure ulcers and venous leg ulcers, the hydrocolloid DuoDERM (ConvaTec, also known as Granuflex in the UK and Varihesive in Germany) was most cost-effective in France. The combination of published data and expert consensus opinion is a valid technique, and in this case suggests that treating pressure ulcers and venous leg ulcers with hydrocolloid dressings is more cost-effective than treating them with saline gauze, in spite of the lower unit cost of the latter.

Estimating the cost of major ongoing cost plus hardware development programs

NASA Technical Reports Server (NTRS)

Bush, J. C.

1990-01-01

Approaches are developed for forecasting the cost of major hardware development programs while these programs are in the design and development C/D phase. Three approaches are developed: a schedule assessment technique for bottom-line summary cost estimation, a detailed cost estimation approach, and an intermediate cost element analysis procedure. The schedule assessment technique was developed using historical cost/schedule performance data.

Overview of innovative remediation of emerging contaminants

NASA Astrophysics Data System (ADS)

Keller, A. A.; Adeleye, A. S.; Huang, Y.; Garner, K.

2015-12-01

The application of nanotechnology in drinking water treatment and pollution cleanup is promising, as demonstrated by a number of field-based (pilot and full scale) and bench scale studies. A number of reviews exist for these nanotechnology-based applications; but to better illustrate its importance and guide its development, a direct comparison between traditional treatment technologies and emerging approaches using nanotechnology is needed. In this review, the performances of traditional technologies and nanotechnology for water treatment and environmental remediation were compared with the goal of providing an up-to-date reference on the state of treatment techniques for researchers, industry, and policy makers. Pollutants were categorized into broad classes, and the most cost-effective techniques (traditional and nanotechnology-based) in each category reported in the literature were compared. Where information was available, cost and environmental implications of both technologies were also compared. Traditional treatment technologies were found to currently offer the most cost-effective choices for removal of several common pollutants from drinking water and polluted sites. Nano-based techniques may however become important in complicated remediation conditions and meeting increasingly stringent water quality standards, especially in removal of emerging pollutants and low levels of contaminants. We also discuss challenges facing environmental application of nanotechnology were also discussed and potential solutions.

Cost-effectiveness and cost-utility of combination therapy in early rheumatoid arthritis: randomized comparison of combined step-down prednisolone, methotrexate and sulphasalazine with sulphasalazine alone. COBRA Trial Group. Combinatietherapie Bij Reumatoïde Artritis.

PubMed

Verhoeven, A C; Bibo, J C; Boers, M; Engel, G L; van der Linden, S

1998-10-01

Assessment of the cost-effectiveness and cost-utility of early intervention in rheumatoid arthritis (RA) patients, with combined step-down prednisolone, methotrexate and sulphasalazine, compared to sulphasalazine alone. Multicentre 56 week randomized double-blind trial with full economic analysis of direct costs and utility analysis with rating scale and standard gamble measurement techniques. The combined-treatment group included 76 patients and the sulphasalazine group 78 patients. The mean total costs per patient in the first 56 weeks of follow-up were $5519 for combined treatment and $6511 for treatment with sulphasalazine alone (P = 0.37). Out-patient care, in-patient care and non-health care each contributed about one-third to the total costs. The combined-treatment group appeared to generate savings in the length of hospital stay for RA, non-protocol drugs and costs of home help, but comparisons were not statistically significant. Protocol drugs and monitoring were slightly more expensive in the combined-treatment group. Clinical, radiographic and functional outcomes significantly favoured combined treatment at week 28 (radiography also at week 56). Utility scores also favoured combined treatment. Combined treatment is cost-effective due to enhanced efficacy at lower or equal direct costs.

The economic evaluation of pharmacotherapies for Parkinson's disease.

PubMed

Coyle, D; Barbeau, M; Guttman, M; Baladi, J-F

2003-06-01

As well as the significant clinical effects of Parkinson's disease (PD), the disease places a high economic burden on society. Given the scarcity of health care resources, it is becoming increasingly necessary to demonstrate that new therapies for PD provide value for money in comparison with other potential interventions. This paper outlines the basic techniques of cost-effectiveness analysis and its application to PD. These techniques are illustrated by a recent economic evaluation of entacapone for use in Canada.

Lean principles optimize on-time vascular surgery operating room starts and decrease resident work hours.

PubMed

Warner, Courtney J; Walsh, Daniel B; Horvath, Alexander J; Walsh, Teri R; Herrick, Daniel P; Prentiss, Steven J; Powell, Richard J

2013-11-01

Lean process improvement techniques are used in industry to improve efficiency and quality while controlling costs. These techniques are less commonly applied in health care. This study assessed the effectiveness of Lean principles on first case on-time operating room starts and quantified effects on resident work hours. Standard process improvement techniques (DMAIC methodology: define, measure, analyze, improve, control) were used to identify causes of delayed vascular surgery first case starts. Value stream maps and process flow diagrams were created. Process data were analyzed with Pareto and control charts. High-yield changes were identified and simulated in computer and live settings prior to implementation. The primary outcome measure was the proportion of on-time first case starts; secondary outcomes included hospital costs, resident rounding time, and work hours. Data were compared with existing benchmarks. Prior to implementation, 39% of first cases started on time. Process mapping identified late resident arrival in preoperative holding as a cause of delayed first case starts. Resident rounding process inefficiencies were identified and changed through the use of checklists, standardization, and elimination of nonvalue-added activity. Following implementation of process improvements, first case on-time starts improved to 71% at 6 weeks (P = .002). Improvement was sustained with an 86% on-time rate at 1 year (P < .001). Resident rounding time was reduced by 33% (from 70 to 47 minutes). At 9 weeks following implementation, these changes generated an opportunity cost potential of $12,582. Use of Lean principles allowed rapid identification and implementation of perioperative process changes that improved efficiency and resulted in significant cost savings. This improvement was sustained at 1 year. Downstream effects included improved resident efficiency with decreased work hours. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Modelling the Cost Effectiveness of Disease-Modifying Treatments for Multiple Sclerosis

PubMed Central

Thompson, Joel P.; Abdolahi, Amir; Noyes, Katia

2013-01-01

Several cost-effectiveness models of disease-modifying treatments (DMTs) for multiple sclerosis (MS) have been developed for different populations and different countries. Vast differences in the approaches and discrepancies in the results give rise to heated discussions and limit the use of these models. Our main objective is to discuss the methodological challenges in modelling the cost effectiveness of treatments for MS. We conducted a review of published models to describe the approaches taken to date, to identify the key parameters that influence the cost effectiveness of DMTs, and to point out major areas of weakness and uncertainty. Thirty-six published models and analyses were identified. The greatest source of uncertainty is the absence of head-to-head randomized clinical trials. Modellers have used various techniques to compensate, including utilizing extension trials. The use of large observational cohorts in recent studies aids in identifying population-based, ‘real-world’ treatment effects. Major drivers of results include the time horizon modelled and DMT acquisition costs. Model endpoints must target either policy makers (using cost-utility analysis) or clinicians (conducting cost-effectiveness analyses). Lastly, the cost effectiveness of DMTs outside North America and Europe is currently unknown, with the lack of country-specific data as the major limiting factor. We suggest that limited data should not preclude analyses, as models may be built and updated in the future as data become available. Disclosure of modelling methods and assumptions could improve the transferability and applicability of models designed to reflect different healthcare systems. PMID:23640103

On implementation of an endodontic program.

PubMed

Koch, Margaretha

2013-01-01

It is widely accepted that the uptake of research findings by practitioners is unpredictable, yet until they are adopted, advances in technology and clinical research cannot improve health outcomes in patients. Despite extensive research there is limited knowledge of the processes by which changes occur and ways of measuring the effectiveness of change of practice. The overall aim of this thesis was to investigate aspects of an educational intervention in clinical endodontic routines and new instrumentation techniques in a Swedish County Public Dental Service. Special reference was made to the establishment of changed behaviour in practice, the process of change, and the clinical effects. Although a high level of competence in root canal treatment procedures is required in general dental practice, a number of Swedish studies have revealed inadequate root-fillings quality and associated periapical inflammation in general populations. It is suggested that the adoption of the nickel-titanium rotary instrumentation (NiTiR) technique would improve the cleaning and shaping of root canals and the quality of the root-filling. However, there is limited knowledge of the effectiveness of the technique when applied in general dental practice. In two of four consecutive studies, the subjects were employees of a county Public Dental Service. The aim was to investigate the rate of adoption of clinical routines and the NiTiR technique: the output, and the qualitative meaning of successful change in clinical practice. In the other two studies the aim was to investigate treatment effect and the cost-effectiveness of root canal treatment in a general population: the outcome. Four hundred employees (dentists, dental assistants, administrative assistants and clinical managers) of a Swedish County Public Dental Service were mandatorily enrolled in an educational and training program over two years. Change of practice was investigated in a post-education survey. The NiTiR technique was adopted by significantly more dentists in the intervention county compared to a control county (77% and 6% respectively). Dentists in the intervention county completed root canal instrumentation in significantly fewer sessions than the dentists in the control county. Eight in-depth interviews, two with each participant, (dentist, dental assistant, receptionist, clinical manager), were strategically selected for a phenomenological analysis. Four factors were identified as necessary for successful change: 1) disclosed motivation, 2) allowance for individual learning processes, 3) continuous professional collaboration, and 4) a facilitating educator. A random sample of 850 performed root canal treatments was used for a study of treatment outcome; 425 before and 425 after the education and adoption of the NiTiR technique. Root-filling quality, periapical status and tooth survival were assessed on radiographs taken at treatment and at follow-up, > or = 4 years later. Apical periodontitis was found in 34% of the teeth root-filled before the education compared to 33%, after. After the education, root-filling quality improved significantly, tooth survival was significantly higher, however, without a subsequent improvement in success rate post-education; 68% vs. 67%. A micro-costing model was used to calculate the costs of root canal instrumentation, pre- and post-education, in the same sample used in the study of treatment outcome. Costs were lower post-education: by SEK 264 for teeth with one canal and SEK 564 for teeth with three or more canals. A reason for lower costs was that the NiTiR technique dominated after the education and required significantly fewer instrumentation sessions. A cost-minimization analysis disclosed that root canal treatments undertaken post-education were more cost-effective. In conclusion, there was only a partial relationship between output and outcome. Although root-filling quality improved significantly, the study did not show any association between the more frequent use of NiTiR and an improvement in remaining teeth with normal periapical status or success rate. However, the use of NiTiR was more cost-effective. These results are in accordance with previous findings of the so called efficacy-effectiveness gap in clinical practice: a high output is not predictive of a high outcome. The overall conclusion to be drawn from these studies is that further research is warranted to identify factors associated with improvement of the quality of endodontic care. The general interpretation of the findings of these implementation studies is as important as the effects of the change in endodontic instrumentation: a clinically relevant and applicable intervention, introduced by experienced expertise under allowing learning and collaborating circumstances, disclosed clinicians' motivation and facilitated implementation. The finding of qualitative differences between the questionnaire responses and the in-depth interviews suggest that a critical approach is warranted when comparing surveys and qualitative methods aimed at investigating qualitative experiences of change, due to their different epistemological premises.

Cost minimization analysis for combinations of sampling techniques in bronchoscopy of endobronchial lesions.

PubMed

Roth, Kjetil; Hardie, Jon Andrew; Andreassen, Alf Henrik; Leh, Friedemann; Eagan, Tomas Mikal Lind

2009-06-01

The choice of sampling techniques in bronchoscopy with sampling from a visible lesion will depend on the expected diagnostic yields and the costs of the sampling techniques. The aim of this study was to determine the most economical combination of sampling techniques when approaching endobronchial visible lesions. A cost minimization analysis was performed. All bronchoscopies from 2003 and 2004 at Haukeland university hospital, Bergen, Norway, were reviewed retrospectively for diagnostic yields. 162 patients with endobronchial disease were included. Potential sampling techniques used were biopsy, brushing, endobronchial needle aspiration (EBNA) and washings. Costs were estimated based on registration of equipment costs and personnel costs. Sensitivity analyses were performed to determine threshold values. The combination of biopsy, brushing and EBNA was the most economical strategy with an average cost of Euro 893 (95% CI: 657, 1336). The cost of brushing had to be below Euro 83 and it had to increase the diagnostic yield more than 2.2%, for biopsy and brushing to be more economical than biopsy alone. The combination of biopsy, brushing and EBNA was more economical than biopsy and brushing when the cost of EBNA was below Euro 205 and the increase in diagnostic yield was above 5.2%. In the current study setting, biopsy, brushing and EBNA was the most economical combination of sampling techniques for endobronchial visible lesions.

Cost-benefit and effectiveness analysis of rapid testing for MRSA carriage in a hospital setting.

PubMed

Henson, Gay; Ghonim, Elham; Swiatlo, Andrea; King, Shelia; Moore, Kimberly S; King, S Travis; Sullivan, Donna

2014-01-01

A cost-effectiveness analysis was conducted comparing the polymerase chain reaction assay and traditional microbiological culture as screening tools for the identification of methicillin-resistant Staphylococcus aureus (MRSA) in patients admitted to the pediatric and surgical intensive care units (PICU and SICU) at a 722 bed academic medical center. In addition, the cost benefits of identification of colonized MRSA patients were determined. The cost-effectiveness analysis employed actual hospital and laboratory costs, not patient costs. The actual cost of the PCR assay was higher than the microbiological culture identification of MRSA ($602.95 versus $364.30 per positive carrier identified). However, this did not include the decreased turn-around time of PCR assays compared to traditional culture techniques. Patient costs were determined indirectly in the cost-benefit analysis of clinical outcome. There was a reduction in MRSA hospital-acquired infection (3.5 MRSA HAI/month without screening versus 0.6/month with screening by PCR). A cost-benefit analysis based on differences in length of stay suggests an associated savings in hospitalization costs: MRSA HAI with 29.5 day median LOS at $63,810 versus MRSA identified on admission with 6 day median LOS at $14,561, a difference of $49,249 per hospitalization. Although this pilot study was small and it is not possible to directly relate the cost-effectiveness and cost-benefit analysis due to confounding factors such as patient underlying morbidity and mortality, a reduction of 2.9 MRSA HAI/month associated with PCR screening suggests potential savings in hospitalization costs of $142,822 per month.

Economic evaluations and randomized trials in spinal disorders: principles and methods.

PubMed

Korthals-de Bos, Ingeborg; van Tulder, Maurits; van Dieten, Hiske; Bouter, Lex

2004-02-15

Descriptive methodologic recommendations. To help researchers designing, conducting, and reporting economic evaluations in the field of back and neck pain. Economic evaluations of both existing and new therapeutic interventions are becoming increasingly important. There is a need to improve the methods of economic evaluations in the field of spinal disorders. To improve the methods of economic evaluations in the field of spinal disorders, this article describes the various steps in an economic evaluation, using as example a study on the cost-effectiveness of manual therapy, physiotherapy, and usual care provided by the general practitioner for patients with neck pain. An economic evaluation is a study in which two or more interventions are systematically compared with regard to both costs and effects. There are four types of economic evaluations, based on analysis of: (1) cost-effectiveness, (2) cost-utility, (3) cost-minimization, and (4) cost-benefit. The cost-utility analysis is a special case of cost-effectiveness analysis. The first step in all these economic evaluations is to identify the perspective of the study. The choice of the perspective will have consequences for the identification of costs and effects. Secondly, the alternatives that will be compared should be identified. Thirdly, the relevant costs and effects should be identified. Economic evaluations are usually performed from a societal perspective and include consequently direct health care costs, direct nonhealth care costs, and indirect costs. Fourthly, effect data are collected by means of questionnaires or interviews, and relevant cost data with regard to effect measures and health care utilization, work absenteeism, travel expenses, use of over-the-counter medication, and help from family and friends, are collected by means of cost diaries, questionnaires, or (telephone) interviews. Fifthly, real costs are calculated, or the costs are estimated on the basis of real costs, guideline prices, or tariffs. Finally, in the statistical analysis the mean direct, indirect, and total costs of the alternatives are compared, using bootstrapping techniques. Incremental cost-effectiveness ratios are graphically presented on a cost-effectiveness plane and acceptability curves are calculated. Economic evaluations require specific methods. These recommendations may be helpful in improving the quality of economic evaluations of new and existing therapeutic interventions in the field of spinal disorders.

A timer inventory based upon manual and automated analysis of ERTS-1 and supporting aircraft data using multistage probability sampling. [Plumas National Forest, California

NASA Technical Reports Server (NTRS)

Nichols, J. D.; Gialdini, M.; Jaakkola, S.

1974-01-01

A quasi-operational study demonstrating that a timber inventory based on manual and automated analysis of ERTS-1, supporting aircraft data and ground data was made using multistage sampling techniques. The inventory proved to be a timely, cost effective alternative to conventional timber inventory techniques. The timber volume on the Quincy Ranger District of the Plumas National Forest was estimated to be 2.44 billion board feet with a sampling error of 8.2 percent. Costs per acre for the inventory procedure at 1.1 cent/acre compared favorably with the costs of a conventional inventory at 25 cents/acre. A point-by-point comparison of CALSCAN-classified ERTS data with human-interpreted low altitude photo plots indicated no significant differences in the overall classification accuracies.

Non-invasive prenatal diagnosis (NIPD) for single gene disorders: cost analysis of NIPD and invasive testing pathways.

PubMed

Verhoef, Talitha I; Hill, Melissa; Drury, Suzanne; Mason, Sarah; Jenkins, Lucy; Morris, Stephen; Chitty, Lyn S

2016-07-01

Evaluate the costs of offering non-invasive prenatal diagnosis (NIPD) for single gene disorders compared to traditional invasive testing to inform NIPD implementation into clinical practice. Total costs of diagnosis using NIPD or invasive testing pathways were compared for a representative set of single gene disorders. For autosomal dominant conditions, where NIPD molecular techniques are straightforward, NIPD cost £314 less than invasive testing. NIPD for autosomal recessive and X-linked conditions requires more complicated technical approaches and total costs were more than invasive testing, e.g. NIPD for spinal muscular atrophy was £1090 more than invasive testing. Impact of test uptake on costs was assessed using sickle cell disorder as an example. Anticipated high uptake of NIPD resulted in an incremental cost of NIPD over invasive testing of £48 635 per 100 pregnancies at risk of sickle cell disorder. Total costs of NIPD are dependent upon the complexity of the testing technique required. Anticipated increased demand for testing may have economic implications for prenatal diagnostic services. Ethical issues requiring further consideration are highlighted including directing resources to NIPD when used for information only and restricting access to safe tests if it is not cost-effective to develop NIPD for rare conditions. © 2016 The Authors. Prenatal Diagnosis published by John Wiley & Sons, Ltd. © 2016 The Authors. Prenatal Diagnosis published by John Wiley & Sons, Ltd.

The cost-effectiveness of insulin glargine vs. neutral protamine Hagedorn insulin in type 2 diabetes: a focus on health economics.

PubMed

Levin, P

2008-07-01

Diabetes mellitus is a major public health problem, in particular because of long-term complications affecting essential organs, such as the eyes and kidneys, which can lead to a reduction in life expectancy and high healthcare costs. The number of individuals with diabetes mellitus is projected to rise worldwide from 171 million people in 2000 to 366 million people in 2030. With the number of patients with diabetes continually growing, the burden of pressure on worldwide health systems is huge. Accordingly, regulatory and marketing approvals of new medicines are beginning to incorporate economic evaluation techniques to determine their cost-effectiveness. Overall, the studies included in this review show that the initiation of insulin glargine is cost-effective and is expected to lead to substantial improvements in both life years (LYs) and quality-adjusted LYs compared with neutral protamine Hagedorn insulin.

Does Paid Promotion Pay?

ERIC Educational Resources Information Center

Scherer, Chris

1980-01-01

A study to determine the cost effectiveness of newspaper display advertising for cooperative extension programs showed such publicity to be more effective in large metropolitan areas. Though not a technique for increasing enrollment, this method provided long-range benefits in the overall promotion of extension educational services. (SK)

75 FR 16527 - Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-01

... applies to all of the approximately 5,178 firms registered with the Commission that effect transactions on... confirmations than larger firms because they effect fewer transactions. The Commission staff estimates the costs... of automated collection techniques or other forms of information technology. Consideration will be...

NATURAL BIOREMEDIATION PERSPECTIVE FOR BTX CONTAMINATED GROUNDWATER IN BRAZIL: EFFECT OF ETHANOL (R823420)

EPA Science Inventory

Abstract

Natural bioremediation, the use of indigenous microorganisms to degrade hazardous substances within aquifers without engineered stimulation, shows great promise as a cost-effective approach to hydrocarbon plume management. This technique requires thorough site...

Refining cost-effectiveness analyses using the net benefit approach and econometric methods: an example from a trial of anti-depressant treatment.

PubMed

Sabes-Figuera, Ramon; McCrone, Paul; Kendricks, Antony

2013-04-01

Economic evaluation analyses can be enhanced by employing regression methods, allowing for the identification of important sub-groups and to adjust for imperfect randomisation in clinical trials or to analyse non-randomised data. To explore the benefits of combining regression techniques and the standard Bayesian approach to refine cost-effectiveness analyses using data from randomised clinical trials. Data from a randomised trial of anti-depressant treatment were analysed and a regression model was used to explore the factors that have an impact on the net benefit (NB) statistic with the aim of using these findings to adjust the cost-effectiveness acceptability curves. Exploratory sub-samples' analyses were carried out to explore possible differences in cost-effectiveness. Results The analysis found that having suffered a previous similar depression is strongly correlated with a lower NB, independent of the outcome measure or follow-up point. In patients with previous similar depression, adding an selective serotonin reuptake inhibitors (SSRI) to supportive care for mild-to-moderate depression is probably cost-effective at the level used by the English National Institute for Health and Clinical Excellence to make recommendations. This analysis highlights the need for incorporation of econometric methods into cost-effectiveness analyses using the NB approach.

End-user perspective of low-cost sensors for outdoor air pollution monitoring.

PubMed

Rai, Aakash C; Kumar, Prashant; Pilla, Francesco; Skouloudis, Andreas N; Di Sabatino, Silvana; Ratti, Carlo; Yasar, Ansar; Rickerby, David

2017-12-31

Low-cost sensor technology can potentially revolutionise the area of air pollution monitoring by providing high-density spatiotemporal pollution data. Such data can be utilised for supplementing traditional pollution monitoring, improving exposure estimates, and raising community awareness about air pollution. However, data quality remains a major concern that hinders the widespread adoption of low-cost sensor technology. Unreliable data may mislead unsuspecting users and potentially lead to alarming consequences such as reporting acceptable air pollutant levels when they are above the limits deemed safe for human health. This article provides scientific guidance to the end-users for effectively deploying low-cost sensors for monitoring air pollution and people's exposure, while ensuring reasonable data quality. We review the performance characteristics of several low-cost particle and gas monitoring sensors and provide recommendations to end-users for making proper sensor selection by summarizing the capabilities and limitations of such sensors. The challenges, best practices, and future outlook for effectively deploying low-cost sensors, and maintaining data quality are also discussed. For data quality assurance, a two-stage sensor calibration process is recommended, which includes laboratory calibration under controlled conditions by the manufacturer supplemented with routine calibration checks performed by the end-user under final deployment conditions. For large sensor networks where routine calibration checks are impractical, statistical techniques for data quality assurance should be utilised. Further advancements and adoption of sophisticated mathematical and statistical techniques for sensor calibration, fault detection, and data quality assurance can indeed help to realise the promised benefits of a low-cost air pollution sensor network. Copyright © 2017 Elsevier B.V. All rights reserved.

Comparing cost-effectiveness of X-Stop with minimally invasive decompression in lumbar spinal stenosis: a randomized controlled trial.

PubMed

Lønne, Greger; Johnsen, Lars Gunnar; Aas, Eline; Lydersen, Stian; Andresen, Hege; Rønning, Roar; Nygaard, Øystein P

2015-04-15

Randomized clinical trial with 2-year follow-up. To compare the cost-effectiveness of X-stop to minimally invasive decompression in patients with symptomatic lumbar spinal stenosis. Lumbar spinal stenosis is the most common indication for operative treatment in elderly. Although surgery is more costly than nonoperative treatment, health outcomes for more than 2 years were shown to be significantly better. Surgical treatment with minimally invasive decompression is widely used. X-stop is introduced as another minimally invasive technique showing good results compared with nonoperative treatment. We enrolled 96 patients aged 50 to 85 years, with symptoms of neurogenic intermittent claudication within 250-m walking distance and 1- or 2-level lumbar spinal stenosis, randomized to either minimally invasive decompression or X-stop. Quality-adjusted life-years were based on EuroQol EQ-5D. The hospital unit costs were estimated by means of the top-down approach. Each cost unit was converted into a monetary value by dividing the overall cost by the amount of cost units produced. The analysis of costs and health outcomes is presented by the incremental cost-effectiveness ratio. The study was terminated after a midway interim analysis because of significantly higher reoperation rate in the X-stop group (33%). The incremental cost for X-stop compared with minimally invasive decompression was &OV0556;2832 (95% confidence interval: 1886-3778), whereas the incremental health gain was 0.11 quality-adjusted life-year (95% confidence interval: -0.01 to 0.23). Based on the incremental cost and effect, the incremental cost-effectiveness ratio was &OV0556;25,700. The majority of the bootstrap samples displayed in the northeast corner of the cost-effectiveness plane, giving a 50% likelihood that X-stop is cost-effective at the extra cost of &OV0556;25,700 (incremental cost-effectiveness ratio) for a quality-adjusted life-year. The significantly higher cost of X-stop is mainly due to implant cost and the significantly higher reoperation rate. 2.

An alternative arrangement of metered dosing fluid using centrifugal pump

NASA Astrophysics Data System (ADS)

Islam, Md. Arafat; Ehsan, Md.

2017-06-01

Positive displacement dosing pumps are extensively used in various types of process industries. They are widely used for metering small flow rates of a dosing fluid into a main flow. High head and low controllable flow rates make these pumps suitable for industrial flow metering applications. However their pulsating flow is not very suitable for proper mixing of fluids and they are relatively more expensive to buy and maintain. Considering such problems, alternative techniques to control the fluid flow from a low cost centrifugal pump is practiced. These include - throttling, variable speed drive, impeller geometry control and bypass control. Variable speed drive and impeller geometry control are comparatively costly and the flow control by throttling is not an energy efficient process. In this study an arrangement of metered dosing flow was developed using a typical low cost centrifugal pump using bypass flow technique. Using bypass flow control technique a wide range of metered dosing flows under a range of heads were attained using fixed pump geometry and drive speed. The bulk flow returning from the system into the main tank ensures better mixing which may eliminate the need of separate agitators. Comparative performance study was made between the bypass flow control arrangement of centrifugal pump and a diaphragm type dosing pump. Similar heads and flow rates were attainable using the bypass control system compared to the diaphragm dosing pump, but using relatively more energy. Geometrical optimization of the centrifugal pump impeller was further carried out to make the bypass flow arrangement more energy efficient. Although both the systems run at low overall efficiencies but the capital cost could be reduced by about 87% compared to the dosing pump. The savings in capital investment and lower maintenance cost very significantly exceeds the relatively higher energy cost of the bypass system. This technique can be used as a cost effective solution for industries in Bangladesh and have been implemented in two salt iodization plants at Narayangang.

Optimization techniques applied to passive measures for in-orbit spacecraft survivability

NASA Technical Reports Server (NTRS)

Mog, Robert A.; Price, D. Marvin

1987-01-01

Optimization techniques applied to passive measures for in-orbit spacecraft survivability, is a six-month study, designed to evaluate the effectiveness of the geometric programming (GP) optimization technique in determining the optimal design of a meteoroid and space debris protection system for the Space Station Core Module configuration. Geometric Programming was found to be superior to other methods in that it provided maximum protection from impact problems at the lowest weight and cost.

A cost-effective method to prepare curcumin nanosuspensions with enhanced oral bioavailability.

PubMed

Wang, Yutong; Wang, Changyuan; Zhao, Jing; Ding, Yanfang; Li, Lei

2017-01-01

Nanosuspension is one of the most promising strategies to improve the oral bioavailability of insoluble drugs. The existing techniques applied to produce nanosuspensions are classified as "bottom-up" or "top-down" methods, or a combination of both. Curcumin (CUR), a Biopharmaceutics Classification System (BCS) class IV substance, is a promising drug candidate in view of its good bioactivity, but its use is limited due to its poor solubility and permeability. In the present study, CUR nanosuspensions were developed to enhance CUR oral bioavailability using a cost-effective method different from conventional techniques. The physicochemical properties of CUR nanosuspensions were characterized by dynamic light scattering (DLS) and transmission electron microscopy (TEM). The crystalline state of CUR in different nanosuspensions analyzed using differential scanning calorimeter (DSC) and X-ray diffraction analysis (PXRD) confirmed its amorphous state. In vitro dissolution degree of the prepared CUR nanosuspensions using TPGS or Brij78 as stabilizer was greatly increased. Pharmacokinetic studies demonstrated that the oral bioavailability of CUR was increased 3.18 and 3.7 times after administration of CUR/TPGS nanosuspensions or CUR/Brij78 nanosuspensions, when compared with the administration of CUR suspension. CUR nanosuspensions produced by our cost-effective method could improve its oral bioavailability. In addition, the low-cost and time-saving method reported here is highly suitable for a fast and inexpensive preparation. Copyright © 2016 Elsevier Inc. All rights reserved.

Modeling the cost-effectiveness of insect rearing on artificial diets: A test with a tephritid fly used in the sterile insect technique.

