Reactive power planning under high penetration of wind energy using Benders decomposition

DOE PAGES

Xu, Yan; Wei, Yanli; Fang, Xin; ...

2015-11-05

This study addresses the optimal allocation of reactive power volt-ampere reactive (VAR) sources under the paradigm of high penetration of wind energy. Reactive power planning (RPP) in this particular condition involves a high level of uncertainty because of wind power characteristic. To properly model wind generation uncertainty, a multi-scenario framework optimal power flow that considers the voltage stability constraint under the worst wind scenario and transmission N 1 contingency is developed. The objective of RPP in this study is to minimise the total cost including the VAR investment cost and the expected generation cost. Therefore RPP under this condition ismore » modelled as a two-stage stochastic programming problem to optimise the VAR location and size in one stage, then to minimise the fuel cost in the other stage, and eventually, to find the global optimal RPP results iteratively. Benders decomposition is used to solve this model with an upper level problem (master problem) for VAR allocation optimisation and a lower problem (sub-problem) for generation cost minimisation. Impact of the potential reactive power support from doubly-fed induction generator (DFIG) is also analysed. Lastly, case studies on the IEEE 14-bus and 118-bus systems are provided to verify the proposed method.« less

A process evaluation of the 'Aware' and 'Supportive Communities' gambling harm-minimisation programmes in New Zealand.

PubMed

Kolandai-Matchett, Komathi; Bellringer, Maria; Landon, Jason; Abbott, Max

2018-04-01

The Gambling Act 2003 mandated a public health strategy for preventing and minimising gambling harm in New Zealand. Aware Communities and Supportive Communities are two public health programmes subsequently implemented nationwide. These programmes differed from common health promotion initiatives such as media or education campaigns as they were community-action based (requiring community involvement in programme planning and delivery). We carried out a process evaluation to determine their implementation effectiveness and inform improvement and future programme planning. Our qualitative dominant mixed methods design comprised analysis of over a hundred implementer progress reports (submitted July 2010 - June 2013), a staff survey and a staff focus group interview. The programmes demonstrated capacity to not only achieve expected outcomes (e.g. enhanced community awareness about harmful gambling), but also to enhance social sustainability at the community level (e.g. established trustful relationships) and achieve some programme sustainability (e.g. community ownership over ongoing programme delivery). The evaluation noted the potential for a sustainable gambling harm-minimisation model. Community-action based harm-minimisation programmes offer programme sustainability potential which in turn offers funding cost-effectiveness when there are continual public health outcomes beyond initial funding. Although resource intensive, the community-action based approach enables culturally appropriate public health programmes suitable for societies where specific ethnic groups have higher gambling risk. Recognition of such harm-minimisation programmes' contribution to social sustainability is important considering the potential for broader public health outcomes (e.g. better life quality, lesser social problems) within socially sustainable societies.

Competitive energy consumption under transmission constraints in a multi-supplier power grid system

NASA Astrophysics Data System (ADS)

Popov, Ivan; Krylatov, Alexander; Zakharov, Victor; Ivanov, Dmitry

2017-04-01

Power grid architectures need to be revised in order to manage the increasing number of producers and, more generally, the decentralisation of energy production and distribution. In this work, we describe a multi-supplier multi-consumer congestion model of a power grid, where the costs of consumers depend on the congestion in nodes and arcs of the power supply network. The consumer goal is both to meet their energy demand and to minimise the costs. We show that the methods of non-atomic routing can be applied in this model in order to describe current distribution in the network. We formulate a consumer cost minimisation game for this setting, and discuss the challenges arising in equilibrium search for this game.

Cost-effectiveness of the LABA/LAMA dual bronchodilator indacaterol/glycopyrronium in a Swedish healthcare setting.

PubMed

Price, David; Keininger, Dorothy; Costa-Scharplatz, Madlaina; Mezzi, Karen; Dimova, Maria; Asukai, Yumi; Ställberg, Björn

2014-12-01

Indacaterol/glycopyrronium (IND/GLY) is a once-daily inhaled fixed-dose combination of indacaterol (IND), a long-acting β2-adrenergic agonist (LABA), and glycopyrronium (GLY), a long-acting muscarinic antagonist (LAMA) for use as maintenance treatment to relieve symptoms of chronic obstructive pulmonary disease (COPD) in adults. To determine the economic benefits of IND/GLY compared with the free combination of indacaterol and glycopyrronium (IND + GLY), and with the fixed-dose combination of salmeterol/fluticasone (SFC), in a moderate-to-severe COPD population with low-exacerbation risk. The model-based analysis extrapolated results up to lifetime time horizon and calculated costs per quality-adjusted life year. Assuming equal efficacy, a cost-minimisation analysis compared IND/GLY vs IND + GLY using model inputs from the double-blind, randomised SHINE trial. The double-blind, randomised ILLUMINATE and TORCH trials were used to analyse cost-effectiveness versus SFC. To consider ICS-related pneumonia events, published odds ratio comparing an ICS-exposed group to a control group of COPD patients was used. Direct and indirect drug costs as well as drug acquisition costs (in Swedish Krona [SEK]) were derived from published Swedish sources. Cost and effects were discounted with 3%. Uncertainty was assessed by one-way and probabilistic sensitivity analyses (PSA). IND/GLY was cost-saving vs IND + GLY with incremental savings of SEK (EUR) 768 (85), and 3309 (368) per patient over one and five years. IND/GLY was found to be less costly and more effective compared to SFC with cost savings of SEK (EUR) 2744 (303), 8854 (976), 13,938 (1536), 27,495 (3031) and 43,033 (4744) over one, three, five, ten years and lifetime. The PSA indicated that all iterations produced dominant results for IND/GLY. IND/GLY is cost-minimising vs IND + GLY and dominates SFC in the maintenance treatment of COPD patients in Sweden. Encouraging dual bronchodilator therapy over an ICS-containing combination results in lower total costs and better outcomes compared to combination therapy including fluticasone in moderate-to-severe COPD patients with low exacerbation risk. Copyright © 2014 Elsevier Ltd. All rights reserved.

Cost accounting methodologies in price setting of acute inpatient services in Hungary.

PubMed

Gaal, Peter; Stefka, Nóra; Nagy, Júlia

2006-08-01

On the basis of documentary analysis and interviews with decision makers, this paper discusses the cost accounting methodologies used for price setting of inpatient services in the Hungarian health care system focusing on sector of acute inpatient care, which is financed through the Hungarian adaptation of Diagnosis Related Groups since 1993. Hungary has a quite sophisticated DRG system, which had a deep impact on the efficiency of the acute inpatient care sector. Nevertheless, the system requires continuous maintenance, where the cooperation of hospitals, as well as the minimisation of political influence are critical success factors.

Economic evaluation of nasogastric versus intravenous hydration in infants with bronchiolitis.

PubMed

Oakley, Ed; Carter, Rob; Murphy, Bridie; Borland, Meredith; Neutze, Jocelyn; Acworth, Jason; Krieser, David; Dalziel, Stuart; Davidson, Andrew; Donath, Susan; Jachno, Kim; South, Mike; Babl, Franz E

2017-06-01

Bronchiolitis is the most common lower respiratory tract infection in infants and the leading cause of hospitalisation. We aimed to assess whether intravenous hydration (IVH) was more cost-effective than nasogastric hydration (NGH) as a planned secondary economic analysis of a randomised trial involving 759 infants (aged 2-12 months) admitted to hospital with a clinical diagnosis of bronchiolitis and requiring non-oral hydration. No Australian cost data exist to aid clinicians in decision-making around interventions in bronchiolitis. Cost data collections included hospital and intervention-specific costs. The economic analysis was reduced to a cost-minimisation study, focusing on intervention-specific costs of IVH versus NGH, as length of stay was equal between groups. All analyses are reported as intention to treat. Intervention costs were greater for IVH than NGH ($113 vs $74; cost difference of $39 per child). The intervention-specific cost advantage to NGH was robust to inter-site variation in unit prices and treatment activity. Intervention-specific costs account for <10% of total costs of bronchiolitis admissions, with NGH having a small cost saving across all sites. © 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

A cost minimisation and Bayesian inference model predicts startle reflex modulation across species.

PubMed

Bach, Dominik R

2015-04-07

In many species, rapid defensive reflexes are paramount to escaping acute danger. These reflexes are modulated by the state of the environment. This is exemplified in fear-potentiated startle, a more vigorous startle response during conditioned anticipation of an unrelated threatening event. Extant explanations of this phenomenon build on descriptive models of underlying psychological states, or neural processes. Yet, they fail to predict invigorated startle during reward anticipation and instructed attention, and do not explain why startle reflex modulation evolved. Here, we fill this lacuna by developing a normative cost minimisation model based on Bayesian optimality principles. This model predicts the observed pattern of startle modification by rewards, punishments, instructed attention, and several other states. Moreover, the mathematical formalism furnishes predictions that can be tested experimentally. Comparing the model with existing data suggests a specific neural implementation of the underlying computations which yields close approximations to the optimal solution under most circumstances. This analysis puts startle modification into the framework of Bayesian decision theory and predictive coding, and illustrates the importance of an adaptive perspective to interpret defensive behaviour across species. Copyright © 2015 The Author. Published by Elsevier Ltd.. All rights reserved.

Health economic evaluations comparing insulin glargine with NPH insulin in patients with type 1 diabetes: a systematic review

PubMed Central

2011-01-01

Background Compared to conventional human basal insulin (neutral protamine Hagedorn; NPH) the long-acting analogue insulin glargine (GLA) is associated with a number of advantages regarding metabolic control, hypoglycaemic events and convenience. However, the unit costs of GLA exceed those of NPH. This study aims to systematically review the economic evidence comparing GLA with NPH in basal-bolus treatment (intensified conventional therapy; ICT) of type 1 diabetes in order to facilitate informed decision making in clinical practice and health policy. Methods A systematic literature search was performed for the period of January 1st 2000 to December 1st 2009 via Embase, Medline, the Cochrane Library, the databases GMS (German Medical Science) and DAHTA (Deutsche Agentur für Health Technology Assessment), and the abstract books of relevant international scientific congresses. Retrieved studies were reviewed based on predefined inclusion criteria, methodological and quality aspects. In order to allow comparison between studies, currencies were converted using purchasing power parities (PPP). Results A total of 7 health economic evaluations from 4 different countries fulfilled the predefined criteria: 6 modelling studies, all of them cost-utility analyses, and one claims data analysis with a cost-minimisation design. One cost-utility analysis showed dominance of GLA over NPH. The other 5 cost-utility analyses resulted in additional costs per quality adjusted life year (QALY) gained for GLA, ranging from € 3,859 to € 57,002 (incremental cost effectiveness ratio; ICER). The cost-minimisation analysis revealed lower annual diabetes-specific costs in favour of NPH from the perspective of the German Statutory Health Insurance (SHI). Conclusions The incremental cost-utility-ratios (ICER) show favourable values for GLA with considerable variation. If a willingness-to-pay threshold of £ 30,000 (National Institute of Clinical Excellence, UK) is adopted, GLA is cost-effective in 4 of 6 cost utility analyses (CUA) included. Thus insulin glargine (GLA) seems to offer good value for money. Comparability between studies is limited because of methodological and country specific aspects. The results of this review underline that evaluation of insulin therapy should use evidence on efficacy of therapy from information synthesis. The concept of relating utility decrements to fear of hypoglycaemia is a plausible approach but needs further investigation. Also future evaluations of basal-bolus insulin therapy should include costs of consumables such as needles for insulin injection as well as test strips and lancets for blood glucose self monitoring. PMID:21978524

Minimisation of costs by using disintegration at a full-scale anaerobic digestion plant.

PubMed

Winter, A

2002-01-01

Various half-scale and lab-scale investigations have already shown that the disintegration of excess sludge is a possible pre-treatment to optimise anaerobic digestion. To control these results different methods of disintegration were investigated at a full-scale plant. Two stirred ball mills and a plant for oxidation with ozone were applied. A positive influence of disintegration on the anaerobic biodegradability can be established with application of a stirred ball mill. Biogas production as well as the degree of degradation were increased by about 20%. Laboratory investigations also validate that disintegration increases the polymer demand and leads to a lower solid content after dewatering. A higher pollution level of process water after dewatering even with ammonia and COD corroborates the results of the anaerobic degradation. Capital costs for the stirred ball mill, costs for energy, manpower and maintenance can be covered if the specific costs for disposal are high. If the development of costs in future and the current discussion about sludge disposal are taken into account sewage sludge disintegration can be a suitable technique to minimise costs at waste water treatment plants.

[Cost analysis of patient blood management].

PubMed

Kleinerüschkamp, A G; Zacharowski, K; Ettwein, C; Müller, M M; Geisen, C; Weber, C F; Meybohm, P

2016-06-01

Patient blood management (PBM) is a multidisciplinary approach focusing on the diagnosis and treatment of preoperative anaemia, the minimisation of blood loss, and the optimisation of the patient-specific anaemia reserve to improve clinical outcomes. Economic aspects of PBM have not yet been sufficiently analysed. The aim of this study is to analyse the costs associated with the clinical principles of PBM and the project costs associated with the implementation of a PBM program from an institutional perspective. Patient-related costs of materials and services were analysed at the University Hospital Frankfurt for 2013. Personnel costs of all major processes were quantified based on the time required to perform each step. Furthermore, general project costs of the implementation phase were determined. Direct costs of transfusing a single unit of red blood cells can be calculated to a minimum of €147.43. PBM-associated costs varied depending on individual patient requirements. The following costs per patient were calculated: diagnosis of preoperative anaemia €48.69-123.88; treatment of preoperative anaemia (including iron-deficiency anaemia and megaloblastic anaemia) €12.61-127.99; minimising perioperative blood loss (including point-of-care diagnostics, coagulation management and cell salvage) €3.39-1,901.81; and costs associated with the optimisation of the tolerance to anaemia (including patient monitoring and volume therapy) €28.62. General project costs associated with the implementation of PBM were €24,998.24. PBM combines various alternatives to the transfusion of red blood cells and improves clinical outcome. Costs of PBM vary from institution to institution and depend on the extent to which different aspects of PBM have been implemented. The quantification of costs associated with PBM is essential in order to assess the economic impact of PBM, and thereby, to efficiently re-allocate health care resources. Costs were determined at a single university hospital. Thus, further analyses of both the costs of transfusion and the costs of PBM-principles will be necessary to evaluate the cost-effectiveness of PBM.

Multi-objective ACO algorithms to minimise the makespan and the total rejection cost on BPMs with arbitrary job weights

NASA Astrophysics Data System (ADS)

Jia, Zhao-hong; Pei, Ming-li; Leung, Joseph Y.-T.

2017-12-01

In this paper, we investigate the batch-scheduling problem with rejection on parallel machines with non-identical job sizes and arbitrary job-rejected weights. If a job is rejected, the corresponding penalty has to be paid. Our objective is to minimise the makespan of the processed jobs and the total rejection cost of the rejected jobs. Based on the selected multi-objective optimisation approaches, two problems, P1 and P2, are considered. In P1, the two objectives are linearly combined into one single objective. In P2, the two objectives are simultaneously minimised and the Pareto non-dominated solution set is to be found. Based on the ant colony optimisation (ACO), two algorithms, called LACO and PACO, are proposed to address the two problems, respectively. Two different objective-oriented pheromone matrices and heuristic information are designed. Additionally, a local optimisation algorithm is adopted to improve the solution quality. Finally, simulated experiments are conducted, and the comparative results verify the effectiveness and efficiency of the proposed algorithms, especially on large-scale instances.

An optimal policy for a single-vendor and a single-buyer integrated system with setup cost reduction and process-quality improvement

NASA Astrophysics Data System (ADS)

Shu, Hui; Zhou, Xideng

2014-05-01

The single-vendor single-buyer integrated production inventory system has been an object of study for a long time, but little is known about the effect of investing in reducing setup cost reduction and process-quality improvement for an integrated inventory system in which the products are sold with free minimal repair warranty. The purpose of this article is to minimise the integrated cost by optimising simultaneously the number of shipments and the shipment quantity, the setup cost, and the process quality. An efficient algorithm procedure is proposed for determining the optimal decision variables. A numerical example is presented to illustrate the results of the proposed models graphically. Sensitivity analysis of the model with respect to key parameters of the system is carried out. The paper shows that the proposed integrated model can result in significant savings in the integrated cost.

Cost-minimisation analysis of subcutaneous methotrexate versus biologic therapy for the treatment of patients with rheumatoid arthritis who have had an insufficient response or intolerance to oral methotrexate.

PubMed

Fitzpatrick, Ray; Scott, David Gi; Keary, Ian

2013-11-01

This study aims to model the economic impact of subcutaneous methotrexate (SC MTX) or a biologic over a 12-month period using a hypothetical population of rheumatoid arthritis patients who failed to tolerate or respond to oral MTX and were suitable candidates for biologic therapy. A decision-based model was developed using current National Institute for Health and Clinical Excellence (NICE) guidance to determine the management of this hypothetical UK population. Published data on the continuation rates of SC MTX and biologics were used to compare the costs of the two treatment options. The economic model used a cost-minimisation methodology from a UK National Health Service (NHS) perspective, with the cost of all drugs and resources being estimated on this basis. Sensitivity analyses were also performed to determine the effects of changing key assumptions on the mean cost differences. The routine use of SC MTX following oral MTX failure has the potential to save an estimated £7,197 per patient in the first year of therapy and £9.3m per year nationally in new patients. Sensitivity analyses support the robustness of the results. The results of this study suggest that routine use of SC MTX following oral MTX failure has the potential to provide considerable savings to the NHS through optimised use of MTX first-line therapy. It is proposed, therefore, that patients should start on oral MTX with a subsequent switch to SC MTX in the case of an insufficient response or tolerability issues, before introducing a biologic agent.

High-fidelity phase and amplitude control of phase-only computer generated holograms using conjugate gradient minimisation.

PubMed

Bowman, D; Harte, T L; Chardonnet, V; De Groot, C; Denny, S J; Le Goc, G; Anderson, M; Ireland, P; Cassettari, D; Bruce, G D

2017-05-15

We demonstrate simultaneous control of both the phase and amplitude of light using a conjugate gradient minimisation-based hologram calculation technique and a single phase-only spatial light modulator (SLM). A cost function, which incorporates the inner product of the light field with a chosen target field within a defined measure region, is efficiently minimised to create high fidelity patterns in the Fourier plane of the SLM. A fidelity of F = 0.999997 is achieved for a pattern resembling an LG10 mode with a calculated light-usage efficiency of 41.5%. Possible applications of our method in optical trapping and ultracold atoms are presented and we show uncorrected experimental realisation of our patterns with F = 0.97 and 7.8% light efficiency.

The commercial performance of cellulosic ethanol supply-chains in Europe

PubMed Central

Slade, Raphael; Bauen, Ausilio; Shah, Nilay

2009-01-01

Background The production of fuel-grade ethanol from lignocellulosic biomass resources has the potential to increase biofuel production capacity whilst minimising the negative environmental impacts. These benefits will only be realised if lignocellulosic ethanol production can compete on price with conventional fossil fuels and if it can be produced commercially at scale. This paper focuses on lignocellulosic ethanol production in Europe. The hypothesis is that the eventual cost of production will be determined not only by the performance of the conversion process but by the performance of the entire supply-chain from feedstock production to consumption. To test this, a model for supply-chain cost comparison is developed, the components of representative ethanol supply-chains are described, the factors that are most important in determining the cost and profitability of ethanol production are identified, and a detailed sensitivity analysis is conducted. Results The most important cost determinants are the cost of feedstocks, primarily determined by location and existing markets, and the value obtained for ethanol, primarily determined by the oil price and policy incentives. Both of these factors are highly uncertain. The best performing chains (ethanol produced from softwood and sold as a low percentage blend with gasoline) could ultimately be cost competitive with gasoline without requiring subsidy, but production from straw would generally be less competitive. Conclusion Supply-chain design will play a critical role in determining commercial viability. The importance of feedstock supply highlights the need for location-specific assessments of feedstock availability and price. Similarly, the role of subsidies and policy incentives in creating and sustaining the ethanol market highlights the importance of political engagement and the need to include political risks in investment appraisal. For the supply-chains described here, and with the cost and market parameters selected, selling ethanol as a low percentage blend with gasoline will maximise ethanol revenues and minimise the need for subsidies. It follows, therefore, that the market for low percentage blends should be saturated before markets for high percentage blends. PMID:19192294

Cost minimisation analysis of using acellular dermal matrix (Strattice™) for breast reconstruction compared with standard techniques.

PubMed

Johnson, R K; Wright, C K; Gandhi, A; Charny, M C; Barr, L

2013-03-01

We performed a cost analysis (using UK 2011/12 NHS tariffs as a proxy for cost) comparing immediate breast reconstruction using the new one-stage technique of acellular dermal matrix (Strattice™) with implant versus the standard alternative techniques of tissue expander (TE)/implant as a two-stage procedure and latissimus dorsi (LD) flap reconstruction. Clinical report data were collected for operative time, length of stay, outpatient procedures, and number of elective and emergency admissions in our first consecutive 24 patients undergoing one-stage Strattice reconstruction. Total cost to the NHS based on tariff, assuming top-up payments to cover Strattice acquisition costs, was assessed and compared to the two historical control groups matched on key variables. Eleven patients having unilateral Strattice reconstruction were compared to 10 having TE/implant reconstruction and 10 having LD flap and implant reconstruction. Thirteen patients having bilateral Strattice reconstruction were compared to 12 having bilateral TE/implant reconstruction. Total costs were: unilateral Strattice, £3685; unilateral TE, £4985; unilateral LD and implant, £6321; bilateral TE, £5478; and bilateral Strattice, £6771. The cost analysis shows a financial advantage of using acellular dermal matrix (Strattice) in unilateral breast reconstruction versus alternative procedures. The reimbursement system in England (Payment by Results) is based on disease-related groups similar to that of many countries across Europe and tariffs are based on reported hospital costs, making this analysis of relevance in other countries. Copyright © 2013 Elsevier Ltd. All rights reserved.

What Are the Real Procedural Costs of Bariatric Surgery? A Systematic Literature Review of Published Cost Analyses.

PubMed

Doble, Brett; Wordsworth, Sarah; Rogers, Chris A; Welbourn, Richard; Byrne, James; Blazeby, Jane M

2017-08-01

This review aims to evaluate the current literature on the procedural costs of bariatric surgery for the treatment of severe obesity. Using a published framework for the conduct of micro-costing studies for surgical interventions, existing cost estimates from the literature are assessed for their accuracy, reliability and comprehensiveness based on their consideration of seven 'important' cost components. MEDLINE, PubMed, key journals and reference lists of included studies were searched up to January 2017. Eligible studies had to report per-case, total procedural costs for any type of bariatric surgery broken down into two or more individual cost components. A total of 998 citations were screened, of which 13 studies were included for analysis. Included studies were mainly conducted from a US hospital perspective, assessed either gastric bypass or adjustable gastric banding procedures and considered a range of different cost components. The mean total procedural costs for all included studies was US$14,389 (range, US$7423 to US$33,541). No study considered all of the recommended 'important' cost components and estimation methods were poorly reported. The accuracy, reliability and comprehensiveness of the existing cost estimates are, therefore, questionable. There is a need for a comparative cost analysis of the different approaches to bariatric surgery, with the most appropriate costing approach identified to be micro-costing methods. Such an analysis will not only be useful in estimating the relative cost-effectiveness of different surgeries but will also ensure appropriate reimbursement and budgeting by healthcare payers to ensure barriers to access this effective treatment by severely obese patients are minimised.

Attitudes and behaviour towards construction waste minimisation: a comparative analysis between China and the USA.

PubMed

Liu, Jingkuang; Gong, Enqin; Wang, Dong; Lai, XiaoHong; Zhu, Jian

2018-05-21

With the spread of the concept of sustainable development, people have gained awareness about the problem of massive illegal dumping of construction waste. In this research, a questionnaire survey was carried out in the USA and China. The results indicated the following. (1) Workers in both the countries had positive minimisation attitudes, and the attitude of Chinese construction workers was not significantly different from that of American construction workers. Furthermore, their average values were 3.9 and 4.07, respectively. (2) Business owners had a poor understanding of the obligations that should be fulfilled by contractors and construction workers, which greatly reduced (a) construction workers' and contractors' motivation to implement waste minimisation management and (b) the benefit-driven effect. (3) In terms of perceived behavioural control, Chinese construction workers had poorer minimisation technologies and knowledge than American construction workers, and it was very difficult for them to implement construction waste minimisation. The research conclusions and relevant suggestions may be used to improve the construction waste minimisation behaviour and awareness of Chinese people and promote China's construction waste minimisation management.

Minimisation of Signal Intensity Differences in Distortion Correction Approaches of Brain Magnetic Resonance Diffusion Tensor Imaging.

PubMed

Lee, Dong-Hoon; Lee, Do-Wan; Henry, David; Park, Hae-Jin; Han, Bong-Soo; Woo, Dong-Cheol

2018-04-12

To evaluate the effects of signal intensity differences between the b0 image and diffusion tensor imaging (DTI) in the image registration process. To correct signal intensity differences between the b0 image and DTI data, a simple image intensity compensation (SIMIC) method, which is a b0 image re-calculation process from DTI data, was applied before the image registration. The re-calculated b0 image (b0 ext ) from each diffusion direction was registered to the b0 image acquired through the MR scanning (b0 nd ) with two types of cost functions and their transformation matrices were acquired. These transformation matrices were then used to register the DTI data. For quantifications, the dice similarity coefficient (DSC) values, diffusion scalar matrix, and quantified fibre numbers and lengths were calculated. The combined SIMIC method with two cost functions showed the highest DSC value (0.802 ± 0.007). Regarding diffusion scalar values and numbers and lengths of fibres from the corpus callosum, superior longitudinal fasciculus, and cortico-spinal tract, only using normalised cross correlation (NCC) showed a specific tendency toward lower values in the brain regions. Image-based distortion correction with SIMIC for DTI data would help in image analysis by accounting for signal intensity differences as one additional option for DTI analysis. • We evaluated the effects of signal intensity differences at DTI registration. • The non-diffusion-weighted image re-calculation process from DTI data was applied. • SIMIC can minimise the signal intensity differences at DTI registration.

Disease and disaster: Optimal deployment of epidemic control facilities in a spatially heterogeneous population with changing behaviour.

PubMed

Gaythorpe, Katy; Adams, Ben

2016-05-21

Epidemics of water-borne infections often follow natural disasters and extreme weather events that disrupt water management processes. The impact of such epidemics may be reduced by deployment of transmission control facilities such as clinics or decontamination plants. Here we use a relatively simple mathematical model to examine how demographic and environmental heterogeneities, population behaviour, and behavioural change in response to the provision of facilities, combine to determine the optimal configurations of limited numbers of facilities to reduce epidemic size, and endemic prevalence. We show that, if the presence of control facilities does not affect behaviour, a good general rule for responsive deployment to minimise epidemic size is to place them in exactly the locations where they will directly benefit the most people. However, if infected people change their behaviour to seek out treatment then the deployment of facilities offering treatment can lead to complex effects that are difficult to foresee. So careful mathematical analysis is the only way to get a handle on the optimal deployment. Behavioural changes in response to control facilities can also lead to critical facility numbers at which there is a radical change in the optimal configuration. So sequential improvement of a control strategy by adding facilities to an existing optimal configuration does not always produce another optimal configuration. We also show that the pre-emptive deployment of control facilities has conflicting effects. The configurations that minimise endemic prevalence are very different to those that minimise epidemic size. So cost-benefit analysis of strategies to manage endemic prevalence must factor in the frequency of extreme weather events and natural disasters. Copyright © 2016 Elsevier Ltd. All rights reserved.

Economic Evaluation of Hospital and Community Pharmacy Services.

PubMed

Gammie, Todd; Vogler, Sabine; Babar, Zaheer-Ud-Din

2017-01-01

To review the international body of literature from 2010 to 2015 concerning methods of economic evaluations used in hospital- and community-based studies of pharmacy services in publicly funded health systems worldwide, their clinical outcomes, and economic effectiveness. The literature search was undertaken between May 2, 2015, and September 4, 2015. Keywords included "health economics" and "evaluation" "assessment" or "appraisal," "methods," "hospital" or "community" or "residential care," "pharmacy" or "pharmacy services" and "cost minimisation analysis" or "cost utility analysis" or "cost effectiveness analysis" or "cost benefit analysis." The databases searched included MEDLINE, PubMed, Google Scholar, Science Direct, Springer Links, and Scopus, and journals searched included PLoS One, PLoS Medicine, Nature, Health Policy, Pharmacoeconomics, The European Journal of Health Economics, Expert Review of Pharmacoeconomics and Outcomes Research, and Journal of Health Economics. Studies were selected on the basis of study inclusion criteria. These criteria included full-text original research articles undertaking an economic evaluation of hospital- or community-based pharmacy services in peer-reviewed scientific journals and in English, in countries with a publicly funded health system published between 2010 and 2015. 14 articles were included in this review. Cost-utility analysis (CUA) was the most utilized measure. Cost-minimization analysis (CMA) was not used by any studies. The limited use of cost-benefit analyses (CBAs) is likely a result of technical challenges in quantifying the cost of clinical benefits, risks, and outcomes. Hospital pharmacy services provided clinical benefits including improvements in patient health outcomes and reductions in adverse medication use, and all studies were considered cost-effective due to meeting a cost-utility (per quality-adjusted life year) threshold or were cost saving. Community pharmacy services were considered cost-effective in 8 of 10 studies. Economic evaluations of hospital and community pharmacy services are becoming increasingly commonplace to enable an understanding of which health care services provide value for money and to inform policy makers as to which services will be cost-effective in light of limited health care resources.

Minimising Backbreak at the Dewan Cement Limestone Quarry Using an Artificial Neural Network

NASA Astrophysics Data System (ADS)

Muhammad, Khan; Shah, Akram

2017-12-01

Backbreak, defined as excessive breakage behind the last row of blastholes in blasting operations at a quarry, causes destabilisation of rock slopes, improper fragmentation, minimises drilling efficiency. In this paper an artificial neural network (ANN) is applied to predict backbreak, using 12 input parameters representing various controllable factors, such as the characteristics of explosives and geometrical blast design, at the Dewan Cement limestone quarry in Hattar, Pakistan. This ANN was trained with several model architectures. The 12-2-1 ANN model was selected as the simplest model yielding the best result, with a reported correlation coefficient of 0.98 and 0.97 in the training and validation phases, respectively. Sensitivity analysis of the model suggested that backbreak can be reduced most effectively by reducing powder factor, blasthole inclination, and burden. Field tests were subsequently carried out in which these sensitive parameters were varied accordingly; as a result, backbreak was controlled and reduced from 8 m to less than a metre. The resulting reduction in powder factor (kg of explosives used per m3 of blasted material) also reduced blasting costs.

Towards a methodology to formulate sustainable diets for livestock: accounting for environmental impact in diet formulation.

PubMed

Mackenzie, S G; Leinonen, I; Ferguson, N; Kyriazakis, I

2016-05-28

The objective of this study was to develop a novel methodology that enables pig diets to be formulated explicitly for environmental impact objectives using a Life Cycle Assessment (LCA) approach. To achieve this, the following methodological issues had to be addressed: (1) account for environmental impacts caused by both ingredient choice and nutrient excretion, (2) formulate diets for multiple environmental impact objectives and (3) allow flexibility to identify the optimal nutritional composition for each environmental impact objective. An LCA model based on Canadian pig farms was integrated into a diet formulation tool to compare the use of different ingredients in Eastern and Western Canada. By allowing the feed energy content to vary, it was possible to identify the optimum energy density for different environmental impact objectives, while accounting for the expected effect of energy density on feed intake. A least-cost diet was compared with diets formulated to minimise the following objectives: non-renewable resource use, acidification potential, eutrophication potential, global warming potential and a combined environmental impact score (using these four categories). The resulting environmental impacts were compared using parallel Monte Carlo simulations to account for shared uncertainty. When optimising diets to minimise a single environmental impact category, reductions in the said category were observed in all cases. However, this was at the expense of increasing the impact in other categories and higher dietary costs. The methodology can identify nutritional strategies to minimise environmental impacts, such as increasing the nutritional density of the diets, compared with the least-cost formulation.

Stroke rehabilitation services to accelerate hospital discharge and provide home-based care: an overview and cost analysis.

PubMed

Anderson, Craig; Ni Mhurchu, Cliona; Brown, Paul M; Carter, Kristie

2002-01-01

Limited information exists on the best way to organise stroke rehabilitation after hospital discharge and the relative costs of such services. To review the evidence of the cost effectiveness of services that accelerate hospital discharge and provide home-based rehabilitation for patients with acute stroke. A systematic review with economic analysis of published randomised clinical trials (available to March 2001) comparing early hospital discharge and domiciliary rehabilitation with usual care in patients with stroke was conducted. From included studies, data were extracted on study quality; major clinical outcomes including hospital stay, death, institutionalisation, disability, and readmission rates; and resource use associated with hospital stay, rehabilitation, and community services. The resources were priced using Australian dollars ($A) healthcare costs. The outcomes and costs of the new intervention were compared with standard care. Seven published trials involving 1277 patients (54% men; mean age 73 years) were identified. The pooled data showed that overall, a policy of early hospital discharge and domiciliary rehabilitation reduced total length of stay by 13 days [95% confidence interval (CI): -19 to -7 days]. There was no significant effect on mortality (odds ratio = 0.95; 95% CI: 0.65 to 1.38) or other clinical outcomes making a cost minimisation analysis for the economic analysis appropriate. The overall mean costs were approximately 15% lower for the early discharge intervention [$A16 016 ($US9941) versus $A18 350] ($US11 390)] compared with standard care. A policy of early hospital discharge and home-based rehabilitation for patients with stroke may reduce the use of hospital beds without compromising clinical outcomes. Our analysis shows this service to be a cost saving alternative to conventional in-hospital stroke rehabilitation for an important subgroup of patients with stroke-related disability.

A cost-minimisation study of 1,001 NHS Direct users

PubMed Central

2013-01-01

Background To determine financial and quality of life impact of patients calling the ‘0845’ NHS Direct (NHS Direct) telephone helpline from the perspective of NHS service providers. Methods Cost-minimisation of repeated cohort measures from a National Survey of NHS Direct’s telephone service using telephone survey results. 1,001 people contacting NHS Direct’s 0845 telephone service in 2009 who agreed to a 4-6 week follow-up. A cost comparison between NHS Direct recommendation and patient-stated first alternative had NHS Direct not been available. Analysis also considers impact on quality of life of NHS Direct recommendations using the Visual Analogue Scale of the EQ-5D. Results Significant referral pattern differences were observed between NHS Direct recommendation and patient-stated first alternatives (p < 0.001). Per patient cost savings resulted from NHS Direct’s recommendation to attend A&E (£36.54); GP Practice (£19.41); Walk-In Centre (£49.85); Pharmacist (£25.80); Dentist (£2.35) and do nothing/treat at home (£19.77), while it was marginally more costly for 999 calls (£3.33). Overall an average per patient saving of £19.55 was found (a 36% saving compared with patient-stated first alternatives). For 5 million NHS Direct telephone calls per year, this represents an annual cost saving of £97,756,013. Significant quality of life differences were observed at baseline and follow-up between those who believed their problem was ‘urgent’ (p = 0.001) and those who said it was ‘non-urgent’ (p = 0.045). Whilst both groups improved, self-classified ‘urgent’ cases made greater health gains than those who said they were ‘non-urgent’ (urgent by 21.5 points; non-urgent by 16.1 points). Conclusions The ‘0845’ service of NHS Direct produced substantial cost savings in terms of referrals to the other parts of the NHS when compared with patients’ own stated first alternative. Health-related quality of life also improved for users of this service demonstrating that these savings can be produced without perceived harm to patients. PMID:23927451

A cost-minimisation study of 1,001 NHS Direct users.

PubMed

Lambert, Rod; Fordham, Richard; Large, Shirley; Gaffney, Brian

2013-08-08

To determine financial and quality of life impact of patients calling the '0845' NHS Direct (NHS Direct) telephone helpline from the perspective of NHS service providers. Cost-minimisation of repeated cohort measures from a National Survey of NHS Direct's telephone service using telephone survey results. 1,001 people contacting NHS Direct's 0845 telephone service in 2009 who agreed to a 4-6 week follow-up. A cost comparison between NHS Direct recommendation and patient-stated first alternative had NHS Direct not been available. Analysis also considers impact on quality of life of NHS Direct recommendations using the Visual Analogue Scale of the EQ-5D. Significant referral pattern differences were observed between NHS Direct recommendation and patient-stated first alternatives (p < 0.001). Per patient cost savings resulted from NHS Direct's recommendation to attend A&E (£36.54); GP Practice (£19.41); Walk-In Centre (£49.85); Pharmacist (£25.80); Dentist (£2.35) and do nothing/treat at home (£19.77), while it was marginally more costly for 999 calls (£3.33). Overall an average per patient saving of £19.55 was found (a 36% saving compared with patient-stated first alternatives). For 5 million NHS Direct telephone calls per year, this represents an annual cost saving of £97,756,013. Significant quality of life differences were observed at baseline and follow-up between those who believed their problem was 'urgent' (p = 0.001) and those who said it was 'non-urgent' (p = 0.045). Whilst both groups improved, self-classified 'urgent' cases made greater health gains than those who said they were 'non-urgent' (urgent by 21.5 points; non-urgent by 16.1 points). The '0845' service of NHS Direct produced substantial cost savings in terms of referrals to the other parts of the NHS when compared with patients' own stated first alternative. Health-related quality of life also improved for users of this service demonstrating that these savings can be produced without perceived harm to patients.

Economic evaluation of different screening alternatives for patients with clinically suspected acute deep vein thrombosis.

PubMed

Bogavac-Stanojević, Natasa; Dopsaj, Violeta; Jelić-Ivanović, Zorana; Lakić, Dragana; Vasić, Dragan; Petrova, Guenka

2013-01-01

We examined the cost-effectiveness of the three different D-dimer measurements in the screening of DVT in models with and without calculation of pre-test probability (PTP) score. Moreover, we calculated the minimal cost in DVT detection. In the group of 192 patients with clinically suspected acute DVT, we examined the three different D-dimer measurements (Innovance D-dimer, Hemosil D-dimer HS and Vidas D-dimer Exclusion II) in combination with and without PTP assessment. The diagnostic alternative employing Vidas D-dimer Exclusion II assay without and with PTP calculation gave lower incremental cost-effectiveness ratio (ICER) than the alternative employing Hemosil D-dimer HS assay (0.187 Euros vs. 0.998 Euros per one additional DVT positive patient selected for CUS in model without PTP assessment and 0.450 vs. 0.753 Euros per one DVT positive patient selected for CUS in model with PTP assessment). According to sensitivity analysis, the Hemosil D-dimer HS assay was the most cost effective alternative when one patient was admitted to the vascular ambulance per day. Vidas D-dimer Exclusion II assay was the most cost effective alternative when more than one patient were admitted to the vascular ambulance per day. Cost minimisation analysis indicated that selection of patients according to PTP score followed by D-dimer analysis decreases the cost of DVT diagnosis. ICER analysis enables laboratories to choose optimal laboratory tests according to number of patients admitted to laboratory. Results support the feasibility of using PTP scoring and D-dimer measurement before CUS examination in DVT screening.

Prosthetic Joint Infections and Cost Analysis?

PubMed

Haddad, F S; Ngu, A; Negus, J J

2017-01-01

Prosthetic joint infection is a devastating complication of arthroplasty surgery that can lead to debilitating morbidity for the patient and significant expense for the healthcare system. With the continual rise of arthroplasty cases worldwide every year, the revision load for infection is becoming a greater financial burden on healthcare budgets. Prevention of infection has to be the key to reducing this burden. For treatment, it is critical for us to collect quality data that can guide future management strategies to minimise healthcare costs and morbidity / mortality for patients. There has been a management shift in many countries to a less expensive 1-stage strategy and in selective cases to the use of debridement, antibiotics and implant retention. These appear very attractive options on many levels, not least cost. However, with a consensus on the definition of joint infection only clarified in 2011, there is still the need for high quality cost analysis data to be collected on how the use of these different methods could impact the healthcare expenditure of countries around the world. With a projected spend on revision for infection at US$1.62 billion in the US alone, this data is vital and urgently needed.

Cost characteristics of hospitals.

PubMed

Smet, Mike

2002-09-01

Modern hospitals are complex multi-product organisations. The analysis of a hospital's production and/or cost structure should therefore use the appropriate techniques. Flexible functional forms based on the neo-classical theory of the firm seem to be most suitable. Using neo-classical cost functions implicitly assumes minimisation of (variable) costs given that input prices and outputs are exogenous. Local and global properties of flexible functional forms and short-run versus long-run equilibrium are further issues that require thorough investigation. In order to put the results based on econometric estimations of cost functions in the right perspective, it is important to keep these considerations in mind when using flexible functional forms. The more recent studies seem to agree that hospitals generally do not operate in their long-run equilibrium (they tend to over-invest in capital (capacity and equipment)) and that it is therefore appropriate to estimate a short-run variable cost function. However, few studies explicitly take into account the implicit assumptions and restrictions embedded in the models they use. An alternative method to explain differences in costs uses management accounting techniques to identify the cost drivers of overhead costs. Related issues such as cost-shifting and cost-adjusting behaviour of hospitals and the influence of market structure on competition, prices and costs are also discussed shortly.

[Economic evaluation of a manual-based, multimodal cognitive behavioural therapy for school avoiding children with psychiatric disorder].

PubMed

Weschenfelder, Ann-Kathrin; Reissner, Volker; Knollmann, Martin; Hebebrand, Johannes; Wasem, Jürgen; Neumann, Anja

2018-01-01

Untreated school refusal increases the risk of a premature discontinuation of the educational career. The aim of this study is the economic evaluation of a manual-based treatment for school refusal in comparison to the standard treatment. Within the cost-minimisation analysis, resource use is measured retrospectively for six months using the CSSRI questionnaire. Unit costs for most health care services are derived from published standard prices. Costs are calculated from the societal perspective based on prices compiled in 2011. The cost comparison during the one-year intervention period applies a difference in differences Approach. The most common diagnoses among the 112 participants are phobic and emotional disorders. The average cost per patient during the intervention period amounts to 7197 € (95 %-CI: 4746 € – 10 079 €) for the manual group and 9294 € (95 %-CI: 6313 € – 12 878 €) for the control group. The difference in adjusted costs of 1453 € in favour of the manual group is not statistically relevant. The manual-based treatment is equivalent if not slightly advantageous compared to the standard treatment considering the clinical outcomes and cost of illness.

Economic evaluation of a group-based exercise program for falls prevention among the older community-dwelling population.

PubMed

McLean, Kendra; Day, Lesley; Dalton, Andrew

2015-03-26

Falls among older people are of growing concern globally. Implementing cost-effective strategies for their prevention is of utmost importance given the ageing population and associated potential for increased costs of fall-related injury over the next decades. The purpose of this study was to undertake a cost-utility analysis and secondary cost-effectiveness analysis from a healthcare system perspective, of a group-based exercise program compared to routine care for falls prevention in an older community-dwelling population. A decision analysis using a decision tree model was based on the results of a previously published randomised controlled trial with a community-dwelling population aged over 70. Measures of falls, fall-related injuries and resource use were directly obtained from trial data and supplemented by literature-based utility measures. A sub-group analysis was performed of women only. Cost estimates are reported in 2010 British Pound Sterling (GBP). The ICER of GBP£51,483 per QALY for the base case analysis was well above the accepted cost-effectiveness threshold of GBP£20,000 to £30,000 per QALY, but in a sensitivity analysis with minimised program implementation the incremental cost reached GBP£25,678 per QALY. The ICER value at 95% confidence in the base case analysis was GBP£99,664 per QALY and GBP£50,549 per QALY in the lower cost analysis. Males had a 44% lower injury rate if they fell, compared to females resulting in a more favourable ICER for the women only analysis. For women only the ICER was GBP£22,986 per QALY in the base case and was below the cost-effectiveness threshold for all other variations of program implementation. The ICER value at 95% confidence was GBP£48,212 in the women only base case analysis and GBP£23,645 in the lower cost analysis. The base case incremental cost per fall averted was GBP£652 (GBP£616 for women only). A threshold analysis indicates that this exercise program cannot realistically break even. The results suggest that this exercise program is cost-effective for women only. There is no evidence to support its cost-effectiveness in a group of mixed gender unless the costs of program implementation are minimal. Conservative assumptions may have underestimated the true cost-effectiveness of the program.

Cost minimisation analysis: kilovoltage imaging with automated repositioning versus electronic portal imaging in image-guided radiotherapy for prostate cancer.

PubMed

Gill, S; Younie, S; Rolfo, A; Thomas, J; Siva, S; Fox, C; Kron, T; Phillips, D; Tai, K H; Foroudi, F

2012-10-01

To compare the treatment time and cost of prostate cancer fiducial marker image-guided radiotherapy (IGRT) using orthogonal kilovoltage imaging (KVI) and automated couch shifts and orthogonal electronic portal imaging (EPI) and manual couch shifts. IGRT treatment delivery times were recorded automatically on either unit. Costing was calculated from real costs derived from the implementation of a new radiotherapy centre. To derive cost per minute for EPI and KVI units the total annual setting up and running costs were divided by the total annual working time. The cost per IGRT fraction was calculated by multiplying the cost per minute by the duration of treatment. A sensitivity analysis was conducted to test the robustness of our analysis. Treatment times without couch shift were compared. Time data were analysed for 8648 fractions, 6057 from KVI treatment and 2591 from EPI treatment from a total of 294 patients. The median time for KVI treatment was 6.0 min (interquartile range 5.1-7.4 min) and for EPI treatment it was 10.0 min (interquartile range 8.3-11.8 min) (P value < 0.0001). The cost per fraction for KVI was A$258.79 and for EPI was A$345.50. The cost saving per fraction for KVI varied between A$66.09 and A$101.64 by sensitivity analysis. In patients where no couch shift was made, the median treatment delivery time for EPI was 8.8 min and for KVI was 5.1 min. Treatment time is less on KVI units compared with EPI units. This is probably due to automation of couch shift and faster evaluation of imaging on KVI units. Annual running costs greatly outweigh initial setting up costs and therefore the cost per fraction was less with KVI, despite higher initial costs. The selection of appropriate IGRT equipment can make IGRT practical within radiotherapy departments. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

Thermal energy and economic analysis of a PCM-enhanced household envelope considering different climate zones in Morocco

NASA Astrophysics Data System (ADS)

Kharbouch, Yassine; Mimet, Abdelaziz; El Ganaoui, Mohammed; Ouhsaine, Lahoucine

2018-07-01

This study investigates the thermal energy potentials and economic feasibility of an air-conditioned family household-integrated phase change material (PCM) considering different climate zones in Morocco. A simulation-based optimisation was carried out in order to define the optimal design of a PCM-enhanced household envelope for thermal energy effectiveness and cost-effectiveness of predefined candidate solutions. The optimisation methodology is based on coupling Energyplus® as a dynamic simulation tool and GenOpt® as an optimisation tool. Considering the obtained optimum design strategies, a thermal energy and economic analysis are carried out to investigate PCMs' integration feasibility in the Moroccan constructions. The results show that the PCM-integrated household envelope allows minimising the cooling/heating thermal energy demand vs. a reference household without PCM. While for the cost-effectiveness optimisation, it has been deduced that the economic feasibility is stilling insufficient under the actual PCM market conditions. The optimal design parameters results are also analysed.

TELEMAM: a cluster randomised trial to assess the use of telemedicine in multi-disciplinary breast cancer decision making.

PubMed

Kunkler, I H; Prescott, R J; Lee, R J; Brebner, J A; Cairns, J A; Fielding, R G; Bowman, A; Neades, G; Walls, A D F; Chetty, U; Dixon, J M; Smith, M E; Gardner, T W; Macnab, M; Swann, S; Maclean, J R

2007-11-01

The TELEMAM trial aimed to assess the clinical effectiveness and costs of telemedicine in conducting breast cancer multi-disciplinary meetings (MDTs). Over 12 months 473 MDT patient discussions in two district general hospitals (DGHs) were cluster randomised (2:1) to the intervention of telemedicine linkage to breast specialists in a cancer centre or to the control group of 'in-person' meetings. Primary endpoints were clinical effectiveness and costs. Economic analysis was based on a cost-minimisation approach. Levels of agreement of MDT members on a scale from 1 to 5 were high and similar in both the telemedicine and standard meetings for decision sharing (4.04 versus 4.17), consensus (4.06 versus 4.20) and confidence in the decision (4.16 versus 4.07). The threshold at which the telemedicine meetings became cheaper than standard MDTs was approximately 40 meetings per year. Telemedicine delivered breast cancer multi-disciplinary meetings have similar clinical effectiveness to standard 'in-person' meetings.

Towards Zero Waste in emerging countries - A South African experience

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

Matete, Ntlibi; Trois, Cristina

2008-07-01

The aim of this paper is to describe the optimisation of Waste Minimisation/Zero Waste strategies into an already established integrated waste management system and to present a Zero Waste model for post-consumer waste for urban communities in South Africa. The research was undertaken towards the fulfilment of the goals of the Polokwane Declaration on Waste Management , which has set as its target the reduction of waste generation and disposal by 50% and 25%, respectively, by 2012 and the development of a plan for Zero Waste by 2022. Two communities, adjacent to the Mariannhill Landfill site in Durban, were selectedmore » as a case study for a comparative analysis of formal and informal settlements. Since the waste generated from these two communities is disposed of at the Mariannhill landfill, the impact of Zero Waste on landfill volumes could be readily assessed. A Zero Waste scheme, based on costs and landfill airspace savings, was proposed for the area. The case study demonstrates that waste minimisation schemes can be introduced into urban areas, in emerging countries, with differing levels of service and that Zero Waste models are appropriate to urban areas in South Africa.« less

Barriers to sexually transmitted infection testing in New Zealand: a qualitative study.

PubMed

Denison, Hayley J; Bromhead, Collette; Grainger, Rebecca; Dennison, Elaine M; Jutel, Annemarie

2017-08-01

To investigate the barriers that prevent or delay people seeking a sexually transmitted infection (STI) test. Qualitative in-depth interviews were conducted with 24 university students, who are a group prone to behaviours putting them at risk of STIs, to understand the factors that had prevented or delayed them from going for an STI test in the past. Resulting data were thematically analysed employing a qualitative content analysis method, and a final set of themes identified. There were three main types of barrier to STI testing. These were: personal (underestimating risk, perceiving STIs as not serious, fear of invasive procedure, self-consciousness in genital examination and being too busy); structural (financial cost of test and clinician attributes and attitude); and social (concern of being stigmatised). Conclusions and implications for public health: These data will help health providers and policy-makers provide services that minimise barriers and develop effective strategies for improving STI testing rates. The results of this study suggest a holistic approach to encouraging testing is required, which includes addressing personal beliefs, working with healthcare providers to minimise structural barriers and developing initiatives to change social views about STIs. © 2017 The Authors.

Routeing of power lines through least-cost path analysis and multicriteria evaluation to minimise environmental impacts

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

Bagli, Stefano, E-mail: stefano.bagli@gecosistema.i; Geneletti, Davide, E-mail: davide.geneletti@ing.unitn.i; Center for International Development, Harvard University, 79 JFK Street, Cambridge, MA 02138

2011-04-15

Least-cost path analysis (LCPA) allows designers to find the 'cheapest' way to connect two locations within a cost surface, which can be computed by combining multiple criteria, and therefore by accounting for different issues (environmental impact, economic investment, etc.). This procedure can be easily implemented with modern Geographic Information System (GIS) technologies, and consequently it has been widely employed to support planning and design of different types of linear infrastructures, ranging from roads to pipelines. This paper presents an approach based on the integration of multicriteria evaluation (MCE) and LCPA to identify the most suitable route for a 132 kVmore » power line. Criteria such as cost, visibility, population density, and ecosystem naturalness were used for the analysis. Firstly, spatial MCE and LCPA were combined to generate cost surfaces, and to identify alternative paths. Subsequently, MCE was used to compare the alternatives, and rank them according to their overall suitability. Finally, a sensitivity analysis allowed the stability of the results to be tested and the most critical factors of the evaluation to be detected. The study found that small changes in the location of the power line start and end points can result in significantly different paths, and consequently impact levels. This suggested that planners should always consider alternative potential locations of terminals in order to identify the best path. Furthermore, it was shown that the use of different weight scenarios may help making the model adaptable to varying environmental and social contexts. The approach was tested on a real-world case study in north-eastern Italy.« less

The economics of a pharmacy-based central intravenous additive service for paediatric patients.

PubMed

Armour, D J; Cairns, C J; Costello, I; Riley, S J; Davies, E G

1996-10-01

This study was designed to compare the costs of a pharmacy-based Central Intravenous Additive Service (CIVAS) with those of traditional ward-based preparation of intravenous doses for a paediatric population. Labour costs were derived from timings of preparation of individual doses in both the pharmacy and ward by an independent observer. The use of disposables and diluents was recorded and their acquisition costs apportioned to the cost of each dose prepared. Data were collected from 20 CIVAS sessions (501 doses) and 26 ward-based sessions (30 doses). In addition, the costs avoided by the use of part vials in CIVAS was calculated. This was derived from a total of 50 CIVAS sessions. Labour, disposable and diluent costs were significantly lower for CIVAS compared with ward-based preparation (p < 0.001). The ratio of costs per dose [in 1994 pounds sterling] between ward and pharmacy was 2.35:1 (2.51 pounds:1.07 pounds). Sensitivity analysis of the best and worst staff mixes in both locations ranged from 2.3:1 to 4.0:1, always in favour of CIVAS. There were considerable costs avoided in CIVAS from the multiple use of vials; the estimated annual sum derived from the study was 44,000 pounds. In addition, CIVAS was less vulnerable to unanticipated interruptions in work flow than ward-based preparation. CIVAS for children was more economical than traditional ward-based preparation, because of a cost-minimisation effect. Sensitivity analysis showed that these advantages were maintained over a full range of skill mixes. Additionally, significant savings accrued from the multiple use of vials in CIVAS.

Review of Battery Technologies for Military Land Vehicles

DTIC Science & Technology

2017-01-01

be fast charged (to minimise engine-on time during silent watch operations), cycle life, cost, safety, and the effect of temperature . In addition...4 3.2 Effect of Temperature ... temperature [4]. These effects are reversed for lower discharge rates. UNCLASSIFIED DST-Group-TN-1597 UNCLASSIFIED 5 3.2 Effect of

The EPQ model under conditions of two levels of trade credit and limited storage capacity in supply chain management

NASA Astrophysics Data System (ADS)

Chung, Kun-Jen

2013-09-01

An inventory problem involves a lot of factors influencing inventory decisions. To understand it, the traditional economic production quantity (EPQ) model plays rather important role for inventory analysis. Although the traditional EPQ models are still widely used in industry, practitioners frequently question validities of assumptions of these models such that their use encounters challenges and difficulties. So, this article tries to present a new inventory model by considering two levels of trade credit, finite replenishment rate and limited storage capacity together to relax the basic assumptions of the traditional EPQ model to improve the environment of the use of it. Keeping in mind cost-minimisation strategy, four easy-to-use theorems are developed to characterise the optimal solution. Finally, the sensitivity analyses are executed to investigate the effects of the various parameters on ordering policies and the annual total relevant costs of the inventory system.

Cost-effectiveness of internal limiting membrane peeling versus no peeling for patients with an idiopathic full-thickness macular hole: results from a randomised controlled trial.

PubMed

Ternent, Laura; Vale, Luke; Boachie, Charles; Burr, Jennifer M; Lois, Noemi

2012-03-01

To determine whether internal limiting membrane (ILM) peeling is cost-effective compared with no peeling for patients with an idiopathic stage 2 or 3 full-thickness macular hole. A cost-effectiveness analysis was performed alongside a randomised controlled trial. 141 participants were randomly allocated to receive macular-hole surgery, with either ILM peeling or no peeling. Health-service resource use, costs and quality of life were calculated for each participant. The incremental cost per quality-adjusted life year (QALY) gained was calculated at 6 months. At 6 months, the total costs were on average higher (£424, 95% CI -182 to 1045) in the No Peel arm, primarily owing to the higher reoperation rate in the No Peel arm. The mean additional QALYs from ILM peel at 6 months were 0.002 (95% CI 0.01 to 0.013), adjusting for baseline EQ-5D and other minimisation factors. A mean incremental cost per QALY was not computed, as Peeling was on average less costly and slightly more effective. A stochastic analysis suggested that there was more than a 90% probability that Peeling would be cost-effective at a willingness-to-pay threshold of £20,000 per QALY. Although there is no evidence of a statistically significant difference in either costs or QALYs between macular hole surgery with or without ILM peeling, the balance of probabilities is that ILM Peeling is likely to be a cost-effective option for the treatment of macular holes. Further long-term follow-up data are needed to confirm these findings.

Economic evaluation of home-based telebehavioural health care compared to in-person treatment delivery for depression.

PubMed

Bounthavong, Mark; Pruitt, Larry D; Smolenski, Derek J; Gahm, Gregory A; Bansal, Aasthaa; Hansen, Ryan N

2018-02-01

Introduction Home-based telebehavioural healthcare improves access to mental health care for patients restricted by travel burden. However, there is limited evidence assessing the economic value of home-based telebehavioural health care compared to in-person care. We sought to compare the economic impact of home-based telebehavioural health care and in-person care for depression among current and former US service members. Methods We performed trial-based cost-minimisation and cost-utility analyses to assess the economic impact of home-based telebehavioural health care versus in-person behavioural care for depression. Our analyses focused on the payer perspective (Department of Defense and Department of Veterans Affairs) at three months. We also performed a scenario analysis where all patients possessed video-conferencing technology that was approved by these agencies. The cost-utility analysis evaluated the impact of different depression categories on the incremental cost-effectiveness ratio. One-way and probabilistic sensitivity analyses were performed to test the robustness of the model assumptions. Results In the base case analysis the total direct cost of home-based telebehavioural health care was higher than in-person care (US$71,974 versus US$20,322). Assuming that patients possessed government-approved video-conferencing technology, home-based telebehavioural health care was less costly compared to in-person care (US$19,177 versus US$20,322). In one-way sensitivity analyses, the proportion of patients possessing personal computers was a major driver of direct costs. In the cost-utility analysis, home-based telebehavioural health care was dominant when patients possessed video-conferencing technology. Results from probabilistic sensitivity analyses did not differ substantially from base case results. Discussion Home-based telebehavioural health care is dependent on the cost of supplying video-conferencing technology to patients but offers the opportunity to increase access to care. Health-care policies centred on implementation of home-based telebehavioural health care should ensure that these technologies are able to be successfully deployed on patients' existing technology.

The economics of employing a counsellor in general practice: analysis of data from a randomised controlled trial.

PubMed Central

Friedli, K; King, M B; Lloyd, M

2000-01-01

BACKGROUND: Counselling is currently adopted in many general practices, despite limited evidence of clinical and cost effectiveness. AIM: To compare direct and indirect costs of counsellors and general practitioners (GPs) in providing care to people with emotional problems. METHOD: We carried out a prospective, randomized controlled trial of non-directive counselling and routine general practice care in 14 general practices in north London. Counsellors adhered to a Rogerian model of counselling. The counselling sessions ranged from one to 12 sessions over 12 weeks. As reported elsewhere, there were no differences in clinical outcomes between the two groups. Therefore, we conducted a cost minimisation analysis. We present only the economic outcomes in this paper. Main outcome measures were cost data (service utilisation, travel, and work absence) at baseline, three months, and nine months. RESULTS: One hundred and thirty-six patients with emotional problems, mainly depression, took part. Seventy patients were randomised to the counsellors and 66 to the GPs. The average direct and indirect costs for the counsellor was 162.09 Pounds more per patient after three months compared with costs for the GP group; however, over the following six months the counsellor group was 87.00 Pounds less per patient than the GP group. Over the total nine-month period, the counsellor group remained more expensive per patient. CONCLUSIONS: Referral to counselling is no more clinically effective or expensive than GP care over a nine-month period in terms of direct plus indirect costs. However, further research is needed to establish indirect costs of introducing a counsellor into general practice. PMID:10897510

Anticipatory vigilance: A grounded theory study of minimising risk within the perioperative setting.

PubMed

O'Brien, Brid; Andrews, Tom; Savage, Eileen

2018-01-01

To explore and explain how nurses minimise risk in the perioperative setting. Perioperative nurses care for patients who are having surgery or other invasive explorative procedures. Perioperative care is increasingly focused on how to improve patient safety. Safety and risk management is a global priority for health services in reducing risk. Many studies have explored safety within the healthcare settings. However, little is known about how nurses minimise risk in the perioperative setting. Classic grounded theory. Ethical approval was granted for all aspects of the study. Thirty-seven nurses working in 11 different perioperative settings in Ireland were interviewed and 33 hr of nonparticipant observation was undertaken. Concurrent data collection and analysis was undertaken using theoretical sampling. Constant comparative method, coding and memoing and were used to analyse the data. Participants' main concern was how to minimise risk. Participants resolved this through engaging in anticipatory vigilance (core category). This strategy consisted of orchestrating, routinising and momentary adapting. Understanding the strategies of anticipatory vigilance extends and provides an in-depth explanation of how nurses' behaviour ensures that risk is minimised in a complex high-risk perioperative setting. This is the first theory situated in the perioperative area for nurses. This theory provides a guide and understanding for nurses working in the perioperative setting on how to minimise risk. It makes perioperative nursing visible enabling positive patient outcomes. This research suggests the need for training and education in maintaining safety and minimising risk in the perioperative setting. © 2017 John Wiley & Sons Ltd.

Economic optimisation of wildfire intervention activities

Treesearch

David T. Butry; Jeffrey P. Prestemon; Karen L. Abt; Ronda Sutphen

2010-01-01

We describe how two important tools of wildfire management, wildfire prevention education and prescribed fire for fuels management, can be coordinated to minimise the combination of management costs and expected societal losses resulting from wildland fire. We present a long-run model that accounts for the dynamics of wildfire, the effects of fuels management on...

Should patients with abnormal liver function tests in primary care be tested for chronic viral hepatitis: cost minimisation analysis based on a comprehensively tested cohort.

PubMed

Arnold, David T; Bentham, Louise M; Jacob, Ruth P; Lilford, Richard J; Girling, Alan J

2011-03-03

Liver function tests (LFTs) are ordered in large numbers in primary care, and the Birmingham and Lambeth Liver Evaluation Testing Strategies (BALLETS) study was set up to assess their usefulness in patients with no pre-existing or self-evident liver disease. All patients were tested for chronic viral hepatitis thereby providing an opportunity to compare various strategies for detection of this serious treatable disease. This study uses data from the BALLETS cohort to compare various testing strategies for viral hepatitis in patients who had received an abnormal LFT result. The aim was to inform a strategy for identification of patients with chronic viral hepatitis. We used a cost-minimisation analysis to define a base case and then calculated the incremental cost per case detected to inform a strategy that could guide testing for chronic viral hepatitis. Of the 1,236 study patients with an abnormal LFT, 13 had chronic viral hepatitis (nine hepatitis B and four hepatitis C). The strategy advocated by the current guidelines (repeating the LFT with a view to testing for specific disease if it remained abnormal) was less efficient (more expensive per case detected) than a simple policy of testing all patients for viral hepatitis without repeating LFTs. A more selective strategy of viral testing all patients for viral hepatitis if they were born in countries where viral hepatitis was prevalent provided high efficiency with little loss of sensitivity. A notably high alanine aminotransferase (ALT) level (greater than twice the upper limit of normal) on the initial ALT test had high predictive value, but was insensitive, missing half the cases of viral infection. Based on this analysis and on widely accepted clinical principles, a "fast and frugal" heuristic was produced to guide general practitioners with respect to diagnosing cases of viral hepatitis in asymptomatic patients with abnormal LFTs. It recommends testing all patients where a clear clinical indication of infection is present (e.g. evidence of intravenous drug use), followed by testing all patients who originated from countries where viral hepatitis is prevalent, and finally testing those who have a notably raised ALT level (more than twice the upper limit of normal). Patients not picked up by this efficient algorithm had a risk of chronic viral hepatitis that is lower than the general population.

Allergy medical care network: a new model of care for specialties.

PubMed

Ferré-Ybarz, L; Salinas Argente, R; Nevot Falcó, S; Gómez Galán, C; Franquesa Rabat, J; Trapé Pujol, J; Oliveras Alsina, P; Pons Serra, M; Corbella Virós, X

2015-01-01

In 2005 the Althaia Foundation Allergy Department performed its daily activity in the Hospital Sant Joan de Deu of Manresa. Given the increasing demand for allergy care, the department's performance was analysed and a strategic plan (SP) for 2005-2010 was designed. The main objective of the study was to assess the impact of the application of the SP on the department's operations and organisational level in terms of profitability, productivity and quality of care. Descriptive, retrospective study which evaluated the operation of the allergy department. The baseline situation was analysed and the SP was designed. Indicators were set to perform a comparative analysis after application of the SP. The indicators showed an increase in medical care activity (first visits, 34%; successive visits, 29%; day hospital treatments, 51%), high rates of resolution, reduced waiting lists. Economic analysis indicated an increase in direct costs justified by increased activity and territory attended. Cost optimisation was explained by improved patient accessibility, minimised absenteeism in the workplace and improved cost per visit. After application of the SP a networking system was established for the allergy speciality that has expanded the territory for which it provides care, increased total activity and the ability to resolve patients, optimised human resources, improved quality of care and streamlined medical costs. Copyright © 2013 SEICAP. Published by Elsevier Espana. All rights reserved.

Profile and Status of Untrained Teachers: Experiences in Basic Schools in Rural Ghana

ERIC Educational Resources Information Center

Tanaka, Chisato

2012-01-01

Untrained teachers are deployed in basic schools in many developing countries as a measure to address enrolment escalation; minimising the financial burden on the government, much of whose education budget is already a recurrent cost. However, there has been little research into untrained teachers. Employing a mixed-methods approach, this article…

Re-Purposing Google Maps Visualisation for Teaching Logistics Systems

ERIC Educational Resources Information Center

Cheong, France; Cheong, Christopher; Jie, Ferry

2012-01-01

Routing is the process of selecting appropriate paths and ordering waypoints in a network. It plays an important part in logistics and supply chain management as choosing the optimal route can minimise distribution costs. Routing optimisation, however, is a difficult problem to solve and computer software is often used to determine the best route.…

Risk management and lessons learned solutions for satellite product assurance

NASA Astrophysics Data System (ADS)

Larrère, Jean-Luc

2004-08-01

The historic trend of the space industry towards lower cost programmes and more generally a better economic efficiency raises a difficult question to the quality assurance community: how to achieve the same—or better—mission success rate while drastically reducing the cost of programmes, hence the cost and level of quality assurance activities. EADS Astrium Earth Observation and Science (France) Business Unit have experimented Risk Management and Lessons Learned on their satellite programmes to achieve this goal. Risk analysis and management are deployed from the programme proposal phase through the development and operations phases. Results of the analysis and the corresponding risk mitigation actions are used to tailor the product assurance programme and activities. Lessons learned have been deployed as a systematic process to collect positive and negative experience from past and on-going programmes and feed them into new programmes. Monitoring and justification of their implementation in programmes is done under supervision from the BU quality assurance function. Control of the system is ensured by the company internal review system. Deployment of these methods has shown that the quality assurance function becomes more integrated in the programme team and development process and that its tasks gain focus and efficiency while minimising the risks associated with new space programmes.

Home-based care after a shortened hospital stay versus hospital-based care postpartum: an economic evaluation.

PubMed

Petrou, Stavros; Boulvain, Michel; Simon, Judit; Maricot, Patrice; Borst, François; Perneger, Thomas; Irion, Olivier

2004-08-01

To compare the cost effectiveness of early postnatal discharge and home midwifery support with a traditional postnatal hospital stay. Cost minimisation analysis within a pragmatic randomised controlled trial. The University Hospital of Geneva and its catchment area. Four hundred and fifty-nine deliveries of a single infant at term following an uncomplicated pregnancy. Prospective economic evaluation alongside a randomised controlled trial in which women were allocated to either early postnatal discharge combined with home midwifery support (n= 228) or a traditional postnatal hospital stay (n= 231). Costs (Swiss francs, 2000 prices) to the health service, social services, patients, carers and society accrued between delivery and 28 days postpartum. Clinical and psychosocial outcomes were similar in the two trial arms. Early postnatal discharge combined with home midwifery support resulted in a significant reduction in postnatal hospital care costs (bootstrap mean difference 1524 francs, 95% confidence interval [CI] 675 to 2403) and a significant increase in community care costs (bootstrap mean difference 295 francs, 95% CI 245 to 343). There were no significant differences in average hospital readmission, hospital outpatient care, direct non-medical and indirect costs between the two trial groups. Overall, early postnatal discharge combined with home midwifery support resulted in a significant cost saving of 1221 francs per mother-infant dyad (bootstrap mean difference 1209 francs, 95% CI 202 to 2155). This finding remained relatively robust following variations in the values of key economic parameters performed as part of a comprehensive sensitivity analysis. A policy of early postnatal discharge combined with home midwifery support exhibits weak economic dominance over traditional postnatal care, that is, it significantly reduces costs without compromising the health and wellbeing of the mother and infant.

Minimisation of the LCOE for the hybrid power supply system with the lead-acid battery

NASA Astrophysics Data System (ADS)

Kasprzyk, Leszek; Tomczewski, Andrzej; Bednarek, Karol; Bugała, Artur

2017-10-01

The paper presents the methodology of minimisation of the unit cost of production of energy generated in the hybrid system compatible with the lead-acid battery, and used to power a load with the known daily load curve. For this purpose, the objective function in the form of the LCOE and the genetic algorithm method were used. Simulation tests for three types of load with set daily load characteristics were performed. By taking advantage of the legal regulations applicable in the territory of Poland, regarding the energy storing in the power system, the optimal structure of the prosumer solar-wind system including the lead-acid battery, which meets the condition of maximum rated power, was established. An assumption was made that the whole solar energy supplied to the load would be generated in the optimised system.

Integrated approach to oral health in aged care facilities using oral health practitioners and teledentistry in rural Queensland.

PubMed

Tynan, Anna; Deeth, Lisa; McKenzie, Debra; Bourke, Carolyn; Stenhouse, Shayne; Pitt, Jacinta; Linneman, Helen

2018-04-16

Residents of residential aged care facilities are at very high risk of developing complex oral diseases and dental problems. Key barriers exist in delivering oral health services to residential aged care facilities, particularly in regional and rural areas. A quality improvement study incorporating pre- and post chart audits and pre- and post consultation with key stakeholders, including staff and residents, expert opinion on cost estimates and field notes were used. One regional and three rural residential aged care facilities situated in a non-metropolitan hospital and health service in Queensland. Number of appointments avoided at an oral health facility Feedback on program experience by staff and residents Compliance with oral health care plan implementation Observations of costs involved to deliver new service. The model developed incorporated a visit by an oral health therapist for screening, education, simple intervention and referral for a teledentistry session if required. Results showed an improvement in implementation of oral health care plans and a minimisation of need for residents to attend an oral health care facility. Potential financial and social cost savings for residents and the facilities were also noted. Screening via the oral health therapist and teledentistry appointment minimises the need for a visit to an oral health facility and subsequent disruption to residents in residential aged care facilities. © 2018 National Rural Health Alliance Ltd.

Defence Reporter. Spring 2011

DTIC Science & Technology

2011-01-01

R000248A8 High Capacity Communications from Airborne Platforms Dstl Porton Down (GB) (2010) In order to provide high capacity data over a wide area...the role of airborne platforms within the communications infrastructure is investigated. In order to minimise system costs the potential to use...commercial off the shelf (COTS) communications technology within this airborne infrastructure is also discussed. A number of different architectures

Public Infrastructure, Location of Private Schools and Primary School Attainment in an Emerging Economy

ERIC Educational Resources Information Center

Pal, Sarmistha

2010-01-01

The paper argues that access to public infrastructure plays a crucial role on the presence of private schools in a community, as it could not only minimise the cost of production, but also ensure a high return to private investment. Results using community, school and child/household-level PROBE survey data from five north Indian states provide…

The key to security is a balancing act.

PubMed

Macdonald, Grant

2011-11-01

Grant Macdonald, managing director at supplier of mechanical and electronic door locks, Codelocks, examines some of the important issues for healthcare estates and facilities personnel considering how best to protect parts of a healthcare facility--large or small--given the need to minimise costs and not "over-specify" on security, while simultaneously ensuring that patients, staff, and hospital property, are safeguarded.

Optimal control of switching time in switched stochastic systems with multi-switching times and different costs

NASA Astrophysics Data System (ADS)

Liu, Xiaomei; Li, Shengtao; Zhang, Kanjian

2017-08-01

In this paper, we solve an optimal control problem for a class of time-invariant switched stochastic systems with multi-switching times, where the objective is to minimise a cost functional with different costs defined on the states. In particular, we focus on problems in which a pre-specified sequence of active subsystems is given and the switching times are the only control variables. Based on the calculus of variation, we derive the gradient of the cost functional with respect to the switching times on an especially simple form, which can be directly used in gradient descent algorithms to locate the optimal switching instants. Finally, a numerical example is given, highlighting the validity of the proposed methodology.

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

PubMed

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

2006-11-01

To compare patient outcomes, resource use and costs to the NHS and NHS Blood Transfusion Authority (BTA) associated with cell salvage and alternative methods of minimising perioperative allogeneic blood transfusion. Electronic databases covering the period 1996-2004 for systematic reviews and 1994-2004 for economic evidence. Existing systematic reviews were updated with data from selected randomised controlled trials (RCTs) that involved adults scheduled for elective non-urgent surgery. Any resource use or cost data were extracted for potential use in populating an economic model. Relative risks or weighted mean difference of each outcome for each intervention were assessed, taking into account the number of RCTs included in each outcome and intervention and the presence of any heterogeneity. This allowed indirect comparison of the relative effectiveness of each intervention when the intervention is compared with allogeneic blood transfusion. A decision analytic model synthesised clinical and economic data from several sources, to estimate the relative cost-effectiveness of cell salvage for people undergoing elective surgery with moderate to major expected blood loss. The perspective of the NHS and patients and a time horizon of 1 month were used. The economic model was developed from reviews of effectiveness and cost-effectiveness and clinical experts. Secondary analysis explored the robustness of the results to changes in the timing and costs of cell salvage equipment, surgical procedure, use of transfusion protocols and time horizon of analysis. Overall, 668 studies were identified electronically for the update of the two systematic reviews. This included five RCTs, of which two were cell salvage and three preoperative autologous donation (PAD). Five published systematic reviews were identified for antifibrinolytics, fibrin sealants and restrictive transfusion triggers, PAD plus erythropoietin, erythropoietin alone and acute normovolaemic haemodilution (ANH). Twelve published studies reported full economic evaluations. All but two of the transfusion strategies significantly reduced exposure to allogeneic blood. The relative risk of exposure to allogeneic blood was 0.59 for the pooled trials of cell salvage (95% confidence interval: 0.48 to 0.73). This varied by the type and timing of cell salvage and type of surgical procedure. For cell salvage, the relative risk of allogeneic blood transfusion was higher in cardiac surgery than in orthopaedic surgery. Cell salvage had lower costs and slightly higher quality-adjusted life years compared with all of the alternative transfusion strategies except ANH. The likelihood that cell salvage is cost-effective compared with strategies other than ANH is over 50%. Most of the secondary analyses indicated similar results to the primary analysis. However, the primary and secondary analyses indicated that ANH may be more cost-effective than cell salvage. The available evidence indicates that cell salvage may be a cost-effective method to reduce exposure to allogeneic blood transfusion. However, ANH may be more cost-effective than cell salvage. The results of this analysis are subject to the low quality and reliability of the data used and the use of indirect comparisons. This may affect the reliability and robustness of the clinical and economic results. There is a need for further research that includes adequately powered high-quality RCTs to compare directly various blood transfusion strategies. These should include measures of health status, health-related quality of life and patient preferences for alternative transfusion strategies. Observational and tracking studies are needed to estimate reliably the incidence of adverse events and infections transmitted during blood transfusion and to identify the lifetime consequences of the serious hazards of transfusion on mortality, health status and health-related quality of life.