PubMed

Pascacio-Villafán, Carlos; Birke, Andrea; Williams, Trevor; Aluja, Martín

2017-01-01

We modeled the cost-effectiveness of rearing Anastrepha ludens, a major fruit fly pest currently mass reared for sterilization and release in pest control programs implementing the sterile insect technique (SIT). An optimization model was generated by combining response surface models of artificial diet cost savings with models of A. ludens pupation, pupal weight, larval development time and adult emergence as a function of mixtures of yeast, a costly ingredient, with corn flour and corncob fractions in the diet. Our model revealed several yeast-reduced mixtures that could be used to prepare diets that were considerably cheaper than a standard diet used for mass rearing. Models predicted a similar production of insects (pupation and adult emergence), with statistically similar pupal weights and larval development times between yeast-reduced diets and the standard mass rearing diet formulation. Annual savings from using the modified diets could be up to 5.9% of the annual cost of yeast, corn flour and corncob fractions used in the standard diet, representing a potential saving of US $27.45 per ton of diet (US $47,496 in the case of the mean annual production of 1,730.29 tons of artificial diet in the Moscafrut mass rearing facility at Metapa, Chiapas, Mexico). Implementation of the yeast-reduced diet on an experimental scale at mass rearing facilities is still required to confirm the suitability of new mixtures of artificial diet for rearing A. ludens for use in SIT. This should include the examination of critical quality control parameters of flies such as adult flight ability, starvation resistance and male sexual competitiveness across various generations. The method used here could be useful for improving the cost-effectiveness of invertebrate or vertebrate mass rearing diets worldwide.

Modeling the cost-effectiveness of insect rearing on artificial diets: A test with a tephritid fly used in the sterile insect technique

PubMed Central

Birke, Andrea; Williams, Trevor; Aluja, Martín

2017-01-01

We modeled the cost-effectiveness of rearing Anastrepha ludens, a major fruit fly pest currently mass reared for sterilization and release in pest control programs implementing the sterile insect technique (SIT). An optimization model was generated by combining response surface models of artificial diet cost savings with models of A. ludens pupation, pupal weight, larval development time and adult emergence as a function of mixtures of yeast, a costly ingredient, with corn flour and corncob fractions in the diet. Our model revealed several yeast-reduced mixtures that could be used to prepare diets that were considerably cheaper than a standard diet used for mass rearing. Models predicted a similar production of insects (pupation and adult emergence), with statistically similar pupal weights and larval development times between yeast-reduced diets and the standard mass rearing diet formulation. Annual savings from using the modified diets could be up to 5.9% of the annual cost of yeast, corn flour and corncob fractions used in the standard diet, representing a potential saving of US $27.45 per ton of diet (US $47,496 in the case of the mean annual production of 1,730.29 tons of artificial diet in the Moscafrut mass rearing facility at Metapa, Chiapas, Mexico). Implementation of the yeast-reduced diet on an experimental scale at mass rearing facilities is still required to confirm the suitability of new mixtures of artificial diet for rearing A. ludens for use in SIT. This should include the examination of critical quality control parameters of flies such as adult flight ability, starvation resistance and male sexual competitiveness across various generations. The method used here could be useful for improving the cost-effectiveness of invertebrate or vertebrate mass rearing diets worldwide. PMID:28257496

Cone penetrometer testing and discrete-depth ground water sampling techniques: A cost-effective method of site characterization in a multiple-aquifer setting

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

Zemo, D.A.; Pierce, Y.G.; Gallinatti, J.D.

Cone penetrometer testing (CPT), combined with discrete-depth ground water sampling methods, can significantly reduce the time and expense required to characterize large sites that have multiple aquifers. Results from the screening site characterization can then be used to design and install a cost-effective monitoring well network. At a site in northern California, it was necessary to characterize the stratigraphy and the distribution of volatile organic compounds (VOCs). To expedite characterization, a five-week field screening program was implemented that consisted of a shallow ground water survey, CPT soundings and pore-pressure measurements, and discrete-depth ground water sampling. Based on continuous lithologic informationmore » provided by the CPT soundings, four predominantly coarse-grained, water yielding stratigraphic packages were identified. Seventy-nine discrete-depth ground water samples were collected using either shallow ground water survey techniques, the BAT Enviroprobe, or the QED HydroPunch I, depending on subsurface conditions. Using results from these efforts, a 20-well monitoring network was designed and installed to monitor critical points within each stratigraphic package. Good correlation was found for hydraulic head and chemical results between discrete-depth screening data and monitoring well data. Understanding the vertical VOC distribution and concentrations produced substantial time and cost savings by minimizing the number of permanent monitoring wells and reducing the number of costly conductor casings that had to be installed. Additionally, significant long-term cost savings will result from reduced sampling costs, because fewer wells comprise the monitoring network. The authors estimate these savings to be 50% for site characterization costs, 65% for site characterization time, and 60% for long-term monitoring costs.« less

48 CFR 9904.404-50 - Techniques for application.

Code of Federal Regulations, 2010 CFR

2010-10-01

.... 9904.404-50 Section 9904.404-50 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.404-50 Techniques for application. (a) The cost to...

48 CFR 9904.406-50 - Techniques for application.

Code of Federal Regulations, 2010 CFR

2010-10-01

.... 9904.406-50 Section 9904.406-50 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.406-50 Techniques for application. (a) The cost of an...

An Evaluation of the Effectiveness of a Computer-Assisted Reading Intervention

ERIC Educational Resources Information Center

Messer, David; Nash, Gilly

2018-01-01

Background: A cost-effective method to address reading delays is to use computer-assisted learning, but these techniques are not always effective. Methods: We evaluated a commercially available computer system that uses visual mnemonics, in a randomised controlled trial with 78 English-speaking children (mean age 7 years) who their schools…

VOLATILE ORGANIC COMPOUNDS (VOC) RECOVERY ...

EPA Pesticide Factsheets

The purpose of the seminar was to bring researchers, technology developers, and industry representatives together to discuss recovery technologies and techniques for VOCs. The seminar focused on the specific VOC recovery needs of industry and on case studies that summarize effective VOC product recovery techniques applicable to air, water, and solid waste. The case studies highlighted examples in which existing and new recovery technologies resulted in significant cost savings to industry. The seminar focused on the following key issues:. Status and future direction of EPA< DOE, and other major research programs.. What are the latest technology innovations in VOC treatment and recovery?. Performance and cost effectiveness of VOC recovery techniques.. How are recovery techniques applied to air, water, and solid waste?Presenters were from industry, academia, EPA, and various consulting firms. The presentations were followed by several facilitated breakout sessions; these sessions allowed participants an opportunity to discuss their needs and opinions on VOC recovery trends, research, and other issues.This document contains summaries of the presentations and discussions during the seminar. It does not constitute an actual proceedings, since the presentations were informal and no written versions were required. The list of participants and contact information are included in Appendix A. Information

Dexmedetomidine in Attenuation of Haemodynamic Response and Dose Sparing Effect on Opioid and Anaesthetic Agents in Patients undergoing Laparoscopic Cholecystectomy- A Randomized Study

PubMed Central

Bhagat, Nandlal; Karim, Habib Md Reazaul; Hajong, Ranendra; Bhattacharyya, Prithwis; Singh, Manorama

2016-01-01

Introduction Perioperative procedures are stressful and lead to haemodynamic instability with potentially devastating consequences. Dexmedetomidine is found to have many of the desired characteristics that are required in perioperative period. Aim To evaluate the ability of pre and intraoperative dexmedetomidine to attenuate stress induced haemodynamic responses, quantifying the anaesthetic agents sparing as well as its cost-effectiveness in patients undergoing laparoscopic cholecystectomy. Materials and Methods The present single blind randomized study was conducted with 120 ASA I and II consented patients who underwent laparoscopic cholecystectomy. Patients were randomly divided into 2 groups (i.e., group D and group N). Prior to induction, group D received 1 μg/kg of Dexmedetomidine and group N received Normal saline infusion over 20 minutes. Group D also received maintenance Dexmedetomidine intraoperatively. Bispectral index and minimum alveolar concentration monitoring was done in both the groups. Haemodynamic parameters were noted till 100 minutes post laryngoscopy. Opioid and anaesthetic agent consumptions were also noted and cost analysis was done. Medcalc–Version 12.5.0.0 software was used for statistics and p <0.05 was considered significant. Results Dexmedetomidine attenuated the stress induced haemodynamics responses and produced stable, relatively non fluctuating haemodynamics throughout. The Minimum Alveolar Concentration (MAC) requirement and the consumptions of Fentanyl and Isoflurane were significantly less in the Dexmedetomidine group (p<0.0001). However, despite anaesthetic dose sparing effect the anaesthetic technique was not cost-effective. Conclusion Dexmedetomidine is effective in attenuating haemodynamic responses in laparoscopic surgery and having dose sparing effect on Fentanyl, Propofol and Isoflurane. However, overall this technique is not cost-effective. PMID:28050479

Cost-effective and rapid concrete repair techniques.

DOT National Transportation Integrated Search

2016-02-08

Concrete is a principal component of many transportation structures. While highly durable, a : variety of processes degrade and damage concrete. Replacement is expensive. Many cases : warrant repair instead of replacement. Since many damage processes...

Ventriculostomy Simulation Using Patient-Specific Ventricular Anatomy, 3D Printing, and Hydrogel Casting.

PubMed

Ryan, Justin R; Chen, Tsinsue; Nakaji, Peter; Frakes, David H; Gonzalez, L Fernando

2015-11-01

Educational simulators provide a means for students and experts to learn and refine surgical skills. Educators can leverage the strengths of medical simulators to effectively teach complex and high-risk surgical procedures, such as placement of an external ventricular drain. Our objective was to develop a cost-effective, patient-derived medical simulacrum for cerebral lateral ventriculostomy. A cost-effective, patient-derived medical simulacrum was developed for placement of an external lateral ventriculostomy. Elastomeric and gel casting techniques were used to achieve realistic brain geometry and material properties. 3D printing technology was leveraged to develop accurate cranial properties and dimensions. An economical, gravity-driven pump was developed to provide normal and abnormal ventricular pressures. A small pilot study was performed to gauge simulation efficacy using a technology acceptance model. An accurate geometric representation of the brain was developed with independent lateral cerebral ventricular chambers. A gravity-driven pump pressurized the ventricular cavities to physiologic values. A qualitative study illustrated that the simulation has potential as an educational tool to train medical professionals in the ventriculostomy procedure. The ventricular simulacrum can improve learning in a medical education environment. Rapid prototyping and multi-material casting techniques can produce patient-derived models for cost-effective and realistic surgical training scenarios. Copyright © 2015 Elsevier Inc. All rights reserved.

Diagnostics of wear in aeronautical systems

NASA Technical Reports Server (NTRS)

Wedeven, L. D.

1979-01-01

The use of appropriate diagnostic tools for aircraft oil wetted components is reviewed, noting that it can reduce direct operating costs through reduced unscheduled maintenance, particularly in helicopter engine and transmission systems where bearing failures are a significant cost factor. Engine and transmission wear modes are described, and diagnostic methods for oil and wet particle analysis, the spectrometric oil analysis program, chip detectors, ferrography, in-line oil monitor and radioactive isotope tagging are discussed, noting that they are effective over a limited range of particle sizes but compliment each other if used in parallel. Fine filtration can potentially increase time between overhauls, but reduces the effectiveness of conventional oil monitoring techniques so that alternative diagnostic techniques must be used. It is concluded that the development of a diagnostic system should be parallel and integral with the development of a mechanical system.

Carbon nanotube-embedded advanced aerospace composites for early-stage damage sensing

NASA Astrophysics Data System (ADS)

Nataraj, Latha; Coatney, Michael; Cain, Jason; Hall, Asha

2018-03-01

Fiber reinforced polymer (FRP) composites featuring outstanding fatigue performance, high specific stiffness and strength, and low density have evolved as critical structural materials in aerospace applications. Microscale damage such as fiber breakage, matrix cracking, and delamination could occur in layered composites compromising structural integrity, emphasizing the critical need to monitor structural health. Early damage detection would lead to enhanced reliability, lifetime, and performance while minimizing maintenance time, leading to enormous scientific and technical interest in realizing physically stable, quick responding, and cost effective strain sensing materials, devices, and techniques with high sensitivity over a broad range of the practical strain spectrum. Today's most commonly used strain sensing techniques are metal foil strain gauges and optical fiber sensors. Metal foil gauges offer high stability and cost-effectiveness but can only be surface-mounted and have a low gauge factor. Optical fibers require expensive instrumentation, are mostly insensitive to cracks parallel to the fiber orientation and may lead to crack initiation as the diameter is larger than that of the reinforcement fibers. Carbon nanotubes (CNTs) have attracted much attention due to high aspect ratio and superior electrical, thermal, and mechanical properties. CNTs embedded in layered composites have improved performance. A variety of CNT architectures and configurations have shown improved piezoresistive behavior and stability for sensing applications. However, scaling up and commercialization remain serious challenges. The current study investigates a simple, cost effective and repeatable technique for highly sensitive, stable, linear and repeatable strain sensing for damage detection by integrating CNT laminates into composites.

Pipeline embolization device versus coiling for the treatment of large and giant unruptured intracranial aneurysms: a cost-effectiveness analysis.

PubMed

Wali, Arvin R; Park, Charlie C; Santiago-Dieppa, David R; Vaida, Florin; Murphy, James D; Khalessi, Alexander A

2017-06-01

OBJECTIVE Rupture of large or giant intracranial aneurysms leads to significant morbidity, mortality, and health care costs. Both coiling and the Pipeline embolization device (PED) have been shown to be safe and clinically effective for the treatment of unruptured large and giant intracranial aneurysms; however, the relative cost-to-outcome ratio is unknown. The authors present the first cost-effectiveness analysis to compare the economic impact of the PED compared with coiling or no treatment for the endovascular management of large or giant intracranial aneurysms. METHODS A Markov model was constructed to simulate a 60-year-old woman with a large or giant intracranial aneurysm considering a PED, endovascular coiling, or no treatment in terms of neurological outcome, angiographic outcome, retreatment rates, procedural and rehabilitation costs, and rupture rates. Transition probabilities were derived from prior literature reporting outcomes and costs of PED, coiling, and no treatment for the management of aneurysms. Cost-effectiveness was defined, with the incremental cost-effectiveness ratios (ICERs) defined as difference in costs divided by the difference in quality-adjusted life years (QALYs). The ICERs < $50,000/QALY gained were considered cost-effective. To study parameter uncertainty, 1-way, 2-way, and probabilistic sensitivity analyses were performed. RESULTS The base-case model demonstrated lifetime QALYs of 12.72 for patients in the PED cohort, 12.89 for the endovascular coiling cohort, and 9.7 for patients in the no-treatment cohort. Lifetime rehabilitation and treatment costs were $59,837.52 for PED; $79,025.42 for endovascular coiling; and $193,531.29 in the no-treatment cohort. Patients who did not undergo elective treatment were subject to increased rates of aneurysm rupture and high treatment and rehabilitation costs. One-way sensitivity analysis demonstrated that the model was most sensitive to assumptions about the costs and mortality risks for PED and coiling. Probabilistic sampling demonstrated that PED was the cost-effective strategy in 58.4% of iterations, coiling was the cost-effective strategy in 41.4% of iterations, and the no-treatment option was the cost-effective strategy in only 0.2% of iterations. CONCLUSIONS The authors' cost-effective model demonstrated that elective endovascular techniques such as PED and endovascular coiling are cost-effective strategies for improving health outcomes and lifetime quality of life measures in patients with large or giant unruptured intracranial aneurysm.

Low-Cost Oil Quality Sensor Based on Changes in Complex Permittivity

PubMed Central

Pérez, Angel Torres; Hadfield, Mark

2011-01-01

Real time oil quality monitoring techniques help to protect important industry assets, minimize downtime and reduce maintenance costs. The measurement of a lubricant’s complex permittivity is an effective indicator of the oil degradation process and it can be useful in condition based maintenance (CBM) to select the most adequate oil replacement maintenance schedules. A discussion of the working principles of an oil quality sensor based on a marginal oscillator to monitor the losses of the dielectric at high frequencies (>1 MHz) is presented. An electronic design procedure is covered which results in a low cost, effective and ruggedized sensor implementation suitable for use in harsh environments. PMID:22346666

48 CFR 9904.412-50 - Techniques for application.

Code of Federal Regulations, 2010 CFR

2010-10-01

.... 9904.412-50 Section 9904.412-50 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD... ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.412-50 Techniques for application. (a) Components of... identified part of the pension cost of a cost accounting period and shall be included in equal annual...

Comparing terrestrial laser scanning with ground and UAV-based imaging for national-level assessment of upland soil erosion

NASA Astrophysics Data System (ADS)

McShane, Gareth; Farrow, Luke; Morgan, David; Glendell, Miriam; James, Mike; Quinton, John; Evans, Martin; Anderson, Karen; Rawlins, Barry; Quine, Timothy; Debell, Leon; Benaud, Pia; Jones, Lee; Kirkham, Matthew; Lark, Murray; Rickson, Jane; Brazier, Richard

2015-04-01

Quantifying soil loss through erosion processes at a high resolution can be a time consuming and costly undertaking. In this pilot study 'a cost effective framework for monitoring soil erosion in England and Wales', funded by the UK Department for Environment, Food and Rural Affairs (Defra), we compare methods for collecting suitable topographic measurements via remote sensing. The aim is to enable efficient but detailed site-scale studies of erosion forms in inaccessible UK upland environments, to quantify dynamic processes, such as erosion and mass movement. The techniques assessed are terrestrial laser scanning (TLS), and unmanned aerial vehicle (UAV) photography and ground-based photography, both processed using structure-from-motion (SfM) 3D reconstruction software. Compared to other established techniques, such as expensive TLS, SfM offers a potentially low-cost alternative for the reconstruction of 3D high-resolution micro-topographic models from photographs taken with consumer grade cameras. However, whilst an increasing number of research papers examine the relative merits of these novel versus more established survey techniques, no study to date has compared both ground-based and aerial SfM photogrammetry with TLS scanning across a range of scales (from m2 to 16ha). The evaluation of these novel low cost techniques is particularly relevant in upland landscapes, where the remoteness and inaccessibility of field sites may render some of the more established survey techniques impractical. Volumetric estimates of soil loss are quantified using the digital surface models (DSMs) derived from the data from each technique and subtracted from a modelled pre-erosion surface. The results from each technique are compared. The UAV was able to capture information over a wide area, a range of altitudes and angles over the study area. Combined with automated SfM-based processing, this technique was able to produce rapid orthophotos to support ground-based data acquisition, as well as a DSM for volume loss measurement in larger features. However, the DSM of erosion features lacked the detail of those captured using the ground-based methods. Terrestrial laser scanning provided detailed, accurate, high density measurements of the ground surface over long (100s m) distances, but size and weight of the instrument made it difficult to use in mountainous environments. In addition, deriving a reliable bare-earth digital terrain model (DTM) from TLS was at times problematic due to the presence of tall shrubby vegetation. Ground-based photography produced comparable data sets to terrestrial laser scanning and was the most useful for characterising small and difficult to view features. The relative advantages, limitations and cost-effectiveness of each approach at 5 upland sites across the UK are discussed.

Active distribution network planning considering linearized system loss

NASA Astrophysics Data System (ADS)

Li, Xiao; Wang, Mingqiang; Xu, Hao

2018-02-01

In this paper, various distribution network planning techniques with DGs are reviewed, and a new distribution network planning method is proposed. It assumes that the location of DGs and the topology of the network are fixed. The proposed model optimizes the capacities of DG and the optimal distribution line capacity simultaneously by a cost/benefit analysis and the benefit is quantified by the reduction of the expected interruption cost. Besides, the network loss is explicitly analyzed in the paper. For simplicity, the network loss is appropriately simplified as a quadratic function of difference of voltage phase angle. Then it is further piecewise linearized. In this paper, a piecewise linearization technique with different segment lengths is proposed. To validate its effectiveness and superiority, the proposed distribution network planning model with elaborate linearization technique is tested on the IEEE 33-bus distribution network system.

Advantages of the net benefit regression framework for economic evaluations of interventions in the workplace: a case study of the cost-effectiveness of a collaborative mental health care program for people receiving short-term disability benefits for psychiatric disorders.

PubMed

Hoch, Jeffrey S; Dewa, Carolyn S

2014-04-01

Economic evaluations commonly accompany trials of new treatments or interventions; however, regression methods and their corresponding advantages for the analysis of cost-effectiveness data are not well known. To illustrate regression-based economic evaluation, we present a case study investigating the cost-effectiveness of a collaborative mental health care program for people receiving short-term disability benefits for psychiatric disorders. We implement net benefit regression to illustrate its strengths and limitations. Net benefit regression offers a simple option for cost-effectiveness analyses of person-level data. By placing economic evaluation in a regression framework, regression-based techniques can facilitate the analysis and provide simple solutions to commonly encountered challenges. Economic evaluations of person-level data (eg, from a clinical trial) should use net benefit regression to facilitate analysis and enhance results.

The New Meteor Radar at Penn State: Design and First Observations

NASA Technical Reports Server (NTRS)

Urbina, J.; Seal, R.; Dyrud, L.

2011-01-01

In an effort to provide new and improved meteor radar sensing capabilities, Penn State has been developing advanced instruments and technologies for future meteor radars, with primary objectives of making such instruments more capable and more cost effective in order to study the basic properties of the global meteor flux, such as average mass, velocity, and chemical composition. Using low-cost field programmable gate arrays (FPGAs), combined with open source software tools, we describe a design methodology enabling one to develop state-of-the art radar instrumentation, by developing a generalized instrumentation core that can be customized using specialized output stage hardware. Furthermore, using object-oriented programming (OOP) techniques and open-source tools, we illustrate a technique to provide a cost-effective, generalized software framework to uniquely define an instrument s functionality through a customizable interface, implemented by the designer. The new instrument is intended to provide instantaneous profiles of atmospheric parameters and climatology on a daily basis throughout the year. An overview of the instrument design concepts and some of the emerging technologies developed for this meteor radar are presented.

Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial

PubMed Central

Bos, Ingeborg B C Korthals-de; Hoving, Jan L; van Tulder, Maurits W; Mölken, Maureen P M H Rutten-van; Adèr, Herman J; de Vet, Henrica C W; Koes, Bart W; Vondeling, Hindrik; Bouter, Lex M

2003-01-01

Objective To evaluate the cost effectiveness of physiotherapy, manual therapy, and care by a general practitioner for patients with neck pain. Design Economic evaluation alongside a randomised controlled trial. Setting Primary care. Participants 183 patients with neck pain for at least two weeks recruited by 42 general practitioners and randomly allocated to manual therapy (n=60, spinal mobilisation), physiotherapy (n=59, mainly exercise), or general practitioner care (n=64, counselling, education, and drugs). Main outcome measures Clinical outcomes were perceived recovery, intensity of pain, functional disability, and quality of life. Direct and indirect costs were measured by means of cost diaries that were kept by patients for one year. Differences in mean costs between groups, cost effectiveness, and cost utility ratios were evaluated by applying non-parametric bootstrapping techniques. Results The manual therapy group showed a faster improvement than the physiotherapy group and the general practitioner care group up to 26 weeks, but differences were negligible by follow up at 52 weeks. The total costs of manual therapy (€447; £273; $402) were around one third of the costs of physiotherapy (€1297) and general practitioner care (€1379). These differences were significant: P<0.01 for manual therapy versus physiotherapy and manual therapy versus general practitioner care and P=0.55 for general practitioner care versus physiotherapy. The cost effectiveness ratios and the cost utility ratios showed that manual therapy was less costly and more effective than physiotherapy or general practitioner care. Conclusions Manual therapy (spinal mobilisation) is more effective and less costly for treating neck pain than physiotherapy or care by a general practitioner. What is already known on this topicThe cost of treating neck pain is considerableMany conservative interventions are available, such as prescription drugs, yet their cost effectiveness has not been evaluatedNo randomised trials of conservative treatment for neck pain have so far included an economic evaluationWhat this study addsManual therapy is more effective and less costly than physiotherapy or care by a general practitioner for treating neck painPatients undergoing manual therapy recovered more quickly than those undergoing the other interventions PMID:12714472

Are critical pathways and implant standardization programs effective in reducing costs in total knee replacement operations?

PubMed

Ho, David M; Huo, Michael H

2007-07-01

Total knee replacement (TKR) operation is one of the most effective procedures, both clinically and in terms of cost. Because of increased volume and cost for this procedure during the past 3 decades, TKRs are often targeted for cost reduction. The purpose of this study was to evaluate the efficacy of two cost reducing methodologies, establishment of critical clinical pathways, and standardization of implant costs. Ninety patients (90 knees) were randomly selected from a population undergoing primary TKR during a 2-year period at a tertiary teaching hospital. Patients were assigned to three groups that corresponded to different strategies implemented during the evolution of the joint-replacement program. Medical records were reviewed for type of anesthesia, operative time, length of stay, and any perioperative complications. Financial information for each patient was compared among the three groups. Data analysis demonstrated that the institution of a critical pathway significantly shortened length of hospital stay and was effective in reducing the hospital costs by 18% (p < 0.05). In addition, standardization of surgical techniques under the care of a single surgeon substantially reduced the operative time. Selection of implants from a single vendor did not have any substantial effect in additionally reducing the costs. Standardized postoperative management protocols and critical clinical pathways can reduce costs and operative time. Future efforts must focus on lowering the costs of the prostheses, particularly with competitive bidding or capitation of prostheses costs. Although a single-vendor approach was not effective in this study, it is possible that a cost reduction could have been realized if more TKRs were performed, because the pricing contract was based on projected volume of TKRs to be done by the hospital.

A Marxian interpretation of the growth and development of coronary care technology.

PubMed Central

Waitzkin, H

1979-01-01

Cost containment efforts will fail if they continue to ignore the structural relationships between health care costs and private profit in capitalist society. The recent history of coronary care shows that apparent irrationalities of health policy make sense from the standpoint of capitalist profit structure. Coronary care units (CCUs) gained wide acceptance, despite high costs. Studies of CCU effectiveness, using random controlled trials and epidemiologic techniques, do not show a consistent advantage of CCUs over non-intensive ward care or simple rest at home. From a Marxian perspective, the proliferation of CCUs and similar innovations is a complex historical process that includes initiatives by industrial corporations, cooperation by clinical investigators at academic medical centers, support by private philanthropies linked to corporate interests, intervention by state agencies, and changes in the health care labor force. Cost-effective methodology obscures the profit motive as a basic source of high costs and ineffective practices. Health-policy alternatives curtailing corporate involvement in medicine would reduce costs by restricting profit. PMID:116553

Optimal pipe size design for looped irrigation water supply system using harmony search: Saemangeum project area.

PubMed

Yoo, Do Guen; Lee, Ho Min; Sadollah, Ali; Kim, Joong Hoon

2015-01-01

Water supply systems are mainly classified into branched and looped network systems. The main difference between these two systems is that, in a branched network system, the flow within each pipe is a known value, whereas in a looped network system, the flow in each pipe is considered an unknown value. Therefore, an analysis of a looped network system is a more complex task. This study aims to develop a technique for estimating the optimal pipe diameter for a looped agricultural irrigation water supply system using a harmony search algorithm, which is an optimization technique. This study mainly serves two purposes. The first is to develop an algorithm and a program for estimating a cost-effective pipe diameter for agricultural irrigation water supply systems using optimization techniques. The second is to validate the developed program by applying the proposed optimized cost-effective pipe diameter to an actual study region (Saemangeum project area, zone 6). The results suggest that the optimal design program, which applies an optimization theory and enhances user convenience, can be effectively applied for the real systems of a looped agricultural irrigation water supply.

Optimal Pipe Size Design for Looped Irrigation Water Supply System Using Harmony Search: Saemangeum Project Area

PubMed Central

Lee, Ho Min; Sadollah, Ali

2015-01-01

Water supply systems are mainly classified into branched and looped network systems. The main difference between these two systems is that, in a branched network system, the flow within each pipe is a known value, whereas in a looped network system, the flow in each pipe is considered an unknown value. Therefore, an analysis of a looped network system is a more complex task. This study aims to develop a technique for estimating the optimal pipe diameter for a looped agricultural irrigation water supply system using a harmony search algorithm, which is an optimization technique. This study mainly serves two purposes. The first is to develop an algorithm and a program for estimating a cost-effective pipe diameter for agricultural irrigation water supply systems using optimization techniques. The second is to validate the developed program by applying the proposed optimized cost-effective pipe diameter to an actual study region (Saemangeum project area, zone 6). The results suggest that the optimal design program, which applies an optimization theory and enhances user convenience, can be effectively applied for the real systems of a looped agricultural irrigation water supply. PMID:25874252

Cost-effectiveness analysis of neonatal hearing screening program in China: should universal screening be prioritized?

PubMed

Huang, Li-Hui; Zhang, Luo; Tobe, Ruo-Yan Gai; Qi, Fang-Hua; Sun, Long; Teng, Yue; Ke, Qing-Lin; Mai, Fei; Zhang, Xue-Feng; Zhang, Mei; Yang, Ru-Lan; Tu, Lin; Li, Hong-Hui; Gu, Yan-Qing; Xu, Sai-Nan; Yue, Xiao-Yan; Li, Xiao-Dong; Qi, Bei-Er; Cheng, Xiao-Huan; Tang, Wei; Xu, Ling-Zhong; Han, De-Min

2012-04-17

Neonatal hearing screening (NHS) has been routinely offered as a vital component of early childhood care in developed countries, whereas such a screening program is still at the pilot or preliminary stage as regards its nationwide implementation in developing countries. To provide significant evidence for health policy making in China, this study aims to determine the cost-effectiveness of NHS program implementation in case of eight provinces of China. A cost-effectiveness model was conducted and all neonates annually born from 2007 to 2009 in eight provinces of China were simulated in this model. The model parameters were estimated from the established databases in the general hospitals or maternal and child health hospitals of these eight provinces, supplemented from the published literature. The model estimated changes in program implementation costs, disability-adjusted life years (DALYs), average cost-effectiveness ratio (ACER), and incremental cost-effectiveness ratio (ICER) for universal screening compared to targeted screening in eight provinces. A multivariate sensitivity analysis was performed to determine uncertainty in health effect estimates and cost-effectiveness ratios using a probabilistic modeling technique. Targeted strategy trended to be cost-effective in Guangxi, Jiangxi, Henan, Guangdong, Zhejiang, Hebei, Shandong, and Beijing from the level of 9%, 9%, 8%, 4%, 3%, 7%, 5%, and 2%, respectively; while universal strategy trended to be cost-effective in those provinces from the level of 70%, 70%, 48%, 10%, 8%, 28%, 15%, 4%, respectively. This study showed although there was a huge disparity in the implementation of the NHS program in the surveyed provinces, both universal strategy and targeted strategy showed cost-effectiveness in those relatively developed provinces, while neither of the screening strategy showed cost-effectiveness in those relatively developing provinces. This study also showed that both strategies especially universal strategy achieve a good economic effect in the long term costs. Universal screening might be considered as the prioritized implementation goal especially in those relatively developed provinces of China as it provides the best health and economic effects, while targeted screening might be temporarily more realistic than universal screening in those relatively developing provinces of China.

48 CFR 9905.506-50 - Techniques for application.

Code of Federal Regulations, 2010 CFR

2010-10-01

.... 9905.506-50 Section 9905.506-50 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD... ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS FOR EDUCATIONAL INSTITUTIONS 9905.506-50 Techniques for application. (a) The cost of an indirect function which exists for only a part of a cost accounting period may...

Exploiting Redundancy and Application Scalability for Cost-Effective, Time-Constrained Execution of HPC Applications on Amazon EC2

DOE PAGES

Marathe, Aniruddha P.; Harris, Rachel A.; Lowenthal, David K.; ...

2015-12-17

The use of clouds to execute high-performance computing (HPC) applications has greatly increased recently. Clouds provide several potential advantages over traditional supercomputers and in-house clusters. The most popular cloud is currently Amazon EC2, which provides fixed-cost and variable-cost, auction-based options. The auction market trades lower cost for potential interruptions that necessitate checkpointing; if the market price exceeds the bid price, a node is taken away from the user without warning. We explore techniques to maximize performance per dollar given a time constraint within which an application must complete. Specifically, we design and implement multiple techniques to reduce expected cost bymore » exploiting redundancy in the EC2 auction market. We then design an adaptive algorithm that selects a scheduling algorithm and determines the bid price. We show that our adaptive algorithm executes programs up to seven times cheaper than using the on-demand market and up to 44 percent cheaper than the best non-redundant, auction-market algorithm. We extend our adaptive algorithm to incorporate application scalability characteristics for further cost savings. In conclusion, we show that the adaptive algorithm informed with scalability characteristics of applications achieves up to 56 percent cost savings compared to the expected cost for the base adaptive algorithm run at a fixed, user-defined scale.« less

Using mediation techniques to manage conflict and create healthy work environments.

PubMed

Gerardi, Debra

2004-01-01

Healthcare organizations must find ways for managing conflict and developing effective working relationships to create healthy work environments. The effects of unresolved conflict on clinical outcomes, staff retention, and the financial health of the organization lead to many unnecessary costs that divert resources from clinical care. The complexity of delivering critical care services makes conflict resolution difficult. Developing collaborative working relationships helps to manage conflict in complex environments. Working relationships are based on the ability to deal with differences. Dealing with differences requires skill development and techniques for balancing interests and communicating effectively. Techniques used by mediators are effective for resolving disputes and developing working relationships. With practice, these techniques are easily transferable to the clinical setting. Listening for understanding, reframing, elevating the definition of the problem, and forming clear agreements can foster working relationships, decrease the level of conflict, and create healthy work environments that benefit patients and professionals.

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

PubMed

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

2009-03-01

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

Surveying drainage culvert use by carnivores: sampling design and cost-benefit analyzes of track-pads vs. video-surveillance methods.

PubMed

Mateus, Ana Rita A; Grilo, Clara; Santos-Reis, Margarida

2011-10-01

Environmental assessment studies often evaluate the effectiveness of drainage culverts as habitat linkages for species, however, the efficiency of the sampling designs and the survey methods are not known. Our main goal was to estimate the most cost-effective monitoring method for sampling carnivore culvert using track-pads and video-surveillance. We estimated the most efficient (lower costs and high detection success) interval between visits (days) when using track-pads and also determined the advantages of using each method. In 2006, we selected two highways in southern Portugal and sampled 15 culverts over two 10-day sampling periods (spring and summer). Using the track-pad method, 90% of the animal tracks were detected using a 2-day interval between visits. We recorded a higher number of crossings for most species using video-surveillance (n = 129) when compared with the track-pad technique (n = 102); however, the detection ability using the video-surveillance method varied with type of structure and species. More crossings were detected in circular culverts (1 m and 1.5 m diameter) than in box culverts (2 m to 4 m width), likely because video cameras had a reduced vision coverage area. On the other hand, carnivore species with small feet such as the common genet Genetta genetta were detected less often using the track-pad surveying method. The cost-benefit analyzes shows that the track-pad technique is the most appropriate technique, but video-surveillance allows year-round surveys as well as the behavior response analyzes of species using crossing structures.

Current techniques in rice mill effluent treatment: Emerging opportunities for waste reuse and waste-to-energy conversion.

PubMed

Kumar, Anuj; Priyadarshinee, Rashmi; Roy, Abhishek; Dasgupta, Dalia; Mandal, Tamal

2016-12-01

Rice mills release huge volumes of wastewater and other by-products when processing paddy rice. The wastewater often contains toxic inorganic and organic contaminants which cause environmental damage when released. Accordingly, cost-effective techniques for removing contaminants are needed. This article reviews current processes for curbing pollution and also reusing and recycling waste products. Novel techniques exist for converting waste products into energy and value-added products. Copyright © 2016 Elsevier Ltd. All rights reserved.

Field and laboratory investigations for full depth reclamation projects.

DOT National Transportation Integrated Search

2011-03-01

Full-depth reclamation (FDR) offers a timely, cost-effective solution to restore a pavements condition. : However, FDR represents only one technique in the engineers toolkit available for addressing deteriorating : pavement conditions. The purp...

Cost-effectiveness of pressure-relieving devices for the prevention and treatment of pressure ulcers.

PubMed

Fleurence, Rachael L

2005-01-01

The cost-effectiveness of alternating pressure-relieving devices, mattress replacements, and mattress overlays compared with a standard hospital (high-specification foam mattress) for the prevention and treatment of pressure ulcers in hospital patients in the United Kingdom was investigated. A decision-analytic model was constructed to evaluate different strategies to prevent or treat pressure ulcers. Three scenarios were evaluated: the prevention of pressure ulcers, the treatment of superficial ulcers, and the treatment of severe ulcers. Epidemiological and effectiveness data were obtained from the clinical literature. Expert opinion using a rating scale technique was used to obtain quality of life data. Costs of the devices were obtained from manufacturers, whereas costs of treatment were obtained from the literature. Uncertainty was explored through probabilistic sensitivity analysis. Using 30,000 pounds sterling/QALY (quality-adjusted life year) as the decision-maker's cut off point (the current UK standard), in scenario 1 (prevention), the cost-effective strategy was the mattress overlay at 1, 4, and 12 weeks. In scenarios 2 and 3, the cost-effective strategy was the mattress replacement at 1, 4, and 12 weeks. Standard care was a dominated intervention in all scenarios for values of the decision-maker's ceiling ratio ranging from 5,000 pounds sterling to 100,000 pounds sterling/QALY. However, the probabilistic sensitivity analysis results reflected the high uncertainty surrounding the choice of devices. Current information suggests that alternating pressure mattress overlays may be cost-effective for the prevention of pressure ulcers, whereas alternating pressure mattress replacements appears to be cost-effective for the treatment of superficial and severe pressure ulcers.

Evaluating effectiveness and cost of time-lapse triggered camera trapping techniques to detect terrestrial squamate diversity

Treesearch

Connor S. Adams; Wade A. Ryberg; Toby J. Hibbitts; Brian L. Pierce; Josh B. Pierce; D. Craig Rudolph

2017-01-01

Recent advancements in camera trap technology have allowed researchers to explore methodologies that are minimally invasive, and both time and cost efficient (Long et al. 2008; O’Connell et al. 2010; Gregory et al. 2014; Meek et al. 2014; Swinnen et al. 2014; Newey et al. 2015). The use of cameras for understanding the distribution and ecology of mammals is advanced;...

The Role of Training Providers in Manpower Planning.

ERIC Educational Resources Information Center

Gray, Lynton

1993-01-01

Research in Nigeria and Thailand is used to demonstrate that, where vocational training is cost effective (graduates get appropriate jobs), links with employers are closer than in other labor markets. Techniques such as reverse tracer studies, labor market signaling, and skills analysis can be used to improve training effectiveness. (SK)

Quantifying livestock effects on bunchgrass vegetation with Landsat ETM+ data across a single growing season

USDA-ARS?s Scientific Manuscript database

Working grassland systems provide important habitat for native biodiversity and forage for livestock, with proper livestock grazing playing an important role for sustainable ecosystem function. Traditional in-field techniques to monitor the effects of grazing on vegetation are costly and limited to ...

SOME QUANTITATIVE ASPECTS OF THE INSTRUCTIONAL PROCESS.

ERIC Educational Resources Information Center

GAVIN, WILLIAM J.; SPITZER, MURRAY

THE DATA FROM THE SEVERAL STUDIES ANALYZED IN THIS REPORT HAVE BEEN COLLECTED AS PART OF AN ON-GOING EFFORT TO IMPLEMENT THE ABT ASSOCIATES' EDUCATION COST EFFECTIVENESS INSTRUCTIONAL PROCESS SUBMODEL, WHICH IS DEVELOPING TECHNIQUES TO EVALUATE THE QUANTITATIVE, CAUSE-AND-EFFECT RELATIONSHIP BETWEEN THE INSTRUCTIONAL PROCESS AND SCHOLASTIC…

Biomedical microfluidic devices by using low-cost fabrication techniques: A review.

PubMed

Faustino, Vera; Catarino, Susana O; Lima, Rui; Minas, Graça

2016-07-26

One of the most popular methods to fabricate biomedical microfluidic devices is by using a soft-lithography technique. However, the fabrication of the moulds to produce microfluidic devices, such as SU-8 moulds, usually requires a cleanroom environment that can be quite costly. Therefore, many efforts have been made to develop low-cost alternatives for the fabrication of microstructures, avoiding the use of cleanroom facilities. Recently, low-cost techniques without cleanroom facilities that feature aspect ratios more than 20, for fabricating those SU-8 moulds have been gaining popularity among biomedical research community. In those techniques, Ultraviolet (UV) exposure equipment, commonly used in the Printed Circuit Board (PCB) industry, replaces the more expensive and less available Mask Aligner that has been used in the last 15 years for SU-8 patterning. Alternatively, non-lithographic low-cost techniques, due to their ability for large-scale production, have increased the interest of the industrial and research community to develop simple, rapid and low-cost microfluidic structures. These alternative techniques include Print and Peel methods (PAP), laserjet, solid ink, cutting plotters or micromilling, that use equipment available in almost all laboratories and offices. An example is the xurography technique that uses a cutting plotter machine and adhesive vinyl films to generate the master moulds to fabricate microfluidic channels. In this review, we present a selection of the most recent lithographic and non-lithographic low-cost techniques to fabricate microfluidic structures, focused on the features and limitations of each technique. Only microfabrication methods that do not require the use of cleanrooms are considered. Additionally, potential applications of these microfluidic devices in biomedical engineering are presented with some illustrative examples. Copyright © 2015 Elsevier Ltd. All rights reserved.

The costs and service implications of substituting intermediate care for acute hospital care.

PubMed

Mayhew, Leslie; Lawrence, David

2006-05-01

Intermediate care is part of a package of initiatives introduced by the UK Government mainly to relieve pressure on acute hospital beds and reduce delayed discharge (bed blocking). Intermediate care involves caring for patients in a range of settings, such as in the home or community or in nursing and residential homes. This paper considers the scope of intermediate care and its role in relation to acute hospital services. In particular, it develops a framework that can be used to inform decisions about the most cost-effective care pathways for given clinical situations, and also for wider planning purposes. It does this by providing a model for evaluating the costs of intermediate care services provided by different agencies and techniques for calibrating the model locally. It finds that consistent application of the techniques over a period of time, coupled with sound planning and accounting, should result in savings to the health economy.

Economic Analysis in the Pacific Northwest Land Resources Project: Theoretical Considerations and Preliminary Results

NASA Technical Reports Server (NTRS)

Morse, D. R. A.; Sahlberg, J. T.

1977-01-01

The Pacific Northwest Land Resources Inventory Demonstration Project i s an a ttempt to combine a whole spectrum of heterogeneous geographic, institutional and applications elements in a synergistic approach to the evaluation of remote sensing techniques. This diversity is the prime motivating factor behind a theoretical investigation of alternative economic analysis procedures. For a multitude of reasons--simplicity, ease of understanding, financial constraints and credibility, among others--cost-effectiveness emerges as the most practical tool for conducting such evaluation determinatIons in the Pacific Northwest. Preliminary findings in two water resource application areas suggest, in conformity with most published studies, that Lands at-aided data collection methods enjoy substantial cost advantages over alternative techniques. The pntential for sensitivity analysis based on cost/accuracy tradeoffs is considered on a theoretical plane in the absence of current accuracy figures concerning the Landsat-aided approach.

Cost-effectiveness analysis of low-molecular-weight heparin versus aspirin thromboprophylaxis in patients newly diagnosed with multiple myeloma.

PubMed

Chalayer, Emilie; Bourmaud, Aurélie; Tinquaut, Fabien; Chauvin, Franck; Tardy, Bernard

2016-09-01

The aim of this study was to assess the cost-effectiveness of low molecular weight heparin versus aspirin as primary thromboprophylaxis throughout chemotherapy for newly diagnosed multiple myeloma patients treated with protocols including thalidomide from the perspective of French health care providers. We used a modeling approach combining data from the only randomized trial evaluating the efficacy of the two treatments and secondary sources for costs, and utility values. We performed a decision-tree analysis and our base case was a hypothetical cohort of 10,000 patients. A bootstrap resampling technique was used. The incremental cost-effectiveness ratio was calculated using estimated quality-adjusted life years as the efficacy outcome. Incremental costs and effectiveness were estimated for each strategy and the incremental cost-effectiveness ratio was calculated. One-way sensitivity analyses were performed. The number of quality-adjusted life years was estimated to be 0.300 with aspirin and 0.299 with heparin. The estimated gain with aspirin was therefore approximately one day. Over 6months, the mean total cost was € 1518 (SD=601) per patient in the heparin arm and € 273 (SD=1019) in the aspirin arm. This resulted in an incremental cost of € 1245 per patient treated with heparin. The incremental cost-effectiveness ratio for the aspirin versus heparin strategy was calculated to be - 687,398 € (95% CI, -13,457,369 to -225,385). Aspirin rather than heparin thromboprophylaxis, during the first six months of chemotherapy for myeloma, is associated with significant cost savings per patient and also with an unexpected slight increase in quality of life. Copyright © 2016 Elsevier Ltd. All rights reserved.

Architectural Considerations of Fiber-Radio Millimeter-Wave Wireless Access Systems

NASA Astrophysics Data System (ADS)

Kitayama, Ken-Ichi

The architecture of fiber-radio mm-wave wireless access systems critically depends upon the optical mm-wave generation and transport techniques. Four optical mm-wave generation and transport techniques: 1) optical self-heterodyning, 2) external modulation, 3) up- and downconversion, and 4) optical transceiver, will be assessed. From the technical viewpoints, their advantages and disadvantages are discussed. The economical assessment, focusing on the cost of a base station BS ( ), will suggest that the optical transceiver looks the most promising in the long run, but in the near future, however, the external modulation will be cost-effective. The experimental results of 60 GHz testbeds using the external modulation will support the conclusion.

Evaluating the cost of one telehealth application connecting an acute and long-term care setting.

PubMed

Specht, J K; Wakefield, B; Flanagan, J

2001-01-01

This article describes a study of the costs of a pilot telemedicine chronic wound consultation clinic. Cost minimization analysis is the technique used to examine the costs of the clinic. The components of cost analysis include the fixed costs of personnel and equipment and the indirect costs of circuit and line charges. Cost avoidance is also examined. Cost avoidance evaluates what costs were avoided by the use of the telemedicine clinic. Additionally, the cost perspectives of the consulting agency, the referring agency, and the patient are examined. The average cost of a chronic wound consultation was $136.16 (acute care perspective). Costs of a traditional face-to-face consultation, if the residents were transported to the acute care facility would be $246.28. Fifteen telehealth consultations per month were used to determine per consultation costs for line charges and depreciation/maintenance costs. In this pilot study, a cost savings was realized and patients benefited. Increased volume will help to offset the cost of the equipment depreciation and maintenance and make telehealth chronic wound consultations more cost effective.

The use of a resource-based relative value scale (RBRVS) to determine practice expense costs: a novel technique of practice management for the vascular surgeon.

PubMed

Mabry, C D

2001-03-01

Vascular surgeons have had to contend with rising costs while their reimbursements have undergone steady reductions. The use of newer accounting techniques can help vascular surgeons better manage their practices, plan for future expansion, and control costs. This article reviews traditional accounting methods, together with activity-based costing (ABC) principles that have been used in the past for practice expense analysis. The main focus is on a new technique-resource-based costing (RBC)-which uses the widely available Resource-Based Relative Value Scale (RBRVS) as its basis. The RBC technique promises easier implementation as well as more flexibility in determining true costs of performing various procedures, as opposed to more traditional accounting methods. It is hoped that RBC will assist vascular surgeons in coping with decreasing reimbursement. Copyright 2001 by W.B. Saunders Company

Performance of US teaching hospitals: a panel analysis of cost inefficiency.

PubMed

Rosko, Michael D

2004-02-01

This research summarizes an analysis of the impact of environment pressures on hospital inefficiency during the period 1990-1999. The panel design included 616 hospitals. Of these, 211 were academic medical centers and 415 were hospitals with smaller teaching programs. The primary sources of data were the American Hospital Association's Annual Survey of Hospitals and Medicare Cost Reports. Hospital inefficiency was estimated by a regression technique called stochastic frontier analysis. This technique estimates a "best practice cost frontier" for each hospital that is based on the hospital's outputs and input prices. The cost efficiency of each hospital was defined as the ratio of the stochastic frontier total costs to observed total costs. Average inefficiency declined from 14.35% in 1990 to 11.42% in 1998. It increased to 11.78% in 1999. Decreases in inefficiency were associated with the HMO penetration rate and time. Increases in inefficiency were associated with for-profit ownership status and Medicare share of admissions. The implementation of the provisions of the Balanced Budget Act of 1997 was followed by a small decrease in average hospital inefficiency. Analysis found that the SFA results were moderately sensitive to the specification of the teaching output variable. Thus, although the SFA technique can be useful for detecting differences in inefficiency between groups of hospitals (i.e., those with high versus those with low Medicare shares or for-profit versus not-for-profit hospitals), its relatively low precision indicates it should not be used for exact estimates of the magnitude of differences associated with inefficiency-effects variables.

The effectiveness and cost-effectiveness of intraoperative imaging in high-grade glioma resection; a comparative review of intraoperative ALA, fluorescein, ultrasound and MRI.

PubMed

Eljamel, M Sam; Mahboob, Syed Osama

2016-12-01

Surgical resection of high-grade gliomas (HGG) is standard therapy because it imparts significant progression free (PFS) and overall survival (OS). However, HGG-tumor margins are indistinguishable from normal brain during surgery. Hence intraoperative technology such as fluorescence (ALA, fluorescein) and intraoperative ultrasound (IoUS) and MRI (IoMRI) has been deployed. This study compares the effectiveness and cost-effectiveness of these technologies. Critical literature review and meta-analyses, using MEDLINE/PubMed service. The list of references in each article was double-checked for any missing references. We included all studies that reported the use of ALA, fluorescein (FLCN), IoUS or IoMRI to guide HGG-surgery. The meta-analyses were conducted according to statistical heterogeneity between studies. If there was no heterogeneity, fixed effects model was used; otherwise, a random effects model was used. Statistical heterogeneity was explored by χ 2 and inconsistency (I 2 ) statistics. To assess cost-effectiveness, we calculated the incremental cost per quality-adjusted life-year (QALY). Gross total resection (GTR) after ALA, FLCN, IoUS and IoMRI was 69.1%, 84.4%, 73.4% and 70% respectively. The differences were not statistically significant. All four techniques led to significant prolongation of PFS and tended to prolong OS. However none of these technologies led to significant prolongation of OS compared to controls. The cost/QALY was $16,218, $3181, $6049 and $32,954 for ALA, FLCN, IoUS and IoMRI respectively. ALA, FLCN, IoUS and IoMRI significantly improve GTR and PFS of HGG. Their incremental cost was below the threshold for cost-effectiveness of HGG-therapy, denoting that each intraoperative technology was cost-effective on its own. Copyright © 2016 Elsevier B.V. All rights reserved.

Demonstration of decomposition and optimization in the design of experimental space systems

NASA Technical Reports Server (NTRS)

Padula, Sharon; Sandridge, Chris A.; Haftka, Raphael T.; Walsh, Joanne L.

1989-01-01

Effective design strategies for a class of systems which may be termed Experimental Space Systems (ESS) are needed. These systems, which include large space antenna and observatories, space platforms, earth satellites and deep space explorers, have special characteristics which make them particularly difficult to design. It is argued here that these same characteristics encourage the use of advanced computer-aided optimization and planning techniques. The broad goal of this research is to develop optimization strategies for the design of ESS. These strategics would account for the possibly conflicting requirements of mission life, safety, scientific payoffs, initial system cost, launch limitations and maintenance costs. The strategies must also preserve the coupling between disciplines or between subsystems. Here, the specific purpose is to describe a computer-aided planning and scheduling technique. This technique provides the designer with a way to map the flow of data between multidisciplinary analyses. The technique is important because it enables the designer to decompose the system design problem into a number of smaller subproblems. The planning and scheduling technique is demonstrated by its application to a specific preliminary design problem.

Costs and cost containment in nursing homes.

PubMed Central

Smith, H L; Fottler, M D

1981-01-01

The study examines the impact of structural and process variables on the cost of nursing home care and the utilization of various cost containment methods in 43 california nursing homes. Several predictors were statistically significant in their relation to cost per patient day. A diverse range of cost containment techniques was discovered along with strong predictors of the utilization of these techniques by nursing home administrators. The trade-off between quality of care and cost of care is discussed. PMID:7228713

Automated array assembly

NASA Technical Reports Server (NTRS)

Williams, B. F.

1976-01-01

Manufacturing techniques are evaluated using expenses based on experience and studying basic cost factors for each step to evaluate expenses from a first-principles point of view. A formal cost accounting procedure is developed which is used throughout the study for cost comparisons. The first test of this procedure is a comparison of its predicted costs for array module manufacturing with costs from a study which is based on experience factors. A manufacturing cost estimate for array modules of $10/W is based on present-day manufacturing techniques, expenses, and materials costs.

Business Case Analysis: Continuous Integrated Logistics Support-Targeted Allowance Technique (CILS-TAT)

DTIC Science & Technology

2013-06-01

In this research, we examine the Naval Sea Logistics Command s Continuous Integrated Logistics Support Targeted Allowancing Technique (CILS TAT) and... the feasibility of program re-implementation. We conduct an analysis of this allowancing method s effectiveness onboard U.S. Navy Ballistic Missile...Defense (BMD) ships, measure the costs associated with performing a CILS TAT, and provide recommendations concerning possible improvements to the

A bark-shaving technique to deter rat snakes from climbing red-cockaded woodpecker cavity trees

Treesearch

Daniel Saenz; Christopher S. Collins; Richard N. Conner

1999-01-01

We developed a bark-shaving technique to deter rat snakes (Elaphe obsoleta) from climbing red-cockaded woodpecker (Picoides borealis) trees as an aesthetically pleasing, more cost-effective, and safer alternative to other snake excluder devices. We used a drawknife to carefully shave the bark around the circumference of 4 treatment trees in a l-m-wide band to...

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

Critical infrastructure monitoring using UAV imagery

NASA Astrophysics Data System (ADS)

Maltezos, Evangelos; Skitsas, Michael; Charalambous, Elisavet; Koutras, Nikolaos; Bliziotis, Dimitris; Themistocleous, Kyriacos

2016-08-01

The constant technological evolution in Computer Vision enabled the development of new techniques which in conjunction with the use of Unmanned Aerial Vehicles (UAVs) may extract high quality photogrammetric products for several applications. Dense Image Matching (DIM) is a Computer Vision technique that can generate a dense 3D point cloud of an area or object. The use of UAV systems and DIM techniques is not only a flexible and attractive solution to produce accurate and high qualitative photogrammetric results but also is a major contribution to cost effectiveness. In this context, this study aims to highlight the benefits of the use of the UAVs in critical infrastructure monitoring applying DIM. A Multi-View Stereo (MVS) approach using multiple images (RGB digital aerial and oblique images), to fully cover the area of interest, is implemented. The application area is an Olympic venue in Attica, Greece, at an area of 400 acres. The results of our study indicate that the UAV+DIM approach respond very well to the increasingly greater demands for accurate and cost effective applications when provided with, a 3D point cloud and orthomosaic.

Wear study of Al-SiC metal matrix composites processed through microwave energy

NASA Astrophysics Data System (ADS)

Honnaiah, C.; Srinath, M. S.; Prasad, S. L. Ajit

2018-04-01

Particulate reinforced metal matrix composites are finding wider acceptance in many industrial applications due to their isotropic properties and ease of manufacture. Uniform distribution of reinforcement particulates and good bonding between matrix and reinforcement phases are essential features in order to obtain metal matrix composites with improved properties. Conventional powder metallurgy technique can successfully overcome the limitation of stir casting techniques, but it is time consuming and not cost effective. Use of microwave technology for processing particulate reinforced metal matrix composites through powder metallurgy technique is being increasingly explored in recent times because of its cost effectiveness and speed of processing. The present work is an attempt to process Al-SiC metal matrix composites using microwaves irradiated at 2.45 GHz frequency and 900 W power for 10 minutes. Further, dry sliding wear studies were conducted at different loads at constant velocity of 2 m/s for various sliding distances using pin-on-disc equipment. Analysis of the obtained results show that the microwave processed Al-SiC composite material shows around 34 % of resistance to wear than the aluminium alloy.

Block-accelerated aggregation multigrid for Markov chains with application to PageRank problems

NASA Astrophysics Data System (ADS)

Shen, Zhao-Li; Huang, Ting-Zhu; Carpentieri, Bruno; Wen, Chun; Gu, Xian-Ming

2018-06-01

Recently, the adaptive algebraic aggregation multigrid method has been proposed for computing stationary distributions of Markov chains. This method updates aggregates on every iterative cycle to keep high accuracies of coarse-level corrections. Accordingly, its fast convergence rate is well guaranteed, but often a large proportion of time is cost by aggregation processes. In this paper, we show that the aggregates on each level in this method can be utilized to transfer the probability equation of that level into a block linear system. Then we propose a Block-Jacobi relaxation that deals with the block system on each level to smooth error. Some theoretical analysis of this technique is presented, meanwhile it is also adapted to solve PageRank problems. The purpose of this technique is to accelerate the adaptive aggregation multigrid method and its variants for solving Markov chains and PageRank problems. It also attempts to shed some light on new solutions for making aggregation processes more cost-effective for aggregation multigrid methods. Numerical experiments are presented to illustrate the effectiveness of this technique.

Advanced geophysical underground coal gasification monitoring

DOE PAGES

Mellors, Robert; Yang, X.; White, J. A.; ...

2014-07-01

Underground Coal Gasification (UCG) produces less surface impact, atmospheric pollutants and greenhouse gas than traditional surface mining and combustion. Therefore, it may be useful in mitigating global change caused by anthropogenic activities. Careful monitoring of the UCG process is essential in minimizing environmental impact. Here we first summarize monitoring methods that have been used in previous UCG field trials. We then discuss in more detail a number of promising advanced geophysical techniques. These methods – seismic, electromagnetic, and remote sensing techniques – may provide improved and cost-effective ways to image both the subsurface cavity growth and surface subsidence effects. Activemore » and passive seismic data have the promise to monitor the burn front, cavity growth, and observe cavity collapse events. Electrical resistance tomography (ERT) produces near real time tomographic images autonomously, monitors the burn front and images the cavity using low-cost sensors, typically running within boreholes. Interferometric synthetic aperture radar (InSAR) is a remote sensing technique that has the capability to monitor surface subsidence over the wide area of a commercial-scale UCG operation at a low cost. It may be possible to infer cavity geometry from InSAR (or other surface topography) data using geomechanical modeling. The expected signals from these monitoring methods are described along with interpretive modeling for typical UCG cavities. They are illustrated using field results from UCG trials and other relevant subsurface operations.« less

Prospects and Pitfalls in the Coming Wave of High-frequency Environmental Data: What to Look Forward to, and Watch out for

NASA Astrophysics Data System (ADS)

Keller, A. A.; Adeleye, A. S.; Huang, Y.; Garner, K.