Aeroelastic Model Structure Computation for Envelope Expansion

NASA Technical Reports Server (NTRS)

Kukreja, Sunil L.

2007-01-01

Structure detection is a procedure for selecting a subset of candidate terms, from a full model description, that best describes the observed output. This is a necessary procedure to compute an efficient system description which may afford greater insight into the functionality of the system or a simpler controller design. Structure computation as a tool for black-box modelling may be of critical importance in the development of robust, parsimonious models for the flight-test community. Moreover, this approach may lead to efficient strategies for rapid envelope expansion which may save significant development time and costs. In this study, a least absolute shrinkage and selection operator (LASSO) technique is investigated for computing efficient model descriptions of nonlinear aeroelastic systems. The LASSO minimises the residual sum of squares by the addition of an l(sub 1) penalty term on the parameter vector of the traditional 2 minimisation problem. Its use for structure detection is a natural extension of this constrained minimisation approach to pseudolinear regression problems which produces some model parameters that are exactly zero and, therefore, yields a parsimonious system description. Applicability of this technique for model structure computation for the F/A-18 Active Aeroelastic Wing using flight test data is shown for several flight conditions (Mach numbers) by identifying a parsimonious system description with a high percent fit for cross-validated data.

The effect of governance mechanisms on food safety in the supply chain: Evidence from the Lebanese dairy sector.

PubMed

Abebe, Gumataw K; Chalak, Ali; Abiad, Mohamad G

2017-07-01

Food safety is a key public health issue worldwide. This study aims to characterise existing governance mechanisms - governance structures (GSs) and food safety management systems (FSMSs) - and analyse the alignment thereof in detecting food safety hazards, based on empirical evidence from Lebanon. Firm-to-firm and public baseline are the dominant FSMSs applied in a large-scale, while chain-wide FSMSs are observed only in a small-scale. Most transactions involving farmers are relational and market-based in contrast to (large-scale) processors, which opt for hierarchical GSs. Large-scale processors use a combination of FSMSs and GSs to minimise food safety hazards albeit potential increase in coordination costs; this is an important feature of modern food supply chains. The econometric analysis reveals contract period, on-farm inspection and experience having significant effects in minimising food safety hazards. However, the potential to implement farm-level FSMS is influenced by formality of the contract, herd size, trading partner choice, and experience. Public baseline FSMSs appear effective in controlling food safety hazards; however, this may not be viable due to the scarcity of public resources. We suggest public policies to focus on long-lasting governance mechanisms by introducing incentive schemes and farm-level FSMSs by providing loans and education to farmers. © 2016 Society of Chemical Industry. © 2016 Society of Chemical Industry.

Towards zero waste in emerging countries - a South African experience.

PubMed

Matete, Ntlibi; Trois, Cristina

2008-01-01

The aim of this paper is to describe the optimisation of Waste Minimisation/Zero Waste strategies into an already established integrated waste management system and to present a Zero Waste model for post-consumer waste for urban communities in South Africa. The research was undertaken towards the fulfilment of the goals of the Polokwane Declaration on Waste Management [DEAT, 2001. Department of Environmental Affairs and Tourism, Government of South Africa. Polokwane Declaration. Drafted by Government, Civil Society and the Business Community. National Waste Summit, Polokwane, 26-28 September 2001], which has set as its target the reduction of waste generation and disposal by 50% and 25%, respectively, by 2012 and the development of a plan for Zero Waste by 2022. Two communities, adjacent to the Mariannhill Landfill site in Durban, were selected as a case study for a comparative analysis of formal and informal settlements. Since the waste generated from these two communities is disposed of at the Mariannhill landfill, the impact of Zero Waste on landfill volumes could be readily assessed. A Zero Waste scheme, based on costs and landfill airspace savings, was proposed for the area. The case study demonstrates that waste minimisation schemes can be introduced into urban areas, in emerging countries, with differing levels of service and that Zero Waste models are appropriate to urban areas in South Africa.

Optimisation of active suspension control inputs for improved vehicle ride performance

NASA Astrophysics Data System (ADS)

Čorić, Mirko; Deur, Joško; Xu, Li; Tseng, H. Eric; Hrovat, Davor

2016-07-01

A collocation-type control variable optimisation method is used in the paper to analyse to which extent the fully active suspension (FAS) can improve the vehicle ride comfort while preserving the wheel holding ability. The method is first applied for a cosine-shaped bump road disturbance of different heights, and for both quarter-car and full 10 degree-of-freedom vehicle models. A nonlinear anti-wheel hop constraint is considered, and the influence of bump preview time period is analysed. The analysis is then extended to the case of square- or cosine-shaped pothole with different lengths, and the quarter-car model. In this case, the cost function is extended with FAS energy consumption and wheel damage resilience costs. The FAS action is found to be such to provide a wheel hop over the pothole, in order to avoid or minimise the damage at the pothole trailing edge. In the case of long pothole, when the FAS cannot provide the wheel hop, the wheel is travelling over the pothole bottom and then hops over the pothole trailing edge. The numerical optimisation results are accompanied by a simplified algebraic analysis.

A tool for cost-effectiveness analysis of field scale sediment-bound phosphorus mitigation measures and application to analysis of spatial and temporal targeting in the Lunan Water catchment, Scotland.

PubMed

Vinten, Andy; Sample, James; Ibiyemi, Adekunle; Abdul-Salam, Yakubu; Stutter, Marc

2017-05-15

The cost-effectiveness of six edge-of-field measures for mitigating diffuse pollution from sediment bound phosphorus (P) runoff from temperate arable farmland is analysed at catchment/field scales. These measures were: buffer strips, permanent grassland in the lowest 7% of arable fields, dry detention bunds, wetlands, and temporary barriers such as sediment fences. Baseline field P export was estimated using export coefficients (low risk crops) or a modified Universal Soil Loss Equation (high risk crops). The impact of measures was estimated using simple equations. Costs were estimated from gross margin losses or local data on grants. We used a net cost:benefit (NCB) factor to normalise the costs and impacts of each measure over time. Costs minimisation for target impact was done using PuLP, a linear programming module for Python, across 1634 riparian and non-riparian fields in the Lunan Water, a mixed arable catchment in Eastern Scotland. With all measures in place, average cost-effectiveness increases from £9 to £48/kg P as target P mitigation increases from 500 to 2500kg P across the catchment. Costs increase significantly when the measures available are restricted only to those currently eligible for government grants (buffers, bunds and wetlands). The assumed orientation of the average field slope makes a strong difference to the potential for storage of water by bunds and overall cost-effectiveness, but the non-funded measures can substitute for the extra expense incurred by bunds, where the slope orientation is not suitable. Economic discounting over time of impacts and costs of measures favours those measures, such as sediment fences, which are strongly targeted both spatially and temporally. This tool could be a useful guide for dialogue with land users about the potential fields to target for mitigation to achieve catchment targets. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Solving lot-sizing problem with quantity discount and transportation cost

NASA Astrophysics Data System (ADS)

Lee, Amy H. I.; Kang, He-Yau; Lai, Chun-Mei

2013-04-01

Owing to today's increasingly competitive market and ever-changing manufacturing environment, the inventory problem is becoming more complicated to solve. The incorporation of heuristics methods has become a new trend to tackle the complex problem in the past decade. This article considers a lot-sizing problem, and the objective is to minimise total costs, where the costs include ordering, holding, purchase and transportation costs, under the requirement that no inventory shortage is allowed in the system. We first formulate the lot-sizing problem as a mixed integer programming (MIP) model. Next, an efficient genetic algorithm (GA) model is constructed for solving large-scale lot-sizing problems. An illustrative example with two cases in a touch panel manufacturer is used to illustrate the practicality of these models, and a sensitivity analysis is applied to understand the impact of the changes in parameters to the outcomes. The results demonstrate that both the MIP model and the GA model are effective and relatively accurate tools for determining the replenishment for touch panel manufacturing for multi-periods with quantity discount and batch transportation. The contributions of this article are to construct an MIP model to obtain an optimal solution when the problem is not too complicated itself and to present a GA model to find a near-optimal solution efficiently when the problem is complicated.

Target-controlled inhalation anaesthesia: A cost-benefit analysis based on the cost per minute of anaesthesia by inhalation.

PubMed

Ponsonnard, Sébastien; Galy, Antoine; Cros, Jérôme; Daragon, Armelle Marie; Nathan, Nathalie

2017-02-01

End-tidal target-controlled inhalational anaesthesia (TCIA) with halogenated agents (HA) provides a faster and more accurately titrated anaesthesia as compared to manually-controlled anaesthesia. This study aimed to measure the macro-economic cost-benefit ratio of TCIA as compared to manually-controlled anaesthesia. This retrospective and descriptive study compared direct drug spending between two hospitals before 2011 and then after the replacement of three of six anaesthesia machines with TCIA mode machines in 2012 (Aisys carestation ® , GE). The direct costs were obtained from the pharmacy department and the number and duration of the anaesthesia procedures from the computerized files of the hospital. The cost of halogenated agents was reduced in the hospital equipped with an Aisys carestation ® by 13% as was the cost of one minute of anaesthesia by inhalation (€0.138 and €0.121/min between 2011 and 2012). The extra cost of the implementation of the 3 anaesthesia machines could be paid off with the resulting savings over 6 years. TCIA appears to have a favourable cost-benefit ratio. Despite a number of factors, which would tend to minimise the saving and increase costs, we still managed to observe a 13% savings. Shorter duration of surgery, type of induction as well as the way HA concentration is targeted may influence the savings results obtained. Copyright © 2016 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

[Economic assessment of the routine use of Oncotype DX® assay for early breast cancer in Franche-Comte region].

PubMed

Nerich, Virginie; Curtit, Elsa; Bazan, Fernando; Montcuquet, Philippe; Villanueva, Cristian; Chaigneau, Loïc; Cals, Laurent; Méneveau, Nathalie; Dobi, Erion; Altmotlak, Hamadi; Algros, Marie-Paule; Choulot, Marie-Jeanne; Nallet, Gilles; Limat, Samuel; Mansion, Sylvie; Pivot, Xavier

2014-01-01

Oncotype DX® has been validated as quantifying the likelihood of distant recurrence at 10 years and overall chemotherapy benefit in patients with estrogen-receptor-positive and HER-2-negative early breast cancer. In 2012, this genomic signature was routinely available for patients in Franche-Comté, France. Patients eligible for Oncotype DX(®) testing had a ER-positive, HER-2-négative early breast cancer with a nodal involvement limited to 0 or 1 positive-node without extracapsular spread; an adjuvant chemotherapy was indicated based on usual prognostic factors. The aim was to assess the economic impact of Oncotype DX(®) testing in a French region. A cost-minimisation analysis from the French Public Healthcare System perspective was performed. The availability of Oncotype DX(®) in Franche-Comté, France, and its use in clinical routine allowed a decrease of 73 % of adjuvant chemotherapy without increase of the cost of the patients' management and with a potential reduction of the cost for the French Public Healthcare System. This strategy was successful and may allow the reimbursement of this test in France for patients with early breast cancer.

Paying the price: a cross-sectional survey of Australian socioeconomically disadvantaged smokers' responses to hypothetical cigarette price rises.

PubMed

Guillaumier, Ashleigh; Bonevski, Billie; Paul, Christine; D'Este, Catherine; Doran, Christopher; Siahpush, Mohammad

2014-03-01

Increases in tobacco taxation can lead to reductions in tobacco consumption and prevalence of use across social groups. However, use of price-minimisation strategies to manage current and future tobacco use and the role of financial stress is less understood. This study aimed to measure the effect of cigarette price increases on price-minimisation strategy endorsement and financial stress among socioeconomically disadvantaged smokers. Community service organisation welfare recipients in NSW, Australia completed a touchscreen survey. Smoking history, financial stress, highest price to quit and responses to hypothetical cigarette price increases were assessed. Participants were 354 smokers (response rate = 79%). Most participants received income from a government pension (95%), earned

Cervical screening programmes: can automation help? Evidence from systematic reviews, an economic analysis and a simulation modelling exercise applied to the UK.

PubMed

Willis, B H; Barton, P; Pearmain, P; Bryan, S; Hyde, C

2005-03-01

To assess the effectiveness and cost-effectiveness of adding automated image analysis to cervical screening programmes. Searching of all major electronic databases to the end of 2000 was supplemented by a detailed survey for unpublished UK literature. Four systematic reviews were conducted according to recognised guidance. The review of 'clinical effectiveness' included studies assessing reproducibility and impact on health outcomes and processes in addition to evaluations of test accuracy. A discrete event simulation model was developed, although the economic evaluation ultimately relied on a cost-minimisation analysis. The predominant finding from the systematic reviews was the very limited amount of rigorous primary research. None of the included studies refers to the only commercially available automated image analysis device in 2002, the AutoPap Guided Screening (GS) System. The results of the included studies were debatably most compatible with automated image analysis being equivalent in test performance to manual screening. Concerning process, there was evidence that automation does lead to reductions in average slide processing times. In the PRISMATIC trial this was reduced from 10.4 to 3.9 minutes, a statistically significant and practically important difference. The economic evaluation tentatively suggested that the AutoPap GS System may be efficient. The key proviso is that credible data become available to support that the AutoPap GS System has test performance and processing times equivalent to those obtained for PAPNET. The available evidence is still insufficient to recommend implementation of automated image analysis systems. The priority for action remains further research, particularly the 'clinical effectiveness' of the AutoPap GS System. Assessing the cost-effectiveness of introducing automation alongside other approaches is also a priority.

Multi-level methods and approximating distribution functions

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

Wilson, D., E-mail: daniel.wilson@dtc.ox.ac.uk; Baker, R. E.

2016-07-15

Biochemical reaction networks are often modelled using discrete-state, continuous-time Markov chains. System statistics of these Markov chains usually cannot be calculated analytically and therefore estimates must be generated via simulation techniques. There is a well documented class of simulation techniques known as exact stochastic simulation algorithms, an example of which is Gillespie’s direct method. These algorithms often come with high computational costs, therefore approximate stochastic simulation algorithms such as the tau-leap method are used. However, in order to minimise the bias in the estimates generated using them, a relatively small value of tau is needed, rendering the computational costs comparablemore » to Gillespie’s direct method. The multi-level Monte Carlo method (Anderson and Higham, Multiscale Model. Simul. 10:146–179, 2012) provides a reduction in computational costs whilst minimising or even eliminating the bias in the estimates of system statistics. This is achieved by first crudely approximating required statistics with many sample paths of low accuracy. Then correction terms are added until a required level of accuracy is reached. Recent literature has primarily focussed on implementing the multi-level method efficiently to estimate a single system statistic. However, it is clearly also of interest to be able to approximate entire probability distributions of species counts. We present two novel methods that combine known techniques for distribution reconstruction with the multi-level method. We demonstrate the potential of our methods using a number of examples.« less

Assessment of environmental impact on air quality by cement industry and mitigating measures: a case study.

PubMed

Kabir, G; Madugu, A I

2010-01-01

In this study, environmental impact on air quality was evaluated for a typical Cement Industry in Nigeria. The air pollutants in the atmosphere around the cement plant and neighbouring settlements were determined using appropriate sampling techniques. Atmospheric dust and CO2 were prevalent pollutants during the sampling period; their concentrations were recorded to be in the range of 249-3,745 mg/m3 and 2,440-2,600 mg/m3, respectively. Besides atmospheric dust and CO2, the air pollutants such as NOx, SOx and CO were in trace concentrations, below the safe limits approved by FEPA that are 0.0062-0.093 mg/m3 NOx, 0.026 mg/m3 SOx and 114.3 mg/m3 CO, respectively. Some cost-effective mitigating measures were recommended that include the utilisation of readily available and low-cost pozzolans material to produce blended cement, not only could energy efficiency be improved, but carbon dioxide emission could also be minimised during clinker production; and the installation of an advance high-pressure grinding rolls (clinker-roller-press process) to maximise energy efficiency to above what is obtainable from the traditional ball mills and to minimise CO2 emission from the power plant.

Aeroelastic Model Structure Computation for Envelope Expansion

NASA Technical Reports Server (NTRS)

Kukreja, Sunil L.

2007-01-01

Structure detection is a procedure for selecting a subset of candidate terms, from a full model description, that best describes the observed output. This is a necessary procedure to compute an efficient system description which may afford greater insight into the functionality of the system or a simpler controller design. Structure computation as a tool for black-box modeling may be of critical importance in the development of robust, parsimonious models for the flight-test community. Moreover, this approach may lead to efficient strategies for rapid envelope expansion that may save significant development time and costs. In this study, a least absolute shrinkage and selection operator (LASSO) technique is investigated for computing efficient model descriptions of non-linear aeroelastic systems. The LASSO minimises the residual sum of squares with the addition of an l(Sub 1) penalty term on the parameter vector of the traditional l(sub 2) minimisation problem. Its use for structure detection is a natural extension of this constrained minimisation approach to pseudo-linear regression problems which produces some model parameters that are exactly zero and, therefore, yields a parsimonious system description. Applicability of this technique for model structure computation for the F/A-18 (McDonnell Douglas, now The Boeing Company, Chicago, Illinois) Active Aeroelastic Wing project using flight test data is shown for several flight conditions (Mach numbers) by identifying a parsimonious system description with a high percent fit for cross-validated data.

Monetising the impacts of waste incinerators sited on brownfield land using the hedonic pricing method.

PubMed

Rivas Casado, Monica; Serafini, Jan; Glen, John; Angus, Andrew

2017-03-01

In England and Wales planning regulations require local governments to treat waste near its source. This policy principle alongside regional self-sufficiency and the logistical advantages of minimising distances for waste treatment mean that energy from waste incinerators have been built close to, or even within urban conurbations. There is a clear policy and research need to balance the benefits of energy production from waste incinerators against the negative externalities experienced by local residents. However, the monetary costs of nuisance emissions from incinerators are not immediately apparent. This study uses the Hedonic Pricing Method to estimate the monetary value of impacts associated with three incinerators in England. Once operational, the impact of the incinerators on local house prices ranged from approximately 0.4% to 1.3% of the mean house price for the respective areas. Each of the incinerators studied had been sited on previously industrialised land to minimise overall impact. To an extent this was achieved and results support the effectiveness of spatial planning strategies to reduce the impact on residents. However, negative impacts occurred in areas further afield from the incinerator, suggesting that more can be done to minimise the impacts of incinerators. The results also suggest that in some case the incinerator increased the value of houses within a specified distance of incinerators under specific circumstances, which requires further investigation. Copyright © 2016 Elsevier Ltd. All rights reserved.

Novel Euler-LaCoste linkage as a very low frequency vertical vibration isolator.

PubMed

Hosain, M A; Sirr, A; Ju, L; Blair, D G

2012-08-01

LaCoste linkage vibration isolators have shown excellent performance for ultra-low frequency vertical vibration isolation. However, such isolators depend on the use of conventional pre-stressed coil springs, which suffer from creep. Here, we show that compressional Euler springs can be configured to create a stable tension unit for use in a LaCoste structure. In a proof of concept experiment, we demonstrate a vertical resonance frequency of 0.15 Hz in an Euler-LaCoste configuration with 200 mm height. The system enables the use of very low creep maraging steel as spring elements to eliminate the creep while minimising spring mass and reducing the effect of parasitic resonances. Larger scale systems with optimized Euler spring boundary conditions should achieve performance suitable for applications on third generation gravitational wave detectors such as the proposed Einstein telescope.

Thermal imager for dismounted infantry

NASA Astrophysics Data System (ADS)

Bigwood, Christopher R.; Eccles, Lee; Jones, Arwyn O.; Jones, Berwyn; Meakin, David L.; Rickard, Steve; Robinson, Rob

2004-12-01

Thermal Imager for Dismounted Infantry (TIDI), is a UK MOD / Thales Optics Ltd. joint funded technology demonstrator programme and is part of the overall programme managed by QinetiQ. The aim of this programme is to evaluate and demonstrate a cost effective route to equipping the infantry soldier with a small, lightweight, rugged, short range, weapon mounted thermal imaging sight; intended for mass deployment. TIDI is an unusual programme in that the requirement was not rigidly defined in terms of a detailed specification. Instead, the requirement was expressed in terms of the question 'What weapon sight performance can be achieved for a volume production cost of 5000 Euro?' This requirement was subject to the constraints that the sight mass should be less than 500 g and the volume should be less than 500 ml. To address the requirements of this programme, Thales Optics Ltd. have performed a detailed trade-off analysis considering alternative uncooled LWIR sensor formats and technologies. The effect of using alternative sensors on the sight cost, mass, volume, power and performance has been compared. A design study has been performed concentrating on simplification of the optics, mechanics and electronics to minimise the overall sight complexity. Based on this analysis, a demonstrator sight has been designed that is cost effective and suitable for volume manufacture, whilst still offering useful performance to the user. Six technical demonstrator units based on this design have been manufactured and evaluated. This paper will give an overview of the work completed to date on the TIDI program, including a description of the demonstrator hardware and its performance.

Cost-benefit analysis of management practices for ewes lame with footrot.

PubMed

Winter, Joanne R; Green, Laura E

2017-02-01

The aim of this study was to investigate the cost-benefit of different strategies to treat and control ovine footrot. In November 2006, 162 sheep farmers in England responded to a survey on prevalence and management of lameness. The costs of lameness per ewe per year (PEPY) were calculated for 116 flocks. Linear regression was used to model the overall cost of lameness PEPY by management method. Associations between farmer satisfaction and time and money spent managing lameness were investigated. The median prevalence of lameness was 5% (inter-quartile range, IQR, 4-10%). The overall cost of lameness PEPY in flocks with ≥10% lameness was UK £6.35 versus £3.90 for flocks with <5% lameness. Parenteral antibiotic treatment was associated with a significantly lower overall cost of lameness by £0.79 PEPY. Routine foot trimming and foot bathing were associated with significantly higher overall costs of lameness PEPY of £2.96 and £0.90, respectively. Farmers satisfied with time managing lameness spent significantly less time (1.46 h PEPY) than unsatisfied farmers (1.90 h PEPY). Farmers satisfied with money spent managing lameness had significantly lower treatment (£2.94 PEPY) and overall (£5.00 PEPY) costs than dissatisfied farmers (£5.50 and £7.60 PEPY, respectively). If the farmers in this study adopted best practice of parenteral antibiotic treatment with no routine foot trimming, and minimised foot bathing to treatment/prevention of interdigital dermatitis, the financial benefits would be approximately £4.65 PEPY. If these costs are similar on other farms the management changes would lead to significant economic benefits for the sheep industry. Copyright © 2016 Elsevier Ltd. All rights reserved.

Development of the hard and soft constraints based optimisation model for unit sizing of the hybrid renewable energy system designed for microgrid applications

NASA Astrophysics Data System (ADS)

Sundaramoorthy, Kumaravel

2017-02-01

The hybrid energy systems (HESs) based electricity generation system has become a more attractive solution for rural electrification nowadays. Economically feasible and technically reliable HESs are solidly based on an optimisation stage. This article discusses about the optimal unit sizing model with the objective function to minimise the total cost of the HES. Three typical rural sites from southern part of India have been selected for the application of the developed optimisation methodology. Feasibility studies and sensitivity analysis on the optimal HES are discussed elaborately in this article. A comparison has been carried out with the Hybrid Optimization Model for Electric Renewable optimisation model for three sites. The optimal HES is found with less total net present rate and rate of energy compared with the existing method

A study on the impact of prioritising emergency department arrivals on the patient waiting time.

PubMed

Van Bockstal, Ellen; Maenhout, Broos

2018-05-03

In the past decade, the crowding of the emergency department has gained considerable attention of researchers as the number of medical service providers is typically insufficient to fulfil the demand for emergency care. In this paper, we solve the stochastic emergency department workforce planning problem and consider the planning of nurses and physicians simultaneously for a real-life case study in Belgium. We study the patient arrival pattern of the emergency department in depth and consider different patient acuity classes by disaggregating the arrival pattern. We determine the personnel staffing requirements and the design of the shifts based on the patient arrival rates per acuity class such that the resource staffing cost and the weighted patient waiting time are minimised. In order to solve this multi-objective optimisation problem, we construct a Pareto set of optimal solutions via the -constraints method. For a particular staffing composition, the proposed model minimises the patient waiting time subject to upper bounds on the staffing size using the Sample Average Approximation Method. In our computational experiments, we discern the impact of prioritising the emergency department arrivals. Triaging results in lower patient waiting times for higher priority acuity classes and to a higher waiting time for the lowest priority class, which does not require immediate care. Moreover, we perform a sensitivity analysis to verify the impact of the arrival and service pattern characteristics, the prioritisation weights between different acuity classes and the incorporated shift flexibility in the model.

Teicoplanin. A pharmacoeconomic evaluation of its use in the treatment of gram-positive infections.

PubMed

Spencer, C M; Bryson, H M

1995-04-01

Teicoplanin, a glycopeptide antibiotic, is active against Gram-positive organisms, including methicillin-resistant staphylococci. It has demonstrated similar efficacy to vancomycin in the treatment of Gram-positive infections in febrile patients with neutropenia; fewer comparative data are available in patients with other infection types. Compared with vancomycin, teicoplanin is associated with less nephrotoxicity, appears to cause fewer anaphylactoid reactions, requires less monitoring and is more convenient to administer (once daily by intravenous bolus or intramuscular injection vs 2 to 4 times daily by intravenous infusion). Two European cost-minimisation studies have demonstrated that while the acquisition cost per dose of teicoplanin was approximately twice that of vancomycin, the cost of 2 weeks' therapy with either agent was similar (difference of 1 to 2%). However, in order to fully explore potential differences between these agents, a full economic analysis which considers all treatment-related costs is needed. Home therapy of Gram-positive infections, a setting in which teicoplanin may be preferred over vancomycin because of its tolerability profile and ease of administration, is particularly worthy of future economic study. Thus, there are a number of areas needing further study before the optimum formulary positioning of teicoplanin can be definitely stated. Nevertheless, present evidence suggests that teicoplanin is likely to have pharmacoeconomic advantages over vancomycin in at least some situations.

Optimal muscle fascicle length and tendon stiffness for maximising gastrocnemius efficiency during human walking and running.

PubMed

Lichtwark, G A; Wilson, A M

2008-06-21

Muscles generate force to resist gravitational and inertial forces and/or to undertake work, e.g. on the centre of mass. A trade-off in muscle architecture exists in muscles that do both; the fibres should be as short as possible to minimise activation cost but long enough to maintain an appropriate shortening velocity. Energetic cost is also influenced by tendon compliance which modulates the timecourse of muscle mechanical work. Here we use a Hill-type muscle model of the human medial gastrocnemius to determine the muscle fascicle length and Achilles tendon compliance that maximise efficiency during the stance phase of walking (1.2m/s) and running (3.2 and 3.9 m/s). A broad range of muscle fascicle lengths (ranging from 45 to 70 mm) and tendon stiffness values (150-500 N/mm) can achieve close to optimal efficiency at each speed of locomotion; however, efficient walking requires shorter muscle fascicles and a more compliant tendon than running. The values that maximise efficiency are within the range measured in normal populations. A non-linear toe-region region of the tendon force-length properties may further influence the optimal values, requiring a stiffer tendon with slightly longer muscle fascicles; however, it does not alter the main results. We conclude that muscle fibre length and tendon compliance combinations may be tuned to maximise efficiency under a given gait condition. Efficiency is maximised when the required volume of muscle is minimised, which may also help reduce limb inertia and basal metabolic costs.

Substrate Metabolism During Ironman Triathlon: Different Horses on the Same Courses.

PubMed

Maunder, Ed; Kilding, Andrew E; Plews, Daniel J

2018-05-18

Ironman triathlons are ultra-endurance events of extreme duration. The performance level of those competing varies dramatically, with elite competitors finishing in ~ 8:00:00, and lower performing amateurs finishing in ~ 14-15:00:00. When applying appropriate values for swimming, cycling and running economies to these performance times, it is demonstrated that the absolute energy cost of these events is high, and the rate of energy expenditure increases in proportion with the athlete's competitive level. Given the finite human capacity for endogenous carbohydrate storage, minimising the endogenous carbohydrate cost associated with performing exercise at competitive intensities should be a goal of Ironman preparation. A range of strategies exist that may help to achieve this goal, including, but not limited to, adoption of a low-carbohydrate diet, exogenous carbohydrate supplementation and periodised training with low carbohydrate availability. Given the diverse metabolic stimuli evoked by Ironman triathlons at different performance levels, it is proposed that the performance level of the Ironman triathlete is considered when adopting metabolic strategies to minimise the endogenous carbohydrate cost associated with exercise at competitive intensities. Specifically, periodised training with low carbohydrate availability combined with exogenous carbohydrate supplementation during competition might be most appropriate for elite and top-amateur Ironman triathletes who elicit very high rates of energy expenditure. Conversely, the adoption of a low-carbohydrate or ketogenic diet might be appropriate for some lower performance amateurs (> 12 h), in whom associated high rates of fat oxidation may be almost completely sufficient to match the energy demands required.

An environmental analysis of options for utilising wasted food and food residue.

PubMed

Oldfield, Thomas L; White, Eoin; Holden, Nicholas M

2016-12-01

The potential environmental impact of wasted food minimisation versus its utilisation in a circular bioeconomy is investigated based on a case study of Ireland. The amount of wasted food and food residue (WFFR) produced in 2010 was used for business-as-usual, (a) and four management options were assessed, (b) minimisation, (c) composting, (d) anaerobic digestion and (e) incineration. The environmental impacts Global Warming Potential (GWP), Acidification Potential (AP) and Eutrophication Potential (EP) were considered. A carbon return on investment (CRoI) was calculated for the three processing technologies (c-e). The results showed that a minimisation strategy for wasted food would result in the greatest reduction of all three impacts, -4.5 Mt CO 2 -e (GWP), -11.4 kt PO 4 3 -e (EP) and -43.9 kt SO 2 -e (AP) compared to business as usual. For WFFR utilisation in the circular bioeconomy, anaerobic digestion resulted in the lowest environmental impact and best CRoI of -0.84 kg CO 2 -e per Euro. From an economic perspective, for minimisation to be beneficial, 0.15 kg of wasted food would need to be reduced per Euro spent. Copyright © 2016 Elsevier Ltd. All rights reserved.

Optimising the location of antenatal classes.

PubMed

Tomintz, Melanie N; Clarke, Graham P; Rigby, Janette E; Green, Josephine M

2013-01-01

To combine microsimulation and location-allocation techniques to determine antenatal class locations which minimise the distance travelled from home by potential users. Microsimulation modeling and location-allocation modeling. City of Leeds, UK. Potential users of antenatal classes. An individual-level microsimulation model was built to estimate the number of births for small areas by combining data from the UK Census 2001 and the Health Survey for England 2006. Using this model as a proxy for service demand, we then used a location-allocation model to optimize locations. Different scenarios show the advantage of combining these methods to optimize (re)locating antenatal classes and therefore reduce inequalities in accessing services for pregnant women. Use of these techniques should lead to better use of resources by allowing planners to identify optimal locations of antenatal classes which minimise women's travel. These results are especially important for health-care planners tasked with the difficult issue of targeting scarce resources in a cost-efficient, but also effective or accessible, manner. (169 words). Copyright © 2011 Elsevier Ltd. All rights reserved.

A hybrid approach for integrated healthcare cooperative purchasing and supply chain configuration.

PubMed

Rego, Nazaré; Claro, João; Pinho de Sousa, Jorge

2014-12-01

This paper presents an innovative and flexible approach for recommending the number, size and composition of purchasing groups, for a set of hospitals willing to cooperate, while minimising their shared supply chain costs. This approach makes the financial impact of the various cooperation alternatives transparent to the group and the individual participants, opening way to a negotiation process concerning the allocation of the cooperation costs and gains. The approach was developed around a hybrid Variable Neighbourhood Search (VNS)/Tabu Search metaheuristic, resulting in a flexible tool that can be applied to purchasing groups with different characteristics, namely different operative and market circumstances, and to supply chains with different topologies and atypical cost characteristics. Preliminary computational results show the potential of the approach in solving a broad range of problems.

Production system with process quality control: modelling and application

NASA Astrophysics Data System (ADS)

Tsou, Jia-Chi

2010-07-01

Over the past decade, there has been a great deal of research dedicated to the study of quality and the economics of production. In this article, we develop a dynamic model which is based on the hypothesis of a traditional economic production quantity model. Taguchi's cost of poor quality is used to evaluate the cost of poor quality in the dynamic production system. A practical case from the automotive industry, which uses the Six-sigma DMAIC methodology, is discussed to verify the proposed model. This study shows that there is an optimal value of quality investment to make the production system reach a reasonable quality level and minimise the production cost. Based on our model, the management can adjust its investment in quality improvement to generate considerable financial return.

Decision and cost analysis of empirical antibiotic therapy of acute sinusitis in the era of increasing antimicrobial resistance: do we have an additional tool for antibiotic policy decisions?

PubMed

Babela, Robert; Jarcuska, Pavol; Uraz, Vladimir; Krčméry, Vladimír; Jadud, Branislav; Stevlik, Jan; Gould, Ian M

2017-11-01

No previous analyses have attempted to determine optimal therapy for upper respiratory tract infections on the basis of cost-minimization models and the prevalence of antimicrobial resistance among respiratory pathogens in Slovakia. This investigation compares macrolides and cephalosporines for empirical therapy and look at this new tool from the aspect of potential antibiotic policy decision-making process. We employed a decision tree model to determine the threshold level of macrolides and cephalosporines resistance among community respiratory pathogens that would make cephalosporines or macrolides cost-minimising. To obtain information on clinical outcomes and cost of URTIs, a systematic review of the literature was performed. The cost-minimization model of upper respiratory tract infections (URTIs) treatment was derived from the review of literature and published models. We found that the mean cost of empirical treatment with macrolides for an URTIs was €93.27 when the percentage of resistant Streptococcus pneumoniae in the community was 0%; at 5%, the mean cost was €96.45; at 10%, €99.63; at 20%, €105.99, and at 30%, €112.36. Our model demonstrated that when the percentage of macrolide resistant Streptococcus pneumoniae exceeds 13.8%, use of empirical cephalosporines rather than macrolides minimizes the treatment cost of URTIs. Empirical macrolide therapy is less expensive than cephalosporines therapy for URTIs unless macrolide resistance exceeds 13.8% in the community. Results have important antibiotic policy implications, since presented model can be use as an additional decision-making tool for new guidelines and reimbursement processes by local authorities in the era of continual increase in antibiotic resistance.

Numerical Simulation Of Shock Response To Wall Changes In High Speed Intakes

NASA Astrophysics Data System (ADS)

Fincham, J.; Taylor, N. V.

2011-05-01

Hypersonic flight presents a number of challenges to the designer, one of which is the intake behaviour. Minimising drag requires careful positioning of the intake shock structure, while accurate understanding of the dynamic behaviour is required to allow minimisation of margins. In this paper, a two shock external compression intake derived from the Reaction Engines Limited SABRE engine is examined using inviscid axisymmetric CFD analysis to determine the response of the normal shockwave to axial motion of the intake centrebody. An approximately linear relationship between centrebody position and both the normal shock position and additive drag in steady flow is demonstrated. Initial results from an unsteady analysis are also given, which show complex behaviours may be triggered by rapid motion of the centrebody in response to control input.

Shape Optimisation of Holes in Loaded Plates by Minimisation of Multiple Stress Peaks

DTIC Science & Technology

2015-04-01

UNCLASSIFIED UNCLASSIFIED Shape Optimisation of Holes in Loaded Plates by Minimisation of Multiple Stress Peaks Witold Waldman and Manfred...minimising the peak tangential stresses on multiple segments around the boundary of a hole in a uniaxially-loaded or biaxially-loaded plate . It is based...RELEASE UNCLASSIFIED UNCLASSIFIED Shape Optimisation of Holes in Loaded Plates by Minimisation of Multiple Stress Peaks Executive Summary Aerospace

A chance-constrained stochastic approach to intermodal container routing problems.

PubMed

Zhao, Yi; Liu, Ronghui; Zhang, Xi; Whiteing, Anthony

2018-01-01

We consider a container routing problem with stochastic time variables in a sea-rail intermodal transportation system. The problem is formulated as a binary integer chance-constrained programming model including stochastic travel times and stochastic transfer time, with the objective of minimising the expected total cost. Two chance constraints are proposed to ensure that the container service satisfies ship fulfilment and cargo on-time delivery with pre-specified probabilities. A hybrid heuristic algorithm is employed to solve the binary integer chance-constrained programming model. Two case studies are conducted to demonstrate the feasibility of the proposed model and to analyse the impact of stochastic variables and chance-constraints on the optimal solution and total cost.

A chance-constrained stochastic approach to intermodal container routing problems

PubMed Central

Zhao, Yi; Zhang, Xi; Whiteing, Anthony

2018-01-01

We consider a container routing problem with stochastic time variables in a sea-rail intermodal transportation system. The problem is formulated as a binary integer chance-constrained programming model including stochastic travel times and stochastic transfer time, with the objective of minimising the expected total cost. Two chance constraints are proposed to ensure that the container service satisfies ship fulfilment and cargo on-time delivery with pre-specified probabilities. A hybrid heuristic algorithm is employed to solve the binary integer chance-constrained programming model. Two case studies are conducted to demonstrate the feasibility of the proposed model and to analyse the impact of stochastic variables and chance-constraints on the optimal solution and total cost. PMID:29438389

Estimating the clinical and economic benefit associated with incremental improvements in sustained virologic response in chronic hepatitis C.

PubMed

McEwan, Phil; Ward, Thomas; Bennett, Hayley; Kalsekar, Anupama; Webster, Samantha; Brenner, Michael; Yuan, Yong

2015-01-01

Hepatitis C virus (HCV) infection is one of the principle causes of chronic liver disease. Successful treatment significantly decreases the risk of hepatic morbidity and mortality. Current standard of care achieves sustained virologic response (SVR) rates of 40-80%; however, the HCV therapy landscape is rapidly evolving. The objective of this study was to quantify the clinical and economic benefit associated with increasing levels of SVR. A published Markov model (MONARCH) that simulates the natural history of hepatitis C over a lifetime horizon was used. Discounted and non-discounted life-years (LYs), quality-adjusted life-years (QALYs) and cost of complication management were estimated for various plausible SVR rates. To demonstrate the robustness of projections obtained, the model was validated to ten UK-specific HCV studies. QALY estimates ranged from 18.0 years for those treated successfully in fibrosis stage F0 to 7.5 years (discounted) for patients in fibrosis stage F4 who remain untreated. Predicted QALY gains per 10% improvement in SVR ranged from 0.23 (F0) to 0.64 (F4) and 0.58 (F0) to 1.35 (F4) in 40 year old patients (discounted and non-discounted results respectively). In those aged 40, projected discounted HCV-related costs are minimised with successful treatment in F0/F1 (at approximately £ 300), increasing to £ 49,300 in F4 patients who remain untreated. Validation of the model to published UK cost-effectiveness studies produce R2 goodness of fit statistics of 0.988, 0.978 and of 0.973 for total costs, QALYs and incremental cost effectiveness ratios, respectively. Projecting the long-term clinical and economic consequences associated with chronic hepatitis C is a necessary requirement for the evaluation of new treatments. The principle analysis demonstrates the significant impact on expected costs, LYs and QALYs associated with increasing SVR. A validation analysis demonstrated the robustness of the results reported.

The Financial Benefits of Various Catastrophic Failure Prevention Strategies in a Wind Farm: Two market studies (UK-Spain)

NASA Astrophysics Data System (ADS)

Yürüşen, N. Y.; Tautz-Weinert, J.; Watson, S. J.; Melero, J. J.

2017-11-01

Operation of wind farms is driven by the overall aim of minimising costs while maximising energy sales. However, in certain circumstances investments are required to guarantee safe operation and survival of an asset. In this paper, we discuss the merits of various catastrophic failure prevention strategies in a Spanish wind farm. The wind farm operator was required to replace blades in two phases: temporary and final repair. We analyse the power performance of the turbine in the different states and investigate four scenarios with different timing of temporary and final repair during one year. The financial consequences of the scenarios are compared with a baseline by using a discounted cash flow analysis that considers the wholesale electricity market selling prices and interest rates. A comparison with the UK electricity market is conducted to highlight differences in the rate of return in the two countries.

"It just forces hardship": impacts of government financial penalties on non-vaccinating parents.

PubMed

Helps, Catherine; Leask, Julie; Barclay, Lesley

2018-01-22

Despite strong evidence confirming vaccination is safe and effective, some parents choose not to vaccinate their children. In 2016, the Australian Government introduced legislation strengthening links between vaccination compliance and some government payments. We interviewed thirty-one non-vaccinating parents about the impacts of this policy. Data analysis produced three key themes: 'questioning policy integrity', 'minimising impact' and 'holding my ground'. Affected parents offset reduced income by removing children from early childhood learning, reducing work commitments, moving residence to reduce living costs and accessing informal childcare arrangements. Parents reported a greater commitment to their decision not to vaccinate and an increased desire to maintain control over health choices for their children including an unprecedented willingness to become involved in protest action. Our study identifies why financial penalties have not been an effective policy measure for this sample of non-vaccinating parents, an understanding which may assist in the development of future legislation.

Purity assessment of organic calibration standards using a combination of quantitative NMR and mass balance.

PubMed

Davies, Stephen R; Jones, Kai; Goldys, Anna; Alamgir, Mahuiddin; Chan, Benjamin K H; Elgindy, Cecile; Mitchell, Peter S R; Tarrant, Gregory J; Krishnaswami, Maya R; Luo, Yawen; Moawad, Michael; Lawes, Douglas; Hook, James M

2015-04-01

Quantitative NMR spectroscopy (qNMR) has been examined for purity assessment using a range of organic calibration standards of varying structural complexities, certified using the traditional mass balance approach. Demonstrated equivalence between the two independent purity values confirmed the accuracy of qNMR and highlighted the benefit of using both methods in tandem to minimise the potential for hidden bias, thereby conferring greater confidence in the overall purity assessment. A comprehensive approach to purity assessment is detailed, utilising, where appropriate, multiple peaks in the qNMR spectrum, chosen on the basis of scientific reason and statistical analysis. Two examples are presented in which differences between the purity assignment by qNMR and mass balance are addressed in different ways depending on the requirement of the end user, affording fit-for-purpose calibration standards in a cost-effective manner.

A dynamic model for costing disaster mitigation policies.

PubMed

Altay, Nezih; Prasad, Sameer; Tata, Jasmine

2013-07-01

The optimal level of investment in mitigation strategies is usually difficult to ascertain in the context of disaster planning. This research develops a model to provide such direction by relying on cost of quality literature. This paper begins by introducing a static approach inspired by Joseph M. Juran's cost of quality management model (Juran, 1951) to demonstrate the non-linear trade-offs in disaster management expenditure. Next it presents a dynamic model that includes the impact of dynamic interactions of the changing level of risk, the cost of living, and the learning/investments that may alter over time. It illustrates that there is an optimal point that minimises the total cost of disaster management, and that this optimal point moves as governments learn from experience or as states get richer. It is hoped that the propositions contained herein will help policymakers to plan, evaluate, and justify voluntary disaster mitigation expenditures. © 2013 The Author(s). Journal compilation © Overseas Development Institute, 2013.

An Analysis of Mode Effects in the 2010 Course Experience Questionnaire

ERIC Educational Resources Information Center

Carroll, David

2011-01-01

Historically, responses to the Course Experience Questionnaire (CEQ) were required to be collected by self-administered paper or online questionnaire to be eligible for official analysis. CEQ responses collected by telephone were excluded from the final analysis file to minimise the potential for bias due to mode effects: systematic variation in…

DIY Tomography sample holder

NASA Astrophysics Data System (ADS)

Lari, L.; Wright, I.; Boyes, E. D.

2015-10-01

A very simple tomography sample holder at minimal cost was developed in-house. The holder is based on a JEOL single tilt fast exchange sample holder where its exchangeable tip was modified to allow high angle degree tilt. The shape of the tip was designed to retain mechanical stability while minimising the lateral size of the tip. The sample can be mounted on as for a standard 3mm Cu grids as well as semi-circular grids from FIB sample preparation. Applications of the holder on different sample systems are shown.

Laser vibrometry for wind turbines inspection

NASA Astrophysics Data System (ADS)

Ebert, R.

2016-04-01

The maintenance and repair of wind energy converters is a significant cost factor. Therefore it is mandatory to minimise the downtime caused by unnoticed faults. A key contributor to the load on the wind turbine installation and to material fatigue is the plant's unavoidable vibration. We report about a development of a new 1.5 μm laser vibrometer system to measure vibrations of rotating blades of wind turbines up to a distance of several hundred meters - based on a very precise imaged tracking system.

Clinical outcomes and cost-effectiveness of brief guided parent-delivered cognitive behavioural therapy and solution-focused brief therapy for treatment of childhood anxiety disorders: a randomised controlled trial.

PubMed

Creswell, Cathy; Violato, Mara; Fairbanks, Hannah; White, Elizabeth; Parkinson, Monika; Abitabile, Gemma; Leidi, Alessandro; Cooper, Peter J

2017-07-01

Half of all lifetime anxiety disorders emerge before age 12 years; however, access to evidence-based psychological therapies for affected children is poor. We aimed to compare the clinical outcomes and cost-effectiveness of two brief psychological treatments for children with anxiety referred to routine child mental health settings. We hypothesised that brief guided parent-delivered cognitive behavioural therapy (CBT) would be associated with better clinical outcomes than solution-focused brief therapy and would be cost-effective. We did this randomised controlled trial at four National Health Service primary child and mental health services in Oxfordshire, UK. Children aged 5-12 years referred for anxiety difficulties were randomly allocated (1:1), via a secure online minimisation tool, to receive brief guided parent-delivered CBT or solution-focused brief therapy, with minimisation for age, sex, anxiety severity, and level of parental anxiety. The allocation sequence was not accessible to the researcher enrolling participants or to study assessors. Research staff who obtained outcome measurements were masked to group allocation and clinical staff who delivered the intervention did not measure outcomes. The primary outcome was recovery, on the basis of Clinical Global Impressions of Improvement (CGI-I). Parents recorded patient-level resource use. Quality-adjusted life-years (QALYs) for use in cost-utility analysis were derived from the Child Health Utility 9D. Assessments were done at baseline (before randomisation), after treatment (primary endpoint), and 6 months after treatment completion. We did analysis by intention to treat. This trial is registered with the ISCRTN registry, number ISRCTN07627865. Between March 23, 2012, and March 31, 2014, we randomly assigned 136 patients to receive brief guided parent-delivered CBT (n=68) or solution-focused brief therapy (n=68). At the primary endpoint assessment (June, 2012, to September, 2014), 40 (59%) children in the brief guided parent-delivered CBT group versus 47 (69%) children in the solution-focused brief therapy group had an improvement of much or very much in CGI-I score, with no significant differences between groups in either clinical (CGI-I: relative risk 1·01, 95% CI 0·86-1·19; p=0·95) or economic (QALY: mean difference 0·006, -0·009 to 0·02; p=0·42) outcome measures. However, brief guided parent-delivered CBT was associated with lower costs (mean difference -£448; 95% CI -934 to 37; p=0·070) and, taking into account sampling uncertainty, was likely to represent a cost-effective use of resources compared with solution-focused brief therapy. No treatment-related or trial-related adverse events were reported in either group. Our findings show no evidence of clinical superiority of brief guided parent-delivered CBT. However, guided parent-delivered CBT is likely to be a cost-effective alternative to solution-focused brief therapy and might be considered as a first-line treatment for children with anxiety problems. National Institute for Health Research. Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Statistical aspects of quantitative real-time PCR experiment design.

PubMed

Kitchen, Robert R; Kubista, Mikael; Tichopad, Ales

2010-04-01

Experiments using quantitative real-time PCR to test hypotheses are limited by technical and biological variability; we seek to minimise sources of confounding variability through optimum use of biological and technical replicates. The quality of an experiment design is commonly assessed by calculating its prospective power. Such calculations rely on knowledge of the expected variances of the measurements of each group of samples and the magnitude of the treatment effect; the estimation of which is often uninformed and unreliable. Here we introduce a method that exploits a small pilot study to estimate the biological and technical variances in order to improve the design of a subsequent large experiment. We measure the variance contributions at several 'levels' of the experiment design and provide a means of using this information to predict both the total variance and the prospective power of the assay. A validation of the method is provided through a variance analysis of representative genes in several bovine tissue-types. We also discuss the effect of normalisation to a reference gene in terms of the measured variance components of the gene of interest. Finally, we describe a software implementation of these methods, powerNest, that gives the user the opportunity to input data from a pilot study and interactively modify the design of the assay. The software automatically calculates expected variances, statistical power, and optimal design of the larger experiment. powerNest enables the researcher to minimise the total confounding variance and maximise prospective power for a specified maximum cost for the large study. Copyright 2010 Elsevier Inc. All rights reserved.

Cost of privatisation versus government alcohol retailing systems: Canadian example.

PubMed

Popova, Svetlana; Patra, Jayadeep; Sarnocinska-Hart, Anna; Gnam, William H; Giesbrecht, Norman; Rehm, Jürgen

2012-01-01

Alcohol retail monopolies have been established in many countries to restrict alcohol availability and thus, minimise alcohol-related harm.The aim of this study was to estimate the impact of the privatisation of alcohol sales on the burden and direct health-care, law enforcement costs and indirect costs (lost productivity due to disability or premature mortality) in Canada. Simulation modelling. International Guidelines for the Estimation of the Avoidable Costs of Substance Abuse were used. All burden and costs were compared with the baseline taken from the aggregate Cost Study on Substance Abuse in Canada 2002. If all Canadian provinces and territories were to privatise alcohol sales we assume that consumption would increase from 10% to 20% based on available Canadian literature. Under the 10% scenario the costs would increase from 6% ($828 million) and under the 20% scenario costs would increase 12% ($1.6 billion).This increase is substantially greater than the tax and mark-up revenue gained from increased sales,and represents a net loss. Alcohol-attributable burden and associated costs will increase markedly if all Canadian provinces and territories gave up the government alcohol retailing systems.For public health and economic reasons, governments should continue to have a strong role in alcohol retailing.

Treatment of Advanced Glaucoma Study: a multicentre randomised controlled trial comparing primary medical treatment with primary trabeculectomy for people with newly diagnosed advanced glaucoma-study protocol.

PubMed

King, Anthony J; Fernie, Gordon; Azuara-Blanco, Augusto; Burr, Jennifer M; Garway-Heath, Ted; Sparrow, John M; Vale, Luke; Hudson, Jemma; MacLennan, Graeme; McDonald, Alison; Barton, Keith; Norrie, John

2017-10-26

Presentation with advanced glaucoma is the major risk factor for lifetime blindness. Effective intervention at diagnosis is expected to minimise risk of further visual loss in this group of patients. To compare clinical and cost-effectiveness of primary medical management compared with primary surgery for people presenting with advanced open-angle glaucoma (OAG). Design : A prospective, pragmatic multicentre randomised controlled trial (RCT). Twenty-seven UK hospital eye services. Four hundred and forty patients presenting with advanced OAG, according to the Hodapp-Parish-Anderson classification of visual field loss. Participants will be randomised to medical treatment or augmented trabeculectomy (1:1 allocation minimised by centre and presence of advanced disease in both eyes). The primary outcome is vision-related quality of life measured by the National Eye Institute-Visual Function Questionnaire-25 at 24 months. Secondary outcomes include generic EQ-5D-5L, Health Utility Index-3 and glaucoma-related health status (Glaucoma Utility Index), patient experience, visual field measured by mean deviation value, logarithm of the mean angle of resolution visual acuity, intraocular pressure, adverse events, standards for driving and eligibility for blind certification. Incremental cost per quality-adjusted life-year (QALY) based on EQ-5D-5L and glaucoma profile instrument will be estimated. The study will report the comparative effectiveness and cost-effectiveness of medical treatment against augmented trabeculectomy in patients presenting with advanced glaucoma in terms of patient-reported health and visual function, clinical outcomes and incremental cost per QALY at 2 years. Treatment of Advanced Glaucoma Study will be the first RCT reporting outcomes from the perspective of those with advanced glaucoma. ISRCTN56878850, Pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Estimating the limits of adaptation from historical behaviour: Insights from the American Climate Prospectus

NASA Astrophysics Data System (ADS)

Jina, A.; Hsiang, S. M.; Kopp, R. E., III; Rasmussen, D.; Rising, J.

2014-12-01

The American Climate Prospectus (ACP), the technical analysis underlying the Risky Business project, quantitatively assessed the climate risks posed to the United States' economy in a number of economic sectors [1]. The main analysis presents projections of climate impacts with an assumption of "no adaptation". Yet, historically, when the climate imposed an economic cost upon society, adaptive responses were taken to minimise these costs. These adaptive behaviours, both autonomous and planned, can be expected to occur as climate impacts increase in the future. To understand the extent to which adaptation might decrease some of the worst impacts of climate change, we empirically estimate adaptive responses. We do this in three sectors considered in the analysis - crop yield, crime, and mortality - and estimate adaptive capacity in two steps. First, looking at changes in climate impacts through time, we identify a historical rate of adaptation. Second, spatial differences in climate impacts are then used to stratify regions into more adapted or less adapted based on climate averages. As these averages change across counties in the US, we allow each to become more adapted at the rate identified in step one. We are then able to estimate the residual damages, assuming that only the historical adaptive behaviours have taken place (fig 1). Importantly, we are unable to estimate any costs associated with these adaptations, nor are we able to estimate more novel (for example, new technological discoveries) or more disruptive (for example, migration) adaptive behaviours. However, an important insight is that historical adaptive behaviours may not be capable of reducing the worst impacts of climate change. The persistence of impacts in even the most exposed areas indicates that there are non-trivial costs associated with adaptation that will need to be met from other sources or through novel behavioural changes. References: [1] T. Houser et al. (2014), American Climate Prospectus, www.climateprospectus.org.

Floating-to-Fixed-Point Conversion for Digital Signal Processors

NASA Astrophysics Data System (ADS)

Menard, Daniel; Chillet, Daniel; Sentieys, Olivier

2006-12-01

Digital signal processing applications are specified with floating-point data types but they are usually implemented in embedded systems with fixed-point arithmetic to minimise cost and power consumption. Thus, methodologies which establish automatically the fixed-point specification are required to reduce the application time-to-market. In this paper, a new methodology for the floating-to-fixed point conversion is proposed for software implementations. The aim of our approach is to determine the fixed-point specification which minimises the code execution time for a given accuracy constraint. Compared to previous methodologies, our approach takes into account the DSP architecture to optimise the fixed-point formats and the floating-to-fixed-point conversion process is coupled with the code generation process. The fixed-point data types and the position of the scaling operations are optimised to reduce the code execution time. To evaluate the fixed-point computation accuracy, an analytical approach is used to reduce the optimisation time compared to the existing methods based on simulation. The methodology stages are described and several experiment results are presented to underline the efficiency of this approach.

Optimal consensus algorithm integrated with obstacle avoidance

NASA Astrophysics Data System (ADS)

Wang, Jianan; Xin, Ming

2013-01-01

This article proposes a new consensus algorithm for the networked single-integrator systems in an obstacle-laden environment. A novel optimal control approach is utilised to achieve not only multi-agent consensus but also obstacle avoidance capability with minimised control efforts. Three cost functional components are defined to fulfil the respective tasks. In particular, an innovative nonquadratic obstacle avoidance cost function is constructed from an inverse optimal control perspective. The other two components are designed to ensure consensus and constrain the control effort. The asymptotic stability and optimality are proven. In addition, the distributed and analytical optimal control law only requires local information based on the communication topology to guarantee the proposed behaviours, rather than all agents' information. The consensus and obstacle avoidance are validated through simulations.

Cost Structure and Life Cycle Cost (LCC) for Military Systems (structures de couts globaux de possession (LCC) pour systemes militaires)

DTIC Science & Technology

2003-06-01

variables. Dans le plan (p = 2), la méthode de régression linéaire ajuste au nuage de points une droite qui minimise la somme des écarts au carré entre...cohérence de la définition du produit. Par exemple, pour un blindé, il faut valider l ’ « harmonie » du trio masse, puissance du moteur et vitesse maximale. Il...en condition opérationnelle. De façon plus générale, la DGA devrait s’orienter vers l ‘élaboration et l’acquisition de modèle d’estimation de coûts du

Constraints on global oceanic emissions of N2O from observations and models

NASA Astrophysics Data System (ADS)

Buitenhuis, Erik T.; Suntharalingam, Parvadha; Le Quéré, Corinne

2018-04-01

We estimate the global ocean N2O flux to the atmosphere and its confidence interval using a statistical method based on model perturbation simulations and their fit to a database of ΔpN2O (n = 6136). We evaluate two submodels of N2O production. The first submodel splits N2O production into oxic and hypoxic pathways following previous publications. The second submodel explicitly represents the redox transformations of N that lead to N2O production (nitrification and hypoxic denitrification) and N2O consumption (suboxic denitrification), and is presented here for the first time. We perturb both submodels by modifying the key parameters of the N2O cycling pathways (nitrification rates; NH4+ uptake; N2O yields under oxic, hypoxic and suboxic conditions) and determine a set of optimal model parameters by minimisation of a cost function against four databases of N cycle observations. Our estimate of the global oceanic N2O flux resulting from this cost function minimisation derived from observed and model ΔpN2O concentrations is 2.4 ± 0.8 and 2.5 ± 0.8 Tg N yr-1 for the two N2O submodels. These estimates suggest that the currently available observational data of surface ΔpN2O constrain the global N2O flux to a narrower range relative to the large range of results presented in the latest IPCC report.

Obesity-related health impacts of fuel excise taxation- an evidence review and cost-effectiveness study.

PubMed

Brown, V; Moodie, M; Cobiac, L; Mantilla Herrera, A M; Carter, R

2017-05-04

Reducing automobile dependence and improving rates of active transport may reduce the impact of obesogenic environments, thereby decreasing population prevalence of obesity and other diseases where physical inactivity is a risk factor. Increasing the relative cost of driving by an increase in fuel taxation may therefore be a promising public health intervention for obesity prevention. A scoping review of the evidence for obesity or physical activity effect of changes in fuel price or taxation was undertaken. Potential health benefits of an increase in fuel excise taxation in Australia were quantified using Markov modelling to simulate obesity, injury and physical activity related health impacts of a fuel excise taxation intervention for the 2010 Australian population. Health adjusted life years (HALYs) gained and healthcare cost savings from diseases averted were estimated. Incremental cost-effectiveness ratios (ICERs) were reported and results were tested through sensitivity analysis. Limited evidence on the effect of policies such as fuel taxation on health-related behaviours currently exists. Only three studies were identified reporting associations between fuel price or taxation and obesity, whilst nine studies reported associations specifically with physical activity, walking or cycling. Estimates of the cross price elasticity of demand for public transport with respect to fuel price vary, with limited consensus within the literature on a probable range for the Australian context. Cost-effectiveness modelling of a AUD0.10 per litre increase in fuel excise taxation using a conservative estimate of cross price elasticity for public transport suggests that the intervention would be cost-effective from a limited societal perspective (237 HALYs gained, AUD2.6 M in healthcare cost savings), measured against a comparator of no additional increase in fuel excise. Under "best case" assumptions, the intervention would be more cost-effective (3181 HALYs gained, AUD34.2 M in healthcare cost savings). Exploratory analysis suggests that an intervention to increase fuel excise taxation may deliver obesity and physical activity related benefits. Whilst such an intervention has significant potential for cost-effectiveness, potential equity and acceptability impacts would need to be minimised. A better understanding of the effectiveness and cost-effectiveness of a range of transport interventions is required in order to achieve more physically active transport environments.

Predicting urinary incontinence in women in later life: A systematic review.

PubMed

Troko, Joy; Bach, Fiona; Toozs-Hobson, Philip

2016-12-01

Urinary incontinence (UI) affects 10-40% of the population and treatment costs in the UK are estimated to be £233 million per annum. A systematic review of online medical databases between July 1974 and 2016 was conducted to identify studies that had investigated risk and prediction strategies of UI in later life. Eighteen prospective longitudinal studies fulfilled the search criteria. These were analysed systematically (as per the PRISMA checklist) and bias risk through study design was minimised where possible upon data analysis. One paper proposed a predictive assessment tool called the 'continence index'. It was derived following secondary analysis of a cohort study and its predictive threshold had suboptimal sensitivity (79%) and specificity (65%) rates. Seventeen studies identified multiple strong risk factors for UI but despite a large selection of papers on the topic, no robust risk assessment tool prospectively identified patients at risk of UI in later life. Thus more research in this field is required. Clinicians should be aware particularly of modifiable UI risk factors to help reduce the clinical burden of UI in the long term. Copyright © 2016. Published by Elsevier Ireland Ltd.

Minimising post-operative risk using a Post-Anaesthetic Care Tool (PACT): protocol for a prospective observational study and cost-effectiveness analysis

PubMed Central

Phillips, Nicole M; Kent, Bridie; Colgan, Stephen; Mohebbi, Mohammadreza

2015-01-01

Introduction While the risk of adverse events following surgery has been identified, the impact of nursing care on early detection of these events is not well established. A systematic review of the evidence and an expert consensus study in post-anaesthetic care identified essential criteria for nursing assessment of patient readiness for discharge from the post-anaesthetic care unit (PACU). These criteria were included in a new nursing assessment tool, the Post-Anaesthetic Care Tool (PACT), and incorporated into the post-anaesthetic documentation at a large health service. The aim of this study is to test the clinical reliability of the PACT and evaluate whether the use of PACT will (1) enhance the recognition and response to patients at risk of deterioration in PACU; (2) improve documentation for handover from PACU nurse to ward nurse; (3) result in improved patient outcomes and (4) reduce healthcare costs. Methods and analysis A prospective, non-randomised, pre-implementation and post-implementation design comparing: (1) patients (n=750) who have surgery prior to the implementation of the PACT and (2) patients (n=750) who have surgery after PACT. The study will examine the use of the tool through the observation of patient care and nursing handover. Patient outcomes and cost-effectiveness will be determined from health service data and medical record audit. Descriptive statistics will be used to describe the sample and compare the two patient groups (pre-intervention and post-intervention). Differences in patient outcomes between the two groups will be compared using the Cochran-Mantel-Haenszel test and regression analyses and reported as ORs with the corresponding 95% CIs. Conclusions This study will test the clinical reliability and cost-effectiveness of the PACT. It is hypothesised that the PACT will enable nurses to recognise and respond to patients at risk of deterioration, improve handover to ward nurses, improve patient outcomes, and reduce healthcare costs. PMID:26033942

Robust design of (s, S) inventory policy parameters in supply chains with demand and lead time uncertainties

NASA Astrophysics Data System (ADS)

Karimi Movahed, Kamran; Zhang, Zhi-Hai

2015-09-01

Demand and lead time uncertainties have significant effects on supply chain behaviour. In this paper, we present a single-product three-level multi-period supply chain with uncertain demands and lead times by using robust techniques to study the managerial insights of the supply chain inventory system under uncertainty. We formulate this problem as a robust mixed-integer linear program with minimised expected cost and total cost variation to determine the optimal (s, S) values of the inventory parameters. Several numerical studies are performed to investigate the supply chain behaviour. Useful guidelines for the design of a robust supply chain are also provided. Results show that the order variance and the expected cost in a supply chain significantly increase when the manufacturer's review period is an integer ratio of the distributor's and the retailer's review periods.

Estimating parameters with pre-specified accuracies in distributed parameter systems using optimal experiment design

NASA Astrophysics Data System (ADS)

Potters, M. G.; Bombois, X.; Mansoori, M.; Hof, Paul M. J. Van den

2016-08-01

Estimation of physical parameters in dynamical systems driven by linear partial differential equations is an important problem. In this paper, we introduce the least costly experiment design framework for these systems. It enables parameter estimation with an accuracy that is specified by the experimenter prior to the identification experiment, while at the same time minimising the cost of the experiment. We show how to adapt the classical framework for these systems and take into account scaling and stability issues. We also introduce a progressive subdivision algorithm that further generalises the experiment design framework in the sense that it returns the lowest cost by finding the optimal input signal, and optimal sensor and actuator locations. Our methodology is then applied to a relevant problem in heat transfer studies: estimation of conductivity and diffusivity parameters in front-face experiments. We find good correspondence between numerical and theoretical results.

Minimising barriers to dental care in older people

PubMed Central

Borreani, Elena; Wright, Desmond; Scambler, Sasha; Gallagher, Jennifer E

2008-01-01

Background Older people are increasingly retaining their natural teeth but at higher risk of oral disease with resultant impact on their quality of life. Socially deprived people are more at risk of oral disease and yet less likely to take up care. Health organisations in England and Wales are exploring new ways to commission and provide dental care services in general and for vulnerable groups in particular. This study was undertaken to investigate barriers to dental care perceived by older people in socially deprived inner city area where uptake of care was low and identify methods for minimising barriers in older people in support of oral health. Methods A qualitative dual-methodological approach, utilising both focus groups and individual interviews, was used in this research. Participants, older people and carers of older people, were recruited using purposive sampling through day centres and community groups in the inner city boroughs of Lambeth, Southwark and Lewisham in South London. A topic guide was utilised to guide qualitative data collection. Informants' views were recorded on tape and in field notes. The data were transcribed and analysed using Framework Methodology. Results Thirty-nine older people and/or their carers participated in focus groups. Active barriers to dental care in older people fell into five main categories: cost, fear, availability, accessibility and characteristics of the dentist. Lack of perception of a need for dental care was a common 'passive barrier' amongst denture wearers in particular. The cost of dental treatment, fear of care and perceived availability of dental services emerged to influence significantly dental attendance. Minimising barriers involves three levels of action to be taken: individual actions (such as persistence in finding available care following identification of need), system changes (including reducing costs, improving information, ensuring appropriate timing and location of care, and good patient management) and societal issues (such as reducing isolation and loneliness). Older people appeared to place greater significance on system and societal change than personal action. Conclusion Older people living within the community in an inner city area where NHS dental care is available face barriers to dental care. Improving access to care involves actions at individual, societal and system level. The latter includes appropriate management of older people by clinicians, policy change to address NHS charges; consideration of when, where and how dental care is provided; and clear information for older people and their carers on available local dental services, dental charges and care pathways. PMID:18366785

Estimation of the diagnostic threshold accounting for decision costs and sampling uncertainty.

PubMed

Skaltsa, Konstantina; Jover, Lluís; Carrasco, Josep Lluís

2010-10-01

Medical diagnostic tests are used to classify subjects as non-diseased or diseased. The classification rule usually consists of classifying subjects using the values of a continuous marker that is dichotomised by means of a threshold. Here, the optimum threshold estimate is found by minimising a cost function that accounts for both decision costs and sampling uncertainty. The cost function is optimised either analytically in a normal distribution setting or empirically in a free-distribution setting when the underlying probability distributions of diseased and non-diseased subjects are unknown. Inference of the threshold estimates is based on approximate analytically standard errors and bootstrap-based approaches. The performance of the proposed methodology is assessed by means of a simulation study, and the sample size required for a given confidence interval precision and sample size ratio is also calculated. Finally, a case example based on previously published data concerning the diagnosis of Alzheimer's patients is provided in order to illustrate the procedure.

Using economic evaluations to make formulary coverage decisions. So much for guidelines.

PubMed

Anis, A H; Gagnon, Y

2000-07-01

It is mandatory for drug manufacturers requesting formulary inclusion under the British Columbia (BC) provincial drug plan to submit a pharmacoeconomic analysis according to published guidelines. These submissions are reviewed by the Pharmacoeconomic Initiative (PI) of BC. To assess the compliance of submitted studies with specific criteria outlined in the guidelines, to assess the methodological quality of individual submissions, and to demonstrate the importance of submitting guidelines-compliant pharmacoeconomic analyses. All submissions between January 1996 and April 1999 assessed by the PI of BC were included. Submissions were reviewed according to a checklist to establish compliance with respect to choice of comparator drug, study perspective, sensitivity analysis, analytical horizon and discounting. Submissions were examined for association between analytical technique and author, and between source of submission and compliance. Association between compliance and recommendation for approval was also examined. 95 applications were reviewed. Seven submitted no analyses. There were 25 cost-comparison/consequence, 14 cost-effectiveness, 11 cost-minimisation, 9 cost-utility/benefit and 29 budget-impact analyses. 65 of these 88 submissions failed to comply with guidelines. Of these, 45% used an inappropriate comparator drug, 61% lacked a sensitivity analysis, 73% used a third-party payer and excluded a societal perspective, 66% did not provide a long term evaluation and 25% did not specify any time horizon. 80% of noncompliant studies were cost-comparison/consequence or budget-impact analyses (p < 0.001, Fisher's Exact). Of 25 cost-comparison/consequence and 29 budget-impact analyses, 19 (76%) and 24 (83%), respectively, were industry-conducted, whereas cost-effectiveness (11 of 14) and cost-utility/benefit (6 of 9) analyses were mostly subcontracted to private consultants or academics (p < 0.001, Fisher's Exact). 74% of all submissions (compliant and noncompliant) were not recommended by the PI for listing as a provincial drug plan benefit, 16% received approval for restricted benefit and 9% were recommended as full benefit. 80% of the noncompliant submissions were not recommended (p = 0.06, Fisher's Exact test). Moreover, a strong association between type of analysis and type of recommendation was found (p = 0.03, Fisher's Exact test). Cost-comparison/consequence and budget-impact analyses were less likely to be recommended. IMPLICATIONS OF FINDINGS: Our findings show poor compliance with guidelines, especially among industry-conducted studies. Possible explanations are lack of expertise in pharmacoeconomics and/or scepticism regarding the importance of guidelines and submission quality in decision making. As corroborated by the strong associations between type of recommendation and compliance, and between type of recommendation and type of analysis, these 2 characteristics have a significant impact on decision making.

Unlocking nature’s treasure-chest: screening for oleaginous algae

PubMed Central

Slocombe, Stephen P.; Zhang, QianYi; Ross, Michael; Anderson, Avril; Thomas, Naomi J.; Lapresa, Ángela; Rad-Menéndez, Cecilia; Campbell, Christine N.; Black, Kenneth D.; Stanley, Michele S.; Day, John G.

2015-01-01

Micro-algae synthesize high levels of lipids, carbohydrates and proteins photoautotrophically, thus attracting considerable interest for the biotechnological production of fuels, environmental remediation, functional foods and nutraceuticals. Currently, only a few micro-algae species are grown commercially at large-scale, primarily for “health-foods” and pigments. For a range of potential products (fuel to pharma), high lipid productivity strains are required to mitigate the economic costs of mass culture. Here we present a screen concentrating on marine micro-algal strains, which if suitable for scale-up would minimise competition with agriculture for water. Mass-Spectrophotometric analysis (MS) of nitrogen (N) and carbon (C) was subsequently validated by measurement of total fatty acids (TFA) by Gas-Chromatography (GC). This identified a rapid and accurate screening strategy based on elemental analysis. The screen identified Nannochloropsis oceanica CCAP 849/10 and a marine isolate of Chlorella vulgaris CCAP 211/21A as the best lipid producers. Analysis of C, N, protein, carbohydrate and Fatty Acid (FA) composition identified a suite of strains for further biotechnological applications e.g. Dunaliella polymorpha CCAP 19/14, significantly the most productive for carbohydrates, and Cyclotella cryptica CCAP 1070/2, with utility for EPA production and N-assimilation. PMID:26202369

Telemonitoring-based service redesign for the management of uncontrolled hypertension (HITS): cost and cost-effectiveness analysis of a randomised controlled trial

PubMed Central

Stoddart, Andrew; Hanley, Janet; Wild, Sarah; Pagliari, Claudia; Paterson, Mary; Lewis, Steff; Sheikh, Aziz; Krishan, Ashma; Padfield, Paul; McKinstry, Brian

2013-01-01

Objectives To compare the costs and cost-effectiveness of managing patients with uncontrolled blood pressure (BP) using telemonitoring versus usual care from the perspective of the National Health Service (NHS). Design Within trial post hoc economic evaluation of data from a pragmatic randomised controlled trial using an intention-to-treat approach. Setting 20 socioeconomically diverse general practices in Lothian, Scotland. Participants 401 primary care patients aged 29–95 with uncontrolled daytime ambulatory blood pressure (ABP) (≥135/85, but <210/135 mm Hg). Intervention Participants were centrally randomised to 6 months of a telemonitoring service comprising of self-monitoring of BP transmitted to a secure website for review by the attending nurse/doctor and patient, with optional automated patient decision-support by text/email (n=200) or usual care (n-201). Randomisation was undertaken with minimisation for age, sex, family practice, use of three or more hypertension drugs and self-monitoring history. Main outcome measures Mean difference in total NHS costs between trial arms and blinded assessment of mean cost per 1 mm Hg systolic BP point reduced. Results Home telemonitoring of BP costs significantly more than usual care (mean difference per patient £115.32 (95% CI £83.49 to £146.63; p<0.001)). Increased costs were due to telemonitoring service costs, patient training and additional general practitioner and nurse consultations. The mean cost of systolic BP reduction was £25.56/mm Hg (95% CI £16.06 to £46.89) per patient. Conclusions Over the 6-month trial period, supported telemonitoring was more effective at reducing BP than usual care but also more expensive. If clinical gains are maintained, these additional costs would be very likely to be compensated for by reductions in the cost of future cardiovascular events. Longer-term modelling of costs and outcomes is required to fully examine the cost-effectiveness implications. Trial registration International Standard Randomised Controlled Trials, number ISRCTN72614272. PMID:23793650

Evolving aerodynamic airfoils for wind turbines through a genetic algorithm

NASA Astrophysics Data System (ADS)

Hernández, J. J.; Gómez, E.; Grageda, J. I.; Couder, C.; Solís, A.; Hanotel, C. L.; Ledesma, JI

2017-01-01

Nowadays, genetic algorithms stand out for airfoil optimisation, due to the virtues of mutation and crossing-over techniques. In this work we propose a genetic algorithm with arithmetic crossover rules. The optimisation criteria are taken to be the maximisation of both aerodynamic efficiency and lift coefficient, while minimising drag coefficient. Such algorithm shows greatly improvements in computational costs, as well as a high performance by obtaining optimised airfoils for Mexico City's specific wind conditions from generic wind turbines designed for higher Reynolds numbers, in few iterations.

Turbodrilling performance offshore Qatar

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

Rana, L.A.; Abdulrahman, E.A.

Until the first quarter of 1979 Qatar General Petroleum Corporation Offshore routinely rotary drilled its vertical development wells using tricone bits. Turbodrilling the 17 1/2'' and 8 1/2'' hole sections was introduced in the second quarter of 1979 followed by the 12 1/4'' hole section in the first qarter of 1980. This resulted in avoiding/minimising downhole problems and the elimination of 7'' and 4 1/2'' liners. As a result of introducing these practices a 50 percent time saving and a 30 percent cost saving has been achieved, equivalent to $550,000/well.

Acute exacerbations of chronic bronchitis: a pharmacoeconomic review of antibacterial use.

PubMed

Morris, Stephen; Anderson, Pippa; Irwin, Debra E

2002-01-01

Chronic bronchitis is a common problem affecting a large proportion of the adult population. People with chronic bronchitis are subject to recurrent attacks of bronchial inflammation called acute exacerbations of chronic bronchitis (AECBs). In patients with AECBs, symptoms may worsen due to a bacterial infection; the exacerbation is then known as an acute bacterial exacerbation of chronic bronchitis (ABECB). ABECBs are thought to be controllable through the use of antibacterial agents. In this paper we review current evidence on the cost of chronic bronchitis and AECBs, the cost effectiveness of antibacterials in the management of ABECB, and the factors that may affect the cost-effectiveness of antibacterials in the management of ABECB. We find that the number of economic evaluations conducted in this area is small. Of the few economic evaluations that have been conducted there has been only one prospective economic evaluation based on a clinical trial. The remainder are simple decision analysis-based modelling studies or retrospective database studies. Our principle findings are as follows: a key factor affecting the cost-effective use of antibacterials in the management of ABECB is the definitive diagnosis of the condition. Unfortunately, diagnosing a bacterial cause of an AECB is difficult, which presents problems in ensuring that antibacterials are not prescribed unnecessarily;current evidence suggests but does not prove that use of more effective but more costly first-line antibacterials may be relatively cost effective and may minimise overall expenditure by reducing the high costs associated with treatment failure;chronic bronchitis and AECB have a significant and negative physical and psychological effect on health-related quality of life. In conclusion, the small number of economic evaluations conducted in this area, coupled with the nature of the design of these studies, precludes a definitive statement recommending which specific antibacterial should be preferred on cost-effectiveness grounds for the management of ABECB. On the basis of our findings we suggest some topics for further research.

Financial burden for tuberculosis patients in low- and middle-income countries: a systematic review

PubMed Central

Tanimura, Tadayuki; Jaramillo, Ernesto; Weil, Diana; Raviglione, Mario; Lönnroth, Knut

2014-01-01

In order to inform the development of appropriate strategies to improve financial risk protection, we conducted a systematic literature review of the financial burden of tuberculosis (TB) faced by patients and affected families. The mean total costs ranged from $55 to $8198, with an unweighted average of $847. On average, 20% (range 0–62%) of the total cost was due to direct medical costs, 20% (0–84%) to direct non-medical costs, and 60% (16–94%) to income loss. Half of the total cost was incurred before TB treatment. On average, the total cost was equivalent to 58% (range 5–306%) of reported annual individual and 39% (4–148%) of reported household income. Cost as percentage of income was particularly high among poor people and those with multidrug-resistant TB. Commonly reported coping mechanisms included taking a loan and selling household items. The total cost of TB for patients can be catastrophic. Income loss often constitutes the largest financial risk for patients. Apart from ensuring that healthcare services are fairly financed and delivered in a way that minimises direct and indirect costs, there is a need to ensure that TB patients and affected families receive appropriate income replacement and other social protection interventions. PMID:24525439

Financial burden for tuberculosis patients in low- and middle-income countries: a systematic review.

PubMed

Tanimura, Tadayuki; Jaramillo, Ernesto; Weil, Diana; Raviglione, Mario; Lönnroth, Knut

2014-06-01

In order to inform the development of appropriate strategies to improve financial risk protection, we conducted a systematic literature review of the financial burden of tuberculosis (TB) faced by patients and affected families. The mean total costs ranged from $55 to $8198, with an unweighted average of $847. On average, 20% (range 0-62%) of the total cost was due to direct medical costs, 20% (0-84%) to direct non-medical costs, and 60% (16-94%) to income loss. Half of the total cost was incurred before TB treatment. On average, the total cost was equivalent to 58% (range 5-306%) of reported annual individual and 39% (4-148%) of reported household income. Cost as percentage of income was particularly high among poor people and those with multidrug-resistant TB. Commonly reported coping mechanisms included taking a loan and selling household items. The total cost of TB for patients can be catastrophic. Income loss often constitutes the largest financial risk for patients. Apart from ensuring that healthcare services are fairly financed and delivered in a way that minimises direct and indirect costs, there is a need to ensure that TB patients and affected families receive appropriate income replacement and other social protection interventions. ©ERS 2014.

Total hip arthroplasty revision due to infection: a cost analysis approach.

PubMed

Klouche, S; Sariali, E; Mamoudy, P

2010-04-01

The treatment of total hip arthroplasty (THA) infections is long and costly. However,the number of studies in the literature analysing the real cost of THA revision in relation to their etiology, including infection, is limited. The aim of this retrospective study was to determine the cost of revision of infected THA and to compare these costs to those of primary THA and revision of non-infected THA. We performed a retrospective cost analysis for the year 2006 using an identical analytic accounting system in each hospital department (according to internal criteria) based on allotment of direct costs and receipts for each department. From January to December 2006, 424 primary THA, 57 non-infected THA revisions and 40 THA revisions due to infection were performed. The different cost areas of the patient's treatment were identified.This included preoperative medical work-up, medicosurgical management during hospital stay,a second stay in an orthopedic rehabilitation hospital (ORH) and post-hospitalisation antibiotic therapy after revision due to infection, as well as home-based hospitalisation (HH) costs, if this was the selected alternative option. We used the national health insurance fee schedule found in the "Common classification of medical procedures" and the "General nomenclature of professional procedures" applicable in France since September 1, 2005. Hospital costs included direct costs (hospital overhead costs) and indirect costs, (medical, surgical, technical settings and net general service expenses). The calculation of HH costs and ORH costs were based on the average daily charge of these departments. The cost of primary THA was used as the reference.We then compared our surgical costs with those found for the corresponding comparable hospital stay groups (Groupes homogènes de séjour). The average hospital stay (AHS) was 7.5 +/- 1.8 days for primary THA, 8.9 +/- 2.2 days for non-infected revisions and 30.6 +/- 14.9 days for revisions due to infection. The rate of transfer to a rehabilitation hospital (ORH) was 55% for primary THA, 77% in non infected revision cases and 65% in revisions due to infection. Moreover, 30% of these infected THA were prescribed HH. Non-infected THA revisions cost 1.4 times more than primary THA. THA revisions due to infection cost 3.6 times more than primary THA. The economic impact of THA infections is considerable. The extra costs are mainly due to an extended hospital stay and to longer rehabilitation consuming significant substantial human and material resources. The cost of treating infected THA is high. Treatment strategies should therefore be optimised to increase the success rate and minimise total costs. Level IV. Economic and decision analyses, retrospective study 2010 Elsevier Masson SAS. All rights reserved.

Ganciclovir. A pharmacoeconomic review of its use as intravenous or oral maintenance therapy in the management of cytomegalovirus retinitis in patients with AIDS.

PubMed

Perry, C M; Davis, R

1997-08-01

Cytomegalovirus retinitis, an opportunistic infection caused by the herpesvirus cytomegalovirus, is a major cause of illness in patients with advanced AIDS. As infected patients require long term drug treatment to delay disease progression and minimise loss of vision, the disease is associated with substantial treatment costs which considerably increase overall expenditure on AIDS-related health care. During the last decade, intravenous ganciclovir has been a mainstay of treatment for patients with cytomegalovirus retinitis. However, notwithstanding its demonstrated efficacy as maintenance therapy for this condition, long term intravenous drug administration is both inconvenient and uncomfortable for many patients. Moreover, neutropenia and catheter-related infections have been reported commonly in patients receiving ganciclovir via the intravenous route. To overcome the limitations of intravenous ganciclovir, an oral formulation of the drug has been developed for use as maintenance therapy. In comparative clinical trials, both intravenous and oral ganciclovir maintenance therapy slowed disease progression and preserved visual acuity in patients with stabilised cytomegalo-virus retinitis, although there was evidence that the intravenous formulation was more effective in terms of delaying recurrence of active disease. This suggests that oral ganciclovir use should be limited to the treatment of patients without evidence of immediately sight-threatening cytomegalovirus retinitis. Three published cost analyses, which were based on efficacy and tolerability data derived from 2 randomised, comparative clinical trials, have shown that oral ganciclovir maintenance therapy offers cost advantages over intravenous maintenance therapy, despite the higher acquisition cost of the oral formulation. The higher overall costs of intravenous maintenance treatment, compared with oral therapy, were attributed to higher drug administration and adverse event treatment costs. In one analysis, estimated lifetime treatment costs of oral maintenance therapy were 25.2% lower than those of intravenous maintenance treatment. As yet, no formal cost-effectiveness evaluations of oral and intravenous ganciclovir have been published. Few published data are available regarding the relative effects of intravenous and oral ganciclovir on quality of life. However, in a health state utility analysis, there was a large overall preference among HIV-infected individuals for oral over intravenous maintenance treatment. In conclusion, oral ganciclovir appears to be a cost-saving and patient-preferred alternative to its intravenous counterpart for the maintenance therapy of AIDS patients with stabilised cytomegalovirus retinitis in whom there is no evidence of sight-threatening disease.

Cost-effective and robust mitigation of space debris in low earth orbit

NASA Astrophysics Data System (ADS)

Walker, R.; Martin, C.

It is predicted that the space debris population in low Earth orbit (LEO) will continue to grow and in an exponential manner in the long-term due to an increasing rate of collisions between large objects, unless internationally-accepted space debris mitigation measures are adopted soon. Such measures are aimed at avoiding the future generation of space debris objects and primarily need to be effective in preventing significant long-term growth in the debris population, even in the potential scenario of an increase in future space activity. It is also important that mitigation measures can limit future debris population levels, and therefore the underlying collision risk to space missions, to the lowest extent possible. However, for their wide acceptance, the cost of implementation associated with mitigation measures needs to be minimised as far as possible. Generally, a lower collision risk will cost more to achieve and vice versa, so it is necessary to strike a balance between cost and risk in order to find a cost-effective set of mitigation measures. In this paper, clear criteria are established in order to assess the cost-effectiveness of space debris mitigation measures. A full cost-risk-benefit trade-off analysis of numerous mitigation scenarios is presented. These scenarios consider explosion prevention and post-mission disposal of space systems, including de-orbiting to limited lifetime orbits and re-orbiting above the LEO region. The ESA DELTA model is used to provide long-term debris environment projections for these scenarios as input to the benefit and risk parts of the trade-off analysis. Manoeuvre requirements for the different post-mission disposal scenarios were also calculated in order to define the cost-related element. A 25-year post-mission lifetime de-orbit policy, combined with explosion prevention and mission-related object limitation, was found to be the most cost-effective solution to the space debris problem in LEO. This package would also remain effective after a significant increase in future launch traffic. It was found that the re-orbiting of space systems above the LEO region would not lead to significant collision activity there over the next century. However, above-LEO disposal should be used sparingly because the disposal region could become unstable after a limited number of explosions or collisions due to a lack of air drag to remove the resulting fragments.

Failure Diagnosis and Prognosis of Rolling - Element Bearings using Artificial Neural Networks: A Critical Overview

NASA Astrophysics Data System (ADS)

Rao, B. K. N.; Srinivasa Pai, P.; Nagabhushana, T. N.

2012-05-01

Rolling - Element Bearings are extensively used in almost all global industries. Any critical failures in these vitally important components would not only affect the overall systems performance but also its reliability, safety, availability and cost-effectiveness. Proactive strategies do exist to minimise impending failures in real time and at a minimum cost. Continuous innovative developments are taking place in the field of Artificial Neural Networks (ANNs) technology. Significant research and development are taking place in many universities, private and public organizations and a wealth of published literature is available highlighting the potential benefits of employing ANNs in intelligently monitoring, diagnosing, prognosing and managing rolling-element bearing failures. This paper attempts to critically review the recent trends in this topical area of interest.

A soft computing-based approach to optimise queuing-inventory control problem

NASA Astrophysics Data System (ADS)

Alaghebandha, Mohammad; Hajipour, Vahid

2015-04-01

In this paper, a multi-product continuous review inventory control problem within batch arrival queuing approach (MQr/M/1) is developed to find the optimal quantities of maximum inventory. The objective function is to minimise summation of ordering, holding and shortage costs under warehouse space, service level and expected lost-sales shortage cost constraints from retailer and warehouse viewpoints. Since the proposed model is Non-deterministic Polynomial-time hard, an efficient imperialist competitive algorithm (ICA) is proposed to solve the model. To justify proposed ICA, both ganetic algorithm and simulated annealing algorithm are utilised. In order to determine the best value of algorithm parameters that result in a better solution, a fine-tuning procedure is executed. Finally, the performance of the proposed ICA is analysed using some numerical illustrations.

Economic costs of protistan and metazoan parasites to global mariculture.

PubMed

Shinn, A P; Pratoomyot, J; Bron, J E; Paladini, G; Brooker, E E; Brooker, A J

2015-01-01

Parasites have a major impact on global finfish and shellfish aquaculture, having significant effects on farm production, sustainability and economic viability. Parasite infections and impacts can, according to pathogen and context, be considered to be either unpredictable/sporadic or predictable/regular. Although both types of infection may result in the loss of stock and incur costs associated with the control and management of infection, predictable infections can also lead to costs associated with prophylaxis and related activities. The estimation of the economic cost of a parasite event is frequently complicated by the complex interplay of numerous factors associated with a specific incident, which may range from direct production losses to downstream socio-economic impacts on livelihoods and satellite industries associated with the primary producer. In this study, we examine the world's major marine and brackish water aquaculture production industries and provide estimates of the potential economic costs attributable to a range of key parasite pathogens using 498 specific events for the purposes of illustration and estimation of costs. This study provides a baseline resource for risk assessment and the development of more robust biosecurity practices, which can in turn help mitigate against and/or minimise the potential impacts of parasite-mediated disease in aquaculture.

A new approach to tag design in dolphin telemetry: Computer simulations to minimise deleterious effects

NASA Astrophysics Data System (ADS)

Pavlov, V. V.; Wilson, R. P.; Lucke, K.

2007-02-01

Remote-sensors and transmitters are powerful devices for studying cetaceans at sea. However, despite substantial progress in microelectronics and miniaturisation of systems, dolphin tags are imperfectly designed; additional drag from tags increases swim costs, compromises swimming capacity and manoeuvrability, and leads to extra loads on the animal's tissue. We propose a new approach to tag design, elaborating basic principles and incorporating design stages to minimise device effects by using computer-aided design. Initially, the operational conditions of the device are defined by quantifying the shape, hydrodynamics and range of the natural deformation of the dolphin body at the tag attachment site (such as close to the dorsal fin). Then, parametric models of both of the dorsal fin and a tag are created using the derived data. The link between parameters of the fin and a tag model allows redesign of tag models according to expected changes of fin geometry (difference in fin shape related with species, sex, and age peculiarities, simulation of the bend of the fin during manoeuvres). A final virtual modelling stage uses iterative improvement of a tag model in a computer fluid dynamics (CFD) environment to enhance tag performance. This new method is considered as a suitable tool of tag design before creation of the physical model of a tag and testing with conventional wind/water tunnel technique. Ultimately, tag materials are selected to conform to the conditions identified by the modelling process and thus help create a physical model of a tag, which should minimise its impact on the animal carrier and thus increase the reliability and quality of the data obtained.

Evidence of Biased Advertising in the Case of Social Egg Freezing.

PubMed

Barbey, Christopher

2017-11-01

Oocyte cryopreservation, or 'egg freezing,' is the practice of preserving unfertilised oocytes for later fertilisation. This practice allows women to extend their reproductive years. In 2014, Facebook and Apple announced that they would subsidise their female employees' elective - or 'social' - use of egg freezing so that these women can more easily reconcile the demands of career and family life. This announcement engendered controversy and moral debate. Given that social egg freezing (SEF) is becoming more popular, ethical and empirical analyses are warranted. Here, I utilise content analysis to examine media messages in advertising for SEF. I conclude that many fertility clinics engage in biased advertising - i.e. they advertise the service persuasively, not informatively, emphasising indirect benefits while minimising risks and the low chance of successfully bringing a child to term. As advertising for medical services has been shown to influence the use of those services, advertising for SEF should emphasise clear and easily interpretable statistics about success rate, usage rate, cost, and risk.

21st century trucking: A trajectory for ergonomics and road freight.

PubMed

Bedinger, M; Walker, G H; Piecyk, M; Greening, P

2016-03-01

Over the past decade there has been significant pressure to minimise emissions and safety risks related to commercial driving. This pressure to meet the triple bottom line of cost, environment, and society has often resulted in the rapid application of vehicle technologies designed to mitigate undesired effects. Often the cognitive and behavioural effects of technologies on the commercial driver have not received in-depth analysis to determine comprehensive viability. As such, this paper aims to identify a timescale for implementation for future technologies for UK road freight, and likely associated human factors issues, improving upon the currently employed 'trial-and-error' approach to implementation which may carry high economic, environmental, safety-related risk. Thought experiments are carried out to broadly explore these future systems. Furthermore, this work aims to examine whether technology alone will be enough to meet future CO2 reduction targets, and assess the role of behavioural and systems interventions for future research. Copyright © 2015 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Protecting the autonomy of states to enact tobacco control measures under trade and investment agreements.

PubMed

Mitchell, Andrew; Sheargold, Elizabeth

2015-06-01

Since the adoption of the WHO's WHO Framework Convention on Tobacco Control, governments have been pursuing progressively stronger and more wide-reaching tobacco control measures. In response, tobacco companies are frequently using international trade and investment agreements as tools to challenge domestic tobacco control measures. Several significant new trade and investment agreements that some fear may provide new legal avenues to the tobacco industry to challenge health measures are currently under negotiation, including the Trans-Pacific Partnership (a 12 party agreement of Asia-Pacific regional countries) and the Transatlantic Trade and Investment Partnership (an agreement between the USA and the European Union). This commentary examines different options for treaty provisions that the parties could employ in these agreements to minimise legal risks relating to tobacco control measures. It recommends that parties take a comprehensive approach, combining provisions that minimise the potential costs of litigation with provisions that increase the likelihood of a state successfully defending tobacco control measures in such litigation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Optimal pricing and lot-sizing for perishable inventory with price and time dependent ramp-type demand

NASA Astrophysics Data System (ADS)

Panda, S.; Saha, S.; Basu, M.

2013-01-01

Product perishability is an important aspect of inventory control. To minimise the effect of deterioration, retailers in supermarkets, departmental store managers, etc. always want higher inventory depletion rate. In this article, we propose a dynamic pre- and post-deterioration cumulative discount policy to enhance inventory depletion rate resulting low volume of deterioration cost, holding cost and hence higher profit. It is assumed that demand is a price and time dependent ramp-type function and the product starts to deteriorate after certain amount of time. Unlike the conventional inventory models with pricing strategies, which are restricted to a fixed number of price changes and to a fixed cycle length, we allow the number of price changes before as well as after the start of deterioration and the replenishment cycle length to be the decision variables. Before start of deterioration, discounts on unit selling price are provided cumulatively in successive pricing cycles. After the start of deterioration, discounts on reduced unit selling price are also provided in a cumulative way. A mathematical model is developed and the existence of the optimal solution is verified. A numerical example is presented, which indicates that under the cumulative effect of price discounting, dynamic pricing policy outperforms static pricing strategy. Sensitivity analysis of the model is carried out.

Mechanical energy and power flow analysis of wheelchair use with different camber settings.

PubMed

Huang, Yueh-Chu; Guo, Lan-Yuen; Tsai, Chung-Ying; Su, Fong-Chin

2013-04-01

It has been suggested that minimisation of energy cost is one of the primary determinants of wheelchair designs. Wheel camber is one important parameter related to wheelchair design and its angle may affect usability during manual propulsion. However, there is little available literature addressing the effect of wheel camber on the mechanical energy or power flow involved in manual wheelchair propulsion. Twelve normal subjects (mean age, 22.3 years; SD, 1.6 years) participated in this study. A video-tracking system and an instrumented wheel were used to collect 3D kinematic and kinetic data. Wheel camber of 0° and 15° was chosen to examine the difference between mechanical power and power flow of the upper extremity during manual wheelchair propulsion. The work calculated from power flow and the discrepancy between the mechanical work and power flow work of upper extremity had significantly greater values with increased camber. The upper arm had a larger active muscle power compared with that in the forearm and hand segments. While propelling the increased camber, the magnitude of both the proximal and distal joint power and proximal muscle power was increased in all three segments. While the propelling wheel with camber not only needs a greater energy cost but also there is greater energy loss.

The use of an ordinary colour scanner to fingerprint sediment sources in the South African Karoo.

PubMed

Pulley, Simon; Rowntree, Kate

2016-01-01

The widespread adoption of sediment fingerprinting methodologies for the purpose of catchment management has been restricted by the high cost of tracer analysis as well as the potential for significant uncertainties to be present in results. Sediment colour has shown potential to be an inexpensive tracer able to discriminate between sediment sources. However, at present colour has not been demonstrated to be conservative during sediment erosion and transport. Sediment particle size and organic matter have been shown to strongly affect sediment colour, introducing significant uncertainties associated with its use. This study aimed to assess the suitability of colour as a tracer when it is measured using a commercially available colour scanner. The use of hydrogen peroxide (H2O2) to decompose sediment-associated organic matter was assessed as a means of minimising uncertainty. The impact of particle size on the accurate use of colour signatures as a tracer was also assessed. It was concluded that colour performed comparably to mineral magnetic signatures and showed good potential for use as a tracer. The use of H2O2 pre-treatment and limitation of the analysis to either the <32 μm or the >32 μm fraction of the samples were indicated to be important methods to limit uncertainties associated with organic matter and particle size. The methods used were considerably more time and cost effective than the measurement of most conventional tracers. Copyright © 2015 Elsevier Ltd. All rights reserved.

Minimising Stress for Patients in the Veterinary Hospital: Why It Is Important and What Can Be Done about It

PubMed Central

Lloyd, Janice K. F.

2017-01-01

Minimising stress for patients should always be a priority in the veterinary hospital. However, this is often overlooked. While a “no stress” environment is not possible, understanding how to create a “low stress” (sometimes called “fear-free”) environment and how to handle animals in a less stressful manner benefits patients, staff and the hospital alike. Many veterinary practitioners believe creating a low stress environment is too hard and too time consuming, but this need not be the case. With some simple approaches, minimising patient, and hence staff, stress is achievable in all veterinary practices. This article provides a background on why minimising stress is important and outlines some practical steps that can be taken by staff to minimise stress for presenting and hospitalised patients. Useful resources on recognising signs of stress in dogs and cats, handling, restraint, behaviour modification, medications, and hospital design are provided. PMID:29056681

"Change Can Only Be a Good Thing:" Staff Views on the Introduction of a Harm Minimisation Policy in a Forensic Learning Disability Service

ERIC Educational Resources Information Center

Fish, Rebecca; Woodward, Sarah; Duperouzel, Helen

2012-01-01

Recent local research about personal experiences of self-injury and discussions about the use of harm minimisation with service users who self-injure were the motivation behind this study to glean staff opinions and advice about the introduction of a harm minimisation policy. An online survey was designed, and all staff were invited by email to…

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

PubMed

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

2018-03-08

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

Waste minimisation in a hard chromiun plating Small Medium Enterprise (SME).

PubMed

Viguri, J R; Andrés, A; Irabien, A

2002-01-01

The high potential of waste stream minimisation in the metal finishing sector justifies specific studies of Small and Medium Enterprises (SME). In this work, the minimisation options of the wastes generated in a hard chromium plating activity have been analysed. The study has been performed in a small job shop company, which works in batch mode with big pieces. A process flowsheet after connecting the unit operations and determining the process inputs (raw and secondary materials) and outputs (waste streams) has been carried out. The main properties, quantity and current management of the waste streams have been shown. The obvious lack of information has been identified and finally the waste minimisation options that could be adopted by the company have been recorded.

Are the lowest-cost healthful food plans culturally and socially acceptable?

PubMed Central

Maillot, Matthieu; Darmon, Nicole; Drewnowski, Adam

2014-01-01

Objective Nutritious yet inexpensive foods do exist. However, many such foods are rejected by the low-income consumer. Is it because their use violates unspoken social norms? The present study was designed to assess the variety and cost of the lowest-cost market basket of foods that simultaneously met required dietary standards and progressively stricter consumption constraints. Design A mathematical optimisation model was used to develop the lowest-cost food plans to meet three levels of nutritional requirements and seven levels of consumption constraints. Subjects: The nationally representative INCA (National Individual Survey of Food Consumption) dietary survey study of 1332 adults provided population estimates of food consumption patterns in France. Food plan costs were based on retail food prices. Results The lowest-cost food plans that provided 9204 kJ/d (2200 kcal/d) for men and 7531 kJ/d (1800 kcal/d) for women and met specified dietary standards could be obtained for ,1?50 h/d. The progressive imposition of consumption constraints designed to create more mainstream French diets sharply increased food plan costs, without improving nutritional value. Conclusions Minimising diet costs, while meeting nutrition standards only, led to food plans that provided little variety and deviated substantially from social norms. Aligning the food plan with mainstream consumption led to higher costs. Food plans designed for low-income groups need to be socially acceptable as well as affordable and nutritious. PMID:20105388

Flat-panel display solutions for ground-environment military displays (Invited Paper)

NASA Astrophysics Data System (ADS)

Thomas, J., II; Roach, R.

2005-05-01

Displays for military vehicles have very distinct operational and cost requirements that differ from other military applications. These requirements demand that display suppliers to Army and Marine ground-environments provide low cost equipment that is capable of operation across environmental extremes. Inevitably, COTS components form the foundation of these "affordable" display solutions. This paper will outline the major display requirements and review the options that satisfy conflicting and difficult operational demands, using newly developed equipment as an example. Recently, a new supplier was selected for the Drivers Vision Enhancer (DVE) equipment, including the Display Control Module (DCM). The paper will outline the DVE and describe development of a new DCM solution. The DVE programme, with several thousand units presently in service and operational in conflicts such as "Operation Iraqi Freedom", represents a critical balance between cost and performance. We shall describe design considerations that include selection of COTS sources, the need to minimise display modification; video interfaces, power interfaces, operator interfaces and new provisions to optimise displayed video content.

The macroeconomic impact of pandemic influenza: estimates from models of the United Kingdom, France, Belgium and The Netherlands.

PubMed

Keogh-Brown, Marcus Richard; Smith, Richard D; Edmunds, John W; Beutels, Philippe

2010-12-01

The 2003 outbreak of severe acute respiratory syndrome (SARS) showed that infectious disease outbreaks can have notable macroeconomic impacts. The current H1N1 and potential H5N1 flu pandemics could have a much greater impact. Using a multi-sector single country computable general equilibrium model of the United Kingdom, France, Belgium and The Netherlands, together with disease scenarios of varying severity, we examine the potential economic cost of a modern pandemic. Policies of school closure, vaccination and antivirals, together with prophylactic absence from work are evaluated and their cost impacts are estimated. Results suggest GDP losses from the disease of approximately 0.5-2% but school closure and prophylactic absenteeism more than triples these effects. Increasing school closures from 4 weeks at the peak to entire pandemic closure almost doubles the economic cost, but antivirals and vaccinations seem worthwhile. Careful planning is therefore important to ensure expensive policies to mitigate the pandemic are effective in minimising illness and deaths.

Free electron lasers for 13nm EUV lithography: RF design strategies to minimise investment and operational costs

NASA Astrophysics Data System (ADS)

Keens, Simon; Rossa, Bernhard; Frei, Marcel

2016-03-01

As the semiconductor industry proceeds to develop ever better sources of extreme ultraviolet (EUV) light for photolithography applications, two distinct technologies have come to prominence: Tin-plasma and free electron laser (FEL) sources. Tin plasma sources have been in development within the industry for many years, and have been widely reported. Meanwhile, FELs represent the most promising alternative to create high power EUV frequencies and, while tin-plasma source development has been ongoing, such lasers have been continuously developed by academic institutions for use in fundamental research programmes in conjunction with universities and national scientific institutions. This paper follows developments in the field of academic FELs, and presents information regarding novel technologies, specifically in the area of RF design strategy, that may be incorporated into future industrial FEL systems for EUV lithography in order to minimize the necessary investment and operational costs. It goes on to try to assess the cost-benefit of an alternate RF design strategy, based upon previous studies.

Finite horizon EOQ model for non-instantaneous deteriorating items with price and advertisement dependent demand and partial backlogging under inflation

NASA Astrophysics Data System (ADS)

Palanivel, M.; Uthayakumar, R.

2015-07-01

This paper deals with an economic order quantity (EOQ) model for non-instantaneous deteriorating items with price and advertisement dependent demand pattern under the effect of inflation and time value of money over a finite planning horizon. In this model, shortages are allowed and partially backlogged. The backlogging rate is dependent on the waiting time for the next replenishment. This paper aids the retailer in minimising the total inventory cost by finding the optimal interval and the optimal order quantity. An algorithm is designed to find the optimum solution of the proposed model. Numerical examples are given to demonstrate the results. Also, the effect of changes in the different parameters on the optimal total cost is graphically presented and the implications are discussed in detail.

A new and inexpensive pyranometer for the visible spectral range.

PubMed

Martínez, Miguel A; Andújar, José M; Enrique, Juan M

2009-01-01

This paper presents the design, construction and testing of a new photodiode-based pyranometer for the visible spectral range (approx. 400 to 750 nm), whose principal characteristics are: accuracy, ease of connection, immunity to noise, remote programming and operation, interior temperature regulation, cosine error minimisation and all this at a very low cost, tens of times lower than that of commercial thermopile-based devices. This new photodiode-based pyranometer overcomes traditional problems in this type of device and offers similar characteristics to those of thermopile-based pyranometers and, therefore, can be used in any installation where reliable measurement of solar irradiance is necessary, especially in those where cost is a deciding factor in the choice of a meter. This new pyranometer has been registered in the Spanish Patent and Trademark Office under the number P200703162.

A New and Inexpensive Pyranometer for the Visible Spectral Range

PubMed Central

Martínez, Miguel A.; Andújar, José M.; Enrique, Juan M.

2009-01-01

This paper presents the design, construction and testing of a new photodiode-based pyranometer for the visible spectral range (approx. 400 to 750 nm), whose principal characteristics are: accuracy, ease of connection, immunity to noise, remote programming and operation, interior temperature regulation, cosine error minimisation and all this at a very low cost, tens of times lower than that of commercial thermopile-based devices. This new photodiode-based pyranometer overcomes traditional problems in this type of device and offers similar characteristics to those of thermopile-based pyranometers and, therefore, can be used in any installation where reliable measurement of solar irradiance is necessary, especially in those where cost is a deciding factor in the choice of a meter. This new pyranometer has been registered in the Spanish Patent and Trademark Office under the number P200703162. PMID:22408545

Influence of superstition on the date of hospital discharge and medical cost in Japan: retrospective and descriptive study.

PubMed

Hira, K; Fukui, T; Endoh, A; Rahman, M; Maekawa, M

To determine the influence of superstition about Taian (a lucky day)-Butsumetsu (an unlucky day) on decision to leave hospital. To estimate the costs of the effect of this superstition. Retrospective and descriptive study. University hospital in Kyoto, Japan. Patients who were discharged alive from Kyoto University Hospital from 1 April 1992 to 31 March 1995. Mean number, age, and hospital stay of patients discharged on each day of six day cycle. The mean number, age, and hospital stay of discharged patients were highest on Taian and lowest on Butsumetsu (25.8 v 19.3 patients/day, P=0.0001; 43.9 v 41.4 years, P=0.0001; and 43.1 v 33.3 days, P=0.0001 respectively). The effect of this difference on the hospital's costs was estimated to be 7.4 million yen (¿31 000). The superstition influenced the decision to leave hospital, contributing to higher medical care costs in Japan. Although hospital stays need to be kept as short as possible to minimise costs, doctors should not ignore the possible psychological effects on patients' health caused by dismissing the superstition.

Where and when should sensors move? Sampling using the expected value of information.

PubMed

de Bruin, Sytze; Ballari, Daniela; Bregt, Arnold K

2012-11-26

In case of an environmental accident, initially available data are often insufficient for properly managing the situation. In this paper, new sensor observations are iteratively added to an initial sample by maximising the global expected value of information of the points for decision making. This is equivalent to minimizing the aggregated expected misclassification costs over the study area. The method considers measurement error and different costs for class omissions and false class commissions. Constraints imposed by a mobile sensor web are accounted for using cost distances to decide which sensor should move to the next sample location. The method is demonstrated using synthetic examples of static and dynamic phenomena. This allowed computation of the true misclassification costs and comparison with other sampling approaches. The probability of local contamination levels being above a given critical threshold were computed by indicator kriging. In the case of multiple sensors being relocated simultaneously, a genetic algorithm was used to find sets of suitable new measurement locations. Otherwise, all grid nodes were searched exhaustively, which is computationally demanding. In terms of true misclassification costs, the method outperformed random sampling and sampling based on minimisation of the kriging variance.

Where and When Should Sensors Move? Sampling Using the Expected Value of Information

PubMed Central

de Bruin, Sytze; Ballari, Daniela; Bregt, Arnold K.

2012-01-01

In case of an environmental accident, initially available data are often insufficient for properly managing the situation. In this paper, new sensor observations are iteratively added to an initial sample by maximising the global expected value of information of the points for decision making. This is equivalent to minimizing the aggregated expected misclassification costs over the study area. The method considers measurement error and different costs for class omissions and false class commissions. Constraints imposed by a mobile sensor web are accounted for using cost distances to decide which sensor should move to the next sample location. The method is demonstrated using synthetic examples of static and dynamic phenomena. This allowed computation of the true misclassification costs and comparison with other sampling approaches. The probability of local contamination levels being above a given critical threshold were computed by indicator kriging. In the case of multiple sensors being relocated simultaneously, a genetic algorithm was used to find sets of suitable new measurement locations. Otherwise, all grid nodes were searched exhaustively, which is computationally demanding. In terms of true misclassification costs, the method outperformed random sampling and sampling based on minimisation of the kriging variance. PMID:23443379

A Programme for Risk Assessment and Minimisation of Progressive Multifocal Leukoencephalopathy Developed for Vedolizumab Clinical Trials.

PubMed

Parikh, Asit; Stephens, Kristin; Major, Eugene; Fox, Irving; Milch, Catherine; Sankoh, Serap; Lev, Michael H; Provenzale, James M; Shick, Jesse; Patti, Mark; McAuliffe, Megan; Berger, Joseph R; Clifford, David B

2018-05-08

Over the past decade, the potential for drug-associated progressive multifocal leukoencephalopathy (PML) has become an increasingly important consideration in certain drug development programmes, particularly those of immunomodulatory biologics. Whether the risk of PML with an investigational agent is proven (e.g. extrapolated from relevant experience, such as a class effect) or merely theoretical, the serious consequences of acquiring PML require careful risk minimisation and assessment. No single standard for such risk minimisation exists. Vedolizumab is a recently developed monoclonal antibody to α4β7 integrin. Its clinical development necessitated a dedicated PML risk minimisation assessment as part of a global preapproval regulatory requirement. The aim of this study was to describe the multiple risk minimisation elements that were incorporated in vedolizumab clinical trials in inflammatory bowel disease patients as part of the risk assessment and minimisation of PML programme for vedolizumab. A case evaluation algorithm was developed for sequential screening and diagnostic evaluation of subjects who met criteria that indicated a clinical suspicion of PML. An Independent Adjudication Committee provided an independent, unbiased opinion regarding the likelihood of PML. Although no cases were detected, all suspected PML events were thoroughly reviewed and successfully adjudicated, making it unlikely that cases were missed. We suggest that this programme could serve as a model for pragmatic screening for PML during the clinical development of new drugs.

Comparison of different strategies in prenatal screening for Down's syndrome: cost effectiveness analysis of computer simulation.

PubMed

Gekas, Jean; Gagné, Geneviève; Bujold, Emmanuel; Douillard, Daniel; Forest, Jean-Claude; Reinharz, Daniel; Rousseau, François

2009-02-13

To assess and compare the cost effectiveness of three different strategies for prenatal screening for Down's syndrome (integrated test, sequential screening, and contingent screenings) and to determine the most useful cut-off values for risk. Computer simulations to study integrated, sequential, and contingent screening strategies with various cut-offs leading to 19 potential screening algorithms. The computer simulation was populated with data from the Serum Urine and Ultrasound Screening Study (SURUSS), real unit costs for healthcare interventions, and a population of 110 948 pregnancies from the province of Québec for the year 2001. Cost effectiveness ratios, incremental cost effectiveness ratios, and screening options' outcomes. The contingent screening strategy dominated all other screening options: it had the best cost effectiveness ratio ($C26,833 per case of Down's syndrome) with fewer procedure related euploid miscarriages and unnecessary terminations (respectively, 6 and 16 per 100,000 pregnancies). It also outperformed serum screening at the second trimester. In terms of the incremental cost effectiveness ratio, contingent screening was still dominant: compared with screening based on maternal age alone, the savings were $C30,963 per additional birth with Down's syndrome averted. Contingent screening was the only screening strategy that offered early reassurance to the majority of women (77.81%) in first trimester and minimised costs by limiting retesting during the second trimester (21.05%). For the contingent and sequential screening strategies, the choice of cut-off value for risk in the first trimester test significantly affected the cost effectiveness ratios (respectively, from $C26,833 to $C37,260 and from $C35,215 to $C45,314 per case of Down's syndrome), the number of procedure related euploid miscarriages (from 6 to 46 and from 6 to 45 per 100,000 pregnancies), and the number of unnecessary terminations (from 16 to 26 and from 16 to 25 per 100,000 pregnancies). Contingent screening, with a first trimester cut-off value for high risk of 1 in 9, is the preferred option for prenatal screening of women for pregnancies affected by Down's syndrome.

Including quality attributes in efficiency measures consistent with net benefit: creating incentives for evidence based medicine in practice.

PubMed

Eckermann, Simon; Coelli, Tim

2013-01-01

Evidence based medicine supports net benefit maximising therapies and strategies in processes of health technology assessment (HTA) for reimbursement and subsidy decisions internationally. However, translation of evidence based medicine to practice is impeded by efficiency measures such as cost per case-mix adjusted separation in hospitals, which ignore health effects of care. In this paper we identify a correspondence method that allows quality variables under control of providers to be incorporated in efficiency measures consistent with maximising net benefit. Including effects framed from a disutility bearing (utility reducing) perspective (e.g. mortality, morbidity or reduction in life years) as inputs and minimising quality inclusive costs on the cost-disutility plane is shown to enable efficiency measures consistent with maximising net benefit under a one to one correspondence. The method combines advantages of radial properties with an appropriate objective of maximising net benefit to overcome problems of inappropriate objectives implicit with alternative methods, whether specifying quality variables with utility bearing output (e.g. survival, reduction in morbidity or life years), hyperbolic or exogenous variables. This correspondence approach is illustrated in undertaking efficiency comparison at a clinical activity level for 45 Australian hospitals allowing for their costs and mortality rates per admission. Explicit coverage and comparability conditions of the underlying correspondence method are also shown to provide a robust framework for preventing cost-shifting and cream-skimming incentives, with appropriate qualification of analysis and support for data linkage and risk adjustment where these conditions are not satisfied. Comparison on the cost-disutility plane has previously been shown to have distinct advantages in comparing multiple strategies in HTA, which this paper naturally extends to a robust method and framework for comparing efficiency of health care providers in practice. Consequently, the proposed approach provides a missing link between HTA and practice, to allow active incentives for evidence based net benefit maximisation in practice. Copyright © 2012 Elsevier Ltd. All rights reserved.

[Retrospective Analysis of Diabetics with Regard to Treatment Duration and Costs].

PubMed

Pscherer, S; Nüssler, A; Bahrs, C; Reumann, M; Ihle, C; Stöckle, U; Ehnert, S; Freude, T; Ochs, B G; Flesch, I; Ziegler, P

2017-02-01

Background: The increasing incidence of diabetes mellitus is also reflected in the patient population of a trauma and orthopaedic centre. Diabetics also exhibit more comorbidities than non-diabetics. In addition to surgical problems in these patients, hospitalisation is often accompanied by complications, which can prolong treatment and increase costs. The aim of this retrospective study is to analyse hospitalisation of diabetics compared to non-diabetics, as well as differences in treatment costs, depending on associated age and comorbidities. Patients/Material and Methods: 17,185 patients were treated at a transregional trauma and orthopaedic centre and were included in this retrospective analysis between 2012 and 2015. Comorbidities and hospitalisation of diabetics and non-diabetics were recorded. All costs charged by DRG were evaluated to calculate the cost per day and per patient, on the basis of the specific case rate. In this calculation, patient-related case rates were divided by the average residence time and the means of the calculated daily rates were calculated. Inclusion criteria were treatment within the various departments and a minimum hospitalisation of one day. Statistical analysis was performed with the SPSS program (version 22.0, SPSS Inc., Chicago, USA). Results: In comparison to non-diabetics (ND), diabetics (D) exhibited significantly more comorbidities, including: obesity, arterial hypertension, coronary heart disease, myocardial infarction (in the history), peripheral arterial disease, chronic kidney disease and hyperlipidaemia. Pneumonia in hospital was considerably commoner in diabetics (2.45 % [D] vs. 1.02 % [ND], p < 0.001). Time in hospital was significantly longer in diabetics (endoprosthetics 13.52 days [D] vs. 12.54 days [ND], p < 0.001; septic surgery 18.62 days [D] vs. 16.31 days [ND], p = 0.007; traumatology 9.82 days [D] vs. 7.07 days [ND], p < 0.001). For patients aged under 60 years, time in hospital was significantly longer for diabetics than for non-diabetics (9.98 days [D] vs. 6.43 days [ND] p < 0.001). Because of the longer time in hospital, treatment costs were higher by € 1,932,929.42 during the investigated time period. Conclusion: Because of their comorbidities, diabetics need to be categorised at an early stage as high-risk patients in traumatological and orthopaedic departments. Hospitalisation and the associated increased treatment costs, as well as postoperative complications, could be minimised in patients with diabetes by implementing an interdisciplinary treatment concept. Georg Thieme Verlag KG Stuttgart · New York.

Psychometric Evaluation of the Student Authorship Questionnaire: A Confirmatory Factor Analysis Approach

ERIC Educational Resources Information Center

Ballantine, Joan; Guo, Xin; Larres, Patricia

2015-01-01

This research provides new insights into the measurement of students' authorial identity and its potential for minimising the incidence of unintentional plagiarism by providing evidence about the psychometric properties of the Student Authorship Questionnaire (SAQ). Exploratory and confirmatory factor analyses (EFA and CFA) are employed to…

Cost effectiveness of home ultraviolet B phototherapy for psoriasis: economic evaluation of a randomised controlled trial (PLUTO study).

PubMed

Koek, Mayke B G; Sigurdsson, Vigfús; van Weelden, Huib; Steegmans, Paul H A; Bruijnzeel-Koomen, Carla A F M; Buskens, Erik

2010-04-20

To assess the costs and cost effectiveness of phototherapy with ultraviolet B light provided at home compared with outpatient ultraviolet B phototherapy for psoriasis. Cost utility, cost effectiveness, and cost minimisation analyses performed alongside a pragmatic randomised clinical trial (the PLUTO study) at the end of phototherapy (mean 17.6 weeks) and at one year after the end of phototherapy (mean 68.4 weeks). Secondary care, provided by a dermatologist in the Netherlands. 196 adults with psoriasis who were clinically eligible for narrowband (TL-01) ultraviolet B phototherapy were recruited from the dermatology departments of 14 hospitals and were followed until the end of phototherapy. From the end of phototherapy onwards, follow-up was continued for an unselected, consecutive group of 105 patients for one year after end of phototherapy. Ultraviolet B phototherapy provided at home (intervention) and conventional outpatient ultraviolet B phototherapy (control) in a setting reflecting routine practice in the Netherlands. Both treatments used narrowband ultraviolet B lamps (TL-01). Total costs to society, quality adjusted life years (QALYs) as calculated using utilities measured by the EQ-5D questionnaire, and the number of days with a relevant treatment effect (>/=50% improvement of the baseline self administered psoriasis area and severity index (SAPASI)). Home phototherapy is at least as effective and safe as outpatient phototherapy, therefore allowing cost minimisation analyses (simply comparing costs). The average total costs by the end of phototherapy were euro800 for home treatment and euro752 for outpatient treatment, showing an incremental cost per patient of euro48 (95% CI euro-77 to euro174). The average total costs by one year after the end of phototherapy were euro1272 and euro1148 respectively (difference euro124, 95% CI euro-155 to euro403). Cost utility analyses revealed that patients experienced equal health benefits-that is, a gain of 0.296 versus 0.291 QALY (home v outpatient) by the end of phototherapy (difference 0.0052, -0.0244 to 0.0348) and 1.153 versus 1.126 QALY by one year after the end of phototherapy (difference 0.0267, -0.024 to 0.078). Incremental costs per QALY gained were euro9276 and euro4646 respectively, both amounts well below the normally accepted standard of euro20 000 per QALY. Cost effectiveness analyses indicated that the mean number of days with a relevant treatment effect was 42.4 versus 55.3 by the end of phototherapy (difference -12.9, -23.4 to -2.4). By one year after the end of phototherapy the number of days with a relevant treatment effect were 216.5 and 210.4 respectively (6.1, -41.1 to 53.2), yielding an incremental cost of euro20 per additional day with a relevant treatment effect. Home ultraviolet B phototherapy for psoriasis is not more expensive than phototherapy in an outpatient setting and proved to be cost effective. As both treatments are at least equally effective and patients express a preference for home treatment, the authors conclude that home phototherapy should be the primary treatment option for patients who are eligible for phototherapy with ultraviolet B light. Current Controlled Trials ISRCTN83025173 and Clinicaltrials.gov NCT00150930.

Cost effectiveness of home ultraviolet B phototherapy for psoriasis: economic evaluation of a randomised controlled trial (PLUTO study)

PubMed Central

Sigurdsson, Vigfús; van Weelden, Huib; Steegmans, Paul H A; Bruijnzeel-Koomen, Carla A F M; Buskens, Erik

2010-01-01

Objective To assess the costs and cost effectiveness of phototherapy with ultraviolet B light provided at home compared with outpatient ultraviolet B phototherapy for psoriasis. Design Cost utility, cost effectiveness, and cost minimisation analyses performed alongside a pragmatic randomised clinical trial (the PLUTO study) at the end of phototherapy (mean 17.6 weeks) and at one year after the end of phototherapy (mean 68.4 weeks). Setting Secondary care, provided by a dermatologist in the Netherlands. Participants 196 adults with psoriasis who were clinically eligible for narrowband (TL-01) ultraviolet B phototherapy were recruited from the dermatology departments of 14 hospitals and were followed until the end of phototherapy. From the end of phototherapy onwards, follow-up was continued for an unselected, consecutive group of 105 patients for one year after end of phototherapy. Interventions Ultraviolet B phototherapy provided at home (intervention) and conventional outpatient ultraviolet B phototherapy (control) in a setting reflecting routine practice in the Netherlands. Both treatments used narrowband ultraviolet B lamps (TL-01). Main outcome measures Total costs to society, quality adjusted life years (QALYs) as calculated using utilities measured by the EQ-5D questionnaire, and the number of days with a relevant treatment effect (≥50% improvement of the baseline self administered psoriasis area and severity index (SAPASI)). Results Home phototherapy is at least as effective and safe as outpatient phototherapy, therefore allowing cost minimisation analyses (simply comparing costs). The average total costs by the end of phototherapy were €800 for home treatment and €752 for outpatient treatment, showing an incremental cost per patient of €48 (95% CI €−77 to €174). The average total costs by one year after the end of phototherapy were €1272 and €1148 respectively (difference €124, 95% CI €−155 to €403). Cost utility analyses revealed that patients experienced equal health benefits—that is, a gain of 0.296 versus 0.291 QALY (home v outpatient) by the end of phototherapy (difference 0.0052, −0.0244 to 0.0348) and 1.153 versus 1.126 QALY by one year after the end of phototherapy (difference 0.0267, −0.024 to 0.078). Incremental costs per QALY gained were €9276 and €4646 respectively, both amounts well below the normally accepted standard of €20 000 per QALY. Cost effectiveness analyses indicated that the mean number of days with a relevant treatment effect was 42.4 versus 55.3 by the end of phototherapy (difference −12.9, −23.4 to −2.4). By one year after the end of phototherapy the number of days with a relevant treatment effect were 216.5 and 210.4 respectively (6.1, −41.1 to 53.2), yielding an incremental cost of €20 per additional day with a relevant treatment effect. Conclusions Home ultraviolet B phototherapy for psoriasis is not more expensive than phototherapy in an outpatient setting and proved to be cost effective. As both treatments are at least equally effective and patients express a preference for home treatment, the authors conclude that home phototherapy should be the primary treatment option for patients who are eligible for phototherapy with ultraviolet B light. Trial registration Current Controlled Trials ISRCTN83025173 and Clinicaltrials.gov NCT00150930 PMID:20406865

PWHATSHAP: efficient haplotyping for future generation sequencing.

PubMed

Bracciali, Andrea; Aldinucci, Marco; Patterson, Murray; Marschall, Tobias; Pisanti, Nadia; Merelli, Ivan; Torquati, Massimo

2016-09-22

Haplotype phasing is an important problem in the analysis of genomics information. Given a set of DNA fragments of an individual, it consists of determining which one of the possible alleles (alternative forms of a gene) each fragment comes from. Haplotype information is relevant to gene regulation, epigenetics, genome-wide association studies, evolutionary and population studies, and the study of mutations. Haplotyping is currently addressed as an optimisation problem aiming at solutions that minimise, for instance, error correction costs, where costs are a measure of the confidence in the accuracy of the information acquired from DNA sequencing. Solutions have typically an exponential computational complexity. WHATSHAP is a recent optimal approach which moves computational complexity from DNA fragment length to fragment overlap, i.e., coverage, and is hence of particular interest when considering sequencing technology's current trends that are producing longer fragments. Given the potential relevance of efficient haplotyping in several analysis pipelines, we have designed and engineered PWHATSHAP, a parallel, high-performance version of WHATSHAP. PWHATSHAP is embedded in a toolkit developed in Python and supports genomics datasets in standard file formats. Building on WHATSHAP, PWHATSHAP exhibits the same complexity exploring a number of possible solutions which is exponential in the coverage of the dataset. The parallel implementation on multi-core architectures allows for a relevant reduction of the execution time for haplotyping, while the provided results enjoy the same high accuracy as that provided by WHATSHAP, which increases with coverage. Due to its structure and management of the large datasets, the parallelisation of WHATSHAP posed demanding technical challenges, which have been addressed exploiting a high-level parallel programming framework. The result, PWHATSHAP, is a freely available toolkit that improves the efficiency of the analysis of genomics information.

Minimising the risk of Mycobacterium chimaera infection during cardiopulmonary bypass by the removal of heater-cooler units from the operating room.

PubMed

Barker, Thomas A; Dandekar, Uday; Fraser, Nina; Dawkin, Lincoln; Sweeney, Paul; Heron, Fraser; Simmons, Jacqui; Parmar, Jitendra

2018-05-01

Mycobacterium chimaera ( M. chimaera) is a recently characterised bacterium that can cause life-threatening infections in small numbers of patients who undergo cardiopulmonary bypass during cardiac surgery. The likely mode of transmission is thought to occur through aerosolisation from contaminated water reservoirs. The airborne bacteria then contaminate the surgical field, leading to an infection months or even years later. The preferred practical solution to disrupt the transmission of these airborne bacteria to the patient is to remove the heater-cooler units (HCUs) from the operating room (OR). We describe a process of achieving this in order to provide information to guide other institutions who wish to do a similar thing. A multidisciplinary team was assembled to work on the project. The planning phase involved trialling different OR layouts and simulating the alterations in the HCU circuit function. The changes to the OR were made over a weekend to minimise disruption to the operating schedule. The HCU was moved to the dirty utility room adjacent to the OR. Standard operating procedures (SOP) and risk assessments were made to enable this to be used for a dual purpose. One of the ORs was reconfigured to allow the cardiopulmonary bypass machine to be located close to the HCU in the dirty utility room. The total cost of the alterations was £6,158. Although we have provided a physical barrier to interrupt patient exposure to aerosolised M. chimaera from HCUs, we continue to perform cultures and decontamination as per the national recommendations. The SOP was designed to be auditable to ensure compliance with the protocols. We show a method by which the HCU can be removed from the OR in a relatively low-cost, straightforward and practical manner.

Analysing concurrent transcranial magnetic stimulation and electroencephalographic data: A review and introduction to the open-source TESA software.

PubMed

Rogasch, Nigel C; Sullivan, Caley; Thomson, Richard H; Rose, Nathan S; Bailey, Neil W; Fitzgerald, Paul B; Farzan, Faranak; Hernandez-Pavon, Julio C

2017-02-15

The concurrent use of transcranial magnetic stimulation with electroencephalography (TMS-EEG) is growing in popularity as a method for assessing various cortical properties such as excitability, oscillations and connectivity. However, this combination of methods is technically challenging, resulting in artifacts both during recording and following typical EEG analysis methods, which can distort the underlying neural signal. In this article, we review the causes of artifacts in EEG recordings resulting from TMS, as well as artifacts introduced during analysis (e.g. as the result of filtering over high-frequency, large amplitude artifacts). We then discuss methods for removing artifacts, and ways of designing pipelines to minimise analysis-related artifacts. Finally, we introduce the TMS-EEG signal analyser (TESA), an open-source extension for EEGLAB, which includes functions that are specific for TMS-EEG analysis, such as removing and interpolating the TMS pulse artifact, removing and minimising TMS-evoked muscle activity, and analysing TMS-evoked potentials. The aims of TESA are to provide users with easy access to current TMS-EEG analysis methods and to encourage direct comparisons of these methods and pipelines. It is hoped that providing open-source functions will aid in both improving and standardising analysis across the field of TMS-EEG research. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Large signal-to-noise ratio quantification in MLE for ARARMAX models

NASA Astrophysics Data System (ADS)

Zou, Yiqun; Tang, Xiafei

2014-06-01

It has been shown that closed-loop linear system identification by indirect method can be generally transferred to open-loop ARARMAX (AutoRegressive AutoRegressive Moving Average with eXogenous input) estimation. For such models, the gradient-related optimisation with large enough signal-to-noise ratio (SNR) can avoid the potential local convergence in maximum likelihood estimation. To ease the application of this condition, the threshold SNR needs to be quantified. In this paper, we build the amplitude coefficient which is an equivalence to the SNR and prove the finiteness of the threshold amplitude coefficient within the stability region. The quantification of threshold is achieved by the minimisation of an elaborately designed multi-variable cost function which unifies all the restrictions on the amplitude coefficient. The corresponding algorithm based on two sets of physically realisable system input-output data details the minimisation and also points out how to use the gradient-related method to estimate ARARMAX parameters when local minimum is present as the SNR is small. Then, the algorithm is tested on a theoretical AutoRegressive Moving Average with eXogenous input model for the derivation of the threshold and a gas turbine engine real system for model identification, respectively. Finally, the graphical validation of threshold on a two-dimensional plot is discussed.

Alternative approaches for vertebrate ecotoxicity tests in the ...

EPA Pesticide Factsheets

The need for alternative approaches to the use of vertebrate animals for hazard assessing chemicals and pollutants has become of increasing importance. It is now the first consideration when initiating a vertebrate ecotoxicity test, to ensure that unnecessary use of vertebrate organisms is minimised wherever possible. For some regulatory purposes, the use of vertebrate organisms for environmental risk assessments (ERA) has even been banned, and in other situations the numbers of organisms tested has been dramatically reduced, or the severity of the procedure refined. However, there is still a long way to go to achieve replacement of vertebrate organisms to generate environmental hazard data. The development of animal alternatives is not just based on ethical considerations but also to reduce the cost of performing vertebrate ecotoxicity tests and in some cases to provide better information aimed at improving ERAs. The present focus paper provides an overview of the considerable advances that have been made towards alternative approaches for ecotoxicity assessments over the last few decades. The need for alternative approaches to the use of vertebrate animals for hazard assessing chemicals and pollutants has become of increasing importance. It is now the first consideration when initiating a vertebrate ecotoxicity test, to ensure that unnecessary use of vertebrate organisms is minimised wherever possible. For some regulatory purposes, the use of vertebrate organi

A Compact Optical Instrument with Artificial Neural Network for pH Determination

PubMed Central

Capel-Cuevas, Sonia; López-Ruiz, Nuria; Martinez-Olmos, Antonio; Cuéllar, Manuel P.; Pegalajar, Maria del Carmen; Palma, Alberto José; de Orbe-Payá, Ignacio; Capitán-Vallvey, Luis Fermin

2012-01-01

The aim of this work was the determination of pH with a sensor array-based optical portable instrument. This sensor array consists of eleven membranes with selective colour changes at different pH intervals. The method for the pH calculation is based on the implementation of artificial neural networks that use the responses of the membranes to generate a final pH value. A multi-objective algorithm was used to select the minimum number of sensing elements required to achieve an accurate pH determination from the neural network, and also to minimise the network size. This helps to minimise instrument and array development costs and save on microprocessor energy consumption. A set of artificial neural networks that fulfils these requirements is proposed using different combinations of the membranes in the sensor array, and is evaluated in terms of accuracy and reliability. In the end, the network including the response of the eleven membranes in the sensor was selected for validation in the instrument prototype because of its high accuracy. The performance of the instrument was evaluated by measuring the pH of a large set of real samples, showing that high precision can be obtained in the full range. PMID:22778668

Energy-efficient quantum frequency estimation

NASA Astrophysics Data System (ADS)

Liuzzo-Scorpo, Pietro; Correa, Luis A.; Pollock, Felix A.; Górecka, Agnieszka; Modi, Kavan; Adesso, Gerardo

2018-06-01

The problem of estimating the frequency of a two-level atom in a noisy environment is studied. Our interest is to minimise both the energetic cost of the protocol and the statistical uncertainty of the estimate. In particular, we prepare a probe in a ‘GHZ-diagonal’ state by means of a sequence of qubit gates applied on an ensemble of n atoms in thermal equilibrium. Noise is introduced via a phenomenological time-non-local quantum master equation, which gives rise to a phase-covariant dissipative dynamics. After an interval of free evolution, the n-atom probe is globally measured at an interrogation time chosen to minimise the error bars of the final estimate. We model explicitly a measurement scheme which becomes optimal in a suitable parameter range, and are thus able to calculate the total energetic expenditure of the protocol. Interestingly, we observe that scaling up our multipartite entangled probes offers no precision enhancement when the total available energy {\\boldsymbol{ \\mathcal E }} is limited. This is at stark contrast with standard frequency estimation, where larger probes—more sensitive but also more ‘expensive’ to prepare—are always preferred. Replacing {\\boldsymbol{ \\mathcal E }} by the resource that places the most stringent limitation on each specific experimental setup, would thus help to formulate more realistic metrological prescriptions.

Design considerations for genetic linkage and association studies.

PubMed

Nsengimana, Jérémie; Bishop, D Timothy

2012-01-01

This chapter describes the main issues that genetic epidemiologists usually consider in the design of linkage and association studies. For linkage, we briefly consider the situation of rare, highly penetrant alleles showing a disease pattern consistent with Mendelian inheritance investigated through parametric methods in large pedigrees or with autozygosity mapping in inbred families, and we then turn our focus to the most common design, affected sibling pairs, of more relevance for common, complex diseases. Theoretical and more practical power and sample size calculations are provided as a function of the strength of the genetic effect being investigated. We also discuss the impact of other determinants of statistical power such as disease heterogeneity, pedigree, and genotyping errors, as well as the effect of the type and density of genetic markers. Linkage studies should be as large as possible to have sufficient power in relation to the expected genetic effect size. Segregation analysis, a formal statistical technique to describe the underlying genetic susceptibility, may assist in the estimation of the relevant parameters to apply, for instance. However, segregation analyses estimate the total genetic component rather than a single-locus effect. Locus heterogeneity should be considered when power is estimated and at the analysis stage, i.e. assuming smaller locus effect than the total the genetic component from segregation studies. Disease heterogeneity should be minimised by considering subtypes if they are well defined or by otherwise collecting known sources of heterogeneity and adjusting for them as covariates; the power will depend upon the relationship between the disease subtype and the underlying genotypes. Ultimately, identifying susceptibility alleles of modest effects (e.g. RR≤1.5) requires a number of families that seem unfeasible in a single study. Meta-analysis and data pooling between different research groups can provide a sizeable study, but both approaches require even a higher level of vigilance about locus and disease heterogeneity when data come from different populations. All necessary steps should be taken to minimise pedigree and genotyping errors at the study design stage as they are, for the most part, due to human factors. A two-stage design is more cost-effective than one stage when using short tandem repeats (STRs). However, dense single-nucleotide polymorphism (SNP) arrays offer a more robust alternative, and due to their lower cost per unit, the total cost of studies using SNPs may in the future become comparable to that of studies using STRs in one or two stages. For association studies, we consider the popular case-control design for dichotomous phenotypes, and we provide power and sample size calculations for one-stage and multistage designs. For candidate genes, guidelines are given on the prioritisation of genetic variants, and for genome-wide association studies (GWAS), the issue of choosing an appropriate SNP array is discussed. A warning is issued regarding the danger of designing an underpowered replication study following an initial GWAS. The risk of finding spurious association due to population stratification, cryptic relatedness, and differential bias is underlined. GWAS have a high power to detect common variants of high or moderate effect. For weaker effects (e.g. relative risk<1.2), the power is greatly reduced, particularly for recessive loci. While sample sizes of 10,000 or 20,000 cases are not beyond reach for most common diseases, only meta-analyses and data pooling can allow attaining a study size of this magnitude for many other diseases. It is acknowledged that detecting the effects from rare alleles (i.e. frequency<5%) is not feasible in GWAS, and it is expected that novel methods and technology, such as next-generation resequencing, will fill this gap. At the current stage, the choice of which GWAS SNP array to use does not influence the power in populations of European ancestry. A multistage design reduces the study cost but has less power than the standard one-stage design. If one opts for a multistage design, the power can be improved by jointly analysing the data from different stages for the SNPs they share. The estimates of locus contribution to disease risk from genome-wide scans are often biased, and relying on them might result in an underpowered replication study. Population structure has so far caused less spurious associations than initially feared, thanks to systematic ethnicity matching and application of standard quality control measures. Differential bias could be a more serious threat and must be minimised by strictly controlling all the aspects of DNA acquisition, storage, and processing.

Does the private sector receive an excessive return from investments in health care infrastructure projects? Evidence from the UK.

PubMed

Vecchi, Veronica; Hellowell, Mark; Gatti, Stefano

2013-05-01

This paper is concerned with the cost-efficiency of Private Finance Initiatives (PFIs) in the delivery of hospital facilities in the UK. We outline a methodology for identifying the "fair" return on equity, based on the Weighted Average Cost of Capital (WACC) of each investor. We apply this method to assess the expected returns on a sample of 77 contracts signed between 1997 and 2011 by health care provider organisations in the UK. We show that expected returns are in general in excess of the WACC benchmarks. The findings highlight significant problems in current procurement practices and the methodologies by which bids are assessed. To minimise the financial impact of hospital investments on health care systems, a regulatory regime must ensure that expected returns are set at the "fair" rate. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Multiobjective assessment of distributed energy storage location in electricity networks

NASA Astrophysics Data System (ADS)

Ribeiro Gonçalves, José António; Neves, Luís Pires; Martins, António Gomes

2017-07-01

This paper presents a methodology to provide information to a decision maker on the associated impacts, both of economic and technical nature, of possible management schemes of storage units for choosing the best location of distributed storage devices, with a multiobjective optimisation approach based on genetic algorithms. The methodology was applied to a case study, a known distribution network model in which the installation of distributed storage units was tested, using lithium-ion batteries. The obtained results show a significant influence of the charging/discharging profile of batteries on the choice of their best location, as well as the relevance that these choices may have for the different network management objectives, for example, for reducing network energy losses or minimising voltage deviations. Results also show a difficult cost-effectiveness of an energy-only service, with the tested systems, both due to capital cost and due to the efficiency of conversion.

Optimal ordering and production policy for a recoverable item inventory system with learning effect

NASA Astrophysics Data System (ADS)

Tsai, Deng-Maw

2012-02-01

This article presents two models for determining an optimal integrated economic order quantity and economic production quantity policy in a recoverable manufacturing environment. The models assume that the unit production time of the recovery process decreases with the increase in total units produced as a result of learning. A fixed proportion of used products are collected from customers and then recovered for reuse. The recovered products are assumed to be in good condition and acceptable to customers. Constant demand can be satisfied by utilising both newly purchased products and recovered products. The aim of this article is to show how to minimise total inventory-related cost. The total cost functions of the two models are derived and two simple search procedures are proposed to determine optimal policy parameters. Numerical examples are provided to illustrate the proposed models. In addition, sensitivity analyses have also been performed and are discussed.

The utilisation of engineered invert traps in the management of near bed solids in sewer networks.

PubMed

Ashley, R M; Tait, S J; Stovin, V R; Burrows, R; Framer, A; Buxton, A P; Blackwood, D J; Saul, A J; Blanksby, J R

2003-01-01

Large existing sewers are considerable assets which wastewater utilities will require to operate for the foreseeable future to maintain health and the quality of life in cities. Despite their existence for more than a century there is surprisingly little guidance available to manage these systems to minimise problems associated with in-sewer solids. A joint study has been undertaken in the UK, to refine and utilise new knowledge gained from field data, laboratory results and Computational Fluid Dynamics (CFD) simulations to devise cost beneficial engineering tools for the application of small invert traps to localise the deposition of sediments in sewers at accessible points for collection. New guidance has been produced for trap siting and this has been linked to a risk-cost-effectiveness assessment procedure to enable system operators to approach in-sewer sediment management pro-actively rather than reactively as currently happens.

Impressions of defensive medical practice and medical litigation among South African neurosurgeons.

PubMed

Roytowski, D; Smith, T R; Fieggen, A G; Taylor, A

2014-11-01

From a litigation perspective, neurosurgery is considered a 'super high-risk' field, and this has been associated with rapidly increasing malpractice cover costs. In 2013 the annual Medical Protection Society fee for cover was R250,900. We wished to determine whether high malpractice cover was influencing how neurosurgeons managed patients. A 40-question online survey asking questions on defensive medicine was distributed to determine perceptions around liability risk and whether these influenced how patients were managed. Eighty-four per cent of respondents agreed that a medicolegal crisis existed, and over half (53.8%) had been sued for malpractice during their career. Altering practice behaviour to minimise the risk of a lawsuit is common. The increasing number of legal claims against respondents in this survey has resulted in most neurosurgeons practising defensive medicine. Arguably this will result in increased healthcare costs, inferior patient care and decreased access to skilled surgeons.

Robust optimization based energy dispatch in smart grids considering demand uncertainty

NASA Astrophysics Data System (ADS)

Nassourou, M.; Puig, V.; Blesa, J.

2017-01-01

In this study we discuss the application of robust optimization to the problem of economic energy dispatch in smart grids. Robust optimization based MPC strategies for tackling uncertain load demands are developed. Unexpected additive disturbances are modelled by defining an affine dependence between the control inputs and the uncertain load demands. The developed strategies were applied to a hybrid power system connected to an electrical power grid. Furthermore, to demonstrate the superiority of the standard Economic MPC over the MPC tracking, a comparison (e.g average daily cost) between the standard MPC tracking, the standard Economic MPC, and the integration of both in one-layer and two-layer approaches was carried out. The goal of this research is to design a controller based on Economic MPC strategies, that tackles uncertainties, in order to minimise economic costs and guarantee service reliability of the system.

HIV/AIDS, growth and poverty in KwaZulu-Natal and South Africa: an integrated survey, demographic and economy-wide analysis

PubMed Central

2009-01-01

Background This paper estimates the economic impact of HIV/AIDS on the KwaZulu-Natal province and the rest of South Africa. Methods We extended previous studies by employing: an integrated analytical framework that combined firm surveys of workers' HIV prevalence by sector and occupation; a demographic model that produced both population and workforce projections; and a regionalized economy-wide model linked to a survey-based micro-simulation module. This framework permits a full macro-microeconomic assessment. Results Results indicate that HIV/AIDS greatly reduces annual economic growth, mainly by lowering the long-run rate of technical change. However, impacts on income poverty are small, and inequality is reduced by HIV/AIDS. This is because high unemployment among low-income households minimises the economic costs of increased mortality. By contrast, slower economic growth hurts higher income households despite lower HIV prevalence. Conclusion We conclude that the increase in economic growth that results from addressing HIV/AIDS is sufficient to offset the population pressure placed on income poverty. Moreover, incentives to mitigate HIV/AIDS lie not only with poorer infected households, but also with uninfected higher income households. Our findings reveal the substantial burden that HIV/AIDS places on future economic development in KwaZulu-Natal and South Africa, and confirms the need for policies to curb the economic costs of the pandemic. PMID:19758444

An update on equine post-operative ileus: Definitions, pathophysiology and management.

PubMed

Lisowski, Z M; Pirie, R S; Blikslager, A T; Lefebvre, D; Hume, D A; Hudson, N P H

2018-05-01

Post-operative ileus (POI) is a serious condition which any horse undergoing abdominal surgery is at risk of developing, leading to increased hospitalisation time and resulting costs. Advances in the understanding of the development of equine POI are mainly based on human and rodent literature, where manipulation-induced inflammation has been identified as a trigger, with activation of resident muscularis externa macrophages playing a crucial role in the pathophysiology. Despite many pharmacological trials in all species, there is no single completely successful treatment for POI, highlighting that the condition is multifactorial in cause and requires a multimodal approach to minimise its incidence. © 2017 EVJ Ltd.

Therapeutic potential of cannabis-related drugs.

PubMed

Alexander, Stephen P H

2016-01-04

In this review, I will consider the dual nature of Cannabis and cannabinoids. The duality arises from the potential and actuality of cannabinoids in the laboratory and clinic and the 'abuse' of Cannabis outside the clinic. The therapeutic areas currently best associated with exploitation of Cannabis-related medicines include pain, epilepsy, feeding disorders, multiple sclerosis and glaucoma. As with every other medicinal drug of course, the 'trick' will be to maximise the benefit and minimise the cost. After millennia of proximity and exploitation of the Cannabis plant, we are still playing catch up with an understanding of its potential influence for medicinal benefit. Copyright © 2015 Elsevier Inc. All rights reserved.

Informed use of patients' records on trusted health care services.

PubMed

Sahama, Tony; Miller, Evonne

2011-01-01

Health care is an information-intensive business. Sharing information in health care processes is a smart use of data enabling informed decision-making whilst ensuring. the privacy and security of patient information. To achieve this, we propose data encryption techniques embedded Information Accountability Framework (IAF) that establishes transitions of the technological concept, thus enabling understanding of shared responsibility, accessibility, and efficient cost effective informed decisions between health care professionals and patients. The IAF results reveal possibilities of efficient informed medical decision making and minimisation of medical errors. Of achieving this will require significant cultural changes and research synergies to ensure the sustainability, acceptability and durability of the IAF.

Linear triangular optimization technique and pricing scheme in residential energy management systems

NASA Astrophysics Data System (ADS)

Anees, Amir; Hussain, Iqtadar; AlKhaldi, Ali Hussain; Aslam, Muhammad

2018-06-01

This paper presents a new linear optimization algorithm for power scheduling of electric appliances. The proposed system is applied in a smart home community, in which community controller acts as a virtual distribution company for the end consumers. We also present a pricing scheme between community controller and its residential users based on real-time pricing and likely block rates. The results of the proposed optimization algorithm demonstrate that by applying the anticipated technique, not only end users can minimise the consumption cost, but it can also reduce the power peak to an average ratio which will be beneficial for the utilities as well.

Cattle Uterus: A Novel Animal Laboratory Model for Advanced Hysteroscopic Surgery Training

PubMed Central

Ewies, Ayman A. A.; Khan, Zahid R.

2015-01-01

In recent years, due to reduced training opportunities, the major shift in surgical training is towards the use of simulation and animal laboratories. Despite the merits of Virtual Reality Simulators, they are far from representing the real challenges encountered in theatres. We introduce the “Cattle Uterus Model” in the hope that it will be adopted in training courses as a low cost and easy-to-set-up tool. It adds new dimensions to the advanced hysteroscopic surgery training experience by providing tactile sensation and simulating intraoperative difficulties. It complements conventional surgical training, aiming to maximise clinical exposure and minimise patients' harm. PMID:26265918

Enhancing steel properties through in situ formation of ultrahard ceramic surface

PubMed Central

Pahlevani, Farshid; Kumar, Rahul; Gorjizadeh, Narjes; Hossain, Rumana; Cholake, Sagar T; Privat, Karen; Sahajwalla, Veena

2016-01-01

Abrasion and corrosion resistant steel has attracted considerable interest for industrial application as a means of minimising the costs associated with product/component failures and/or short replacement cycles. These classes of steels contain alloying elements that increase their resistance to abrasion and corrosion. Their benefits, however, currently come at a potentially prohibitive cost; such high performance steel products are both more technically challenging and more expensive to produce. Although these methods have proven effective in improving the performance of more expensive, high-grade steel components, they are not economically viable for relatively low cost steel products. New options are needed. In this study, a complex industrial waste stream has been transformed in situ via precisely controlled high temperature reactions to produce an ultrahard ceramic surface on steel. This innovative ultrahard ceramic surface increases both the hardness and compressive strength of the steel. Furthermore, by modifying the composition of the waste input and the processing parameters, the ceramic surface can be effectively customised to match the intended application of the steel. This economical new approach marries industry demands for more cost-effective, durable steel products with global imperatives to address resource depletion and environmental degradation through the recovery of resources from waste. PMID:27929096

Enhancing steel properties through in situ formation of ultrahard ceramic surface.

PubMed

Pahlevani, Farshid; Kumar, Rahul; Gorjizadeh, Narjes; Hossain, Rumana; Cholake, Sagar T; Privat, Karen; Sahajwalla, Veena

2016-12-08

Abrasion and corrosion resistant steel has attracted considerable interest for industrial application as a means of minimising the costs associated with product/component failures and/or short replacement cycles. These classes of steels contain alloying elements that increase their resistance to abrasion and corrosion. Their benefits, however, currently come at a potentially prohibitive cost; such high performance steel products are both more technically challenging and more expensive to produce. Although these methods have proven effective in improving the performance of more expensive, high-grade steel components, they are not economically viable for relatively low cost steel products. New options are needed. In this study, a complex industrial waste stream has been transformed in situ via precisely controlled high temperature reactions to produce an ultrahard ceramic surface on steel. This innovative ultrahard ceramic surface increases both the hardness and compressive strength of the steel. Furthermore, by modifying the composition of the waste input and the processing parameters, the ceramic surface can be effectively customised to match the intended application of the steel. This economical new approach marries industry demands for more cost-effective, durable steel products with global imperatives to address resource depletion and environmental degradation through the recovery of resources from waste.

A qualitative study of recruiting for investigations in primary care: Plan, pay, minimise intermediaries and keep it simple

PubMed Central

Hao’uli, Sefita; Arroll, Bruce

2015-01-01

Objectives: We sought successful strategies to recruit patient and practitioner participants for studies from primary care. Methods: We interviewed people who had participated and who had not participated in a randomised controlled trial that did not reach recruitment target and successful primary care researchers. The participants and non-participants were mostly Pacific peoples. Interviews were recorded, transcribed, and analysed and reported using qualitative description. The study took place in New Zealand in 2013–2014. Results: A total of 31 people were interviewed. Researchers agreed that recruitment was usually the single most important phase of research but was usually under-planned and under-funded. All researchers recommended a pilot study that addressed recruitment. Successful researchers actively monitored recruitment and adapted the process as needed. Most projects were undertaken by our researchers recruited via an intermediary such as a general practice nurse. Strategies were adapted to the target population, such as specific acute or chronic conditions, age, ethnicity and gender. Intermediaries were actively recruited and retained in a manner that was often more intense than actual participant recruitment and retention. ‘Layers’ of intermediaries were kept to a minimum as each layer needed to be actively recruited and retained and each layer reduced participant recruitment rates. The task of intermediaries was kept simple and minimal and they were paid in some manner. Similarly, participant workload was kept to a minimum and they were paid in some manner that was intended to cover their participation costs and perhaps a little more. Even the most experienced researchers did not always achieve recruitment targets. Our interviews focused on patient participants but included recruiting general practitioners, nurses and others as research subjects. Conclusion: Strategy details varied with the target population but had in common the need to intensively recruit and retain intermediaries, minimise layers of intermediaries, and the need to pay and minimise workload for both intermediaries and participants. PMID:26770794

Sterilization by oxygen plasma

NASA Astrophysics Data System (ADS)

Moreira, Adir José; Mansano, Ronaldo Domingues; Andreoli Pinto, Terezinha de Jesus; Ruas, Ronaldo; Zambon, Luis da Silva; da Silva, Mônica Valero; Verdonck, Patrick Bernard

2004-07-01

The use of polymeric medical devices has stimulated the development of new sterilization methods. The traditional techniques rely on ethylene oxide, but there are many questions concerning the carcinogenic properties of the ethylene oxide residues adsorbed on the materials after processing. Another common technique is the gamma irradiation process, but it is costly, its safe operation requires an isolated site and it also affects the bulk properties of the polymers. The use of a gas plasma is an elegant alternative sterilization technique. The plasma promotes an efficient inactivation of the micro-organisms, minimises the damage to the materials and presents very little danger for personnel and the environment. Pure oxygen reactive ion etching type of plasmas were applied to inactivate a biologic indicator, the Bacillus stearothermophilus, to confirm the efficiency of this process. The sterilization processes took a short time, in a few minutes the mortality was complete. In situ analysis of the micro-organisms' inactivating time was possible using emission spectrophotometry. The increase in the intensity of the 777.5 nm oxygen line shows the end of the oxidation of the biologic materials. The results were also observed and corroborated by scanning electron microscopy.