2014-12-01

The application of nanotechnology in drinking water treatment and pollution cleanup is promising, as demonstrated by a number of field-based (pilot and full scale) and bench scale studies. A number of reviews exist for these nanotechnology-based applications; but to better illustrate its importance and guide its development, a direct comparison between traditional treatment technologies and emerging approaches using nanotechnology is needed. In this review, the performances of traditional technologies and nanotechnology for water treatment and environmental remediation were compared with the goal of providing an up-to-date reference on the state of treatment techniques for researchers, industry, and policy makers. Pollutants were categorized into broad classes, and the most cost-effective techniques (traditional and nanotechnology-based) in each category reported in the literature were compared. Where information was available, cost and environmental implications of both technologies were also compared. Traditional treatment technologies were found to currently offer the most cost-effective choices for removal of several common pollutants from drinking water and polluted sites. Nano-based techniques may however become important in complicated remediation conditions and meeting increasingly stringent water quality standards, especially in removal of emerging pollutants and low levels of contaminants. We also discuss challenges facing environmental application of nanotechnology were also discussed and potential solutions.

A protocol of a randomized controlled multicenter trial for surgical treatment of lumbar spondylolisthesis: the Lumbar Interbody Fusion Trial (LIFT).

PubMed

de Kunder, Suzanne L; Rijkers, Kim; van Kuijk, Sander M J; Evers, Silvia M A A; de Bie, Rob A; van Santbrink, Henk

2016-10-06

With a steep increase in the number of instrumented spinal fusion procedures, there is a need for comparative data to develop evidence based treatment recommendations. Currently, the available data on cost and clinical effectiveness of the two most frequently performed surgeries for lumbar spondylolisthesis, transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF), are not sufficient. Therefore, current guidelines do not advise which is the most appropriate surgical treatment strategy for these patients. Non-randomized studies comparing TLIF and PLIF moreover suggest that TLIF is associated with fewer complications, less blood loss, shorter surgical time and hospital duration. TLIF may therefore be more cost-effective. The results of this study will provide knowledge on short- and long-term clinical and economical effects of TLIF and PLIF procedures, which will lead to recommendations for treating patients with lumbar spondylolisthesis. Multicenter blinded Randomized Controlled Trial (RCT; blinding for the patient and statistician, not for the clinician and researcher). A total of 144 patients over 18 years old with symptomatic single level lumbar degenerative, isthmic or iatrogenic spondylolisthesis whom are candidates for LIF (lumbar interbody fusion) surgery through a posterior approach will be randomly allocated to TLIF or PLIF. The study will consist of three parts: 1) a clinical effectiveness study, 2) a cost-effectiveness study, and 3) a process evaluation. The primary clinical outcome measures are: change in disability measured with Oswestry Disability Index (ODI) and change in quality adjusted life years (QALY) measured with EQ-5D-5L. Secondary clinical outcome measures are: Short Form (36) Health Survey (SF-36), VAS back pain, VAS leg pain, Hospital Anxiety Depression Scale (HADS), complications, productivity related costs (iPCQ) and medical costs (iMCQ). Measurements will be carried out at five fixed time points (pre-operatively and at 3, 6, 12 and 24 months). It is hypothesized that TLIF, compared to PLIF, has similar clinical outcome or is possibly better in reducing disability. Moreover, direct medical costs are expected to be lower due to less surgical morbidity, shorter hospital stay and shorter surgical time. Indirect costs are assumed to be lower for TLIF as well, because we suspect less working days are lost. Currently, prospective data comparing clinical and cost-effectiveness of both techniques are not available. Therefore, in clinical practice both techniques are used and the choice for technique is greatly based on surgeon's preference. The demand for spinal fusion surgery has risen steeply over the last 10 years and is expected to increase even further in the near future. As a result, the burden on society (and the working population) will increase. In case our hypothesis is confirmed, treatment guidelines will be adapted, and TLIF will be recommended as first choice surgical treatment of lumbar spondylolisthesis. Ultimately this will lead to reduction of (direct and indirect) costs and better clinical outcome for spondylolisthesis patients eligible for instrumented spinal surgery. Netherlands Trial Registry, number 5722 (registration date March 30, 2016).

Modeling the patient and health system impacts of alternative xpert® MTB/RIF algorithms for the diagnosis of pulmonary tuberculosis in Addis Ababa, Ethiopia.

PubMed

Tesfaye, Abraham; Fiseha, Daniel; Assefa, Dawit; Klinkenberg, Eveline; Balanco, Silvia; Langley, Ivor

2017-05-02

To reduce global tuberculosis (TB) burden, the active disease must be diagnosed quickly and accurately and patients should be treated and cured. In Ethiopia, TB diagnosis mainly relies on spot-morning-spot (SMS) sputum sample smear analysis using Ziehl-Neelsen staining techniques (ZN). Since 2014 targeted use of xpert has been implemented. New diagnostic techniques have higher sensitivity and are likely to detect more cases if routinely implemented. The objective of our study was to project the effects of alternative diagnostic algorithms on the patient, health system, and costs, and identify cost-effective algorithms that increase TB case detection in Addis Ababa, Ethiopia. An observational quantitative modeling framework was applied using the Virtual Implementation approach. The model was designed to represent the operational and epidemiological context of Addis Ababa, the capital city of Ethiopia. We compared eight diagnostic algorithm with ZN microscopy, light emitting diode (LED) fluorescence microscopy and Xpert MTB/RIF. Interventions with an annualized cost per averted disability adjusted life year (DALY) of less than the Gross Domestic Product (GDP) per capita are considered cost-effective interventions. With a cost lower than the average per-capita GDP (US$690 for Ethiopia) for each averted disability adjusted life year (DALY), three of the modeled algorithms are cost-effective. Implementing them would have important patient, health system, and population-level effects in the context of Addis Ababa ❖ The full roll-out of Xpert MTB/RIF as the primary test for all presumptive TB cases would avert 91170 DALYs (95% credible interval [CrI] 54888 - 127448) with an additional health system cost of US$ 11.6 million over the next 10 years. The incremental cost-effectiveness ratio (ICER) is $370 per DALY averted. ❖ Same day LED fluorescence microscopy for all presumptive TB cases combined with Xpert MTB/RIF targeted to HIV-positive and High multidrug resistant (MDR) risk groups would avert 73600 DALYs( 95% CrI 48373 - 99214) with an additional cost of US$5.1 million over the next 10 years. The ICER is $169per DALY averted. ❖ Same-day LED fluorescence microscopy for all presumptive TB cases (and no Xpert MTB/RIF) would avert 43580 DALYs with a reduction cost of US$ 0.2 million over the next 10years. The ICER is $13 per DALY averted. The full roll-out of Xpert MTB/RIF is predicted to be the best option to substantially reduce the TB burden in Addis Ababa and is considered cost effective. However, the investment cost to implement this is far beyond the budget of the national TB control program. Targeted use of Xpert MTB/RIF for HIV positive and high MDR risk groups with same-day LED fluorescence microscopy for all other presumptive TB cases is an affordable alternative.

A cost comparison analysis of adjuvant radiation therapy techniques after breast-conserving surgery.

PubMed

Lanni, Thomas; Keisch, Martin; Shah, Chirag; Wobb, Jessica; Kestin, Larry; Vicini, Frank

2013-01-01

The aim of this study is to perform a cost analysis to compare adjuvant radiation therapy schedules following breast conserving surgery. Treatment planning and delivery utilization data were modeled for a series of 10 different breast RT techniques. The whole breast (WB) regimens consisted of: (1) Wedge based WB (25 fractions [fx]), (2) WB using IMRT, (3) WBRT with a boost (B), (4) WBRT using IMRT with a B, (5) Canadian WB (16 fx) with 3D-CRT, and (6) Canadian using IMRT. The accelerated partial breast irradiation (APBI) regimens included (7): APBI using 3D-CRT, (8) IMRT, (9) single channel balloon, and (10) multi-channel balloon. Costs incurred by the payer (i.e., direct medical costs) were taken from the 2011 Medicare Fee Schedule. Among all the different regimens examined, Canadian 3D-CRT and APBI 3D-CRT were the least costly whereas WB using IMRT with a B was the most expensive. Both APBI brachytherapy techniques were less costly than conventional WB with a B. In terms of direct medical costs, the technical component accounted for most, if not all, of the disparity among the various treatments. A general trend of decreasing RT costs was observed with further reductions in overall treatment time for WBRT techniques, but not all of the alternative treatment regimens led to similar total cost savings. APBI using brachytherapy techniques was less costly than conventional WBRT with a standard boost. © 2013 Wiley Periodicals, Inc.

Estimating the costs of tsetse control options: an example for Uganda.

PubMed

Shaw, A P M; Torr, S J; Waiswa, C; Cecchi, G; Wint, G R W; Mattioli, R C; Robinson, T P

2013-07-01

Decision-making and financial planning for tsetse control is complex, with a particularly wide range of choices to be made on location, timing, strategy and methods. This paper presents full cost estimates for eliminating or continuously controlling tsetse in a hypothetical area of 10,000km(2) located in south-eastern Uganda. Four tsetse control techniques were analysed: (i) artificial baits (insecticide-treated traps/targets), (ii) insecticide-treated cattle (ITC), (iii) aerial spraying using the sequential aerosol technique (SAT) and (iv) the addition of the sterile insect technique (SIT) to the insecticide-based methods (i-iii). For the creation of fly-free zones and using a 10% discount rate, the field costs per km(2) came to US$283 for traps (4 traps per km(2)), US$30 for ITC (5 treated cattle per km(2) using restricted application), US$380 for SAT and US$758 for adding SIT. The inclusion of entomological and other preliminary studies plus administrative overheads adds substantially to the overall cost, so that the total costs become US$482 for traps, US$220 for ITC, US$552 for SAT and US$993 - 1365 if SIT is added following suppression using another method. These basic costs would apply to trouble-free operations dealing with isolated tsetse populations. Estimates were also made for non-isolated populations, allowing for a barrier covering 10% of the intervention area, maintained for 3 years. Where traps were used as a barrier, the total cost of elimination increased by between 29% and 57% and for ITC barriers the increase was between 12% and 30%. In the case of continuous tsetse control operations, costs were estimated over a 20-year period and discounted at 10%. Total costs per km(2) came to US$368 for ITC, US$2114 for traps, all deployed continuously, and US$2442 for SAT applied at 3-year intervals. The lower costs compared favourably with the regular treatment of cattle with prophylactic trypanocides (US$3862 per km(2) assuming four doses per annum at 45 cattle per km(2)). Throughout the study, sensitivity analyses were conducted to explore the impact on cost estimates of different densities of ITC and traps, costs of baseline studies and discount rates. The present analysis highlights the cost differentials between the different intervention techniques, whilst attesting to the significant progress made over the years in reducing field costs. Results indicate that continuous control activities can be cost-effective in reducing tsetse populations, especially where the creation of fly-free zones is challenging and reinvasion pressure high. Copyright © 2013 Food and Agriculture Organization of the United Nations. Published by Elsevier B.V. All rights reserved.

Cost-utility of cognitive behavioral therapy for low back pain from the commercial payer perspective.

PubMed

Norton, Giulia; McDonough, Christine M; Cabral, Howard; Shwartz, Michael; Burgess, James F

2015-05-15

Markov cost-utility model. To evaluate the cost-utility of cognitive behavioral therapy (CBT) for the treatment of persistent nonspecific low back pain (LBP) from the perspective of US commercial payers. CBT is widely deemed clinically effective for LBP treatment. The evidence is suggestive of cost-effectiveness. We constructed and validated a Markov intention-to-treat model to estimate the cost-utility of CBT, with 1-year and 10-year time horizons. We applied likelihood of improvement and utilities from a randomized controlled trial assessing CBT to treat LBP. The trial randomized subjects to treatment but subjects freely sought health care services. We derived the cost of equivalent rates and types of services from US commercial claims for LBP for a similar population. For the 10-year estimates, we derived recurrence rates from the literature. The base case included medical and pharmaceutical services and assumed gradual loss of skill in applying CBT techniques. Sensitivity analyses assessed the distribution of service utilization, utility values, and rate of LBP recurrence. We compared health plan designs. Results are based on 5000 iterations of each model and expressed as an incremental cost per quality-adjusted life-year. The incremental cost-utility of CBT was $7197 per quality-adjusted life-year in the first year and $5855 per quality-adjusted life-year over 10 years. The results are robust across numerous sensitivity analyses. No change of parameter estimate resulted in a difference of more than 7% from the base case for either time horizon. Including chiropractic and/or acupuncture care did not substantively affect cost-effectiveness. The model with medical but no pharmaceutical costs was more cost-effective ($5238 for 1 yr and $3849 for 10 yr). CBT is a cost-effective approach to manage chronic LBP among commercial health plans members. Cost-effectiveness is demonstrated for multiple plan designs. 2.

Comparison of the deep inferior epigastric perforator flap and free transverse rectus abdominis myocutaneous flap in postmastectomy reconstruction: a cost-effectiveness analysis.

PubMed

Thoma, Achilleas; Veltri, Karen; Khuthaila, Dana; Rockwell, Gloria; Duku, Eric

2004-05-01

This study compared the deep inferior epigastric perforator (DIEP) flap and the free transverse rectus abdominis myocutaneous (TRAM) flap in postmastectomy reconstruction using a cost-effectiveness analysis. A decision analytic model was used. Medical costs associated with the two techniques were estimated from the Ontario Ministry of Health Schedule of Benefits for 2002. Hospital costs were obtained from St. Joseph's Healthcare, a university teaching hospital in Hamilton, Ontario, Canada. The utilities of clinically important health states related to breast reconstruction were obtained from 32 "experts" across Canada and converted into quality-adjusted life years. The probabilities of these various clinically important health states being associated with the DIEP and free TRAM flaps were obtained after a thorough review of the literature. The DIEP flap was more costly than the free TRAM flap ($7026.47 versus $6508.29), but it provided more quality-adjusted life years than the free TRAM flap (28.88 years versus 28.53 years). The baseline incremental cost-utility ratio was $1464.30 per quality-adjusted life year, favoring adoption of the DIEP flap. Sensitivity analyses were performed by assuming that the probabilities of occurrence of hernia, abdominal bulging, total flap loss, operating room time, and hospital stay were identical with the DIEP and free TRAM techniques. By assuming that the probability of postoperative hernia for the DIEP flap increased from 0.008 to 0.054 (same as for TRAM flap), the incremental cost-utility ratio changed to $1435.00 per quality-adjusted life year. A sensitivity analysis was performed for the complication of hernia because the DIEP flap allegedly diminishes this complication. Increasing the probability of abdominal bulge from 0.041 to 0.103 for the DIEP flap changed the ratio to $2731.78 per quality-adjusted life year. When the probability of total flap failure was increased from 0.014 to 0.016, the ratio changed to $1384.01 per quality-adjusted life year. When the time in the operating room was assumed to be the same for both flaps, the ratio changed to $4026.57 per quality-adjusted life year. If the hospital stay was assumed to be the same for both flaps, the ratio changed to $1944.30 per quality-adjusted life year. On the basis of the baseline calculation and sensitivity analyses, the DIEP flap remained a cost-effective procedure. Thus, adoption of this new technique for postmastectomy reconstruction is warranted in the Canadian health care system.

Simulation/Emulation Techniques: Compressing Schedules With Parallel (HW/SW) Development

NASA Technical Reports Server (NTRS)

Mangieri, Mark L.; Hoang, June

2014-01-01

NASA has always been in the business of balancing new technologies and techniques to achieve human space travel objectives. NASA's Kedalion engineering analysis lab has been validating and using many contemporary avionics HW/SW development and integration techniques, which represent new paradigms to NASA's heritage culture. Kedalion has validated many of the Orion HW/SW engineering techniques borrowed from the adjacent commercial aircraft avionics solution space, inserting new techniques and skills into the Multi - Purpose Crew Vehicle (MPCV) Orion program. Using contemporary agile techniques, Commercial-off-the-shelf (COTS) products, early rapid prototyping, in-house expertise and tools, and extensive use of simulators and emulators, NASA has achieved cost effective paradigms that are currently serving the Orion program effectively. Elements of long lead custom hardware on the Orion program have necessitated early use of simulators and emulators in advance of deliverable hardware to achieve parallel design and development on a compressed schedule.

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

PubMed

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

2015-12-01

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

Holographic daylighting

NASA Astrophysics Data System (ADS)

Ludman, Jacques E.; Riccobono, Juanita R.; Savant, Gajendra D.; Jannson, Joanna L.; Campbell, Eugene W.; Hall, Robyn

1995-09-01

Daylighting techniques are an effective means of reducing both lighting and cooling costs; however, many of the standard techniques have flaws which reduce their effectiveness. Daylighting holograms are an efficient and effective method for diffracting sunlight up onto the ceiling, deep in a room, without diffracting the light at eye-level. They need only cover the top half of a window to produce significant energy savings. They may be used as part of a new glazing system or as a retrofit to existing windows. These holograms are broadband and are able to passively track the movement of the sun across the sky, throughout the day and year.

Heart failure disease management programs: a cost-effectiveness analysis.

PubMed

Chan, David C; Heidenreich, Paul A; Weinstein, Milton C; Fonarow, Gregg C

2008-02-01

Heart failure (HF) disease management programs have shown impressive reductions in hospitalizations and mortality, but in studies limited to short time frames and high-risk patient populations. Current guidelines thus only recommend disease management targeted to high-risk patients with HF. This study applied a new technique to infer the degree to which clinical trials have targeted patients by risk based on observed rates of hospitalization and death. A Markov model was used to assess the incremental life expectancy and cost of providing disease management for high-risk to low-risk patients. Sensitivity analyses of various long-term scenarios and of reduced effectiveness in low-risk patients were also considered. The incremental cost-effectiveness ratio of extending coverage to all patients was $9700 per life-year gained in the base case. In aggregate, universal coverage almost quadrupled life-years saved as compared to coverage of only the highest quintile of risk. A worst case analysis with simultaneous conservative assumptions yielded an incremental cost-effectiveness ratio of $110,000 per life-year gained. In a probabilistic sensitivity analysis, 99.74% of possible incremental cost-effectiveness ratios were <$50,000 per life-year gained. Heart failure disease management programs are likely cost-effective in the long-term along the whole spectrum of patient risk. Health gains could be extended by enrolling a broader group of patients with HF in disease management.

Cost effective prevention of reflective cracking of composite pavement.

DOT National Transportation Integrated Search

2011-09-01

Louisiana experimented with various techniques and treatments to control reflective cracking since the : 1970s. The objective of this study is to evaluate and compare different reflective cracking control : treatments by evaluating the performance, c...

Novel high speed fiber-optic pressure sensor systems.

DOT National Transportation Integrated Search

2014-03-01

The goal of this project is to develop a complete test of this technology for high-speed, high-accuracy applications, specifically cost-effective data acquisition techniques and practical mounting methods tailored for the subject environment. The sec...

Finite Element Modeling and Analysis of Thorax/Restraint System Interlock

DOT National Transportation Integrated Search

1994-05-23

Various modeling techniques are playing an increasingly important role as a cost effective means of supplementing crashworthiness data for gaining a better understanding of the injury mechanisms associated with automotive crashes. The interaction of ...

Steep cut slope composting : field trials and evaluation.

DOT National Transportation Integrated Search

2011-04-01

Three different depths of compost and five compost retention techniques were tested to determine : their efficacy and cost effectiveness for increasing the establishment of native grass seedings and decreasing : erosion on steep roadside cut slopes i...

[Comparative cost analysis of molecular biology methods in the diagnosis of sarcomas].

PubMed

Baffert, Sandrine; Italiano, Antoine; Pierron, Gaëlle; Traoré, Marie-Angèle; Rapp, Jocelyn; Escande, Fabienne; Ghnassia, Jean-Pierre; Terrier, Philippe; Voegeli, Anne-Claire; Ranchere-Vince, Dominique; Coindre, Jean-Michel; Pedeutour, Florence

2013-10-01

Sarcomas represent a complex and heterogeneous group of rare malignant tumors and their correct diagnosis is often difficult. Recent molecular biological techniques have been of great diagnostic use and there is a need to assess the cost of these procedures in routine clinical practice. Using prospective and observational data from eight molecular biology laboratories in France, we used "microcosting" method to assess the cost of molecular biological techniques in the diagnosis of five types of sarcoma. The mean cost of fluorescence in situ hybridization (FISH) was 318 € (273-393) per sample; mean reverse transcription polymerase chain reaction (RT-PCR) cost ranged from 300 € (229-481) per formalin-fixed, paraffin-embedded specimen to 258 € (213-339) per frozen specimen; mean quantitative polymerase chain reaction (Q-PCR) cost was 184 € (112-229) and mean CGH-array cost was 332 € (329-335). The cost of these recently implemented techniques varied according to the type of sarcoma; the method of tissue collection and local organizational factors including the level of local expertise and investment. The cost of molecular diagnostic techniques needs to be balanced against their respective performance.

Depth-Based Detection of Standing-Pigs in Moving Noise Environments.

PubMed

Kim, Jinseong; Chung, Yeonwoo; Choi, Younchang; Sa, Jaewon; Kim, Heegon; Chung, Yongwha; Park, Daihee; Kim, Hakjae

2017-11-29

In a surveillance camera environment, the detection of standing-pigs in real-time is an important issue towards the final goal of 24-h tracking of individual pigs. In this study, we focus on depth-based detection of standing-pigs with "moving noises", which appear every night in a commercial pig farm, but have not been reported yet. We first apply a spatiotemporal interpolation technique to remove the moving noises occurring in the depth images. Then, we detect the standing-pigs by utilizing the undefined depth values around them. Our experimental results show that this method is effective for detecting standing-pigs at night, in terms of both cost-effectiveness (using a low-cost Kinect depth sensor) and accuracy (i.e., 94.47%), even with severe moving noises occluding up to half of an input depth image. Furthermore, without any time-consuming technique, the proposed method can be executed in real-time.

Cost-effectiveness and cost-utility of a Web-based or print-delivered tailored intervention to promote physical activity among adults aged over fifty: an economic evaluation of the Active Plus intervention.

PubMed

Golsteijn, Rianne Hj; Peels, Denise A; Evers, Silvia Maa; Bolman, Catherine; Mudde, Aart N; de Vries, Hein; Lechner, Lilian

2014-09-28

The adverse health effects of insufficient physical activity (PA) result in high costs to society. The economic burden of insufficient PA, which increases in our aging population, stresses the urgency for cost-effective interventions to promote PA among older adults. The current study provides insight in the cost-effectiveness and cost-utility of different versions of a tailored PA intervention (Active Plus) among adults aged over fifty. The intervention conditions (i.e. print-delivered basic (PB; N = 439), print-delivered environmental (PE; N = 435), Web-based basic (WB; N = 423), Web-based environmental (WE; N = 432)) and a waiting-list control group were studied in a clustered randomized controlled trial. Intervention costs were registered during the trial. Health care costs, participant costs and productivity losses were identified and compared with the intervention effects on PA (in MET-hours per week) and quality-adjusted life years (QALYs) 12 months after the start of the intervention. Cost-effectiveness ratios (ICERs) and cost-utility ratios (ICURs) were calculated per intervention condition. Non-parametric bootstrapping techniques and sensitivity analyses were performed to account for uncertainty. As a whole (i.e. the four intervention conditions together) the Active Plus intervention was found to be cost-effective. The PB-intervention (ICER = €-55/MET-hour), PE-intervention (ICER = €-94/MET-hour) and the WE-intervention (ICER = €-139/MET-hour) all resulted in higher effects on PA and lower societal costs than the control group. With regard to QALYs, the PB-intervention (ICUR = €38,120/QALY), the PE-intervention (ICUR = €405,892/QALY) and the WE-intervention (ICUR = €-47,293/QALY) were found to be cost-effective when considering a willingness-to-pay threshold of €20,000/QALY. In most cases PE had the highest probability to be cost-effective. The Active Plus intervention was found to be a cost-effective manner to increase PA in a population aged over fifty when compared to no-intervention. The tailored Active Plus intervention delivered through printed material and with additional environmental information (PE) turned out to be the most cost-effective intervention condition as confirmed by the different sensitivity analyses. By increasing PA at relatively low costs, the Active Plus intervention can contribute to a better public health. Dutch Trial Register: NTR2297.

Cost-Effectiveness of Endoscopic Versus Microscopic Transsphenoidal Surgery for Pituitary Adenoma.

PubMed

Ament, Jared D; Yang, Zhuo; Khatchadourian, Vic; Strong, Edward B; Shahlaie, Kiarash

2018-02-01

Endoscopic transsphenoidal surgery (ETPS) has become increasingly popular for resection of pituitary tumors, whereas microscopic transsphenoidal surgery (MTPS) also remains a commonly used approach. The economic sustainability of new techniques and technologies is rarely evaluated in the neurosurgical skull base literature. The aim of this study was to determine the cost-effectiveness of ETPS compared with MTPS. A Markov model was constructed to conduct a cost-utility analysis of ETPS versus MTPS from a single-payer health care perspective. Data were obtained from previously published outcomes studies. Costs were based on Medicare reimbursement rates, considering covariates such as complications, length of stay, and operative time. The base case adopted a 2-year follow-up period. Univariate and multivariate sensitivity analyses were conducted. On average, ETPS costs $143 less and generates 0.014 quality-adjusted life years (QALYs) compared with MTPS over 2 years. The incremental cost-effectiveness ratio (ICER) is -$10,214 per QALY, suggesting economic dominance. The QALY benefit increased to 0.105 when modeled to 10 years, suggesting that ETPS becomes even more favorable over time. ETPS appears to be cost-effective when compared with MTPS because the ICER falls below the commonly accepted $50,000 per QALY benchmark. Model limitations and assumptions affect the generalizability of the conclusion; however, ongoing efforts to improve rhinologic morbidity related to ETPS would appear to further augment the marginal cost savings and QALYs gained. Further research on the cost-effectiveness of ETPS using prospective data is warranted. Copyright © 2017 Elsevier Inc. All rights reserved.

Financial Impact of PEVAR Compared With Standard Endovascular Repair in Canadian Hospitals.

PubMed

Roche-Nagle, Graham; Hazel, Maureen; Rajan, Dheeraj K

2018-05-01

The percutaneous endovascular abdominal aortic repair (PEVAR) approach is a minimally invasive technique that has demonstrated clinical benefit over traditional surgical cut down associated with standard endovascular abdominal aortic aneurysm (AAA) repair (EVAR). The objective of our study was to evaluate the budget impact to a Canadian hospital of changing the technique for AAA repair from the EVAR approach to the PEVAR approach. We examined the budget impact of replacing the EVAR approach with the PEVAR approach in a Canadian hospital that performs 100 endovascular AAA repairs annually. The model incorporates the costs associated with surgery, length of stay, and postoperative complications occurring within 30 days. The use of PEVAR in AAA repair is associated with increased access device costs when compared with the EVAR approach (CAD$1000 vs CAD$400). However, AAA repair completed with the PEVAR approach demonstrates reduced operating time (101 minutes vs 133 minutes), length of stay (2.2 days vs 3.5 days), time in the recovery room (174 minutes vs 193 minutes), and postoperative complications (6% vs 30%), which offset the increased device costs. The model establishes that switching to the PEVAR approach in a Canadian hospital performing 100 AAA repairs annually would result in a potential cost avoidance of CAD$245,120. A change in AAA repair technique from EVAR to PEVAR can be a cost-effective solution for Canadian hospitals. Copyright © 2017 Canadian Association of Radiologists. Published by Elsevier Inc. All rights reserved.

Markov modeling and discrete event simulation in health care: a systematic comparison.

PubMed

Standfield, Lachlan; Comans, Tracy; Scuffham, Paul

2014-04-01

The aim of this study was to assess if the use of Markov modeling (MM) or discrete event simulation (DES) for cost-effectiveness analysis (CEA) may alter healthcare resource allocation decisions. A systematic literature search and review of empirical and non-empirical studies comparing MM and DES techniques used in the CEA of healthcare technologies was conducted. Twenty-two pertinent publications were identified. Two publications compared MM and DES models empirically, one presented a conceptual DES and MM, two described a DES consensus guideline, and seventeen drew comparisons between MM and DES through the authors' experience. The primary advantages described for DES over MM were the ability to model queuing for limited resources, capture individual patient histories, accommodate complexity and uncertainty, represent time flexibly, model competing risks, and accommodate multiple events simultaneously. The disadvantages of DES over MM were the potential for model overspecification, increased data requirements, specialized expensive software, and increased model development, validation, and computational time. Where individual patient history is an important driver of future events an individual patient simulation technique like DES may be preferred over MM. Where supply shortages, subsequent queuing, and diversion of patients through other pathways in the healthcare system are likely to be drivers of cost-effectiveness, DES modeling methods may provide decision makers with more accurate information on which to base resource allocation decisions. Where these are not major features of the cost-effectiveness question, MM remains an efficient, easily validated, parsimonious, and accurate method of determining the cost-effectiveness of new healthcare interventions.

A New Radiofrequency Ablation Procedure to Treat Sacroiliac Joint Pain.