Cloud-based adaptive exon prediction for DNA analysis.

PubMed

Putluri, Srinivasareddy; Zia Ur Rahman, Md; Fathima, Shaik Yasmeen

2018-02-01

Cloud computing offers significant research and economic benefits to healthcare organisations. Cloud services provide a safe place for storing and managing large amounts of such sensitive data. Under conventional flow of gene information, gene sequence laboratories send out raw and inferred information via Internet to several sequence libraries. DNA sequencing storage costs will be minimised by use of cloud service. In this study, the authors put forward a novel genomic informatics system using Amazon Cloud Services, where genomic sequence information is stored and accessed for processing. True identification of exon regions in a DNA sequence is a key task in bioinformatics, which helps in disease identification and design drugs. Three base periodicity property of exons forms the basis of all exon identification techniques. Adaptive signal processing techniques found to be promising in comparison with several other methods. Several adaptive exon predictors (AEPs) are developed using variable normalised least mean square and its maximum normalised variants to reduce computational complexity. Finally, performance evaluation of various AEPs is done based on measures such as sensitivity, specificity and precision using various standard genomic datasets taken from National Center for Biotechnology Information genomic sequence database.

The influence of client brief and change order in construction project

NASA Astrophysics Data System (ADS)

Mahat, N. A. A.; Adnan, H.

2018-02-01

Construction briefing is a statement of needs about intentions and projects objectives. Briefing process is the preliminary stage in the design process and successful briefing can achieve project delivery right on target time, cost and quality of project confidently. Although there are many efforts to approach client’s requirement and needs for a project, it is still not collected adequately to make proper solutions in design. Thus, these may lead the client to include change orders during the construction phase. This paper is concerned toward the influence of client’s briefing of a construction project that impact on the change order on the construction works. The research objective is to identify the influence of client’s brief on change orders, therefore, the aims of the research is to reduce change orders in project delivery. This research adopted both qualitative and quantitative data collection methods which are content analysis and semi structure interview. The findings highlight factors contributing to change orders and the essential attributes of clients during the briefing stage that may help minimise them.

Extreme Heat and Health: Perspectives from Health Service Providers in Rural and Remote Communities in South Australia

PubMed Central

Williams, Susan; Bi, Peng; Newbury, Jonathan; Robinson, Guy; Pisaniello, Dino; Saniotis, Arthur; Hansen, Alana

2013-01-01

Among the challenges for rural communities and health services in Australia, climate change and increasing extreme heat are emerging as additional stressors. Effective public health responses to extreme heat require an understanding of the impact on health and well-being, and the risk or protective factors within communities. This study draws on lived experiences to explore these issues in eleven rural and remote communities across South Australia, framing these within a socio-ecological model. Semi-structured interviews with health service providers (n = 13), and a thematic analysis of these data, has identified particular challenges for rural communities and their health services during extreme heat. The findings draw attention to the social impacts of extreme heat in rural communities, the protective factors (independence, social support, education, community safety), and challenges for adaptation (vulnerabilities, infrastructure, community demographics, housing and local industries). With temperatures increasing across South Australia, there is a need for local planning and low-cost strategies to address heat-exacerbating factors in rural communities, to minimise the impact of extreme heat in the future. PMID:24173140

The concordance of serial ANA tests in an Australian tertiary hospital pathology laboratory.

PubMed

Lee, Adrian Y S; Hudspeth, Andrew R; Adelstein, Stephen

2016-10-01

The antinuclear antibody (ANA) tests are some of the more frequently requested tests for the diagnosis of autoimmunity. Although they are used primarily as diagnostic blood tests, multiple requests on the same patient continue to be encountered in the laboratory. This retrospective analysis of serial ANA testing at one pathology laboratory in Australia is the first study that examines the statistical concordance and possible implications of this on clinical practice. High-titred ANA have quite good repeatability for titre and pattern, and low-titred ANA, which can be non-specific, have poor repeatability. Staining patterns are, in general, almost random in nature on serial tests when compared to the first-obtained ANA pattern for each patient. This study confirms that there is little benefit in serial ANA testing, and only if there is a clear change in the patient's clinical picture would repeat of an initial low-titred ANA be useful. The findings reinforce the need for pathology stewardship to minimise costs, wasted resources and unnecessary referrals. Copyright © 2016 Royal College of Pathologists of Australasia. All rights reserved.

An analysis of the radioactive contamination due to radon in a granite processing plant and its decontamination by ventilation.

PubMed

Dieguez-Elizondo, Pedro M; Gil-Lopez, Tomas; O'Donohoe, Paul G; Castejon-Navas, Juan; Galvez-Huerta, Miguel A

2017-02-01

This work focuses on studying concentration distribution of 222 Rn radioisotope in a granite processing plant. Using Computational Fluid Dynamic Techniques (CFD), the exposure of the workers to radiation was assessed and, in order to minimise this exposure, different decontamination scenarios using ventilation were analysed. Natural ventilation showed not sufficient to maintain radon concentration below acceptable limits, so a forced ventilation was used instead. Position of the granite blocks also revealed as a determining factor in the radioactive level distribution. Thus, a correct layout of the stored material and an adequate ventilation system can guarantee free of exposure to radiation zones within the studied workshop. This leads to a drastic fall in the exposure of the workers and consequently minimises their risk of developing aggressive illness like lung cancer. Copyright © 2016 Elsevier Ltd. All rights reserved.

Developing and promoting hygiene in the home and community.

PubMed

Bloomfield, S F; Signorelli, C; Fara, G

2010-01-01

The last two decades have seen infectious diseases (IDs) moving back up the health agenda. If the burden of ID is to be contained, the responsibility must be shared by the public. The International Scientific Forum on Home Hygiene (IFH) is working to raise awareness of the role of home hygiene, and promote understanding of hygiene practice. To develop a strategy for home hygiene, IFH has used the available scientific data to formulate a risk-based approach. This "targeted hygiene" approach maximises protection against infection, whilst minimising any impact on the environment from cleaning and disinfection products, minimising any risks associated antimicrobial resistance, and sustaining interaction with the microbial flora of the environment. IFH has developed a comprehensive range of materials which are being promoted through the IFH website and other channels. Analysis of website traffic indicates significant demand for home hygiene information including scientific material and information in "plain language".

Petri-net-based 2D design of DNA walker circuits.

PubMed

Gilbert, David; Heiner, Monika; Rohr, Christian

2018-01-01

We consider localised DNA computation, where a DNA strand walks along a binary decision graph to compute a binary function. One of the challenges for the design of reliable walker circuits consists in leakage transitions, which occur when a walker jumps into another branch of the decision graph. We automatically identify leakage transitions, which allows for a detailed qualitative and quantitative assessment of circuit designs, design comparison, and design optimisation. The ability to identify leakage transitions is an important step in the process of optimising DNA circuit layouts where the aim is to minimise the computational error inherent in a circuit while minimising the area of the circuit. Our 2D modelling approach of DNA walker circuits relies on coloured stochastic Petri nets which enable functionality, topology and dimensionality all to be integrated in one two-dimensional model. Our modelling and analysis approach can be easily extended to 3-dimensional walker systems.

Efficient cost-sensitive human-machine collaboration for offline signature verification

NASA Astrophysics Data System (ADS)

Coetzer, Johannes; Swanepoel, Jacques; Sabourin, Robert

2012-01-01

We propose a novel strategy for the optimal combination of human and machine decisions in a cost-sensitive environment. The proposed algorithm should be especially beneficial to financial institutions where off-line signatures, each associated with a specific transaction value, require authentication. When presented with a collection of genuine and fraudulent training signatures, produced by so-called guinea pig writers, the proficiency of a workforce of human employees and a score-generating machine can be estimated and represented in receiver operating characteristic (ROC) space. Using a set of Boolean fusion functions, the majority vote decision of the human workforce is combined with each threshold-specific machine-generated decision. The performance of the candidate ensembles is estimated and represented in ROC space, after which only the optimal ensembles and associated decision trees are retained. When presented with a questioned signature linked to an arbitrary writer, the system first uses the ROC-based cost gradient associated with the transaction value to select the ensemble that minimises the expected cost, and then uses the corresponding decision tree to authenticate the signature in question. We show that, when utilising the entire human workforce, the incorporation of a machine streamlines the authentication process and decreases the expected cost for all operating conditions.

The role of art education in adult prisons: The Western Australian experience

NASA Astrophysics Data System (ADS)

Giles, Margaret; Paris, Lisa; Whale, Jacqui

2016-12-01

Incarceration costs are high; in Australia, for example, each prisoner costs an average of AUD 115,000 per year. Other countries are also feeling the fiscal pinch of high incarceration costs, and a number of jurisdictions are now closing some of their prisons. Most prison costs are non-discretionary (accommodation, meals, etc.). But some of the costs relate to discretionary activities, services and facilities (including schooling). In terms of correctional education, many prison managers try to invest any meagre correctional education resources available to them in those classes and courses which have proven to have the best results, such as improved labour market outcomes and reduced recidivism, minimising subsequent re-imprisonment. Course offers for prisoner-students include vocational training, adult basic education (ABE) and art studies. The two-tiered question this paper asks is: do art classes and courses produce these measurable outcomes and, if not, are there other reasons why they should continue to be funded? Addressing these issues, the authors argue that (1) these measurable outcomes are too narrow and do not reflect the complex but less quantifiable benefits to the individual and the community of studying art in prison, and (2) better measures of all impacts of art studies in prisons are needed, including qualitative and humanitarian aspects.

Radar-raingauge data combination techniques: a revision and analysis of their suitability for urban hydrology.

PubMed

Wang, Li-Pen; Ochoa-Rodríguez, Susana; Simões, Nuno Eduardo; Onof, Christian; Maksimović, Cedo

2013-01-01

The applicability of the operational radar and raingauge networks for urban hydrology is insufficient. Radar rainfall estimates provide a good description of the spatiotemporal variability of rainfall; however, their accuracy is in general insufficient. It is therefore necessary to adjust radar measurements using raingauge data, which provide accurate point rainfall information. Several gauge-based radar rainfall adjustment techniques have been developed and mainly applied at coarser spatial and temporal scales; however, their suitability for small-scale urban hydrology is seldom explored. In this paper a review of gauge-based adjustment techniques is first provided. After that, two techniques, respectively based upon the ideas of mean bias reduction and error variance minimisation, were selected and tested using as case study an urban catchment (∼8.65 km(2)) in North-East London. The radar rainfall estimates of four historical events (2010-2012) were adjusted using in situ raingauge estimates and the adjusted rainfall fields were applied to the hydraulic model of the study area. The results show that both techniques can effectively reduce mean bias; however, the technique based upon error variance minimisation can in general better reproduce the spatial and temporal variability of rainfall, which proved to have a significant impact on the subsequent hydraulic outputs. This suggests that error variance minimisation based methods may be more appropriate for urban-scale hydrological applications.

Protocol for a systematic review and economic evaluation of the clinical and cost-effectiveness of non-hospital-based non-invasive ventilation (NIV) in patients with stable end-stage COPD with hypercapnic respiratory failure.

PubMed

Dave, Chirag; Turner, Alice; Dretzke, Janine; Bayliss, Sue; O'Brien, Deirdre; Jowett, Sue; Moore, David

2014-03-27

Chronic obstructive pulmonary disease (COPD) remains a significant public health burden. Non-invasive ventilation (NIV) is a method of supported breathing used as standard care for acutely unwell patients in hospital with COPD, but there is uncertainty around the potential benefits of using NIV in the treatment of stable patients in a non-hospital setting. This is a protocol for systematic reviews of the clinical and cost-effectiveness of NIV in this context, being undertaken in support of a model based economic evaluation. Standard systematic review methods aimed at minimising bias will be employed for study identification, selection and data extraction for both the clinical and economic systematic reviews. Bibliographic databases (for example MEDLINE, EMBASE) and ongoing trials registers will be searched from 1980 onwards. The search strategy will combine terms for the population with those for the intervention. Studies will be selected for review if the population includes adult patients with COPD and hypercapnic respiratory failure, however defined. Systematic reviews, randomised controlled trials and observational studies (with n >1) will be included, and quality assessment will be tailored to the different study designs. The primary outcome measures of interest are survival, quality of life, and healthcare utilisations (hospitalisation and Accident and Emergency attendances). Meta-analyses will be undertaken where clinical and methodological homogeneity exists, supported by predefined subgroup analyses where appropriate. A systematic review of the evidence on the cost-effectiveness of non-hospital NIV will be completed, and a model-based cost-utility analysis undertaken to determine the cost-effectiveness of non-hospital-based NIV compared with standard care. These reviews will attempt to clarify the clinical effectiveness of non-hospital NIV in COPD patients as well as the cost-effectiveness. The findings may indicate whether NIV in a non-hospital setting should be considered more routinely in this patient group, and what the likely cost implications will be. 2012:CRD42012003286.

A systematic review of the cost of data collection for performance monitoring in hospitals.

PubMed

Jones, Cheryl; Gannon, Brenda; Wakai, Abel; O'Sullivan, Ronan

2015-04-01

Key performance indicators (KPIs) are used to identify where organisational performance is meeting desired standards and where performance requires improvement. Valid and reliable KPIs depend on the availability of high-quality data, specifically the relevant minimum data set ((MDS) the core data identified as the minimum required to measure performance for a KPI) elements. However, the feasibility of collecting the relevant MDS elements is always a limitation of performance monitoring using KPIs. Preferably, data should be integrated into service delivery, and, where additional data are required that are not currently collected as part of routine service delivery, there should be an economic evaluation to determine the cost of data collection. The aim of this systematic review was to synthesise the evidence base concerning the costs of data collection in hospitals for performance monitoring using KPI, and to identify hospital data collection systems that have proven to be cost minimising. We searched MEDLINE (1946 to May week 4 2014), Embase (1974 to May week 2 2014), and CINAHL (1937 to date). The database searches were supplemented by searching for grey literature through the OpenGrey database. Data was extracted, tabulated, and summarised as part of a narrative synthesis. The searches yielded a total of 1,135 publications. After assessing each identified study against specific inclusion exclusion criteria only eight studies were deemed as relevant for this review. The studies attempt to evaluate different types of data collection interventions including the installation of information communication technology (ICT), improvements to current ICT systems, and how different analysis techniques may be used to monitor performance. The evaluation methods used to measure the costs and benefits of data collection interventions are inconsistent across the identified literature. Overall, the results weakly indicate that collection of hospital data and improvements in data recording can be cost-saving. Given the limitations of this systematic review, it is difficult to conclude whether improvements in data collection systems can save money, increase quality of care, and assist performance monitoring of hospitals. With that said, the results are positive and suggest that data collection improvements may lead to cost savings and aid quality of care. PROSPERO CRD42014007450 .

Machine learning prediction for classification of outcomes in local minimisation

NASA Astrophysics Data System (ADS)

Das, Ritankar; Wales, David J.

2017-01-01

Machine learning schemes are employed to predict which local minimum will result from local energy minimisation of random starting configurations for a triatomic cluster. The input data consists of structural information at one or more of the configurations in optimisation sequences that converge to one of four distinct local minima. The ability to make reliable predictions, in terms of the energy or other properties of interest, could save significant computational resources in sampling procedures that involve systematic geometry optimisation. Results are compared for two energy minimisation schemes, and for neural network and quadratic functions of the inputs.

Cleanup of industrial effluents containing heavy metals: a new opportunity of valorising the biomass produced by brewing industry.

PubMed

Soares, Eduardo V; Soares, Helena M V M

2013-08-01

Heavy metal pollution is a matter of concern in industrialised countries. Contrary to organic pollutants, heavy metals are not metabolically degraded. This fact has two main consequences: its bioremediation requires another strategy and heavy metals can be indefinitely recycled. Yeast cells of Saccharomyces cerevisiae are produced at high amounts as a by-product of brewing industry constituting a cheap raw material. In the present work, the possibility of valorising this type of biomass in the bioremediation of real industrial effluents containing heavy metals is reviewed. Given the auto-aggregation capacity (flocculation) of brewing yeast cells, a fast and off-cost yeast separation is achieved after the treatment of metal-laden effluent, which reduces the costs associated with the process. This is a critical issue when we are looking for an effective, eco-friendly, and low-cost technology. The possibility of the bioremediation of industrial effluents linked with the selective recovery of metals, in a strategy of simultaneous minimisation of environmental hazard of industrial wastes with financial benefits from reselling or recycling the metals, is discussed.

One world health: socioeconomic burden and parasitic disease control priorities.

PubMed

Torgerson, Paul R

2013-08-01

Parasitic diseases present a considerable socio-economic impact to society. Zoonotic parasites can result in a considerable burden of disease in people and substantive economic losses to livestock populations. Ameliorating the effects of these diseases may consist of attempts at eradicating specific diseases at a global level, eliminating them at a national or local level or controlling them to minimise incidence. Alternatively with some parasitic zoonoses it may only be possible to treat human and animal cases as they arise. The choice of approach will be determined by the potential effectiveness of a disease control programme, its cost and the cost effectiveness or cost benefit of undertaking the intervention. Furthermore human disease burden is being increasingly measured by egalitarian non-financial measures which are difficult to apply to livestock. This adds additional challenges to the assessment of socio-economic burdens of zoonotic diseases. Using examples from the group of neglected zoonotic diseases, information regarding the socio-economic effects is reviewed together with how this information is used in decision making with regard to disease control and treatment. Copyright © 2013 Elsevier B.V. All rights reserved.

Is expanding HPV vaccination programs to include school-aged boys likely to be value-for-money: a cost-utility analysis in a country with an existing school-girl program.

PubMed

Pearson, Amber L; Kvizhinadze, Giorgi; Wilson, Nick; Smith, Megan; Canfell, Karen; Blakely, Tony

2014-06-26

Similar to many developed countries, vaccination against human papillomavirus (HPV) is provided only to girls in New Zealand and coverage is relatively low (47% in school-aged girls for dose 3). Some jurisdictions have already extended HPV vaccination to school-aged boys. Thus, exploration of the cost-utility of adding boys' vaccination is relevant. We modeled the incremental health gain and costs for extending the current girls-only program to boys, intensifying the current girls-only program to achieve 73% coverage, and extension of the intensive program to boys. A Markov macro-simulation model, which accounted for herd immunity, was developed for an annual cohort of 12-year-olds in 2011 and included the future health states of: cervical cancer, pre-cancer (CIN I to III), genital warts, and three other HPV-related cancers. In each state, health sector costs, including additional health costs from extra life, and quality-adjusted life-years (QALYs) were accumulated. The model included New Zealand data on cancer incidence and survival, and other cause mortality (all by sex, age, ethnicity and deprivation). At an assumed local willingness-to-pay threshold of US$29,600, vaccination of 12-year-old boys to achieve the current coverage for girls would not be cost-effective, at US$61,400/QALY gained (95% UI $29,700 to $112,000; OECD purchasing power parities) compared to the current girls-only program, with an assumed vaccine cost of US$59 (NZ$113). This was dominated though by the intensified girls-only program; US$17,400/QALY gained (95% UI: dominant to $46,100). Adding boys to this intensified program was also not cost-effective; US$128,000/QALY gained, 95% UI: $61,900 to $247,000).Vaccination of boys was not found to be cost-effective, even for additional scenarios with very low vaccine or program administration costs - only when combined vaccine and administration costs were NZ$125 or lower per dose was vaccination of boys cost-effective. These results suggest that adding boys to the girls-only HPV vaccination program in New Zealand is highly unlikely to be cost-effective. In order for vaccination of males to become cost-effective in New Zealand, vaccine would need to be supplied at very low prices and administration costs would need to be minimised.

A health economic evaluation of screening and treatment in patients with adolescent idiopathic scoliosis.

PubMed

Adobor, Raphael D; Joranger, Paal; Steen, Harald; Navrud, Ståle; Brox, Jens Ivar

2014-01-01

Adolescent idiopathic scoliosis can progress and affect the health related quality of life of the patients. Research shows that screening is effective in early detection, which allows for bracing and reduced surgical rates, and may save costs, but is still controversial from a health economic perspective. Model based cost minimisation analysis using hospital's costs, administrative data, and market prices to estimate costs in screening, bracing and surgical treatment. Uncertainty was characterised by deterministic and probabilistic sensitivity analyses. Time horizon was 6 years from first screening at 11 years of age. To compare estimated costs in screening and non-screening scenarios (reduced treatment rates of 90%, 80%, 70% of screening, and non-screening Norway 2012). Data was based on screening and treatment costs in primary health care and in hospital care settings. Participants were 4000, 12-year old children screened in Norway, 115190 children screened in Hong Kong and 112 children treated for scoliosis in Norway in 2012. We assumed equivalent outcome of health related quality of life, and compared only relative costs in screening and non-screening settings. Incremental cost was defined as positive when a non-screening scenario was more expensive relative to screening. Screening per child was € 8.4 (95% CrI 6.6 to10.6), € 10350 (8690 to 12180) per patient braced, and € 45880 (39040 to 55400) per child operated. Incremental cost per child in non-screening scenario of 90% treatment rate was € 13.3 (1 to 27), increasing from € 1.3 (-8 to 11) to € 27.6 (14 to 44) as surgical rates relative to bracing increased from 40% to 80%. For the 80% treatment rate non-screening scenario, incremental cost was € 5.5 (-6 to 18) when screening all, and € 11.3 (2 to 22) when screening girls only. For the non-screening Norwegian scenario, incremental cost per child was € -0.1(-14 to 16). Bracing and surgery were the main cost drivers and contributed most to uncertainty. With the assumptions applied in the present study, screening is cost saving when performed in girls only, and when it leads to reduced treatment rates. Cost of surgery was dominating in non-screening whilst cost of bracing was dominating in screening. The economic gain of screening increases when it leads to higher rates of bracing and reduced surgical rates.

Is expanding HPV vaccination programs to include school-aged boys likely to be value-for-money: a cost-utility analysis in a country with an existing school-girl program

PubMed Central

2014-01-01

Background Similar to many developed countries, vaccination against human papillomavirus (HPV) is provided only to girls in New Zealand and coverage is relatively low (47% in school-aged girls for dose 3). Some jurisdictions have already extended HPV vaccination to school-aged boys. Thus, exploration of the cost-utility of adding boys’ vaccination is relevant. We modeled the incremental health gain and costs for extending the current girls-only program to boys, intensifying the current girls-only program to achieve 73% coverage, and extension of the intensive program to boys. Methods A Markov macro-simulation model, which accounted for herd immunity, was developed for an annual cohort of 12-year-olds in 2011 and included the future health states of: cervical cancer, pre-cancer (CIN I to III), genital warts, and three other HPV-related cancers. In each state, health sector costs, including additional health costs from extra life, and quality-adjusted life-years (QALYs) were accumulated. The model included New Zealand data on cancer incidence and survival, and other cause mortality (all by sex, age, ethnicity and deprivation). Results At an assumed local willingness-to-pay threshold of US$29,600, vaccination of 12-year-old boys to achieve the current coverage for girls would not be cost-effective, at US$61,400/QALY gained (95% UI $29,700 to $112,000; OECD purchasing power parities) compared to the current girls-only program, with an assumed vaccine cost of US$59 (NZ$113). This was dominated though by the intensified girls-only program; US$17,400/QALY gained (95% UI: dominant to $46,100). Adding boys to this intensified program was also not cost-effective; US$128,000/QALY gained, 95% UI: $61,900 to $247,000). Vaccination of boys was not found to be cost-effective, even for additional scenarios with very low vaccine or program administration costs – only when combined vaccine and administration costs were NZ$125 or lower per dose was vaccination of boys cost-effective. Conclusions These results suggest that adding boys to the girls-only HPV vaccination program in New Zealand is highly unlikely to be cost-effective. In order for vaccination of males to become cost-effective in New Zealand, vaccine would need to be supplied at very low prices and administration costs would need to be minimised. PMID:24965837

Ten clinician-driven strategies for maximising value of Australian health care.

PubMed

Scott, Ian

2014-05-01

To articulate the concept of high-value care (i.e. clinically relevant, patient-important benefit at lowest possible cost) and suggest strategies by which clinicians can promote such care in rendering the Australian healthcare system more affordable and sustainable. Strategies were developed by the author based on personal experience in clinical practice, evidence-based medicine and quality improvement. Relevant literature was reviewed in retrieving studies supporting each strategy. Ten strategies were developed: (1) minimise errors in diagnosis; (2) discontinue low- or no-value practices that provide little benefit or cause harm; (3) defer the use of unproven interventions; (4) select care options according to comparative cost-effectiveness; (5) target clinical interventions to those who derive greatest benefit; (6) adopt a more conservative approach nearing the end of life; (7) actively involve patients in shared decision making and self-management; (8) minimise day-to-day operational waste; (9) convert healthcare institutions into rapidly learning organisations; and (10) advocate for integrated patient care across all clinical settings. Clinicians and their professional organisations, in partnership with managers, can implement strategies capable of maximising value and sustainability of health care in Australia. What is known about this topic? Value-based care has emerged as a unitary concept that integrates quality and cost, and is being increasingly used to inform healthcare policy making and reform. What does this paper add? There is scant literature that translates the concept of high value care into actionable enhancement strategies for clinicians in everyday practice settings. This article provides 10 strategies with supporting studies in an attempt to fill this gap. What are the implications for practitioners? If all practitioners, in partnership with healthcare managers, attempted to enact all 10 strategies in their workplaces, a significant quantum of healthcare resources could be redirected from low- to high-value care, culminating in much greater health benefit from the healthcare dollars currently being spent. However, such reforms will require a shift in clinician thinking and practice away from volume-based care to value-based care.

Impact and quantification of the sources of error in DNA pooling designs.

PubMed

Jawaid, A; Sham, P

2009-01-01

The analysis of genome wide variation offers the possibility of unravelling the genes involved in the pathogenesis of disease. Genome wide association studies are also particularly useful for identifying and validating targets for therapeutic intervention as well as for detecting markers for drug efficacy and side effects. The cost of such large-scale genetic association studies may be reduced substantially by the analysis of pooled DNA from multiple individuals. However, experimental errors inherent in pooling studies lead to a potential increase in the false positive rate and a loss in power compared to individual genotyping. Here we quantify various sources of experimental error using empirical data from typical pooling experiments and corresponding individual genotyping counts using two statistical methods. We provide analytical formulas for calculating these different errors in the absence of complete information, such as replicate pool formation, and for adjusting for the errors in the statistical analysis. We demonstrate that DNA pooling has the potential of estimating allele frequencies accurately, and adjusting the pooled allele frequency estimates for differential allelic amplification considerably improves accuracy. Estimates of the components of error show that differential allelic amplification is the most important contributor to the error variance in absolute allele frequency estimation, followed by allele frequency measurement and pool formation errors. Our results emphasise the importance of minimising experimental errors and obtaining correct error estimates in genetic association studies.

Classify epithelium-stroma in histopathological images based on deep transferable network.

PubMed

Yu, X; Zheng, H; Liu, C; Huang, Y; Ding, X

2018-04-20

Recently, the deep learning methods have received more attention in histopathological image analysis. However, the traditional deep learning methods assume that training data and test data have the same distributions, which causes certain limitations in real-world histopathological applications. However, it is costly to recollect a large amount of labeled histology data to train a new neural network for each specified image acquisition procedure even for similar tasks. In this paper, an unsupervised domain adaptation is introduced into a typical deep convolutional neural network (CNN) model to mitigate the repeating of the labels. The unsupervised domain adaptation is implemented by adding two regularisation terms, namely the feature-based adaptation and entropy minimisation, to the object function of a widely used CNN model called the AlexNet. Three independent public epithelium-stroma datasets were used to verify the proposed method. The experimental results have demonstrated that in the epithelium-stroma classification, the proposed method can achieve better performance than the commonly used deep learning methods and some existing deep domain adaptation methods. Therefore, the proposed method can be considered as a better option for the real-world applications of histopathological image analysis because there is no requirement for recollection of large-scale labeled data for every specified domain. © 2018 The Authors Journal of Microscopy © 2018 Royal Microscopical Society.

Determining factors for the presence of impurities in selectively collected biowaste.

PubMed

Puig-Ventosa, Ignasi; Freire-González, Jaume; Jofra-Sora, Marta

2013-05-01

The presence of impurities in biodegradable waste (biowaste) causes problems with the management of waste, among which are additional costs derived from the need to improve pre-treatment of biowaste, loss of treatment capacity and the difficulty selling treated biowaste as compost owing to its low quality. When treated biowaste is used for soil conditioning it can also cause soil pollution. Understanding the reasons why impurities are in biowaste and the factors affecting the percentage of impurities present can be used to determine ways to minimise these negative effects. This article attempts to identify the main causes for the presence of impurities in biowaste. In order to do so, it carries out an empirical analysis of the level of impurities in biowaste from municipal waste collection in two steps. First, a bivariate analysis focuses on significant correlations between the presence of impurities and several variables. Second, the construction of an explanatory model based on the significant relations obtained in the first step, and on literature research, are used to check the stated hypothesis. The estimates demonstrate that the collection system, the global levels of separate collection, the urban density of the municipality and the requirement to use compostable bags may be the main drivers of impurity levels in biowaste.

Managing carbon emissions in China through building energy efficiency.

PubMed

Li, Jun; Colombier, Michel

2009-06-01

This paper attempts to analyse the role of building energy efficiency (BEE) in China in addressing climate change mitigation. It provides an analysis of the current situation and future prospects for the adoption of BEE technologies in Chinese cities. It outlines the economic and institutional barriers to large-scale deployment of the sustainable, low-carbon, and even carbon-free construction techniques. Based on a comprehensive overview of energy demand characteristics and development trends driven by economic and demographic growth, different policy tools for cost-effective CO(2) emission reduction in the Chinese construction sector are described. We propose a comprehensive approach combining building design and construction, and the urban planning and building material industries, in order to drastically improve BEE during this period of rapid urban development. A coherent institutional framework needs to be established to ensure the implementation of efficiency policies. Regulatory and incentive options should be integrated into the policy portfolios of BEE to minimise the efficiency gap and to realise sizeable carbon emissions cuts in the next decades. We analyse in detail several policies and instruments, and formulate relevant policy proposals fostering low-carbon construction technology in China. Specifically, Our analysis shows that improving building energy efficiency can generate considerable carbon emissions reduction credits with competitive price under the CDM framework.

The relation between input-output transformation and gastrointestinal nematode infections on dairy farms.

PubMed

van der Voort, M; Van Meensel, J; Lauwers, L; Van Huylenbroeck, G; Charlier, J

2016-02-01

Efficiency analysis is used for assessing links between technical efficiency (TE) of livestock farms and animal diseases. However, previous studies often do not make the link with the allocation of inputs and mainly present average effects that ignore the often huge differences among farms. In this paper, we studied the relationship between exposure to gastrointestinal (GI) nematode infections, the TE and the input allocation on dairy farms. Although the traditional cost allocative efficiency (CAE) indicator adequately measures how a given input allocation differs from the cost-minimising input allocation, they do not represent the unique input allocation of farms. Similar CAE scores may be obtained for farms with different input allocations. Therefore, we propose an adjusted allocative efficiency index (AAEI) to measure the unique input allocation of farms. Combining this AAEI with the TE score allows determining the unique input-output position of each farm. The method is illustrated by estimating efficiency scores using data envelopment analysis (DEA) on a sample of 152 dairy farms in Flanders for which both accountancy and parasitic monitoring data were available. Three groups of farms with a different input-output position can be distinguished based on cluster analysis: (1) technically inefficient farms, with a relatively low use of concentrates per 100 l milk and a high exposure to infection, (2) farms with an intermediate TE, relatively high use of concentrates per 100 l milk and a low exposure to infection, (3) farms with the highest TE, relatively low roughage use per 100 l milk and a relatively high exposure to infection. Correlation analysis indicates for each group how the level of exposure to GI nematodes is associated or not with improved economic performance. The results suggest that improving both the economic performance and exposure to infection seems only of interest for highly TE farms. The findings indicate that current farm recommendations regarding GI nematode infections could be improved by also accounting for the allocation of inputs on the farm.

Clinical effectiveness and cost-effectiveness of surgical options for the management of anterior and/or posterior vaginal wall prolapse: two randomised controlled trials within a comprehensive cohort study - results from the PROSPECT Study.

PubMed

Glazener, Cathryn; Breeman, Suzanne; Elders, Andrew; Hemming, Christine; Cooper, Kevin; Freeman, Robert; Smith, Anthony; Hagen, Suzanne; Montgomery, Isobel; Kilonzo, Mary; Boyers, Dwayne; McDonald, Alison; McPherson, Gladys; MacLennan, Graeme; Norrie, John

2016-12-01

The use of mesh in prolapse surgery is controversial, leading to a number of enquiries into its safety and efficacy. To compare synthetic non-absorbable mesh inlay, biological graft and mesh kit with a standard repair in terms of clinical effectiveness, adverse effects, quality of life (QoL), costs and cost-effectiveness. Two randomised controlled trials within a comprehensive cohort (CC) study. Allocation was by a remote web-based randomisation system in a 1 :1 : 1 ratio (Primary trial) or 1 : 1 : 2 ratio (Secondary trial), and was minimised on age, type of prolapse repair planned, need for a concomitant continence procedure, need for a concomitant upper vaginal prolapse procedure and surgeon. Participants and outcome assessors were blinded to randomisation; participants were unblinded if they requested the information. Surgeons were not blinded to allocated procedure. Thirty-five UK hospitals. Primary study : 2474 women in the analysis (including 1348 randomised) having primary anterior or posterior prolapse surgery. Secondary study : 398 in the analysis (including 154 randomised) having repeat anterior or posterior prolapse surgery. CC3 : 215 women having either uterine or vault prolapse repair. Anterior or posterior repair alone, or with mesh inlay, biological graft or mesh kit. Prolapse symptoms [Pelvic Organ Prolapse Symptom Score (POP-SS)]; prolapse-specific QoL; cost-effectiveness [incremental cost per quality-adjusted life-year (QALY)]. Primary trials : adjusting for baseline and minimisation covariates, mean POP-SS was similar for each comparison {standard 5.4 [standard deviation (SD) 5.5] vs. mesh 5.5 (SD 5.1), mean difference (MD) 0.00, 95% confidence interval (CI) -0.70 to 0.71; standard 5.5 (SD 5.6) vs. graft 5.6 (SD 5.6), MD -0.15, 95% CI -0.93 to 0.63}. Serious non-mesh adverse effects rates were similar between the groups in year 1 [standard 7.2% vs. mesh 7.8%, risk ratio (RR) 1.08, 95% CI 0.68 to 1.72; standard 6.3% vs. graft 9.8%, RR 1.57, 95% CI 0.95 to 2.59]. There were no statistically significant differences between groups in any other outcome measure. The cumulative mesh complication rates over 2 years were 2 of 430 (0.5%) for standard repair (trial 1), 46 of 435 (10.6%) for mesh inlay and 2 of 368 (0.5%) for biological graft. The CC findings were comparable. Incremental costs were £363 (95% CI -£32 to £758) and £565 (95% CI £180 to £950) for mesh and graft vs. standard, respectively. Incremental QALYs were 0.071 (95% CI -0.004 to 0.145) and 0.039 (95% CI -0.041 to 0.120) for mesh and graft vs. standard, respectively. A Markov decision model extrapolating trial results over 5 years showed standard repair had the highest probability of cost-effectiveness, but results were surrounded by considerable uncertainty. Secondary trials : there were no statistically significant differences between the randomised groups in any outcome measure, but the sample size was too small to be conclusive. The cumulative mesh complication rates over 2 years were 7 of 52 (13.5%) for mesh inlay and 4 of 46 (8.7%) for mesh kit, with no mesh exposures for standard repair. In women who were having primary repairs, there was evidence of no benefit from the use of mesh inlay or biological graft compared with standard repair in terms of efficacy, QoL or adverse effects (other than mesh complications) in the short term. The Secondary trials were too small to provide conclusive results. Women in the Primary trials included some with a previous repair in another compartment. Follow-up is vital to identify any long-term potential benefits and serious adverse effects. Long-term follow-up to at least 6 years after surgery is ongoing to identify recurrence rates, need for further prolapse surgery, adverse effects and cost-effectiveness. Current Controlled Trials ISRCTN60695184. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol. 20, No. 95. See the NIHR Journals Library website for further project information.

Testing MacArthur's minimisation principle: do communities minimise energy wastage during succession?

PubMed

Ghedini, Giulia; Loreau, Michel; White, Craig R; Marshall, Dustin J

2018-05-20

Robert MacArthur developed a theory of community assembly based on competition. By incorporating energy flow, MacArthur's theory allows for predictions of community function. A key prediction is that communities minimise energy wastage over time, but this minimisation is a trade-off between two conflicting processes: exploiting food resources, and maintaining low metabolism and mortality. Despite its simplicity and elegance, MacArthur's principle has not been tested empirically despite having long fascinated theoreticians. We used a combination of field chronosequence experiments and laboratory assays to estimate how the energy wastage of a community changes during succession. We found that older successional stages wasted more energy in maintenance, but there was no clear pattern in how communities of different age exploited food resources. We identify several reasons for why MacArthur's original theory may need modification and new avenues to further explore community efficiency, an understudied component of ecosystem functioning. © 2018 John Wiley & Sons Ltd/CNRS.

Analysis of the shrinkage at the thick plate part using response surface methodology

NASA Astrophysics Data System (ADS)

Hatta, N. M.; Azlan, M. Z.; Shayfull, Z.; Roselina, S.; Nasir, S. M.

2017-09-01

Injection moulding is well known for its manufacturing process especially in producing plastic products. To measure the final product quality, there are lots of precautions to be taken into such as parameters setting at the initial stage of the process. Sometimes, if these parameters were set up wrongly, defects may be occurred and one of the well-known defects in the injection moulding process is a shrinkage. To overcome this problem, a maximisation at the precaution stage by making an optimal adjustment on the parameter setting need to be done and this paper focuses on analysing the shrinkage by optimising the parameter at thick plate part with the help of Response Surface Methodology (RSM) and ANOVA analysis. From the previous study, the outstanding parameter gained from the optimisation method in minimising the shrinkage at the moulded part was packing pressure. Therefore, with the reference from the previous literature, packing pressure was selected as the parameter setting for this study with other three parameters which are melt temperature, cooling time and mould temperature. The analysis of the process was obtained from the simulation by Autodesk Moldflow Insight (AMI) software and the material used for moulded part was Acrylonitrile Butadiene Styrene (ABS). The analysis and result were obtained and it found that the shrinkage can be minimised and the significant parameters were found as packing pressure, mould temperature and melt temperature.

Minimisation de l'influence de la témperature sur un capteur polarimétrique de position angulaire

NASA Astrophysics Data System (ADS)

Gaumont, Eric; Chakari, Ayoub; Clement, Michel; Meyrueis, Patrick

2018-04-01

This paper, "Minimisation de l'influence de la témperature sur un capteur polarimétrique de position angulaire," was presented as part of International Conference on Space Optics—ICSO 1997, held in Toulouse, France.

Price Incentivised Electric Vehicle Charge Control for Community Voltage Regulation

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

Kelly, Damian; Baroncelli, Fabio; Fowler, Christopher

2014-11-03

With the growing availability of Electric Vehicles, there is a significant opportunity to use battery 'smart-charging' for voltage regulation. This work designs and experimentally evaluates a system for price-incentivised electric vehicle charging. The system is designed to eliminate negative impacts to the user while minimising the cost of charging and achieving a more favourable voltage behaviour throughout the local grid over time. The practical issues associated with a real-life deployment are identified and resolved. The efficacy of the system is evaluated in the challenging scenario in which EVs are deployed in six closely distributed homes, serviced by the same lowmore » voltage residential distribution feeder.« less

A health app developer's guide to law and policy: a multi-sector policy analysis.

PubMed

Parker, Lisa; Karliychuk, Tanya; Gillies, Donna; Mintzes, Barbara; Raven, Melissa; Grundy, Quinn

2017-10-02

Apps targeted at health and wellbeing sit in a rapidly growing industry associated with widespread optimism about their potential to deliver accessible and cost-effective healthcare. App developers might not be aware of all the regulatory requirements and best practice principles are emergent. Health apps are regulated in order to minimise their potential for harm due to, for example, loss of personal health privacy, financial costs, and health harms from delayed or unnecessary diagnosis, monitoring and treatment. We aimed to produce a comprehensive guide to assist app developers in producing health apps that are legally compliant and in keeping with high professional standards of user protection. We conducted a case study analysis of the Australian and related international policy environment for mental health apps to identify relevant sectors, policy actors, and policy solutions. We identified 29 policies produced by governments and non-government organisations that provide oversight of health apps. In consultation with stakeholders, we developed an interactive tool targeted at app developers, summarising key features of the policy environment and highlighting legislative, industry and professional standards around seven relevant domains: privacy, security, content, promotion and advertising, consumer finances, medical device efficacy and safety, and professional ethics. We annotated this developer guidance tool with information about: the relevance of each domain; existing legislative and non-legislative guidance; critiques of existing policy; recommendations for developers; and suggestions for other key stakeholders. We anticipate that mental health apps developed in accordance with this tool will be more likely to conform to regulatory requirements, protect consumer privacy, protect consumer finances, and deliver health benefit; and less likely to attract regulatory penalties, offend consumers and communities, mislead consumers, or deliver health harms. We encourage government, industry and consumer organisations to use and publicise the tool.

Comparing multilayer brain networks between groups: Introducing graph metrics and recommendations.

PubMed

Mandke, Kanad; Meier, Jil; Brookes, Matthew J; O'Dea, Reuben D; Van Mieghem, Piet; Stam, Cornelis J; Hillebrand, Arjan; Tewarie, Prejaas

2018-02-01

There is an increasing awareness of the advantages of multi-modal neuroimaging. Networks obtained from different modalities are usually treated in isolation, which is however contradictory to accumulating evidence that these networks show non-trivial interdependencies. Even networks obtained from a single modality, such as frequency-band specific functional networks measured from magnetoencephalography (MEG) are often treated independently. Here, we discuss how a multilayer network framework allows for integration of multiple networks into a single network description and how graph metrics can be applied to quantify multilayer network organisation for group comparison. We analyse how well-known biases for single layer networks, such as effects of group differences in link density and/or average connectivity, influence multilayer networks, and we compare four schemes that aim to correct for such biases: the minimum spanning tree (MST), effective graph resistance cost minimisation, efficiency cost optimisation (ECO) and a normalisation scheme based on singular value decomposition (SVD). These schemes can be applied to the layers independently or to the multilayer network as a whole. For correction applied to whole multilayer networks, only the SVD showed sufficient bias correction. For correction applied to individual layers, three schemes (ECO, MST, SVD) could correct for biases. By using generative models as well as empirical MEG and functional magnetic resonance imaging (fMRI) data, we further demonstrated that all schemes were sensitive to identify network topology when the original networks were perturbed. In conclusion, uncorrected multilayer network analysis leads to biases. These biases may differ between centres and studies and could consequently lead to unreproducible results in a similar manner as for single layer networks. We therefore recommend using correction schemes prior to multilayer network analysis for group comparisons. Copyright © 2017 Elsevier Inc. All rights reserved.

ViibraTip for Testing Vibration Perception to Detect Diabetic Peripheral Neuropathy: A NICE Medical Technology Guidance.

PubMed

Willits, Iain; Cole, Helen; Jones, Roseanne; Dimmock, Paul; Arber, Mick; Craig, Joyce; Sims, Andrew

2015-08-01

VibraTip™ was selected by the Medical Technologies Advisory Committee (MTAC) to undergo evaluation through the National Institute for Health and Care Excellence (NICE). VibraTip™ provides a vibratory stimulus for the purpose of detecting diabetic peripheral neuropathy (DPN) in patients with type 1 or 2 diabetes mellitus, and is intended to replace the current practice of using the 128 Hz tuning fork or 10 g monofilament (comparators). The sponsor (McCallan Medical) provided clinical and economic submissions which were evaluated by an External Assessment Centre (EAC). Of six diagnostic studies identified, the EAC considered that only one was directly relevant to the assessment. This study indicated VibraTip™ had a sensitivity of 0.79 (95 % CI 0.69-0.90) and specificity of 0.82 (95 % CI 0.74-0.90) for DPN using a neurothesiometer at 25 V as a reference standard. This was non-inferior to the comparators, but the sample size (n = 141) was too small to draw unequivocal conclusions and it is unclear how generalisable results were to clinical practice. The sponsor presented a de facto cost-minimisation model that in the base case showed minimal cost savings and, in sensitivity analysis which assumed diagnostic superiority of VibraTip™, showed large savings. The EAC appraised this model and concluded it was flawed as it was not evidence based and costs were likely to be unrealistic. The MTAC considered that the technology showed promise but decided the case for adoption was not proven, and therefore made a research recommendation as is reflected in NICE Medical Technology Guidance 22.

Optimisation modelling to assess cost of dietary improvement in remote Aboriginal Australia.

PubMed

Brimblecombe, Julie; Ferguson, Megan; Liberato, Selma C; O'Dea, Kerin; Riley, Malcolm

2013-01-01

The cost and dietary choices required to fulfil nutrient recommendations defined nationally, need investigation, particularly for disadvantaged populations. We used optimisation modelling to examine the dietary change required to achieve nutrient requirements at minimum cost for an Aboriginal population in remote Australia, using where possible minimally-processed whole foods. A twelve month cross-section of population-level purchased food, food price and nutrient content data was used as the baseline. Relative amounts from 34 food group categories were varied to achieve specific energy and nutrient density goals at minimum cost while meeting model constraints intended to minimise deviation from the purchased diet. Simultaneous achievement of all nutrient goals was not feasible. The two most successful models (A & B) met all nutrient targets except sodium (146.2% and 148.9% of the respective target) and saturated fat (12.0% and 11.7% of energy). Model A was achieved with 3.2% lower cost than the baseline diet (which cost approximately AUD$13.01/person/day) and Model B at 7.8% lower cost but with a reduction in energy of 4.4%. Both models required very large reductions in sugar sweetened beverages (-90%) and refined cereals (-90%) and an approximate four-fold increase in vegetables, fruit, dairy foods, eggs, fish and seafood, and wholegrain cereals. This modelling approach suggested population level dietary recommendations at minimal cost based on the baseline purchased diet. Large shifts in diet in remote Aboriginal Australian populations are needed to achieve national nutrient targets. The modeling approach used was not able to meet all nutrient targets at less than current food expenditure.

Reduced Metabolic Cost of Locomotion in Svalbard Rock Ptarmigan (Lagopus muta hyperborea) during Winter

PubMed Central

Lees, John; Nudds, Robert; Stokkan, Karl-Arne; Folkow, Lars; Codd, Jonathan

2010-01-01

The Svalbard rock ptarmigan, Lagopus muta hyperborea experiences extreme photoperiodic and climatic conditions on the Arctic archipelago of Svalbard. This species, however, is highly adapted to live in this harsh environment. One of the most striking adaptations found in these birds is the deposition, prior to onset of winter, of fat stores which may comprise up to 32% of body mass and are located primarily around the sternum and abdominal region. This fat, while crucial to the birds' survival, also presents a challenge in that the bird must maintain normal physiological function with this additional mass. In particular these stores are likely to constrain the respiratory system, as the sternum and pelvic region must be moved during ventilation and carrying this extra load may also impact upon the energetic cost of locomotion. Here we demonstrate that winter birds have a reduced cost of locomotion when compared to summer birds. A remarkable finding given that during winter these birds have almost twice the body mass of those in summer. These results suggest that Svalbard ptarmigan are able to carry the additional winter fat without incurring any energetic cost. As energy conservation is paramount to these birds, minimising the costs of moving around when resources are limited would appear to be a key adaptation crucial for their survival in the barren Arctic environment. PMID:21125015

Increasing social welfare by taxing pesticide externalities in the Indian cotton sector.

PubMed

Rasche, Livia; Dietl, Alexander; Shakhramanyan, Nikolinka; Pandey, Divya; Schneider, Uwe A

2016-12-01

Pesticide use in the Indian cotton industry has decreased with the introduction of Bt cotton, but rates are still high in comparison with other countries. The adoption of alternative strategies, such as integrated pest management, has been slow, even though benefits are potentially high, more so if the full costs of the external effects of the technologies are taken into account. In order to estimate true societal benefits of different strategies, we compare their external costs and economic performance under external cost taxation, using a state-of-the-art partial equilibrium model of the Indian agricultural sector. Pesticide externalities lower social welfare in the Indian cotton sector by $US 400-2200 million, depending on the technologies employed. A full internalisation reduces producer revenues by $US 100 ha -1 if only Bt cotton is used, and by $US 30 ha -1 if IPM is another option. Consumers do not start to lose surplus until 20-70% are internalised, and losses are smaller if all technologies are available. External pesticide costs can be internalised partially without substantially affecting consumer surplus while still increasing social welfare, but producers need to have access to and the knowledge to employ all available cotton production technologies to minimise losses. © 2016 Society of Chemical Industry. © 2016 Society of Chemical Industry.

A multi-criteria decision-making approach to rank supplier selection criteria for hospital waste management: A case from Pakistan.

PubMed

Ishtiaq, Palvisha; Khan, Sharfuddin Ahmed; Haq, Moiz-Ul

2018-04-01

To address environmental issues and cost effectiveness, waste management is necessary for healthcare facilities. Most importantly, segregation of hazardous and non-hazardous waste must be done as in many developing countries; disposal of both types of healthcare waste is done together, which is an unsafe practice. Waste generated in hospitals needs proper management to minimise hazards for patient and healthcare workers. At the same time, it is quite difficult for hospitals to find a systematic way to select appropriate suppliers for hospital waste management. Therefore, the purpose of this article is to identify, validate, and rank criteria that are essential for hospital waste management suppliers' selection. The analytical hierarchal process approach has been used and a survey from Pakistan's largest city (Karachi) has been considered to rank the most appropriate criteria that is necessary to select the supplier, especially in a developing country like Pakistan. Results show that waste management cost (45.5%) and suppliers' details (31.5%) are the top two main criteria for supplier selection; and storage cost (15.7%), waste handling cost (14.7%), and qualification of the suppliers (10.9%) are the top three most important overall sub-criteria for supplier selection for hospital waste management.

Seal or Varnish? A randomised controlled trial to determine the relative cost and effectiveness of pit and fissure sealant and fluoride varnish in preventing dental decay.

PubMed

Chestnutt, Ivor Gordon; Hutchings, Simon; Playle, Rebecca; Morgan-Trimmer, Sarah; Fitzsimmons, Deborah; Aawar, Nadine; Angel, Lianna; Derrick, Sharron; Drew, Cheney; Hoddell, Ceri; Hood, Kerenza; Humphreys, Ioan; Kirby, Nigel; Lau, Tin Man Mandy; Lisles, Catherine; Morgan, Maria Zeta; Murphy, Simon; Nuttall, Jacqueline; Onishchenko, Kateryna; Phillips, Ceri; Pickles, Timothy; Scoble, Charlotte; Townson, Julia; Withers, Beverley; Chadwick, Barbara Lesley

2017-04-01

Fissure sealant (FS) and fluoride varnish (FV) have been shown to be effective in preventing dental caries when tested against a no-treatment control. However, the relative clinical effectiveness and cost-effectiveness of these interventions is unknown. To compare the clinical effectiveness and cost-effectiveness of FS and FV in preventing dental caries in first permanent molars (FPMs) in 6- and 7-year-olds and to determine their acceptability. A randomised controlled allocation-blinded clinical trial with two parallel arms. A targeted population programme using mobile dental clinics (MDCs) in schools located in areas of high social and economic deprivation in South Wales. In total, 1016 children were randomised, but one parent subsequently withdrew permission and so the analysis was based on 1015 children. The randomisation of participants was stratified by school and balanced for sex and primary dentition baseline caries levels using minimisation in a 1 : 1 ratio for treatments. A random component was added to the minimisation algorithm, such that it was not completely deterministic. Of the participants, 514 were randomised to receive FS and 502 were randomised to receive FV. Resin-based FS was applied to caries-free FPMs and maintained at 6-monthly intervals. FV was applied at baseline and at 6-month intervals over the course of 3 years. The proportion of children developing caries into dentine (decayed, missing, filled teeth in permanent dentition, i.e. D 4-6 MFT) on any one of up to four treated FPMs after 36 months. The assessors were blinded to treatment allocation; however, the presence or absence of FS at assessment would obviously indicate the probable treatment received. Economic measures established the costs and budget impact of FS and FV and the relative cost-effectiveness of these technologies. Qualitative interviews determined the acceptability of the interventions. At 36 months, 835 (82%) children remained in the trial: 417 in the FS arm and 418 in the FV arm. The proportion of children who developed caries into dentine on a least one FPM was lower in the FV arm (73; 17.5%) than in the FS arm (82, 19.6%) [odds ratio (OR) 0.84, 95% confidence interval (CI) 0.59 to 1.21; p  = 0.35] but the difference was not statistically significant. The results were similar when the numbers of newly decayed teeth (OR 0.86, 95% CI 0.60 to 1.22) and tooth surfaces (OR 0.85, 95% CI 0.59 to 1.21) were examined. Trial fidelity was high: 95% of participants received five or six of the six scheduled treatments. Between 74% and 93% of sealants (upper and lower teeth) were intact at 36 months. The costs of the two technologies showed a small but statistically significant difference; the mean cost to the NHS (including intervention costs) per child was £500 for FS, compared with £432 for FV, a difference of £68.13 (95% CI £5.63 to £130.63; p  = 0.033) in favour of FV. The budget impact analysis suggests that there is a cost saving of £68.13 (95% CI £5.63 to £130.63; p  = 0.033) per child treated if using FV compared with the application of FS over this time period. An acceptability score completed by the children immediately after treatment and subsequent interviews demonstrated that both interventions were acceptable to the children. No adverse effects were reported. There are no important limitations to this study. In a community oral health programme utilising MDCs and targeted at children with high caries risk, the twice-yearly application of FV resulted in caries prevention that is not significantly different from that obtained by applying and maintaining FSs after 36 months. FV proved less expensive. The clinical effectiveness and cost-effectiveness of FS and FV following the cessation of active intervention merits investigation. EudraCT number 2010-023476-23, Current Controlled Trials ISRCTN17029222 and UKCRN reference 9273. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol. 21, No. 21. See the NIHR Journals Library website for further project information.

A knowledge-based control system for air-scour optimisation in membrane bioreactors.

PubMed

Ferrero, G; Monclús, H; Sancho, L; Garrido, J M; Comas, J; Rodríguez-Roda, I

2011-01-01

Although membrane bioreactors (MBRs) technology is still a growing sector, its progressive implementation all over the world, together with great technical achievements, has allowed it to reach a mature degree, just comparable to other more conventional wastewater treatment technologies. With current energy requirements around 0.6-1.1 kWh/m3 of treated wastewater and investment costs similar to conventional treatment plants, main market niche for MBRs can be areas with very high restrictive discharge limits, where treatment plants have to be compact or where water reuse is necessary. Operational costs are higher than for conventional treatments; consequently there is still a need and possibilities for energy saving and optimisation. This paper presents the development of a knowledge-based decision support system (DSS) for the integrated operation and remote control of the biological and physical (filtration and backwashing or relaxation) processes in MBRs. The core of the DSS is a knowledge-based control module for air-scour consumption automation and energy consumption minimisation.

Application of particle swarm optimisation for solving deteriorating inventory model with fluctuating demand and controllable deterioration rate

NASA Astrophysics Data System (ADS)

Chen, Yu-Ren; Dye, Chung-Yuan

2013-06-01

In most of the inventory models in the literature, the deterioration rate of goods is viewed as an exogenous variable, which is not subject to control. In the real market, the retailer can reduce the deterioration rate of product by making effective capital investment in storehouse equipments. In this study, we formulate a deteriorating inventory model with time-varying demand by allowing preservation technology cost as a decision variable in conjunction with replacement policy. The objective is to find the optimal replenishment and preservation technology investment strategies while minimising the total cost over the planning horizon. For any given feasible replenishment scheme, we first prove that the optimal preservation technology investment strategy not only exists but is also unique. Then, a particle swarm optimisation is coded and used to solve the nonlinear programming problem by employing the properties derived from this article. Some numerical examples are used to illustrate the features of the proposed model.

LQ optimal and reaching law-based sliding modes for inventory management systems

NASA Astrophysics Data System (ADS)

Ignaciuk, Przemysław; Bartoszewicz, Andrzej

2012-01-01

In this article, the theory of discrete sliding-mode control is used to design new supply strategies for periodic-review inventory systems. In the considered systems, the stock used to fulfil an unknown, time-varying demand can be replenished from a single supply source or from multiple suppliers procuring orders with different delays. The proposed strategies guarantee that demand is always entirely satisfied from the on-hand stock (yielding the maximum service level), and the warehouse capacity is not exceeded (which eliminates the cost of emergency storage). In contrast to the classical, stochastic approaches, in this article, we focus on optimising the inventory system dynamics. The parameters of the first control strategy are selected by minimising a quadratic cost functional. Next, it is shown how the system dynamical performance can be improved by applying the concept of a reaching law with the appropriately adjusted reaching phase. The stable, nonoscillatory behaviour of the closed-loop system is demonstrated and the properties of the designed controllers are discussed and strictly proved.

Multicentre randomised controlled trial examining the cost-effectiveness of contrast-enhanced high field magnetic resonance imaging in women with primary breast cancer scheduled for wide local excision (COMICE).

PubMed

Turnbull, L W; Brown, S R; Olivier, C; Harvey, I; Brown, J; Drew, P; Hanby, A; Manca, A; Napp, V; Sculpher, M; Walker, L G; Walker, S

2010-01-01

To determine whether the addition of magnetic resonance imaging (MRI) to current patient evaluation by triple assessment would aid tumour localisation within the breast and thus reduce the reoperation rate in women with primary breast tumours who are scheduled for wide local excision (WLE), and to assess whether the addition of MRI would be cost-effective for the UK NHS. A multicentre, randomised controlled, open, parallel group trial with equal randomisation. The main design was supplemented with a qualitative study to assess patients' experiences of the treatment process and care pathway, and involved the development of a non-scheduled standardised interview (NSSI). The study took place at 45 hospitals throughout the UK. Women aged 18 years or over with biopsy-proven primary breast cancer who had undergone triple assessment, were scheduled for WLE, and were capable of providing written informed consent. Patients were randomised to receive MRI or no MR1. Randomisation was performed using minimisation, incorporating a random element. All MRI was performed at 1.5 T or 1.0 T with a dedicated bilateral breast coil. The primary end point of the trial was the reoperation rate. Secondary outcome measures included discrepancies between imaging and histopathology, and the effectiveness of using both procedures; change in clinical management after using MRI; the clinical significance of MRI-only-detected lesions; the rate of interventions; the ipsilateral tumour recurrence rate; patient quality of life (QoL); and cost-effectiveness. From a total of 1623 patients, 816 were randomised to MRI and 807 to no MRI. No differences in reoperation rates were found between the two groups of patients [MRI patients 18.75%, no MRI 19.33%, difference 0.58%, 95% confidence interval (CI) -3.24 to 4.40]. Therefore, the addition of MRI to conventional triple assessment was not found to be statistically significantly associated with a reduced reoperation rate (odds ratio = 0.96, 95% CI 0.75-1.24, p = 0.7691). The best agreement between all imaging modalities and histopathology with regard to tumour size and extent of disease was found in patients over 50 years old with ductal tumours NST and who were node negative. In the imaging arm, mastectomy was found to be pathologically avoidable for 16 (27.6%) out of 58 patients who underwent the procedure. There were no significant differences between the groups regarding the proportion of patients receiving chemotherapy, radiotherapy or additional adjuvant therapies, as well as for local recurrence-free interval rates and QoL. An acceptable NSSI was developed for use in this population of patients. Economic analysis found no difference in outcomes between the two trial arms. The addition of MRI to triple assessment did not result in a reduction in operation rates, and the use of MRI would thus consume extra resource with few or no benefits in terms of cost-effectiveness or HRQoL. However, MRI showed potential to improve tumour localisation, and preoperative biopsy of MRI-only-detected lesions is likely to minimise the incidence of inappropriate mastectomy. Current Controlled Trials ISRCTN57474502.

Incineration of European non-nuclear radioactive waste in the USA

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

Moloney, B. P.; Ferguson, D.; Stephenson, B.

2013-07-01

Incineration of dry low level radioactive waste from nuclear stations is a well established process achieving high volume reduction factors to minimise disposal costs and to stabilise residues for disposal. Incineration has also been applied successfully in many European Union member countries to wastes arising from use of radionuclides in medicine, nonnuclear research and industry. However, some nations have preferred to accumulate wastes over many years in decay stores to reduce the radioactive burden at point of processing. After decay and sorting the waste, they then require a safe, industrial scale and affordable processing solution for the large volumes accumulated.more » This paper reports the regulatory, logistical and technical issues encountered in a programme delivered for Eckert and Ziegler Nuclitec to incinerate safely 100 te of waste collected originally from German research, hospital and industrial centres, applying for the first time a 'burn and return' process model for European waste in the US. The EnergySolutions incinerators at Bear Creek, Oak Ridge, Tennessee, USA routinely incinerate waste arising from the non-nuclear user community. To address the requirement from Germany, EnergySolutions had to run a dedicated campaign to reduce cross-contamination with non-German radionuclides to the practical minimum. The waste itself had to be sampled in a carefully controlled programme to ensure the exacting standards of Bear Creek's license and US emissions laws were maintained. Innovation was required in packaging of the waste to minimise transportation costs, including sea freight. The incineration was inspected on behalf of the German regulator (the BfS) to ensure suitability for return to Germany and disposal. This first 'burn and return' programme has safely completed the incineration phase in February and the arising ash will be returned to Germany presently. The paper reports the main findings and lessons learned on this first of its kind project. (authors)« less

Minimising the harm from nicotine use: finding the right regulatory framework

PubMed Central

Borland, Ron

2013-01-01

The tobacco problem can be usefully conceptualised as two problems: eliminating the most harmful forms of nicotine use (certainly cigarettes, and probably all smoked tobacco), and minimising the use and/or harms from use of lower-harm, but addictive forms of nicotine. A possible target would be to effectively eliminate use of the most harmful forms of nicotine within the next decade and then turn our focus to a long-term strategy for the low-harm forms. This paper focuses on the administrative framework(s) needed to accomplish these twin tasks. For a phase-out taking a long time and/or for dealing with residually net harmful and addictive products, there are severe limitations to allowing for-profit marketing of tobacco because such an arrangement (the current one in most countries) can markedly slow down progress and because of the difficulty of constraining marketing in ways that minimise undesirable use. A harm reduction model where the marketing is under the control of a non-profit entity (a regulated market) is required to curtail the incredible power of for-profit marketing and to allow tobacco marketing to be done in ways that further the goal of minimising tobacco-related harm. Countries with a nationalised industry can move their industry onto a harm minimisation framework if they have the political will. Countries with a for-profit industry should consider whether the time and effort required to reconstruct the market may, in the longer term, facilitate achieving their policy goals. PMID:23591515

Minimising the harm from nicotine use: finding the right regulatory framework.

PubMed

Borland, Ron

2013-05-01

The tobacco problem can be usefully conceptualised as two problems: eliminating the most harmful forms of nicotine use (certainly cigarettes, and probably all smoked tobacco), and minimising the use and/or harms from use of lower-harm, but addictive forms of nicotine. A possible target would be to effectively eliminate use of the most harmful forms of nicotine within the next decade and then turn our focus to a long-term strategy for the low-harm forms. This paper focuses on the administrative framework(s) needed to accomplish these twin tasks. For a phase-out taking a long time and/or for dealing with residually net harmful and addictive products, there are severe limitations to allowing for-profit marketing of tobacco because such an arrangement (the current one in most countries) can markedly slow down progress and because of the difficulty of constraining marketing in ways that minimise undesirable use. A harm reduction model where the marketing is under the control of a non-profit entity (a regulated market) is required to curtail the incredible power of for-profit marketing and to allow tobacco marketing to be done in ways that further the goal of minimising tobacco-related harm. Countries with a nationalised industry can move their industry onto a harm minimisation framework if they have the political will. Countries with a for-profit industry should consider whether the time and effort required to reconstruct the market may, in the longer term, facilitate achieving their policy goals.

The household economic burden of eating disorders and adherence to treatment in Australia.

PubMed

Gatt, Lauren; Jan, Stephen; Mondraty, Naresh; Horsfield, Sarah; Hart, Susan; Russell, Janice; Laba, Tracey Lea; Essue, Beverley

2014-11-29

This study investigated the household economic burden of eating disorders and cost-related non-adherence to treatment in Australia. Multi-centre prospective observational study using a structured questionnaire. Ninety participants were recruited from two clinic settings in New South Wales, Australia and from the community using social media. The primary outcome measures were household economic burden of illness measured in terms of out-of-pocket expenditure, household economic hardship and cost-related non-adherence. The pattern of out-of-pocket expenditure varied by diagnosis, with Bulimia Nervosa associated with the highest total mean expenditure (per three months). Economic hardship was reported in 96.7% of participants and 17.8% reported cost-related non-adherence. Those most likely to report cost-related non-adherence had a longer time since diagnosis. Cost-related non-adherence and higher out-of-pocket expenditure were associated with poorer quality of life, a more threatening perception of the impact of the illness and poor self-reported health. This study is the first to empirically and quantitatively examine the household economic burden of eating disorders from the patient perspective. Results indicate that households experience a substantial burden associated with the treatment and management of an eating disorder. This burden may contribute to maintaining the illness for those who experience cost-related non-adherence and by negatively influencing health outcomes. Current initiatives to implement sustainable and integrated models of care for eating disorders should strive to minimise the economic impact of treatment on families.

A clinical and economic evaluation of Control of Hyperglycaemia in Paediatric intensive care (CHiP): a randomised controlled trial.

PubMed

Macrae, Duncan; Grieve, Richard; Allen, Elizabeth; Sadique, Zia; Betts, Helen; Morris, Kevin; Pappachan, Vithayathil John; Parslow, Roger; Tasker, Robert C; Baines, Paul; Broadhead, Michael; Duthie, Mark L; Fortune, Peter-Marc; Inwald, David; McMaster, Paddy; Peters, Mark J; Schindler, Margrid; Guerriero, Carla; Piercy, Deborah; Slavik, Zdenek; Snowdon, Claire; Van Dyck, Laura; Elbourne, Diana

2014-04-01

Early research in adults admitted to intensive care suggested that tight control of blood glucose during acute illness can be associated with reductions in mortality, length of hospital stay and complications such as infection and renal failure. Prior to our study, it was unclear whether or not children could also benefit from tight control of blood glucose during critical illness. This study aimed to determine if controlling blood glucose using insulin in paediatric intensive care units (PICUs) reduces mortality and morbidity and is cost-effective, whether or not admission follows cardiac surgery. Randomised open two-arm parallel group superiority design with central randomisation with minimisation. Analysis was on an intention-to-treat basis. Following random allocation, care givers and outcome assessors were no longer blind to allocation. The setting was 13 English PICUs. Patients who met the following criteria were eligible for inclusion: ≥ 36 weeks corrected gestational age; ≤ 16 years; in the PICU following injury, following major surgery or with critical illness; anticipated treatment > 12 hours; arterial line; mechanical ventilation; and vasoactive drugs. Exclusion criteria were as follows: diabetes mellitus; inborn error of metabolism; treatment withdrawal considered; in the PICU > 5 consecutive days; and already in CHiP (Control of Hyperglycaemia in Paediatric intensive care). The intervention was tight glycaemic control (TGC): insulin by intravenous infusion titrated to maintain blood glucose between 4.0 and 7.0 mmol/l. This consisted of insulin by intravenous infusion only if blood glucose exceeded 12.0 mmol/l on two samples at least 30 minutes apart; insulin was stopped when blood glucose fell below 10.0 mmol/l. The primary outcome was the number of days alive and free from mechanical ventilation within 30 days of trial entry (VFD-30). The secondary outcomes comprised clinical and economic outcomes at 30 days and 12 months and lifetime cost-effectiveness, which included costs per quality-adjusted life-year. CHiP recruited from May 2008 to September 2011. In total, 19,924 children were screened and 1369 eligible patients were randomised (TGC, 694; CM, 675), 60% of whom were in the cardiac surgery stratum. The randomised groups were comparable at trial entry. More children in the TGC than in the CM arm received insulin (66% vs. 16%). The mean VFD-30 was 23 [mean difference 0.36; 95% confidence interval (CI) -0.42 to 1.14]. The effect did not differ among prespecified subgroups. Hypoglycaemia occurred significantly more often in the TGC than in the CM arm (moderate, 12.5% vs. 3.1%; severe, 7.3% vs. 1.5%). Mean 30-day costs were similar between arms, but mean 12-month costs were lower in the TGC than in CM arm (incremental costs -£3620, 95% CI -£7743 to £502). For the non-cardiac surgery stratum, mean costs were lower in the TGC than in the CM arm (incremental cost -£9865, 95% CI -£18,558 to -£1172), but, in the cardiac surgery stratum, the costs were similar between the arms (incremental cost £133, 95% CI -£3568 to £3833). Lifetime incremental net benefits were positive overall (£3346, 95% CI -£11,203 to £17,894), but close to zero for the cardiac surgery stratum (-£919, 95% CI -£16,661 to £14,823). For the non-cardiac surgery stratum, the incremental net benefits were high (£11,322, 95% CI -£15,791 to £38,615). The probability that TGC is cost-effective is relatively high for the non-cardiac surgery stratum, but, for the cardiac surgery subgroup, the probability that TGC is cost-effective is around 0.5. Sensitivity analyses showed that the results were robust to a range of alternative assumptions. CHiP found no differences in the clinical or cost-effectiveness of TGC compared with CM overall, or for prespecified subgroups. A higher proportion of the TGC arm had hypoglycaemia. This study did not provide any evidence to suggest that PICUs should stop providing CM for children admitted to PICUs following cardiac surgery. For the subgroup not admitted for cardiac surgery, TGC reduced average costs at 12 months and is likely to be cost-effective. Further research is required to refine the TGC protocol to minimise the risk of hypoglycaemic episodes and assess the long-term health benefits of TGC. Current Controlled Trials ISRCTN61735247. This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 18, No. 26. See the NIHR Journals Library website for further project information.

Wavefield reconstruction inversion with a multiplicative cost function

NASA Astrophysics Data System (ADS)

da Silva, Nuno V.; Yao, Gang

2018-01-01

We present a method for the automatic estimation of the trade-off parameter in the context of wavefield reconstruction inversion (WRI). WRI formulates the inverse problem as an optimisation problem, minimising the data misfit while penalising with a wave equation constraining term. The trade-off between the two terms is balanced by a scaling factor that balances the contributions of the data-misfit term and the constraining term to the value of the objective function. If this parameter is too large then it implies penalizing for the wave equation imposing a hard constraint in the inversion. If it is too small, then this leads to a poorly constrained solution as it is essentially penalizing for the data misfit and not taking into account the physics that explains the data. This paper introduces a new approach for the formulation of WRI recasting its formulation into a multiplicative cost function. We demonstrate that the proposed method outperforms the additive cost function when the trade-off parameter is appropriately scaled in the latter, when adapting it throughout the iterations, and when the data is contaminated with Gaussian random noise. Thus this work contributes with a framework for a more automated application of WRI.

How to Establish and Follow up a Large Prospective Cohort Study in the 21st Century--Lessons from UK COSMOS.

PubMed

Toledano, Mireille B; Smith, Rachel B; Brook, James P; Douglass, Margaret; Elliott, Paul

2015-01-01

Large-scale prospective cohort studies are invaluable in epidemiology, but they are increasingly difficult and costly to establish and follow-up. More efficient methods for recruitment, data collection and follow-up are essential if such studies are to remain feasible with limited public and research funds. Here, we discuss how these challenges were addressed in the UK COSMOS cohort study where fixed budget and limited time frame necessitated new approaches to consent and recruitment between 2009-2012. Web-based e-consent and data collection should be considered in large scale observational studies, as they offer a streamlined experience which benefits both participants and researchers and save costs. Commercial providers of register and marketing data, smartphones, apps, email, social media, and the internet offer innovative possibilities for identifying, recruiting and following up cohorts. Using examples from UK COSMOS, this article sets out the dos and don'ts for today's cohort studies and provides a guide on how best to take advantage of new technologies and innovative methods to simplify logistics and minimise costs. Thus a more streamlined experience to the benefit of both research participants and researchers becomes achievable.

How to Establish and Follow up a Large Prospective Cohort Study in the 21st Century - Lessons from UK COSMOS

PubMed Central

Toledano, Mireille B.; Smith, Rachel B.; Brook, James P.; Douglass, Margaret; Elliott, Paul

2015-01-01

Large-scale prospective cohort studies are invaluable in epidemiology, but they are increasingly difficult and costly to establish and follow-up. More efficient methods for recruitment, data collection and follow-up are essential if such studies are to remain feasible with limited public and research funds. Here, we discuss how these challenges were addressed in the UK COSMOS cohort study where fixed budget and limited time frame necessitated new approaches to consent and recruitment between 2009-2012. Web-based e-consent and data collection should be considered in large scale observational studies, as they offer a streamlined experience which benefits both participants and researchers and save costs. Commercial providers of register and marketing data, smartphones, apps, email, social media, and the internet offer innovative possibilities for identifying, recruiting and following up cohorts. Using examples from UK COSMOS, this article sets out the dos and don’ts for today's cohort studies and provides a guide on how best to take advantage of new technologies and innovative methods to simplify logistics and minimise costs. Thus a more streamlined experience to the benefit of both research participants and researchers becomes achievable. PMID:26147611

Monitoring Moving Queries inside a Safe Region

PubMed Central

Al-Khalidi, Haidar; Taniar, David; Alamri, Sultan

2014-01-01

With mobile moving range queries, there is a need to recalculate the relevant surrounding objects of interest whenever the query moves. Therefore, monitoring the moving query is very costly. The safe region is one method that has been proposed to minimise the communication and computation cost of continuously monitoring a moving range query. Inside the safe region the set of objects of interest to the query do not change; thus there is no need to update the query while it is inside its safe region. However, when the query leaves its safe region the mobile device has to reevaluate the query, necessitating communication with the server. Knowing when and where the mobile device will leave a safe region is widely known as a difficult problem. To solve this problem, we propose a novel method to monitor the position of the query over time using a linear function based on the direction of the query obtained by periodic monitoring of its position. Periodic monitoring ensures that the query is aware of its location all the time. This method reduces the costs associated with communications in client-server architecture. Computational results show that our method is successful in handling moving query patterns. PMID:24696652

Target validation: linking target and chemical properties to desired product profile.

PubMed

Wyatt, Paul G; Gilbert, Ian H; Read, Kevin D; Fairlamb, Alan H

2011-01-01

The discovery of drugs is a lengthy, high-risk and expensive business taking at least 12 years and is estimated to cost upwards of US$800 million for each drug to be successfully approved for clinical use. Much of this cost is driven by the late phase clinical trials and therefore the ability to terminate early those projects destined to fail is paramount to prevent unwanted costs and wasted effort. Although neglected diseases drug discovery is driven more by unmet medical need rather than financial considerations, the need to minimise wasted money and resources is even more vital in this under-funded area. To ensure any drug discovery project is addressing the requirements of the patients and health care providers and delivering a benefit over existing therapies, the ideal attributes of a novel drug needs to be pre-defined by a set of criteria called a target product profile. Using a target product profile the drug discovery process, clinical study design, and compound characteristics can be defined all the way back through to the suitability or druggability of the intended biochemical target. Assessment and prioritisation of the most promising targets for entry into screening programmes is crucial for maximising chances of success.

Enoxaparin. A pharmacoeconomic appraisal of its use in thromboembolic prophylaxis after total hip arthroplasty.

PubMed

Dunn, C J; Goa, K L

1996-08-01

Total hip arthroplasty (THA) is a major orthopaedic procedure with a high risk of postoperative thromboembolism. Increasing demand for this type of surgery, together with its high cost, has led to examination of means by which the cost of THA may be minimised. Current clinical opinion favours the use of suitable pharmacological thromboprophylaxis in patients undergoing THA; such prophylaxis may be provided with subcutaneous standard unfractionated heparin (UFH), oral warfarin or subcutaneous low molecular weight heparin (LMWH). Traditionally, LMWHs have been perceived as being more expensive to use than UFH or warfarin because of their relatively high acquisition cost. However, recent pharmacoeconomic data have shown that cost savings are possible when LMWHs are used. This is attributed mainly to reduced frequency of administration, reductions in costs associated with diagnosis and treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and the lack of need for laboratory monitoring of blood coagulation parameters. LMWHs have proportionally less anti-factor IIa (antithrombin) activity relative to anti-factor Xa activity than UFH. Enoxaparin, a LMWH with a mean molecular weight of 4 to 5kD, is reported to have approximately 5 times less activity against thrombin than UFH, for equivalent anti-factor Xa activity. Randomised clinical trials in patients undergoing THA have shown enoxaparin to be at least as effective as UFH in the prevention of DVT and PE, with consistent trends towards a lower incidence of DVT with enoxaparin than with UFH. Similar rates of haemorrhagic complications were reported for enoxaparin and UFH in most trials, although a significantly higher total transfusion requirement was reported for UFH than for enoxaparin in a double-blind study. A significantly higher incidence of bleeding was observed with UFH than with enoxaparin in another study, with similar transfusion requirements for both treatment groups. Cost comparisons in which costs were assigned retrospectively to clinical data have shown cost advantages for LMWHs in general over UFH when costs of administration, hospital bed occupancy and laboratory/radiology procedures are calculated. Cost savings with LMWHs were attributed mainly to reductions in the cost of managing thromboembolic complications in patients receiving these drugs. One meta-analysis showed a saving of $US50 000 (1993 figures) for LMWH over UFH (both subcutaneously twice daily) for every 1000 patients. Subcutaneous enoxaparin at a dosage of 30mg twice daily was shown to be more cost effective than oral warfarin in the prophylaxis of DVT and PE in 2 North American studies in which costs were related to outcomes. One study comprised the application of a decision analysis to a hypothetical group of 10 000 patients; an incremental cost effectiveness of $US12 288 (1993 figures) per death averted was reported for enoxaparin. Enoxaparin was also associated with an overall incremental cost effectiveness of $Can29 140 (1992 figures) per year of life saved (YLS) in the other study, in which costs were applied to clinical data obtained retrospectively from 10 randomised trials. Although no cost-effectiveness analyses have been carried out to compare enoxaparin with UFH, a UK cost comparison reported an overall cost saving of pounds 20 per patient (figures from 1989 to 1990) with enoxaparin 40mg once daily subcutaneously over subcutaneous UFH 5000IU 3 times daily. It has also been suggested that the use of once- or twice-daily enoxaparin in preference to UFH may reduce the overall length of hospital stay; a significant difference emerged in 1 analysis (9.9 or 9.5 vs 11.3 days). Pharmacoeconomic data therefore support the use of enoxaparin as an effective thromboprophylactic treatment with potential cost advantages over warfarin and UFH. Cost-effecti

A Multidisciplinary Investigation of Aquatic Pollution and How to Minimise It

ERIC Educational Resources Information Center

Vergnoux, A.; Allari, E.; Sassi, M.; Thimonier, J.; Hammond, C.; Clouzot, L.

2011-01-01

The impact of humans on aquatic systems is covered in French high schools in the "Premiere" level (ages 16 to 17) by students studying economics and social sciences. We designed experiments to teach critical thinking about water pollution and how citizens can act to minimise it. The experimental session, which lasts three consecutive…

Optimising cluster survey design for planning schistosomiasis preventive chemotherapy.

PubMed

Knowles, Sarah C L; Sturrock, Hugh J W; Turner, Hugo; Whitton, Jane M; Gower, Charlotte M; Jemu, Samuel; Phillips, Anna E; Meite, Aboulaye; Thomas, Brent; Kollie, Karsor; Thomas, Catherine; Rebollo, Maria P; Styles, Ben; Clements, Michelle; Fenwick, Alan; Harrison, Wendy E; Fleming, Fiona M

2017-05-01

The cornerstone of current schistosomiasis control programmes is delivery of praziquantel to at-risk populations. Such preventive chemotherapy requires accurate information on the geographic distribution of infection, yet the performance of alternative survey designs for estimating prevalence and converting this into treatment decisions has not been thoroughly evaluated. We used baseline schistosomiasis mapping surveys from three countries (Malawi, Côte d'Ivoire and Liberia) to generate spatially realistic gold standard datasets, against which we tested alternative two-stage cluster survey designs. We assessed how sampling different numbers of schools per district (2-20) and children per school (10-50) influences the accuracy of prevalence estimates and treatment class assignment, and we compared survey cost-efficiency using data from Malawi. Due to the focal nature of schistosomiasis, up to 53% simulated surveys involving 2-5 schools per district failed to detect schistosomiasis in low endemicity areas (1-10% prevalence). Increasing the number of schools surveyed per district improved treatment class assignment far more than increasing the number of children sampled per school. For Malawi, surveys of 15 schools per district and 20-30 children per school reliably detected endemic schistosomiasis and maximised cost-efficiency. In sensitivity analyses where treatment costs and the country considered were varied, optimal survey size was remarkably consistent, with cost-efficiency maximised at 15-20 schools per district. Among two-stage cluster surveys for schistosomiasis, our simulations indicated that surveying 15-20 schools per district and 20-30 children per school optimised cost-efficiency and minimised the risk of under-treatment, with surveys involving more schools of greater cost-efficiency as treatment costs rose.

Cloud-based adaptive exon prediction for DNA analysis

PubMed Central

Putluri, Srinivasareddy; Fathima, Shaik Yasmeen

2018-01-01

Cloud computing offers significant research and economic benefits to healthcare organisations. Cloud services provide a safe place for storing and managing large amounts of such sensitive data. Under conventional flow of gene information, gene sequence laboratories send out raw and inferred information via Internet to several sequence libraries. DNA sequencing storage costs will be minimised by use of cloud service. In this study, the authors put forward a novel genomic informatics system using Amazon Cloud Services, where genomic sequence information is stored and accessed for processing. True identification of exon regions in a DNA sequence is a key task in bioinformatics, which helps in disease identification and design drugs. Three base periodicity property of exons forms the basis of all exon identification techniques. Adaptive signal processing techniques found to be promising in comparison with several other methods. Several adaptive exon predictors (AEPs) are developed using variable normalised least mean square and its maximum normalised variants to reduce computational complexity. Finally, performance evaluation of various AEPs is done based on measures such as sensitivity, specificity and precision using various standard genomic datasets taken from National Center for Biotechnology Information genomic sequence database. PMID:29515813

Public opinion about the source separation of municipal solid waste in Shanghai, China.

PubMed

Zhang, Weiqian; Che, Yue; Yang, Kai; Ren, Xiangyu; Tai, Jun

2012-12-01

For decades the generation of municipal solid waste (MSW) in Shanghai has been increasing. Despite the long-time efforts aimed at MSW management (MSWM), the disposal of MSW achieves poor performance. Thus, a MSW minimisation plan for Shanghai was proposed in December 2010. In this study, direct face-to-face interviews and a structured questionnaire survey were used in four different Shanghai community types. We conducted an econometric analysis of the social factors that influence the willingness to pay for MSW separation and discussed the household waste characteristics, the daily waste generation and the current treatment of kitchen wastes. The results suggested that the respondents are environmentally aware of separation, but only practise minimal separation. Negative neighbour effects, confused classification of MSW, and mixed transportation and disposal are the dominant limitations of MSW source-separated collection. Most respondents are willing to pay for MSWM. Public support is influenced by household population, income and cost. The attitudes and behaviours of citizens are important for reducing the amount of MSW disposal by 50% per capita by 2020 (relative to 2010). Concerted efforts should be taken to enlarge pilot areas. In addition, the source separation of kitchen wastes should be promoted.

Customisation of the exome data analysis pipeline using a combinatorial approach.

PubMed

Pattnaik, Swetansu; Vaidyanathan, Srividya; Pooja, Durgad G; Deepak, Sa; Panda, Binay

2012-01-01

The advent of next generation sequencing (NGS) technologies have revolutionised the way biologists produce, analyse and interpret data. Although NGS platforms provide a cost-effective way to discover genome-wide variants from a single experiment, variants discovered by NGS need follow up validation due to the high error rates associated with various sequencing chemistries. Recently, whole exome sequencing has been proposed as an affordable option compared to whole genome runs but it still requires follow up validation of all the novel exomic variants. Customarily, a consensus approach is used to overcome the systematic errors inherent to the sequencing technology, alignment and post alignment variant detection algorithms. However, the aforementioned approach warrants the use of multiple sequencing chemistry, multiple alignment tools, multiple variant callers which may not be viable in terms of time and money for individual investigators with limited informatics know-how. Biologists often lack the requisite training to deal with the huge amount of data produced by NGS runs and face difficulty in choosing from the list of freely available analytical tools for NGS data analysis. Hence, there is a need to customise the NGS data analysis pipeline to preferentially retain true variants by minimising the incidence of false positives and make the choice of right analytical tools easier. To this end, we have sampled different freely available tools used at the alignment and post alignment stage suggesting the use of the most suitable combination determined by a simple framework of pre-existing metrics to create significant datasets.

Spectral and spatial characterisation of laser-driven positron beams

DOE PAGES

Sarri, G.; Warwick, J.; Schumaker, W.; ...

2016-10-18

The generation of high-quality relativistic positron beams is a central area of research in experimental physics, due to their potential relevance in a wide range of scientific and engineering areas, ranging from fundamental science to practical applications. There is now growing interest in developing hybrid machines that will combine plasma-based acceleration techniques with more conventional radio-frequency accelerators, in order to minimise the size and cost of these machines. Here we report on recent experiments on laser-driven generation of high-quality positron beams using a relatively low energy and potentially table-top laser system. Lastly, the results obtained indicate that current technology allowsmore » to create, in a compact setup, positron beams suitable for injection in radio-frequency accelerators.« less

Prophylactic antibiotics in dermatological surgery.

PubMed

Lee, Michael R; Paver, Robert

2016-05-01

This is a review of the common pathogens of surgical site infections, antibiotic coverage for particular anatomical sites, mechanisms by which surgical site infections occur and the latest data and recommendations for prophylactic antibiotics in the prevention of surgical site infections, infective endocarditis and haematogenous joint infections. Recent evidence-based guidelines on surgical prophylaxis is for restricted indications and a shorter duration of antibiotic prophylaxis in situations where no clinical benefit of prolonged therapy has been proven, in order to minimise the potential adverse ecological and clinical effects associated with antibiotic therapy. This review recommends the cautious use of prophylactic antibiotics in dermatological surgery to help prevent the growing problem of bacterial resistance as well as other morbidity and health-care costs. © 2015 The Australasian College of Dermatologists.

Enhanced recovery in total hip replacement: a clinical review.

PubMed

Ibrahim, M S; Twaij, H; Giebaly, D E; Nizam, I; Haddad, F S

2013-12-01

The outcome after total hip replacement has improved with the development of surgical techniques, better pain management and the introduction of enhanced recovery pathways. These pathways require a multidisciplinary team to manage pre-operative education, multimodal pain control and accelerated rehabilitation. The current economic climate and restricted budgets favour brief hospitalisation while minimising costs. This has put considerable pressure on hospitals to combine excellent results, early functional recovery and shorter admissions. In this review we present an evidence-based summary of some common interventions and methods, including pre-operative patient education, pre-emptive analgesia, local infiltration analgesia, pre-operative nutrition, the use of pulsed electromagnetic fields, peri-operative rehabilitation, wound dressings, different surgical techniques, minimally invasive surgery and fast-track joint replacement units.

Application of multi attribute failure mode analysis of milk production using analytical hierarchy process method

NASA Astrophysics Data System (ADS)

Rucitra, A. L.

2018-03-01

Pusat Koperasi Induk Susu (PKIS) Sekar Tanjung, East Java is one of the modern dairy industries producing Ultra High Temperature (UHT) milk. A problem that often occurs in the production process in PKIS Sekar Tanjung is a mismatch between the production process and the predetermined standard. The purpose of applying Analytical Hierarchy Process (AHP) was to identify the most potential cause of failure in the milk production process. Multi Attribute Failure Mode Analysis (MAFMA) method was used to eliminate or reduce the possibility of failure when viewed from the failure causes. This method integrates the severity, occurrence, detection, and expected cost criteria obtained from depth interview with the head of the production department as an expert. The AHP approach was used to formulate the priority ranking of the cause of failure in the milk production process. At level 1, the severity has the highest weight of 0.41 or 41% compared to other criteria. While at level 2, identifying failure in the UHT milk production process, the most potential cause was the average mixing temperature of more than 70 °C which was higher than the standard temperature (≤70 ° C). This failure cause has a contributes weight of 0.47 or 47% of all criteria Therefore, this study suggested the company to control the mixing temperature to minimise or eliminate the failure in this process.

Investigating the relationship between predictability and imbalance in minimisation: a simulation study

PubMed Central

2013-01-01

Background The use of restricted randomisation methods such as minimisation is increasing. This paper investigates under what conditions it is preferable to use restricted randomisation in order to achieve balance between treatment groups at baseline with regard to important prognostic factors and whether trialists should be concerned that minimisation may be considered deterministic. Methods Using minimisation as the randomisation algorithm, treatment allocation was simulated for hypothetical patients entering a theoretical study having values for prognostic factors randomly assigned with a stipulated probability. The number of times the allocation could have been determined with certainty and the imbalances which might occur following randomisation using minimisation were examined. Results Overall treatment balance is relatively unaffected by reducing the probability of allocation to optimal treatment group (P) but within-variable balance can be affected by any P <1. This effect is magnified by increased numbers of prognostic variables, the number of categories within them and the prevalence of these categories within the study population. Conclusions In general, for smaller trials, probability of treatment allocation to the treatment group with fewer numbers requires a larger value P to keep treatment and variable groups balanced. For larger trials probability of allocation values from P = 0.5 to P = 0.8 can be used while still maintaining balance. For one prognostic variable there is no significant benefit in terms of predictability in reducing the value of P. However, for more than one prognostic variable, significant reduction in levels of predictability can be achieved with the appropriate choice of P for the given trial design. PMID:23537389

Investigating the relationship between predictability and imbalance in minimisation: a simulation study.

PubMed

McPherson, Gladys C; Campbell, Marion K; Elbourne, Diana R

2013-03-27

The use of restricted randomisation methods such as minimisation is increasing. This paper investigates under what conditions it is preferable to use restricted randomisation in order to achieve balance between treatment groups at baseline with regard to important prognostic factors and whether trialists should be concerned that minimisation may be considered deterministic. Using minimisation as the randomisation algorithm, treatment allocation was simulated for hypothetical patients entering a theoretical study having values for prognostic factors randomly assigned with a stipulated probability. The number of times the allocation could have been determined with certainty and the imbalances which might occur following randomisation using minimisation were examined. Overall treatment balance is relatively unaffected by reducing the probability of allocation to optimal treatment group (P) but within-variable balance can be affected by any P <1. This effect is magnified by increased numbers of prognostic variables, the number of categories within them and the prevalence of these categories within the study population. In general, for smaller trials, probability of treatment allocation to the treatment group with fewer numbers requires a larger value P to keep treatment and variable groups balanced. For larger trials probability of allocation values from P = 0.5 to P = 0.8 can be used while still maintaining balance. For one prognostic variable there is no significant benefit in terms of predictability in reducing the value of P. However, for more than one prognostic variable, significant reduction in levels of predictability can be achieved with the appropriate choice of P for the given trial design.

Minimising post-operative risk using a Post-Anaesthetic Care Tool (PACT): protocol for a prospective observational study and cost-effectiveness analysis.

PubMed

Street, Maryann; Phillips, Nicole M; Kent, Bridie; Colgan, Stephen; Mohebbi, Mohammadreza

2015-06-01

While the risk of adverse events following surgery has been identified, the impact of nursing care on early detection of these events is not well established. A systematic review of the evidence and an expert consensus study in post-anaesthetic care identified essential criteria for nursing assessment of patient readiness for discharge from the post-anaesthetic care unit (PACU). These criteria were included in a new nursing assessment tool, the Post-Anaesthetic Care Tool (PACT), and incorporated into the post-anaesthetic documentation at a large health service. The aim of this study is to test the clinical reliability of the PACT and evaluate whether the use of PACT will (1) enhance the recognition and response to patients at risk of deterioration in PACU; (2) improve documentation for handover from PACU nurse to ward nurse; (3) result in improved patient outcomes and (4) reduce healthcare costs. A prospective, non-randomised, pre-implementation and post-implementation design comparing: (1) patients (n=750) who have surgery prior to the implementation of the PACT and (2) patients (n=750) who have surgery after PACT. The study will examine the use of the tool through the observation of patient care and nursing handover. Patient outcomes and cost-effectiveness will be determined from health service data and medical record audit. Descriptive statistics will be used to describe the sample and compare the two patient groups (pre-intervention and post-intervention). Differences in patient outcomes between the two groups will be compared using the Cochran-Mantel-Haenszel test and regression analyses and reported as ORs with the corresponding 95% CIs. This study will test the clinical reliability and cost-effectiveness of the PACT. It is hypothesised that the PACT will enable nurses to recognise and respond to patients at risk of deterioration, improve handover to ward nurses, improve patient outcomes, and reduce healthcare costs. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Farm systems assessment of bioenergy feedstock production: Integrating bio-economic models and life cycle analysis approaches

PubMed Central

Glithero, N.J.; Ramsden, S.J.; Wilson, P.

2012-01-01

Climate change and energy security concerns have driven the development of policies that encourage bioenergy production. Meeting EU targets for the consumption of transport fuels from bioenergy by 2020 will require a large increase in the production of bioenergy feedstock. Initially an increase in ‘first generation’ biofuels was observed, however ‘food competition’ concerns have generated interest in second generation biofuels (SGBs). These SGBs can be produced from co-products (e.g. cereal straw) or energy crops (e.g. miscanthus), with the former largely negating food competition concerns. In order to assess the sustainability of feedstock supply for SGBs, the financial, environmental and energy costs and benefits of the farm system must be quantified. Previous research has captured financial costs and benefits through linear programming (LP) approaches, whilst environmental and energy metrics have been largely been undertaken within life cycle analysis (LCA) frameworks. Assessing aspects of the financial, environmental and energy sustainability of supplying co-product second generation biofuel (CPSGB) feedstocks at the farm level requires a framework that permits the trade-offs between these objectives to be quantified and understood. The development of a modelling framework for Managing Energy and Emissions Trade-Offs in Agriculture (MEETA Model) that combines bio-economic process modelling and LCA is presented together with input data parameters obtained from literature and industry sources. The MEETA model quantifies arable farm inputs and outputs in terms of financial, energy and emissions results. The model explicitly captures fertiliser: crop-yield relationships, plus the incorporation of straw or removal for sale, with associated nutrient impacts of incorporation/removal on the following crop in the rotation. Key results of crop-mix, machinery use, greenhouse gas (GHG) emissions per kg of crop product and energy use per hectare are in line with previous research and industry survey findings. Results show that the gross margin – energy trade-off is £36 GJ−1, representing the gross margin forgone by maximising net farm energy cf. maximising farm gross margin. The gross margin–GHG emission trade-off is £0.15 kg−1 CO2 eq, representing the gross margin forgone per kg of CO2 eq reduced when GHG emissions are minimised cf. maximising farm gross margin. The energy–GHG emission trade-off is 0.03 GJ kg−1 CO2 eq quantifying the reduction in net energy from the farm system per kg of CO2 eq reduced when minimising GHG emissions cf. maximising net farm energy. When both farm gross margin and net farm energy are maximised all the cereal straw is baled for sale. Sensitivity analysis of the model in relation to different prices of cereal straw shows that it becomes financially optimal to incorporate wheat straw at price of £11 t−1 for this co-product. Local market conditions for straw and farmer attitudes towards incorporation or sale of straw will impact on the straw price at which farmers will supply this potential bioenergy feedstock and represent important areas for future research. PMID:25540473

Quadratic Optimisation with One Quadratic Equality Constraint

DTIC Science & Technology

2010-06-01

This report presents a theoretical framework for minimising a quadratic objective function subject to a quadratic equality constraint. The first part of the report gives a detailed algorithm which computes the global minimiser without calling special nonlinear optimisation solvers. The second part of the report shows how the developed theory can be applied to solve the time of arrival geolocation problem.

Optimisation Modelling to Assess Cost of Dietary Improvement in Remote Aboriginal Australia

PubMed Central

Brimblecombe, Julie; Ferguson, Megan; Liberato, Selma C.; O'Dea, Kerin; Riley, Malcolm

2013-01-01

Background The cost and dietary choices required to fulfil nutrient recommendations defined nationally, need investigation, particularly for disadvantaged populations. Objective We used optimisation modelling to examine the dietary change required to achieve nutrient requirements at minimum cost for an Aboriginal population in remote Australia, using where possible minimally-processed whole foods. Design A twelve month cross-section of population-level purchased food, food price and nutrient content data was used as the baseline. Relative amounts from 34 food group categories were varied to achieve specific energy and nutrient density goals at minimum cost while meeting model constraints intended to minimise deviation from the purchased diet. Results Simultaneous achievement of all nutrient goals was not feasible. The two most successful models (A & B) met all nutrient targets except sodium (146.2% and 148.9% of the respective target) and saturated fat (12.0% and 11.7% of energy). Model A was achieved with 3.2% lower cost than the baseline diet (which cost approximately AUD$13.01/person/day) and Model B at 7.8% lower cost but with a reduction in energy of 4.4%. Both models required very large reductions in sugar sweetened beverages (−90%) and refined cereals (−90%) and an approximate four-fold increase in vegetables, fruit, dairy foods, eggs, fish and seafood, and wholegrain cereals. Conclusion This modelling approach suggested population level dietary recommendations at minimal cost based on the baseline purchased diet. Large shifts in diet in remote Aboriginal Australian populations are needed to achieve national nutrient targets. The modeling approach used was not able to meet all nutrient targets at less than current food expenditure. PMID:24391790

Warpage analysis on thin shell part using response surface methodology (RSM)

NASA Astrophysics Data System (ADS)

Zulhasif, Z.; Shayfull, Z.; Nasir, S. M.; Fathullah, M.; Hazwan, M. H. M.

2017-09-01

The optimisation of moulding parameters appropriate to reduce warpage defects produce using Autodesk Moldflow Insight (AMI) 2012 software The product is injected by using Acrylonitrile-Butadiene-Styrene (ABS) materials. This analysis has processing parameter that varies in melting temperature, mould temperature, packing pressure and packing time. Design of Experiments (DOE) has been integrated to obtain a polynomial model using Response Surface Methodology (RSM). The Glowworm Swarm Optimisation (GSO) method is used to predict a best combination parameters to minimise warpage defect in order to produce high quality parts.

Challenge and response: HIV in Asia and the Pacific.

PubMed

Dwyer, J M; Mahathir, M; Nath, L M

1996-11-04

Inexorably, the epicentre of the global HIV pandemic is moving from Africa to Asia. Despite many years of much-publicised analysis of the African epidemic, most countries in Asia and many in the Pacific have not introduced the public health strategies known to minimise the spread of HIV. What must be done now, and how can the developed countries in the region, such as Australia, assist their neighbours?

A national public health programme on gambling policy development in New Zealand: insights from a process evaluation.

PubMed

Kolandai-Matchett, Komathi; Landon, Jason; Bellringer, Maria; Abbott, Max

2018-03-06

In New Zealand, a public health programme on gambling policy development is part of a national gambling harm reduction and prevention strategy mandated by the Gambling Act 2003. Funded by the Ministry of Health, the programme directs workplace/organisational gambling policies, non-gambling fundraising policies, and local council policies on electronic gaming machines (EGMs). We carried out a process evaluation of this programme to identify practical information (e.g. advocacy approaches; challenges and ameliorating strategies) that can be used by programme planners and implementers to reinforce programme effectiveness and serve to guide similar policy-focused public health initiatives elsewhere. Evaluation criteria, based on the programme's official service specifications, guided our evaluation questions, analysis and reporting. To identify informative aspects of programme delivery, we thematically analysed over 100 six-monthly implementer progress reports (representing 3 years of programme delivery) and transcript of a focus group with public health staff. Identified output-related themes included purposeful awareness raising to build understanding about gambling harms and the need for harm-reduction policies and stakeholder relationship development. Outcome-related themes included enhanced community awareness about gambling harms, community involvement in policy development, some workplace/organisational policy development, and some influences on council EGM policies. Non-gambling fundraising policy development was not common. The programme offers an unprecedented gambling harm reduction approach. Although complex (due to its three distinct policy focus areas targeting different sectors) and challenging (due to the extensive time and resources needed to develop relationships and overcome counteractive views), the programme resulted in some policy development. Encouraging workplace/organisational policy development requires increased awareness of costs to employers and society and appreciation of policy value. Although encouraging non-gambling fundraising policies will likely remain challenging, public debate on ethical aspects could stimulate policy consideration. Influencing council EGM policy decisions will remain important for minimising EGM accessibility among vulnerable communities. Public involvement in EGM policy decisions has strong implications for policy effectiveness. Given the expanding range of gambling activities (including online gambling) presently accessible to communities worldwide, both organisational and public policies (as advocated through the programme) are needed to minimise gambling harms.

Multi-objective optimisation of wastewater treatment plant control to reduce greenhouse gas emissions.

PubMed

Sweetapple, Christine; Fu, Guangtao; Butler, David

2014-05-15

This study investigates the potential of control strategy optimisation for the reduction of operational greenhouse gas emissions from wastewater treatment in a cost-effective manner, and demonstrates that significant improvements can be realised. A multi-objective evolutionary algorithm, NSGA-II, is used to derive sets of Pareto optimal operational and control parameter values for an activated sludge wastewater treatment plant, with objectives including minimisation of greenhouse gas emissions, operational costs and effluent pollutant concentrations, subject to legislative compliance. Different problem formulations are explored, to identify the most effective approach to emissions reduction, and the sets of optimal solutions enable identification of trade-offs between conflicting objectives. It is found that multi-objective optimisation can facilitate a significant reduction in greenhouse gas emissions without the need for plant redesign or modification of the control strategy layout, but there are trade-offs to consider: most importantly, if operational costs are not to be increased, reduction of greenhouse gas emissions is likely to incur an increase in effluent ammonia and total nitrogen concentrations. Design of control strategies for a high effluent quality and low costs alone is likely to result in an inadvertent increase in greenhouse gas emissions, so it is of key importance that effects on emissions are considered in control strategy development and optimisation. Copyright © 2014 Elsevier Ltd. All rights reserved.

Childhood varicella-zoster virus vaccination in Belgium: cost-effective only in the long run or without exogenous boosting?

PubMed

Bilcke, Joke; van Hoek, Albert Jan; Beutels, Philippe

2013-04-01

To assess the effectiveness and cost-effectiveness of a universal childhood varicella-zoster vaccination programme in Belgium (1) using the most recent Belgian data on varicella-zoster burden, (2) exploring different options for the timing of the second dose, (3) obtaining results with and without exogenous natural boosting, and (4) investigating the possible additional benefit of zoster booster vaccination for adults at age 50 or 60 y. An extensively studied and improved dynamic model is used to estimate primary and breakthrough chickenpox and zoster cases over time. For a range of vaccination options, we compared the direct costs (health care payer perspective) and health outcomes (including Quality-Adjusted Life-Years (QALYs) lost) associated with chickenpox and herpes zoster. Estimates of social contact patterns, health care use, costs and QALY losses are almost exclusively based on Belgian databases and surveys. If exogenous natural boosting exists, a net loss in QALYs is expected for several decades after implementing a universal chickenpox vaccination programme, due to an increase in zoster mainly in persons aged 50-80 y. This result holds also for scenarios that minimise or counteract the expected increase in zoster incidence (e.g. additional booster vaccinations in adults). However, if the boosting hypothesis is not true or if costs and QALYs are cumulated over at least 33 to more than 100 y after vaccination (depending on the assumptions made), different options for universal 2-dose vaccination against chickenpox in Belgium would be cost-effective at a vaccine price of €43/dose or lower.

Shared Ageing Research Models (ShARM): a new facility to support ageing research.

PubMed

Duran, Adele L; Potter, Paul; Wells, Sara; Kirkwood, Tom; von Zglinicki, Thomas; McArdle, Anne; Scudamore, Cheryl; Meng, Qing-Jun; de Haan, Gerald; Corcoran, Anne; Bellantuono, Ilaria

2013-12-01

In order to manage the rise in life expectancy and the concomitant increased occurrence of age-related diseases, research into ageing has become a strategic priority. Mouse models are commonly utilised as they share high homology with humans and show many similar signs and diseases of ageing. However, the time and cost needed to rear aged cohorts can limit research opportunities. Sharing of resources can provide an ethically and economically superior framework to overcome some of these issues but requires dedicated infrastructure. Shared Ageing Research Models (ShARM) ( www.ShARMUK.org ) is a new, not-for-profit organisation funded by Wellcome Trust, open to all investigators. It collects, stores and distributes flash frozen tissues from aged murine models through its biorepository and provides a database of live ageing mouse colonies available in the UK and abroad. It also has an online environment (MICEspace) for collation and analysis of data from communal models and discussion boards on subjects such as the welfare of ageing animals and common endpoints for intervention studies. Since launching in July 2012, thanks to the generosity of researchers in UK and Europe, ShARM has collected more than 2,500 tissues and has in excess of 2,000 mice registered in live ageing colonies. By providing the appropriate support, ShARM has been able to bring together the knowledge and experience of investigators in the UK and Europe to maximise research outputs with little additional cost and minimising animal use in order to facilitate progress in ageing research.

The effects of shoe-worn insoles on gait biomechanics in people with knee osteoarthritis: a systematic review and meta-analysis.

PubMed

Shaw, Kathryn E; Charlton, Jesse M; Perry, Christina K L; de Vries, Courtney M; Redekopp, Matthew J; White, Jordan A; Hunt, Michael A

2018-02-01

The effect of shoe-worn insoles on biomechanical variables in people with medial knee osteoarthritis has been studied extensively. The majority of research has focused specifically on the effect of lateral wedge insoles at the knee. The aim of this systematic review and meta-analysis was to summarise the known effects of different shoe-worn insoles on all biomechanical variables during level walking in this patient population to date. Four electronic databases were searched to identify studies containing biomechanical data using shoe-worn insole devices in the knee osteoarthritis population. Methodological quality was assessed and a random effects meta-analysis was performed on biomechanical variables reported in three or more studies for each insole. Twenty-seven studies of moderate-to-high methodological quality were included in this review. The primary findings were consistent reductions in the knee adduction moment with lateral wedge insoles, although increases in ankle eversion with these insoles were also found. Lateral wedge insoles produce small reductions in knee adduction angles and external moments, and moderate increases in ankle eversion. The addition of an arch support to a lateral wedge minimises ankle eversion change, and also minimises adduction moment reductions. The paucity of available data on other insole types and other biomechanical outcomes presents an opportunity for future research. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Simulated ward round: reducing costs, not outcomes.

PubMed

Ford, Helen; Cleland, Jennifer; Thomas, Ian

2017-02-01

Distractions and interruptions on the ward pose substantial patient safety risks, but medical students receive little training on their management. Although there is some evidence that medical students can be taught how to manage distractions and interruptions in a simulated ward environment, the only model to date is based on individual feedback, which is resource-expensive, mitigating curricular integration. Our aim was to assess the educational utility of a cost-efficient approach to a patient safety-focused simulated ward round. Twenty-three of 55 final-year medical students took part in a cost-reduced simulated ward round. Costs were minimised by providing group rather than individualised feedback, thereby shortening the duration of each simulation and reducing the number of interruptions. The utility of the simulation was assessed via student evaluation and performance on a patient safety station of an objective structured clinical examination (OSCE). The direct costs of the simulation were more than 50 per cent lower per student compared with the original study, mostly as a result of a reduction in the time that faculty members took to give feedback. Students managed distractions better and received higher scores in the OSCE station than those who had not undergone the ward round. Group feedback was evaluated positively by most participants: 94 per cent of those who provided feedback agreed or strongly agreed that the simulation would make them a safer doctor and would improve their handling of distractions. Our aim was to assess the educational utility of a cost-efficient approach to a patient safety-focused simulated ward round DISCUSSION: The costs of a simulated ward round can be significantly reduced whilst maintaining educational utility. These findings should encourage medical schools to integrate ward simulation into curricula. © 2016 John Wiley & Sons Ltd.

Optimising cluster survey design for planning schistosomiasis preventive chemotherapy

PubMed Central

Sturrock, Hugh J. W.; Turner, Hugo; Whitton, Jane M.; Gower, Charlotte M.; Jemu, Samuel; Phillips, Anna E.; Meite, Aboulaye; Thomas, Brent; Kollie, Karsor; Thomas, Catherine; Rebollo, Maria P.; Styles, Ben; Clements, Michelle; Fenwick, Alan; Harrison, Wendy E.; Fleming, Fiona M.

2017-01-01

Background The cornerstone of current schistosomiasis control programmes is delivery of praziquantel to at-risk populations. Such preventive chemotherapy requires accurate information on the geographic distribution of infection, yet the performance of alternative survey designs for estimating prevalence and converting this into treatment decisions has not been thoroughly evaluated. Methodology/Principal findings We used baseline schistosomiasis mapping surveys from three countries (Malawi, Côte d’Ivoire and Liberia) to generate spatially realistic gold standard datasets, against which we tested alternative two-stage cluster survey designs. We assessed how sampling different numbers of schools per district (2–20) and children per school (10–50) influences the accuracy of prevalence estimates and treatment class assignment, and we compared survey cost-efficiency using data from Malawi. Due to the focal nature of schistosomiasis, up to 53% simulated surveys involving 2–5 schools per district failed to detect schistosomiasis in low endemicity areas (1–10% prevalence). Increasing the number of schools surveyed per district improved treatment class assignment far more than increasing the number of children sampled per school. For Malawi, surveys of 15 schools per district and 20–30 children per school reliably detected endemic schistosomiasis and maximised cost-efficiency. In sensitivity analyses where treatment costs and the country considered were varied, optimal survey size was remarkably consistent, with cost-efficiency maximised at 15–20 schools per district. Conclusions/Significance Among two-stage cluster surveys for schistosomiasis, our simulations indicated that surveying 15–20 schools per district and 20–30 children per school optimised cost-efficiency and minimised the risk of under-treatment, with surveys involving more schools of greater cost-efficiency as treatment costs rose. PMID:28552961

Guidelines for treatment of lice in sheep with long wool based on a model of the development of wool damage.

PubMed

Lucas, P G; Horton, B J

2014-01-01

This study used a model of the development of wool damage caused by lice in long wool to examine the conditions under which treatment of the sheep is advisable on an economic basis. The model uses the proportion of a flock showing visible signs of rubbing and the number of days until the next shearing to compare the cost of treatment (product plus labour) with production losses because of the reduction in wool value caused by lice. From the model output, guidelines are provided to inform producers of the most cost-effective option for lice control. Under normal conditions, if there are any signs of rubbing ≥140 days before shearing, then treatment was the best option. If signs of wool damage are not observed until there are ≤70 days before shearing, then the most cost-effective option is to not treat at all. Between these two periods, the time period in which not treating is the most cost-effective option decreases as the number of sheep visibly affected by lice increases. At higher wool values (A$70/head vs A$35), the option to treat is brought forward approximately 25 days, whereas at a low wool value (A$17.50/head) the period in which no treatment is the most cost-effective is extended by approximately 25 days. Treating only the visibly affected sheep is the best option only for a very short time for all wool values and treatment costs. The model provides guidelines for control of lice in long wool to minimise the net cost of infestation and limit unnecessary pesticide use. © 2014 Australian Veterinary Association.

Retrieval medicine: a review and guide for UK practitioners. Part 2: safety in patient retrieval systems

PubMed Central

Hearns, S; Shirley, P J

2006-01-01

Retrieval and transfer of critically ill and injured patients is a high risk activity. Risk can be minimised with robust safety and clinical governance systems in place. This article describes the various governance systems that can be employed to optimise safety and efficiency in retrieval services. These include operating procedure development, equipment management, communications procedures, crew resource management, significant event analysis, audit and training. PMID:17130608

Towards a more efficient diabetes control in primary care: six-monthly monitoring compared with three-monthly monitoring in type 2 diabetes - The EFFIMODI trial. Design of a randomised controlled patient-preference equivalence trial in primary care.

PubMed

Wermeling, Paulien R; van den Donk, Maureen; Gorter, Kees J; Ardine de Wit, G; van der Graaf, Yolanda; Rutten, Guy Ehm

2010-05-11

Scientific evidence for the frequency of monitoring of type 2 diabetes patients is lacking. If three-monthly control in general practice could be reduced to six-monthly control in some patients, this would on the one hand reduce the use of medical services including involvement of practice nurses, and thus reduce costs, and on the other hand alleviate the burden of people with type 2 diabetes. The goal of this study is to make primary diabetes care as efficient as possible for patients and health care providers. Therefore, we want to determine whether six-monthly monitoring of well-controlled type 2 diabetes patients in primary care leads to equivalent cardiometabolic control compared to the generally recommended three-monthly monitoring. The study is a randomised controlled patient-preference equivalence trial. Participants are asked if they prefer three-monthly (usual care) or six-monthly diabetes monitoring. If they do not have a preference, they are randomised to a three-monthly or six-monthly monitoring group. Patients are eligible for the study if they are between 40 and 80 years old, diagnosed with type 2 diabetes more than one year ago, treated by a general practitioner, not on insulin treatment, and with HbA1c < or = 7.5%, systolic blood pressure < or = 145 mmHg and total cholesterol < or = 5.2 mmol/l. The intervention group (six-monthly monitoring) will receive the same treatment with the same treatment targets as the control group (three-monthly monitoring). The intervention period will last one and a half year. After the intervention, the three-monthly and six-monthly monitoring groups are compared on equivalence of cardiometabolic control. Secondary outcome measures are HbA1c, blood pressure, cholesterol level, Body Mass Index, smoking behaviour, physical activity, loss of work due to illness, health status, diabetes-specific distress, satisfaction with treatment and adherence to medications. We will use intention-to-treat analysis with repeated measures. For outcomes that have only baseline and final measurements, we will use ANCOVA. Depending on the results, a cost-minimisation analysis or an incremental cost-effectiveness analysis will be done. This study will provide valuable information on the most efficient control frequency of well-controlled type 2 diabetes patients in primary care.

Robust consensus algorithm for multi-agent systems with exogenous disturbances under convergence conditions

NASA Astrophysics Data System (ADS)

Jiang, Yulian; Liu, Jianchang; Tan, Shubin; Ming, Pingsong

2014-09-01

In this paper, a robust consensus algorithm is developed and sufficient conditions for convergence to consensus are proposed for a multi-agent system (MAS) with exogenous disturbances subject to partial information. By utilizing H∞ robust control, differential game theory and a design-based approach, the consensus problem of the MAS with exogenous bounded interference is resolved and the disturbances are restrained, simultaneously. Attention is focused on designing an H∞ robust controller (the robust consensus algorithm) based on minimisation of our proposed rational and individual cost functions according to goals of the MAS. Furthermore, sufficient conditions for convergence of the robust consensus algorithm are given. An example is employed to demonstrate that our results are effective and more capable to restrain exogenous disturbances than the existing literature.

In vitro genotoxicity testing strategy for nanomaterials and the adaptation of current OECD guidelines

PubMed Central

Doak, S.H.; Manshian, B.; Jenkins, G.J.S.; Singh, N.

2012-01-01

There is a pressing requirement to define a hazard identification and risk management strategy for nanomaterials due to the rapid growth in the nanotechnology industry and their promise of life-style revolutions through the development of wide-ranging nano-containing consumer products. Consequently, a battery of well defined and appropriate in vitro assays to assess a number of genotoxicity endpoints is required to minimise extensive and costly in vivo testing. However, the validity of the established protocols in current OECD recognised genotoxicity assays for nanomaterials is currently being questioned. In this report, we therefore consider the in vitro OECD genotoxicity test battery including the Ames, micronucleus and HPRT forward mutation assays, and their potential role in the safety assessment of nanomaterial induced DNA damage in vitro. PMID:21971291

Application of ion-sensitive sensors in water quality monitoring.

PubMed

Winkler, S; Rieger, L; Saracevic, E; Pressl, A; Gruber, G

2004-01-01

Within the last years a trend towards in-situ monitoring can be observed, i.e. most new sensors for water quality monitoring are designed for direct installation in the medium, compact in size and use measurement principles which minimise maintenance demand. Ion-sensitive sensors (Ion-Sensitive-Electrode--ISE) are based on a well known measurement principle and recently some manufacturers have released probe types which are specially adapted for application in water quality monitoring. The function principle of ISE-sensors, their advantages, limitations and the different methods for sensor calibration are described. Experiences with ISE-sensors from applications in sewer networks, at different sampling points within wastewater treatment plants and for surface water monitoring are reported. An estimation of investment and operation costs in comparison to other sensor types is given.

Economic considerations and decision support tool for wastewater reuse scheme planning.

PubMed

Hochstrat, R; Joksimovic, D; Wintgens, T; Melin, T; Savic, D

2007-01-01

The reuse of upgraded wastewater for beneficial uses is increasingly adopted and accepted as a tool in water management. However, funding of schemes is still a critical issue. The focus of this paper is on economic considerations of water reuse planning. A survey of pricing mechanisms for reclaimed water revealed that most schemes are subsidised to a great extent. In order to minimise these state contributions to the implementation and operation of reuse projects, their planning should identify a least cost design option. This also has to take into account the established pricing structure for conventional water resources and the possibility of gaining revenues from reclaimed water pricing. The paper presents a case study which takes into account these aspects. It evaluates different scheme designs with regard to their Net Present Value (NPV). It could be demonstrated that for the same charging level, quite different amounts of reclaimed water can be delivered while still producing an overall positive NPV. Moreover, the economic feasibility and competitiveness of a reuse scheme is highly determined by the cost structure of the conventional water market.

Role of rescue IVF-ET treatment in the management of high response in stimulated IUI cycles.

PubMed

Olufowobi, O; Sharif, K; Papaioannou, S; Mohamed, H; Neelakantan, D; Afnan, M

2005-02-01

Rescue in-vitro fertilisation and embryo transfer (IVF-ET) has been used in high response gonadotrophin intrauterine insemination (IUI) cycles to minimise the risks of ovarian hyperstimulation and multiple gestation. Such unplanned IVF treatment increases the cost of treatment. But can this added cost and the risks associated with IVF be justified? We present our experience with this treatment using clinical pregnancy and live birth rates as the primary outcomes. Between 1998 to 2001, 40 women undergoing IUI cycles who over responded (>3 follicles measuring >15 mm in diameter on the planned day of hCG administration) to gonadotrophin were offered the choice of conversion to IVF-ET or cancel the cycle. 17/40 declined rescue IVF/ET and had their cycles cancelled. 23/40 converted to IVF/ET and underwent transvaginal oocyte retrieval. 21/23 had embryo transferred. The clinical pregnancy and live birth rates were 52% and 48%, respectively. Rescue IVF-ET offers excellent clinical pregnancy and live birth rates in high responders. However, affordability can be an obstacle in the utilization of this treatment option.

Costing Human Rights and Community Support Interventions as a Part of Universal Access to HIV Treatment and Care in a Southern African Setting

PubMed Central

Jones, Louisa; Akugizibwe, Paula; Clayton, Michaela; Amon, Joseph J; Sabin, Miriam Lewis; Bennett, Rod; Stegling, Christine; Baggaley, Rachel; Kahn, James G; Holmes, Charles B; Garg, Navneet; Obermeyer, Carla Makhlouf; Mack, Christina DeFilippo; Williams, Phoebe; Smyth, Caoimhe; Vitoria, Marco; Crowley, Siobhan; Williams, Brian; McClure, Craig; Granich, Reuben; Hirnschall, Gottfried

2011-01-01

Expanding access to antiretroviral therapy (ART) has both individual health benefits and potential to decrease HIV incidence. Ensuring access to HIV services is a significant human rights issue and successful programmes require adequate human rights protections and community support. However, the cost of specific human rights and community support interventions for equitable, sustainable and non-discriminatory access to ART are not well described. Human rights and community support interventions were identified using the literature and through consultations with experts. Specific costs were then determined for these health sector interventions. Population and epidemic data were provided through the Statistics South Africa 2009 national mid-year estimates. Costs of scale up of HIV prevention and treatment were taken from recently published estimates. Interventions addressed access to services, minimising stigma and discrimination against people living with HIV, confidentiality, informed consent and counselling quality. Integrated HIV programme interventions included training for counsellors, ‘Know Your Rights’ information desks, outreach campaigns for most at risk populations, and adherence support. Complementary measures included post-service interviews, human rights abuse monitoring, transportation costs, legal assistance, and funding for human rights and community support organisations. Other essential non-health sector interventions were identified but not included in the costing framework. The annual costs for the human rights and community support interventions are United States (US) $63.8 million (US $1.22 per capita), representing 1.5% of total health sector HIV programme costs. Respect for human rights and community engagement can be understood both as an obligation of expanded ART programmes and as a critically important factor in their success. Basic rights-based and community support interventions constitute only a small percentage of overall programmes costs. ART programs should consider measuring the cost and impact of human rights and community support interventions as key aspects of successful programme expansion. PMID:21999777

Costing human rights and community support interventions as a part of universal access to HIV treatment and care in a Southern African setting.

PubMed

Jones, Louisa; Akugizibwe, Paula; Clayton, Michaela; Amon, Joseph J; Sabin, Miriam Lewis; Bennett, Rod; Stegling, Christine; Baggaley, Rachel; Kahn, James G; Holmes, Charles B; Garg, Navneet; Obermeyer, Carla Makhlouf; Mack, Christina DeFilippo; Williams, Phoebe; Smyth, Caoimhe; Vitoria, Marco; Crowley, Siobhan; Williams, Brian; McClure, Craig; Granich, Reuben; Hirnschall, Gottfried

2011-09-01

Expanding access to antiretroviral therapy (ART) has both individual health benefits and potential to decrease HIV incidence. Ensuring access to HIV services is a significant human rights issue and successful programmes require adequate human rights protections and community support. However, the cost of specific human rights and community support interventions for equitable, sustainable and non-discriminatory access to ART are not well described. Human rights and community support interventions were identified using the literature and through consultations with experts. Specific costs were then determined for these health sector interventions. Population and epidemic data were provided through the Statistics South Africa 2009 national mid-year estimates. Costs of scale up of HIV prevention and treatment were taken from recently published estimates. Interventions addressed access to services, minimising stigma and discrimination against people living with HIV, confidentiality, informed consent and counselling quality. Integrated HIV programme interventions included training for counsellors, 'Know Your Rights' information desks, outreach campaigns for most at risk populations, and adherence support. Complementary measures included post-service interviews, human rights abuse monitoring, transportation costs, legal assistance, and funding for human rights and community support organisations. Other essential non-health sector interventions were identified but not included in the costing framework. The annual costs for the human rights and community support interventions are United States (US) $63.8 million (US $1.22 per capita), representing 1.5% of total health sector HIV programme costs. Respect for human rights and community engagement can be understood both as an obligation of expanded ART programmes and as a critically important factor in their success. Basic rights-based and community support interventions constitute only a small percentage of overall programmes costs. ART programs should consider measuring the cost and impact of human rights and community support interventions as key aspects of successful programme expansion.

Minimising twins in in vitro fertilisation: a modelling study assessing the costs, consequences and cost-utility of elective single versus double embryo transfer over a 20-year time horizon.

PubMed

Scotland, G S; McLernon, D; Kurinczuk, J J; McNamee, P; Harrild, K; Lyall, H; Rajkhowa, M; Hamilton, M; Bhattacharya, S

2011-08-01

To assess the cumulative costs and consequences of double embryo transfer (DET) or elective single embryo transfer (eSET) in women commencing in vitro fertilisation (IVF) treatment aged 32, 36 and 39 years. Microsimulation model. Three assisted reproduction centres in Scotland. A total of 6153 women undergoing treatment at one of three Scottish IVF clinics, between January 1997 and June 2007. A microsimulation model, populated using data inputs derived from a large clinical data set and published literature, was developed to compare the costs and consequences of using eSET or DET over multiple treatment cycles. Disability-free live births; twin pregnancy rate; women's quality-adjusted life-years (QALYs); health service costs. Not only did DET produce a higher cumulative live birth rate compared with eSET for women of all three ages, but also a higher twin pregnancy rate. Compared with eSET, DET ranged from costing an additional £ 27,356 per extra live birth in women commencing treatment aged 32 years, to costing £ 15,539 per extra live birth in 39-year-old women. DET cost ∼ £ 28,300 and ∼ £ 20,300 per additional QALY in women commencing treatment aged 32 and 39 years, respectively. Considering the high twin pregnancy rate associated with DET, coupled with uncertainty surrounding QALY gains, eSET is likely to be the preferred option for most women aged ≤ 36 years. The cost-effectiveness of DET improves with age, and may be considered cost-effective in some groups of older women. The decision may best be considered on a case-by-case basis for women aged 37-39 years. © 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.

Solid oxide fuel cell systems for residential micro-combined heat and power in the UK: Key economic drivers

NASA Astrophysics Data System (ADS)

Hawkes, Adam; Leach, Matthew

The ability of combined heat and power (CHP) to meet residential heat and power demands efficiently offers potentially significant financial and environmental advantages over centralised power generation and heat-provision through natural-gas fired boilers. A solid oxide fuel cell (SOFC) can operate at high overall efficiencies (heat and power) of 80-90%, offering an improvement over centralised generation, which is often unable to utilise waste heat. This paper applies an equivalent annual cost (EAC) minimisation model to a residential solid oxide fuel cell CHP system to determine what the driving factors are behind investment in this technology. We explore the performance of a hypothetical SOFC system—representing expectations of near to medium term technology development—under present UK market conditions. We find that households with small to average energy demands do not benefit from installation of a SOFC micro-CHP system, but larger energy demands do benefit under these conditions. However, this result is sensitive to a number of factors including stack capital cost, energy import and export prices, and plant lifetime. The results for small and average dwellings are shown to reverse under an observed change in energy import prices, an increase in electricity export price, a decrease in stack capital costs, or an improvement in stack lifetime.

Persistence and withdrawal by students in a preservice science and mathematics teacher education course

NASA Astrophysics Data System (ADS)

Tulip, David F.; Lucas, Keith B.

1991-12-01

At a time when recruitment into preservice teacher education courses in mathematics and science is difficult, one strategy to increase the number of graduates is to minimise the number of students who fail to complete their university courses. This study sought to determine factors which distinguish withdrawers from persisters in the first semester of a B.Ed course. Discriminant analysis was employed; a discriminant function employing seven factors resulted in correct classification in 81% of cases. Further analysis distinguishing between dropouts and transferees resulted in two discriminant functions with some common variables.

Minimising losses to predation during microalgae cultivation.

PubMed

Flynn, Kevin J; Kenny, Philip; Mitra, Aditee

2017-01-01

We explore approaches to minimise impacts of zooplanktonic pests upon commercial microalgal crops using system dynamics models to describe algal growth controlled by light and nutrient availability and zooplankton growth controlled by crop abundance and nutritional quality. Losses of microalgal crops are minimised when their growth is fastest and, in contrast, also when growing slowly under conditions of nutrient exhaustion. In many culture systems, however, dwindling light availability due to self-shading in dense suspensions favours slow growth under nutrient sufficiency. Such a situation improves microalgal quality as prey, enhancing zooplankton growth, and leads to rapid crop collapse. Timing of pest entry is important; crop losses are least likely in established, nutrient-exhausted microalgal communities grown for high C-content (e.g. for biofuels). A potentially useful approach is to promote a low level of P-stress that does not adversely affect microalgal growth but which produces a crop that is suboptimal for zooplankton growth.

A Critical Review of the Harm-Minimisation Tools Available for Electronic Gambling.

PubMed

Harris, Andrew; Griffiths, Mark D

2017-03-01

The increasing sophistication of gambling products afforded by electronic technologies facilitates increased accessibility to gambling, as well as encouraging rapid and continuous play. This poses several challenges from a responsible gambling perspective, in terms of facilitating player self-awareness and self-control. The same technological advancements in gambling that may facilitate a loss of control may also be used to provide responsible gambling tools and solutions to reduce gambling-related harm. Indeed, several harm-minimisation strategies have been devised that aim to facilitate self-awareness and self-control within a gambling session. Such strategies include the use of breaks in play, 'pop-up' messaging, limit setting, and behavioural tracking. The present paper reviews the theoretical argument underpinning the application of specific harm-minimisation tools, as well as providing one of the first critical reviews of the empirical research assessing their efficacy, in terms of influencing gambling cognitions and behaviour.

Dwell time-based stabilisation of switched delay systems using free-weighting matrices

NASA Astrophysics Data System (ADS)

Koru, Ahmet Taha; Delibaşı, Akın; Özbay, Hitay

2018-01-01

In this paper, we present a quasi-convex optimisation method to minimise an upper bound of the dwell time for stability of switched delay systems. Piecewise Lyapunov-Krasovskii functionals are introduced and the upper bound for the derivative of Lyapunov functionals is estimated by free-weighting matrices method to investigate non-switching stability of each candidate subsystems. Then, a sufficient condition for the dwell time is derived to guarantee the asymptotic stability of the switched delay system. Once these conditions are represented by a set of linear matrix inequalities , dwell time optimisation problem can be formulated as a standard quasi-convex optimisation problem. Numerical examples are given to illustrate the improvements over previously obtained dwell time bounds. Using the results obtained in the stability case, we present a nonlinear minimisation algorithm to synthesise the dwell time minimiser controllers. The algorithm solves the problem with successive linearisation of nonlinear conditions.

Increasing Liability Premiums in Obstetrics - Analysis, Effects and Options.

PubMed

Soergel, P; Schöffski, O; Hillemanns, P; Hille-Betz, U; Kundu, S

2015-04-01

Whenever people act, mistakes are made. In Germany, it is thought that a total of 40 000 cases of malpractice occur per year. In recent years, costs for liability insurance have risen significantly in almost all spheres of medicine as a whole. Liability in the health care sector is founded on the contractual relationship between doctor and patient. Most recently, case law developed over many years has been codified with the Patients' Rights Act. In obstetrics, the focus of liability law is on brain damage caused by hypoxia or ischemia as a result of management errors during birth. The costs per claim are made up of various components together with different shares of damage costs (increased needs, in particular therapy costs and nursing fees, acquisition damage, treatment costs, compensation). In obstetrics in particular, recent focus has been on massively increased liability payments, also accompanied by higher liability premiums. This causes considerable financial burdens on hospitals as well as on midwives and attending physicians. The premiums are so high, especially for midwives and attending physicians, that professional practice becomes uneconomical in some cases. In recent years, these circumstances have also been intensely debated in the public sphere and in politics. However, the focus here is on the occupation of midwife. In 2014, in the GKV-FQWG (Statutory Health Insurance - Quality and Further Development Act), a subsidy towards the occupational liability premium was defined for midwives who only attended a few deliveries. However, to date, a complete solution to the problem has not been found. A birth will never be a fully controllable risk, but in rare cases will always end with injury to the child. The goal must be to minimise this risk, through good education and continuous training, as well as constant critical analysis of one's own activities. Furthermore, it seems sensible, especially in non-clinical Obstetrics, to look at the current study data more closely. Among the many solutions which have been proposed, such as the development of quality management, risk management and prevention, better remuneration, a waiver on recourse claims by social insurance underwriters, a cap on damage costs of liability insurers, state liability, an indemnity fund, a system change to Medical Treatment Risk Insurance, as well as a discussion on whether or not it makes sense to use non-clinical obstetrics for the prevention of a further increase in premiums, not one stands out as being especially convincing. On the contrary, a meaningful coordination of various concepts should follow. What seems sensible is a higher remuneration per birth, taking into account the liability premiums as well as, in the medium term, the establishment of a liability fund which, from a certain limit upwards, steps in as liable third party.

Increasing Liability Premiums in Obstetrics – Analysis, Effects and Options

PubMed Central

Soergel, P.; Schöffski, O.; Hillemanns, P.; Hille-Betz, U.; Kundu, S.

2015-01-01

Whenever people act, mistakes are made. In Germany, it is thought that a total of 40 000 cases of malpractice occur per year. In recent years, costs for liability insurance have risen significantly in almost all spheres of medicine as a whole. Liability in the health care sector is founded on the contractual relationship between doctor and patient. Most recently, case law developed over many years has been codified with the Patientsʼ Rights Act. In obstetrics, the focus of liability law is on brain damage caused by hypoxia or ischemia as a result of management errors during birth. The costs per claim are made up of various components together with different shares of damage costs (increased needs, in particular therapy costs and nursing fees, acquisition damage, treatment costs, compensation). In obstetrics in particular, recent focus has been on massively increased liability payments, also accompanied by higher liability premiums. This causes considerable financial burdens on hospitals as well as on midwives and attending physicians. The premiums are so high, especially for midwives and attending physicians, that professional practice becomes uneconomical in some cases. In recent years, these circumstances have also been intensely debated in the public sphere and in politics. However, the focus here is on the occupation of midwife. In 2014, in the GKV-FQWG (Statutory Health Insurance – Quality and Further Development Act), a subsidy towards the occupational liability premium was defined for midwives who only attended a few deliveries. However, to date, a complete solution to the problem has not been found. A birth will never be a fully controllable risk, but in rare cases will always end with injury to the child. The goal must be to minimise this risk, through good education and continuous training, as well as constant critical analysis of oneʼs own activities. Furthermore, it seems sensible, especially in non-clinical Obstetrics, to look at the current study data more closely. Among the many solutions which have been proposed, such as the development of quality management, risk management and prevention, better remuneration, a waiver on recourse claims by social insurance underwriters, a cap on damage costs of liability insurers, state liability, an indemnity fund, a system change to Medical Treatment Risk Insurance, as well as a discussion on whether or not it makes sense to use non-clinical obstetrics for the prevention of a further increase in premiums, not one stands out as being especially convincing. On the contrary, a meaningful coordination of various concepts should follow. What seems sensible is a higher remuneration per birth, taking into account the liability premiums as well as, in the medium term, the establishment of a liability fund which, from a certain limit upwards, steps in as liable third party. PMID:26028694

A determination of the fragmentation functions of pions, kaons, and protons with faithful uncertainties. The NNPDF Collaboration

NASA Astrophysics Data System (ADS)

Bertone, Valerio; Carrazza, Stefano; Hartland, Nathan P.; Nocera, Emanuele R.; Rojo, Juan

2017-08-01

We present NNFF1.0, a new determination of the fragmentation functions (FFs) of charged pions, charged kaons, and protons/antiprotons from an analysis of single-inclusive hadron production data in electron-positron annihilation. This determination, performed at leading, next-to-leading, and next-to-next-to-leading order in perturbative QCD, is based on the NNPDF methodology, a fitting framework designed to provide a statistically sound representation of FF uncertainties and to minimise any procedural bias. We discuss novel aspects of the methodology used in this analysis, namely an optimised parametrisation of FFs and a more efficient χ ^2 minimisation strategy, and validate the FF fitting procedure by means of closure tests. We then present the NNFF1.0 sets, and discuss their fit quality, their perturbative convergence, and their stability upon variations of the kinematic cuts and the fitted dataset. We find that the systematic inclusion of higher-order QCD corrections significantly improves the description of the data, especially in the small- z region. We compare the NNFF1.0 sets to other recent sets of FFs, finding in general a reasonable agreement, but also important differences. Together with existing sets of unpolarised and polarised parton distribution functions (PDFs), FFs and PDFs are now available from a common fitting framework for the first time.

Patient beliefs and attitudes to taking statins: systematic review of qualitative studies.

PubMed

Ju, Angela; Hanson, Camilla S; Banks, Emily; Korda, Rosemary; Craig, Jonathan C; Usherwood, Tim; MacDonald, Peter; Tong, Allison

2018-06-01

Statins are effective in preventing cardiovascular disease (CVD) events and are recommended for at-risk individuals but estimated adherence rates are low. To describe patients' perspectives, experiences, and attitudes towards taking statins. Systematic review of qualitative studies reporting perspectives of patients on statins. PsycINFO, CINAHL, Embase, MEDLINE, and PhD dissertations from inception to 6 October 2016 were searched for qualitative studies on adult patients' perspectives on statins. All text and participant quotations were extracted from each article and analysed by thematic synthesis. Thirty-two studies involving 888 participants aged 22-93 years across eight countries were included. Seven themes were identified: confidence in prevention (trust in efficacy, minimising long-term catastrophic CVD, taking control, easing anxiety about high cholesterol); routinising into daily life; questioning utility (imperceptible benefits, uncertainties about pharmacological mechanisms); medical distrust (scepticism about overprescribing, pressure to start therapy); threatening health (competing priorities and risks, debilitating side effects, toxicity to body); signifying sickness (fear of perpetual dependence, losing the battle); and financial strain. An expectation that statins could prevent CVD and being able to integrate the statin regimen in daily life facilitated acceptance of statins among patients. However, avoiding the 'sick' identity and prolonged dependence on medications, uncertainties about the pharmacological mechanisms, risks to health, side effects, costs, and scepticism about clinicians' motives for prescribing statins were barriers to uptake. Shared decision making that addresses the risks, reasons for prescribing, patient priorities, and implementing strategies to minimise lifestyle intrusion and manage side effects may improve patient satisfaction and continuation of statins. © British Journal of General Practice 2018.

Sleep loss and circadian disruption in shift work: health burden and management.

PubMed

Rajaratnam, Shantha M W; Howard, Mark E; Grunstein, Ronald R

2013-10-21

About 1.5 million Australians are shift workers. Shift work is associated with adverse health, safety and performance outcomes. Circadian rhythm misalignment, inadequate and poor-quality sleep, and sleep disorders such as sleep apnoea, insomnia and shift work disorder (excessive sleepiness and/or insomnia temporally associated with the work schedule) contribute to these associations. Falling asleep at work at least once a week occurs in 32%-36% of shift workers. Risk of occupational accidents is at least 60% higher for non-day shift workers. Shift workers also have higher rates of cardiometabolic diseases and mood disturbances. Road and workplace accidents related to excessive sleepiness, to which shift work is a significant contributor, are estimated to cost $71-$93 billion per annum in the United States. There is growing evidence that understanding the interindividual variability in sleep-wake responses to shift work will help detect and manage workers vulnerable to the health consequences of shift work. A range of approaches can be used to enhance alertness in shift workers, including screening and treating sleep disorders, melatonin treatment to promote sleep during the daytime, and avoidance of inappropriate use of sedatives and wakefulness-promoters such as modafinil and caffeine. Short naps, which minimise sleep inertia, are generally effective. Shifting the circadian pacemaker with appropriately timed melatonin and/or bright light may be used to facilitate adjustment to a shift work schedule in some situations, such as a long sequence of night work. It is important to manage the health risk of shift workers by minimising vascular risk factors through dietary and other lifestyle approaches.

Efficacy of community-based physiotherapy networks for patients with Parkinson's disease: a cluster-randomised trial.

PubMed

Munneke, Marten; Nijkrake, Maarten J; Keus, Samyra Hj; Kwakkel, Gert; Berendse, Henk W; Roos, Raymund Ac; Borm, George F; Adang, Eddy M; Overeem, Sebastiaan; Bloem, Bastiaan R

2010-01-01

Many patients with Parkinson's disease are treated with physiotherapy. We have developed a community-based professional network (ParkinsonNet) that involves training of a selected number of expert physiotherapists to work according to evidence-based recommendations, and structured referrals to these trained physiotherapists to increase the numbers of patients they treat. We aimed to assess the efficacy of this approach for improving health-care outcomes. Between February, 2005, and August, 2007, we did a cluster-randomised trial with 16 clusters (defined as community hospitals and their catchment area). Clusters were randomly allocated by use of a variance minimisation algorithm to ParkinsonNet care (n=8) or usual care (n=8). Patients were assessed at baseline and at 8, 16, and 24 weeks of follow-up. The primary outcome was a patient preference disability score, the patient-specific index score, at 16 weeks. Health secondary outcomes were functional mobility, mobility-related quality of life, and total societal costs over 24 weeks. Analysis was by intention to treat. This trial is registered, number NCT00330694. We included 699 patients. Baseline characteristics of the patients were comparable between the ParkinsonNet clusters (n=358) and usual-care clusters (n=341). The primary endpoint was similar for patients within the ParkinsonNet clusters (mean 47.7, SD 21.9) and control clusters (48.3, 22.4). Health secondary endpoints were also similar for patients in both study groups. Total costs over 24 weeks were lower in ParkinsonNet clusters compared with usual-care clusters (difference euro727; 95% CI 56-1399). Implementation of ParkinsonNet networks did not change health outcomes for patients living in ParkinsonNet clusters. However, health-care costs were reduced in ParkinsonNet clusters compared with usual-care clusters. ZonMw; Netherlands Organisation for Scientific Research; Dutch Parkinson's Disease Society; National Parkinson Foundation; Stichting Robuust. Copyright 2010 Elsevier Ltd. All rights reserved.

Visual perception-based criminal identification: a query-based approach

NASA Astrophysics Data System (ADS)

Singh, Avinash Kumar; Nandi, G. C.

2017-01-01

The visual perception of eyewitness plays a vital role in criminal identification scenario. It helps law enforcement authorities in searching particular criminal from their previous record. It has been reported that searching a criminal record manually requires too much time to get the accurate result. We have proposed a query-based approach which minimises the computational cost along with the reduction of search space. A symbolic database has been created to perform a stringent analysis on 150 public (Bollywood celebrities and Indian cricketers) and 90 local faces (our data-set). An expert knowledge has been captured to encapsulate every criminal's anatomical and facial attributes in the form of symbolic representation. A fast query-based searching strategy has been implemented using dynamic decision tree data structure which allows four levels of decomposition to fetch respective criminal records. Two types of case studies - viewed and forensic sketches have been considered to evaluate the strength of our proposed approach. We have derived 1200 views of the entire population by taking into consideration 80 participants as eyewitness. The system demonstrates an accuracy level of 98.6% for test case I and 97.8% for test case II. It has also been reported that experimental results reduce the search space up to 30 most relevant records.

A Fuzzy Model to Interpret Data of Drive Performances from Patients with Sleep Deprivation

PubMed Central

Sena, Pasquale; Attianese, Paolo; Carbone, Francesca; Pellegrino, Arcangelo; Pinto, Aldo; Villecco, Francesco

2012-01-01

The search for safe vehicles is increasing with both diffusion of high traffic density over the world and availability of new technologies providing sophisticated tools previously impossible to realize. Design and development of the necessary devices may be based on simulation tests that reduce cost allowing trials in many directions. A proper choice of the arrangement of the drive simulators, as much as of the parameters to be monitored, is of basic importance as they can address the design of devices somehow responsible for the drivers safety or, even their lives. This system setup, consisting of a free car simulator equipped with a monitoring system, collects in a nonintrusive way data of the car lateral position within the road lane and of its first derivative. Based on these measured parameters, the system is able to detect symptoms of drowsiness and sleepiness. The analysis is realized by a fuzzy inferential process that provides an immediate warning signal as soon as drowsiness is detected with a high level of certainty. Enhancement of reliability and minimisation of the false alarm rate are obtained by operating continuous comparison between learned driver typical modalities of operation on the control command of the vehicle the pattern recorded. PMID:22969834

Analysis of Maintenance Service Contracts for Dump Trucks Used in Mining Industry with Simulation Approach

NASA Astrophysics Data System (ADS)

Dymasius, A.; Wangsaputra, R.; Iskandar, B. P.

2016-02-01

A mining company needs high availability of dump trucks used to haul mining materials. As a result, an effective maintenance action is required to keep the dump trucks in a good condition and hence reducing failure and downtime of the dump trucks. To carry out maintenance in-house requires a high intensive maintenance facility and high skilled maintenance specialists. Often, outsourcing maintenance is an economic option for the company. An external agent takes a proactive action with offering some maintenance contract options to the owner. The decision problem for the owner is to decide the best option and for the agent is to determine the optimal price for each option offered. A non-cooperative game-theory is used to formulate the decision problems for the owner and the agent. We consider that failure pattern of each truck follows a non-homogeneous Poisson process (NHPP) and a queueing theory with multiple servers is used to estimate the downtime. As it involves high complexity to model downtime using a queueing theory, then in this paper we use a simulation method. Furthermore, we conduct experiment to seek for the best number of maintenance facilities (servers) which minimises maintenance and penalty costs incurred to the agent.

Sorbent Film-Coated Passive Samplers for Explosives Vapour Detection Part A: Materials Optimisation and Integration with Analytical Technologies.

PubMed

McEneff, Gillian L; Murphy, Bronagh; Webb, Tony; Wood, Dan; Irlam, Rachel; Mills, Jim; Green, David; Barron, Leon P

2018-04-11

A new thin-film passive sampler is presented as a low resource dependent and discrete continuous monitoring solution for explosives-related vapours. Using 15 mid-high vapour pressure explosives-related compounds as probes, combinations of four thermally stable substrates and six film-based sorbents were evaluated. Meta-aramid and phenylene oxide-based materials showed the best recoveries from small voids (~70%). Analysis was performed using liquid chromatography-high resolution accurate mass spectrometry which also enabled tentative identification of new targets from the acquired data. Preliminary uptake kinetics experiments revealed plateau concentrations on the device were reached between 3-5 days. Compounds used in improvised explosive devices, such as triacetone triperoxide, were detected within 1 hour and were stably retained by the sampler for up to 7 days. Sampler performance was consistent for 22 months after manufacture. Lastly, its direct integration with currently in-service explosives screening equipment including ion mobility spectrometry and thermal desorption mass spectrometry is presented. Following exposure to several open environments and targeted interferences, sampler performance was subsequently assessed and potential interferences identified. High-security building and area monitoring for concealed explosives using such cost-effective and discrete passive samplers can add extra assurance to search routines while minimising any additional burden on personnel or everyday site operation.

Advances in chemical and physical properties of electric arc furnace carbon steel slag by hot stage processing and mineral mixing.

PubMed

Liapis, Ioannis; Papayianni, Ioanna

2015-01-01

Slags are recognised as a highly efficient, cost effective tool in the metal processing industry, by minimising heat losses, reducing metal oxidation through contact with air, removing metal impurities and protecting refractories and graphite electrodes. When compared to natural aggregates for use in the construction industry, slags have higher specific weight that acts as an economic deterrent. A method of altering the specific weight of EAFC slag by hot stage processing and mineral mixing, during steel production is presented in this article. The method has minimal interference with the production process of steel, even by limited additions of appropriate minerals at high temperatures. Five minerals are examined, namely perlite, ladle furnace slag, bauxite, diatomite and olivine. Measurements of specific weight are accompanied by X-ray diffraction (XRD) and fluorescence (XRF) analysis and scanning electron microscopy spectral images. It is also shown how altering the chemical composition is expected to affect the furnace refractory lining. Additionally, the process has been repeated for the most suitable mix in gas furnace and physical properties (FI, SI, LA, PSV, AAV, volume stability) examined. Alteration of the specific weight can result in tailoring slag properties for specific applications in the construction sector. Copyright © 2014 Elsevier B.V. All rights reserved.

Childhood varicella-zoster virus vaccination in Belgium

PubMed Central

Bilcke, Joke; Jan van Hoek, Albert; Beutels, Philippe

2013-01-01

Aim: To assess the effectiveness and cost-effectiveness of a universal childhood varicella-zoster vaccination programme in Belgium (1) using the most recent Belgian data on varicella-zoster burden, (2) exploring different options for the timing of the second dose, (3) obtaining results with and without exogenous natural boosting, and (4) investigating the possible additional benefit of zoster booster vaccination for adults at age 50 or 60 years. Methods: An extensively studied and improved dynamic model is used to estimate primary and breakthrough chickenpox and zoster cases over time. For a range of vaccination options, we compared the direct costs (health care payer perspective) and health outcomes (including Quality-Adjusted Life-Years (QALYs) lost) associated with chickenpox and herpes zoster.  Estimates of social contact patterns, health care use, costs and QALY losses are almost exclusively based on Belgian databases and surveys. Results and Conclusions: If exogenous natural boosting exists, a net loss in QALYs is expected for several decades after implementing a universal chickenpox vaccination programme, due to an increase in zoster mainly in persons aged 50-80 years. This result holds also for scenarios that minimise or counteract the expected increase in zoster incidence (e.g. additional booster vaccinations in adults). However, if the boosting hypothesis is not true or if costs and QALYs are cumulated over at least 33 to more than 100 years after vaccination (depending on the assumptions made), different options for universal 2-dose vaccination against chickenpox in Belgium would be cost-effective at a vaccine price of €43/dose or lower. PMID:23321955

Review article: the economic impact of the irritable bowel syndrome.

PubMed

Canavan, C; West, J; Card, T

2014-11-01

Irritable bowel syndrome (IBS) is a chronic functional disorder of the gastrointestinal system affecting a large number of people worldwide. Whilst it has no attributable mortality, it has substantial impact on patients' quality of life (QoL) and is associated with considerable healthcare resource use. To review the economic impact of IBS, firstly on the individual, secondly on healthcare systems internationally and thirdly to society. Appropriate databases were searched for relevant papers using the terms: Irritable Bowel Syndrome; IBS; irritable colon; functional bowel/colonic disease; economics; health care/service costs; health expenditure/resources; health care/service utilisation; productivity. Irritable bowel syndrome impacts most substantially on patients' work and social life. Reduction in QoL is such that on average patients would sacrifice between 10 and 15 years of their remaining life expectancy for an immediate cure. Between 15% and 43% of patients pay for remedies. No studies quantify loss of earnings related to IBS. Direct care costs are substantial; 48% of patients incur some costs in any year with annual international estimates per patient of: USA $742-$7547, UK £90-£316, France €567-€862, Canada $259, Germany €791, Norway NOK 2098 (€262) and Iran $92. Minimising extensive diagnostic investigations could generate savings and has been shown as not detrimental to patients. Cost to industry internationally through absenteeism and presenteeism related to IBS is estimated between £400 and £900 per patient annually. Irritable bowel syndrome is associated with substantial costs to patients, healthcare systems and society. Considerable benefit could be obtained from effective interventions. © 2014 John Wiley & Sons Ltd.