PubMed

Cheng, Jianguo; Chen, See Loong; Zimmerman, Nicole; Dalton, Jarrod E; LaSalle, Garret; Rosenquist, Richard

2016-01-01

Low back pain may arise from disorders of the sacroiliac joint in up to 30% of patients. Radiofrequency ablation (RFA) of the nerves innervating the sacroiliac joint has been shown to be a safe and efficacious strategy. We aimed to develop a new RFA technique to relieve low back pain secondary to sacroiliac joint disorders. Methodology development with validation through prospective observational non-randomized trial (PONRT). Academic multidisciplinary health care system, Ohio, USA. We devised a guide-block to facilitate accurate placement of multiple electrodes to simultaneously ablate the L5 dorsal ramus and lateral branches of the S1, S2, and S3 dorsal rami. This was achieved by bipolar radiofrequency ablation (b-RFA) to create a strip lesion from the lateral border of the base of the sacral superior articular process (L5-S1 facet joint) to the lateral border of the S3 sacral foramen. We applied this technique in 31 consecutive patients and compared the operating time, x-ray exposure time and dose, and clinical outcomes with patients (n = 62) who have been treated with the cooled radiofrequency technique. Patients' level of pain relief was reported as < 50%, 50 - 80%, and > 80% pain relief at one, 3, 6, and 12 months after the procedure. The relationship between RFA technique and duration of pain relief was evaluated using interval-censored multivariable Cox regression. The new technique allowed reduction of operating time by more than 50%, x-ray exposure time and dose by more than 80%, and cost by more than $1,000 per case. The percent of patients who achieved > 50% pain reduction was significantly higher in the b-RFA group at 3, 6, and 12 months follow-up, compared to the cooled radiofrequency group. No complications were observed in either group. Although the major confounding factors were taken into account in the analysis, use of historical controls does not balance observed and unobserved potential confounding variables between groups so that the reported results are potentially confounded. Compared to the cooled radiofrequency ablation (c-RFA) technique, the new b-RFA technique reduced operating time by more than 50%, decreased x-ray exposure by more than 80%, and cut the cost by more than $1000 per case. The new method was associated with significantly improved clinical outcomes despite the limitations of the study design. Thus this new technique appeared to be safe, efficacious, and cost-effective. Key words: Sacroiliac joint pain, sacroiliac joint, low back pain, radiofrequency ablation (RFA), bipolar radiofrequency ablation (b-RFA), cooled radiofrequency ablation (c-RFA), cost-effectiveness.

Evaluating cost-efficiency and accuracy of hunter harvest survey designs

USGS Publications Warehouse

Lukacs, P.M.; Gude, J.A.; Russell, R.E.; Ackerman, B.B.

2011-01-01

Effective management of harvested wildlife often requires accurate estimates of the number of animals harvested annually by hunters. A variety of techniques exist to obtain harvest data, such as hunter surveys, check stations, mandatory reporting requirements, and voluntary reporting of harvest. Agencies responsible for managing harvested wildlife such as deer (Odocoileus spp.), elk (Cervus elaphus), and pronghorn (Antilocapra americana) are challenged with balancing the cost of data collection versus the value of the information obtained. We compared precision, bias, and relative cost of several common strategies, including hunter self-reporting and random sampling, for estimating hunter harvest using a realistic set of simulations. Self-reporting with a follow-up survey of hunters who did not report produces the best estimate of harvest in terms of precision and bias, but it is also, by far, the most expensive technique. Self-reporting with no followup survey risks very large bias in harvest estimates, and the cost increases with increased response rate. Probability-based sampling provides a substantial cost savings, though accuracy can be affected by nonresponse bias. We recommend stratified random sampling with a calibration estimator used to reweight the sample based on the proportions of hunters responding in each covariate category as the best option for balancing cost and accuracy. ?? 2011 The Wildlife Society.

Kick Detection at the Bit: Early Detection via Low Cost Monitoring

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

Tost, Brian; Rose, Kelly; Aminzadeh, Fred

2016-06-07

Formation fluid influxes (i.e. kicks) pose persistent challenges and operational costs during drilling operations. Implications of kicks range in scale but cumulatively result in substantial costs that affect drilling safety, environment, schedule, and infrastructure. Early kick detection presents a low-cost, easily adopted solution for avoiding well control challenges associated with kicks near the bit. Borehole geophysical tools used during the drilling process as part of the logging-while-drilling (LWD) and measurement-while-drilling (MWD) provide the advantage of offering real-time downhole data. LWD/MWD collect data on both the annulus and borehole wall. The annular data are normally treated as background, and are filteredmore » out to isolate the formation measurements. Because kicks will change the local physical properties of annular fluids, bottom-hole measurements are among the first indicators that a formation fluid has invaded the wellbore. This report describes and validates a technique for using the annular portion of LWD/MWD data to facilitate early kick detection using first order principles. The detection technique leverages data from standard and cost-effective technologies that are typically implemented during well drilling, such as MWD/LWD data in combination with mud-pulse telemetry for data transmission.« less

Advances in paper-based sample pretreatment for point-of-care testing.

PubMed

Tang, Rui Hua; Yang, Hui; Choi, Jane Ru; Gong, Yan; Feng, Shang Sheng; Pingguan-Murphy, Belinda; Huang, Qing Sheng; Shi, Jun Ling; Mei, Qi Bing; Xu, Feng

2017-06-01

In recent years, paper-based point-of-care testing (POCT) has been widely used in medical diagnostics, food safety and environmental monitoring. However, a high-cost, time-consuming and equipment-dependent sample pretreatment technique is generally required for raw sample processing, which are impractical for low-resource and disease-endemic areas. Therefore, there is an escalating demand for a cost-effective, simple and portable pretreatment technique, to be coupled with the commonly used paper-based assay (e.g. lateral flow assay) in POCT. In this review, we focus on the importance of using paper as a platform for sample pretreatment. We firstly discuss the beneficial use of paper for sample pretreatment, including sample collection and storage, separation, extraction, and concentration. We highlight the working principle and fabrication of each sample pretreatment device, the existing challenges and the future perspectives for developing paper-based sample pretreatment technique.

Cost-effective broad-band electrical impedance spectroscopy measurement circuit and signal analysis for piezo-materials and ultrasound transducers

PubMed Central

Lewis, George K; Lewis, George K; Olbricht, William

2008-01-01

This paper explains the circuitry and signal processing to perform electrical impedance spectroscopy on piezoelectric materials and ultrasound transducers. Here, we measure and compare the impedance spectra of 2−5 MHz piezoelectrics, but the methodology applies for 700 kHz–20 MHz ultrasonic devices as well. Using a 12 ns wide 5 volt pulsing circuit as an impulse, we determine the electrical impedance curves experimentally using Ohm's law and fast Fourier transform (FFT), and compare results with mathematical models. The method allows for rapid impedance measurement for a range of frequencies using a narrow input pulse, digital oscilloscope and FFT techniques. The technique compares well to current methodologies such as network and impedance analyzers while providing additional versatility in the electrical impedance measurement. The technique is theoretically simple, easy to implement and completed with ordinary laboratory instrumentation for minimal cost. PMID:19081773

Bayesian component separation: The Planck experience

NASA Astrophysics Data System (ADS)

Wehus, Ingunn Kathrine; Eriksen, Hans Kristian

2018-05-01

Bayesian component separation techniques have played a central role in the data reduction process of Planck. The most important strength of this approach is its global nature, in which a parametric and physical model is fitted to the data. Such physical modeling allows the user to constrain very general data models, and jointly probe cosmological, astrophysical and instrumental parameters. This approach also supports statistically robust goodness-of-fit tests in terms of data-minus-model residual maps, which are essential for identifying residual systematic effects in the data. The main challenges are high code complexity and computational cost. Whether or not these costs are justified for a given experiment depends on its final uncertainty budget. We therefore predict that the importance of Bayesian component separation techniques is likely to increase with time for intensity mapping experiments, similar to what has happened in the CMB field, as observational techniques mature, and their overall sensitivity improves.

Suitability of soil bioengineering techniques in Central America: a case study in Nicaragua

NASA Astrophysics Data System (ADS)

Petrone, A.; Preti, F.

2008-10-01

In the last few years "D. I. A. F." (Department of Agriculture and Forestry Engineering of Florence University), has been testing the effectiveness of soil bioengineering techniques in Central America. The focus of the present study was to find out which native plants were most suited for soil bioengineering purposes, particularly in the realization of riverbank protection in Nicaragua. Furthermore, we have also been aiming at economic efficiency. These techniques are appropriate for sustainable watershed management especially in underdeveloped countries. Concerning the plants to be used we experimented four native species. Gliricidia Sepium, Cordia dentata and Jatropha curcas are suitable for soil bioengineering more than Bursera Simaruba. Economically speaking, the sustainability of such interventions in underdeveloped countries, has been shown by the evaluation of the cost of riverbank protection using vegetated crib-walls in Nicaragua compared to the cost in different contexts.

Cost-effectiveness landscape analysis of treatments addressing xerostomia in patients receiving head and neck radiation therapy

PubMed Central

Sasportas, Laura S.; Hosford, Andrew T.; Sodini, Maria A.; Waters, Dale J.; Zambricki, Elizabeth A.; Barral, Joëlle K.; Graves, Edward E.; Brinton, Todd J.; Yock, Paul G.; Le, Quynh-Thu; Sirjani, Davud

2014-01-01

Head and neck (H&N) radiation therapy (RT) can induce irreversible damage to the salivary glands thereby causing long-term xerostomia or dry mouth in 68%–85% of the patients. Not only does xerostomia significantly impair patients’ quality-of-life (QOL) but it also has important medical sequelae, incurring high medical and dental costs. In this article, we review various measures to assess xerostomia and evaluate current and emerging solutions to address this condition in H&N cancer patients. These solutions typically seek to accomplish 1 of the 4 objectives: (1) to protect the salivary glands during RT, (2) to stimulate the remaining gland function, (3) to treat the symptoms of xerostomia, or (4) to regenerate the salivary glands. For each treatment, we assess its mechanisms of action, efficacy, safety, clinical utilization, and cost. We conclude that intensity-modulated radiation therapy is both the most widely used prevention approach and the most cost-effective existing solution and we highlight novel and promising techniques on the cost-effectiveness landscape. PMID:23643579

An analysis of the accuracy and cost-effectiveness of a cropland inventory utilizing remote sensing techniques

NASA Technical Reports Server (NTRS)

Jensen, J. R.; Tinney, L. R.; Estes, J. E.

1975-01-01

Cropland inventories utilizing high altitude and Landsat imagery were conducted in Kern County, California. It was found that in terms of the overall mean relative and absolute inventory accuracies, a Landsat multidate analysis yielded the most optimum results, i.e., 98% accuracy. The 1:125,000 CIR high altitude inventory is a serious alternative which can be very accurate (97% or more) if imagery is available for a specific study area. The operational remote sensing cropland inventories documented in this study are considered cost-effective. When compared to conventional survey costs of $62-66 per 10,000 acres, the Landsat and high-altitude inventories required only 3-5% of this amount, i.e., $1.97-2.98.

[The socio-hygienic monitoring as an integral system for health risk assessment and risk management at the regional level].

PubMed

Kuzmin, S V; Gurvich, V B; Dikonskaya, O V; Malykh, O L; Yarushin, S V; Romanov, S V; Kornilkov, A S

2013-01-01

The information and analytical framework for the introduction of health risk assessment and risk management methodologies in the Sverdlovsk Region is the system of socio-hygienic monitoring. Techniques of risk management that take into account the choice of most cost-effective and efficient actions for improvement of the sanitary and epidemiologic situation at the level of the region, municipality, or a business entity of the Russian Federation, have been developed and proposed. To assess the efficiency of planning and activities for health risk management common method approaches and economic methods of "cost-effectiveness" and "cost-benefit" analyses provided in method recommendations and introduced in the Russian Federation are applied.

A systematic approach to designing statistically powerful heteroscedastic 2 × 2 factorial studies while minimizing financial costs.

PubMed

Jan, Show-Li; Shieh, Gwowen

2016-08-31

The 2 × 2 factorial design is widely used for assessing the existence of interaction and the extent of generalizability of two factors where each factor had only two levels. Accordingly, research problems associated with the main effects and interaction effects can be analyzed with the selected linear contrasts. To correct for the potential heterogeneity of variance structure, the Welch-Satterthwaite test is commonly used as an alternative to the t test for detecting the substantive significance of a linear combination of mean effects. This study concerns the optimal allocation of group sizes for the Welch-Satterthwaite test in order to minimize the total cost while maintaining adequate power. The existing method suggests that the optimal ratio of sample sizes is proportional to the ratio of the population standard deviations divided by the square root of the ratio of the unit sampling costs. Instead, a systematic approach using optimization technique and screening search is presented to find the optimal solution. Numerical assessments revealed that the current allocation scheme generally does not give the optimal solution. Alternatively, the suggested approaches to power and sample size calculations give accurate and superior results under various treatment and cost configurations. The proposed approach improves upon the current method in both its methodological soundness and overall performance. Supplementary algorithms are also developed to aid the usefulness and implementation of the recommended technique in planning 2 × 2 factorial designs.

A Cost Benefit Technique for R & D Based Information.

ERIC Educational Resources Information Center

Stern, B. T.

A cost benefit technique consisting of the following five phases is proposed: (a) specific objectives of the service, (b) measurement of work flow, (c) work costing, (d) charge to users of the information service, and (e) equating demand and cost. In this approach, objectives are best stated by someone not routinely concerned with the individual…

Cost-effectiveness of manual therapy versus physiotherapy in patients with sub-acute and chronic neck pain: a randomised controlled trial.

PubMed

van Dongen, J M; Groeneweg, R; Rubinstein, S M; Bosmans, J E; Oostendorp, R A B; Ostelo, R W J G; van Tulder, M W

2016-07-01

To evaluate the cost-effectiveness of manual therapy according to the Utrecht School (MTU) in comparison with physiotherapy (PT) in sub-acute and chronic non-specific neck pain patients from a societal perspective. An economic evaluation was conducted alongside a 52-week randomized controlled trial, in which 90 patients were randomized to the MTU group and 91 to the PT group. Clinical outcomes included perceived recovery (yes/no), functional status (continuous and yes/no), and quality-adjusted life-years (QALYs). Costs were measured from a societal perspective using self-reported questionnaires. Missing data were imputed using multiple imputation. To estimate statistical uncertainty, bootstrapping techniques were used. After 52 weeks, there were no significant between-group differences in clinical outcomes. During follow-up, intervention costs (β:€-32; 95 %CI: -54 to -10) and healthcare costs (β:€-126; 95 %CI: -235 to -32) were significantly lower in the MTU group than in the PT group, whereas unpaid productivity costs were significantly higher (β:€186; 95 %CI:19-557). Societal costs did not significantly differ between groups (β:€-96; 95 %CI:-1975-2022). For QALYs and functional status (yes/no), the maximum probability of MTU being cost-effective in comparison with PT was low (≤0.54). For perceived recovery (yes/no) and functional status (continuous), a large amount of money must be paid per additional unit of effect to reach a reasonable probability of cost-effectiveness. From a societal perspective, MTU was not cost-effective in comparison with PT in patients with sub-acute and chronic non-specific neck pain for perceived recovery, functional status, and QALYs. As no clear total societal cost and effect differences were found between MTU and PT, the decision about what intervention to administer, reimburse, and/or implement can be based on the preferences of the patient and the decision-maker at hand. ClinicalTrials.gov Identifier: NCT00713843.

Blood flow measurement in extracorporeal circulation using self-mixing laser diode

NASA Astrophysics Data System (ADS)

Cattini, Stefano; Norgia, Michele; Pesatori, Alessandro; Rovati, Luigi

2010-02-01

To measure blood flow rate in ex-vivo circulation, we propose an optical Doppler flowmeter based on the self-mixing effect within a laser diode (SM-LD). Advantages in adopting SM-LD techniques derive from reduced costs, ease of implementation and limited size. Moreover, the provided contactless sensing allows sensor reuse, hence further cost reduction. Preliminary measurements performed on bovine blood are reported, thus demonstrating the applicability of the proposed measurement method.

Optimization strategies for sediment reduction practices on roads in steep, forested terrain

USGS Publications Warehouse

Madej, Mary Ann; Eschenbach, E.A.; Diaz, C.; Teasley, R.; Baker, K.

2006-01-01

Many forested steeplands in the western United States display a legacy of disturbances due to timber harvest, mining or wildfires, for example. Such disturbances have caused accelerated hillslope erosion, leading to increased sedimentation in fish-bearing streams. Several restoration techniques have been implemented to address these problems in mountain catchments, many of which involve the removal of abandoned roads and re-establishing drainage networks across road prisms. With limited restoration funds to be applied across large catchments, land managers are faced with deciding which areas and problems should be treated first, and by which technique, in order to design the most effective and cost-effective sediment reduction strategy. Currently most restoration is conducted on a site-specific scale according to uniform treatment policies. To create catchment-scale policies for restoration, we developed two optimization models - dynamic programming and genetic algorithms - to determine the most cost-effective treatment level for roads and stream crossings in a pilot study basin with approximately 700 road segments and crossings. These models considered the trade-offs between the cost and effectiveness of different restoration strategies to minimize the predicted erosion from all forest roads within a catchment, while meeting a specified budget constraint. The optimal sediment reduction strategies developed by these models performed much better than two strategies of uniform erosion control which are commonly applied to road erosion problems by land managers, with sediment savings increased by an additional 48 to 80 per cent. These optimization models can be used to formulate the most cost-effective restoration policy for sediment reduction on a catchment scale. Thus, cost savings can be applied to further restoration work within the catchment. Nevertheless, the models are based on erosion rates measured on past restoration sites, and need to be up-dated as additional monitoring studies evaluate long-term basin response to erosion control treatments. Copyright ?? 2006 John Wiley & Sons, Ltd.

Recommendations for Conduct, Methodological Practices, and Reporting of Cost-effectiveness Analyses: Second Panel on Cost-Effectiveness in Health and Medicine.

PubMed

Sanders, Gillian D; Neumann, Peter J; Basu, Anirban; Brock, Dan W; Feeny, David; Krahn, Murray; Kuntz, Karen M; Meltzer, David O; Owens, Douglas K; Prosser, Lisa A; Salomon, Joshua A; Sculpher, Mark J; Trikalinos, Thomas A; Russell, Louise B; Siegel, Joanna E; Ganiats, Theodore G

2016-09-13

Since publication of the report by the Panel on Cost-Effectiveness in Health and Medicine in 1996, researchers have advanced the methods of cost-effectiveness analysis, and policy makers have experimented with its application. The need to deliver health care efficiently and the importance of using analytic techniques to understand the clinical and economic consequences of strategies to improve health have increased in recent years. To review the state of the field and provide recommendations to improve the quality of cost-effectiveness analyses. The intended audiences include researchers, government policy makers, public health officials, health care administrators, payers, businesses, clinicians, patients, and consumers. In 2012, the Second Panel on Cost-Effectiveness in Health and Medicine was formed and included 2 co-chairs, 13 members, and 3 additional members of a leadership group. These members were selected on the basis of their experience in the field to provide broad expertise in the design, conduct, and use of cost-effectiveness analyses. Over the next 3.5 years, the panel developed recommendations by consensus. These recommendations were then reviewed by invited external reviewers and through a public posting process. The concept of a "reference case" and a set of standard methodological practices that all cost-effectiveness analyses should follow to improve quality and comparability are recommended. All cost-effectiveness analyses should report 2 reference case analyses: one based on a health care sector perspective and another based on a societal perspective. The use of an "impact inventory," which is a structured table that contains consequences (both inside and outside the formal health care sector), intended to clarify the scope and boundaries of the 2 reference case analyses is also recommended. This special communication reviews these recommendations and others concerning the estimation of the consequences of interventions, the valuation of health outcomes, and the reporting of cost-effectiveness analyses. The Second Panel reviewed the current status of the field of cost-effectiveness analysis and developed a new set of recommendations. Major changes include the recommendation to perform analyses from 2 reference case perspectives and to provide an impact inventory to clarify included consequences.

Cost-effective hydrocele ablation.

PubMed

Fracchia, J A; Armenakas, N A; Kohan, A D

1998-03-01

The surgical repair of hydroceles can be relatively expensive in some cases in terms of costs and initial limitation of activity. We ascertain whether aspiration and sclerotherapy of hydroceles is a safe, efficient, cost-effective treatment modality in select patients. In 47 patients 51 hydroceles were treated in the office with aspiration and instillation of a sclerosing solution based on a sodium tetradecyl sulfate preparation. One treatment was done in 14 cases and 2 in the remainder. Medicare data for 1995 were used for charge analysis. The overall success rate was 61% (34 of 51 cases) with success defined as no perceptible ipsilateral scrotal fluid reaccumulation on palpation by a physician and complete patient satisfaction. The failure rate was 39% (17 cases) with failure defined as perceptible ipsilateral scrotal fluid reaccumulation on palpation by a physician and/or patient dissatisfaction. The charge differential of surgery versus aspiration and sclerotherapy was greater than 9:1. The aspiration and sclerotherapy technique that we used appears to be an efficacious, safe, cost-effective treatment modality in select patients with idiopathic hydroceles.

Cost-effective bidirectional digitized radio-over-fiber systems employing sigma delta modulation

NASA Astrophysics Data System (ADS)

Lee, Kyung Woon; Jung, HyunDo; Park, Jung Ho

2016-11-01

We propose a cost effective digitized radio-over-fiber (D-RoF) system employing a sigma delta modulation (SDM) and a bidirectional transmission technique using phase modulated downlink and intensity modulated uplink. SDM is transparent to different radio access technologies and modulation formats, and more suitable for a downlink of wireless system because a digital to analog converter (DAC) can be avoided at the base station (BS). Also, Central station and BS share the same light source by using a phase modulation for the downlink and an intensity modulation for the uplink transmission. Avoiding DACs and light sources have advantages in terms of cost reduction, power consumption, and compatibility with conventional wireless network structure. We have designed a cost effective bidirectional D-RoF system using a low pass SDM and measured the downlink and uplink transmission performance in terms of error vector magnitude, signal spectra, and constellations, which are based on the 10MHz LTE 64-QAM standard.

48 CFR 9904.403-50 - Techniques for application.

Code of Federal Regulations, 2010 CFR

2010-10-01

.... 9904.403-50 Section 9904.403-50 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.403-50 Techniques for application. (a)(1) Separate...

48 CFR 9904.401-50 - Techniques for application.

Code of Federal Regulations, 2010 CFR

2010-10-01

.... 9904.401-50 Section 9904.401-50 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.401-50 Techniques for application. (a) The standard...

Direct laser writing of polymeric nanostructures via optically induced local thermal effect

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

Tong, Quang Cong; Institute of Materials Science, Vietnam Academy of Science and Technology, 18 Hoang Quoc Viet, Cau Giay, 10000 Hanoi; Nguyen, Dam Thuy Trang

We demonstrate the fabrication of desired structures with feature size below the diffraction limit by use of a positive photoresist. The direct laser writing technique employing a continuous-wave laser was used to optically induce a local thermal effect in a positive photoresist, which then allowed the formation of solid nanostructures. This technique enabled us to realize multi-dimensional sub-microstructures by use of a positive photoresist, with a feature size down to 57 nm. This mechanism acting on positive photoresists opens a simple and low-cost way for nanofabrication.

How Digital Image Processing Became Really Easy

NASA Astrophysics Data System (ADS)

Cannon, Michael

1988-02-01

In the early and mid-1970s, digital image processing was the subject of intense university and corporate research. The research lay along two lines: (1) developing mathematical techniques for improving the appearance of or analyzing the contents of images represented in digital form, and (2) creating cost-effective hardware to carry out these techniques. The research has been very effective, as evidenced by the continued decline of image processing as a research topic, and the rapid increase of commercial companies to market digital image processing software and hardware.

3-D Printing as an Effective Educational Tool for MEMS Design and Fabrication

ERIC Educational Resources Information Center

Dahle, Reena; Rasel, Rafiul

2016-01-01

This paper presents a series of course modules developed as a high-impact and cost-effective learning tool for modeling and simulating the microfabrication process and design of microelectromechanical systems (MEMS) devices using three-dimensional (3-D) printing. Microfabrication technology is an established fabrication technique for small and…

Effective Design of Educational Virtual Reality Applications for Medicine Using Knowledge-Engineering Techniques

ERIC Educational Resources Information Center

Górski, Filip; Bun, Pawel; Wichniarek, Radoslaw; Zawadzki, Przemyslaw; Hamrol, Adam

2017-01-01

Effective medical and biomedical engineering education is an important problem. Traditional methods are difficult and costly. That is why Virtual Reality is often used for that purpose. Educational medical VR is a well-developed IT field, with many available hardware and software solutions. Current solutions are prepared without methodological…

Environmental assessment of combustion modification controls for stationary internal combustion engines. Final report Sep 78-Jul 79

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

Lips, H.I.; Gotterba, J.A.; Lim, K.J.

1981-07-01

The report gives results of an environmental assessment of combustion modification techniques for stationary internal combustion engines, with respect to NOx control reduction effectiveness, operational impact, thermal efficiency impact, capital and annualized operating costs, and effects on emissions of pollutants other than NOx.

ASSESSMENT OF CHEMICAL EFFECTS ON NEURONAL DIFFERENTIATION USING THE ARRAYSCAN HIGH CONTENT SCREENING SYSTEM

EPA Science Inventory

The development of alternative methods for toxicity testing is driven by the need for scientifically valid data that can be obtained in a rapid and cost-efficient manner. In vitro systems provide a model in which chemical effects on cellular events can be examined using technique...

Strategic Placement of Treatments (SPOTS): Maximizing the Effectiveness of Fuel and Vegetation Treatments on Problem Fire Behavior and Effects

Treesearch

Diane M. Gercke; Susan A. Stewart

2006-01-01

In 2005, eight U.S. Forest Service and Bureau of Land Management interdisciplinary teams participated in a test of strategic placement of treatments (SPOTS) techniques to maximize the effectiveness of fuel treatments in reducing problem fire behavior, adverse fire effects, and suppression costs. This interagency approach to standardizing the assessment of risks and...

Cost analysis of open radical cystectomy versus robot-assisted radical cystectomy.

PubMed

Mmeje, Chinedu O; Martin, Aaron D; Nunez-Nateras, Rafael; Parker, Alexander S; Thiel, David D; Castle, Erik P

2013-02-01

Bladder cancer is the fourth and ninth most common malignancy in males and females, respectively, in the U.S. and one of the most costly cancers to manage. With the current economic condition, physicians will need to become more aware of cost-effective therapies for the treatment of various malignancies. Robot-assisted radical cystectomy (RARC) is the latest minimally invasive surgical option for muscle-invasive bladder cancer. Current reports have shown less blood loss, a shorter hospital stay, and a lower morbidity with RARC, as compared with the traditional open radical cystectomy (ORC), although long-term oncologic results of RARC are still maturing. There are few studies that have assessed the cost outcomes of RARC as compared with ORC. Currently, ORC appears to offer a direct cost advantage due to the high purchase and maintenance cost of the robotic platform, although when the indirect costs of complications and extended hospital stay with ORC are considered, RARC may be less expensive than the traditional open procedure. In order to accurately evaluate the cost effectiveness of RARC versus ORC, prospective randomized trials between the two surgical techniques with long-term oncologic efficacy are needed.

Methodologies for Evaluating the Impact of Contraceptive Social Marketing Programs.

ERIC Educational Resources Information Center

Bertrand, Jane T.; And Others

1989-01-01

An overview of the evaluation issues associated with contraceptive social marketing programs is provided. Methodologies covered include survey techniques, cost-effectiveness analyses, retail audits of sales data, time series analysis, nested logit analysis, and discriminant analysis. (TJH)

Sustainability and training materials for in-place recycling.

DOT National Transportation Integrated Search

2016-04-22

Hot and cold in-place recycling techniques recycle 100 percent of a hot mix asphalt (HMA) pavement, in place, during the maintenance/rehabilitation process. Numerous studies have shown in-place recycling to be a sustainable, cost-effective procedure ...

Construction of crack-free bridge decks.

DOT National Transportation Integrated Search

2017-04-01

This serves as the final report on Transportation Pooled-Fund Program Project No. TPF-5(174), Construction : of Crack-Free Bridge Decks. The goal of the study was to implement the most cost-effective techniques for : improving bridge deck life ...

A Novel Approach for the Characterization of the Rutting Performance of Pavement Foundations

DOT National Transportation Integrated Search

2017-10-01

Various modeling techniques are playing an increasingly important role as a cost effective means of supplementing crashworthiness data for gaining a better understanding of the injury mechanisms associated with automotive crashes. The interaction of ...

Business Case Analysis: Continuous Integrated Logistics Support-Targeted Allowance Technique (CILS-TAT)

DTIC Science & Technology

2013-05-30

In this research, we examine the Naval Sea Logistics Command’s Continuous Integrated Logistics Support-Targeted Allowancing Technique (CILS-TAT) and... the feasibility of program re-implementation. We conduct an analysis of this allowancing method’s effectiveness onboard U.S. Navy Ballistic Missile...Defense (BMD) ships, measure the costs associated with performing a CILS-TAT, and provide recommendations concerning possible improvements to the

Systematic review of cost-effectiveness analyses for combinations of prevention strategies against human papillomavirus (HPV) infection: a general trend.

PubMed

Gervais, Frédéric; Dunton, Kyle; Jiang, Yiling; Largeron, Nathalie

2017-03-28

Due to the arrival of multi-valent HPV vaccines, it is more and more important to have a better understanding of the relationship between vaccination and screening programmes. This review aimed to: (1) collect published evidence on the cost-effectiveness profile of different HPV prevention strategies and, in particular, those combining vaccination with changes in screening practices; (2) explore the cost-effectiveness of alternative preventive strategies based on screening and vaccination. A systematic literature review was conducted in order to identify the relevant studies regarding the cost-effectiveness of prevention strategies against HPV infection. Analysis comparing the modelling approaches between studies was made along with an assessment of the magnitude of impact of several factors on the cost-effectiveness of different screening strategies. A total of 18 papers were quantitatively summarised within the narrative. A high degree of heterogeneity was found in terms of how HPV prevention strategies have been assessed in terms of their economic and epidemiological impact, with variation in screening practice and valence of HPV vaccination found to have large implications in terms of cost-effectiveness. This review demonstrated synergies between screening and vaccination. New prevention strategies involving multi-valence vaccination, HPV DNA test screening, delayed commencement and frequency of screening could be implemented in the future. Strategies implemented in the future should be chosen with care, and informed knowledge of the potential impact of all possible prevention strategies. Highlighted in this review is the difficulty in assessing multiple strategies. Appropriate modelling techniques will need to be utilised to assess the most cost-effective strategies.

Cost-effectiveness of aortic valve replacement in the elderly: an introductory study.

PubMed

Wu, YingXing; Jin, Ruyun; Gao, Guangqiang; Grunkemeier, Gary L; Starr, Albert

2007-03-01

With increased life expectancy and improved technology, valve replacement is being offered to increasing numbers of elderly patients with satisfactory clinical results. By using standard econometric techniques, we estimated the relative cost-effectiveness of aortic valve replacement by drawing on a large prospective database at our institution. By using aortic valve replacement as an example, this introductory report paves the way to more definitive studies of these issues in the future. From 1961 to 2003, 4617 adult patients underwent aortic valve replacement at our service. These patients were provided with a prospective lifetime follow-up. As of 2005, these patients had accumulated 31,671 patient-years of follow-up (maximum 41 years) and had returned 22,396 yearly questionnaires. A statistical model was used to estimate the future life years of patients who are currently alive. In the absence of direct estimates of utility, quality-adjusted life years were estimated from New York Heart Association class. The cost-effectiveness ratio was calculated by the patient's age at surgery. The overall cost-effectiveness ratio was approximately 13,528 dollars per quality-adjusted life year gained. The cost-effectiveness ratio increased according to age at surgery, up to 19,826 dollars per quality-adjusted life year for octogenarians and 27,182 dollars per quality-adjusted life year for nonagenarians. Given the limited scope of this introductory study, aortic valve replacement is cost-effective for all age groups and is very cost-effective for all but the most elderly according to standard econometric rules of thumb.

An Economic Evaluation of a Video- and Text-Based Computer-Tailored Intervention for Smoking Cessation: A Cost-Effectiveness and Cost-Utility Analysis of a Randomized Controlled Trial

PubMed Central

Stanczyk, Nicola E.; Smit, Eline S.; Schulz, Daniela N.; de Vries, Hein; Bolman, Catherine; Muris, Jean W. M.; Evers, Silvia M. A. A.

2014-01-01

Background Although evidence exists for the effectiveness of web-based smoking cessation interventions, information about the cost-effectiveness of these interventions is limited. Objective The study investigated the cost-effectiveness and cost-utility of two web-based computer-tailored (CT) smoking cessation interventions (video- vs. text-based CT) compared to a control condition that received general text-based advice. Methods In a randomized controlled trial, respondents were allocated to the video-based condition (N = 670), the text-based condition (N = 708) or the control condition (N = 721). Societal costs, smoking status, and quality-adjusted life years (QALYs; EQ-5D-3L) were assessed at baseline, six-and twelve-month follow-up. The incremental costs per abstinent respondent and per QALYs gained were calculated. To account for uncertainty, bootstrapping techniques and sensitivity analyses were carried out. Results No significant differences were found in the three conditions regarding demographics, baseline values of outcomes and societal costs over the three months prior to baseline. Analyses using prolonged abstinence as outcome measure indicated that from a willingness to pay of €1,500, the video-based intervention was likely to be the most cost-effective treatment, whereas from a willingness to pay of €50,400, the text-based intervention was likely to be the most cost-effective. With regard to cost-utilities, when quality of life was used as outcome measure, the control condition had the highest probability of being the most preferable treatment. Sensitivity analyses yielded comparable results. Conclusion The video-based CT smoking cessation intervention was the most cost-effective treatment for smoking abstinence after twelve months, varying the willingness to pay per abstinent respondent from €0 up to €80,000. With regard to cost-utility, the control condition seemed to be the most preferable treatment. Probably, more time will be required to assess changes in quality of life. Future studies with longer follow-up periods are needed to investigate whether cost-utility results regarding quality of life may change in the long run. Trial Registration Nederlands Trial Register NTR3102 PMID:25310007

An economic evaluation of a video- and text-based computer-tailored intervention for smoking cessation: a cost-effectiveness and cost-utility analysis of a randomized controlled trial.

PubMed

Stanczyk, Nicola E; Smit, Eline S; Schulz, Daniela N; de Vries, Hein; Bolman, Catherine; Muris, Jean W M; Evers, Silvia M A A

2014-01-01

Although evidence exists for the effectiveness of web-based smoking cessation interventions, information about the cost-effectiveness of these interventions is limited. The study investigated the cost-effectiveness and cost-utility of two web-based computer-tailored (CT) smoking cessation interventions (video- vs. text-based CT) compared to a control condition that received general text-based advice. In a randomized controlled trial, respondents were allocated to the video-based condition (N = 670), the text-based condition (N = 708) or the control condition (N = 721). Societal costs, smoking status, and quality-adjusted life years (QALYs; EQ-5D-3L) were assessed at baseline, six-and twelve-month follow-up. The incremental costs per abstinent respondent and per QALYs gained were calculated. To account for uncertainty, bootstrapping techniques and sensitivity analyses were carried out. No significant differences were found in the three conditions regarding demographics, baseline values of outcomes and societal costs over the three months prior to baseline. Analyses using prolonged abstinence as outcome measure indicated that from a willingness to pay of €1,500, the video-based intervention was likely to be the most cost-effective treatment, whereas from a willingness to pay of €50,400, the text-based intervention was likely to be the most cost-effective. With regard to cost-utilities, when quality of life was used as outcome measure, the control condition had the highest probability of being the most preferable treatment. Sensitivity analyses yielded comparable results. The video-based CT smoking cessation intervention was the most cost-effective treatment for smoking abstinence after twelve months, varying the willingness to pay per abstinent respondent from €0 up to €80,000. With regard to cost-utility, the control condition seemed to be the most preferable treatment. Probably, more time will be required to assess changes in quality of life. Future studies with longer follow-up periods are needed to investigate whether cost-utility results regarding quality of life may change in the long run. Nederlands Trial Register NTR3102.

Systems design analysis applied to launch vehicle configuration

NASA Technical Reports Server (NTRS)

Ryan, R.; Verderaime, V.

1993-01-01

As emphasis shifts from optimum-performance aerospace systems to least lift-cycle costs, systems designs must seek, adapt, and innovate cost improvement techniques in design through operations. The systems design process of concept, definition, and design was assessed for the types and flow of total quality management techniques that may be applicable in a launch vehicle systems design analysis. Techniques discussed are task ordering, quality leverage, concurrent engineering, Pareto's principle, robustness, quality function deployment, criteria, and others. These cost oriented techniques are as applicable to aerospace systems design analysis as to any large commercial system.

Energy and life-cycle cost analysis of a six-story office building

NASA Astrophysics Data System (ADS)

Turiel, I.

1981-10-01

An energy analysis computer program, DOE-2, was used to compute annual energy use for a typical office building as originally designed and with several energy conserving design modifications. The largest energy use reductions were obtained with the incorporation of daylighting techniques, the use of double pane windows, night temperature setback, and the reduction of artificial lighting levels. A life-cycle cost model was developed to assess the cost-effectiveness of the design modifications discussed. The model incorporates such features as inclusion of taxes, depreciation, and financing of conservation investments. The energy conserving strategies are ranked according to economic criteria such as net present benefit, discounted payback period, and benefit to cost ratio.

Markov modeling for the neurosurgeon: a review of the literature and an introduction to cost-effectiveness research.

PubMed

Wali, Arvin R; Brandel, Michael G; Santiago-Dieppa, David R; Rennert, Robert C; Steinberg, Jeffrey A; Hirshman, Brian R; Murphy, James D; Khalessi, Alexander A

2018-05-01

OBJECTIVE Markov modeling is a clinical research technique that allows competing medical strategies to be mathematically assessed in order to identify the optimal allocation of health care resources. The authors present a review of the recently published neurosurgical literature that employs Markov modeling and provide a conceptual framework with which to evaluate, critique, and apply the findings generated from health economics research. METHODS The PubMed online database was searched to identify neurosurgical literature published from January 2010 to December 2017 that had utilized Markov modeling for neurosurgical cost-effectiveness studies. Included articles were then assessed with regard to year of publication, subspecialty of neurosurgery, decision analytical techniques utilized, and source information for model inputs. RESULTS A total of 55 articles utilizing Markov models were identified across a broad range of neurosurgical subspecialties. Sixty-five percent of the papers were published within the past 3 years alone. The majority of models derived health transition probabilities, health utilities, and cost information from previously published studies or publicly available information. Only 62% of the studies incorporated indirect costs. Ninety-three percent of the studies performed a 1-way or 2-way sensitivity analysis, and 67% performed a probabilistic sensitivity analysis. A review of the conceptual framework of Markov modeling and an explanation of the different terminology and methodology are provided. CONCLUSIONS As neurosurgeons continue to innovate and identify novel treatment strategies for patients, Markov modeling will allow for better characterization of the impact of these interventions on a patient and societal level. The aim of this work is to equip the neurosurgical readership with the tools to better understand, critique, and apply findings produced from cost-effectiveness research.

Comparative cost assessment of the Kato-Katz and FLOTAC techniques for soil-transmitted helminth diagnosis in epidemiological surveys

PubMed Central

2010-01-01

Background The Kato-Katz technique is widely used for the diagnosis of soil-transmitted helminthiasis in epidemiological surveys and is believed to be an inexpensive method. The FLOTAC technique shows a higher sensitivity for the diagnosis of light-intensity soil-transmitted helminth infections but is reported to be more complex and expensive. We assessed the costs related to the collection, processing and microscopic examination of stool samples using the Kato-Katz and FLOTAC techniques in an epidemiological survey carried out in Zanzibar, Tanzania. Methods We measured the time for the collection of a single stool specimen in the field, transfer to a laboratory, preparation and microscopic examination using standard protocols for the Kato-Katz and FLOTAC techniques. Salaries of health workers, life expectancy and asset costs of materials, and infrastructure costs were determined. The average cost for a single or duplicate Kato-Katz thick smears and the FLOTAC dual or double technique were calculated. Results The average time needed to collect a stool specimen and perform a single or duplicate Kato-Katz thick smears or the FLOTAC dual or double technique was 20 min and 34 sec (20:34 min), 27:21 min, 28:14 min and 36:44 min, respectively. The total costs for a single and duplicate Kato-Katz thick smears were US$ 1.73 and US$ 2.06, respectively, and for the FLOTAC double and dual technique US$ 2.35 and US$ 2.83, respectively. Salaries impacted most on the total costs of either method. Conclusions The time and cost for soil-transmitted helminth diagnosis using either the Kato-Katz or FLOTAC method in epidemiological surveys are considerable. Our results can help to guide healthcare decision makers and scientists in budget planning and funding for epidemiological surveys, anthelminthic drug efficacy trials and monitoring of control interventions. PMID:20707931

Evaluating the effects of pinyon thinning treatments at a wildland urban interface

Treesearch

J. R. Matchett; Matthew Brooks; Anne Halford; Dale Johnson; Helen Smith

2010-01-01

This study evaluated the short-term effects of thinning methods for pinyon pine woodlands at two sites in the southwestern Great Basin. Both cut/pile/burn and mastication treatments were equally effective at reducing the target fuels which were mature, live pinyon trees. Application costs though differed substantially, with the cut/pile/burn technique being less...

Simulation of the Effects of Cooling Techniques on Turbine Blade Heat Transfer

NASA Astrophysics Data System (ADS)

Shaw, Vince; Fatuzzo, Marco

Increases in the performance demands of turbo machinery has stimulated the development many new technologies over the last half century. With applications that spread beyond marine, aviation, and power generation, improvements in gas turbine technologies provide a vast impact. High temperatures within the combustion chamber of the gas turbine engine are known to cause an increase in thermal efficiency and power produced by the engine. However, since operating temperatures of these engines reach above 1000 K within the turbine section, the need for advances in material science and cooling techniques to produce functioning engines under these high thermal and dynamic stresses is crucial. As with all research and development, costs related to the production of prototypes can be reduced through the use of computational simulations. By making use of Ansys Simulation Software, the effects of turbine cooling techniques were analyzed. Simulation of the Effects of Cooling Techniques on Turbine Blade Heat Transfer.

Wire blade development for Fixed Abrasive Slicing Technique (FAST) slicing

NASA Technical Reports Server (NTRS)

Khattak, C. P.; Schmid, F.; Smith, M. B.

1982-01-01

A low cost, effective slicing method is essential to make ingot technology viable for photovoltaics in terrestrial applications. The fixed abrasive slicing technique (FAST) combines the advantages of the three commercially developed techniques. In its development stage FAST demonstrated cutting effectiveness of 10 cm and 15 cm diameter workpieces. Wire blade development is still the critical element for commercialization of FAST technology. Both impregnated and electroplated wire blades have been developed; techniques have been developed to fix diamonds only in the cutting edge of the wire. Electroplated wires show the most near term promise and this approach is emphasized. With plated wires it has been possible to control the size and shape of the electroplating, it is expected that this feature reduces kerf and prolongs the life of the wirepack.

Improvement of modulation bandwidth in electroabsorption-modulated laser by utilizing the resonance property in bonding wire.

PubMed

Kwon, Oh Kee; Han, Young Tak; Baek, Yong Soon; Chung, Yun C

2012-05-21

We present and demonstrate a simple and cost-effective technique for improving the modulation bandwidth of electroabsorption-modulated laser (EML). This technique utilizes the RF resonance caused by the EML chip (i.e., junction capacitance) and bonding wire (i.e, wire inductance). We analyze the effects of the lengths of the bonding wires on the frequency responses of EML by using an equivalent circuit model. To verify this analysis, we package a lumped EML chip on the sub-mount and measure its frequency responses. The results show that, by using the proposed technique, we can increase the modulation bandwidth of EML from ~16 GHz to ~28 GHz.

Mathematical modeling and pharmaceutical pricing: analyses used to inform in-licensing and developmental go/No-Go decisions.

PubMed

Vernon, John A; Hughen, W Keener; Johnson, Scott J

2005-05-01

In the face of significant real healthcare cost inflation, pressured budgets, and ongoing launches of myriad technology of uncertain value, payers have formalized new valuation techniques that represent a barrier to entry for drugs. Cost-effectiveness analysis predominates among these methods, which involves differencing a new technological intervention's marginal costs and benefits with a comparator's, and comparing the resulting ratio to a payer's willingness-to-pay threshold. In this paper we describe how firms are able to model the feasible range of future product prices when making in-licensing and developmental Go/No-Go decisions by considering payers' use of the cost-effectiveness method. We illustrate this analytic method with a simple deterministic example and then incorporate stochastic assumptions using both analytic and simulation methods. Using this strategic approach, firms may reduce product development and in-licensing risk.

Clinical governance and operations management methodologies.

PubMed

Davies, C; Walley, P

2000-01-01

The clinical governance mechanism, introduced since 1998 in the UK National Health Service (NHS), aims to deliver high quality care with efficient, effective and cost-effective patient services. Scally and Donaldson recognised that new approaches are needed, and operations management techniques comprise potentially powerful methodologies in understanding the process of care, which can be applied both within and across professional boundaries. This paper summarises four studies in hospital Trusts which took approaches to improving process that were different from and less structured than business process re-engineering (BPR). The problems were then amenable to change at a relatively low cost and short timescale, producing significant improvement to patient care. This less structured approach to operations management avoided incurring overhead costs of large scale and costly change such as new information technology (IT) systems. The most successful changes were brought about by formal tools to control quantity, content and timing of changes.

48 CFR 9904.413-50 - Techniques for application.

Code of Federal Regulations, 2010 CFR

2010-10-01

.... 9904.413-50 Section 9904.413-50 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD... ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.413-50 Techniques for application. (a) Assignment of actuarial gains and losses. (1) In accordance with the provisions of Cost Accounting Standard 9904.412...

48 CFR 9904.409-50 - Techniques for application.

Code of Federal Regulations, 2010 CFR

2010-10-01

.... 9904.409-50 Section 9904.409-50 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD... ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.409-50 Techniques for application. (a) Determination of... of consumption of services in the cost accounting periods included in such life. In selecting service...

48 CFR 9904.414-50 - Techniques for application.

Code of Federal Regulations, 2010 CFR

2010-10-01

... the case of process cost accounting systems, the contracting parties may agree to substitute an.... 9904.414-50 Section 9904.414-50 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD... ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.414-50 Techniques for application. (a) The investment...

48 CFR 9904.405-50 - Techniques for application.

Code of Federal Regulations, 2010 CFR

2010-10-01

.... 9904.405-50 Section 9904.405-50 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.405-50 Techniques for application. (a) The detail and...

Direct cost comparison of totally endoscopic versus open ear surgery.

PubMed

Patel, N; Mohammadi, A; Jufas, N

2018-02-01

Totally endoscopic ear surgery is a relatively new method for managing chronic ear disease. This study aimed to test the null hypothesis that open and endoscopic approaches have similar direct costs for the management of attic cholesteatoma, from an Australian private hospital setting. A retrospective direct cost comparison of totally endoscopic ear surgery and traditional canal wall up mastoidectomy for the management of attic cholesteatoma in a private tertiary setting was undertaken. Indirect and future costs were excluded. A direct cost comparison of anaesthetic setup and resources, operative setup and resources, and surgical time was performed between the two techniques. Totally endoscopic ear surgery has a mean direct cost reduction of AUD$2978.89 per operation from the hospital perspective, when compared to canal wall up mastoidectomy. Totally endoscopic ear surgery is more cost-effective, from an Australian private hospital perspective, than canal wall up mastoidectomy for attic cholesteatoma.

Plasmonics based micro/nano manufacturing

NASA Astrophysics Data System (ADS)

Garner, Quincy

Since the advent of the Information Age, there has been an ever growing demand to continually shrink and reduce the cost of semiconductor products. To meet this demand, a great amount of research has been done to improve our current micro/nano manufacturing processes and develop the next generation of semiconductor fabrication techniques. High throughput, low cost, smaller features, high repeatability, and the simplification of the manufacturing processes are all targets that researchers continually strive for. To this day, there are no perfect systems capable of simultaneously achieving all of these targets. For this reason, much research time is spent improving and developing new techniques in hopes of developing a system that will incorporate all of these targets. While there are numerous techniques being investigated and developed every year, one of the most promising areas of research that may one day be capable of achieving our desired targets is plasmonics. Plasmonics, or the study of the free electron oscillations in metals, is the driving phenomena in the applications reported in this paper. In chapter 2, the formation of ordered gold nanoparticles on a silicon substrate through the use of energetic surface plasmons is reported. Utilizing a gold/alumina nano-hole antenna and 1064 nm Nd:YAG laser system, semi-periodic gold nanoparticles were deposited onto the surface of a silicon substrate. The novel technique is simpler, faster, and safer than any known gold nanoparticle deposition technique reported in literature. The implementation of this technique has potential wide-ranging applications in photovoltaic cells, medical products, and many others. In chapter 3, a low cost lithography technique utilizing surface plasmons is reported. In this technique, a plasmonic photomask is created by coating a pre-made porous alumina membrane with a thin aluminum layer. A coherent, 337 nm UV laser source is used to expose the photomask and excite surface plasmons along the metal layer. The surface plasmons allow for features well below the wavelength of the incident light to be produced. Along with this technique, a unique texturing effect was discovered using the same photomask and 400 nm UV lamp source. The developed technique promises to greatly reduce the cost and complexity of sub-100 nm photolithography using only a UV light source and the novel plasmonic photomask.

Space Station - An integrated approach to operational logistics support

NASA Technical Reports Server (NTRS)

Hosmer, G. J.

1986-01-01

Development of an efficient and cost effective operational logistics system for the Space Station will require logistics planning early in the program's design and development phase. This paper will focus on Integrated Logistics Support (ILS) Program techniques and their application to the Space Station program design, production and deployment phases to assure the development of an effective and cost efficient operational logistics system. The paper will provide the methodology and time-phased programmatic steps required to establish a Space Station ILS Program that will provide an operational logistics system based on planned Space Station program logistics support.

Sustainable microbial water quality monitoring programme design using phage-lysis and multivariate techniques.

PubMed

Nnane, Daniel Ekane

2011-11-15

Contamination of surface waters is a pervasive threat to human health, hence, the need to better understand the sources and spatio-temporal variations of contaminants within river catchments. River catchment managers are required to sustainably monitor and manage the quality of surface waters. Catchment managers therefore need cost-effective low-cost long-term sustainable water quality monitoring and management designs to proactively protect public health and aquatic ecosystems. Multivariate and phage-lysis techniques were used to investigate spatio-temporal variations of water quality, main polluting chemophysical and microbial parameters, faecal micro-organisms sources, and to establish 'sentry' sampling sites in the Ouse River catchment, southeast England, UK. 350 river water samples were analysed for fourteen chemophysical and microbial water quality parameters in conjunction with the novel human-specific phages of Bacteroides GB-124 (Bacteroides GB-124). Annual, autumn, spring, summer, and winter principal components (PCs) explained approximately 54%, 75%, 62%, 48%, and 60%, respectively, of the total variance present in the datasets. Significant loadings of Escherichia coli, intestinal enterococci, turbidity, and human-specific Bacteroides GB-124 were observed in all datasets. Cluster analysis successfully grouped sampling sites into five clusters. Importantly, multivariate and phage-lysis techniques were useful in determining the sources and spatial extent of water contamination in the catchment. Though human faecal contamination was significant during dry periods, the main source of contamination was non-human. Bacteroides GB-124 could potentially be used for catchment routine microbial water quality monitoring. For a cost-effective low-cost long-term sustainable water quality monitoring design, E. coli or intestinal enterococci, turbidity, and Bacteroides GB-124 should be monitored all-year round in this river catchment. Copyright © 2011 Elsevier B.V. All rights reserved.

Mitigating the Hook Effect in Lateral Flow Sandwich Immunoassays Using Real-Time Reaction Kinetics.

PubMed

Rey, Elizabeth G; O'Dell, Dakota; Mehta, Saurabh; Erickson, David

2017-05-02

The quantification of analyte concentrations using lateral flow assays is a low-cost and user-friendly alternative to traditional lab-based assays. However, sandwich-type immunoassays are often limited by the high-dose hook effect, which causes falsely low results when analytes are present at very high concentrations. In this paper, we present a reaction kinetics-based technique that solves this problem, significantly increasing the dynamic range of these devices. With the use of a traditional sandwich lateral flow immunoassay, a portable imaging device, and a mobile interface, we demonstrate the technique by quantifying C-reactive protein concentrations in human serum over a large portion of the physiological range. The technique could be applied to any hook effect-limited sandwich lateral flow assay and has a high level of accuracy even in the hook effect range.

A cost-effective line-based light-balancing technique using adaptive processing.

PubMed

Hsia, Shih-Chang; Chen, Ming-Huei; Chen, Yu-Min

2006-09-01

The camera imaging system has been widely used; however, the displaying image appears to have an unequal light distribution. This paper presents novel light-balancing techniques to compensate uneven illumination based on adaptive signal processing. For text image processing, first, we estimate the background level and then process each pixel with nonuniform gain. This algorithm can balance the light distribution while keeping a high contrast in the image. For graph image processing, the adaptive section control using piecewise nonlinear gain is proposed to equalize the histogram. Simulations show that the performance of light balance is better than the other methods. Moreover, we employ line-based processing to efficiently reduce the memory requirement and the computational cost to make it applicable in real-time systems.

A cost-efficient frequency-domain photoacoustic imaging system

PubMed Central

LeBoulluec, Peter; Liu, Hanli; Yuan, Baohong

2013-01-01

Photoacoustic (PA) imaging techniques have recently attracted much attention and can be used for noninvasive imaging of biological tissues. Most PA imaging systems in research laboratories use the time domain method with expensive nanosecond pulsed lasers that are not affordable for most educational laboratories. Using an intensity modulated light source to excite PA signals is an alternative technique, known as the frequency domain method, with a much lower cost. In this paper, we describe a simple frequency domain PA system and demonstrate its imaging capability. The system provides opportunities not only to observe PA signals in tissue phantoms, but also to acquire hands-on skills in PA signal detection. It also provides opportunities to explore the underlying mechanisms of the PA effect. PMID:24659823

Ultrasonic flowmeters offer oil line leak-detection potential

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

Hettrich, U.

1995-04-01

Ultrasonic flowmeters (USFM) installed on Transalpine Pipeline Co.`s (TAL) crude-oil system have proven to be a cost-effective flow measurement technique and beneficial in batch identification and leak detection. Through close examination, TAL has determined that clamp-on USFMs offer cost-saving advantages in installation, maintenance and operation. USFMs do not disturb pig passage. The technique also provides sound velocity capabilities, which can be used for liquid identification and batch tracking. The instruments have a repeatability of better than 0.25% and achieve an accuracy of better than 1%, depending on the flow profiles predictability. Using USFMs with multiple beams probably will improve accuracymore » further and it should be possible to find leaks even smaller than 1% of flow.« less

Evaluation of the Mechanical Properties of Electroslag Refined Fe-12Ni Alloys

NASA Technical Reports Server (NTRS)

Bhat, G. K.

1978-01-01

Three Fe-12Ni alloys, individually alloyed with small amounts of V, Ti, and Al, were manufactured through different melting techniques, with special emphasis on electroslag remelting, in order to achieve different levels of metal purity and associated costs. The relative effectiveness of these melting techniques was evaluated from tensile and slow bend fracture toughness behavior at 25 C and -196 C after tempering the test specimens at various temperatures. The best melting procedure was vacuum induction melting (VIM) with or without electroslag remelting (ESR). VIM+ESR is the recommended procedure since ESR provides increased yield of plate product, a reduction of overall manufacturing costs and, depending on the alloy composition, improved tensile and fracture toughness properties.

A cost-efficient frequency-domain photoacoustic imaging system.

PubMed

Leboulluec, Peter; Liu, Hanli; Yuan, Baohong

2013-09-01

Photoacoustic (PA) imaging techniques have recently attracted much attention and can be used for noninvasive imaging of biological tissues. Most PA imaging systems in research laboratories use the time domain method with expensive nanosecond pulsed lasers that are not affordable for most educational laboratories. Using an intensity modulated light source to excite PA signals is an alternative technique, known as the frequency domain method, with a much lower cost. In this paper, we describe a simple frequency domain PA system and demonstrate its imaging capability. The system provides opportunities not only to observe PA signals in tissue phantoms, but also to acquire hands-on skills in PA signal detection. It also provides opportunities to explore the underlying mechanisms of the PA effect.

Jumbo Cutter for Removal of A Bent Femoral Interlocking Nail: A Cost Effective Method

PubMed Central

Dhanda, Manjeet Singh; Sharma, Sansar C; Ali, Nadeem; Bhat, Abedullah

2015-01-01

Closed diaphyseal femoral shaft fractures can be treated with multiple surgical options. It is more challenging to remove a bent nail than a broken one because it is difficult to retrieve the bent nail through the intramedullary canal. Various authors have published their techniques for removal of bent femoral interlocking nail. This article describes a simple technique using Jumbo cutter for sectioning and removal of bent interlocking nail. This technique will help orthopaedic surgeons to remove bent nail without using any specialised metal cutting instruments. PMID:26266173

Photo-reconnaissance applications of computer processing of images.

NASA Technical Reports Server (NTRS)

Billingsley, F. C.

1972-01-01

Discussion of imaging processing techniques for enhancement and calibration of Jet Propulsion Laboratory imaging experiment pictures returned from NASA space vehicles such as Ranger, Mariner and Surveyor. Particular attention is given to data transmission, resolution vs recognition, and color aspects of digital data processing. The effectiveness of these techniques in applications to images from a wide variety of sources is noted. It is anticipated that the use of computer processing for enhancement of imagery will increase with the improvement and cost reduction of these techniques in the future.

Higher cost of single incision laparoscopic cholecystectomy due to longer operating time. A study of opportunity cost based on meta-analysis

PubMed Central

GIRABENT-FARRÉS, M.