Effectiveness and cost of recruitment strategies for a community-based randomised controlled trial among rainwater drinkers.

PubMed

Rodrigo, Shelly; Sinclair, Martha; Cunliffe, David; Leder, Karin

2009-07-16

Community-based recruitment is challenging particularly if the sampling frame is not easily defined as in the case of people who drink rainwater. Strategies for contacting participants must be carefully considered to maximise generalisability and minimise bias of the results. This paper assesses the recruitment strategies for a 1-year double-blinded randomised trial on drinking untreated rainwater. The effectiveness of the recruitment strategies and associated costs are described. Community recruitment of households from Adelaide, Australia occurred from February to July 2007 using four methods: electoral roll mail-out, approaches to schools and community groups, newspaper advertising, and other media involvement. Word of mouth communication was also assessed. A total of 810 callers were screened, with 53.5% eligible. Of those who were eligible and sent further information, 76.7% were willing to participate in the study and 75.1% were enrolled. The target for recruitment was 300 households, and this was achieved. The mail-out was the most effective method with respect to number of households randomised, while recruitment via schools had the highest yield (57.3%) and was the most cost effective when considering cost per household randomised (AUD$147.20). Yield and cost effectiveness were lowest for media advertising. The use of electoral roll mail-out and advertising via schools were effective in reaching households using untreated rainwater for drinking. Employing multiple strategies enabled success in achieving the recruitment target. In countries where electoral roll extracts are available to researchers, this method is likely to have a high yield for recruitment into community-based epidemiological studies.

Architects' perspectives on construction waste reduction by design

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

Osmani, M.; Glass, J.; Price, A.D.F.

2008-07-01

The construction, demolition and excavation waste arising in England was estimated at 91 million tonnes in 2003. The current thinking on construction waste minimisation is heavily focussed on several issues relating to physical construction waste and recycling guides. Indeed, much had been published on ways to improve on-site waste management and recycling activities but very few attempts made to address the effect of design practices on waste generation. However, there is a consensus in the literature that the architect has a decisive role to play in helping to reduce waste by focussing on designing out waste. This paper examines previousmore » studies on architects' approach towards construction waste minimisation; and by means of a postal questionnaire, investigates: the origins of waste; waste minimisation design practices in the UK; and responsibilities and barriers within the UK architectural profession. The findings reveal that waste management is not a priority in the design process. Additionally, the architects seemed to take the view that waste is mainly produced during site operations and rarely generated during the design stages; however, about one-third of construction waste could essentially arise from design decisions. Results also indicate that a number of constraints, namely: lack of interest from clients; attitudes towards waste minimisation; and training all act as disincentives to a proactive and sustainable implementation of waste reduction strategies during the design process.« less

Architects' perspectives on construction waste reduction by design.

PubMed

Osmani, M; Glass, J; Price, A D F

2008-01-01

The construction, demolition and excavation waste arising in England was estimated at 91 million tonnes in 2003. The current thinking on construction waste minimisation is heavily focussed on several issues relating to physical construction waste and recycling guides. Indeed, much had been published on ways to improve on-site waste management and recycling activities but very few attempts made to address the effect of design practices on waste generation. However, there is a consensus in the literature that the architect has a decisive role to play in helping to reduce waste by focussing on designing out waste. This paper examines previous studies on architects' approach towards construction waste minimisation; and by means of a postal questionnaire, investigates: the origins of waste; waste minimisation design practices in the UK; and responsibilities and barriers within the UK architectural profession. The findings reveal that waste management is not a priority in the design process. Additionally, the architects seemed to take the view that waste is mainly produced during site operations and rarely generated during the design stages; however, about one-third of construction waste could essentially arise from design decisions. Results also indicate that a number of constraints, namely: lack of interest from clients; attitudes towards waste minimisation; and training all act as disincentives to a proactive and sustainable implementation of waste reduction strategies during the design process.

An update on the development of IO:I: a NIR imager for the Liverpool Telescope

NASA Astrophysics Data System (ADS)

Barnsley, R. M.; Steele, I. A.; Bates, S. D.; Mottram, C. J.

2014-07-01

IO:I is a new instrument in development for the Liverpool Telescope, extending current imaging capabilities beyond the optical and into the near infrared. Cost has been minimised by use of a previously decommissioned instrument's dewar as the base for a prototype, and retrofitting it with a 1.7μm cutoff Hawaii-2RG HgCdTe detector, SIDECAR ASIC controller and JADE2 interface card. Development of this prototype is nearing completion and will be operational mid 2014. In this paper, the mechanical, electronic and cryogenic facets of the dewar retrofitting process will be discussed together with a description of the instrument control system software/hardware setup. Finally, a brief overview of some initial testing undertaken on the engineering grade array will be given, along with future commissioning plans for the instrument.

Review of battery powered embedded systems design for mission-critical low-power applications

NASA Astrophysics Data System (ADS)

Malewski, Matthew; Cowell, David M. J.; Freear, Steven

2018-06-01

The applications and uses of embedded systems is increasingly pervasive. Mission and safety critical systems relying on embedded systems pose specific challenges. Embedded systems is a multi-disciplinary domain, involving both hardware and software. Systems need to be designed in a holistic manner so that they are able to provide the desired reliability and minimise unnecessary complexity. The large problem landscape means that there is no one solution that fits all applications of embedded systems. With the primary focus of these mission and safety critical systems being functionality and reliability, there can be conflicts with business needs, and this can introduce pressures to reduce cost at the expense of reliability and functionality. This paper examines the challenges faced by battery powered systems, and then explores at more general problems, and several real-world embedded systems.

Environmental aspects of the implementation of geogrids for pavement optimisation

NASA Astrophysics Data System (ADS)

Kawalec, Jacek; Gołos, Michał; Mazurowski, Piotr

2018-05-01

Technological developments in highway construction should not only result in durable, safe and cost-effective solutions for roads and pavements but also, and perhaps above all, lead to solutions that minimise the negative impact of construction on the environment. One of the ways to ensure these requirements are met is to apply technology using geosynthetics. This paper discusses the stabilisation of aggregate with hexagonal geogrids and the benefits - from the point of view of reducing the emission of harmful gases to the atmosphere - which can be realised from this approach, compared with traditional approaches. Solutions for the improvement of weak subgrades and optimisation of the entire pavement structure are discussed, along with the presentation of sample calculations of greenhouse gas emissions, carried out with the use of specialized software related to the construction of the structures in various technologies.

Understanding and Minimising Occupational Radiation in the Catheterisation Laboratory with PISAX and the ACIST CVi® Contrast Delivery System

PubMed Central

Bar, Olivier

2013-01-01

This paper provides an overview of radiation exposure and its associated risks in the cardiac catheterisation laboratory (cath lab), as well as strategies to minimise radiation exposure for operators, cath lab staff and patients. The benefits of using a mobile 2 mm lead equivalent radiation shield (PISAX) and adoption of an automated contrast injection system (the ACIST CVi® Contrast Delivery System) are discussed, and the potential advantages of their combination are reviewed. PMID:29588748

Scheduling for the National Hockey League Using a Multi-objective Evolutionary Algorithm

NASA Astrophysics Data System (ADS)

Craig, Sam; While, Lyndon; Barone, Luigi

We describe a multi-objective evolutionary algorithm that derives schedules for the National Hockey League according to three objectives: minimising the teams' total travel, promoting equity in rest time between games, and minimising long streaks of home or away games. Experiments show that the system is able to derive schedules that beat the 2008-9 NHL schedule in all objectives simultaneously, and that it returns a set of schedules that offer a range of trade-offs across the objectives.

A randomised controlled trial of three or one breathing technique training sessions for breathlessness in people with malignant lung disease.

PubMed

Johnson, Miriam J; Kanaan, Mona; Richardson, Gerry; Nabb, Samantha; Torgerson, David; English, Anne; Barton, Rachael; Booth, Sara

2015-09-07

About 90 % of patients with intra-thoracic malignancy experience breathlessness. Breathing training is helpful, but it is unknown whether repeated sessions are needed. The present study aims to test whether three sessions are better than one for breathlessness in this population. This is a multi-centre randomised controlled non-blinded parallel arm trial. Participants were allocated to three sessions or single (1:2 ratio) using central computer-generated block randomisation by an independent Trials Unit and stratified for centre. The setting was respiratory, oncology or palliative care clinics at eight UK centres. Inclusion criteria were people with intrathoracic cancer and refractory breathlessness, expected prognosis ≥3 months, and no prior experience of breathing training. The trial intervention was a complex breathlessness intervention (breathing training, anxiety management, relaxation, pacing, and prioritisation) delivered over three hour-long sessions at weekly intervals, or during a single hour-long session. The main primary outcome was worst breathlessness over the previous 24 hours ('worst'), by numerical rating scale (0 = none; 10 = worst imaginable). Our primary analysis was area under the curve (AUC) 'worst' from baseline to 4 weeks. All analyses were by intention to treat. Between April 2011 and October 2013, 156 consenting participants were randomised (52 three; 104 single). Overall, the 'worst' score reduced from 6.81 (SD, 1.89) to 5.84 (2.39). Primary analysis [n = 124 (79 %)], showed no between-arm difference in the AUC: three sessions 22.86 (7.12) vs single session 22.58 (7.10); P value = 0.83); mean difference 0.2, 95 % CIs (-2.31 to 2.97). Complete case analysis showed a non-significant reduction in QALYs with three sessions (mean difference -0.006, 95 % CIs -0.018 to 0.006). Sensitivity analyses found similar results. The probability of the single session being cost-effective (threshold value of £20,000 per QALY) was over 80 %. There was no evidence that three sessions conferred additional benefits, including cost-effectiveness, over one. A single session of breathing training seems appropriate and minimises patient burden. Registry: ISRCTN; ISRCTN49387307; http://www.isrctn.com/ISRCTN49387307 ; registration date: 25/01/2011.

Optimising the production of succinate and lactate in Escherichia coli using a hybrid of artificial bee colony algorithm and minimisation of metabolic adjustment.

PubMed

Tang, Phooi Wah; Choon, Yee Wen; Mohamad, Mohd Saberi; Deris, Safaai; Napis, Suhaimi

2015-03-01

Metabolic engineering is a research field that focuses on the design of models for metabolism, and uses computational procedures to suggest genetic manipulation. It aims to improve the yield of particular chemical or biochemical products. Several traditional metabolic engineering methods are commonly used to increase the production of a desired target, but the products are always far below their theoretical maximums. Using numeral optimisation algorithms to identify gene knockouts may stall at a local minimum in a multivariable function. This paper proposes a hybrid of the artificial bee colony (ABC) algorithm and the minimisation of metabolic adjustment (MOMA) to predict an optimal set of solutions in order to optimise the production rate of succinate and lactate. The dataset used in this work was from the iJO1366 Escherichia coli metabolic network. The experimental results include the production rate, growth rate and a list of knockout genes. From the comparative analysis, ABCMOMA produced better results compared to previous works, showing potential for solving genetic engineering problems. Copyright © 2014 The Society for Biotechnology, Japan. Published by Elsevier B.V. All rights reserved.

Probabilistic Analysis of Structural Member from Recycled Aggregate Concrete

NASA Astrophysics Data System (ADS)

Broukalová, I.; Šeps, K.

2017-09-01

The paper aims at the topic of sustainable building concerning recycling of waste rubble concrete from demolition. Considering demands of maximising recycled aggregate use and minimising of cement consumption, composite from recycled concrete aggregate was proposed. The objective of the presented investigations was to verify feasibility of the recycled aggregate cement based fibre reinforced composite in a structural member. Reliability of wall from recycled aggregate fibre reinforced composite was assessed in a probabilistic analysis of a load-bearing capacity of the wall. The applicability of recycled aggregate fibre reinforced concrete in structural applications was demonstrated. The outcomes refer to issue of high scatter of material parameters of recycled aggregate concretes.

Effect of andrographolide on cysteamine-induced duodenal ulcer in rats.

PubMed

Panneerselvam, Saranya; Arumugam, Geetha; Karthikeyan, Narmadha Selvamathy Selvaperumal Munis

2011-09-01

The aim of this study was to evaluate the gastroprotective efficacy of andrographolide isolated from Andrographis paniculata in rats induced with duodenal ulcers. Duodenal ulcers were induced by cysteamine administration in rats pretreated with 3 mg kg⁻¹ BW day⁻¹ of andrographolide for 30 days. Ulcer score, myeloperoxidase activity, TBARS level, GSH/GSSG ratio and enzyme antioxidants were measured in the duodenal tissue. Brush border and basolateral membranes were isolated to assay sucrase, maltase, alkaline phosphatase and total ATPases. Ulcer score was significantly minimised in rats pretreated with andrographolide. Elevation in myeloperoxidase and TBARS levels were found to be minimised significantly due to andrographolide treatment. Membrane-bound enzyme activities and the thiol redox status of glutathione were significantly maintained in duodenal mucosa of rats that received andrographolide. This study reveals that the major component of A. paniculata, andrographolide, has potent antiulcer properties that are most likely caused by minimising inflammatory changes, counteracting free radical formation and maintaining the thiol redox status in the duodenum.

Beyond antidoping and harm minimisation: a stakeholder-corporate social responsibility approach to drug control for sport.

PubMed

Mazanov, Jason

2016-04-01

Debate about the ethics of drug control in sport has largely focused on arguing the relative merits of the existing antidoping policy or the adoption of a health-based harm minimisation approach. A number of ethical challenges arising from antidoping have been identified, and a number of, as yet, unanswered questions remain for the maturing ethics of applying harm minimisation principles to drug control for sport. This paper introduces a 'third approach' to the debate, examining some implications of applying a stakeholder theory of corporate social responsibility (CSR) to the issue of doping in sport. The introduction of the stakeholder-CSR model creates an opportunity to challenge the two dominant schools by enabling a different perspective to contribute to the development of an ethically robust drug control for sport. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

A behavioural change package to prevent hand dermatitis in nurses working in the national health service (the SCIN trial): study protocol for a cluster randomised controlled trial.

PubMed

Madan, Ira; Parsons, Vaughan; Cookson, Barry; English, John; Lavender, Tina; McCrone, Paul; Murphy, Caroline; Ntani, Georgia; Rushton, Lesley; Smedley, Julia; Williams, Hywel; Wright, Alison; Coggon, David

2016-03-17

Hand dermatitis can be a serious health problem in healthcare workers. While a range of skin care strategies and policy directives have been developed in recent years to minimise the risk, their effectiveness and cost-effectiveness remain unclear. Evidence now suggests that psychological theory can facilitate behaviour change with respect to improved hand care practices. Therefore, we will test the hypothesis that a behavioural change intervention to improve hand care, based on the Theory of Planned Behaviour and implementation intentions, coupled with provision of hand moisturisers, can produce a clinically useful reduction in the occurrence of hand dermatitis, when compared to standard care, among nurses working in the UK National Health Service (NHS) who are particularly at risk. Secondary aims will be to assess impacts on participants' beliefs and behaviour regarding hand care. In addition, we will assess the cost-effectiveness of the intervention in comparison with normal care. We will conduct a cluster randomised controlled trial at 35 NHS hospital trusts/health boards/universities, focussing on student nurses with a previous history of atopic disease or hand eczema and on nurses in intensive care units. Nurses at 'intervention-light' sites will be managed according to what would currently be regarded as best practice, with provision of an advice leaflet about optimal hand care to prevent hand dermatitis and encouragement to contact their occupational health (OH) department early if hand dermatitis occurs. Nurses at 'intervention-plus' sites will additionally receive a behavioural change programme (BCP) with on-going active reinforcement of its messages, and enhanced provision of moisturising cream. The impact of the interventions will be compared using information collected by questionnaires and through standardised photographs of the hands and wrists, collected at baseline and after 12 months follow-up. In addition, we will assemble relevant economic data for an analysis of costs and benefits, and collect information from various sources to evaluate processes. Statistical analysis will be by multi-level regression modelling to allow for clustering by site, and will compare the prevalence of outcome measures at follow-up after adjustment for values at baseline. The principal outcome measure will be the prevalence of visible hand dermatitis as assessed by the study dermatologists. In addition, several secondary outcome measures will be assessed. This trial will assess the clinical and cost effectiveness of an intervention to prevent hand dermatitis in nurses in the United Kigdom. ISRCTN53303171 : date of registration, 21 June 2013.

'I do the best I can': an in-depth exploration of the aphasia management pathway in the acute hospital setting.

PubMed

Foster, Abby M; Worrall, Linda E; Rose, Miranda L; O'Halloran, Robyn

2016-09-01

While research has begun to explore the management of aphasia across the continuum of care, to date there is little in-depth, context specific knowledge relating to the speech pathology aphasia management pathway. This research aimed to provide an in-depth understanding of the current aphasia management pathway in the acute hospital setting, from the perspective of speech pathologists. Underpinned by a social constructivist paradigm, the researchers implemented an interpretive phenomenological method when conducting in-depth interviews with 14 Australian speech pathologists working in the acute hospital setting. Interview transcripts and interviewer field notes were subjected to a qualitative content analysis. Analysis identified a single guiding construct and five main categories to describe the management of aphasia in the acute hospital setting. The guiding construct, First contact with the profession, informed the entire management pathway. Five additional main categories were identified: Referral processes; Screening and assessment; Therapeutic intervention; Educational and affective counselling; and Advocacy. Findings suggest significant diversity in the pathways of care for people with aphasia and their families in the acute hospital setting. Additional support mechanisms are required in order to support speech pathologists to minimise the evidence-practice gap. Implications for Rehabilitation Significant diversity exists in the current aphasia management pathway for people with acute post-stroke aphasia and their families in the acute hospital setting. Mechanisms that support speech pathologists to minimise the evidence-practice gap, and consequently reduce their sense of professional dissonance, are required.

Reducing health care costs--potential and limitations of local authority health services.

PubMed

Ijsselmuiden, C B; De Beer, C

1990-08-04

Local authorities (LAs) currently provide preventive and promotive services. It is argued that, by extending the role of the LA to the provision of comprehensive services, including ambulatory and hospital curative care, both the quality and the cost-effectiveness of health care would be improved. Making health care the responsibility of the LA would minimise fragmentation, allow for the provision of a number of services that currently are neglected because they fall through the gap that exists between preventive and curative services, and result in the more effective use of personnel currently restricted to providing preventive care only. LAs offer an appropriate structure for effective community control over the health services, and are more likely to be sensitive to local needs and demands. In addition, their administrative proximity to other LA departments responsible for housing, town planning and parks and recreation allows for an effective multisectoral approach to health. The positive aspects of LA care can only be achieved in the context of racially integrated services provided by an LA elected by universal adult franchise. Smaller LAs may need to be grouped together in larger units for the purpose of achieving satisfactory economies of scale in the provision of health care.

From SPOT 5 to Pleiades HR: evolution of the instrumental specifications

NASA Astrophysics Data System (ADS)

Rosak, A.; Latry, C.; Pascal, V.; Laubier, D.

2017-11-01

Image quality specifications should aimed to fulfil high resolution mission requirements of remote sensing satellites with a minimum cost. The most important trade-off to be taken into account is between Modulation Transfer Function, radiometric noise and sampling scheme. This compromise is the main driver during design optimisation and requirement definition in order to achieve good performances and to minimise the mission cost. For the SPOT 5 satellite, a new compromise had been chosen. The supermode principle of imagery (sampling at 2.5 meter with a pixel size of 5 meter) imp roves the resolution by a factor of four compared with the SPOT 4 satellite (10 meter resolution). This paper presents the image quality specifications of the HRG-SPOT 5 instrument. We introduce all the efforts made on the instrument to achieve good image quality and low radiometric noise, then we compare the results with the SPOT 4 instrument's performances to highlight the improvements achieved. Then, the in-orbit performance will be described. Finally, we will present the new goals of image quality specifications for the new Pleiades-HR satellite for earth observation (0.7 meter resolution) and the instrument concept.

Computing design principles for robotic telescopes

NASA Astrophysics Data System (ADS)

Bowman, Mark K.; Ford, Martyn J.; Lett, Robert D. J.; McKay, Derek J.; Mücke-Herzberg, Dorothy; Norbury, Martin A.

2002-12-01

Telescopes capable of making observing decisions independent of human supervision have become a reality in the 21st century. These new telescopes are likely to replace automated systems as the telescopes of choice. A fully robotic implementation offers not only reduced operating costs, but also significant gains in scientific output over automated or remotely operated systems. The design goals are to maximise the telescope operating time and minimise the cost of diagnosis and repair. However, the demands of a robotic telescope greatly exceed those of its remotely operated counterpart, and the design of the computing system is key to its operational performance. This paper outlines the challenges facing the designer of these computing systems, and describes some of the principles of design which may be applied. Issues considered include automatic control and efficiency, system awareness, robustness and reliability, access, security and safety, as well as ease-of-use and maintenance. These requirements cannot be considered simply within the context of the application software. Hence, this paper takes into account operating system, hardware and environmental issues. Consideration is also given to accommodating different levels of manual control within robotic telescopes, as well as methods of accessing and overriding the system in the event of failure.

Patient-specific instruments in total knee arthroplasty.

PubMed

Conteduca, Fabio; Iorio, Raffaele; Mazza, Daniele; Ferretti, Andrea

2014-02-01

In recent years, patient-specific instruments (PSI) has been introduced with the aim of reducing the overall costs of the implants, minimising the size and number of instruments required, and also reducing surgery time. The purpose of this study was to perform a review of the current literature, as well as to report about our personal experience, to assess reliability of patient specific instrument system in total knee arthroplasty (TKA). A literature review was conducted of PSI system reviewing articles related to coronal alignment, clinical knee and function scores, cost, patient satisfaction and complications. Studies have reported incidences of coronal alignment ≥3° from neutral in TKAs performed with patient-specific cutting guides ranging from 6% to 31%. PSI seem not to be able to result in the same degree of accuracy as the CAS system, while comparing well with standard manual technique with respect to component positioning and overall lower axis, in particular in the sagittal plane. In cases in which custom-made cutting jigs were used, we recommend performing an accurate control of the alignment before and after any cuts and in any further step of the procedure, in order to avoid possible outliers.

Economic Evaluations of Pharmaceuticals Granted a Marketing Authorisation Without the Results of Randomised Trials: A Systematic Review and Taxonomy.

PubMed

Hatswell, Anthony J; Freemantle, Nick; Baio, Gianluca

2017-02-01

Pharmaceuticals are usually granted a marketing authorisation on the basis of randomised controlled trials (RCTs). Occasionally the efficacy of a treatment is assessed without a randomised comparator group (either active or placebo). To identify and develop a taxonomic account of economic modelling approaches for pharmaceuticals licensed without RCT data. We searched PubMed, the websites of UK health technology assessment bodies and the International Society for Pharmacoeconomics and Outcomes Research Scientific Presentations Database for assessments of treatments granted a marketing authorisation by the US Food and Drug Administration or European Medicines Agency from January 1999 to May 2014 without RCT data (74 indications). The outcome of interest was the approach to modelling efficacy data. Fifty-one unique models were identified in 29 peer-reviewed articles, 30 health technology appraisals, and 15 International Society for Pharmacoeconomics and Outcomes Research abstracts concerning 30 indications (44 indications had not been modelled). We noted the high rate of non-submission to health technology assessment agencies (28/98). The majority of models (43/51) were based on 'historical controls'-comparisons to previous meta-analysis or pooling of trials (5), individual trials (16), registries/case series (15), or expert opinion (7). Other approaches used the patient as their own control, performed threshold analysis, assumed time on treatment was added to overall survival, or performed cost-minimisation analysis. There is considerable variation in the quality and approach of models constructed for drugs granted a marketing authorisation without a RCT. The most common approach is of a naive comparison to historical data (using other trials/registry data as a control group), which has considerable scope for bias.

Associations with duration of compensation following whiplash sustained in a motor vehicle crash.

PubMed

Casey, Petrina P; Feyer, Anne Marie; Cameron, Ian D

2015-09-01

Continued exposure to compensation systems has been reported as deleterious to the health of participants. Understanding the associations with time to claim closure could allow for targeted interventions aimed at minimising the time participants are exposed to the compensation system. To identify the associations of extended time receiving compensation benefits with the aim of developing a prognostic model that predicts time to claim closure. Prospective cohort study in people with whiplash associated disorder. Time to claim closure, in a privately underwritten fault based third party traffic crash insurance scheme in New South Wales, Australia. Cox proportional hazard regression modelling. Of the 246 participants, 25% remained in the compensation system longer than 24 months with 15% remaining longer than three years. Higher initial disability (Functional Rating Index≥25 at baseline) (HRR: 95% CI, 1.916: 1.324-2.774, p<0.001); and lower initial mental health as measured by SF-36 Mental Component Score (HRR: 95% CI, 0.973: 0.960-0.987, p<0.001) were significantly and independently associated with an increased time-to-claim closure. Shorter time to claim closure was associated with having no legal involvement (HRR: 95% CI, 1.911: 1.169-3.123, p=0.009); and, not having a prior claim for compensation (HRR: 95% CI, 1.523: 1.062-2.198, p=0.022). Health and insurance related factors are independently associated with time to claim closure. Both factors need to be considered by insurers in their assessment of complexity of claims. Interventions aimed at minimising the impact of these factors could reduce claimants' exposure to the compensation system. In turn insurers can potentially reduce claims duration and cost, while improving the health outcomes of claimants. Copyright © 2015 Elsevier Ltd. All rights reserved.

Clinical and cost-effectiveness of the Lightning Process in addition to specialist medical care for paediatric chronic fatigue syndrome: randomised controlled trial

PubMed Central

Crawley, Esther M; Gaunt, Daisy M; Garfield, Kirsty; Hollingworth, William; Sterne, Jonathan A C; Beasant, Lucy; Collin, Simon M; Mills, Nicola; Montgomery, Alan A

2018-01-01

Objective Investigate the effectiveness and cost-effectiveness of the Lightning Process (LP) in addition to specialist medical care (SMC) compared with SMC alone, for children with chronic fatigue syndrome (CFS)/myalgic encephalitis (ME). Design Pragmatic randomised controlled open trial. Participants were randomly assigned to SMC or SMC+LP. Randomisation was minimised by age and gender. Setting Specialist paediatric CFS/ME service. Patients 12–18 year olds with mild/moderate CFS/ME. Main outcome measures The primary outcome was the the 36-Item Short-Form Health Survey Physical Function Subscale (SF-36-PFS) at 6 months. Secondary outcomes included pain, anxiety, depression, school attendance and cost-effectiveness from a health service perspective at 3, 6 and 12 months. Results We recruited 100 participants, of whom 51 were randomised to SMC+LP. Data from 81 participants were analysed at 6 months. Physical function (SF-36-PFS) was better in those allocated SMC+LP (adjusted difference in means 12.5(95% CI 4.5 to 20.5), p=0.003) and this improved further at 12 months (15.1 (5.8 to 24.4), p=0.002). At 6 months, fatigue and anxiety were reduced, and at 12 months, fatigue, anxiety, depression and school attendance had improved in the SMC+LP arm. Results were similar following multiple imputation. SMC+LP was probably more cost-effective in the multiple imputation dataset (difference in means in net monetary benefit at 12 months £1474(95% CI £111 to £2836), p=0.034) but not for complete cases. Conclusion The LP is effective and is probably cost-effective when provided in addition to SMC for mild/moderately affected adolescents with CFS/ME. Trial registration number ISRCTN81456207. PMID:28931531

Effectiveness and cost of recruitment strategies for a community-based randomised controlled trial among rainwater drinkers

PubMed Central

2009-01-01

Background Community-based recruitment is challenging particularly if the sampling frame is not easily defined as in the case of people who drink rainwater. Strategies for contacting participants must be carefully considered to maximise generalisability and minimise bias of the results. This paper assesses the recruitment strategies for a 1-year double-blinded randomised trial on drinking untreated rainwater. The effectiveness of the recruitment strategies and associated costs are described. Methods Community recruitment of households from Adelaide, Australia occurred from February to July 2007 using four methods: electoral roll mail-out, approaches to schools and community groups, newspaper advertising, and other media involvement. Word of mouth communication was also assessed. Results A total of 810 callers were screened, with 53.5% eligible. Of those who were eligible and sent further information, 76.7% were willing to participate in the study and 75.1% were enrolled. The target for recruitment was 300 households, and this was achieved. The mail-out was the most effective method with respect to number of households randomised, while recruitment via schools had the highest yield (57.3%) and was the most cost effective when considering cost per household randomised (AUD$147.20). Yield and cost effectiveness were lowest for media advertising. Conclusion The use of electoral roll mail-out and advertising via schools were effective in reaching households using untreated rainwater for drinking. Employing multiple strategies enabled success in achieving the recruitment target. In countries where electoral roll extracts are available to researchers, this method is likely to have a high yield for recruitment into community-based epidemiological studies. PMID:19604408

Female bladder catheterisation: step by step.

PubMed

Baston, Helen

2011-01-01

Catheterisation of the female urinary bladder is performed by midwives for a range of reasons. This article outlines and the main reasons for this procedure, including during labour and after the birth. It describes the equipment needed and the procedure undertaken, summarising the aseptic technique required to minimise the risk of urinary tract infection. The use of anaesthetic gels to minimise pain and trauma is considered. The article highlights the potentially embarrassing nature of catheterisation for women and urges midwives to perform this skill with maximum dexterity and minimum fuss.

Coupling Radar Rainfall to Hydrological Models for Water Abstraction Management

NASA Astrophysics Data System (ADS)

Asfaw, Alemayehu; Shucksmith, James; Smith, Andrea; MacDonald, Ken

2015-04-01

The impacts of climate change and growing water use are likely to put considerable pressure on water resources and the environment. In the UK, a reform to surface water abstraction policy has recently been proposed which aims to increase the efficiency of using available water resources whilst minimising impacts on the aquatic environment. Key aspects to this reform include the consideration of dynamic rather than static abstraction licensing as well as introducing water trading concepts. Dynamic licensing will permit varying levels of abstraction dependent on environmental conditions (i.e. river flow and quality). The practical implementation of an effective dynamic abstraction strategy requires suitable flow forecasting techniques to inform abstraction asset management. Potentially the predicted availability of water resources within a catchment can be coupled to predicted demand and current storage to inform a cost effective water resource management strategy which minimises environmental impacts. The aim of this work is to use a historical analysis of UK case study catchment to compare potential water resource availability using modelled dynamic abstraction scenario informed by a flow forecasting model, against observed abstraction under a conventional abstraction regime. The work also demonstrates the impacts of modelling uncertainties on the accuracy of predicted water availability over range of forecast lead times. The study utilised a conceptual rainfall-runoff model PDM - Probability-Distributed Model developed by Centre for Ecology & Hydrology - set up in the Dove River catchment (UK) using 1km2 resolution radar rainfall as inputs and 15 min resolution gauged flow data for calibration and validation. Data assimilation procedures are implemented to improve flow predictions using observed flow data. Uncertainties in the radar rainfall data used in the model are quantified using artificial statistical error model described by Gaussian distribution and propagated through the model to assess its influence on the forecasted flow uncertainty. Furthermore, the effects of uncertainties at different forecast lead times on potential abstraction strategies are assessed. The results show that over a 10 year period, an average of approximately 70 ML/d of potential water is missed in the study catchment under a convention abstraction regime. This indicates a considerable potential for the use of flow forecasting models to effectively implement advanced abstraction management and more efficiently utilize available water resources in the study catchment.

wannier90: A tool for obtaining maximally-localised Wannier functions

NASA Astrophysics Data System (ADS)

Mostofi, Arash A.; Yates, Jonathan R.; Lee, Young-Su; Souza, Ivo; Vanderbilt, David; Marzari, Nicola

2008-05-01

We present wannier90, a program for calculating maximally-localised Wannier functions (MLWF) from a set of Bloch energy bands that may or may not be attached to or mixed with other bands. The formalism works by minimising the total spread of the MLWF in real space. This is done in the space of unitary matrices that describe rotations of the Bloch bands at each k-point. As a result, wannier90 is independent of the basis set used in the underlying calculation to obtain the Bloch states. Therefore, it may be interfaced straightforwardly to any electronic structure code. The locality of MLWF can be exploited to compute band-structure, density of states and Fermi surfaces at modest computational cost. Furthermore, wannier90 is able to output MLWF for visualisation and other post-processing purposes. Wannier functions are already used in a wide variety of applications. These include analysis of chemical bonding in real space; calculation of dielectric properties via the modern theory of polarisation; and as an accurate and minimal basis set in the construction of model Hamiltonians for large-scale systems, in linear-scaling quantum Monte Carlo calculations, and for efficient computation of material properties, such as the anomalous Hall coefficient. wannier90 is freely available under the GNU General Public License from http://www.wannier.org/. Program summaryProgram title: wannier90 Catalogue identifier: AEAK_v1_0 Program summary URL:http://cpc.cs.qub.ac.uk/summaries/AEAK_v1_0.html Program obtainable from: CPC Program Library, Queen's University, Belfast, N. Ireland Licensing provisions: Standard CPC licence, http://cpc.cs.qub.ac.uk/licence/licence.html No. of lines in distributed program, including test data, etc.: 556 495 No. of bytes in distributed program, including test data, etc.: 5 709 419 Distribution format: tar.gz Programming language: Fortran 90, perl Computer: any architecture with a Fortran 90 compiler Operating system: Linux, Windows, Solaris, AIX, Tru64 Unix, OSX RAM: 10 MB Word size: 32 or 64 Classification: 7.3 External routines:BLAS ( http://www/netlib.org/blas). LAPACK ( http://www.netlib.org/lapack). Both available under open-source licenses. Nature of problem: Obtaining maximally-localised Wannier functions from a set of Bloch energy bands that may or may not be entangled. Solution method: In the case of entangled bands, the optimally-connected subspace of interest is determined by minimising a functional which measures the subspace dispersion across the Brillouin zone. The maximally-localised Wannier functions within this subspace are obtained by subsequent minimisation of a functional that represents the total spread of the Wannier functions in real space. For the case of isolated energy bands only the second step of the procedure is required. Unusual features: Simple and user-friendly input system. Wannier functions and interpolated band structure output in a variety of file formats for visualisation. Running time: Test cases take 1 minute. References:N. Marzari, D. Vanderbilt, Maximally localized generalized Wannier functions for composite energy bands, Phys. Rev. B 56 (1997) 12847. I. Souza, N. Marzari, D. Vanderbilt, Maximally localized Wannier functions for entangled energy bands, Phys. Rev. B 65 (2001) 035109.

Design, implementation and reporting strategies to reduce the instance and impact of missing patient-reported outcome (PRO) data: a systematic review

PubMed Central

Mercieca-Bebber, Rebecca; Palmer, Michael J; Brundage, Michael; Stockler, Martin R; King, Madeleine T

2016-01-01

Objectives Patient-reported outcomes (PROs) provide important information about the impact of treatment from the patients' perspective. However, missing PRO data may compromise the interpretability and value of the findings. We aimed to report: (1) a non-technical summary of problems caused by missing PRO data; and (2) a systematic review by collating strategies to: (A) minimise rates of missing PRO data, and (B) facilitate transparent interpretation and reporting of missing PRO data in clinical research. Our systematic review does not address statistical handling of missing PRO data. Data sources MEDLINE and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases (inception to 31 March 2015), and citing articles and reference lists from relevant sources. Eligibility criteria English articles providing recommendations for reducing missing PRO data rates, or strategies to facilitate transparent interpretation and reporting of missing PRO data were included. Methods 2 reviewers independently screened articles against eligibility criteria. Discrepancies were resolved with the research team. Recommendations were extracted and coded according to framework synthesis. Results 117 sources (55% discussion papers, 26% original research) met the eligibility criteria. Design and methodological strategies for reducing rates of missing PRO data included: incorporating PRO-specific information into the protocol; carefully designing PRO assessment schedules and defining termination rules; minimising patient burden; appointing a PRO coordinator; PRO-specific training for staff; ensuring PRO studies are adequately resourced; and continuous quality assurance. Strategies for transparent interpretation and reporting of missing PRO data include utilising auxiliary data to inform analysis; transparently reporting baseline PRO scores, rates and reasons for missing data; and methods for handling missing PRO data. Conclusions The instance of missing PRO data and its potential to bias clinical research can be minimised by implementing thoughtful design, rigorous methodology and transparent reporting strategies. All members of the research team have a responsibility in implementing such strategies. PMID:27311907

Energy and time optimal trajectories in exploratory jumps of the spider Phidippus regius.

PubMed

Nabawy, Mostafa R A; Sivalingam, Girupakaran; Garwood, Russell J; Crowther, William J; Sellers, William I

2018-05-08

Jumping spiders are proficient jumpers that use jumps in a variety of behavioural contexts. We use high speed, high resolution video to measure the kinematics of a single regal jumping spider for a total of 15 different tasks based on a horizontal gap of 2-5 body lengths and vertical gap of +/-2 body lengths. For short range jumps, we show that low angled trajectories are used that minimise flight time. For longer jumps, take-off angles are steeper and closer to the optimum for minimum energy cost of transport. Comparison of jump performance against other arthropods shows that Phidippus regius is firmly in the group of animals that use dynamic muscle contraction for actuation as opposed to a stored energy catapult system. We find that the jump power requirements can be met from the estimated mass of leg muscle; hydraulic augmentation may be present but appears not to be energetically essential.

Prices, Costs, and Affordability of New Medicines for Hepatitis C in 30 Countries: An Economic Analysis.

PubMed

Iyengar, Swathi; Tay-Teo, Kiu; Vogler, Sabine; Beyer, Peter; Wiktor, Stefan; de Joncheere, Kees; Hill, Suzanne

2016-05-01

New hepatitis C virus (HCV) medicines have markedly improved treatment efficacy and regimen tolerability. However, their high prices have limited access, prompting wide debate about fair and affordable prices. This study systematically compared the price and affordability of sofosbuvir and ledipasvir/sofosbuvir across 30 countries to assess affordability to health systems and patients. Published 2015 ex-factory prices for a 12-wk course of treatment were provided by the Pharma Price Information (PPI) service of the Austrian public health institute Gesundheit Österreich GmbH or were obtained from national government or drug reimbursement authorities and recent press releases, where necessary. Prices in Organisation for Economic Co-operation and Development (OECD) member countries and select low- and middle-income countries were converted to US dollars using period average exchange rates and were adjusted for purchasing power parity (PPP). We analysed prices compared to national economic performance and estimated market size and the cost of these drugs in terms of countries' annual total pharmaceutical expenditure (TPE) and in terms of the duration of time an individual would need to work to pay for treatment out of pocket. Patient affordability was calculated using 2014 OECD average annual wages, supplemented with International Labour Organization median wage data where necessary. All data were compiled between 17 July 2015 and 25 January 2016. For the base case analysis, we assumed a 23% rebate/discount on the published price in all countries, except for countries with special pricing arrangements or generic licensing agreements. The median nominal ex-factory price of a 12-wk course of sofosbuvir across 26 OECD countries was US$42,017, ranging from US$37,729 in Japan to US$64,680 in the US. Central and Eastern European countries had higher PPP-adjusted prices than other countries: prices of sofosbuvir in Poland and Turkey (PPP$101,063 and PPP$70,331) and of ledipasvir/sofosbuvir in Poland (PPP$118,754) were at least 1.09 and 1.63 times higher, respectively than in the US (PPP$64,680 and PPP$72,765). Based on PPP-adjusted TPE and without the cost of ribavirin and other treatment costs, treating the entire HCV viraemic population with these regimens at the PPP-adjusted prices with a 23% price reduction would amount to at least one-tenth of current TPE across the countries included in this study, ranging from 10.5% of TPE in the Netherlands to 190.5% of TPE in Poland. In 12 countries, the price of a course of sofosbuvir without other costs was equivalent to 1 y or more of the average annual wage of individuals, ranging from 0.21 y in Egypt to 5.28 y in Turkey. This analysis relies on the accuracy of price information and infection prevalence estimates. It does not include the costs of diagnostic testing, supplementary treatments, treatment for patients with reinfection or cirrhosis, or associated health service costs. Current prices of these medicines are variable and unaffordable globally. These prices threaten the sustainability of health systems in many countries and prevent large-scale provision of treatment. Stakeholders should implement a fairer pricing framework to deliver lower prices that take account of affordability. Without lower prices, countries are unlikely to be able to increase investment to minimise the burden of hepatitis C.

Prices, Costs, and Affordability of New Medicines for Hepatitis C in 30 Countries: An Economic Analysis

PubMed Central

Tay-Teo, Kiu; Vogler, Sabine; Beyer, Peter; Wiktor, Stefan; de Joncheere, Kees; Hill, Suzanne

2016-01-01

Introduction New hepatitis C virus (HCV) medicines have markedly improved treatment efficacy and regimen tolerability. However, their high prices have limited access, prompting wide debate about fair and affordable prices. This study systematically compared the price and affordability of sofosbuvir and ledipasvir/sofosbuvir across 30 countries to assess affordability to health systems and patients. Methods and Findings Published 2015 ex-factory prices for a 12-wk course of treatment were provided by the Pharma Price Information (PPI) service of the Austrian public health institute Gesundheit Österreich GmbH or were obtained from national government or drug reimbursement authorities and recent press releases, where necessary. Prices in Organisation for Economic Co-operation and Development (OECD) member countries and select low- and middle-income countries were converted to US dollars using period average exchange rates and were adjusted for purchasing power parity (PPP). We analysed prices compared to national economic performance and estimated market size and the cost of these drugs in terms of countries’ annual total pharmaceutical expenditure (TPE) and in terms of the duration of time an individual would need to work to pay for treatment out of pocket. Patient affordability was calculated using 2014 OECD average annual wages, supplemented with International Labour Organization median wage data where necessary. All data were compiled between 17 July 2015 and 25 January 2016. For the base case analysis, we assumed a 23% rebate/discount on the published price in all countries, except for countries with special pricing arrangements or generic licensing agreements. The median nominal ex-factory price of a 12-wk course of sofosbuvir across 26 OECD countries was US$42,017, ranging from US$37,729 in Japan to US$64,680 in the US. Central and Eastern European countries had higher PPP-adjusted prices than other countries: prices of sofosbuvir in Poland and Turkey (PPP$101,063 and PPP$70,331) and of ledipasvir/sofosbuvir in Poland (PPP$118,754) were at least 1.09 and 1.63 times higher, respectively than in the US (PPP$64,680 and PPP$72,765). Based on PPP-adjusted TPE and without the cost of ribavirin and other treatment costs, treating the entire HCV viraemic population with these regimens at the PPP-adjusted prices with a 23% price reduction would amount to at least one-tenth of current TPE across the countries included in this study, ranging from 10.5% of TPE in the Netherlands to 190.5% of TPE in Poland. In 12 countries, the price of a course of sofosbuvir without other costs was equivalent to 1 y or more of the average annual wage of individuals, ranging from 0.21 y in Egypt to 5.28 y in Turkey. This analysis relies on the accuracy of price information and infection prevalence estimates. It does not include the costs of diagnostic testing, supplementary treatments, treatment for patients with reinfection or cirrhosis, or associated health service costs. Conclusions Current prices of these medicines are variable and unaffordable globally. These prices threaten the sustainability of health systems in many countries and prevent large-scale provision of treatment. Stakeholders should implement a fairer pricing framework to deliver lower prices that take account of affordability. Without lower prices, countries are unlikely to be able to increase investment to minimise the burden of hepatitis C. PMID:27243629

Electronic surveys: how to maximise success.

PubMed

McPeake, Joanne; Bateson, Meghan; O'Neill, Anna

2014-01-01

To draw on the researchers' experience of developing and distributing a UK-wide electronic survey. The evolution of electronic surveys in healthcare research will be discussed, as well as simple techniques that can be used to improve response rates for this type of data collection. There is an increasing use of electronic survey methods in healthcare research. However, in recent published research, electronic surveys have had lower response rates than traditional survey methods, such as postal and telephone surveys. This is a methodology paper. Electronic surveys have many advantages over traditional surveys, including a reduction in cost and ease of analysis. Drawbacks to this type of data collection include the potential for selection bias and poorer response rates. However, research teams can use a range of simple strategies to boost response rates. These approaches target the different stages of achieving a complete response: initial attraction through personalisation, engagement by having an easily accessible link to the survey, and transparency of survey length and completion though targeting the correct, and thereby interested, population. The fast, efficient and often 'free' electronic survey has many advantages over the traditional postal data collection method, including ease of analysis for what can be vast amounts of data. However, to capitalise on these benefits, researchers must carefully consider techniques to maximise response rates and minimise selection bias for their target population. Researchers can use a range of strategies to improve responses from electronic surveys, including sending up to three reminders, personalising each email, adding the updated response rate to reminder emails, and stating the average time it would take to complete the survey in the title of the email.

A LEAST ABSOLUTE SHRINKAGE AND SELECTION OPERATOR (LASSO) FOR NONLINEAR SYSTEM IDENTIFICATION

NASA Technical Reports Server (NTRS)

Kukreja, Sunil L.; Lofberg, Johan; Brenner, Martin J.

2006-01-01

Identification of parametric nonlinear models involves estimating unknown parameters and detecting its underlying structure. Structure computation is concerned with selecting a subset of parameters to give a parsimonious description of the system which may afford greater insight into the functionality of the system or a simpler controller design. In this study, a least absolute shrinkage and selection operator (LASSO) technique is investigated for computing efficient model descriptions of nonlinear systems. The LASSO minimises the residual sum of squares by the addition of a 1 penalty term on the parameter vector of the traditional 2 minimisation problem. Its use for structure detection is a natural extension of this constrained minimisation approach to pseudolinear regression problems which produces some model parameters that are exactly zero and, therefore, yields a parsimonious system description. The performance of this LASSO structure detection method was evaluated by using it to estimate the structure of a nonlinear polynomial model. Applicability of the method to more complex systems such as those encountered in aerospace applications was shown by identifying a parsimonious system description of the F/A-18 Active Aeroelastic Wing using flight test data.

Minimally complex ion traps as modules for quantum communication and computing

NASA Astrophysics Data System (ADS)

Nigmatullin, Ramil; Ballance, Christopher J.; de Beaudrap, Niel; Benjamin, Simon C.

2016-10-01

Optically linked ion traps are promising as components of network-based quantum technologies, including communication systems and modular computers. Experimental results achieved to date indicate that the fidelity of operations within each ion trap module will be far higher than the fidelity of operations involving the links; fortunately internal storage and processing can effectively upgrade the links through the process of purification. Here we perform the most detailed analysis to date on this purification task, using a protocol which is balanced to maximise fidelity while minimising the device complexity and the time cost of the process. Moreover we ‘compile down’ the quantum circuit to device-level operations including cooling and shuttling events. We find that a linear trap with only five ions (two of one species, three of another) can support our protocol while incorporating desirable features such as global control, i.e. laser control pulses need only target an entire zone rather than differentiating one ion from its neighbour. To evaluate the capabilities of such a module we consider its use both as a universal communications node for quantum key distribution, and as the basic repeating unit of a quantum computer. For the latter case we evaluate the threshold for fault tolerant quantum computing using the surface code, finding acceptable fidelities for the ‘raw’ entangling link as low as 83% (or under 75% if an additional ion is available).

Handover training: does one size fit all? The merits of mass customisation.

PubMed

Kicken, Wendy; Van der Klink, Marcel; Barach, Paul; Boshuizen, H P A

2012-12-01

Experts have recommended training and standardisation as promising approaches to improve handovers and minimise the negative consequences of discontinuity of care. Yet the content and delivery of handover training have been only superficially examined and described in literature. The aim of this study was to formulate recommendations for effective handover training and to examine whether standardisation is a viable approach to training large numbers of healthcare professionals. A training needs analysis was conducted by means of a questionnaire, which was filled out by 96 healthcare professionals in primary and secondary care in the Netherlands, Spain, Sweden and Poland. Preferences and recommendations regarding training delivery aspects and training topics that should be included in the handover training were measured. The majority of the participants recommended a short conventional training session with practice assignments, to be completed in small, multidisciplinary groups. Formal examination, e-learning and self-study were not favoured. Recommended training topics were: communication skills, standardised procedures, knowing what to hand over, alertness to vulnerable patient groups and awareness of responsibility. The idea of completely standardised handover training is not in line with the identified differences in preferences and recommendations between different handover stakeholders. Mass customisation of training, in which generic training is adapted to local or individual needs, presents a promising solution to address general and specific needs, while containing the financial and time costs of designing and delivering handover training.

An optimal adder-based hardware architecture for the DCT/SA-DCT

NASA Astrophysics Data System (ADS)

Kinane, Andrew; Muresan, Valentin; O'Connor, Noel

2005-07-01

The explosive growth of the mobile multimedia industry has accentuated the need for ecient VLSI implemen- tations of the associated computationally demanding signal processing algorithms. This need becomes greater as end-users demand increasingly enhanced features and more advanced underpinning video analysis. One such feature is object-based video processing as supported by MPEG-4 core profile, which allows content-based in- teractivity. MPEG-4 has many computationally demanding underlying algorithms, an example of which is the Shape Adaptive Discrete Cosine Transform (SA-DCT). The dynamic nature of the SA-DCT processing steps pose significant VLSI implementation challenges and many of the previously proposed approaches use area and power consumptive multipliers. Most also ignore the subtleties of the packing steps and manipulation of the shape information. We propose a new multiplier-less serial datapath based solely on adders and multiplexers to improve area and power. The adder cost is minimised by employing resource re-use methods. The number of (physical) adders used has been derived using a common sub-expression elimination algorithm. Additional energy eciency is factored into the design by employing guarded evaluation and local clock gating. Our design implements the SA-DCT packing with minimal switching using ecient addressing logic with a transpose mem- ory RAM. The entire design has been synthesized using TSMC 0.09µm TCBN90LP technology yielding a gate count of 12028 for the datapath and its control logic.

Plate with decentralised velocity feedback loops: Power absorption and kinetic energy considerations

NASA Astrophysics Data System (ADS)

Gardonio, P.; Miani, S.; Blanchini, F.; Casagrande, D.; Elliott, S. J.

2012-04-01

This paper is focused on the vibration effects produced by an array of decentralised velocity feedback loops that are evenly distributed over a rectangular thin plate to minimise its flexural response. The velocity feedback loops are formed by collocated ideal velocity sensor and point force actuator pairs, which are unconditionally stable and produce 'sky-hook' damping on the plate. The study compares how the overall flexural vibration of the plate and the local absorption of vibration power by the feedback loops vary with the control gains. The analysis is carried out both considering a typical frequency-domain formulation based on kinetic energy and structural power physical quantities, which is normally used to study vibration and noise problems, and a time-domain formulation also based on kinetic energy and structural power, which is usually implemented to investigate control problems. The time-domain formulation shows to be much more computationally efficient and robust with reference to truncation errors. Thus it has been used to perform a parametric study to assess if, and under which conditions, the minimum of the kinetic energy and the maximum of the absorbed power cost functions match with reference to: (a) the number of feedback control loops, (b) the structural damping in the plate, (c) the mutual distance of a pair of control loops and (d) the mutual gains implemented in a pair of feedback loops.

Silk garments plus standard care compared with standard care for treating eczema in children: A randomised, controlled, observer-blind, pragmatic trial (CLOTHES Trial).

PubMed

Thomas, Kim S; Bradshaw, Lucy E; Sach, Tracey H; Batchelor, Jonathan M; Lawton, Sandra; Harrison, Eleanor F; Haines, Rachel H; Ahmed, Amina; Williams, Hywel C; Dean, Taraneh; Burrows, Nigel P; Pollock, Ian; Llewellyn, Joanne; Crang, Clare; Grundy, Jane D; Guiness, Juliet; Gribbin, Andrew; Mitchell, Eleanor J; Cowdell, Fiona; Brown, Sara J; Montgomery, Alan A

2017-04-01

The role of clothing in the management of eczema (also called atopic dermatitis or atopic eczema) is poorly understood. This trial evaluated the effectiveness and cost-effectiveness of silk garments (in addition to standard care) for the management of eczema in children with moderate to severe disease. This was a parallel-group, randomised, controlled, observer-blind trial. Children aged 1 to 15 y with moderate to severe eczema were recruited from secondary care and the community at five UK medical centres. Participants were allocated using online randomisation (1:1) to standard care or to standard care plus silk garments, stratified by age and recruiting centre. Silk garments were worn for 6 mo. Primary outcome (eczema severity) was assessed at baseline, 2, 4, and 6 mo, by nurses blinded to treatment allocation, using the Eczema Area and Severity Index (EASI), which was log-transformed for analysis (intention-to-treat analysis). A safety outcome was number of skin infections. Three hundred children were randomised (26 November 2013 to 5 May 2015): 42% girls, 79% white, mean age 5 y. Primary analysis included 282/300 (94%) children (n = 141 in each group). The garments were worn more often at night than in the day (median of 81% of nights [25th to 75th centile 57% to 96%] and 34% of days [25th to 75th centile 10% to 76%]). Geometric mean EASI scores at baseline, 2, 4, and 6 mo were, respectively, 9.2, 6.4, 5.8, and 5.4 for silk clothing and 8.4, 6.6, 6.0, and 5.4 for standard care. There was no evidence of any difference between the groups in EASI score averaged over all follow-up visits adjusted for baseline EASI score, age, and centre: adjusted ratio of geometric means 0.95, 95% CI 0.85 to 1.07, (p = 0.43). This confidence interval is equivalent to a difference of -1.5 to 0.5 in the original EASI units, which is not clinically important. Skin infections occurred in 36/142 (25%) and 39/141 (28%) of children in the silk clothing and standard care groups, respectively. Even if the small observed treatment effect was genuine, the incremental cost per quality-adjusted life year was £56,811 in the base case analysis from a National Health Service perspective, suggesting that silk garments are unlikely to be cost-effective using currently accepted thresholds. The main limitation of the study is that use of an objective primary outcome, whilst minimising detection bias, may have underestimated treatment effects. Silk clothing is unlikely to provide additional benefit over standard care in children with moderate to severe eczema. Current Controlled Trials ISRCTN77261365.

Learning from adverse incidents involving medical devices.

PubMed

Amoore, John; Ingram, Paula

While an adverse event involving a medical device is often ascribed to either user error or device failure, the causes are typically multifactorial. A number of incidents involving medical devices are explored using this approach to investigate the various causes of the incident and the protective barriers that minimised or prevented adverse consequences. User factors, including mistakes, omissions and lack of training, conspired with background factors--device controls and device design, storage conditions, hidden device damage and physical layout of equipment when in use--to cause the adverse events. Protective barriers that prevented or minimised the consequences included staff vigilance, operating procedures and alarms.

Simultaneous reconstruction and segmentation for dynamic SPECT imaging

NASA Astrophysics Data System (ADS)

Burger, Martin; Rossmanith, Carolin; Zhang, Xiaoqun

2016-10-01

This work deals with the reconstruction of dynamic images that incorporate characteristic dynamics in certain subregions, as arising for the kinetics of many tracers in emission tomography (SPECT, PET). We make use of a basis function approach for the unknown tracer concentration by assuming that the region of interest can be divided into subregions with spatially constant concentration curves. Applying a regularised variational framework reminiscent of the Chan-Vese model for image segmentation we simultaneously reconstruct both the labelling functions of the subregions as well as the subconcentrations within each region. Our particular focus is on applications in SPECT with the Poisson noise model, resulting in a Kullback-Leibler data fidelity in the variational approach. We present a detailed analysis of the proposed variational model and prove existence of minimisers as well as error estimates. The latter apply to a more general class of problems and generalise existing results in literature since we deal with a nonlinear forward operator and a nonquadratic data fidelity. A computational algorithm based on alternating minimisation and splitting techniques is developed for the solution of the problem and tested on appropriately designed synthetic data sets. For those we compare the results to those of standard EM reconstructions and investigate the effects of Poisson noise in the data.

Rhenium volatilisation as caesium perrhenate from simulated vitrified high level waste from a melter crucible

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

Taylor, T.A.; Short, R.J.; Gribble, N.R.

2013-07-01

The Waste Vitrification Plant (WVP) converts Highly Active Liquor (HAL) from spent nuclear fuel reprocessing into a stable vitrified product. Recently WVP have been experiencing accumulation of solids in their primary off gas (POG) system leading to potential blockages. Chemical analysis of the blockage material via Laser Induced Breakdown Spectroscopy (LIBS) has shown it to exclusively consist of caesium, technetium and oxygen. The solids are understood to be caesium pertechnetate (CsTcO{sub 4}), resulting from the volatilisation of caesium and technetium from the high level waste glass melt. Using rhenium as a chemical surrogate for technetium, a series of full scalemore » experiments have been performed in order to understand the mechanism of rhenium volatilisation as caesium perrhenate (CsReO{sub 4}), and therefore technetium volatilisation as CsTcO{sub 4}. These experiments explored the factors governing volatilisation rates from the melt, potential methods of minimising the amount of volatilisation, and various strategies for mitigating the deleterious effects of the volatile material on the POG. This paper presents the results from those experiments, and discusses potential methods to minimise blockages that can be implemented on WVP, so that the frequency of the CsTcO{sub 4} blockages can be reduced or even eradicated altogether. (authors)« less

A randomised trial and economic evaluation of the effect of response mode on response rate, response bias, and item non-response in a survey of doctors.

PubMed

Scott, Anthony; Jeon, Sung-Hee; Joyce, Catherine M; Humphreys, John S; Kalb, Guyonne; Witt, Julia; Leahy, Anne

2011-09-05

Surveys of doctors are an important data collection method in health services research. Ways to improve response rates, minimise survey response bias and item non-response, within a given budget, have not previously been addressed in the same study. The aim of this paper is to compare the effects and costs of three different modes of survey administration in a national survey of doctors. A stratified random sample of 4.9% (2,702/54,160) of doctors undertaking clinical practice was drawn from a national directory of all doctors in Australia. Stratification was by four doctor types: general practitioners, specialists, specialists-in-training, and hospital non-specialists, and by six rural/remote categories. A three-arm parallel trial design with equal randomisation across arms was used. Doctors were randomly allocated to: online questionnaire (902); simultaneous mixed mode (a paper questionnaire and login details sent together) (900); or, sequential mixed mode (online followed by a paper questionnaire with the reminder) (900). Analysis was by intention to treat, as within each primary mode, doctors could choose either paper or online. Primary outcome measures were response rate, survey response bias, item non-response, and cost. The online mode had a response rate 12.95%, followed by the simultaneous mixed mode with 19.7%, and the sequential mixed mode with 20.7%. After adjusting for observed differences between the groups, the online mode had a 7 percentage point lower response rate compared to the simultaneous mixed mode, and a 7.7 percentage point lower response rate compared to sequential mixed mode. The difference in response rate between the sequential and simultaneous modes was not statistically significant. Both mixed modes showed evidence of response bias, whilst the characteristics of online respondents were similar to the population. However, the online mode had a higher rate of item non-response compared to both mixed modes. The total cost of the online survey was 38% lower than simultaneous mixed mode and 22% lower than sequential mixed mode. The cost of the sequential mixed mode was 14% lower than simultaneous mixed mode. Compared to the online mode, the sequential mixed mode was the most cost-effective, although exhibiting some evidence of response bias. Decisions on which survey mode to use depend on response rates, response bias, item non-response and costs. The sequential mixed mode appears to be the most cost-effective mode of survey administration for surveys of the population of doctors, if one is prepared to accept a degree of response bias. Online surveys are not yet suitable to be used exclusively for surveys of the doctor population.

A randomised trial and economic evaluation of the effect of response mode on response rate, response bias, and item non-response in a survey of doctors

PubMed Central

2011-01-01

Background Surveys of doctors are an important data collection method in health services research. Ways to improve response rates, minimise survey response bias and item non-response, within a given budget, have not previously been addressed in the same study. The aim of this paper is to compare the effects and costs of three different modes of survey administration in a national survey of doctors. Methods A stratified random sample of 4.9% (2,702/54,160) of doctors undertaking clinical practice was drawn from a national directory of all doctors in Australia. Stratification was by four doctor types: general practitioners, specialists, specialists-in-training, and hospital non-specialists, and by six rural/remote categories. A three-arm parallel trial design with equal randomisation across arms was used. Doctors were randomly allocated to: online questionnaire (902); simultaneous mixed mode (a paper questionnaire and login details sent together) (900); or, sequential mixed mode (online followed by a paper questionnaire with the reminder) (900). Analysis was by intention to treat, as within each primary mode, doctors could choose either paper or online. Primary outcome measures were response rate, survey response bias, item non-response, and cost. Results The online mode had a response rate 12.95%, followed by the simultaneous mixed mode with 19.7%, and the sequential mixed mode with 20.7%. After adjusting for observed differences between the groups, the online mode had a 7 percentage point lower response rate compared to the simultaneous mixed mode, and a 7.7 percentage point lower response rate compared to sequential mixed mode. The difference in response rate between the sequential and simultaneous modes was not statistically significant. Both mixed modes showed evidence of response bias, whilst the characteristics of online respondents were similar to the population. However, the online mode had a higher rate of item non-response compared to both mixed modes. The total cost of the online survey was 38% lower than simultaneous mixed mode and 22% lower than sequential mixed mode. The cost of the sequential mixed mode was 14% lower than simultaneous mixed mode. Compared to the online mode, the sequential mixed mode was the most cost-effective, although exhibiting some evidence of response bias. Conclusions Decisions on which survey mode to use depend on response rates, response bias, item non-response and costs. The sequential mixed mode appears to be the most cost-effective mode of survey administration for surveys of the population of doctors, if one is prepared to accept a degree of response bias. Online surveys are not yet suitable to be used exclusively for surveys of the doctor population. PMID:21888678

Seizure-related hospital admissions, readmissions and costs: Comparisons with asthma and diabetes in South Australia.

PubMed

Bellon, Michelle L; Barton, Christopher; McCaffrey, Nikki; Parker, Denise; Hutchinson, Claire

2017-08-01

Seizures are listed as an Ambulatory Care Sensitive Condition (ACSC), where, in some cases, hospitalisation may be avoided with appropriate preventative and early management in primary care. We examined the frequencies, trends and financial costs of first and subsequent seizure-related hospital admissions in the adult and paediatric populations, with comparisons to bronchitis/asthma and diabetes admissions in South Australia between 2012 and 2014. De-identified hospital separation data from five major public hospitals in metropolitan South Australia were analysed to determine the number of children and adults admitted for the following Australian Refined Diagnosis Related Groups: seizure related conditions; bronchitis/asthma; and diabetes. Additional data included length of hospital stay and type of admission. Demographic data were analysed to identify whether social determinants influence admission, and a macro costing approach was then applied to calculate the financial costs to the Health Care System. The rate of total seizure hospitalizations was 649 per 100,000; lower than bronchitis/asthma (751/100,000), yet higher than diabetes (500/100,000). The highest proportions of subsequent separations were recorded by children with seizures regardless of complexity (47% +CSCC; 17% -CSCC) compared with asthma (11% +CSCC; 14% -CSCC) or diabetes (14% +CSCC; 13% -CSCC), and by adults with seizures with catastrophic or severe complications/comorbidity (25%), compared with diabetes (22%) or asthma (14%). The mean cost per separation in both children and adults was highest for diabetes (AU$4438/$7656), followed by seizures (AU$2408/$5691) and asthma (AU$2084/$3295). Following the lead of well-developed and resourced health promotion initiatives in asthma and diabetes, appropriate primary care, community education and seizure management services (including seizure clinics) should be targeted in an effort to reduce seizure related hospitalisations which may be avoidable, minimise costs to the health budget, and maximise health care quality. Copyright © 2017 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Outsourcing and benchmarking in a rural public hospital: does economic theory provide the complete answer?

PubMed

Young, S H

2003-01-01

The ideology and pronouncements of the Australian Government in introducing 'competitive neutrality' to the public sector has improved efficiency and resource usage. In the health sector, the Human Services Department directed that non-clinical and clinical areas be market tested through benchmarking services against the private sector, with the possibility of outsourcing. These services included car parking, computing, laundry, engineering, cleaning, catering, medical imaging (radiology), pathology, pharmacy, allied health and general practice. Managers, when they choose between outsourcing, and internal servicing and production, would thus ideally base their decision on economic principles. Williamson's transaction cost theory studies the governance mechanisms that can be used to achieve economic efficiency and proposes that the optimal organisation structure is that which minimises transaction costs or the costs of exchange. Williamson proposes that four variables will affect such costs, namely: (i) frequency of exchange; (ii) asset specificity; (iii) environmental uncertainty; and (iv) threat of opportunism. This paper provides evidence from a rural public hospital and examines whether Williamson's transaction cost theory is applicable. Case study research operates within the interpretivism paradigm and is used in this research to uncover why the outsourcing decision was made. Such research aims to study real-life experiences by examining the way people think and act and, in contrast to positivism, allows the interviewer to participate to better understand the details and features of the experiences. In the present research, individual interviews were conducted with managers of the hospital and owners and staff of the vendor organisations using semi- and unstructured questions to ascertain the extent of, and processes used in, outsourcing specific functional areas, and areas that were not outsourced. Pathology, radiology, dental technician services and lawn mowing were outsourced while food services was retained internally. The outsourcing of radiology was due to the hospital being unable (or unwilling) to finance new equipment and the problematical relationship between the existing radiologists, and hospital management and staff. Outsourcing resulted in increased staff morale, upgraded capital equipment and improved services. The outsourcing of pathology and dental technical services aimed to increase labour flexibility, thereby decreasing costs. Additional drivers in pathology were the changing nature of the funding arrangements rendering it profitable for the private sector to move into the provision of pathology and the increasing power of the medical scientists' union. The outsourcing of lawn mowing was simply to reduce costs. Food services was not outsourced because there was a lack of evidence that costs could be reduced. In addition, the existing relationships with food services staff were regarded as important because they had previously made immense changes to work practices, reduced staff numbers and decreased costs. Transaction costs are important when analysing how managers make the outsourcing decision, but the evidence from this case is that not all transaction costs are included in the decision, and that such costs are more complex than can be included in the type of analysis often undertaken by decision-makers. Taking into account Williamson's variables, the research shows that the outsourcing of services did not comply solely with the levels of transaction frequency or the requirement of asset specificity. In addition, opportunistic behaviour was evident on the part of all parties and was used in some cases as a reason for outsourcing, and in others to sway the decision to the manager's predisposed choice. A variety of arrangements were used to reduce environmental uncertainty, such as the transfer of staff to the contractor and the use of long-term contracts. Indeed the case shows that relationships between the hospital, its staff and the vendor are an important consideration that may not always be factored into an analysis that relies solely on transaction costs.

Animal welfare implications of neonatal mortality and morbidity in farm animals.

PubMed

Mellor, D J; Stafford, K J

2004-09-01

Much has been learnt during the last 50 years about the causes of neonatal mortality and morbidity and about practical means for minimising them in newborn lambs, kids, bovine calves, deer calves, foals and piglets. The major causes of problems in these newborns are outlined briefly and include hypothermia due to excessive heat loss or to hypoxia-induced, starvation-induced or other forms of inhibited heat production. They also include maternal undernutrition, mismothering, infection and injury. The published literature reveals that the scientific investigations which clarified these causes and led to practical means for minimising the problems, involved iterative successions of self-reinforcing laboratory and field or clinical investigations conducted over many years. These studies focused largely on solutions to the problems, not on the suffering that the newborn might experience, so that an analysis of the associated welfare insults had not apparently been conducted until now. The present assessment focuses on potentially noxious subjective experiences the newborn may have. The account of the causes of neonatal mortality and morbidity outlined early in this review indicates that the key subjective experiences which require analysis in animal welfare terms are breathlessness, hypothermia, hunger, sickness and pain. Reference to documented responses of farm animals and, where appropriate, to human experience, suggests that breathlessness and hypothermia usually represent less severe neonatal welfare insults than do hunger, sickness and pain. Major science-based improvements in the management of pregnancy and birth have markedly reduced the overall amount of welfare compromise experienced by newborn farm animals and further improvements may be expected as knowledge is refined and extended in the future.

A comparison of barriers to mental health support-seeking among farming and non-farming adults in rural South Australia.

PubMed

Hull, Melissa J; Fennell, Kate M; Vallury, Kari; Jones, Martin; Dollman, James

2017-12-01

To assess the differences between farming and non-farming rural adults in perceived barriers to mental health service use. A cross-sectional survey, modified from the Barriers to Help-Seeking Scale (BHSS), was conducted using a computer-assisted telephone interview. Respondents (age 52.6 ± 11.6 years) were recruited from three rural regions of South Australia. Approximately, 78 non-farmers and 45 farmers were included in analyses. 78 retired and two unemployed participants were excluded from the analyses. Farmers and non-farmers were compared on domain scores and individual item responses from the adapted BHSS that represent 'agrarian' attitudes to support-seeking for mental health: stoicism, self-reliance, minimisation of the problem, stigma and distrust of health professionals. In the analysis of domain scores, 'Need for Control and Self-Reliance' was a stronger barrier for farmers than non-farmers (P = 0.009) with a trend (P = 0.07) towards stronger barriers among farmers in the 'Minimising Problem and Resignation' domain. In the analysis of item-level responses, there was a difference (P = 0.03) between farmers and non-farmers in responses to 'I find it difficult to understand my doctor/health professional', with 24.4% of the farmers agreeing that this is a barrier compared with 15.3% of the non-farmers. Long-held stereotypes of stoicism and self-reliance among farmers were somewhat supported, in the context of mental health. Mental health services and professionals in rural Australia might need to adapt their practices to successfully engage this population. © 2017 National Rural Health Alliance Inc.

Exogenous sample contamination. Sources and interference.

PubMed

Cornes, Michael P

2016-12-01

Clinical laboratory medicine is involved in the vast majority of patient care pathways. It has been estimated that pathology results inform 60-70% of critical patient care decisions. The primary goal of the laboratory is to produce precise and accurate results which reflect the true situation in vivo. It is not surprising that interference occurs in laboratory analysis given the complexity of some of the assays used to perform them. Interference is defined as "the effect of a substance upon any step in the determination of the concentration or catalytic activity of the metabolite". Exogenous interferences are defined as those that derive from outside of the body and are therefore not normally found in a specimen and can cause either a positive or negative bias in analytical results. Interferences in analysis can come from various sources and can be classified as endogenous or exogenous. Exogenous substances could be introduced at any point in the sample journey. The laboratory must take responsibility for the quality of results produced. It has a responsibility to have processes in place to identify and minimise the occurrence and effect contamination and interference. To do this well the laboratory needs to work with clinicians and manufacturers. Failure to identify an erroneous result could have an impact on patient care, patient safety and also on hospital budgets. However it is not always easy to recognise interferences. This review summarises the types and sources of exogenous interference and some steps to minimise the impact they have. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

Multicentre imaging measurements for oncology and in the brain

PubMed Central

Tofts, P S; Collins, D J

2011-01-01

Multicentre imaging studies of brain tumours (and other tumour and brain studies) can enable a large group of patients to be studied, yet they present challenging technical problems. Differences between centres can be characterised, understood and minimised by use of phantoms (test objects) and normal control subjects. Normal white matter forms an excellent standard for some MRI parameters (e.g. diffusion or magnetisation transfer) because the normal biological range is low (<2–3%) and the measurements will reflect this, provided the acquisition sequence is controlled. MR phantoms have benefits and they are necessary for some parameters (e.g. tumour volume). Techniques for temperature monitoring and control are given. In a multicentre study or treatment trial, between-centre variation should be minimised. In a cross-sectional study, all groups should be represented at each centre and the effect of centre added as a covariate in the statistical analysis. In a serial study of disease progression or treatment effect, individual patients should receive all of their scans at the same centre; the power is then limited by the within-subject reproducibility. Sources of variation that are generic to any imaging method and analysis parameters include MR sequence mismatch, B1 errors, CT effective tube potential, region of interest generation and segmentation procedure. Specific tissue parameters are analysed in detail to identify the major sources of variation and the most appropriate phantoms or normal studies. These include dynamic contrast-enhanced and dynamic susceptibility contrast gadolinium imaging, T1, diffusion, magnetisation transfer, spectroscopy, tumour volume, arterial spin labelling and CT perfusion. PMID:22433831

A method of determining where to target surveillance efforts in heterogeneous epidemiological systems

PubMed Central

van den Bosch, Frank; Gottwald, Timothy R.; Alonso Chavez, Vasthi

2017-01-01

The spread of pathogens into new environments poses a considerable threat to human, animal, and plant health, and by extension, human and animal wellbeing, ecosystem function, and agricultural productivity, worldwide. Early detection through effective surveillance is a key strategy to reduce the risk of their establishment. Whilst it is well established that statistical and economic considerations are of vital importance when planning surveillance efforts, it is also important to consider epidemiological characteristics of the pathogen in question—including heterogeneities within the epidemiological system itself. One of the most pronounced realisations of this heterogeneity is seen in the case of vector-borne pathogens, which spread between ‘hosts’ and ‘vectors’—with each group possessing distinct epidemiological characteristics. As a result, an important question when planning surveillance for emerging vector-borne pathogens is where to place sampling resources in order to detect the pathogen as early as possible. We answer this question by developing a statistical function which describes the probability distributions of the prevalences of infection at first detection in both hosts and vectors. We also show how this method can be adapted in order to maximise the probability of early detection of an emerging pathogen within imposed sample size and/or cost constraints, and demonstrate its application using two simple models of vector-borne citrus pathogens. Under the assumption of a linear cost function, we find that sampling costs are generally minimised when either hosts or vectors, but not both, are sampled. PMID:28846676

Nonconvex model predictive control for commercial refrigeration

NASA Astrophysics Data System (ADS)

Gybel Hovgaard, Tobias; Boyd, Stephen; Larsen, Lars F. S.; Bagterp Jørgensen, John

2013-08-01

We consider the control of a commercial multi-zone refrigeration system, consisting of several cooling units that share a common compressor, and is used to cool multiple areas or rooms. In each time period we choose cooling capacity to each unit and a common evaporation temperature. The goal is to minimise the total energy cost, using real-time electricity prices, while obeying temperature constraints on the zones. We propose a variation on model predictive control to achieve this goal. When the right variables are used, the dynamics of the system are linear, and the constraints are convex. The cost function, however, is nonconvex due to the temperature dependence of thermodynamic efficiency. To handle this nonconvexity we propose a sequential convex optimisation method, which typically converges in fewer than 5 or so iterations. We employ a fast convex quadratic programming solver to carry out the iterations, which is more than fast enough to run in real time. We demonstrate our method on a realistic model, with a full year simulation and 15-minute time periods, using historical electricity prices and weather data, as well as random variations in thermal load. These simulations show substantial cost savings, on the order of 30%, compared to a standard thermostat-based control system. Perhaps more important, we see that the method exhibits sophisticated response to real-time variations in electricity prices. This demand response is critical to help balance real-time uncertainties in generation capacity associated with large penetration of intermittent renewable energy sources in a future smart grid.

Transitioning EEG experiments away from the laboratory using a Raspberry Pi 2.

PubMed

Kuziek, Jonathan W P; Shienh, Axita; Mathewson, Kyle E

2017-02-01

Electroencephalography (EEG) experiments are typically performed in controlled laboratory settings to minimise noise and produce reliable measurements. These controlled conditions also reduce the applicability of the obtained results to more varied environments and may limit their relevance to everyday situations. Advances in computer portability may increase the mobility and applicability of EEG results while decreasing costs. In this experiment we show that stimulus presentation using a Raspberry Pi 2 computer provides a low cost, reliable alternative to a traditional desktop PC in the administration of EEG experimental tasks. Significant and reliable MMN and P3 activity, typical event-related potentials (ERPs) associated with an auditory oddball paradigm, were measured while experiments were administered using the Raspberry Pi 2. While latency differences in ERP triggering were observed between systems, these differences reduced power only marginally, likely due to the reduced processing power of the Raspberry Pi 2. An auditory oddball task administered using the Raspberry Pi 2 produced similar ERPs to those derived from a desktop PC in a laboratory setting. Despite temporal differences and slight increases in trials needed for similar statistical power, the Raspberry Pi 2 can be used to design and present auditory experiments comparable to a PC. Our results show that the Raspberry Pi 2 is a low cost alternative to the desktop PC when administering EEG experiments and, due to its small size and low power consumption, will enable mobile EEG experiments unconstrained by a traditional laboratory setting. Copyright © 2016 Elsevier B.V. All rights reserved.