2018-01-01

Background We aimed to calculate the opportunity cost of the operating time to demonstrate that single incision laparoscopic cholecystectomy (SILC) is more expensive than classic laparoscopic cholecystectomy (CLC). Methods We identified studies comparing use of both techniques during the period 2008–2016, and to calculate the opportunity cost, we performed another search in the same period of time with an economic evaluation of classic laparoscopy. We performed a meta-analysis of the items selected in the first review considering the cost of surgery and surgical time, and we analyzed their differences. We subsequently calculated the opportunity cost of these time differences based on the design of a cost/time variable using the data from the second literature review. Results Twenty-seven articles were selected from the first review: 26 for operating time (3.138 patients) and 3 for the cost of surgery (831 patients), and 3 articles from the second review. Both techniques have similar operating costs. Single incision laparoscopy surgery takes longer (16.90min) to perform (p <0.00001) and this difference represents an opportunity cost of 755.97 € (cost/time unit factor of 44.73 €/min). Conclusions SILC costs the same as CLC, but the surgery takes longer to perform, and this difference involves an opportunity cost that increases the total cost of SILC. The value of the opportunity cost of the operating time can vary the total cost of a surgical technique and it should be included in the economic evaluation to support the decision to adopt a new surgical technique. PMID:29549678

Cost effectiveness of brace, physiotherapy, or both for treatment of tennis elbow

PubMed Central

Struijs, P A A; Bos, I B C Korthals‐de; van Tulder, M W; van Dijk, C N; Bouter, L M

2006-01-01

Background The annual incidence of tennis elbow in the general population is high (1–3%). Tennis elbow often leads to limitation of activities of daily living and work absenteeism. Physiotherapy and braces are the most common treatments. Objectives The hypothesis of the trial was that no difference exists in the cost effectiveness of physiotherapy, braces, and a combination of the two for treatment of tennis elbow. Methods The trial was designed as a randomised controlled trial with intention to treat analysis. A total of 180 patients with tennis elbow were randomised to brace only (n  =  68), physiotherapy (n  =  56), or a combination of the two (n  =  56). Outcome measures were success rate, severity of complaints, pain, functional disability, and quality of life. Follow up was at six, 26, and 52 weeks. Direct healthcare and non‐healthcare costs and indirect costs were measured. Mean cost differences over 12 months were evaluated by applying non‐parametric bootstrap techniques. Results No clinically relevant or statistically significant differences were found between the groups. Success rate at 12 months was 89% in the physiotherapy group, 86% in the brace group, and 87% in the combination group. Mean total costs per patient were €2069 in the brace only group, €978 in the physiotherapy group, and €1256 in the combination group. The mean difference in total costs between the physiotherapy and brace group was substantial (€1005), although not significant. Cost effectiveness ratios and cost utility ratios showed physiotherapy to be the most cost effective, although this also was not statistically significant. Conclusion No clinically relevant or statistically significant differences in costs were identified between the three strategies. PMID:16687482

The Effect of State Regulatory Stringency on Nursing Home Quality

PubMed Central

Mukamel, Dana B; Weimer, David L; Harrington, Charlene; Spector, William D; Ladd, Heather; Li, Yue

2012-01-01

Objective To test the hypothesis that more stringent quality regulations contribute to better quality nursing home care and to assess their cost-effectiveness. Data Sources/Setting Primary and secondary data from all states and U.S. nursing homes between 2005 and 2006. Study Design We estimated seven models, regressing quality measures on the Harrington Regulation Stringency Index and control variables. To account for endogeneity between regulation and quality, we used instrumental variables techniques. Quality was measured by staffing hours by type per case-mix adjusted day, hotel expenditures, and risk-adjusted decline in activities of daily living, high-risk pressure sores, and urinary incontinence. Data Collection All states' licensing and certification offices were surveyed to obtain data about deficiencies. Secondary data included the Minimum Data Set, Medicare Cost Reports, and the Economic Freedom Index. Principal Findings Regulatory stringency was significantly associated with better quality for four of the seven measures studied. The cost-effectiveness for the activities-of-daily-living measure was estimated at about 72,000 in 2011/ Quality Adjusted Life Year. Conclusions Quality regulations lead to better quality in nursing homes along some dimensions, but not all. Our estimates of cost-effectiveness suggest that increased regulatory stringency is in the ballpark of other acceptable cost-effective practices. PMID:22946859

Lessons from trial-based cost-effectiveness analyses of mental health interventions: why uncertainty about the outcome, estimate and willingness to pay matters.

PubMed

Hoch, Jeffrey S; Dewa, Carolyn S

2007-01-01

The principal aim of this article is to share lessons learned by the authors while conducting economic evaluations, using clinical trial data, of mental health interventions. These lessons are quite general and have clear relevance for pharmacoeconomic studies. In addition, we explore how net benefit regression can be used to enhance consideration of key issues when conducting an economic evaluation based on clinical trial data. The first study we discuss found that cost-effectiveness results varied markedly based on the choice of both the patient outcome and the willingness to pay for more of that outcome. The importance of willingness to pay was also highlighted in the results from the second study. Even with a set willingness-to-pay value, most of the time the probability that the new treatment was cost effective was not 100%. In the third study, the cost effectiveness of the new treatment varied by patient characteristics. These observations have important implications for pharmacoeconomic studies. Namely, analysts must carefully consider choice of patient outcome, willingness to pay, patient heterogeneity and the statistical uncertainty inherent in the data. Net benefit regression is a useful technique for exploring these crucial issues when undertaking an economic evaluation using patient-level data on both costs and effects.

Space transfer vehicle concepts and requirements study. Volume 3, book 1: Program cost estimates

NASA Technical Reports Server (NTRS)

Peffley, Al F.

1991-01-01

The Space Transfer Vehicle (STV) Concepts and Requirements Study cost estimate and program planning analysis is presented. The cost estimating technique used to support STV system, subsystem, and component cost analysis is a mixture of parametric cost estimating and selective cost analogy approaches. The parametric cost analysis is aimed at developing cost-effective aerobrake, crew module, tank module, and lander designs with the parametric cost estimates data. This is accomplished using cost as a design parameter in an iterative process with conceptual design input information. The parametric estimating approach segregates costs by major program life cycle phase (development, production, integration, and launch support). These phases are further broken out into major hardware subsystems, software functions, and tasks according to the STV preliminary program work breakdown structure (WBS). The WBS is defined to a low enough level of detail by the study team to highlight STV system cost drivers. This level of cost visibility provided the basis for cost sensitivity analysis against various design approaches aimed at achieving a cost-effective design. The cost approach, methodology, and rationale are described. A chronological record of the interim review material relating to cost analysis is included along with a brief summary of the study contract tasks accomplished during that period of review and the key conclusions or observations identified that relate to STV program cost estimates. The STV life cycle costs are estimated on the proprietary parametric cost model (PCM) with inputs organized by a project WBS. Preliminary life cycle schedules are also included.

The Array Automated Assembly Task for the Low Cost Solar Array Project, Phase 2

NASA Technical Reports Server (NTRS)

Campbell, R. B. (Editor); Farukhi, S. (Editor)

1978-01-01

During the program a process sequence was proposed and tested for the fabrication of dendritic welb silicon into solar modules. This sequence was analyzed as to yield and cost and these data suggest that the price goals of 1986 are attainable. Specifically, it was shown that a low cost POCL3 is a suitable replacement for the semiconductor grade, and that a suitable CVD oxide can be deposited from a silane/air mixture using a Silox reactor. A dip coating method was developed for depositing an antireflection coating from a metalorganic precursor. Application of photoresist to define contact grids was made cost effective through use of a dip coating technique. Electroplating of both Ag and Cu was shown feasible and cost effective for producing the conductive metal grids on the solar cells. Laser scribing was used to separate the cells from the dendrites without degradation. Ultrasonic welding methods were shown to be feasible for interconnecting the cells. A study of suitable low cost materials for encapsulation suggest that soda lime glass and phenolic filled board are preferred.

48 CFR 9904.417-50 - Techniques for application.

Code of Federal Regulations, 2010 CFR

2010-10-01

... capitalized, such as the method used for financial accounting and reporting, may be used, provided the.... 9904.417-50 Section 9904.417-50 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD... ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.417-50 Techniques for application. (a) The cost of money...

48 CFR 9904.415-50 - Techniques for application.

Code of Federal Regulations, 2010 CFR

2010-10-01

.... 9904.415-50 Section 9904.415-50 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD... ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.415-50 Techniques for application. (a) The contractor... shall be assignable only to the cost accounting period or periods in which the compensation is paid to...

48 CFR 9904.408-50 - Techniques for application.

Code of Federal Regulations, 2010 CFR

2010-10-01

.... 9904.408-50 Section 9904.408-50 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD... ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.408-50 Techniques for application. (a) Determinations... determination shall be made beginning with the first cost accounting period to which such new or changed plan or...

48 CFR 9904.416-50 - Techniques for application.

Code of Federal Regulations, 2010 CFR

2010-10-01

... ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.416-50 Techniques for application. (a) Measurement of.... 9904.416-50 Section 9904.416-50 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD... be assigned pro rata among the cost accounting periods covered by the policy term, except as provided...

48 CFR 9904.410-50 - Techniques for application.

Code of Federal Regulations, 2010 CFR

2010-10-01

.... 9904.410-50 Section 9904.410-50 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.410-50 Techniques for application. (a) G&A expenses of a...

Systematic Review of Economic Evaluation of Laparotomy versus Laparoscopy for Patients Submitted to Roux-en-Y Gastric Bypass

PubMed Central

Sussenbach, Samanta Pereira; Silva, Everton Nunes; Pufal, Milene Amarante; Casagrande, Daniela Shan; Padoin, Alexandre Vontobel; Mottin, Cláudio Corá

2014-01-01

Background Because of the high prevalence of obesity, there is a growing demand for bariatric surgery worldwide. The objective of this systematic review was to analyze the difference in relation to cost-effectiveness of access route by laparoscopy versus laparotomy of Roux en-Y gastric bypass (RYGB). Methods A systematic review was conducted in the electronic databases MEDLINE, Embase, Scopus, Cochrane and Lilacs in order to identify economic evaluation studies that compare the cost-effectiveness of laparoscopic and laparotomic routes in RYGB. Results In a total of 494 articles, only 6 fulfilled the eligibility criteria. All studies were published between 2001 and 2008 in the United States (USA). Three studies fulfilled less than half of the items that evaluated the results quality; two satisfied 5 of the required items, and only 1 study fulfilled 7 of 10 items. The economic evaluation of studies alternated between cost-effectiveness and cost-consequence. Five studies considered the surgery by laparoscopy the dominant strategy, because it showed greater clinical benefit (less probability of post-surgical complications, less hospitalization time) and lower total cost. Conclusion This review indicates that laparoscopy is a safe and well-tolerated technique, despite the costs of surgery being higher when compared with laparotomy. However, the additional costs are compensated by the lower probability of complications after surgery and, consequently, avoiding their costs. PMID:24945704

Application of Graph Theory to Cost-Effective Fire Protection of Chemical Plants During Domino Effects.

PubMed

Khakzad, Nima; Landucci, Gabriele; Reniers, Genserik

2017-09-01

In the present study, we have introduced a methodology based on graph theory and multicriteria decision analysis for cost-effective fire protection of chemical plants subject to fire-induced domino effects. By modeling domino effects in chemical plants as a directed graph, the graph centrality measures such as out-closeness and betweenness scores can be used to identify the installations playing a key role in initiating and propagating potential domino effects. It is demonstrated that active fire protection of installations with the highest out-closeness score and passive fire protection of installations with the highest betweenness score are the most effective strategies for reducing the vulnerability of chemical plants to fire-induced domino effects. We have employed a dynamic graph analysis to investigate the impact of both the availability and the degradation of fire protection measures over time on the vulnerability of chemical plants. The results obtained from the graph analysis can further be prioritized using multicriteria decision analysis techniques such as the method of reference point to find the most cost-effective fire protection strategy. © 2016 Society for Risk Analysis.

Trends in Food Packaging.

ERIC Educational Resources Information Center

Ott, Dana B.

1988-01-01

This article discusses developments in food packaging, processing, and preservation techniques in terms of packaging materials, technologies, consumer benefits, and current and potential food product applications. Covers implications due to consumer life-style changes, cost-effectiveness of packaging materials, and the ecological impact of…

Remote sensing applied to crop disease control, urban planning, and monitoring aquatic plants, oil spills, rangelands, and soil moisture

NASA Technical Reports Server (NTRS)

1975-01-01

The application of remote sensing techniques to land management, urban planning, agriculture, oceanography, and environmental monitoring is discussed. The results of various projects are presented along with cost effective considerations.

75 FR 82061 - Lake Champlain Sea Lamprey Control Alternatives Workgroup

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-29

...] Lake Champlain Sea Lamprey Control Alternatives Workgroup AGENCY: Fish and Wildlife Service, Interior... of the Lake Champlain Sea Lamprey Control Alternatives Workgroup (Workgroup). The Workgroup's purpose... sea lamprey control techniques alternative to lampricide that are technically feasible, cost effective...

Assessing LiDAR elevation data for KDOT applications.

DOT National Transportation Integrated Search

2013-02-01

LiDAR-based elevation surveys are a cost-effective means for mapping topography over large areas. LiDAR : surveys use an airplane-mounted or ground-based laser radar unit to scan terrain. Post-processing techniques are : applied to remove vegetation ...

Evaluation of the performance, cost-effectiveness, and timing of various preventive maintenances : interim report.

DOT National Transportation Integrated Search

2010-10-01

This research study evaluated the performance of various pavement preservation treatments over time and under different : environmental conditions to quantify the economics of each treatment type. There are three primary techniques utilized in Colora...

Crack and seat performance : review report

DOT National Transportation Integrated Search

1987-04-01

The objectives of this review were to obtain a better understanding of the expected performance of C&S and overlaying, and to identify the conditions under which this technique has been used in a cost-effective manner. It is hoped that the informatio...

Review of phase measuring deflectometry

DOE PAGES

Huang, Lei; Idir, Mourad; Zuo, Chao; ...

2018-04-07

As a low cost, full-field three-dimensional shape measurement technique with high dynamic range, Phase Measuring Deflectometry (PMD) has been studied and improved to be a simple and effective manner to inspect specular reflecting surfaces. In this review, the fundamental principle and the basic concepts of PMD technique are introduced and followed by a brief overview of its key developments since it was first proposed. In addition, the similarities and differences compared with other related techniques are discussed to highlight the distinguishing features of the PMD technique. In conclusion, we will address the major challenges, the existing solutions and the remainingmore » limitations in this technique to provide some suggestions for potential future investigations.« less

Airport and Airway Costs: Allocation and Recovery in the 1980’s.

DTIC Science & Technology

1987-02-01

1997 [8]. 3*X S.% Volume 4, FAA Cost Recovery Options [9). Volume 5, Econometric Cost Functions for FAA Cost Allocation Model [10]. Volume 6, Users...and relative price elasticities ( Ramsey pricing technique). User fees based on the Ramsey pricing tend to be less burdensome on users and minimize...full discussion of the Ramsey pricing techniques is provided in Allocation of Federal Airport and Airway Costs for FY 1985 [6]. -12- In step 5

Cost-effectiveness analysis in minimally invasive spine surgery.

PubMed

Al-Khouja, Lutfi T; Baron, Eli M; Johnson, J Patrick; Kim, Terrence T; Drazin, Doniel

2014-06-01

Medical care has been evolving with the increased influence of a value-based health care system. As a result, more emphasis is being placed on ensuring cost-effectiveness and utility in the services provided to patients. This study looks at this development in respect to minimally invasive spine surgery (MISS) costs. A literature review using PubMed, the Cost-Effectiveness Analysis (CEA) Registry, and the National Health Service Economic Evaluation Database (NHS EED) was performed. Papers were included in the study if they reported costs associated with minimally invasive spine surgery (MISS). If there was no mention of cost, CEA, cost-utility analysis (CUA), quality-adjusted life year (QALY), quality, or outcomes mentioned, then the article was excluded. Fourteen studies reporting costs associated with MISS in 12,425 patients (3675 undergoing minimally invasive procedures and 8750 undergoing open procedures) were identified through PubMed, the CEA Registry, and NHS EED. The percent cost difference between minimally invasive and open approaches ranged from 2.54% to 33.68%-all indicating cost saving with a minimally invasive surgical approach. Average length of stay (LOS) for minimally invasive surgery ranged from 0.93 days to 5.1 days compared with 1.53 days to 12 days for an open approach. All studies reporting EBL reported lower volume loss in an MISS approach (range 10-392.5 ml) than in an open approach (range 55-535.5 ml). There are currently an insufficient number of studies published reporting the costs of MISS. Of the studies published, none have followed a standardized method of reporting and analyzing cost data. Preliminary findings analyzing the 14 studies showed both cost saving and better outcomes in MISS compared with an open approach. However, more Level I CEA/CUA studies including cost/QALY evaluations with specifics of the techniques utilized need to be reported in a standardized manner to make more accurate conclusions on the cost effectiveness of minimally invasive spine surgery.

Managing Credit Card Expenses: Nova Southeastern University Shares Cost-Saving Techniques.

ERIC Educational Resources Information Center

Peskin, Carol Ann

1994-01-01

Nova Southeastern University, Florida, has implemented a variety of techniques of cost containment for campus credit card transactions. These include restricted card acceptance parameters, careful merchant rate negotiation, increased automation of transaction processing, and sophisticated processing techniques. The university has demonstrated…

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

PubMed Central

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

2014-01-01

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

Thermal management of VECSELs by front surface direct liquid cooling

NASA Astrophysics Data System (ADS)

Smyth, Conor J. C.; Mirkhanov, Shamil; Quarterman, Adrian H.; Wilcox, Keith G.

2016-03-01

Efficient thermal management is vital for VECSELs, affecting the output power and several aspects of performance of the device. Presently there exist two distinct methods of effective thermal management which both possess their merits and disadvantages. Substrate removal of the VECSEL gain chip has proved a successful method in devices emitting at a wavelength near 1μm. However for other wavelengths the substrate removal technique has proved less effective primarily due to the thermal impedance of the distributed Bragg reflectors. The second method of thermal management involves the use of crystalline heat spreaders bonded to the gain chip surface. Although this is an effective thermal management scheme, the disadvantages are additional loss and the etalon effect that filters the gain spectrum, making mode locking more difficult and normally resulting in multiple peaks in the spectrum. There are considerable disadvantages associated with both methods attributed to heatspreader cost and sample processing. It is for these reasons that a proposed alternative, front surface liquid cooling, has been investigated in this project. Direct liquid cooling involves flowing a temperature-controlled liquid over the sample's surface. In this project COMSOL was used to model surface liquid cooling of a VECSEL sample in order to investigate and compare its potential thermal management with current standard thermal management techniques. Based on modelling, experiments were carried out in order to evaluate the performance of the technique. While modelling suggests that this is potentially a mid-performance low cost alternative to existing techniques, experimental measurements to date do not reflect the performance predicted from modelling.

Cost-effectiveness of digital subtraction angiography in the setting of computed tomographic angiography negative subarachnoid hemorrhage.

PubMed

Jethwa, Pinakin R; Punia, Vineet; Patel, Tapan D; Duffis, E Jesus; Gandhi, Chirag D; Prestigiacomo, Charles J

2013-04-01

Recent studies have documented the high sensitivity of computed tomography angiography (CTA) in detecting a ruptured aneurysm in the presence of acute subarachnoid hemorrhage (SAH). The practice of digital subtraction angiography (DSA) when CTA does not reveal an aneurysm has thus been called into question. We examined this dilemma from a cost-effectiveness perspective by using current decision analysis techniques. A decision tree was created with the use of TreeAge Pro Suite 2012; in 1 arm, a CTA-negative SAH was followed up with DSA; in the other arm, patients were observed without further imaging. Based on literature review, costs and utilities were assigned to each potential outcome. Base-case and sensitivity analyses were performed to determine the cost-effectiveness of each strategy. A Monte Carlo simulation was then conducted by sampling each variable over a plausible distribution to evaluate the robustness of the model. With the use of a negative predictive value of 95.7% for CTA, observation was found to be the most cost-effective strategy ($6737/Quality Adjusted Life Year [QALY] vs $8460/QALY) in the base-case analysis. One-way sensitivity analysis demonstrated that DSA became the more cost-effective option if the negative predictive value of CTA fell below 93.72%. The Monte Carlo simulation produced an incremental cost-effectiveness ratio of $83 083/QALY. At the conventional willingness-to-pay threshold of $50 000/QALY, observation was the more cost-effective strategy in 83.6% of simulations. The decision to perform a DSA in CTA-negative SAH depends strongly on the sensitivity of CTA, and therefore must be evaluated at each center treating these types of patients. Given the high sensitivity of CTA reported in the current literature, performing DSA on all patients with CTA negative SAH may not be cost-effective at every institution.

Cost-effectiveness of focused ultrasound, radiosurgery, and DBS for essential tremor.

PubMed

Ravikumar, Vinod K; Parker, Jonathon J; Hornbeck, Traci S; Santini, Veronica E; Pauly, Kim Butts; Wintermark, Max; Ghanouni, Pejman; Stein, Sherman C; Halpern, Casey H

2017-08-01

Essential tremor remains a very common yet medically refractory condition. A recent phase 3 study demonstrated that magnetic resonance-guided focused ultrasound thalamotomy significantly improved upper limb tremor. The objectives of this study were to assess this novel therapy's cost-effectiveness compared with existing procedural options. Literature searches of magnetic resonance-guided focused ultrasound thalamotomy, DBS, and stereotactic radiosurgery for essential tremor were performed. Pre- and postoperative tremor-related disability scores were collected from 32 studies involving 83 magnetic resonance-guided focused ultrasound thalamotomies, 615 DBSs, and 260 stereotactic radiosurgery cases. Utility, defined as quality of life and derived from percent change in functional disability, was calculated; Medicare reimbursement was employed as a proxy for societal cost. Medicare reimbursement rates are not established for magnetic resonance-guided focused ultrasound thalamotomy for essential tremor; therefore, reimbursements were estimated to be approximately equivalent to stereotactic radiosurgery to assess a cost threshold. A decision analysis model was constructed to examine the most cost-effective option for essential tremor, implementing meta-analytic techniques. Magnetic resonance-guided focused ultrasound thalamotomy resulted in significantly higher utility scores compared with DBS (P < 0.001) or stereotactic radiosurgery (P < 0.001). Projected costs of magnetic resonance-guided focused ultrasound thalamotomy were significantly less than DBS (P < 0.001), but not significantly different from radiosurgery. Magnetic resonance-guided focused ultrasound thalamotomy is cost-effective for tremor compared with DBS and stereotactic radiosurgery and more effective than both. Even if longer follow-up finds changes in effectiveness or costs, focused ultrasound thalamotomy will likely remain competitive with both alternatives. © 2017 International Parkinson and Movement Disorder Society. © 2017 International Parkinson and Movement Disorder Society.

The cost-effectiveness of brief intervention versus brief treatment of Screening, Brief Intervention and Referral to Treatment (SBIRT) in the United States.

PubMed

Barbosa, Carolina; Cowell, Alexander; Dowd, William; Landwehr, Justin; Aldridge, Arnie; Bray, Jeremy

2017-02-01

To conduct a cost-effectiveness analysis (CEA) comparing the delivery of brief intervention (BI) with brief treatment (BT) within Screening, Brief Intervention and Referral to Treatment (SBIRT) programs. Quasi-experimental differences in observed baseline characteristics between BI and BT patients were adjusted using propensity score techniques. Incremental comparison of costs and health outcomes associated with BI and BT. Health-care settings in four US states participating in Substance Abuse and Mental Health Services Administration SBIRT grant programs. Ninety patients who received BT and 878 who received BI. Per-patient cost of SBIRT, patient demographics and six measures of substance use: proportion using alcohol, proportion using alcohol to intoxication, days of alcohol use, days of alcohol use to intoxication, proportion using drugs and days using drugs. BI and BT were associated with better outcomes. The cost of SBIRT was significantly higher for BT patients ($75.54 versus 16.32, 95% confidence interval, P < 0.01). BT would be cost-effective if the decision-maker had a willingness to pay of $8.90 for a 1 percentage point reduction in the probability of using any alcohol. For the other five outcomes, BT was less effective and more costly, and BI would be a better use of resources. It might be cost-effective to offer brief treatment if the goal is to abstain from alcohol. However, the higher effectiveness of brief treatment for this outcome is associated with considerable uncertainty and, because both brief intervention and brief treatment improve all outcomes, brief treatment does not appear to be a good use of resources. © 2017 Society for the Study of Addiction.

A facility monitoring system: The single most valuable and cost-effective tool available to an energy manager

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

Holmes, W.A.

Energy engineering and management combines engineering problem-solving and financial management techniques to reduce utility costs. At present, substantial amounts of time and money are being spent in order to attempt to quantify energy consumption and costs and define opportunities for savings. Unfortunately, accurate verification of results is often overlooked. Advances in technology during the last few years have made the installation of a permanent, PC-based monitoring system possible for any facility, often for no more than the cost of a detailed study. By investing initially in a monitoring system rather than audits or studies, the actual consumption and cost datamore » will be available on a continuing basis and can be used to produce immediate operational savings, more accurately analyze opportunities requiring capital investments, and to verify actual savings resulting from changes. A permanent monitoring system, installed as the first step in a utility cost reduction effort, to identify where and how energy is used in a facility on a dynamic and real-time basis, can provide the most valuable and cost-effective tool available to an energy manager. The resulting data allows energy consumption patterns and utility costs to be understood and managed in the same manner as all other costs within a facility.« less

Cost-effectiveness of raising HDL cholesterol by adding prolonged-release nicotinic acid to statin therapy in the secondary prevention setting: a French perspective.

PubMed

Roze, S; Ferrières, J; Bruckert, E; Van Ganse, E; Chapman, M J; Liens, D; Renaudin, C

2007-11-01

To evaluate the cost-effectiveness of raising high-density lipoprotein cholesterol (HDL-C) with add-on nicotinic acid in statin-treated patients with coronary heart disease (CHD) and low HDL-C, from the French healthcare system perspective. Computer simulation economic modelling incorporating two decision analytic submodels was used. The first submodel generated a cohort of 2000 patients and simulated lipid changes using baseline characteristics and treatment effects from the ARterial Biology for the Investigation of the Treatment Effects of Reducing cholesterol (ARBITER 2) study. Prolonged-release (PR) nicotinic acid (1 g/day) was added in patients with HDL-C < 40 mg/dl (1.03 mmol/l) on statin alone. The second submodel used standard Markov techniques to evaluate long-term clinical and economic outcomes based on Framingham risk estimates. Direct medical costs were accounted from a third party payer perspective [2004 Euros (euro)] and discounted by 3%. Addition of PR nicotinic acid to statin therapy resulted in substantial health gain and increased life expectancy, at a cost well within the threshold (< 50,000 euros per life year gained) considered good value for money in Western Europe. Raising HDL-C by adding PR nicotinic acid to statin therapy in CHD patients was cost-effective in France at a level considered to represent good value for money by reimbursement authorities in Europe. This strategy was highly cost-effective in CHD patients with type 2 diabetes.

Cost-effectiveness analysis of levobupivacaine 0.5 %, a local anesthetic, infusion in the surgical wound after modified radical mastectomy.

PubMed

Ferreira Laso, Lourdes; López Picado, Amanda; Antoñanzas Villar, Fernando; Lamata de la Orden, Laura; Ceballos Garcia, Mar; Ibañez López, Carolina; Pipaon Ruilope, Lorena; Lamata Hernandez, Felix; Valero Martinez, Cesar; Aizpuru, Felipe; Hernandez Chaves, Roberto

2015-09-01

Effective treatment of postoperative pain contributes to decreasing the rate of complications as well as the total cost of the operated patients. The aim of this study was to analyze the costs and the efficiency of use of continuous infusion of levobupivacaine 0.5 % with the help of an infusion pump in modified radical mastectomy. A cost calculation of the analgesic procedures (continuous infusion of levobupivacaine 0.5 % [levobupivacaine group (LG)] or saline [saline group (SG)] (2 ml/h 48 h) has been carried out based on the data of a previous clinical trial (double-blind randomized study) of patients who underwent modified radical mastectomy surgery. The measure of the effectiveness was the point reduction of pain derived from the verbal numeric rating scale (VNRS). The usual incremental cost-effectiveness ratio (ICER) was performed. Considering only the intravenous analgesia, overall costs were lower in LG, as less analgesia was used (EUR14.06 ± 7.89 vs. 27.47 ± 14.79; p < 0.001). In this study the costs of the infusion pump were not calculated as it was used by both groups and they offset each other. However, if the infusion pump costs were included, costs would be higher in the LG, (EUR91.89 ± 7.89 vs. 27.47 ± 14.79; p < 0.001) and then the ICER was -8.51, meaning that for every extra point of decrease in the pain verbal numerical rating score over the 2-day period, the cost increased by EUR8.51. Infiltration of local anesthetics is an effective technique for controlling postoperative pain and the associated added costs are relatively low in relation to the total cost of mastectomy, therefore providing patients with a higher quality of care in the prevention of pain. clinicaltrials.gov: reference number NCT01389934. http://clinicaltrials.gov/show/NCT01389934

Cost-effectiveness of extraperitoneal laparoscopic inguinal hernia repair: a randomized comparison with conventional herniorrhaphy. Coala trial group.

PubMed Central

Liem, M S; Halsema, J A; van der Graaf, Y; Schrijvers, A J; van Vroonhoven, T J

1997-01-01

OBJECTIVE: To determine the cost-effectiveness of laparoscopic inguinal hernia repair. SUMMARY BACKGROUND DATA: Laparoscopic inguinal hernia repair seems superior to open techniques with respect to short-term results. An issue yet to be studied in depth remains the cost-effectiveness of the procedure. As part of a multicenter randomized study in which >1000 patients were included, a cost-effectiveness analysis from a societal point of view was performed. METHODS: After informed consent, all resource costs, both in and outside the hospital, for patients between August 1994 and July 1995 were recorded prospectively. Actual costs were calculated in a standardized fashion according to international guidelines. The main measures used for the evaluation of inguinal hernia repair were the number of averted recurrences and quality of life measured with the Short Form 36 questionnaire. RESULTS: Resource costs were recorded for 273 patients, 139 in the open and 134 in the laparoscopic group. Both groups were comparable at baseline. Average total hospital costs were Dfl 1384.91 (standard deviation: Dfl 440.15) for the open repair group and Dfl 2417.24 (standard deviation: Dfl 577.10) for laparoscopic repair, including a disposable kit of Dfl 676. Societal costs, including costs for days of sick leave, were lower for the laparoscopic repair and offset the hospital costs by Dfl 780.83 (75.6%), leaving the laparoscopic repair Dfl 251.50 more expensive (Dfl 4665 versus Dfl 4916.50). At present, the recurrence rate is 2.6% lower after laparoscopic repair. Thus, 38 laparoscopic repairs, costing an additional Dfl 9,557, prevent the occurrence of one recurrent hernia. Quality of life was better after laparoscopic repair. CONCLUSION: A better quality of life in the recovery period and the possibility of replacing parts of the disposable kit with reusable instruments may result in the laparoscopic repair becoming dominantly better--that is, less expensive and more effective from a societal perspective. PMID:9409566

Recent advances in conventional and contemporary methods for remediation of heavy metal-contaminated soils.

PubMed

Sharma, Swati; Tiwari, Sakshi; Hasan, Abshar; Saxena, Varun; Pandey, Lalit M

2018-04-01

Remediation of heavy metal-contaminated soils has been drawing our attention toward it for quite some time now and a need for developing new methods toward reclamation has come up as the need of the hour. Conventional methods of heavy metal-contaminated soil remediation have been in use for decades and have shown great results, but they have their own setbacks. The chemical and physical techniques when used singularly generally generate by-products (toxic sludge or pollutants) and are not cost-effective, while the biological process is very slow and time-consuming. Hence to overcome them, an amalgamation of two or more techniques is being used. In view of the facts, new methods of biosorption, nanoremediation as well as microbial fuel cell techniques have been developed, which utilize the metabolic activities of microorganisms for bioremediation purpose. These are cost-effective and efficient methods of remediation, which are now becoming an integral part of all environmental and bioresource technology. In this contribution, we have highlighted various augmentations in physical, chemical, and biological methods for the remediation of heavy metal-contaminated soils, weighing up their pros and cons. Further, we have discussed the amalgamation of the above techniques such as physiochemical and physiobiological methods with recent literature for the removal of heavy metals from the contaminated soils. These combinations have showed synergetic effects with a many fold increase in removal efficiency of heavy metals along with economic feasibility.

Periodic health examination, 1995 update: 1. Screening for human papillomavirus infection in asymptomatic women. Canadian Task Force on the Periodic Health Examination.

PubMed

Johnson, K

1995-02-15

To develop recommendations for practising physicians on the advisability of screening for human papillomavirus (HPV) infection in asymptomatic women. Visual inspection, Papanicolaou testing, colposcopy or cervicography, use of HPV group-specific antigen, DNA hybridization, dot blot technique, Southern blot technique or polymerase chain reaction followed by physical or chemical therapeutic intervention. Evidence for a link between HPV infection and cervical cancer, sensitivity and specificity of HPV screening techniques, effectiveness of treatments for HPV infection, and the social and economic costs incurred by screening. MEDLINE was searched for articles published between January 1966 to June 1993 with the use of the key words "papillomavirus," "cervix neoplasms," "mass screening," "prospective studies," "prevalence," "sensitivity," "specificity," "human" and "female." Proven cost-effective screening techniques that could lead to decreased morbidity or mortality were given a high value. The evidence-based methods and values of the Canadian Task Force on the Periodic Health Examination were used. Potential benefits are to prevent cervical cancer and eliminate HPV infection. Potential harmful effects include the creation of an unnecessary burden on the health care system and the labelling of otherwise healthy people as patients with a sexually transmitted disease for which therapy is generally ineffective. Potential costs would include expense of testing, increased use of colposcopy and treatment. There is fair evidence to exclude HPV screening (beyond Papanicolaou testing for cervical cancer) in asymptomatic women (grade D recommendation). The report was reviewed by members of the task force and three external reviewers who were selected to represent different areas of expertise. These guidelines were developed and endorsed by the task force, which is funded by Health Canada and the National Health Research and Development Program. The principal author (K.J.) was supported in part by the National Health Research and Development Program through a National Health Fellowship (AIDS).

Twenty-five-gauge vitrectomy versus 23-gauge vitrectomy in the management of macular diseases: a comparative analysis through a Health Technology Assessment model.

PubMed

Grosso, Andrea; Charrier, Lorena; Lovato, Emanuela; Panico, Claudio; Mariotti, Cesare; Dapavo, Giancarlo; Chiuminatto, Roberto; Siliquini, Roberta; Gianino, Maria Michela

2014-04-01

Small-gauge vitreoretinal techniques have been shown to be safe and effective in the management of a wide spectrum of vitreoretinal diseases. However, the costs of the new technologies may represent a critical issue for national health systems. The aim of the study is to plan a Health Technology Assessment (HTA) by performing a comparative analysis between the 23- and 25-gauge techniques in the management of macular diseases (epiretinal membranes, macular holes, vitreo-macular traction syndrome). In this prospective study, 45-80-year-old patients undergoing vitrectomy surgery for macular disease were enrolled at the Torino Eye Hospital. In the HTA model we assessed the safety, clinical effectiveness, and cost and financial evaluation of 23-gauge compared with 25-gauge vitrectomies. Fifty patients entered the study; 14 patients underwent 23-gauge vitrectomy and 36 underwent 25-gauge vitrectomy. There was no statistically significant difference in post-operative visual acuity at 1 year between the two groups. No cases of retinal detachment or endophtalmitis were registered at 1-year follow-up. The 23-gauge technique was slightly more expensive than the 25-gauge: the total surgical costs were EUR1217.70 versus EUR1164.84 (p = 0.351). We provide a financial comparison between new vitreoretinal procedures recently introduced in the market and reimbursed by the Italian National Health System and we also stimulate a critical debate about the expensive technocratic model of medicine.

Robotic surgery in urological oncology: patient care or market share?

PubMed

Kaye, Deborah R; Mullins, Jeffrey K; Carter, H Ballentine; Bivalacqua, Trinity J

2015-01-01

Surgical robotic use has grown exponentially in spite of limited or uncertain benefits and large costs. In certain situations, adoption of robotic technology provides value to patients and society. In other cases, however, the robot provides little or no increase in surgical quality, with increased expense, and, therefore, does not add value to health care. The surgical robot is expensive to purchase, maintain and operate, and can contribute to increased consumerism in relation to surgical procedures, and increased reliance on the technology, thus driving future increases in health-care expenditure. Given the current need for budget constraints, the cost-effectiveness of specific procedures must be evaluated. The surgical robot should be used when cost-effective, but traditional open and laparoscopic techniques also need to be continually fostered.

Custom LSI plus hybrid equals cost effectiveness

NASA Astrophysics Data System (ADS)

Friedman, S. N.

The possibility to combine various technologies, such as Bi-Polar linear and CMOS/Digital makes it feasible to create systems with a tailored performance not available on a single monolithic circuit. The custom LSI 'BLOCK', especially if it is universal in nature, is proving to be a cost effective way for the developer to improve his product. The custom LSI represents a low price part in contrast to the discrete components it will replace. In addition, the hybrid assembly can realize a savings in labor as a result of the reduced parts handling and associated wire bonds. The possibility of the use of automated system manufacturing techniques leads to greater reliability as the human factor is partly eliminated. Attention is given to reliability predictions, cost considerations, and a product comparison study.

Integrated analysis of remote sensing products from basic geological surveys. [Brazil

NASA Technical Reports Server (NTRS)

Dasilvafagundesfilho, E. (Principal Investigator)

1984-01-01

Recent advances in remote sensing led to the development of several techniques to obtain image information. These techniques as effective tools in geological maping are analyzed. A strategy for optimizing the images in basic geological surveying is presented. It embraces as integrated analysis of spatial, spectral, and temporal data through photoptic (color additive viewer) and computer processing at different scales, allowing large areas survey in a fast, precise, and low cost manner.

U.S. Air Force Research Laboratory's Need for Flow Physics and Control With Applications Involving Aero-Optics and Weapon Bay Cavities

NASA Technical Reports Server (NTRS)

Schmit, Ryan

2010-01-01

To develop New Flow Control Techniques: a) Knowledge of the Flow Physics with and without control. b) How does Flow Control Effect Flow Physics (What Works to Optimize the Design?). c) Energy or Work Efficiency of the Control Technique (Cost - Risk - Benefit Analysis). d) Supportability, e.g. (size of equipment, computational power, power supply) (Allows Designer to include Flow Control in Plans).

Screening and Biosensor-Based Approaches for Lung Cancer Detection

PubMed Central

Wang, Lulu

2017-01-01

Early diagnosis of lung cancer helps to reduce the cancer death rate significantly. Over the years, investigators worldwide have extensively investigated many screening modalities for lung cancer detection, including computerized tomography, chest X-ray, positron emission tomography, sputum cytology, magnetic resonance imaging and biopsy. However, these techniques are not suitable for patients with other pathologies. Developing a rapid and sensitive technique for early diagnosis of lung cancer is urgently needed. Biosensor-based techniques have been recently recommended as a rapid and cost-effective tool for early diagnosis of lung tumor markers. This paper reviews the recent development in screening and biosensor-based techniques for early lung cancer detection. PMID:29065541

Varietal discrimination of hop pellets by near and mid infrared spectroscopy.

PubMed

Machado, Julio C; Faria, Miguel A; Ferreira, Isabel M P L V O; Páscoa, Ricardo N M J; Lopes, João A

2018-04-01

Hop is one of the most important ingredients of beer production and several varieties are commercialized. Therefore, it is important to find an eco-real-time-friendly-low-cost technique to distinguish and discriminate hop varieties. This paper describes the development of a method based on vibrational spectroscopy techniques, namely near- and mid-infrared spectroscopy, for the discrimination of 33 commercial hop varieties. A total of 165 samples (five for each hop variety) were analysed by both techniques. Principal component analysis, hierarchical cluster analysis and partial least squares discrimination analysis were the chemometric tools used to discriminate positively the hop varieties. After optimizing the spectral regions and pre-processing methods a total of 94.2% and 96.6% correct hop varieties discrimination were obtained for near- and mid-infrared spectroscopy, respectively. The results obtained demonstrate the suitability of these vibrational spectroscopy techniques to discriminate different hop varieties and consequently their potential to be used as an authenticity tool. Compared with the reference procedures normally used for hops variety discrimination these techniques are quicker, cost-effective, non-destructive and eco-friendly. Copyright © 2017 Elsevier B.V. All rights reserved.

Algal biofuels: challenges and opportunities.

PubMed

Leite, Gustavo B; Abdelaziz, Ahmed E M; Hallenbeck, Patrick C

2013-10-01

Biodiesel production using microalgae is attractive in a number of respects. Here a number of pros and cons to using microalgae for biofuels production are reviewed. Algal cultivation can be carried out using non-arable land and non-potable water with simple nutrient supply. In addition, algal biomass productivities are much higher than those of vascular plants and the extractable content of lipids that can be usefully converted to biodiesel, triacylglycerols (TAGs) can be much higher than that of the oil seeds now used for first generation biodiesel. On the other hand, practical, cost-effective production of biofuels from microalgae requires that a number of obstacles be overcome. These include the development of low-cost, effective growth systems, efficient and energy saving harvesting techniques, and methods for oil extraction and conversion that are environmentally benign and cost-effective. Promising recent advances in these areas are highlighted. Copyright © 2013 Elsevier Ltd. All rights reserved.

Statewide health information: a tool for improving hospital accountability.

PubMed

Epstein, M H; Kurtzig, B S

1994-07-01

By early 1994, 38 states had invested in data collection, analysis, and dissemination on the use, cost, effectiveness, and performance of hospitals. States use these data to control costs, encourage prudent purchasing, monitor effectiveness and outcomes of health care, guide health policy, and promote informed decision making. Experience in several states suggests that public release of hospital-specific data influences hospital performance. The value of state data organizations' databases to address issues of quality and accountability can be strengthened by ensuring the stability and growth of statewide health information systems, supporting research on information dissemination techniques, and promoting comparisons among hospitals. Information to measure provider performance must be placed in the public domain--to help ensure prudent and cost-effective health care purchasing and to give providers comparable information for improvement of care. State-level health databases are an essential component of the information infrastructure needed to support health reform.

Impact of Collection Equipment on Ash Variability of Baled Corn Stover Biomass for Bioenergy

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

William Smith; Jeffery Einerson; Kevin Kenney

2014-09-01

Cost-effective conversion of agricultural residues for renewable energy hinges not only on the material’s quality but also the biorefinery’s ability to reliably measure quality specifications. The ash content of biomass is one such specification, influencing pretreatment and disposal costs for the conversion facility and the overall value of a delivered lot of biomass. The biomass harvest process represents a primary pathway for accumulation of soil-derived ash within baled material. In this work, the influence of five collection techniques on the total ash content and variability of ash content within baled corn stover in southwest Kansas is discussed. The equipment testedmore » included a mower for cutting the corn stover stubble, a basket rake, wheel rake, or shred flail to gather the stover, and a mixed or uniform in-feed baler for final collection. The results showed mean ash content to range from 11.5 to 28.2 % depending on operational choice. Resulting impacts on feedstock costs for a biochemical conversion process range from $5.38 to $22.30 Mg-1 based on the loss of convertible dry matter and ash disposal costs. Collection techniques that minimized soil contact (shred flail or nonmowed stubble) were shown to prevent excessive ash contamination, whereas more aggressive techniques (mowing and use of a wheel rake) caused greater soil disturbance and entrainment within the final baled material. Material sampling and testing were shown to become more difficult as within-bale ash variability increased, creating uncertainty around feedstock quality and the associated costs of ash mitigation.« less

Surgical Approach and Anesthetic Modality for Carpal Tunnel Release: A Nationwide Database Study With Health Care Cost Implications.

PubMed

Foster, Brock D; Sivasundaram, Lakshmanan; Heckmann, Nathanael; Cohen, Jeremiah R; Pannell, William C; Wang, Jeffrey C; Ghiassi, Alidad

2017-03-01

Background: Carpal tunnel release (CTR) is commonly performed for carpal tunnel syndrome once conservative treatment has failed. Operative technique and anesthetic modality vary by surgeon preference and patient factors. However, CTR practices and anesthetic trends have, to date, not been described on a nationwide scale in the United States. Methods: The PearlDiver Patient Records Database was used to search Current Procedural Terminology codes for elective CTR from 2007 to 2011. Anesthetic modality (eg, general and regional anesthesia vs local anesthesia) and surgical approach (eg, endoscopic vs open) were recorded for this patient population. Cost analysis, patient demographics, regional variation, and annual changes in CTR surgery were evaluated. Results: We identified 86 687 patients who underwent carpal tunnel surgery during this 5-year time period. In this patient sample, 80.5% of CTR procedures were performed using general or regional anesthesia, compared with 19.5% of procedures performed using local anesthesia; 83.9% of all CTR were performed in an open fashion, and 16.1% were performed using an endoscopic technique. Endoscopic surgery was on average $794 more expensive than open surgery, and general or regional anesthesia was $654 more costly than local anesthesia. Conclusions: In the United States, open CTR under local anesthesia is the most cost-effective way to perform a CTR. However, only a small fraction of elective CTR procedures are performed with this technique, representing a potential area for significant health care cost savings. In addition, regional and age variations exist in procedure and anesthetic type utilized.

Building firelines with liquid explosive ... some preliminary results

Treesearch

John D. Dell; Franklin R. Ward

1970-01-01

Building firelines in logging slash or dense brush can be costly and hazardous. A new liquid explosive was tested in these and other forest fuel types, It proved effective in brush, understory vegetation, and light-medium slash, but was not effective in deep, heavy slash. Fireline construction by this technique shows promise, but will require more testing and...

Preservation of bovine hide using less salt with low concentration of antiseptic, part I: effectiveness of developed formulations

USDA-ARS?s Scientific Manuscript database

Bovine raw hides are commercially cured either with high salt concentration of about half the weight of actual hide or 95% saturated brine solution. This conventional technique is very popular due to the availability of common salt (sodium chloride) and its cost effective procedure but it generates ...

Costs incurred by applying computer-aided design/computer-aided manufacturing techniques for the reconstruction of maxillofacial defects.

PubMed

Rustemeyer, Jan; Melenberg, Alex; Sari-Rieger, Aynur

2014-12-01

This study aims to evaluate the additional costs incurred by using a computer-aided design/computer-aided manufacturing (CAD/CAM) technique for reconstructing maxillofacial defects by analyzing typical cases. The medical charts of 11 consecutive patients who were subjected to the CAD/CAM technique were considered, and invoices from the companies providing the CAD/CAM devices were reviewed for every case. The number of devices used was significantly correlated with cost (r = 0.880; p < 0.001). Significant differences in mean costs were found between cases in which prebent reconstruction plates were used (€3346.00 ± €29.00) and cases in which they were not (€2534.22 ± €264.48; p < 0.001). Significant differences were also obtained between the costs of two, three and four devices, even when ignoring the cost of reconstruction plates. Additional fees provided by statutory health insurance covered a mean of 171.5% ± 25.6% of the cost of the CAD/CAM devices. Since the additional fees provide financial compensation, we believe that the CAD/CAM technique is suited for wide application and not restricted to complex cases. Where additional fees/funds are not available, the CAD/CAM technique might be unprofitable, so the decision whether or not to use it remains a case-to-case decision with respect to cost versus benefit. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Assessment of hospital processes using a process mining technique: Outpatient process analysis at a tertiary hospital.

PubMed

Yoo, Sooyoung; Cho, Minsu; Kim, Eunhye; Kim, Seok; Sim, Yerim; Yoo, Donghyun; Hwang, Hee; Song, Minseok

2016-04-01

Many hospitals are increasing their efforts to improve processes because processes play an important role in enhancing work efficiency and reducing costs. However, to date, a quantitative tool has not been available to examine the before and after effects of processes and environmental changes, other than the use of indirect indicators, such as mortality rate and readmission rate. This study used process mining technology to analyze process changes based on changes in the hospital environment, such as the construction of a new building, and to measure the effects of environmental changes in terms of consultation wait time, time spent per task, and outpatient care processes. Using process mining technology, electronic health record (EHR) log data of outpatient care before and after constructing a new building were analyzed, and the effectiveness of the technology in terms of the process was evaluated. Using the process mining technique, we found that the total time spent in outpatient care did not increase significantly compared to that before the construction of a new building, considering that the number of outpatients increased, and the consultation wait time decreased. These results suggest that the operation of the outpatient clinic was effective after changes were implemented in the hospital environment. We further identified improvements in processes using the process mining technique, thereby demonstrating the usefulness of this technique for analyzing complex hospital processes at a low cost. This study confirmed the effectiveness of process mining technology at an actual hospital site. In future studies, the use of process mining technology will be expanded by applying this approach to a larger variety of process change situations. Copyright © 2016. Published by Elsevier Ireland Ltd.

High-tech or field techs: Radio-telemetry is a cost-effective method for reducing bias in songbird nest searching

USGS Publications Warehouse

Peterson, Sean M.; Streby, Henry M.; Lehman, Justin A.; Kramer, Gunnar R.; Fish, Alexander C.; Andersen, David E.

2015-01-01

We compared the efficacy of standard nest-searching methods with finding nests via radio-tagged birds to assess how search technique influenced our determination of nest-site characteristics and nest success for Golden-winged Warblers (Vermivora chrysoptera). We also evaluated the cost-effectiveness of using radio-tagged birds to find nests. Using standard nest-searching techniques for 3 populations, we found 111 nests in locations with habitat characteristics similar to those described in previous studies: edges between forest and relatively open areas of early successional vegetation or shrubby wetlands, with 43% within 5 m of forest edge. The 83 nests found using telemetry were about half as likely (23%) to be within 5 m of forest edge. We spent little time searching >25 m into forest because published reports state that Golden-winged Warblers do not nest there. However, 14 nests found using telemetry (18%) were >25 m into forest. We modeled nest success using nest-searching method, nest age, and distance to forest edge as explanatory variables. Nest-searching method explained nest success better than nest age alone; we estimated that nests found using telemetry were 10% more likely to fledge young than nests found using standard nest-searching methods. Although radio-telemetry was more expensive than standard nest searching, the cost-effectiveness of both methods differed depending on searcher experience, amount of equipment owned, and bird population density. Our results demonstrate that telemetry can be an effective method for reducing bias in Golden-winged Warbler nest samples, can be cost competitive with standard nest-searching methods in some situations, and is likely to be a useful approach for finding nests of other forest-nesting songbirds.

The effect of bovine somatotropin on the cost of producing milk: Estimates using propensity scores.

PubMed

Tauer, Loren W

2016-04-01

Annual farm-level data from New York dairy farms from the years 1994 through 2013 were used to estimate the cost effect from bovine somatotropin (bST) using propensity score matching. Cost of production was computed using the whole-farm method, which subtracts sales of crops and animals from total costs under the assumption that the cost of producing those products is equal to their sales values. For a farm to be included in this data set, milk receipts on that farm must have comprised 85% or more of total receipts, indicating that these farms are primarily milk producers. Farm use of bST, where 25% or more of the herd was treated, ranged annually from 25 to 47% of the farms. The average cost effect from the use of bST was estimated to be a reduction of $2.67 per 100 kg of milk produced in 2013 dollars, although annual cost reduction estimates ranged from statistical zero to $3.42 in nominal dollars. Nearest neighbor matching techniques generated a similar estimate of $2.78 in 2013 dollars. These cost reductions estimated from the use of bST represented a cost savings of 5.5% per kilogram of milk produced. Herd-level production increase per cow from the use of bST over 20 yr averaged 1,160 kg. Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Laser-induced forward transfer for flip-chip packaging of single dies.

PubMed

Kaur, Kamal S; Van Steenberge, Geert

2015-03-20

Flip-chip (FC) packaging is a key technology for realizing high performance, ultra-miniaturized and high-density circuits in the micro-electronics industry. In this technique the chip and/or the substrate is bumped and the two are bonded via these conductive bumps. Many bumping techniques have been developed and intensively investigated since the introduction of the FC technology in 1960(1) such as stencil printing, stud bumping, evaporation and electroless/electroplating2. Despite the progress that these methods have made they all suffer from one or more than one drawbacks that need to be addressed such as cost, complex processing steps, high processing temperatures, manufacturing time and most importantly the lack of flexibility. In this paper, we demonstrate a simple and cost-effective laser-based bump forming technique known as Laser-induced Forward Transfer (LIFT)3. Using the LIFT technique a wide range of bump materials can be printed in a single-step with great flexibility, high speed and accuracy at RT. In addition, LIFT enables the bumping and bonding down to chip-scale, which is critical for fabricating ultra-miniature circuitry.

The D-Prime Directive: Assessing Costs and Benefits in Recognition by Dissociating Mixed-List False Alarm Rates

ERIC Educational Resources Information Center

Forrin, Noah D.; Groot, Brianna; MacLeod, Colin M.

2016-01-01

It can be difficult to judge the effectiveness of encoding techniques in a within-subject design. Consider the "production effect"--the finding that words read aloud are better remembered than words read silently. In the absence of a baseline, a within-subject production effect in a mixed study list could reflect a benefit of reading…

Investigation of radio astronomy image processing techniques for use in the passive millimetre-wave security screening environment

NASA Astrophysics Data System (ADS)

Taylor, Christopher T.; Hutchinson, Simon; Salmon, Neil A.; Wilkinson, Peter N.; Cameron, Colin D.

2014-06-01

Image processing techniques can be used to improve the cost-effectiveness of future interferometric Passive MilliMetre Wave (PMMW) imagers. The implementation of such techniques will allow for a reduction in the number of collecting elements whilst ensuring adequate image fidelity is maintained. Various techniques have been developed by the radio astronomy community to enhance the imaging capability of sparse interferometric arrays. The most prominent are Multi- Frequency Synthesis (MFS) and non-linear deconvolution algorithms, such as the Maximum Entropy Method (MEM) and variations of the CLEAN algorithm. This investigation focuses on the implementation of these methods in the defacto standard for radio astronomy image processing, the Common Astronomy Software Applications (CASA) package, building upon the discussion presented in Taylor et al., SPIE 8362-0F. We describe the image conversion process into a CASA suitable format, followed by a series of simulations that exploit the highlighted deconvolution and MFS algorithms assuming far-field imagery. The primary target application used for this investigation is an outdoor security scanner for soft-sided Heavy Goods Vehicles. A quantitative analysis of the effectiveness of the aforementioned image processing techniques is presented, with thoughts on the potential cost-savings such an approach could yield. Consideration is also given to how the implementation of these techniques in CASA might be adapted to operate in a near-field target environment. This may enable a much wider usability by the imaging community outside of radio astronomy and thus would be directly relevant to portal screening security systems in the microwave and millimetre wave bands.

48 CFR 9904.402-50 - Techniques for application.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.402-50 Techniques for application. (a) The Fundamental...

45 CFR 63.6 - Evaluation of applications.

Code of Federal Regulations, 2012 CFR

2012-10-01

... policy objectives; (2) Feasibility of the project; (3) Soundness of research design, statistical... qualifications and experience, including managerial, of personnel; (8) Adequacy of facilities and other resources... demonstrate to other potential users that such methods or techniques are feasible and cost-effective; (3) That...

45 CFR 63.6 - Evaluation of applications.

Code of Federal Regulations, 2014 CFR

2014-10-01

... policy objectives; (2) Feasibility of the project; (3) Soundness of research design, statistical... qualifications and experience, including managerial, of personnel; (8) Adequacy of facilities and other resources... demonstrate to other potential users that such methods or techniques are feasible and cost-effective; (3) That...

45 CFR 63.6 - Evaluation of applications.

Code of Federal Regulations, 2013 CFR

2013-10-01

... policy objectives; (2) Feasibility of the project; (3) Soundness of research design, statistical... qualifications and experience, including managerial, of personnel; (8) Adequacy of facilities and other resources... demonstrate to other potential users that such methods or techniques are feasible and cost-effective; (3) That...

Assessing LiDAR elevation data for KDOT applications : [technical summary].

DOT National Transportation Integrated Search

2013-02-01

LiDAR-based elevation surveys : are a cost-effective means for : mapping topography over large : areas. LiDAR surveys use an : airplane-mounted or ground-based : laser radar unit to scan terrain. : Post-processing techniques are : applied to remove v...

INDOOR RADON REDUCTION IN CRAWL-SPACE HOUSES: A REVIEW OF ALTERNATIVE APPROACHES

EPA Science Inventory

An analysis has been completed of the performance, mechanisms, and costs of alternative technologies for preventing radon entry into the living areas of houses having crawl-space foundations. Sub-membrane depressurization (SMD) is consistently the most effective technique, often ...

Effectiveness of a Low-Cost Drilling Module in Orthopaedic Surgical Simulation.

PubMed

Ruder, John A; Turvey, Blake; Hsu, Joseph R; Scannell, Brian P

Financial pressures and resident work hour regulations have led to adjunct means of resident education such as surgical simulation. The purpose of this study is to determine the effectiveness of a hands-on training session in orthopaedic drilling technique educational model during a surgical simulation on reducing drill plunging depth and to determine the effectiveness of senior residents teaching a hands-on training session in orthopaedic drilling technique. A total of 13 participants (5 orthopaedic interns and 8 medical students) drilled until they penetrated the far cortex of a synthetic bone model and the plunging depth (PD) was measured. They were then randomized and underwent an education session with an attending orthopaedic surgeon or a senior resident. Next, the subjects drilled again with the PD being calculated. The preeducational and posteducational session were compared to determine if there was any improvement in PD and if there was a difference between educators. The cost of the model was also determined. The mean maximum PD and mean PD before the education session was 1.58 (1.40-2.10) and 1.50cm (1.36-1.76), respectively. Following the educational session, the mean maximum PD and mean PD were 0.53 (0.42-0.75) and 0.50cm (0.40-0.72), respectively. These were both significantly lower than before the education session (p <0.05). After the educational session taught by the attending versus the session taught by the resident, the mean maximum PD was 0.59 (0.42-0.75) and 0.49cm. (0.45-0.75), respectively (p = 0.44). After the educational session taught by the attending versus the session taught by the resident, the mean PD was 0.54 (0.40-0.72) and 0.47cm. (0.40-0.65), respectively (p = 0.44). The cost of the station per participant was $5.44. This study demonstrated a significant reduction in drilling PD with use of a low-cost training model and a formal didactic and skills session on proper drilling technique that can effectively be led by senior residents. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Enhanced Condensation Heat Transfer On Patterned Surfaces

NASA Astrophysics Data System (ADS)

Alizadeh-Birjandi, Elaheh; Kavehpour, H. Pirouz

2017-11-01

Transition from film to drop wise condensation can improve the efficiency of thermal management applications and result in considerable savings in investments and operating costs by millions of dollars every year. The current methods available are either hydrophobic coating or nanostructured surfaces. The former has little adhesion to the structure which tends to detach easily under working conditions, the fabrication techniques of the latter are neither cost-effective nor scalable, and both are made with low thermal conductivity materials that would negate the heat transfer enhancement by drop wise condensation. Therefore, the existing technologies have limitations in enhancing vapor-to-liquid condensation. This work focuses on development of surfaces with wettability contrast to boost drop wise condensation, which its overall heat transfer efficiency is 2-3 times film wise condensation, while maintaining high conduction rate through the surface at low manufacturing costs. The variation in interfacial energy is achieved through crafting hydrophobic patterns to the surface of the metal via scalable fabrication techniques. The results of experimental and surface optimization studies are also presented.

Computerized systems analysis and optimization of aircraft engine performance, weight, and life cycle costs

NASA Technical Reports Server (NTRS)

Fishbach, L. H.

1979-01-01

The computational techniques utilized to determine the optimum propulsion systems for future aircraft applications and to identify system tradeoffs and technology requirements are described. The characteristics and use of the following computer codes are discussed: (1) NNEP - a very general cycle analysis code that can assemble an arbitrary matrix fans, turbines, ducts, shafts, etc., into a complete gas turbine engine and compute on- and off-design thermodynamic performance; (2) WATE - a preliminary design procedure for calculating engine weight using the component characteristics determined by NNEP; (3) POD DRG - a table look-up program to calculate wave and friction drag of nacelles; (4) LIFCYC - a computer code developed to calculate life cycle costs of engines based on the output from WATE; and (5) INSTAL - a computer code developed to calculate installation effects, inlet performance and inlet weight. Examples are given to illustrate how these computer techniques can be applied to analyze and optimize propulsion system fuel consumption, weight, and cost for representative types of aircraft and missions.