Hybrid integration of laser source on silicon photonic integrated circuit for low-cost interferometry medical device

NASA Astrophysics Data System (ADS)

Duperron, Matthieu; Carroll, Lee; Rensing, Marc; Collins, Sean; Zhao, Yan; Li, Yanlu; Baets, Roel; O'Brien, Peter

2017-02-01

The cost-effective integration of laser sources on Silicon Photonic Integrated Circuits (Si-PICs) is a key challenge to realizing the full potential of on-chip photonic solutions for telecommunication and medical applications. Hybrid integration can offer a route to high-yield solutions, using only known-good laser-chips, and simple freespace micro-optics to transport light from a discrete laser-diode to a grating-coupler on the Si-PIC. In this work, we describe a passively assembled micro-optical bench (MOB) for the hybrid integration of a 1550nm 20MHz linewidth laser-diode on a Si-PIC, developed for an on-chip interferometer based medical device. A dual-lens MOB design minimizes aberrations in the laser spot transported to the standard grating-coupler (15 μm x 12 μm) on the Si-PIC, and facilitates the inclusion of a sub-millimeter latched-garnet optical-isolator. The 20dB suppression from the isolator helps ensure the high-frequency stability of the laser-diode, while the high thermal conductivity of the AlN submount (300/W=m.°C), and the close integration of a micro-bead thermistor, ensure the stable and efficient thermo-electric cooling of the laser-diode, which helps minimise low-frequency drift during the approximately 15s of operation needed for the point-of-care measurement. The dual-lens MOB is compatible with cost-effective passively-aligned mass-production, and can be optimised for alternative PIC-based applications.

Optimisation of MSW collection routes for minimum fuel consumption using 3D GIS modelling.

PubMed

Tavares, G; Zsigraiova, Z; Semiao, V; Carvalho, M G

2009-03-01

Collection of municipal solid waste (MSW) may account for more than 70% of the total waste management budget, most of which is for fuel costs. It is therefore crucial to optimise the routing network used for waste collection and transportation. This paper proposes the use of geographical information systems (GIS) 3D route modelling software for waste collection and transportation, which adds one more degree of freedom to the system and allows driving routes to be optimised for minimum fuel consumption. The model takes into account the effects of road inclination and vehicle weight. It is applied to two different cases: routing waste collection vehicles in the city of Praia, the capital of Cape Verde, and routing the transport of waste from different municipalities of Santiago Island to an incineration plant. For the Praia city region, the 3D model that minimised fuel consumption yielded cost savings of 8% as compared with an approach that simply calculated the shortest 3D route. Remarkably, this was true despite the fact that the GIS-recommended fuel reduction route was actually 1.8% longer than the shortest possible travel distance. For the Santiago Island case, the difference was even more significant: a 12% fuel reduction for a similar total travel distance. These figures indicate the importance of considering both the relief of the terrain and fuel consumption in selecting a suitable cost function to optimise vehicle routing.

Outdoor pedestrian fall-related injuries among Swedish senior citizens--injuries and preventive strategies.

PubMed

Gyllencreutz, Lina; Björnstig, Johanna; Rolfsman, Ewa; Saveman, Britt-Inger

2015-06-01

Senior citizens get around, to a large extent, as pedestrians, and safe walking is desirable for senior citizens allowing them to stay mobile, independent and healthy in old age. Senior citizens are over-represented in injury statistics, and fall-related injuries are common. The aim of this study was to investigate fall-related injuries including healthcare costs among senior citizen pedestrians injured when walking in public outdoor environments and to describe their self-reported causes and suggested preventive strategies. The data were based on a combination of information from injury data and a questionnaire. Three hundred senior citizens attended one emergency department after sustaining injuries from pedestrian falls; 60% suffered nonminor injuries, mostly fractures. One-fifth of the pedestrians were hospitalised for an average of 8 days with an indirect hospital cost of 6.2 million EUR (55 million SEK). Environmental factors such as ice were the most commonly described cause of the injury incident. Forty per cent of the respondents indicated that the municipality was responsible for the cause of the injury incident. Fewer respondents mentioned their own responsibility as a preventive strategy. Thirty per cent described a combination of improvements such as better road maintenance, changes in human behaviour and use of safety products as preventive strategies. It is of great importance to highlight general safety, products and preventive strategies to minimise injury risks, so that pedestrians can safely realise the known health benefits of walking and thereby limit healthcare costs. © 2014 Nordic College of Caring Science.

Mineralocorticoid receptor antagonist pretreatment to MINIMISE reperfusion injury after ST-elevation myocardial infarction (the MINIMISE STEMI Trial): rationale and study design.

PubMed

Bulluck, Heerajnarain; Fröhlich, Georg M; Mohdnazri, Shah; Gamma, Reto A; Davies, John R; Clesham, Gerald J; Sayer, Jeremy W; Aggarwal, Rajesh K; Tang, Kare H; Kelly, Paul A; Jagathesan, Rohan; Kabir, Alamgir; Robinson, Nicholas M; Sirker, Alex; Mathur, Anthony; Blackman, Daniel J; Ariti, Cono; Krishnamurthy, Arvindra; White, Steven K; Meier, Pascal; Moon, James C; Greenwood, John P; Hausenloy, Derek J

2015-05-01

Novel therapies capable of reducing myocardial infarct (MI) size when administered prior to reperfusion are required to prevent the onset of heart failure in ST-segment elevation myocardial infarction (STEMI) patients treated by primary percutaneous coronary intervention (PPCI). Experimental animal studies have demonstrated that mineralocorticoid receptor antagonist (MRA) therapy administered prior to reperfusion can reduce MI size, and MRA therapy prevents adverse left ventricular (LV) remodeling in post-MI patients with LV impairment. With these 2 benefits in mind, we hypothesize that initiating MRA therapy prior to PPCI, followed by 3 months of oral MRA therapy, will reduce MI size and prevent adverse LV remodeling in STEMI patients. The MINIMISE-STEMI trial is a prospective, randomized, double-blind, placebo-controlled trial that will recruit 150 STEMI patients from four centers in the United Kingdom. Patients will be randomized to receive either an intravenous bolus of MRA therapy (potassium canrenoate 200 mg) or matching placebo prior to PPCI, followed by oral spironolactone 50 mg once daily or matching placebo for 3 months. A cardiac magnetic resonance imaging scan will be performed within 1 week of PPCI and repeated at 3 months to assess MI size and LV remodeling. Enzymatic MI size will be estimated by the 48-hour area-under-the-curve serum cardiac enzymes. The primary endpoint of the study will be MI size on the 3-month cardiac magnetic resonance imaging scan. The MINIMISE STEMI trial will investigate whether early MRA therapy, initiated prior to reperfusion, can reduce MI size and prevent adverse post-MI LV remodeling. © 2015 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc.

Qualitative research in Spanish cannabis social clubs: "The moment you enter the door, you are minimising the risks".

PubMed

Belackova, Vendula; Tomkova, Alexandra; Zabransky, Tomas

2016-08-01

Cannabis social clubs (CSCs) in Spain are non-profit organisations that connect regular adult cannabis users. One of their functions is to supply cannabis to the closed circuit of members. The CSCs do not breach any international treaties. The aim of the paper is to present the findings of a qualitative study among Spanish CSCs in order to assess their potential for minimising the harm resulting from cannabis use (such as respiratory and mental health risks, the risk of dependence, and social risks). A convenience sample of 11 CSCs was selected from four regions of Spain - the Basque country, Catalonia, the Balearic Islands, and Galicia. 94 respondents took part in 14 focus groups (FGs). The number of participants in a FG ranged from two to 12. A semi-structured interview guide and a structured questionnaire were used in the FG. Members described a variety of risk minimising features of the CSCs: the availability of a quality product and mechanisms for its control, availability of different strains of cannabis and knowledge about their different psychoactive effects, increased control over personal cannabis use, informal information sharing and interaction, reduced stigma, and reduced criminal risks. The fact that the CSCs have no incentive to increase members' consumption means that they should be considered to be feasible spaces for the implementation of public health policies. Policy objectives could include a requirement that CSC members have control over the quality of cannabis, that different strains of cannabis are available together with information on their effects, that quantity of cannabis at intake is restricted and planned for each member, and that harm minimisation activities are both formally and informally implemented in the clubs. Copyright © 2016 Elsevier B.V. All rights reserved.

What are school leavers' priorities for festival preparation?

PubMed

Hutton, Alison; Cusack, Lynette; Zannettino, Lana; Shaefer, Sarah J M; Verdonk, Naomi; Arbon, Paul

2015-01-01

This paper reports on the findings from a qualitative research study that explored how young people prepared to minimise and/or avoid alcohol-related harm while attending a Schoolies Festival (SF). SFs are mass gatherings at which young people (schoolies) celebrate their graduation from high school. The attendance of schoolies, in various Australian communities, ranges between 10 000 and 30 000 individuals during the event. The literature suggests that schoolies are at higher than normal risk of harm at SF from misuse of alcohol, unsafe sex, aggressive behaviour, and other risk-taking factors. As a result of these concerns, SF organisers developed an infrastructure that treats alcohol-related harm, and provides on-site care (first aid stations) by St John Ambulance staff. This study used focus groups to identify strategies used by schoolies to avoid alcohol-related harm during SFs. Data revealed that schoolies did not actively seek health information before attending the event and did not display an interest in doing so. It is important to note that schoolies planned to use alcohol to celebrate and have a good time. Therefore a harm minimisation approach with a focus on providing the necessary infrastructure at SFs to minimise the dangers associated with excess alcohol use is important. Schoolies indicated that they had no desire for information about the hazards of alcohol ingestion. If any health messages were to be used by health authorities, it would be far more appropriate to promote the message of 'take care of your mate', to contribute to building a supportive environment at the event. This may be of more benefit to minimise harm at SFs than funding other health messages.

A randomised crossover trial of minimising medical terminology in secondary care correspondence in patients with chronic health conditions: impact on understanding and patient reported outcomes.

PubMed

Wernick, M; Hale, P; Anticich, N; Busch, S; Merriman, L; King, B; Pegg, T

2016-05-01

There is little existing research on the role that secondary care letters have in ensuring patient understanding of chronic health conditions. To determine whether minimising the use of medical terminology in medical correspondence improved patient understanding and anxiety/depression scores. A single-centre, non-blinded, randomised crossover design assessed health literacy, EQ-5D scores and the impact of the 'translated' letter on the doctor's professionalism, the patient's relationship with their general practitioner (GP) and their perceived impact on chronic disease management. Patients were crossed over between their 'translated' and original letter. Sixty patients were recruited. Use of a 'translated' letter reduced mean terms not understood from 7.78 to 1.76 (t(58) = 4.706, P < 0.001). Most patients (78.0%) preferred the 'translated' letter, with 69.5% patients perceiving an enhancement in their doctor's professionalism (z = 2.864, P = 0.004), 69.0% reporting a positive influence on relationship with their GP (z = 2.943, P = 0.003) and 79.7% reporting an increase in perceived ability to manage their chronic health condition with the 'translated' letter (z = 4.601, P < 0.001). There was no effect on EQ-5D depression/anxiety scores. Minimising the use of medical terminology in medical correspondence significantly improved patient understanding and perception of their ability to manage their chronic health condition. Although there was no impact on EQ-5D depression/anxiety scores, overwhelming patient preference for the 'translated' letter indicates a need for minimisation of medical terminology in medical correspondence for patients with chronic health conditions. © 2016 Royal Australasian College of Physicians.

Reverse logistics network for municipal solid waste management: The inclusion of waste pickers as a Brazilian legal requirement

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

Ferri, Giovane Lopes, E-mail: giovane.ferri@aluno.ufes.br; Diniz Chaves, Gisele de Lorena, E-mail: gisele.chaves@ufes.br; Ribeiro, Glaydston Mattos, E-mail: glaydston@pet.coppe.ufrj.br

Highlights: • We propose a reverse logistics network for MSW involving waste pickers. • A generic facility location mathematical model was validated in a Brazilian city. • The results enable to predict the capacity for screening and storage centres (SSC). • We minimise the costs for transporting MSW with screening and storage centres. • The use of SSC can be a potential source of revenue and a better use of MSW. - Abstract: This study proposes a reverse logistics network involved in the management of municipal solid waste (MSW) to solve the challenge of economically managing these wastes considering themore » recent legal requirements of the Brazilian Waste Management Policy. The feasibility of the allocation of MSW material recovery facilities (MRF) as intermediate points between the generators of these wastes and the options for reuse and disposal was evaluated, as well as the participation of associations and cooperatives of waste pickers. This network was mathematically modelled and validated through a scenario analysis of the municipality of São Mateus, which makes the location model more complete and applicable in practice. The mathematical model allows the determination of the number of facilities required for the reverse logistics network, their location, capacities, and product flows between these facilities. The fixed costs of installation and operation of the proposed MRF were balanced with the reduction of transport costs, allowing the inclusion of waste pickers to the reverse logistics network. The main contribution of this study lies in the proposition of a reverse logistics network for MSW simultaneously involving legal, environmental, economic and social criteria, which is a very complex goal. This study can guide practices in other countries that have realities similar to those in Brazil of accelerated urbanisation without adequate planning for solid waste management, added to the strong presence of waste pickers that, through the characteristic of social vulnerability, must be included in the system. In addition to the theoretical contribution to the reverse logistics network problem, this study aids in decision-making for public managers who have limited technical and administrative capacities for the management of solid wastes.« less

Minimising impairment: Protocol for a multicentre randomised controlled trial of upper limb orthoses for children with cerebral palsy.

PubMed

Imms, Christine; Wallen, Margaret; Elliott, Catherine; Hoare, Brian; Randall, Melinda; Greaves, Susan; Adair, Brooke; Bradshaw, Elizabeth; Carter, Rob; Orsini, Francesca; Shih, Sophy T F; Reddihough, Dinah

2016-05-27

Upper limb orthoses are frequently prescribed for children with cerebral palsy (CP) who have muscle overactivity predominantly due to spasticity, with little evidence of long-term effectiveness. Clinical consensus is that orthoses help to preserve range of movement: nevertheless, they can be complex to construct, expensive, uncomfortable and require commitment from parents and children to wear. This protocol paper describes a randomised controlled trial to evaluate whether long-term use of rigid wrist/hand orthoses (WHO) in children with CP, combined with usual multidisciplinary care, can prevent or reduce musculoskeletal impairments, including muscle stiffness/tone and loss of movement range, compared to usual multidisciplinary care alone. This pragmatic, multicentre, assessor-blinded randomised controlled trial with economic analysis will recruit 194 children with CP, aged 5-15 years, who present with flexor muscle stiffness of the wrist and/or fingers/thumb (Modified Ashworth Scale score ≥1). Children, recruited from treatment centres in Victoria, New South Wales and Western Australia, will be randomised to groups (1:1 allocation) using concealed procedures. All children will receive care typically provided by their treating organisation. The treatment group will receive a custom-made serially adjustable rigid WHO, prescribed for 6 h nightly (or daily) to wear for 3 years. An application developed for mobile devices will monitor WHO wearing time and adverse events. The control group will not receive a WHO, and will cease wearing one if previously prescribed. Outcomes will be measured 6 monthly over a period of 3 years. The primary outcome is passive range of wrist extension, measured with fingers extended using a goniometer at 3 years. Secondary outcomes include muscle stiffness, spasticity, pain, grip strength and hand deformity. Activity, participation, quality of life, cost and cost-effectiveness will also be assessed. This study will provide evidence to inform clinicians, services, funding agencies and parents/carers of children with CP whether the provision of a rigid WHO to reduce upper limb impairment, in combination with usual multidisciplinary care, is worth the effort and costs. ANZ Clinical Trials Registry: U1111-1164-0572 .

Improving the management of multimorbidity in general practice: protocol of a cluster randomised controlled trial (The 3D Study).

PubMed

Man, Mei-See; Chaplin, Katherine; Mann, Cindy; Bower, Peter; Brookes, Sara; Fitzpatrick, Bridie; Guthrie, Bruce; Shaw, Alison; Hollinghurst, Sandra; Mercer, Stewart; Rafi, Imran; Thorn, Joanna; Salisbury, Chris

2016-04-25

An increasing number of people are living with multimorbidity. The evidence base for how best to manage these patients is weak. Current clinical guidelines generally focus on single conditions, which may not reflect the needs of patients with multimorbidity. The aim of the 3D study is to develop, implement and evaluate an intervention to improve the management of patients with multimorbidity in general practice. This is a pragmatic two-arm cluster randomised controlled trial. 32 general practices around Bristol, Greater Manchester and Glasgow will be randomised to receive either the '3D intervention' or usual care. 3D is a complex intervention including components affecting practice organisation, the conduct of patient reviews, integration with secondary care and measures to promote change in practice organisation. Changes include improving continuity of care and replacing reviews of each disease with patient-centred reviews with a focus on patients' quality of life, mental health and polypharmacy. We aim to recruit 1383 patients who have 3 or more chronic conditions. This provides 90% power at 5% significance level to detect an effect size of 0.27 SDs in the primary outcome, which is health-related quality of life at 15 months using the EQ-5D-5L. Secondary outcome measures assess patient centredness, illness burden and treatment burden. The primary analysis will be a multilevel regression model adjusted for baseline, stratification/minimisation, clustering and important co-variables. Nested process evaluation will assess implementation, mechanisms of effectiveness and interaction of the intervention with local context. Economic analysis of cost-consequences and cost-effectiveness will be based on quality-adjusted life years. This study has approval from South-West (Frenchay) National Health Service (NHS) Research Ethics Committee (14/SW/0011). Findings will be disseminated via final report, peer-reviewed publications and guidance to healthcare professionals, commissioners and policymakers. ISRCTN06180958; Pre-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Study protocol: differential effects of diet and physical activity based interventions in pregnancy on maternal and fetal outcomes--individual patient data (IPD) meta-analysis and health economic evaluation.

PubMed

Ruifrok, Anneloes E; Rogozinska, Ewelina; van Poppel, Mireille N M; Rayanagoudar, Girish; Kerry, Sally; de Groot, Christianne J M; Yeo, SeonAe; Molyneaux, Emma; McAuliffe, Fionnuala M; Poston, Lucilla; Roberts, Tracy; Riley, Richard D; Coomarasamy, Arri; Khan, Khalid; Mol, Ben Willem; Thangaratinam, Shakila

2014-11-04

Pregnant women who gain excess weight are at risk of complications during pregnancy and in the long term. Interventions based on diet and physical activity minimise gestational weight gain with varied effect on clinical outcomes. The effect of interventions on varied groups of women based on body mass index, age, ethnicity, socioeconomic status, parity, and underlying medical conditions is not clear. Our individual patient data (IPD) meta-analysis of randomised trials will assess the differential effect of diet- and physical activity-based interventions on maternal weight gain and pregnancy outcomes in clinically relevant subgroups of women. Randomised trials on diet and physical activity in pregnancy will be identified by searching the following databases: MEDLINE, EMBASE, BIOSIS, LILACS, Pascal, Science Citation Index, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, and Health Technology Assessment Database. Primary researchers of the identified trials are invited to join the International Weight Management in Pregnancy Collaborative Network and share their individual patient data. We will reanalyse each study separately and confirm the findings with the original authors. Then, for each intervention type and outcome, we will perform as appropriate either a one-step or a two-step IPD meta-analysis to obtain summary estimates of effects and 95% confidence intervals, for all women combined and for each subgroup of interest. The primary outcomes are gestational weight gain and composite adverse maternal and fetal outcomes. The difference in effects between subgroups will be estimated and between-study heterogeneity suitably quantified and explored. The potential for publication bias and availability bias in the IPD obtained will be investigated. We will conduct a model-based economic evaluation to assess the cost effectiveness of the interventions to manage weight gain in pregnancy and undertake a value of information analysis to inform future research. PROSPERO 2013: CRD42013003804.

Pathogen reduction of whole blood: utility and feasibility.

PubMed

Allain, J-P; Goodrich, R

2017-10-01

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

Challenges of therapeutic substitution of drugs for economic reasons: focus on CVD prevention.

PubMed

Johnston, Atholl

2010-04-01

Healthcare systems throughout the world are under increasing pressure to control and minimise costs. The substitution of initially-prescribed drugs with cheaper equivalents is an obvious option which presents a rapid and visible means to reduce these costs. Whether the substitution improves patient and/or population outcomes must be appraised and this paper highlights the conditions under which therapeutic substitution may require additional thought and consideration. In this paper, some of the medical evidence and the regulatory environment for and against the three types of therapeutic substitution - generic, within-class and between-class - are discussed. This article is not an exhaustive review of the literature, but captures some of the key clinical, pharmacological, economic, policy and ethical issues regarding generic and therapeutic substitution. Search criteria of the most commonly used terms, i.e. therapeutic substitution, switching, interchange, and bioequivalence, were applied to Embase, PubMed and Google Scholar to identify relevant publications. Although population studies support therapeutic substitution in principle, there is evidence that substitution may not always result in therapeutic equivalence in individual patients, with the consequent potential for greater risks of decreased efficacy and/or increased safety concerns. Factors such as patient choice and therapeutic equivalence also play an important role in the effectiveness of the treatment and overall management of the patient. The pan-European regulatory environment provides another contradiction, encouraging widespread cost containment through reduction in drug acquisition costs, while simultaneously promoting an increased role for patients in defining and managing their own treatment. There is a strong rationale for careful management in some patients with cardiovascular disease. Treatment decisions should be transparent and based on strong clinical evidence. If not, drug substitution on economic grounds alone cannot be considered to be in the individual patient's interest and is therefore unethical.

Performance of a large building rainwater harvesting system.

PubMed

Ward, S; Memon, F A; Butler, D

2012-10-15

Rainwater harvesting is increasingly becoming an integral part of the sustainable water management toolkit. Despite a plethora of studies modelling the feasibility of the utilisation of rainwater harvesting (RWH) systems in particular contexts, there remains a significant gap in knowledge in relation to detailed empirical assessments of performance. Domestic systems have been investigated to a limited degree in the literature, including in the UK, but there are few recent longitudinal studies of larger non-domestic systems. Additionally, there are few studies comparing estimated and actual performance. This paper presents the results of a longitudinal empirical performance assessment of a non-domestic RWH system located in an office building in the UK. Furthermore, it compares actual performance with the estimated performance based on two methods recommended by the British Standards Institute - the Intermediate (simple calculations) and Detailed (simulation-based) Approaches. Results highlight that the average measured water saving efficiency (amount of mains water saved) of the office-based RWH system was 87% across an 8-month period, due to the system being over-sized for the actual occupancy level. Consequently, a similar level of performance could have been achieved using a smaller-sized tank. Estimated cost savings resulted in capital payback periods of 11 and 6 years for the actual over-sized tank and the smaller optimised tank, respectively. However, more detailed cost data on maintenance and operation is required to perform whole life cost analyses. These findings indicate that office-scale RWH systems potentially offer significant water and cost savings. They also emphasise the importance of monitoring data and that a transition to the use of Detailed Approaches (particularly in the UK) is required to (a) minimise over-sizing of storage tanks and (b) build confidence in RWH system performance. Copyright © 2012 Elsevier Ltd. All rights reserved.

Rescheduling nursing shifts: scoping the challenge and examining the potential of mathematical model based tools.

PubMed

Clark, Alistair; Moule, Pam; Topping, Annie; Serpell, Martin

2015-05-01

To review research in the literature on nursing shift scheduling / rescheduling, and to report key issues identified in a consultation exercise with managers in four English National Health Service trusts to inform the development of mathematical tools for rescheduling decision-making. Shift rescheduling is unrecognised as an everyday time-consuming management task with different imperatives from scheduling. Poor rescheduling decisions can have quality, cost and morale implications. A systematic critical literature review identified rescheduling issues and existing mathematic modelling tools. A consultation exercise with nursing managers examined the complex challenges associated with rescheduling. Minimal research exists on rescheduling compared with scheduling. Poor rescheduling can result in greater disruption to planned nursing shifts and may impact negatively on the quality and cost of patient care, and nurse morale and retention. Very little research examines management challenges or mathematical modelling for rescheduling. Shift rescheduling is a complex and frequent management activity that is more challenging than scheduling. Mathematical modelling may have potential as a tool to support managers to minimise rescheduling disruption. The lack of specific methodological support for rescheduling that takes into account its complexity, increases the likelihood of harm for patients and stress for nursing staff and managers. © 2013 John Wiley & Sons Ltd.

Developing Ubiquitous Sensor Network Platform Using Internet of Things: Application in Precision Agriculture.

PubMed

Ferrández-Pastor, Francisco Javier; García-Chamizo, Juan Manuel; Nieto-Hidalgo, Mario; Mora-Pascual, Jerónimo; Mora-Martínez, José

2016-07-22

The application of Information Technologies into Precision Agriculture methods has clear benefits. Precision Agriculture optimises production efficiency, increases quality, minimises environmental impact and reduces the use of resources (energy, water); however, there are different barriers that have delayed its wide development. Some of these main barriers are expensive equipment, the difficulty to operate and maintain and the standard for sensor networks are still under development. Nowadays, new technological development in embedded devices (hardware and communication protocols), the evolution of Internet technologies (Internet of Things) and ubiquitous computing (Ubiquitous Sensor Networks) allow developing less expensive systems, easier to control, install and maintain, using standard protocols with low-power consumption. This work develops and test a low-cost sensor/actuator network platform, based in Internet of Things, integrating machine-to-machine and human-machine-interface protocols. Edge computing uses this multi-protocol approach to develop control processes on Precision Agriculture scenarios. A greenhouse with hydroponic crop production was developed and tested using Ubiquitous Sensor Network monitoring and edge control on Internet of Things paradigm. The experimental results showed that the Internet technologies and Smart Object Communication Patterns can be combined to encourage development of Precision Agriculture. They demonstrated added benefits (cost, energy, smart developing, acceptance by agricultural specialists) when a project is launched.

Optimal maintenance policy incorporating system level and unit level for mechanical systems

NASA Astrophysics Data System (ADS)

Duan, Chaoqun; Deng, Chao; Wang, Bingran

2018-04-01

The study works on a multi-level maintenance policy combining system level and unit level under soft and hard failure modes. The system experiences system-level preventive maintenance (SLPM) when the conditional reliability of entire system exceeds SLPM threshold, and also undergoes a two-level maintenance for each single unit, which is initiated when a single unit exceeds its preventive maintenance (PM) threshold, and the other is performed simultaneously the moment when any unit is going for maintenance. The units experience both periodic inspections and aperiodic inspections provided by failures of hard-type units. To model the practical situations, two types of economic dependence have been taken into account, which are set-up cost dependence and maintenance expertise dependence due to the same technology and tool/equipment can be utilised. The optimisation problem is formulated and solved in a semi-Markov decision process framework. The objective is to find the optimal system-level threshold and unit-level thresholds by minimising the long-run expected average cost per unit time. A formula for the mean residual life is derived for the proposed multi-level maintenance policy. The method is illustrated by a real case study of feed subsystem from a boring machine, and a comparison with other policies demonstrates the effectiveness of our approach.

Modelling the impact of liner shipping network perturbations on container cargo routing: Southeast Asia to Europe application.

PubMed

Achurra-Gonzalez, Pablo E; Novati, Matteo; Foulser-Piggott, Roxane; Graham, Daniel J; Bowman, Gary; Bell, Michael G H; Angeloudis, Panagiotis

2016-06-03

Understanding how container routing stands to be impacted by different scenarios of liner shipping network perturbations such as natural disasters or new major infrastructure developments is of key importance for decision-making in the liner shipping industry. The variety of actors and processes within modern supply chains and the complexity of their relationships have previously led to the development of simulation-based models, whose application has been largely compromised by their dependency on extensive and often confidential sets of data. This study proposes the application of optimisation techniques less dependent on complex data sets in order to develop a quantitative framework to assess the impacts of disruptive events on liner shipping networks. We provide a categorization of liner network perturbations, differentiating between systemic and external and formulate a container assignment model that minimises routing costs extending previous implementations to allow feasible solutions when routing capacity is reduced below transport demand. We develop a base case network for the Southeast Asia to Europe liner shipping trade and review of accidents related to port disruptions for two scenarios of seismic and political conflict hazards. Numerical results identify alternative routing paths and costs in the aftermath of port disruptions scenarios and suggest higher vulnerability of intra-regional connectivity. Copyright © 2016 Elsevier Ltd. All rights reserved.

The SKYLON Spaceplane

NASA Astrophysics Data System (ADS)

Varvill, R.; Bond, A.

SKYLON is a single stage to orbit (SSTO) winged spaceplane designed to give routine low cost access to space. At a gross takeoff weight of 275 tonnes of which 220 tonnes is propellant the vehicle is capable of placing 12 tonnes into an equatorial low Earth orbit. The vehicle configuration consists of a slender fuselage containing the propellant tankage and payload bay with delta wings located midway along the fuselage carrying the SABRE engines in axisymmetric nacelles on the wingtips. The vehicle takes off and lands horizontally on it's own undercarriage. The fuselage is constructed as a multilayer structure consisting of aeroshell, insulation, structure and tankage. SKYLON employs extant or near term materials technology in order to minimise development cost and risk. The SABRE engines have a dual mode capability. In rocket mode the engine operates as a closed cycle liquid oxygen/liquid hydrogen high specific impulse rocket engine. In airbreathing mode (from takeoff to Mach 5) the liquid oxygen flow is replaced by atmospheric air, increasing the installed specific impulse 3-6 fold. The airflow is drawn into the engine via a 2 shock axisymmetric intake and cooled to cryogenic temperatures prior to compression. The hydrogen fuel flow acts as a heat sink for the closed cycle helium loop before entering the main combustion chamber.

An Enhanced MEMS Error Modeling Approach Based on Nu-Support Vector Regression

PubMed Central

Bhatt, Deepak; Aggarwal, Priyanka; Bhattacharya, Prabir; Devabhaktuni, Vijay

2012-01-01

Micro Electro Mechanical System (MEMS)-based inertial sensors have made possible the development of a civilian land vehicle navigation system by offering a low-cost solution. However, the accurate modeling of the MEMS sensor errors is one of the most challenging tasks in the design of low-cost navigation systems. These sensors exhibit significant errors like biases, drift, noises; which are negligible for higher grade units. Different conventional techniques utilizing the Gauss Markov model and neural network method have been previously utilized to model the errors. However, Gauss Markov model works unsatisfactorily in the case of MEMS units due to the presence of high inherent sensor errors. On the other hand, modeling the random drift utilizing Neural Network (NN) is time consuming, thereby affecting its real-time implementation. We overcome these existing drawbacks by developing an enhanced Support Vector Machine (SVM) based error model. Unlike NN, SVMs do not suffer from local minimisation or over-fitting problems and delivers a reliable global solution. Experimental results proved that the proposed SVM approach reduced the noise standard deviation by 10–35% for gyroscopes and 61–76% for accelerometers. Further, positional error drifts under static conditions improved by 41% and 80% in comparison to NN and GM approaches. PMID:23012552

Developing Ubiquitous Sensor Network Platform Using Internet of Things: Application in Precision Agriculture

PubMed Central

Ferrández-Pastor, Francisco Javier; García-Chamizo, Juan Manuel; Nieto-Hidalgo, Mario; Mora-Pascual, Jerónimo; Mora-Martínez, José

2016-01-01

The application of Information Technologies into Precision Agriculture methods has clear benefits. Precision Agriculture optimises production efficiency, increases quality, minimises environmental impact and reduces the use of resources (energy, water); however, there are different barriers that have delayed its wide development. Some of these main barriers are expensive equipment, the difficulty to operate and maintain and the standard for sensor networks are still under development. Nowadays, new technological development in embedded devices (hardware and communication protocols), the evolution of Internet technologies (Internet of Things) and ubiquitous computing (Ubiquitous Sensor Networks) allow developing less expensive systems, easier to control, install and maintain, using standard protocols with low-power consumption. This work develops and test a low-cost sensor/actuator network platform, based in Internet of Things, integrating machine-to-machine and human-machine-interface protocols. Edge computing uses this multi-protocol approach to develop control processes on Precision Agriculture scenarios. A greenhouse with hydroponic crop production was developed and tested using Ubiquitous Sensor Network monitoring and edge control on Internet of Things paradigm. The experimental results showed that the Internet technologies and Smart Object Communication Patterns can be combined to encourage development of Precision Agriculture. They demonstrated added benefits (cost, energy, smart developing, acceptance by agricultural specialists) when a project is launched. PMID:27455265

A web-based Decision Support System for the optimal management of construction and demolition waste.

PubMed

Banias, G; Achillas, Ch; Vlachokostas, Ch; Moussiopoulos, N; Papaioannou, I

2011-12-01

Wastes from construction activities constitute nowadays the largest by quantity fraction of solid wastes in urban areas. In addition, it is widely accepted that the particular waste stream contains hazardous materials, such as insulating materials, plastic frames of doors, windows, etc. Their uncontrolled disposal result to long-term pollution costs, resource overuse and wasted energy. Within the framework of the DEWAM project, a web-based Decision Support System (DSS) application - namely DeconRCM - has been developed, aiming towards the identification of the optimal construction and demolition waste (CDW) management strategy that minimises end-of-life costs and maximises the recovery of salvaged building materials. This paper addresses both technical and functional structure of the developed web-based application. The web-based DSS provides an accurate estimation of the generated CDW quantities of twenty-one different waste streams (e.g. concrete, bricks, glass, etc.) for four different types of buildings (residential, office, commercial and industrial). With the use of mathematical programming, the DeconRCM provides also the user with the optimal end-of-life management alternative, taking into consideration both economic and environmental criteria. The DSS's capabilities are illustrated through a real world case study of a typical five floor apartment building in Thessaloniki, Greece. Copyright © 2011 Elsevier Ltd. All rights reserved.

Study on lean thinking among MSMEs in the Machine tool sector in India

NASA Astrophysics Data System (ADS)

Priyaadarshini, R. G.; Sathish Kumar, V. R.; Aishwarya Rajlakshmi, S.

2018-02-01

In the era of stiff competition and customer expectations, manufacturing organizations across the world are struggling hard to minimize their costs and maximise their performance. Micro, Small and Medium enterprises (MSMEs), who are dependent on large corporate for business and support have a tall task of keeping pace quality in processes and output. They are in the constant vigil to adopt new systems and practices so that they can minimise their cost and maximize the productivity. This study has been conducted in the machine tool sector of Coimbatore, India; which houses more than 9000 companies and offers employment to over one lakh employees. They have a tremendous pressure to use scientific processes to increase their product quality and productivity. While Lean manufacturing has been the thrust to improve the competitiveness among MSMEs in India, this study has attempted to understand their attitude towards lean management and understand the extent to which companies practice lean tools and practices. It has been found that most of the organizations in the study possess a culture of lean thinking and possess the support of top management and employees also towards the initiative. It is also seen that the organizations that incorporated lean in their daily operations have been able to scale up their productivity.

Efficient direct yaw moment control: tyre slip power loss minimisation for four-independent wheel drive vehicle

NASA Astrophysics Data System (ADS)

Kobayashi, Takao; Katsuyama, Etsuo; Sugiura, Hideki; Ono, Eiichi; Yamamoto, Masaki

2018-05-01

This paper proposes an efficient direct yaw moment control (DYC) capable of minimising tyre slip power loss on contact patches for a four-independent wheel drive vehicle. Simulations identified a significant power loss reduction with a direct yaw moment due to a change in steer characteristics during acceleration or deceleration while turning. Simultaneously, the vehicle motion can be stabilised. As a result, the proposed control method can ensure compatibility between vehicle dynamics performance and energy efficiency. This paper also describes the results of a full-vehicle simulation that was conducted to examine the effectiveness of the proposed DYC.

Non-adversarial justice and the coroner's court: a proposed therapeutic, restorative, problem-solving model.

PubMed

King, Michael S

2008-12-01

Increasingly courts are using new approaches that promote a more comprehensive resolution of legal problems, minimise any negative effects that legal processes have on participant wellbeing and/or that use legal processes to promote participant wellbeing. Therapeutic jurisprudence, restorative justice, mediation and problem-solving courts are examples. This article suggests a model for the use of these processes in the coroner's court to minimise negative effects of coroner's court processes on the bereaved and to promote a more comprehensive resolution of matters at issue, including the determination of the cause of death and the public health and safety promotion role of the coroner.

Barriers to Seeking Help for Skin Cancer Detection in Rural Australia

PubMed Central

Fennell, Kate M.; Martin, Kimberley; Wilson, Carlene J.; Trenerry, Camilla; Sharplin, Greg; Dollman, James

2017-01-01

This study explores rural South Australians’ barriers to help-seeking for skin cancer detection. A total of 201 randomly selected rural adults (18–94 years, 66% female) were presented with a skin-cancer-related scenario via telephone and were asked the extent to which various barriers would impede their help-seeking, based on an amended version of the Barriers to Help-Seeking Scale. Older (≥63 years) and less educated participants endorsed barriers more strongly than their younger, more educated counterparts in the following domains; “Concrete barriers and distrust of caregivers”, “Emotional control”, “Minimising problem and Normalisation”, “Need for control and self-reliance” (every domain other than “Privacy”). Socioeconomic disadvantage, gender, and farmer status did not predict stronger overall barriers, but some gender and occupation-related differences were detected at the item level. Farmers were also more likely to endorse the “Minimising problem and normalization” domain than their non-farmer working rural counterparts. Widely endorsed barriers included the tendency to minimise the problem, a desire to remain in control/not be influenced by others, reluctance to show emotion or complain, and having concerns about privacy or waiting times. PMID:28208803

[The Swiss population and drug problems: perception of the problems and proposals for solutions].

PubMed

Leuthold, A; Cattaneo, M; Dubois-Arber, F

1993-01-01

The aim of this study is to investigate which problems in relation with drug abuse are considered to be the most important by the Swiss population and which measures do they support to reduce them. Base for this study are the results of a representative telephone survey realized in october 1991 with 1004 Swiss residents. People are mostly concerned with problems related to the danger for youth and those concerning public order but also with the human condition of addicts. Drug addicts are considered as people who have lost the sense of live, as sick but also as dangerous and less truthful. Supported are overall prevention, offers for therapies, the repression of trafficking and money-laundering but not of drug users as well as measures going in the direction of harm-minimisation (shooting rooms, medical prescription of drugs). Younger people, those with higher education and the german-speaking population have a more positive view of drug addicts and support measures in the sense of harm-minimisation. Elder people and the french-speaking population have a rather negative view of drug addicts and don't favour measures for harm-minimisation.

Trouble Spots in Online Direct-to-Consumer Prescription Drug Promotion: Teaching Drug Marketers How to Inform Better or Spin Better? Comment on "Trouble Spots in Online Direct-to-Consumer Prescription Drug Promotion: A Content Analysis of FDA Warning Letters".

PubMed

Doran, Evan

2016-02-21

Hyosun Kim's report "Trouble Spots in Online Direct to Consumer Prescription Drug Promotion: A content Analysis of FDA Warning Letters" aims to teach marketers how to avoid breaching current Food and Drug Administration (FDA) guidelines in their online drug promotion. While Kim hopes to minimise the potential for online promotion to misinform consumers and the study is carefully conducted, teaching drug marketers how to avoid the common mistakes in online drug promotion is more likely to make marketers more adept at spinning information than appropriately balancing it. © 2016 by Kerman University of Medical Sciences.

[Coupled Analysis of Fluid-Structure Interaction of a Micro-Mechanical Valve for Glaucoma Drainage Devices].

PubMed

Siewert, S; Sämann, M; Schmidt, W; Stiehm, M; Falke, K; Grabow, N; Guthoff, R; Schmitz, K-P

2015-12-01

Glaucoma is the leading cause of irreversible blindness worldwide. In therapeutically refractory cases, alloplastic glaucoma drainage devices (GDD) are being increasingly used to decrease intraocular pressure. Current devices are mainly limited by fibrotic encapsulation and postoperative hypotension. Preliminary studies have described the development of a glaucoma microstent to control aqueous humour drainage from the anterior chamber into the suprachoroidal space. One focus of these studies was on the design of a micro-mechanical valve placed in the anterior chamber to inhibit postoperative hypotension. The present report describes the coupled analysis of fluid-structure interaction (FSI) as basis for future improvements in the design micro-mechanical valves. FSI analysis was carried out with ANSYS 14.5 software. Solid and fluid geometry were combined in a model, and the corresponding material properties of silicone (Silastic Rx-50) and water at room temperature were assigned. The meshing of the solid and fluid domains was carried out in accordance with the results of a convergence study with tetrahedron elements. Structural and fluid mechanical boundary conditions completed the model. The FSI analysis takes into account geometric non-linearity and adaptive remeshing to consider changing geometry. A valve opening pressure of 3.26 mmHg was derived from the FSI analysis and correlates well with the results of preliminary experimental fluid mechanical studies. Flow resistance was calculated from non-linear pressure-flow characteristics as 8.5 × 10(-3) mmHg/µl  · min(-1) and 2.7 × 10(-3) mmHg/µl  · min(-1), respectively before and after valve opening pressure is exceeded. FSI analysis indicated leakage flow before valve opening, which is due to the simplified model geometry. The presented bidirectional coupled FSI analysis is a powerful tool for the development of new designs of micro-mechanical valves for GDD and may help to minimise the time and cost expended on manufacturing and testing prototypes. Further optimisation of the FSI model is expected to ensure further convergence between the simulation and the results of experimental investigations. Georg Thieme Verlag KG Stuttgart · New York.

The past, present and future of mental health law: a therapeutic jurisprudence analysis.

PubMed

Allan, Alfred

2003-01-01

This article uses a therapeutic jurisprudence perspective to review the evolution of mental health law in the Western world by examining developments at various stages in history, in particular the 20th century. It suggests that one of the major challenges for the future, from a therapeutic jurisprudence perspective, will be to help minimise the stigma, prejudice and discrimination associated with mental health law. The article concludes with the suggestion that the question of whether mental health law itself, because it contributes to discrimination against mentally disordered people, may be anti-therapeutic requires more investigation and consideration.

Trouble Spots in Online Direct-to-Consumer Prescription Drug Promotion: Teaching Drug Marketers How to Inform Better or Spin Better?

PubMed Central

Doran, Evan

2016-01-01

Hyosun Kim’s report "Trouble Spots in Online Direct to Consumer Prescription Drug Promotion: A content Analysis of FDA Warning Letters" aims to teach marketers how to avoid breaching current Food and Drug Administration (FDA) guidelines in their online drug promotion. While Kim hopes to minimise the potential for online promotion to misinform consumers and the study is carefully conducted, teaching drug marketers how to avoid the common mistakes in online drug promotion is more likely to make marketers more adept at spinning information than appropriately balancing it PMID:27239884

The economic costs of intrapartum care in Tower Hamlets: A comparison between the cost of birth in a freestanding midwifery unit and hospital for women at low risk of obstetric complications.

PubMed

Schroeder, Liz; Patel, Nishma; Keeler, Michelle; Rocca-Ihenacho, Lucia; Macfarlane, Alison J

2017-02-01

to compare the economic costs of intrapartum maternity care in an inner city area for 'low risk' women opting to give birth in a freestanding midwifery unit compared with those who chose birth in hospital. micro-costing of health service resources used in the intrapartum care of mothers and their babies during the period between admission and discharge, data extracted from clinical notes. the Barkantine Birth Centre, a freestanding midwifery unit and the Royal London Hospital's consultant-led obstetric unit, both run by the former Barts and the London NHS Trust in Tower Hamlets, a deprived inner city borough in east London, England, 2007-2010. maternity records of 333 women who were resident in Tower Hamlets and who satisfied the Trust's eligibility criteria for using the Birth Centre. Of these, 167 women started their intrapartum care at the Birth Centre and 166 started care at the Royal London Hospital. women who planned their birth at the Birth Centre experienced continuous intrapartum midwifery care, higher rates of spontaneous vaginal delivery, greater use of a birth pool, lower rates of epidural use, higher rates of established breastfeeding and a longer post-natal stay, compared with those who planned for care in the hospital. The total average cost per mother-baby dyad for care where mothers started their intrapartum care at the Birth Centre was £1296.23, approximately £850 per patient less than the average cost per mother and baby who received all their care at the Royal London Hospital. These costs reflect intrapartum throughput using bottom up costing per patient, from admission to discharge, including transfer, but excluding occupancy rates and the related running costs of the units. the study showed that intrapartum throughput in the Birth Centre could be considered cost-minimising when compared to hospital. Modelling the financial viability of midwifery units at a local level is important because it can inform the appropriate provision of these services. This finding from this study contribute a local perspective and thus further weight to the evidence from the Birthplace Programme in support of freestanding midwifery unit care for women without obstetric complications. Copyright © 2016. Published by Elsevier Ltd.

Tissue adhesives for closure of surgical incisions.

PubMed

Dumville, Jo C; Coulthard, Paul; Worthington, Helen V; Riley, Philip; Patel, Neil; Darcey, James; Esposito, Marco; van der Elst, Maarten; van Waes, Oscar J F

2014-11-28

Sutures (stitches), staples and adhesive tapes have been used for many years as methods of wound closure, but tissue adhesives have entered clinical practice more recently. Closure of wounds with sutures enables the closure to be meticulous, but the sutures may show tissue reactivity and can require removal. Tissue adhesives offer the advantages of an absence of risk of needlestick injury and no requirement to remove sutures later. Initially, tissue adhesives were used primarily in emergency room settings, but this review looks at the use of tissue adhesives in the operating room/theatre where surgeons are using them increasingly for the closure of surgical skin incisions. To determine the effects of various tissue adhesives compared with conventional skin closure techniques for the closure of surgical wounds. In March 2014 for this second update we searched the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL. We did not restrict the search and study selection with respect to language, date of publication or study setting. Only randomised controlled trials were eligible for inclusion. We conducted screening of eligible studies, data extraction and risk of bias assessment independently and in duplicate. We expressed results as random-effects models using mean difference for continuous outcomes and risk ratios (RR) with 95% confidence intervals (CI) for dichotomous outcomes. We investigated heterogeneity, including both clinical and methodological factors. This second update of the review identified 19 additional eligible trials resulting in a total of 33 studies (2793 participants) that met the inclusion criteria. There was low quality evidence that sutures were significantly better than tissue adhesives for reducing the risk of wound breakdown (dehiscence; RR 3.35; 95% CI 1.53 to 7.33; 10 trials, 736 participants that contributed data to the meta-analysis). The number needed to treat for an additional harmful outcome was calculated as 43. For all other outcomes - infection, patient and operator satisfaction and cost - there was no evidence of a difference for either sutures or tissue adhesives. No evidence of differences was found between tissue adhesives and tapes for minimising dehiscence, infection, patients' assessment of cosmetic appearance, patient satisfaction or surgeon satisfaction. However there was evidence in favour of using tape for surgeons' assessment of cosmetic appearance (mean difference (VAS 0 to 100) 9.56 (95% CI 4.74 to 14.37; 2 trials, 139 participants). One trial compared tissue adhesives with a variety of methods of wound closure and found both patients and clinicians were significantly more satisfied with the alternative closure methods than the adhesives. There appeared to be little difference in outcome for different types of tissue adhesives. One study that compared high viscosity with low viscosity adhesives found that high viscosity adhesives were less time-consuming to use than low viscosity tissue adhesives, but the time difference was small. Sutures are significantly better than tissue adhesives for minimising dehiscence. In some cases tissue adhesives may be quicker to apply than sutures. Although surgeons may consider the use of tissue adhesives as an alternative to other methods of surgical site closure in the operating theatre, they need to be aware that sutures minimise dehiscence. There is a need for more well designed randomised controlled trials comparing tissue adhesives with alternative methods of closure. These trials should include people whose health may interfere with wound healing and surgical sites of high tension.

A high performance data parallel tensor contraction framework: Application to coupled electro-mechanics

NASA Astrophysics Data System (ADS)

Poya, Roman; Gil, Antonio J.; Ortigosa, Rogelio

2017-07-01

The paper presents aspects of implementation of a new high performance tensor contraction framework for the numerical analysis of coupled and multi-physics problems on streaming architectures. In addition to explicit SIMD instructions and smart expression templates, the framework introduces domain specific constructs for the tensor cross product and its associated algebra recently rediscovered by Bonet et al. (2015, 2016) in the context of solid mechanics. The two key ingredients of the presented expression template engine are as follows. First, the capability to mathematically transform complex chains of operations to simpler equivalent expressions, while potentially avoiding routes with higher levels of computational complexity and, second, to perform a compile time depth-first or breadth-first search to find the optimal contraction indices of a large tensor network in order to minimise the number of floating point operations. For optimisations of tensor contraction such as loop transformation, loop fusion and data locality optimisations, the framework relies heavily on compile time technologies rather than source-to-source translation or JIT techniques. Every aspect of the framework is examined through relevant performance benchmarks, including the impact of data parallelism on the performance of isomorphic and nonisomorphic tensor products, the FLOP and memory I/O optimality in the evaluation of tensor networks, the compilation cost and memory footprint of the framework and the performance of tensor cross product kernels. The framework is then applied to finite element analysis of coupled electro-mechanical problems to assess the speed-ups achieved in kernel-based numerical integration of complex electroelastic energy functionals. In this context, domain-aware expression templates combined with SIMD instructions are shown to provide a significant speed-up over the classical low-level style programming techniques.

Multi-criteria GIS-based siting of an incineration plant for municipal solid waste.

PubMed

Tavares, Gilberto; Zsigraiová, Zdena; Semiao, Viriato

2011-01-01

Siting a municipal solid waste (MSW) incineration plant requires a comprehensive evaluation to identify the best available location(s) that can simultaneously meet the requirements of regulations and minimise economic, environmental, health, and social costs. A spatial multi-criteria evaluation methodology is presented to assess land suitability for a plant siting and applied to Santiago Island of Cape Verde. It combines the analytical hierarchy process (AHP) to estimate the selected evaluation criteria weights with Geographic Information Systems (GIS) for spatial data analysis that avoids the subjectivity of the judgements of decision makers in establishing the influences between some criteria or clusters of criteria. An innovative feature of the method lies in incorporating the environmental impact assessment of the plant operation as a criterion in the decision-making process itself rather than as an a posteriori assessment. Moreover, a two-scale approach is considered. At a global scale an initial screening identifies inter-municipal zones satisfying the decisive requirements (socio-economic, technical and environmental issues, with weights respectively, of 48%, 41% and 11%). A detailed suitability ranking inside the previously identified zones is then performed at a local scale in two phases and includes environmental assessment of the plant operation. Those zones are ranked by combining the non-environmental feasibility of Phase 1 (with a weight of 75%) with the environmental assessment of the plant operation impact of Phase 2 (with a weight of 25%). The reliability and robustness of the presented methodology as a decision supporting tool is assessed through a sensitivity analysis. The results proved the system effectiveness in the ranking process. Copyright © 2011 Elsevier Ltd. All rights reserved.

Adequate and anticipatory research on the potential hazards of emerging technologies: a case of myopia and inertia?

PubMed

Hansen, Steffen Foss; Gee, David

2014-09-01

History confirms that while technological innovations can bring many benefits, they can also cause much human suffering, environmental degradation and economic costs. But are we repeating history with new and emerging chemical and technological products? In preparation for volume 2 of 'Late Lessons from Early Warnings' (European Environment Agency, 2013), two analyses were carried out to help answer this question. A bibliometric analysis of research articles in 78 environmental, health and safety (EHS) journals revealed that most focused on well-known rather than on newly emerging chemicals. We suggest that this 'scientific inertia' is due to the scientific requirement for high levels of proof via well replicated studies; the need to publish quickly; the use of existing intellectual and technological resources; and the conservative approach of many reviewers and research funders. The second analysis found that since 1996 the funding of EHS research represented just 0.6% of the overall funding of research and technological development (RTD). Compared with RTD funding, EHS research funding for information and communication technologies, nanotechnology and biotechnology was 0.09%, 2.3% and 4% of total research, respectively. The low EHS research ratio seems to be an unintended consequence of disparate funding decisions; technological optimism; a priori assertions of safety; collective hubris; and myopia. In light of the history of past technological risks, where EHS research was too little and too late, we suggest that it would be prudent to devote some 5-15% of RTD on EHS research to anticipate and minimise potential hazards while maximising the commercial longevity of emerging technologies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Optimisation and Characterisation of Lipase-Catalysed Synthesis of a Kojic Monooleate Ester in a Solvent-Free System by Response Surface Methodology.

PubMed

Jumbri, Khairulazhar; Al-Haniff Rozy, Mohd Fahruddin; Ashari, Siti Efliza; Mohamad, Rosfarizan; Basri, Mahiran; Fard Masoumi, Hamid Reza

2015-01-01

Kojic acid is widely used to inhibit the browning effect of tyrosinase in cosmetic and food industries. In this work, synthesis of kojic monooleate ester (KMO) was carried out using lipase-catalysed esterification of kojic acid and oleic acid in a solvent-free system. Response Surface Methodology (RSM) based on central composite rotatable design (CCRD) was used to optimise the main important reaction variables, such as enzyme amount, reaction temperature, substrate molar ratio, and reaction time along with immobilised lipase from Candida Antarctica (Novozym 435) as a biocatalyst. The RSM data indicated that the reaction temperature was less significant in comparison to other factors for the production of a KMO ester. By using this statistical analysis, a quadratic model was developed in order to correlate the preparation variable to the response (reaction yield). The optimum conditions for the enzymatic synthesis of KMO were as follows: an enzyme amount of 2.0 wt%, reaction temperature of 83.69°C, substrate molar ratio of 1:2.37 (mmole kojic acid:oleic acid) and a reaction time of 300.0 min. Under these conditions, the actual yield percentage obtained was 42.09%, which is comparably well with the maximum predicted value of 44.46%. Under the optimal conditions, Novozym 435 could be reused for 5 cycles for KMO production percentage yield of at least 40%. The results demonstrated that statistical analysis using RSM can be used efficiently to optimise the production of a KMO ester. Moreover, the optimum conditions obtained can be applied to scale-up the process and minimise the cost.

Optimisation and Characterisation of Lipase-Catalysed Synthesis of a Kojic Monooleate Ester in a Solvent-Free System by Response Surface Methodology

PubMed Central

Jumbri, Khairulazhar; Al-Haniff Rozy, Mohd Fahruddin; Ashari, Siti Efliza; Mohamad, Rosfarizan; Basri, Mahiran; Fard Masoumi, Hamid Reza

2015-01-01

Kojic acid is widely used to inhibit the browning effect of tyrosinase in cosmetic and food industries. In this work, synthesis of kojic monooleate ester (KMO) was carried out using lipase-catalysed esterification of kojic acid and oleic acid in a solvent-free system. Response Surface Methodology (RSM) based on central composite rotatable design (CCRD) was used to optimise the main important reaction variables, such as enzyme amount, reaction temperature, substrate molar ratio, and reaction time along with immobilised lipase from Candida Antarctica (Novozym 435) as a biocatalyst. The RSM data indicated that the reaction temperature was less significant in comparison to other factors for the production of a KMO ester. By using this statistical analysis, a quadratic model was developed in order to correlate the preparation variable to the response (reaction yield). The optimum conditions for the enzymatic synthesis of KMO were as follows: an enzyme amount of 2.0 wt%, reaction temperature of 83.69°C, substrate molar ratio of 1:2.37 (mmole kojic acid:oleic acid) and a reaction time of 300.0 min. Under these conditions, the actual yield percentage obtained was 42.09%, which is comparably well with the maximum predicted value of 44.46%. Under the optimal conditions, Novozym 435 could be reused for 5 cycles for KMO production percentage yield of at least 40%. The results demonstrated that statistical analysis using RSM can be used efficiently to optimise the production of a KMO ester. Moreover, the optimum conditions obtained can be applied to scale-up the process and minimise the cost. PMID:26657030

Health promotion: an ethical analysis.

PubMed

Carter, Stacy M

2014-04-01

Thinking and practising ethically requires reasoning systematically about the right thing to do. Health promotion ethics - a form of applied ethics - includes analysis of health promotion practice and how this can be ethically justified. Existing frameworks can assist in such evaluation. These acknowledge the moral value of delivering benefits. But benefits need to be weighed against burdens, harms or wrongs, and these should be minimised: they include invading privacy, breaking confidentiality, restraining liberty, undermining self-determination or people's own values, or perpetuating injustice. Thinking about the ethics of health promotion also means recognising health promotion as a normative ideal: a vision of the good society. This ideal society values health, sees citizens as active and includes them in decisions that affect them, and makes the state responsible for providing all of its citizens, no matter how advantaged or disadvantaged, with the conditions and resources they need to be healthy. Ethicists writing about health promotion have focused on this relationship between the citizen and the state. Comparing existing frameworks, theories and the expressed values of practitioners themselves, we can see common patterns. All oppose pursuing an instrumental, individualistic, health-at-all-costs vision of health promotion. And all defend the moral significance of just processes: those that engage with citizens in a transparent, inclusive and open way. In recent years, some Australian governments have sought to delegitimise health promotion, defining it as extraneous to the role of the state. Good evidence is not enough to counter this trend, because it is founded in competing visions of a good society. For this reason, the most pressing agenda for health promotion ethics is to engage with communities, in a procedurally just way, about the role and responsibilities of the citizen and the state in promoting and maintaining good health.

Adequate and anticipatory research on the potential hazards of emerging technologies: a case of myopia and inertia?

PubMed Central

Hansen, Steffen Foss; Gee, David

2014-01-01

History confirms that while technological innovations can bring many benefits, they can also cause much human suffering, environmental degradation and economic costs. But are we repeating history with new and emerging chemical and technological products? In preparation for volume 2 of ‘Late Lessons from Early Warnings’ (European Environment Agency, 2013), two analyses were carried out to help answer this question. A bibliometric analysis of research articles in 78 environmental, health and safety (EHS) journals revealed that most focused on well-known rather than on newly emerging chemicals. We suggest that this ‘scientific inertia’ is due to the scientific requirement for high levels of proof via well replicated studies; the need to publish quickly; the use of existing intellectual and technological resources; and the conservative approach of many reviewers and research funders. The second analysis found that since 1996 the funding of EHS research represented just 0.6% of the overall funding of research and technological development (RTD). Compared with RTD funding, EHS research funding for information and communication technologies, nanotechnology and biotechnology was 0.09%, 2.3% and 4% of total research, respectively. The low EHS research ratio seems to be an unintended consequence of disparate funding decisions; technological optimism; a priori assertions of safety; collective hubris; and myopia. In light of the history of past technological risks, where EHS research was too little and too late, we suggest that it would be prudent to devote some 5–15% of RTD on EHS research to anticipate and minimise potential hazards while maximising the commercial longevity of emerging technologies. PMID:24913017

Insulin lispro: a pharmacoeconomic review of its use in diabetes mellitus.

PubMed

Dunn, Christopher J; Plosker, Greg L

2002-01-01

Insulin lispro is a recombinant insulin analogue with transposed amino acids (proline and lysine) at positions 28 and 29 near the C-terminus of the B-chain. The most prominent practical advantage of insulin lispro over human soluble insulin lies in its very rapid onset of action. This property allows it to be injected immediately before meals and minimises the demands made on patients with type 1 diabetes mellitus, and those with type 2 disease who require insulin, by the ongoing need for careful meal planning and timing. Numerous clinical studies have shown significant improvements in postprandial glycaemic control, with some evidence of reduced rates of severe or nocturnal hypoglycaemia, relative to conventional human insulin in patients receiving lispro-based insulins. Quality-of-life studies show consistent preferences by patients for and increased treatment satisfaction with insulin lispro over human soluble insulin, particularly with variations of the Diabetes Treatment Satisfaction Questionnaire. Willingness of patients and taxpayers to pay additional costs for insulin lispro or a premixed lispro-based formulation over conventional human insulins, and cost benefits favouring formulary inclusion, have been shown in well designed studies carried out in Australia and Canada. Spanish data suggest cost effectiveness in terms of episodes of severe hypoglycaemia avoided, and preliminary German resource utilisation data indicate cost savings related to reduced hospitalisation and general practice costs, with insulin lispro relative to human soluble insulin. Insulin lispro and premixed formulations of lispro-based insulins offer quality-of-life improvements relative to conventional human insulins in patients with diabetes mellitus. Participants in well designed studies have expressed a preference for lispro-based insulins and have been shown to be willing to pay for the advantages they offer, and current cost-benefit data favour the inclusion of these insulins in formularies and their reimbursement by third party payers. Further research into the pharmacoeconomic implications of insulin lispro use in the long term is needed, particularly with respect to effects on indirect costs and those associated with complications of diabetes mellitus.

Lucid dreaming incidence: A quality effects meta-analysis of 50years of research.

PubMed

Saunders, David T; Roe, Chris A; Smith, Graham; Clegg, Helen

2016-07-01

We report a quality effects meta-analysis on studies from the period 1966-2016 measuring either (a) lucid dreaming prevalence (one or more lucid dreams in a lifetime); (b) frequent lucid dreaming (one or more lucid dreams in a month) or both. A quality effects meta-analysis allows for the minimisation of the influence of study methodological quality on overall model estimates. Following sensitivity analysis, a heterogeneous lucid dreaming prevalence data set of 34 studies yielded a mean estimate of 55%, 95% C. I. [49%, 62%] for which moderator analysis showed no systematic bias for suspected sources of variability. A heterogeneous lucid dreaming frequency data set of 25 studies yielded a mean estimate of 23%, 95% C. I. [20%, 25%], moderator analysis revealed no suspected sources of variability. These findings are consistent with earlier estimates of lucid dreaming prevalence and frequent lucid dreaming in the population but are based on more robust evidence. Copyright © 2016 Elsevier Inc. All rights reserved.

A randomised controlled trial of the clinical effectiveness and cost-effectiveness of different knee prostheses: the Knee Arthroplasty Trial (KAT).

PubMed

Murray, David W; MacLennan, Graeme S; Breeman, Suzanne; Dakin, Helen A; Johnston, Linda; Campbell, Marion K; Gray, Alastair M; Fiddian, Nick; Fitzpatrick, Ray; Morris, Richard W; Grant, Adrian M

2014-03-01

In the late 1990s, new developments in knee replacement were identified as a priority for research within the NHS. The newer forms of arthroplasty were more expensive and information was needed on their safety and cost-effectiveness. The Knee Arthroplasty Trial examined the clinical effectiveness and cost-effectiveness of four aspects of knee replacement surgery: patellar resurfacing, mobile bearings, all-polyethylene tibial components and unicompartmental replacement. This study comprised a partial factorial, pragmatic, multicentre randomised controlled trial with a trial-based cost-utility analysis which was conducted from the perspective of the NHS and the patients treated. Allocation was computer generated in a 1 : 1 ratio using a central system, stratified by eligible comparisons and surgeon, minimised by participant age, gender and site of disease. Surgeons were not blinded to allocated procedures. Participants were unblinded if they requested to know the prosthesis they received. The setting for the trial was UK secondary care. Patients were eligible for inclusion if a decision had been made for them to have primary knee replacement surgery. Patients were recruited to comparisons for which the surgeon was in equipoise about which type of operation was most suitable. Patients were randomised to receive a knee replacement with the following: patellar resurfacing or no patellar resurfacing irrespective of the design of the prosthesis used; a mobile bearing between the tibial and femoral components or a bearing fixed to the tibial component; a tibial component made of either only high-density polyethylene ('all polyethylene') or a polyethylene bearing fixed to a metal backing plate with attached stem; or unicompartmental or total knee replacement. The primary outcome was the Oxford Knee Score (OKS). Other outcomes were Short Form 12; EuroQol 5D; intraoperative and postoperative complications; additional surgery; cost; and cost-effectiveness. Patients were followed up for a median of 10 years; the economic evaluation took a 10-year time horizon, discounting costs and quality-adjusted life-years (QALYs) at 3.5% per annum. A total of 116 surgeons in 34 centres participated and 2352 participants were randomised: 1715 in patellar resurfacing; 539 in mobile bearing; 409 in all-polyethylene tibial component; and 34 in the unicompartmental comparisons. Of those randomised, 345 were randomised to two comparisons. We can be more than 95% confident that patellar resurfacing is cost-effective, despite there being no significant difference in clinical outcomes, because of increased QALYs [0.187; 95% confidence interval (CI) -0.025 to 0.399] and reduced costs (-£104; 95% CI -£630 to £423). We found no definite advantage or disadvantage of mobile bearings in OKS, quality of life, reoperation and revision rates or cost-effectiveness. We found improved functional results for metal-backed tibias: complication, reoperation and revision rates were similar. The metal-backed tibia was cost-effective (particularly in the elderly), costing £35 per QALY gained. The results provide evidence to support the routine resurfacing of the patella and the use of metal-backed tibial components even in the elderly. Further follow-up is required to assess the stability of these findings over time and to inform the decision between mobile and fixed bearings. Current Controlled Trials ISRCTN45837371. This project was funded by the NIHR Health Technology Assessment programme and the orthopaedic industry. It will be published in full in Health Technology Assessment; Vol. 18, No. 19. See the NIHR Journals Library website for further project information.

Adaptation responses to increasing drought frequency

NASA Astrophysics Data System (ADS)

Loch, A. J.; Adamson, D. C.; Schwabe, K.

2016-12-01

Using state contingent analysis we discuss how and why irrigators adapt to alternative water supply signals. This analysis approach helps to illustrate how and why producers currently use state-general and state-allocable inputs to adapt and respond to known and possible future climatic alternative natures. Focusing on the timing of water allocations, we explore inherent differences in the demand for water by two key irrigation sectors: annual and perennial producers which in Australia have allowed a significant degree of risk-minimisation during droughts. In the absence of land constraints, producers also had a capacity to respond to positive state outcomes and achieve super-normal profits. In the future, however, the probability of positive state outcomes is uncertain; production systems may need to adapt to minimise losses and/or achieve positive returns under altered water supply conditions that may arise as a consequence of more frequent drought states. As such, producers must assess whether altering current input/output choice sets in response to possible future climate states will enhance their long-run competitive advantage for both expected new normal and extreme water supply outcomes. Further, policy supporting agricultural sector climate change resilience must avoid poorly-designed strategies that increase producer vulnerability in the face of drought. Our analysis explores the reliability of alternative water property right bundles and how reduced allocations across time influence alternative responses by producers. We then extend our analysis to explore how management strategies could adapt to two possible future drier state types: i) where an average reduction in water supply is experienced; and ii) where the frequency of droughts increase. The combination of these findings are subsequently used to discuss the role water reform policy has to deal with current and future climate scenarios. We argue current policy strategies could drive producers to more homogeneous production systems over time, which ultimately entail risky adaptation options under future water supply availability or increased drought frequency scenarios. Lastly, our analysis has shown the flexibility of applying SCA toward examining uncertainty surrounding future states of nature under climate change.

Minimising methodological biases to improve the accuracy of partitioning soil respiration using natural abundance 13C.

PubMed

Snell, Helen S K; Robinson, David; Midwood, Andrew J

2014-11-15

Microbial degradation of soil organic matter (heterotrophic respiration) is a key determinant of net ecosystem exchange of carbon, but it is difficult to measure because the CO2 efflux from the soil surface is derived not only from heterotrophic respiration, but also from plant root and rhizosphere respiration (autotrophic). Partitioning total CO2 efflux can be achieved using the different natural abundance stable isotope ratios (δ(13)C) of root and soil CO2. Successful partitioning requires very accurate measurements of total soil efflux δ(13)CO2 and the δ(13)CO2 of the autotrophic and heterotrophic sources, which typically differ by just 2-8‰. In Scottish moorland and grass mesocosm studies we systematically tested some of the most commonly used techniques in order to identify and minimise methodological errors. Typical partitioning methods are to sample the total soil-surface CO2 efflux using a chamber, then to sample CO2 from incubated soil-free roots and root-free soil. We investigated the effect of collar depth on chamber measurements of surface efflux δ(13)CO2 and the effect of incubation time on estimates of end-member δ(13)CO2. (1) a 5 cm increase in collar depth affects the measurement of surface efflux δ(13)CO2 by -1.5‰ and there are fundamental inconsistencies between modelled and measured biases; (2) the heterotrophic δ(13)CO2 changes by up to -4‰ within minutes of sampling; we recommend using regression to estimate the in situ δ(13)CO2 values; (3) autotrophic δ(13)CO2 measurements are reliable if root CO2 is sampled within an hour of excavation; (4) correction factors should be used to account for instrument drift of up to 3‰ and concentration-dependent non-linearity of CRDS (cavity ringdown spectroscopy) analysis. Methodological biases can lead to large inaccuracies in partitioning estimates. The utility of stable isotope partitioning of soil CO2 efflux will be enhanced by consensus on the optimum measurement protocols and by minimising disturbance, particularly during chamber measurements. Copyright © 2014 John Wiley & Sons, Ltd.

Design, implementation and reporting strategies to reduce the instance and impact of missing patient-reported outcome (PRO) data: a systematic review.

PubMed

Mercieca-Bebber, Rebecca; Palmer, Michael J; Brundage, Michael; Calvert, Melanie; Stockler, Martin R; King, Madeleine T

2016-06-15

Patient-reported outcomes (PROs) provide important information about the impact of treatment from the patients' perspective. However, missing PRO data may compromise the interpretability and value of the findings. We aimed to report: (1) a non-technical summary of problems caused by missing PRO data; and (2) a systematic review by collating strategies to: (A) minimise rates of missing PRO data, and (B) facilitate transparent interpretation and reporting of missing PRO data in clinical research. Our systematic review does not address statistical handling of missing PRO data. MEDLINE and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases (inception to 31 March 2015), and citing articles and reference lists from relevant sources. English articles providing recommendations for reducing missing PRO data rates, or strategies to facilitate transparent interpretation and reporting of missing PRO data were included. 2 reviewers independently screened articles against eligibility criteria. Discrepancies were resolved with the research team. Recommendations were extracted and coded according to framework synthesis. 117 sources (55% discussion papers, 26% original research) met the eligibility criteria. Design and methodological strategies for reducing rates of missing PRO data included: incorporating PRO-specific information into the protocol; carefully designing PRO assessment schedules and defining termination rules; minimising patient burden; appointing a PRO coordinator; PRO-specific training for staff; ensuring PRO studies are adequately resourced; and continuous quality assurance. Strategies for transparent interpretation and reporting of missing PRO data include utilising auxiliary data to inform analysis; transparently reporting baseline PRO scores, rates and reasons for missing data; and methods for handling missing PRO data. The instance of missing PRO data and its potential to bias clinical research can be minimised by implementing thoughtful design, rigorous methodology and transparent reporting strategies. All members of the research team have a responsibility in implementing such strategies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Adopting a healthy lifestyle when pregnant and obese - an interview study three years after childbirth.

PubMed

Dencker, Anna; Premberg, Åsa; Olander, Ellinor K; McCourt, Christine; Haby, Karin; Dencker, Sofie; Glantz, Anna; Berg, Marie

2016-07-30

Obesity during pregnancy is increasing and is related to life-threatening and ill-health conditions in both mother and child. Initiating and maintaining a healthy lifestyle when pregnant with body mass index (BMI) ≥ 30 kg/m(2) can improve health and decrease risks during pregnancy and of long-term illness for the mother and the child. To minimise gestational weight gain women with BMI ≥ 30 kg/m(2) in early pregnancy were invited to a lifestyle intervention including advice and support on diet and physical activity in Gothenburg, Sweden. The aim of this study was to explore the experiences of women with BMI ≥ 30 kg/m(2) regarding minimising their gestational weight gain, and to assess how health professionals' care approaches are reflected in the women's narratives. Semi-structured interviews were conducted with 17 women who had participated in a lifestyle intervention for women with BMI ≥ 30 kg/m(2) during pregnancy 3 years earlier. The interviews were digitally recorded and transcribed in full. Thematic analysis was used. The meaning of changing lifestyle for minimising weight gain and of the professional's care approaches is described in four themes: the child as the main motivation for making healthy changes; a need to be seen and supported on own terms to establish healthy routines; being able to manage healthy activities and own weight; and need for additional support to maintain a healthy lifestyle. To support women with BMI ≥ 30 kg/m(2) to make healthy lifestyle changes and limit weight gain during pregnancy antenatal health care providers should 1) address women's weight in a non-judgmental way using BMI, and provide accurate and appropriate information about the benefits of limited gestational weight gain; 2) support the woman on her own terms in a collaborative relationship with the midwife; 3) work in partnership to give the woman the tools to self-manage healthy activities and 4) give continued personal support and monitoring to maintain healthy eating and regular physical activity habits after childbirth involving also the partner and family.

Mitigating secondary aerosol generation potentials from biofuel use in the energy sector.

PubMed

Tiwary, Abhishek; Colls, Jeremy

2010-01-01

This paper demonstrates secondary aerosol generation potential of biofuel use in the energy sector from the photochemical interactions of precursor gases on a life cycle basis. The paper is divided into two parts-first, employing life cycle analysis (LCA) to evaluate the extent of the problem for a typical biofuel based electricity production system using five baseline scenarios; second, proposing adequate mitigation options to minimise the secondary aerosol generation potential on a life cycle basis. The baseline scenarios cover representative technologies for 2010 utilising energy crop (miscanthus), short rotation coppiced chips and residual/waste wood in different proportions. The proposed mitigation options include three approaches-biomass gasification prior to combustion, delaying the harvest of biomass, and increasing the geographical distance between the biomass plant and the harvest site (by importing the biofuels). Preliminary results indicate that the baseline scenarios (assuming all the biomass is sourced locally) bear significant secondary aerosol formation potential on a life cycle basis from photochemical neutralisation of acidic emissions (hydrogen chloride and sulphur dioxide) with ammonia. Our results suggest that gasification of miscanthus biomass would provide the best option by minimising the acidic emissions from the combustion plant whereas the other two options of delaying the harvest or importing biofuels from elsewhere would only lead to marginal reduction in the life cycle aerosol loadings of the systems.

Executive dysfunction post-stroke: an insight into the perspectives of physiotherapists.

PubMed

Hayes, Sara; Donnellan, Claire; Stokes, Emma

2015-01-01

To gain an understanding of physiotherapy practice in relation to executive dysfunction (ED) post-stroke. Three focus groups were conducted using semi-structured interview schedules to highlight how ED post-stroke was understood by 12 physiotherapists with greater than 1 year of experience working in the area of stroke care. The focus group data were analysed using qualitative data analysis. The themes extracted from the data on physiotherapists' self-reported knowledge of ED post-stroke were: physiotherapists' lack of knowledge of ED post-stroke; current physiotherapy practice regarding ED post-stroke; the negative impact of ED on physiotherapy rehabilitation post-stroke and the future learning needs of physiotherapists regarding ED post-stroke. Current results demonstrate that ED has negative implications for physiotherapy rehabilitation post-stroke. Although further interdisciplinary research is warranted, the present results suggest that physiotherapists should be aware of the presence of ED in people post-stroke and develop strategies to minimise the impact of ED on physiotherapy rehabilitation. Implications for Rehabilitation Physiotherapists report a lack of knowledge of ED post-stroke and a requirement for future learning and training regarding the optimal management of people with ED undergoing physiotherapy rehabilitation post-stroke. ED has negative implications for physiotherapy rehabilitation post-stroke and physiotherapists should be aware of the presence of ED in people post-stroke and develop strategies to minimise the impact of ED on physiotherapy rehabilitation.

Scientific uses of animals: harm-benefit analysis and complementary approaches to implementing the three Rs.

PubMed

Griffin, G; Clark, J MacArthur; Zurlo, J; Ritskes-Hoitinga, M

2014-04-01

The principles of humane experimental technique, first described by Russell and Burch in 1959, focus on minimising suffering to animals used for scientific purposes. Internationally, as these principles became embedded in the various systems of oversight for the use of animals in science, attention focused on how to minimise pain, distress and lasting harm to animals while maximising the benefits to be obtained from the work. Suffering can arise from the experimental procedures, but it can also arise from the manner in which the animals are housed and cared for. Increased attention is therefore being paid to the entire lifetime experience of an animal, in order to afford it as good a quality of life as possible. Russell and Burch were also concerned that animals should not be used if alternatives to such use were available, and that animals were not wasted through poor-quality science. This concept is being revisited through new efforts to ensure that experiments are well designed and properly reported in the literature, that all results--positive, negative or neutral--are made available to ensure a complete research record, and that animal models are properly evaluated through periodic systematic reviews. These efforts should ensure that animal use is truly reduced as far as possible and that the benefits derived through the use of animals truly outweigh the harms.

Effects of a lower limb functional exercise programme aimed at minimising knee valgus angle on running kinematics in youth athletes.

PubMed

Sheerin, Kelly R; Hume, Patria A; Whatman, Chris

2012-11-01

To investigate the effectiveness of 8-weeks of lower limb functional exercises on frontal plane hip and knee angles during running in youth athletes. Pre- and post-intervention quantitative experimental. Nineteen athletes (11 male, 8 female, 11.54 ± 1.34 years) from a long-term athletic development programme had 3-dimensional running gait measured pre and post an 8-week exercise intervention. Youth athletes randomised to control (upper limb strengthening exercises) or experimental (lower limb functional exercises aimed at minimising knee valgus angle) interventions completed the exercises during the first 10 min of training, three mornings a week. Pre- and post-parallel groups' analysis provided estimates of intervention effects for control and experimental groups. Differences in pre- to post-intervention changes in mean frontal plane angles between control and experimental groups were trivial for the left hip (0.1°) and right knee (-0.3°). There was a small beneficial decrease in right hip joint angle (0.4°) but a very large (ES = 0.77, CI 0.1-3.7) detrimental increase in left knee valgus angle (1.9°) between groups. The 8-week lower limb functional exercises had little beneficial effects on lower limb hip and knee mechanics in youth athletes aged 9-14 years. Copyright © 2012 Elsevier Ltd. All rights reserved.

A three-step approach to minimise the impact of a mining site on vicuña (Vicugna vicugna) and to restore landscape connectivity.

PubMed

Mata, Cristina; Malo, Juan E; Galaz, José Luis; Cadorzo, César; Lagunas, Héctor

2016-07-01

Resource extraction projects generate a diversity of negative effects on the environment that are difficult to predict and mitigate. Consequently, adaptive management approaches have been advocated to develop effective responses to impacts that were not predicted. Mammal populations living in or around mine sites are frequently of management concern; yet, there is a dearth of published information on how to minimise the negative effects of different phases of mining operations on them. Here, we present the case study of a copper mine in the Chilean Altiplano, which caused roadkills of the protected vicuña (Vicugna vicugna). This issue led to a three-step solution being implemented: (1) the initial identification of the problem and implementation of an emergency response, (2) the scientific analysis for decision making and (3) the planning and informed implementation of responses for different future scenarios and timescales. The measures taken under each of these steps provide examples of environmental management approaches that make use of scientific information to develop integrated management responses. In brief, our case study showed how (1) the timescale and the necessity/urgency of the case were addressed, (2) the various stakeholders involved were taken into account and (3) changes were included into the physical, human and organisational elements of the company to achieve the stated objectives.

Maximizing the spatial representativeness of NO2 monitoring data using a combination of local wind-based sectoral division and seasonal and diurnal correction factors.

PubMed

Donnelly, Aoife; Naughton, Owen; Misstear, Bruce; Broderick, Brian

2016-10-14

This article describes a new methodology for increasing the spatial representativeness of individual monitoring sites. Air pollution levels at a given point are influenced by emission sources in the immediate vicinity. Since emission sources are rarely uniformly distributed around a site, concentration levels will inevitably be most affected by the sources in the prevailing upwind direction. The methodology provides a means of capturing this effect and providing additional information regarding source/pollution relationships. The methodology allows for the division of the air quality data from a given monitoring site into a number of sectors or wedges based on wind direction and estimation of annual mean values for each sector, thus optimising the information that can be obtained from a single monitoring station. The method corrects for short-term data, diurnal and seasonal variations in concentrations (which can produce uneven weighting of data within each sector) and uneven frequency of wind directions. Significant improvements in correlations between the air quality data and the spatial air quality indicators were obtained after application of the correction factors. This suggests the application of these techniques would be of significant benefit in land-use regression modelling studies. Furthermore, the method was found to be very useful for estimating long-term mean values and wind direction sector values using only short-term monitoring data. The methods presented in this article can result in cost savings through minimising the number of monitoring sites required for air quality studies while also capturing a greater degree of variability in spatial characteristics. In this way, more reliable, but also more expensive monitoring techniques can be used in preference to a higher number of low-cost but less reliable techniques. The methods described in this article have applications in local air quality management, source receptor analysis, land-use regression mapping and modelling and population exposure studies.

Implementing the millennium development food security goals Challenges of the southern African context

NASA Astrophysics Data System (ADS)

Love, David; Twomlow, Steve; Mupangwa, Walter; van der Zaag, Pieter; Gumbo, Bekithemba

The Millennium Development Goals’ target to halve the proportion of people who suffer from hunger is extremely important in southern Africa, where food security has become increasingly problematic over the last 20 years. One “quick-win” proposal is replenishment of soil nutrients for smallholder farmers, through free or subsidised chemical fertilisers. Other proposals include appropriate irrigation technology, improved inputs and interventions targeted at women. Analysis of over 10 years of agro-hydrological and agro-economic studies from southern African show that a different approach is required to interventions proposed. There are sustainability problems with free chemical fertiliser due to transport costs and ancillary costs. Furthermore, recent studies in Zimbabwe and Mozambique show that significant increases in yield can only be obtained when soil fertility management is combined with good crop husbandry, e.g. timely planting and weeding. Ongoing replenishment of fertility would be dependent on a continued free or subsidised fertiliser supply, and transport system. Increasing access to irrigation will help, but is not the only solution and cannot reach even a majority of farmers. It has been determined that short dryspells are often the major cause of low yields in sub-Saharan Africa. Soil-water conservation approaches, e.g. winter weeding and conservation tillage, can reduce risk and increase yield. The following specific recommendations are made for urgent interventions to contribute sustainably to food security in southern Africa: (i) To increases access to fertiliser, consider development of strong input markets at end-user level. (ii) Intensification of technology transfer, focusing on capacity building for transfer of existing technologies and much closer collaboration between state and NGO sectors, agronomists and water engineers. (iii) Increasing the uptake of soil-water conservation methods, including conservation tillage and weeding, and supplementary irrigation to minimise adverse effects of dryspells, through investments in farmer training. (iv) Linking crop development strategies to livestock development practices and strategies. (v) Developing non-agro-based livelihood strategies in marginal lands.

Aerial Prefeeding Followed by Ground Based Toxic Baiting for More Efficient and Acceptable Poisoning of Invasive Small Mammalian Pests

PubMed Central

Morgan, David; Warburton, Bruce; Nugent, Graham

2015-01-01

Introduced brushtail possums (Trichosurus vulpecula) and rat species (Rattus spp.) are major vertebrate pests in New Zealand, with impacts on conservation and agriculture being managed largely through poisoning operations. Aerial distribution of baits containing sodium fluoroacetate (1080) has been refined to maximise cost effectiveness and minimise environmental impact, but this method is strongly opposed by some as it is perceived as being indiscriminate. Although ground based control enables precise placement of baits, operations are often more than twice as costly as aerial control, mainly due to the high labour costs. We investigated a new approach to ground based control that combined aerial distribution of non-toxic ‘prefeed’ baits followed by sparse distribution of toxic baits at regular intervals along the GPS tracked prefeeding flight paths. This approach was tested in two field trials in which both 1080 baits and cholecalciferol baits were used in separate areas. Effectiveness of the approach, assessed primarily using ‘chewcards’, was compared with that of scheduled aerial 1080 operations that were conducted in outlying areas of both trials. Contractors carrying out ground based control were able to follow the GPS tracks of aerial prefeeding flight lines very accurately, and with 1080 baits achieved very high levels of kill of possums and rats similar to those achieved by aerial 1080 baiting. Cholecalciferol was less effective in the first trial, but by doubling the amount of cholecalciferol bait used in the second trial, few possums or rats survived. By measuring the time taken to complete ground baiting from GPS tracks, we predicted that the method (using 1080 baits) would be similarly cost effective to aerial 1080 operations for controlling possums and rats, and considerably less expensive than typical current costs of ground based control. The main limitations to the use of the method will be access to, and size of, the operational site, along with topography and vegetation density. PMID:26218095

Being in control? A thematic content analysis of 14 in-depth interviews with 2,4-dinitrophenol users.

PubMed

Ainsworth, Neha Prasad; Vargo, Elisabeth Julie; Petróczi, Andrea

2018-02-01

2,4-Dinitrophenol (2,4-DNP) is a compound with multiple industrial purposes. Currently unlicensed for human consumption, it is used by the gym-going population for drastic, short-term body fat loss. Nonetheless, physiological mechanisms can lead to potentially fatal hyperthermia. Reported fatal incidents have caused concern and highlighted the need for intervention. Understanding decision-making leading to 2,4-DNP use alongside the perceived outgroup attitudes is vital to forming effective harm minimisation policies targeting current and potential users. First-hand accounts from this elusive population are scarce. Fourteen novel and experienced users (13 male, 1 female) were recruited via "snowballing" techniques. Semi-structured interviews were conducted, comprising 28 questions. Thematic content analysis was conducted using 37 codes. Four characteristic themes emerged: 1. Users considered the Internet to be a crucial multifunctional resource directly impacting their 2,4-DNP use. 2. Users "respected" 2,4-DNP, proactively taking harm reduction measures. 3. Attitudinal polarisation towards 2,4-DNP within the gym-going community was consistent in all accounts. 4. Users perceived outgroup populations to have inherently negative attitudes towards their use. These themes fell under the all-encompassing theme of "being in control". For the first time, this study offers a rich detail of attitudes toward 2,4-DNP use by giving a collective voice to users. The element of control over every aspect of the users' life appears to be a significant contributor to the successful risk-management of 2,4-DNP use. In the absence of an established safe upper limit and effective regulatory control, education is critical to harm minimisation. Copyright © 2017 Elsevier B.V. All rights reserved.

Bi-exponential T2 analysis of healthy and diseased Achilles tendons: an in vivo preliminary magnetic resonance study and correlation with clinical score.

PubMed

Juras, Vladimir; Apprich, Sebastian; Szomolanyi, Pavol; Bieri, Oliver; Deligianni, Xeni; Trattnig, Siegfried

2013-10-01

To compare mono- and bi-exponential T2 analysis in healthy and degenerated Achilles tendons using a recently introduced magnetic resonance variable-echo-time sequence (vTE) for T2 mapping. Ten volunteers and ten patients were included in the study. A variable-echo-time sequence was used with 20 echo times. Images were post-processed with both techniques, mono- and bi-exponential [T2 m, short T2 component (T2 s) and long T2 component (T2 l)]. The number of mono- and bi-exponentially decaying pixels in each region of interest was expressed as a ratio (B/M). Patients were clinically assessed with the Achilles Tendon Rupture Score (ATRS), and these values were correlated with the T2 values. The means for both T2 m and T2 s were statistically significantly different between patients and volunteers; however, for T2 s, the P value was lower. In patients, the Pearson correlation coefficient between ATRS and T2 s was -0.816 (P = 0.007). The proposed variable-echo-time sequence can be successfully used as an alternative method to UTE sequences with some added benefits, such as a short imaging time along with relatively high resolution and minimised blurring artefacts, and minimised susceptibility artefacts and chemical shift artefacts. Bi-exponential T2 calculation is superior to mono-exponential in terms of statistical significance for the diagnosis of Achilles tendinopathy. • Magnetic resonance imaging offers new insight into healthy and diseased Achilles tendons • Bi-exponential T2 calculation in Achilles tendons is more beneficial than mono-exponential • A short T2 component correlates strongly with clinical score • Variable echo time sequences successfully used instead of ultrashort echo time sequences.

Environmental analysis of waste foundry sand via life cycle assessment.

PubMed

Mitterpach, Jozef; Hroncová, Emília; Ladomerský, Juraj; Balco, Karol

2017-01-01

The aim of this manuscript is to provide an environmental assessment of the creation and use of waste foundry sand (WFS) via an LCA in a foundry for grey cast iron. A life cycle impact assessment was carried out using SimaPro 8. This environmental analysis assessed the impact of creating waste foundry sand (WFS) in a foundry, Hronec (Slovakia, Central Europe). According to BREF, this foundry is classified as an iron foundry with a production capacity greater than 20 t/day with processes typical for grey cast iron foundries. Molten metal is poured into single-use sand moulds. We identified those factors influencing the creation and use of WFS which significantly affect the quality of the environment. The use of WFS from the production of cores in regenerated moulding mixtures with installed circuits brings marked minimisation of material and energy inputs in the processes of creating WFS and it positively influences the consumption of resources and the quality of the ecosystem. Space for lessening the impact of WFS processes upon the consumption of resources and ecosystem quality is mainly found in recycling WFS in the building sector. In the next step, it is necessary to thoroughly verify the eco-toxicological properties of not only the created WFS and other foundry waste, but mainly the building products for which this waste is used. In terms of transportation, it is important that waste is recycled at local level. The processes of creating WFS have a marked influence upon all the selected waste categories (consumption of resources, ecosystem quality, human health). By minimising material inputs into processes and the effective adjustment of production technology, a foundry can significantly lessen the impacts of processes for creating WFS upon the environment.

Analyzing parameters optimisation in minimising warpage on side arm using response surface methodology (RSM)

NASA Astrophysics Data System (ADS)

Rayhana, N.; Fathullah, M.; Shayfull, Z.; Nasir, S. M.; Hazwan, M. H. M.

2017-09-01

This paper presents a systematic methodology to analyse the warpage of the side arm part using Autodesk Moldflow Insight software. Response Surface Methodology (RSM) was proposed to optimise the processing parameters that will result in optimal solutions by efficiently minimising the warpage of the side arm part. The variable parameters considered in this study was based on most significant parameters affecting warpage stated by previous researchers, that is melt temperature, mould temperature and packing pressure while adding packing time and cooling time as these is the commonly used parameters by researchers. The results show that warpage was improved by 10.15% and the most significant parameters affecting warpage are packing pressure.

Under-reporting of violent incidents against nursing staff.

PubMed

Ferns, Terry

This article examines factors that contribute to nurses failing to report incidents of violence and aggression in the clinical area and it develops the information published in a previous article (Ferns and Chojnacka 2005). Broader social factors are considered, including gender, violence experienced by women, the status of the nursing profession and bureaucratic structures that contribute to under-reporting. The life experiences of individual nursing staff play a significant role in how they react to violence in the clinical area. Strategies to minimise violence against nurses should consider the social, political and personal issues that limit the reporting of violent incidents. Only by reporting such incidents can the extent of violence towards nurses be determined and minimised.

Transformer Incipient Fault Prediction Using Combined Artificial Neural Network and Various Particle Swarm Optimisation Techniques.

PubMed

Illias, Hazlee Azil; Chai, Xin Rui; Abu Bakar, Ab Halim; Mokhlis, Hazlie

2015-01-01

It is important to predict the incipient fault in transformer oil accurately so that the maintenance of transformer oil can be performed correctly, reducing the cost of maintenance and minimise the error. Dissolved gas analysis (DGA) has been widely used to predict the incipient fault in power transformers. However, sometimes the existing DGA methods yield inaccurate prediction of the incipient fault in transformer oil because each method is only suitable for certain conditions. Many previous works have reported on the use of intelligence methods to predict the transformer faults. However, it is believed that the accuracy of the previously proposed methods can still be improved. Since artificial neural network (ANN) and particle swarm optimisation (PSO) techniques have never been used in the previously reported work, this work proposes a combination of ANN and various PSO techniques to predict the transformer incipient fault. The advantages of PSO are simplicity and easy implementation. The effectiveness of various PSO techniques in combination with ANN is validated by comparison with the results from the actual fault diagnosis, an existing diagnosis method and ANN alone. Comparison of the results from the proposed methods with the previously reported work was also performed to show the improvement of the proposed methods. It was found that the proposed ANN-Evolutionary PSO method yields the highest percentage of correct identification for transformer fault type than the existing diagnosis method and previously reported works.

Transformer Incipient Fault Prediction Using Combined Artificial Neural Network and Various Particle Swarm Optimisation Techniques

PubMed Central

2015-01-01

It is important to predict the incipient fault in transformer oil accurately so that the maintenance of transformer oil can be performed correctly, reducing the cost of maintenance and minimise the error. Dissolved gas analysis (DGA) has been widely used to predict the incipient fault in power transformers. However, sometimes the existing DGA methods yield inaccurate prediction of the incipient fault in transformer oil because each method is only suitable for certain conditions. Many previous works have reported on the use of intelligence methods to predict the transformer faults. However, it is believed that the accuracy of the previously proposed methods can still be improved. Since artificial neural network (ANN) and particle swarm optimisation (PSO) techniques have never been used in the previously reported work, this work proposes a combination of ANN and various PSO techniques to predict the transformer incipient fault. The advantages of PSO are simplicity and easy implementation. The effectiveness of various PSO techniques in combination with ANN is validated by comparison with the results from the actual fault diagnosis, an existing diagnosis method and ANN alone. Comparison of the results from the proposed methods with the previously reported work was also performed to show the improvement of the proposed methods. It was found that the proposed ANN-Evolutionary PSO method yields the highest percentage of correct identification for transformer fault type than the existing diagnosis method and previously reported works. PMID:26103634

Imaging technologies for preclinical models of bone and joint disorders

PubMed Central

2011-01-01

Preclinical models for musculoskeletal disorders are critical for understanding the pathogenesis of bone and joint disorders in humans and the development of effective therapies. The assessment of these models primarily relies on morphological analysis which remains time consuming and costly, requiring large numbers of animals to be tested through different stages of the disease. The implementation of preclinical imaging represents a keystone in the refinement of animal models allowing longitudinal studies and enabling a powerful, non-invasive and clinically translatable way for monitoring disease progression in real time. Our aim is to highlight examples that demonstrate the advantages and limitations of different imaging modalities including magnetic resonance imaging (MRI), computed tomography (CT), positron emission tomography (PET), single-photon emission computed tomography (SPECT) and optical imaging. All of which are in current use in preclinical skeletal research. MRI can provide high resolution of soft tissue structures, but imaging requires comparatively long acquisition times; hence, animals require long-term anaesthesia. CT is extensively used in bone and joint disorders providing excellent spatial resolution and good contrast for bone imaging. Despite its excellent structural assessment of mineralized structures, CT does not provide in vivo functional information of ongoing biological processes. Nuclear medicine is a very promising tool for investigating functional and molecular processes in vivo with new tracers becoming available as biomarkers. The combined use of imaging modalities also holds significant potential for the assessment of disease pathogenesis in animal models of musculoskeletal disorders, minimising the use of conventional invasive methods and animal redundancy. PMID:22214535

Should antibacterials be deregulated?

PubMed

Rovira, J; Figueras, M; Segú, J L

1998-05-01

Deregulation of antibacterials is a recurrent topic in the debate on pharmaceutical policy. This article focuses on one aspect of pharmaceutical regulation, namely the requirement of a medical prescription for purchasing antibacterials. However, a strategy of deregulation should not only concern the switch from prescription-only status to nonprescription status for a given drug, but should consider some complementary measures to minimise potentially harmful effects on health and costs. Risk-benefit and economic evaluations, which are possible approaches to assess the convenience of antibacterial deregulation, force the empirical evidence, the assumptions, as well as the value judgements on which the options are evaluated, to be made explicit. We outline the basic traits of an economic-evaluation approach to assess the issues related to the public interest and the feasibility of a deregulation policy. However, the answer cannot be a generic one, but should address the question for each particular country, and for each antibacterial and indication. Given the limitations of existing evidence on that issue, a tentative research agenda is also proposed.

Growing duckweed for biofuel production: a review.

PubMed

Cui, W; Cheng, J J

2015-01-01

Duckweed can be utilised to produce ethanol, butanol and biogas, which are promising alternative energy sources to minimise dependence on limited crude oil and natural gas. The advantages of this aquatic plant include high rate of nutrient (nitrogen and phosphorus) uptake, high biomass yield and great potential as an alternative feedstock for the production of fuel ethanol, butanol and biogas. The objective of this article is to review the published research on growing duckweed for the production of the biofuels, especially starch enrichment in duckweed plants. There are mainly two processes affecting the accumulation of starch in duckweed biomass: photosynthesis for starch generation and metabolism-related starch consumption. The cost of stimulating photosynthesis is relatively high based on current technologies. Considerable research efforts have been made to inhibit starch degradation. Future research need in this area includes duckweed selection, optimisation of duckweed biomass production, enhancement of starch accumulation in duckweeds and use of duckweeds for production of various biofuels. © 2014 German Botanical Society and The Royal Botanical Society of the Netherlands.

Subnetworks of percolation backbones to model karst systems around Tulum, Mexico

NASA Astrophysics Data System (ADS)

Hendrick, Martin; Renard, Philippe

2016-11-01

Karstic caves, which play a key role in groundwater transport, are often organized as complex connected networks resulting from the dissolution of carbonate rocks. In this work, we propose a new model to describe and study the structures of the two largest submersed karst networks in the world. Both of these networks are located in the area of Tulum (Quintana Roo, Mexico). In a previous work te{hendrick2016fractal} we showed that these networks behave as self-similar structures exhibiting well-defined scaling behaviours. In this paper, we suggest that these networks can be modeled using substructures of percolation clusters (θ-subnetworks) having similar structural behaviour (in terms of fractal dimension and conductivity exponent) to those observed in Tulum's karst networks. We show in addition that these θ-subnetworks correspond to structures that minimise a global function, where this global function includes energy dissipation by the viscous forces when water flows through the network, and the cost of network formation itself.

The regulation of mobile medical applications.

PubMed

Yetisen, Ali Kemal; Martinez-Hurtado, J L; da Cruz Vasconcellos, Fernando; Simsekler, M C Emre; Akram, Muhammad Safwan; Lowe, Christopher R

2014-03-07

The rapidly expanding number of mobile medical applications have the potential to transform the patient-healthcare provider relationship by improving the turnaround time and reducing costs. In September 2013, the U.S. Food and Drug Administration (FDA) issued guidance to regulate these applications and protect consumers by minimising the risks associated with their unintended use. This guidance distinguishes between the subset of mobile medical apps which may be subject to regulation and those that are not. The marketing claims of the application determine the intent. Areas of concern include compliance with regular updates of the operating systems and of the mobile medical apps themselves. In this article, we explain the essence of this FDA guidance by providing examples and evaluating the impact on academia, industry and other key stakeholders, such as patients and clinicians. Our assessment indicates that awareness and incorporation of the guidelines into product development can hasten the commercialisation and market entry process. Furthermore, potential obstacles have been discussed and directions for future development suggested.

Single-stage three-phase boost power factor correction circuit for AC-DC converter

NASA Astrophysics Data System (ADS)

Azazi, Haitham Z.; Ahmed, Sayed M.; Lashine, Azza E.

2018-01-01

This article presents a single-stage three-phase power factor correction (PFC) circuit for AC-to-DC converter using a single-switch boost regulator, leading to improve the input power factor (PF), reducing the input current harmonics and decreasing the number of required active switches. A novel PFC control strategy which is characterised as a simple and low-cost control circuit was adopted, for achieving a good dynamic performance, unity input PF, and minimising the harmonic contents of the input current, at which it can be applied to low/medium power converters. A detailed analytical, simulation and experimental studies were therefore conducted. The effectiveness of the proposed controller algorithm is validated by the simulation results, which were carried out using MATLAB/SIMULINK environment. The proposed system is built and tested in the laboratory using DSP-DS1104 digital control board for an inductive load. The results revealed that the total harmonic distortion in the supply current was very low. Finally, a good agreement between simulation and experimental results was achieved.

Evidence of trapline foraging in honeybees.

PubMed

Buatois, Alexis; Lihoreau, Mathieu

2016-08-15

Central-place foragers exploiting floral resources often use multi-destination routes (traplines) to maximise their foraging efficiency. Recent studies on bumblebees have showed how solitary foragers can learn traplines, minimising travel costs between multiple replenishing feeding locations. Here we demonstrate a similar routing strategy in the honeybee (Apis mellifera), a major pollinator known to recruit nestmates to discovered food resources. Individual honeybees trained to collect sucrose solution from four artificial flowers arranged within 10 m of the hive location developed repeatable visitation sequences both in the laboratory and in the field. A 10-fold increase of between-flower distances considerably intensified this routing behaviour, with bees establishing more stable and more efficient routes at larger spatial scales. In these advanced social insects, trapline foraging may complement cooperative foraging for exploiting food resources near the hive (where dance recruitment is not used) or when resources are not large enough to sustain multiple foragers at once. © 2016. Published by The Company of Biologists Ltd.

(n, N) type maintenance policy for multi-component systems with failure interactions

NASA Astrophysics Data System (ADS)

Zhang, Zhuoqi; Wu, Su; Li, Binfeng; Lee, Seungchul

2015-04-01

This paper studies maintenance policies for multi-component systems in which failure interactions and opportunistic maintenance (OM) involve. This maintenance problem can be formulated as a Markov decision process (MDP). However, since an action set and state space in MDP exponentially expand as the number of components increase, traditional approaches are computationally intractable. To deal with curse of dimensionality, we decompose such a multi-component system into mutually influential single-component systems. Each single-component system is formulated as an MDP with the objective of minimising its long-run average maintenance cost. Under some reasonable assumptions, we prove the existence of the optimal (n, N) type policy for a single-component system. An algorithm to obtain the optimal (n, N) type policy is also proposed. Based on the proposed algorithm, we develop an iterative approximation algorithm to obtain an acceptable maintenance policy for a multi-component system. Numerical examples find that failure interactions and OM pose significant effects on a maintenance policy.

Optimum random and age replacement policies for customer-demand multi-state system reliability under imperfect maintenance

NASA Astrophysics Data System (ADS)

Chen, Yen-Luan; Chang, Chin-Chih; Sheu, Dwan-Fang

2016-04-01

This paper proposes the generalised random and age replacement policies for a multi-state system composed of multi-state elements. The degradation of the multi-state element is assumed to follow the non-homogeneous continuous time Markov process which is a continuous time and discrete state process. A recursive approach is presented to efficiently compute the time-dependent state probability distribution of the multi-state element. The state and performance distribution of the entire multi-state system is evaluated via the combination of the stochastic process and the Lz-transform method. The concept of customer-centred reliability measure is developed based on the system performance and the customer demand. We develop the random and age replacement policies for an aging multi-state system subject to imperfect maintenance in a failure (or unacceptable) state. For each policy, the optimum replacement schedule which minimises the mean cost rate is derived analytically and discussed numerically.

Information and Efficiency in the Nervous System—A Synthesis

PubMed Central

Sengupta, Biswa; Stemmler, Martin B.; Friston, Karl J.

2013-01-01

In systems biology, questions concerning the molecular and cellular makeup of an organism are of utmost importance, especially when trying to understand how unreliable components—like genetic circuits, biochemical cascades, and ion channels, among others—enable reliable and adaptive behaviour. The repertoire and speed of biological computations are limited by thermodynamic or metabolic constraints: an example can be found in neurons, where fluctuations in biophysical states limit the information they can encode—with almost 20–60% of the total energy allocated for the brain used for signalling purposes, either via action potentials or by synaptic transmission. Here, we consider the imperatives for neurons to optimise computational and metabolic efficiency, wherein benefits and costs trade-off against each other in the context of self-organised and adaptive behaviour. In particular, we try to link information theoretic (variational) and thermodynamic (Helmholtz) free-energy formulations of neuronal processing and show how they are related in a fundamental way through a complexity minimisation lemma. PMID:23935475

A supplier selection and order allocation problem with stochastic demands

NASA Astrophysics Data System (ADS)

Zhou, Yun; Zhao, Lei; Zhao, Xiaobo; Jiang, Jianhua

2011-08-01

We consider a system comprising a retailer and a set of candidate suppliers that operates within a finite planning horizon of multiple periods. The retailer replenishes its inventory from the suppliers and satisfies stochastic customer demands. At the beginning of each period, the retailer makes decisions on the replenishment quantity, supplier selection and order allocation among the selected suppliers. An optimisation problem is formulated to minimise the total expected system cost, which includes an outer level stochastic dynamic program for the optimal replenishment quantity and an inner level integer program for supplier selection and order allocation with a given replenishment quantity. For the inner level subproblem, we develop a polynomial algorithm to obtain optimal decisions. For the outer level subproblem, we propose an efficient heuristic for the system with integer-valued inventory, based on the structural properties of the system with real-valued inventory. We investigate the efficiency of the proposed solution approach, as well as the impact of parameters on the optimal replenishment decision with numerical experiments.

When should we save the most endangered species?

PubMed

Wilson, Howard B; Joseph, Liana N; Moore, Alana L; Possingham, Hugh P

2011-09-01

At the heart of our efforts to protect threatened species, there is a controversial debate about whether to give priority to cost-effective actions or whether focusing solely on the most endangered species will ultimately lead to preservation of the greatest number of species. By framing this debate within a decision-analytic framework, we show that allocating resources solely to the most endangered species will typically not minimise the number of extinctions in the long-term, as this does not account for the risk of less endangered species going extinct in the future. It is only favoured when our planning timeframe is short or we have a long-term view and we are optimistic about future conditions. Conservation funding tends to be short-term in nature, which biases allocations to more endangered species. Our work highlights the need to consider resource allocation for biodiversity over the long-term; 'preventive conservation', rather than just short-term fire-fighting. © 2011 Blackwell Publishing Ltd/CNRS.

Optimisation of sensing time and transmission time in cognitive radio-based smart grid networks

NASA Astrophysics Data System (ADS)

Yang, Chao; Fu, Yuli; Yang, Junjie

2016-07-01

Cognitive radio (CR)-based smart grid (SG) networks have been widely recognised as emerging communication paradigms in power grids. However, a sufficient spectrum resource and reliability are two major challenges for real-time applications in CR-based SG networks. In this article, we study the traffic data collection problem. Based on the two-stage power pricing model, the power price is associated with the efficient received traffic data in a metre data management system (MDMS). In order to minimise the system power price, a wideband hybrid access strategy is proposed and analysed, to share the spectrum between the SG nodes and CR networks. The sensing time and transmission time are jointly optimised, while both the interference to primary users and the spectrum opportunity loss of secondary users are considered. Two algorithms are proposed to solve the joint optimisation problem. Simulation results show that the proposed joint optimisation algorithms outperform the fixed parameters (sensing time and transmission time) algorithms, and the power cost is reduced efficiently.

Reduction of energy usage in postharvest horticulture through management of ethylene.

PubMed

Wills, Ron B H; Golding, John B

2015-05-01

Cool chain management is the preferred technology to extend the postharvest life of horticultural produce, but with rising energy costs and community pressure to reduce greenhouse gas emissions, there is a need to use less energy-intensive technologies. Minimising the level of ethylene around horticultural produce inhibits ripening and senescence and therefore has the potential to reduce the use of refrigeration. The long-distance transport of bananas within Australia and from Central America to Europe is used as a case study to show that the need for refrigeration could be reduced if the appropriate concentrations of ethylene were maintained around fruit during transit. Data are also presented to show a similar benefit of ethylene control with green beans, as well as another study showing that apples treated with the ethylene action inhibitor 1-methylcyclopropene could be stored at a higher temperature without loss of quality to the consumer. The range of technologies available to manage ethylene levels is discussed. © 2014 Society of Chemical Industry.

Shopping for health: purchasing health services through contracts.

PubMed

Howden-Chapman, P; Ashton, T

1994-01-01

The 1993 New Zealand health service reforms were based on the purported efficiencies of the purchaser/provider split. Purchasers are required to contract for services that will maintain, improve and restore the health of the populations they serve. The purchasing role, which requires the development of contracting skills as well as the setting of strategic directions and priorities, is new and as yet poorly developed. This paper describes the role of purchasing agents in setting priorities, the different approaches that are being taken to contracting for services and some of the problems that have arisen in the first year of contracting. It explores the trade-off that is evident between the potential for improving efficiency through contestable contracting and the need to minimise transaction costs associated with the contracting process. The purchasers' accountability to the public and the Minister is analysed in the broader political context of the purchasers' role in shaping a public health service and improving the health of the population.

Sustainable sewerage servicing options for peri-urban areas with failing septic systems.

PubMed

Sharma, A K; Tjandraatmadja, G; Grant, A L; Grant, T; Pamminger, F

2010-01-01

The provision of water and wastewater services to peri-urban areas faces very different challenges to providing services to cities. Sustainable solutions for such areas are increasingly being sought, in order to solve the environmental and health risks posed by failing septic systems. These solutions should have the capability to reduce potable water demand, provide fit for purpose reuse options, and minimise impacts on the local and global environment. A methodology for the selection of sustainable sewerage servicing systems and technologies is presented in this paper. This paper describes the outcomes of applying this methodology to a case study in rural community near Melbourne, Australia, and describes the economic and environmental implications of various sewerage servicing options. Applying this methodology has found that it is possible to deliver environmental improvements at a lower community cost, by choosing servicing configurations not historically used by urban water utilities. The selected solution is currently being implemented, with the aim being to generate further transferable learnings for the water industry.

Operative management of acute pavement burns: a case series.

PubMed

Silver, A G; Zamboni, W A; Baynosa, R C

2014-11-01

Acute burns suffered from contact with environmentally heated roadways and walkways are a rare entity. The aim of this report is to assess the information gained from the treatment of a series of patients. A retrospective review of a consecutive series of cases, where operative treatment was necessary, that occurred during July 2010 in southern Arizona. Seven patients were included, with an average total body surface area burn of 10.2%. Direct fascial excision and tangential excision were carried out on three and four patients, respectively. Although tangential excision was carried out to normal endpoints, there was commonly a need for repetitive debridement. The total hospital costs were over $4,400,000 (£2,730,000). Burns suffered from contact with roadways/walkways are often deeper than suggested by their appearance. Direct fascial excision minimises the number of debridement sessions. We hypothesise that the failure to offload pressure on these wounds may be a causative factor in their observed deepening.

Minimising street work disruption by mapping cavities derived from 3D GPR-data: a new sewerage project in Torrente (Valencia, Spain)

NASA Astrophysics Data System (ADS)

Valls, Ana; Garcia, Francisco; Ramirez, Manuel; Benlloch, Javier

2015-04-01

Ground penetrating radar is usually employed for non-destructive detection of cavities in karst areas and road maintenance. This paper describes the inspection for cavity detection in a street located in Torrente (Valencia, Spain) where a new sewerage project was planned. Torrente population growth (more than 80,000 inhabitants last year) has caused urban development southwards from its downtown. According to municipality geologic configuration, new urbanized areas are located in mountains composed of limestone with presence of karst systems. During excavation work for a sewerage system installation, a 4 x 2 x 1.5 m shallow cave was found in one planned street. For this reason, digging activities were stopped and a GPR survey was carried out on the street. A 1x1 m grid was collected using a GSSI SIR-3000 equipment. A 400 MHz frequency antenna was used for reaching 2.5 m approx. depth, attending the characteristics of the discovered cave and the excavation project depth. GPR records were calibrated in situ, thanks to the unearthed cavity. The 3D GPR-data interpretation mapped several caves only on one side of the street. The detected cavities coincided with the sewerage system layout. These underground spaces were isolated from each other, as small individual karst caves. The outcomes of this study allowed the modification of the sewerage project. Therefore, the sewerage system layout was moved to the other side of the street where no cavities were detected with the GPR survey. GPR is proved to be an efficient tool to be taken into consideration by civil engineers and architects for designing new infrastructures (e.g. sewerage systems) in urban planning areas. We conclude GPR helps minimising cost, time and inconveniences to neighbourhood during excavation works, especially in cities.

High-intensity interval exercise training before abdominal aortic aneurysm repair (HIT-AAA): protocol for a randomised controlled feasibility trial.

PubMed

Tew, Garry A; Weston, Matthew; Kothmann, Elke; Batterham, Alan M; Gray, Joanne; Kerr, Karen; Martin, Denis; Nawaz, Shah; Yates, David; Danjoux, Gerard

2014-01-10

In patients with large abdominal aortic aneurysm (AAA), open surgical or endovascular aneurysm repair procedures are often used to minimise the risk of aneurysm-related rupture and death; however, aneurysm repair itself carries a high risk. Low cardiopulmonary fitness is associated with an increased risk of early post-operative complications and death following elective AAA repair. Therefore, fitness should be enhanced before aneurysm repair. High-intensity interval exercise training (HIT) is a potent, time-efficient strategy for enhancing cardiopulmonary fitness. Here, we describe a feasibility study for a definitive trial of a pre-operative HIT intervention to improve post-operative outcomes in patients undergoing elective AAA repair. A minimum of 50 patients awaiting elective repair of a 5.5-7.0 cm infrarenal AAA will be allocated by minimisation to HIT or usual care control in a 1:1 ratio. The patients allocated to HIT will complete three hospital-based exercise sessions per week, for 4 weeks. Each session will include 2 or 4 min of high-intensity stationary cycling followed by the same duration of easy cycling or passive recovery, repeated until a total of 16 min of high-intensity exercise is accumulated. Outcomes to be assessed before randomisation and 24-48 h before aneurysm repair include cardiopulmonary fitness, maximum AAA diameter and health-related quality of life. In the post-operative period, we will record destination (ward or critical care unit), organ-specific morbidity, mortality and the durations of critical care and hospital stay. Twelve weeks after the discharge, participants will be interviewed to reassess quality of life and determine post-discharge healthcare utilisation. The costs associated with the exercise intervention and healthcare utilisation will be calculated. Ethics approval was secured through Sunderland Research Ethics Committee. The findings of the trial will be disseminated through peer-reviewed journals, and national and international presentations. Current Controlled Trials ISRCTN09433624.

Shaping the System - The DRG Evaluation Project of the German Society for Gynaecology and Obstetrics (Deutsche Gesellschaft für Gynäkologie und Geburtshilfe, DGGG).

PubMed

Fiori, W; Renner, S P; Siam, K; Babapirali, J; Roeder, N; Dausch, E; Hildebrandt, T; Hillemanns, P; Nehmzow, M; Zygmunt, M; Piroth, D; Schem, C; Schwenzer, T; Friese, K; Wallwiener, D; Beckmann, M W

2013-08-01

Introduction: The German DRG system is annually adapted to the changing services provided. For the further development, the self-governing body and its DRG Institute (InEK) depend on participation of the users. Methods: For one of the DRG evaluation projects initiated by DGGG, cost and performance data for the year 2011 from 16 hospitals were available. After plausibility checks and corrections, analyses for service and cost homogeneity were performed. In cases of inadequate DRG-representation attributes were sought that would make an appropriate reimbursement possible. Conspicuities and potential solutions were checked for clinical plausibility. Results: 44 concrete modification proposals for further development of the G-DRG system were formulated and submitted in due time to the InEK. In addition, 3 modification proposals were addressed to the German Institute for Medical Documentation and Information (Deutsches Institut für Medizinische Dokumentation und Information, DIMDI) for further development of the diagnosis classification ICD-10-GM. For all modification proposals care was taken to minimise misdirected incentives and to reduce the potential for disputes with the cost bearers and their auditors services in settlements. Discussion: The publication of the G-DRG system 2014 shows which modification proposals have been realised. Essentially, an appropriate redistribution of the resources among the gynaecological and obstetrics departments is to be expected. The financial pressure that is caused by the generally inadequate financing of hospitals will not be reduced by a further development of the G-DRG system.

Shaping the System – The DRG Evaluation Project of the German Society for Gynaecology and Obstetrics (Deutsche Gesellschaft für Gynäkologie und Geburtshilfe, DGGG)

PubMed Central

Fiori, W.; Renner, S. P.; Siam, K.; Babapirali, J.; Roeder, N.; Dausch, E.; Hildebrandt, T.; Hillemanns, P.; Nehmzow, M.; Zygmunt, M.; Piroth, D.; Schem, C.; Schwenzer, T.; Friese, K.; Wallwiener, D.; Beckmann, M. W.

2013-01-01

Introduction: The German DRG system is annually adapted to the changing services provided. For the further development, the self-governing body and its DRG Institute (InEK) depend on participation of the users. Methods: For one of the DRG evaluation projects initiated by DGGG, cost and performance data for the year 2011 from 16 hospitals were available. After plausibility checks and corrections, analyses for service and cost homogeneity were performed. In cases of inadequate DRG-representation attributes were sought that would make an appropriate reimbursement possible. Conspicuities and potential solutions were checked for clinical plausibility. Results: 44 concrete modification proposals for further development of the G-DRG system were formulated and submitted in due time to the InEK. In addition, 3 modification proposals were addressed to the German Institute for Medical Documentation and Information (Deutsches Institut für Medizinische Dokumentation und Information, DIMDI) for further development of the diagnosis classification ICD-10-GM. For all modification proposals care was taken to minimise misdirected incentives and to reduce the potential for disputes with the cost bearers and their auditors services in settlements. Discussion: The publication of the G-DRG system 2014 shows which modification proposals have been realised. Essentially, an appropriate redistribution of the resources among the gynaecological and obstetrics departments is to be expected. The financial pressure that is caused by the generally inadequate financing of hospitals will not be reduced by a further development of the G-DRG system. PMID:24771931

Self-balancing dynamic scheduling of electrical energy for energy-intensive enterprises

NASA Astrophysics Data System (ADS)

Gao, Yunlong; Gao, Feng; Zhai, Qiaozhu; Guan, Xiaohong

2013-06-01

Balancing production and consumption with self-generation capacity in energy-intensive enterprises has huge economic and environmental benefits. However, balancing production and consumption with self-generation capacity is a challenging task since the energy production and consumption must be balanced in real time with the criteria specified by power grid. In this article, a mathematical model for minimising the production cost with exactly realisable energy delivery schedule is formulated. And a dynamic programming (DP)-based self-balancing dynamic scheduling algorithm is developed to obtain the complete solution set for such a multiple optimal solutions problem. For each stage, a set of conditions are established to determine whether a feasible control trajectory exists. The state space under these conditions is partitioned into subsets and each subset is viewed as an aggregate state, the cost-to-go function is then expressed as a function of initial and terminal generation levels of each stage and is proved to be a staircase function with finite steps. This avoids the calculation of the cost-to-go of every state to resolve the issue of dimensionality in DP algorithm. In the backward sweep process of the algorithm, an optimal policy is determined to maximise the realisability of energy delivery schedule across the entire time horizon. And then in the forward sweep process, the feasible region of the optimal policy with the initial and terminal state at each stage is identified. Different feasible control trajectories can be identified based on the region; therefore, optimising for the feasible control trajectory is performed based on the region with economic and reliability objectives taken into account.

Health economic impact of high-dose versus standard-dose cytarabine induction chemotherapy for acute myeloid leukaemia.

PubMed

Fedele, P L; Avery, S; Patil, S; Spencer, A; Haas, M; Wei, A

2014-08-01

Induction chemotherapy for acute myeloid leukaemia (AML) is one of the most resource-intensive cancer therapies delivered in hospitals. To assess the health resource impact of different chemotherapy approaches for AML commonly used in Australia. A retrospective analysis was undertaken in 63 patients aged 18-55 years with AML given induction with either 7 + 3 (cytarabine 100 mg/m(2) days 1-7 and idarubicin 12 mg/m(2) days 1-3) or HiDAC-3 (high-dose cytarabine 3 g/m(2) twice daily days 1, 3, 5 and 7 and idarubicin 12 mg/m(2) days 1-3) chemotherapy. Average costs of hospitalisation, pathology, radiology, chemotherapy and ancillary drugs were calculated and compared with current Victorian casemix funding. Two consolidation approaches, HiDAC (cytarabine 3 g/m(2) twice daily days 1, 3, 5 and 7) × either three or four cycles (following 7 + 3) and IcE (idarubicin 12,mg/m(2) days 1-2, cytarabine 100 mg/m(2) × 5 days and etoposide 75 mg/m(2) × 5 days) × 2 cycles (following HiDAC-3) were modelled, using a policy of discharge following completion of chemotherapy with outpatient monitoring. The cost (in AUD) of induction was similar between 7 + 3 ($58,037) and HiDAC-3 ($56,902), with bed day costs accounting for 61-62% of the total expense. Blood bank costs ranked second, accounting for 15%. Accumulated costs for HiDAC consolidation were $44,289 for a three-cycle protocol and $59,052 for four cycles ($14,763 per cycle) versus $31,456 for two cycles of IcE consolidation ($15,728 per cycle). Overall, the classical 7 + 3 → HiDAC approach ($102,326/$117,089 for three or four consolidation cycles) incurs a greater cost than a HiDAC-3 → IcE × 2 approach ($88,358). For patients requiring complete hospitalisation until neutrophil recovery, the estimated costs of treatment will be even higher, ranging between $122,282 for HiDAC-3 → IcE × 2, $153,212 for 7 + 3 → HiDAC × 3 and $184,937 for 7 + 3 → HiDAC × 4. State-based casemix funding for non-complicated AML therapy is currently $74,013 for 7 + 3 → HiDAC × 4, $64,177 for 7 + 3 → HiDAC × 3 and $54,340 for HiDAC-3 → IcE × 2 based on outpatient recovery after consolidation chemotherapy. These calculations do not take into account additional resource implications associated with complications of consolidation chemotherapy or reinduction for treatment failure. Regimens minimising the total number of chemotherapy cycles may represent the most efficient use of limited health resources for the treatment of AML. © 2014 The Authors; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.

The Effects of Pop-up Harm Minimisation Messages on Electronic Gaming Machine Gambling Behaviour in New Zealand.

PubMed

Palmer du Preez, Katie; Landon, Jason; Bellringer, Maria; Garrett, Nick; Abbott, Max

2016-12-01

In New Zealand a simple pop-up message feature that provides gambling session information and forces a break in play is mandatory on all electronic gaming machines in all venues (EGMs). Previous research has demonstrated small effects of more sophisticated pop-up messages tested predominantly in laboratory environments. The present research examined gambler engagement with and views on the New Zealand pop-up messages and on the relationship between pop-up messages and EGM expenditure. A sample of gamblers was recruited at casino and non-casino (pub) EGM venues. Most participants were aware of pop-up messages (57 %) and many saw them often (38 %). Among gamblers who reported seeing pop-up messages, half read the message content, and a quarter believed that pop-up messages helped them control the amount of money they spend on gambling. Participants who reported being likely to stop gambling in response to pop-up messages spent significantly less money on gambling when variables that were independently associated with EGM expenditure were controlled for. A modest harm minimisation effect of the pop-up message feature that has been operating in New Zealand for 5 years was evident. Suggestions for improvement of the harm minimisation potential of the current pop-up message feature are discussed.

Rorschach missing responses--is this more than nothing?

PubMed

King, M G

2014-01-01

The Rorschach has been demonstrated as a suitable tool for investigating otherwise hidden psychological aspects of sex offenders: sex-related responses are more common. The present paper looks at the established tendency of some clients to minimise their overall Rorschach responding, the linking of this response restraint to particular Rorschach profiles, and the sparse but consistent literature which casts doubt on the proposition that Examiner enthusiasm will cause the minimising client to provide more responses which divulge additional information. In the case of sex offenders, with so much to hide, it is proposed that there may be extensive filtering of responses even among those giving more than "normal" sex-related responses. "What the client did not say", and the corresponding "missing" Rorschach responses in the case of sex offenders is discussed in the light of an individual case: (a sex offender with undue interest in young boys' penii) where "sex-like" images were specifically targeted, but never named as such. The exciting prospect of inferring what the client could have said and thus generating the content of missing responses, whether or not response filtering produced numerical minimisation, must be balanced against the risk of naked men and women (and their genitalia) representing nothing more than an artefact of the clinician's own making--"ce qui n' est pas le cas".

Silk garments plus standard care compared with standard care for treating eczema in children: A randomised, controlled, observer-blind, pragmatic trial (CLOTHES Trial)

PubMed Central

Thomas, Kim S.; Lawton, Sandra; Ahmed, Amina; Dean, Taraneh; Burrows, Nigel P.; Pollock, Ian; Grundy, Jane D.; Guiness, Juliet

2017-01-01

Background The role of clothing in the management of eczema (also called atopic dermatitis or atopic eczema) is poorly understood. This trial evaluated the effectiveness and cost-effectiveness of silk garments (in addition to standard care) for the management of eczema in children with moderate to severe disease. Methods and findings This was a parallel-group, randomised, controlled, observer-blind trial. Children aged 1 to 15 y with moderate to severe eczema were recruited from secondary care and the community at five UK medical centres. Participants were allocated using online randomisation (1:1) to standard care or to standard care plus silk garments, stratified by age and recruiting centre. Silk garments were worn for 6 mo. Primary outcome (eczema severity) was assessed at baseline, 2, 4, and 6 mo, by nurses blinded to treatment allocation, using the Eczema Area and Severity Index (EASI), which was log-transformed for analysis (intention-to-treat analysis). A safety outcome was number of skin infections. Three hundred children were randomised (26 November 2013 to 5 May 2015): 42% girls, 79% white, mean age 5 y. Primary analysis included 282/300 (94%) children (n = 141 in each group). The garments were worn more often at night than in the day (median of 81% of nights [25th to 75th centile 57% to 96%] and 34% of days [25th to 75th centile 10% to 76%]). Geometric mean EASI scores at baseline, 2, 4, and 6 mo were, respectively, 9.2, 6.4, 5.8, and 5.4 for silk clothing and 8.4, 6.6, 6.0, and 5.4 for standard care. There was no evidence of any difference between the groups in EASI score averaged over all follow-up visits adjusted for baseline EASI score, age, and centre: adjusted ratio of geometric means 0.95, 95% CI 0.85 to 1.07, (p = 0.43). This confidence interval is equivalent to a difference of −1.5 to 0.5 in the original EASI units, which is not clinically important. Skin infections occurred in 36/142 (25%) and 39/141 (28%) of children in the silk clothing and standard care groups, respectively. Even if the small observed treatment effect was genuine, the incremental cost per quality-adjusted life year was £56,811 in the base case analysis from a National Health Service perspective, suggesting that silk garments are unlikely to be cost-effective using currently accepted thresholds. The main limitation of the study is that use of an objective primary outcome, whilst minimising detection bias, may have underestimated treatment effects. Conclusions Silk clothing is unlikely to provide additional benefit over standard care in children with moderate to severe eczema. Trial registration Current Controlled Trials ISRCTN77261365 PMID:28399154

Interpretation of aeromagnetic data over Abeokuta and its environs, Southwest Nigeria, using spectral analysis (Fourier transform technique)

NASA Astrophysics Data System (ADS)

Olurin, Oluwaseun T.; Ganiyu, Saheed A.; Hammed, Olaide S.; Aluko, Taiwo J.

2016-10-01

This study presents the results of spectral analysis of magnetic data over Abeokuta area, Southwestern Nigeria, using fast Fourier transform (FFT) in Microsoft Excel. The study deals with the quantitative interpretation of airborne magnetic data (Sheet No. 260), which was conducted by the Nigerian Geological Survey Agency in 2009. In order to minimise aliasing error, the aeromagnetic data was gridded at spacing of 1 km. Spectral analysis technique was used to estimate the magnetic basement depth distributed at two levels. The result of the interpretation shows that the magnetic sources are mainly distributed at two levels. The shallow sources (minimum depth) range in depth from 0.103 to 0.278 km below ground level and are inferred to be due to intrusions within the region. The deeper sources (maximum depth) range in depth from 2.739 to 3.325 km below ground and are attributed to the underlying basement.

RIPOSTE: a framework for improving the design and analysis of laboratory-based research.

PubMed

Masca, Nicholas Gd; Hensor, Elizabeth Ma; Cornelius, Victoria R; Buffa, Francesca M; Marriott, Helen M; Eales, James M; Messenger, Michael P; Anderson, Amy E; Boot, Chris; Bunce, Catey; Goldin, Robert D; Harris, Jessica; Hinchliffe, Rod F; Junaid, Hiba; Kingston, Shaun; Martin-Ruiz, Carmen; Nelson, Christopher P; Peacock, Janet; Seed, Paul T; Shinkins, Bethany; Staples, Karl J; Toombs, Jamie; Wright, Adam Ka; Teare, M Dawn

2015-05-07

Lack of reproducibility is an ongoing problem in some areas of the biomedical sciences. Poor experimental design and a failure to engage with experienced statisticians at key stages in the design and analysis of experiments are two factors that contribute to this problem. The RIPOSTE (Reducing IrreProducibility in labOratory STudiEs) framework has been developed to support early and regular discussions between scientists and statisticians in order to improve the design, conduct and analysis of laboratory studies and, therefore, to reduce irreproducibility. This framework is intended for use during the early stages of a research project, when specific questions or hypotheses are proposed. The essential points within the framework are explained and illustrated using three examples (a medical equipment test, a macrophage study and a gene expression study). Sound study design minimises the possibility of bias being introduced into experiments and leads to higher quality research with more reproducible results.

Payments for Environmental Services in a Policymix: Spatial and Temporal Articulation in Mexico.

PubMed

Ezzine-de-Blas, Driss; Dutilly, Céline; Lara-Pulido, José-Alberto; Le Velly, Gwenolé; Guevara-Sanginés, Alejando

2016-01-01

Government based Payments for Ecosystem Services (PES) have been criticized for not maximizing environmental effectiveness through appropriate targeting, while instead prioritizing social side-objectives. In Mexico, existing literature on how the Payments for Ecosystem Services-Hydrological program (PSA-H) has targeted deforestation and forest degradation shows that both the process of identifying the eligible areas and the choice of the selection criteria for enrolling forest parcels have been under the influence of competing agendas. In the present paper we study the influence of the PSA-H multi-level governance on the environmental effectiveness of the program-the degree to which forest at high risk of deforestation is enrolled- building from a "policyscape" framework. In particular, we combine governance analysis with two distinct applications of the policyscape framework: First, at national level we assess the functional overlap between the PSA-H and other environmental and rural programs with regard to the risk of deforestation. Second, at regional level in the states of Chiapas and Yucatan, we describe the changing policy agenda and the role of technical intermediaries in defining the temporal spatialization of the PSA-H eligible and enrolled areas with regard to key socio-economic criteria. We find that, although at national level the PSA-H program has been described as coping with both social and environmental indicators thanks to successful adaptive management, our analysis show that PSA-H is mainly found in communities where deforestation risk is low and in combination with other environmental programs (protected areas and forest management programs). Such inertia is reinforced at regional level as a result of the eligible areas' characteristics and the behaviour of technical intermediaries, which seek to minimise transaction costs and sources of uncertainty. Our project-specific analysis shows the importance of integrating the governance of a program in the policyscape framework as a way to better systematize complex interactions at different spatial and institutional scales between policies and landscape characteristics.

Application of microwave digestion to the analysis of peat

USGS Publications Warehouse

Papp, C.S.E.; Fischer, L.B.

1987-01-01

A microwave digestion technique for the dissolution of peat is described and compared with a dry ashing method and a nitric - perchloric - hydrofluoric acid wet digestion. Peat samples with different organic matter contents were used and Ca, Mg, Fe, AI, Na, K, Mn, Zn, Cu and Li were determined by atomic absoprtion spectrometry. The results obtained using the three dissolution techniques were in good agreement. The microwave method has the advantage of digesting the samples in less than 2 h and uses less acid than the conventional wet digestion method. Keeping the volume of the acid mixture as small as possible minimises contamination and leads to lower blank values.

The synchronisation of fractional-order hyperchaos compound system

NASA Astrophysics Data System (ADS)

Noghredani, Naeimadeen; Riahi, Aminreza; Pariz, Naser; Karimpour, Ali

2018-02-01

This paper presents a new compound synchronisation scheme among four hyperchaotic memristor system with incommensurate fractional-order derivatives. First a new controller was designed based on adaptive technique to minimise the errors and guarantee compound synchronisation of four fractional-order memristor chaotic systems. According to the suitability of compound synchronisation as a reliable solution for secure communication, we then examined the application of the proposed adaptive compound synchronisation scheme in the presence of noise for secure communication. In addition, the unpredictability and complexity of the drive systems enhance the security of secure communication. The corresponding theoretical analysis and results of simulation validated the effectiveness of the proposed synchronisation scheme using MATLAB.

Family involvement in Chinese immigrants with bipolar disorder in New Zealand.

PubMed

Wang, Grace Y; Henning, Marcus

2012-01-25

To explore the dynamic between Chinese people with bipolar disorder (BD) and family functioning. Nine New Zealand Chinese with BD were interviewed. Data analysis was guided by content and thematic approaches. Four themes summarised from the interviews included: (1) family members are the primary resource; (2) many facets of recovery from BD is integrally linked with caregiving; (3) quality of family relationships is associated with acceptance of the illness; and (4) perception of caregiver burden motivates self-care. The findings support the need for mechanism that can minimise the risk of adverse family functioning associated with BD and the need of professional involvement when working with these families.

A pragmatic randomised controlled trial of the effectiveness and cost-effectiveness of 'PhysioDirect' telephone assessment and advice services for physiotherapy.

PubMed

Salisbury, C; Foster, N E; Hopper, C; Bishop, A; Hollinghurst, S; Coast, J; Kaur, S; Pearson, J; Franchini, A; Hall, J; Grove, S; Calnan, M; Busby, J; Montgomery, A A

2013-01-01

As a result of long delays for physiotherapy for musculoskeletal problems, several areas in the UK have introduced PhysioDirect services in which patients telephone a physiotherapist for initial assessment and treatment advice. However, there is no robust evidence about the effectiveness, cost-effectiveness or acceptability to patients of PhysioDirect. To investigate whether or not PhysioDirect is equally as clinically effective as and more cost-effective than usual care for patients with musculoskeletal (MSK) problems in primary care. Pragmatic randomised controlled trial to assess equivalence, incorporating economic evaluation and nested qualitative research. Patients were randomised in 2 : 1 ratio to PhysioDirect or usual care using a remote automated allocation system at the level of the individual, stratifying by physiotherapy site and minimising by sex, age group and site of MSK problem. For the economic analysis, cost consequences included NHS and patient costs, and the cost of lost production. Cost-effectiveness analysis was carried out from the perspective of the NHS. Interviews were conducted with patients, physiotherapists and their managers. Four community physiotherapy services in England. Adults referred by general practitioners or self-referred for physiotherapy for a MSK problem. Patients allocated to PhysioDirect were invited to telephone a senior physiotherapist for initial assessment and advice using a computerised template, followed by face-to-face care when necessary. Patients allocated to usual care were put on to a waiting list for face-to-face care. Primary outcome was the Short Form questionnaire-36 items, version 2 (SF-36v2) Physical Component Score (PCS) at 6 months after randomisation. Secondary outcomes included other measures of health outcome [Measure Yourself Medical Outcomes Profile, European Quality of Life-5 Dimensions (EuroQol health utility measure, EQ-5D), global improvement, response to treatment], wait for treatment, time lost from work and usual activities, patient satisfaction. Data were collected by postal questionnaires at baseline, 6 weeks and 6 months, and from routine records by researchers blind to allocation. A total of 1506 patients were allocated to PhysioDirect and 743 to usual care. Patients allocated to PhysioDirect had a shorter wait for treatment than those allocated to usual care [median 7 days vs 34 days; arm-time ratio 0.32, 95% confidence interval (CI) 0.29 to 0.35] and had fewer non-attended face-to-face appointments [incidence rate ratio 0.55 (95% CI 0.41 to 0.73)]. The primary outcome at 6 months' follow-up was equivalent between PhysioDirect and usual care [mean PCS 43.50 vs 44.18, adjusted difference in means -0.01 (95% CI -0.80 to 0.79)]. The secondary measures of health outcome all demonstrated equivalence at 6 months, with slightly greater improvement in the PhysioDirect arm at 6 weeks' follow-up. Patients were equally satisfied with access to care but slightly less satisfied overall with PhysioDirect compared with usual care. NHS costs (physiotherapy plus other relevant NHS costs) per patient were similar in the two arms [PhysioDirect £ 198.98 vs usual care £ 179.68, difference in means £ 19.30 (95% CI -£ 37.60 to £ 76.19)], while QALYs gained were also similar [difference in means 0.007 (95% CI -0.003 to 0.016)]. Incremental cost per QALY gained was £ 2889. The probability that PhysioDirect was cost-effective at a £ 20,000 willingness-to-pay threshold was 88%. These conclusions about cost-effectiveness were robust to sensitivity analyses. There was no evidence of difference between trial arms in cost to patients or value of lost production. No adverse events were detected. Providing physiotherapy via PhysioDirect is equally clinically effective compared with usual waiting list-based care, provides faster access to treatment, appears to be safe, and is broadly acceptable to patients. PhysioDirect is probably cost-effective compared with usual care.

The COSMO-CLM 4.8 regional climate model coupled to regional ocean, land surface and global earth system models using OASIS3-MCT: description and performance

NASA Astrophysics Data System (ADS)

Will, Andreas; Akhtar, Naveed; Brauch, Jennifer; Breil, Marcus; Davin, Edouard; Ho-Hagemann, Ha T. M.; Maisonnave, Eric; Thürkow, Markus; Weiher, Stefan

2017-04-01

We developed a coupled regional climate system model based on the CCLM regional climate model. Within this model system, using OASIS3-MCT as a coupler, CCLM can be coupled to two land surface models (the Community Land Model (CLM) and VEG3D), the NEMO-MED12 regional ocean model for the Mediterranean Sea, two ocean models for the North and Baltic seas (NEMO-NORDIC and TRIMNP+CICE) and the MPI-ESM Earth system model.We first present the different model components and the unified OASIS3-MCT interface which handles all couplings in a consistent way, minimising the model source code modifications and defining the physical and numerical aspects of the couplings. We also address specific coupling issues like the handling of different domains, multiple usage of the MCT library and exchange of 3-D fields.We analyse and compare the computational performance of the different couplings based on real-case simulations over Europe. The usage of the LUCIA tool implemented in OASIS3-MCT enables the quantification of the contributions of the coupled components to the overall coupling cost. These individual contributions are (1) cost of the model(s) coupled, (2) direct cost of coupling including horizontal interpolation and communication between the components, (3) load imbalance, (4) cost of different usage of processors by CCLM in coupled and stand-alone mode and (5) residual cost including i.a. CCLM additional computations.Finally a procedure for finding an optimum processor configuration for each of the couplings was developed considering the time to solution, computing cost and parallel efficiency of the simulation. The optimum configurations are presented for sequential, concurrent and mixed (sequential+concurrent) coupling layouts. The procedure applied can be regarded as independent of the specific coupling layout and coupling details.We found that the direct cost of coupling, i.e. communications and horizontal interpolation, in OASIS3-MCT remains below 7 % of the CCLM stand-alone cost for all couplings investigated. This is in particular true for the exchange of 450 2-D fields between CCLM and MPI-ESM. We identified remaining limitations in the coupling strategies and discuss possible future improvements of the computational efficiency.

How to improve WEEE management? Novel approach in mobile collection with application of artificial intelligence.

PubMed

Król, Aleksander; Nowakowski, Piotr; Mrówczyńska, Bogna

2016-04-01

In global demand of improvement of electrical and electronic waste management systems, stakeholders look for effective collection systems that generate minimal costs. In this study we propose a novel model for application in mobile collection schemes - on demand that waste be taken back from household residents. This type of the waste equipment collection is comfortable for residents as they can indicate day and time windows for the take-back. Collecting companies are interested in lowering operational costs required for service. This lowering includes selection of a sufficient number of vehicles and employees, and then minimising the routes' length in order to achieve savings in fuel consumption, and lowering of emissions. In the proposed model we use a genetic algorithm for optimisation of the route length and number of vehicles and fuzzy logic for representation of the household residents' satisfaction on the take-back service provided by collection companies. Also, modern communication channels like websites or mobile phone applications can be used to send the waste equipment take-back request from the household, so it has the potential to be developed in future applications. The operation of the model has been presented in the case study of a city in southern Poland. The results can be useful for collecting companies and software producers for preparation of new applications to be used in waste collection. Copyright © 2016 Elsevier Ltd. All rights reserved.

Thermal modelling approaches to enable mitigation measures implementation for salmonid gravel stages in hydropeaking rivers

NASA Astrophysics Data System (ADS)

Casas-Mulet, R.; Alfredsen, K. T.

2016-12-01

The dewatering of salmon spawning redds can lead to early life stages mortality due to hydropeaking operations, with higher impact on the alevins stages as they have lower tolerance to dewatering than the eggs. Targeted flow-related mitigations measures can reduce such mortality, but it is essential to understand how hydropeaking change thermal regimes in rivers and may impact embryo development; only then optimal measures can be implemented at the right development stage. We present a set of experimental approaches and modelling tools for the estimation of hatch and swim-up dates based on water temperature data in the river Lundesokna (Norway). We identified critical periods for gravel-stages survival and through comparing hydropeaking vs unregulated thermal and hydrological regimes, we established potential flow-release measures to minimise mortality. Modelling outcomes were then used assess the cost-efficiency of each measure. The combinations of modelling tools used in this study were overall satisfactory and their application can be useful especially in systems where little field data is available. Targeted measures built on well-informed modelling approaches can be pre-tested based on their efficiency to mitigate dewatering effects vs. the hydropower system capacity to release or conserve water for power production. Overall, environmental flow releases targeting specific ecological objectives can provide better cost-effective options than conventional operational rules complying with general legislation.

Generic guide concepts for the European Spallation Source

NASA Astrophysics Data System (ADS)

Zendler, C.; Martin Rodriguez, D.; Bentley, P. M.

2015-12-01

The construction of the European Spallation Source (ESS) faces many challenges from the neutron beam transport point of view: the spallation source is specified as being driven by a 5 MW beam of protons, each with 2 GeV energy, and yet the requirements in instrument background suppression relative to measured signal vary between 10-6 and 10-8. The energetic particles, particularly above 20 MeV, which are expected to be produced in abundance in the target, have to be filtered in order to make the beamlines safe, operational and provide good quality measurements with low background. We present generic neutron guides of short and medium length instruments which are optimised for good performance at minimal cost. Direct line of sight to the source is avoided twice, with either the first point out of line of sight or both being inside the bunker (20 m) to minimise shielding costs. These guide geometries are regarded as a baseline to define standards for instruments to be constructed at ESS. They are used to find commonalities and develop principles and solutions for common problems. Lastly, we report the impact of employing the over-illumination concept to mitigate losses from random misalignment passively, and that over-illumination should be used sparingly in key locations to be effective. For more widespread alignment issues, a more direct, active approach is likely to be needed.

Adaptive non-linear control for cancer therapy through a Fokker-Planck observer.

PubMed

Shakeri, Ehsan; Latif-Shabgahi, Gholamreza; Esmaeili Abharian, Amir

2018-04-01

In recent years, many efforts have been made to present optimal strategies for cancer therapy through the mathematical modelling of tumour-cell population dynamics and optimal control theory. In many cases, therapy effect is included in the drift term of the stochastic Gompertz model. By fitting the model with empirical data, the parameters of therapy function are estimated. The reported research works have not presented any algorithm to determine the optimal parameters of therapy function. In this study, a logarithmic therapy function is entered in the drift term of the Gompertz model. Using the proposed control algorithm, the therapy function parameters are predicted and adaptively adjusted. To control the growth of tumour-cell population, its moments must be manipulated. This study employs the probability density function (PDF) control approach because of its ability to control all the process moments. A Fokker-Planck-based non-linear stochastic observer will be used to determine the PDF of the process. A cost function based on the difference between a predefined desired PDF and PDF of tumour-cell population is defined. Using the proposed algorithm, the therapy function parameters are adjusted in such a manner that the cost function is minimised. The existence of an optimal therapy function is also proved. The numerical results are finally given to demonstrate the effectiveness of the proposed method.

Using simulation modelling to examine the impact of venue lockout and last-drink policies on drinking-related harms and costs to licensees.

PubMed

Scott, Nick; Livingston, Michael; Reporter, Iyanoosh; Dietze, Paul

2017-06-01

Many variations of venue lockout and last-drink policies have been introduced in attempts to reduce drinking-related harms. We estimate the public health gains and licensee costs of these policies using a computer simulated population of young adults engaging in heavy drinking. Using an agent-based model we implemented 1 am/2 am/3 am venue lockouts in conjunction with last drinks zero/one/two hours later, or at current closing times. Outcomes included: the number of incidents of verbal aggression in public drinking venues, private venues or on the street; and changed revenue to public venues. The most effective policy in reducing verbal aggression among agents was 1 am lockouts with current closing times. All policies produced substantial reductions in street-based incidents of verbal aggression among agents (33-81%) due to the smoothing of transport demand. Direct revenue losses were 1-9% for simulated licensees, with later lockout times and longer periods between lockout and last drinks producing smaller revenue losses. Simulation models are useful for exploring consequences of policy change. Our simulation suggests that additional hours between lockout and last drinks could reduce aggression by easing transport demand, while minimising revenue loss to venue owners. Implications for public health: Direct policies to reduce late-night transport-related disputes should be considered. © 2017 The Authors.

Injury prevention during physical activity in the Australian Defence Force.

PubMed

Sherrard, J; Lenné, M; Cassell, E; Stokes, M; Ozanne-Smith, J

2004-03-01

Injuries sustained by Australian Defence Force (ADF) personnel during non-combat military training and sports activity are associated with increasing costs due to work days lost, medical treatment, compensation, and early retirement. In 2001, the ADF commissioned a systematic review of the evidence-base for reducing injuries associated with physical activity, while at the same time improving physical activity participation rates to sustain a trained, fit and deployable workforce. Literature from on-line library databases, relevant unclassified military reports, and material from previously published sport-specific injury countermeasure reviews were systematically and critically analysed to address the study aims. Modification of intensity, frequency and duration of basic military training activities and improved equipment is likely to reduce injury occurrence. Sports injury countermeasures used for the civilian population have merit for the ADF physical activity program. Injury countermeasures should be designed to minimise any possible deterrent effect on the motivation to participate in regular physical activity. Increasing the participation of ADF personnel in physical activity in the presence of evidence-based injury prevention strategies has the potential to increase health, fitness and deployability with minimal impact on injury frequency. Recommendations arising from the review include injury intervention trials in basic military training and sports. These and other interventions should be supported by refinement to ADF injury surveillance systems. Research should focus on interventions with the greatest gain for fitness, deployability, and cost effectiveness.

Pyrethroid Treatment of Cattle for Tsetse Control: Reducing Its Impact on Dung Fauna

PubMed Central

Vale, Glyn A.; Hargrove, John W.; Chamisa, Andrew; Grant, Ian F.; Torr, Stephen J.

2015-01-01

Background African trypansomiases of humans and animals can be controlled by attacking the vectors, various species of tsetse fly. Treatment of cattle with pyrethroids to kill tsetse as they feed is the most cost-effective method. However, such treatments can contaminate cattle dung, thereby killing the fauna which disperse the dung and so play an important role in soil fertility. Hence there is a need to identify cost-effective methods of treating cattle with minimal impact on dung fauna. Methodology/Principal Findings We used dung beetles to field bioassay the levels of dung contamination following the use of spray and pour-on formulations of deltamethrin, applied to various parts of the body of cattle in Zimbabwe. Results suggested that dung was contaminated by contact with insecticide on the body surface as the cattle defecated, and by ingestion of insecticide as the cattle licked themselves. Death of dung beetles was reduced to negligible levels by using only the spray and applying it to the legs and belly or legs alone, i.e., places where most tsetse feed. Conclusion/Significance The restricted applications suitable for minimising the impact on dung fauna have the collateral benefits of improving the economy and convenience of cattle treatments for tsetse control. The demonstration of collateral benefits is one of the surest ways of promoting environmentally friendly procedures. PMID:25738836

Harm, benefit and costs associated with low-dose glucocorticoids added to the treatment strategies for rheumatoid arthritis in elderly patients (GLORIA trial): study protocol for a randomised controlled trial.

PubMed

Hartman, Linda; Rasch, Linda A; Klausch, Thomas; Bijlsma, Hans W J; Christensen, Robin; Smulders, Yvo M; Ralston, Stuart H; Buttgereit, Frank; Cutolo, Maurizio; Da Silva, Jose A P; Opris, Daniela; Rovenský, Jozef; Szamosi, Szilvia; Middelink, Leonie M; Lems, Willem F; Boers, Maarten

2018-01-25

Rheumatoid arthritis (RA) is a chronic inflammatory disease of the joints affecting 1% of the world population. It has major impact on patients through disability and associated comorbidities. Current treatment strategies have considerably improved the prognosis, but recent innovations (especially biologic drugs and the new class of so-called "JAK/STAT inhibitors") have important safety issues and are very costly. Glucocorticoids (GCs) are highly effective in RA, and could reduce the need for expensive treatment with biologic agents. However, despite more than 65 years of clinical experience, there is a lack of studies large enough to adequately document the benefit/harm balance. The result is inappropriate treatment strategies, i.e. both under-use and over-use of GCs, and consequently suboptimal treatment of RA. The GLORIA study is a pragmatic multicentre, 2-year, randomised, double-blind, clinical trial to assess the safety and effectiveness of a daily dose of 5 mg prednisolone or matching placebo added to standard of care in elderly patients with RA. Eligible participants are diagnosed with RA, have inadequate disease control (disease activity score, DAS28 ≥ 2.6), and are ≥ 65 years. The primary outcome measures are the time-averaged mean value of the DAS28 and the occurrence of serious adverse events or adverse events of special interest. During the trial, change in antirheumatic therapy is permitted as clinically indicated, except for GCs. Cost-effectiveness and cost-utility are secondary outcomes. The main challenge is the interpretation of the trial result with two primary endpoints and the pragmatic trial design that allows co-interventions. Another challenge is the definition of safety and the relative lack of power to detect differences between treatment groups. We have chosen to define safety as the number of patients experiencing at least one serious adverse event. We also specify a decision tree to guide our conclusion on the balance of benefit and harm, and our methodology to combat potential confounding caused by co-interventions. Pragmatic trials minimise impact on daily practice and maximise clinical relevance of the results, but analysis and interpretation of the results is challenging. We expect that the results of this trial are of importance for all rheumatologists who treat elderly patients with RA. ClinicalTrials.gov, NCT02585258 . Registered on 20 October 2015.

Quasi-optical analysis of a far-infrared spatio-spectral space interferometer concept

NASA Astrophysics Data System (ADS)

Bracken, C.; O'Sullivan, C.; Murphy, J. A.; Donohoe, A.; Savini, G.; Lightfoot, J.; Juanola-Parramon, R.; Fisica Consortium

2016-07-01

FISICA (Far-Infrared Space Interferometer Critical Assessment) was a three year study of a far-infrared spatio-spectral double-Fourier interferometer concept. One of the aims of the FISICA study was to set-out a baseline optical design for such a system, and to use a model of the system to simulate realistic telescope beams for use with an end-to-end instrument simulator. This paper describes a two-telescope (and hub) baseline optical design that fulfils the requirements of the FISICA science case, while minimising the optical mass of the system. A number of different modelling techniques were required for the analysis: fast approximate simulation tools such as ray tracing and Gaussian beam methods were employed for initial analysis, with GRASP physical optics used for higher accuracy in the final analysis. Results are shown for the predicted far-field patterns of the telescope primary mirrors under illumination by smooth walled rectangular feed horns. Far-field patterns for both on-axis and off-axis detectors are presented and discussed.

Attitudes of UK doctors towards euthanasia and physician-assisted suicide: a systematic literature review.

PubMed

McCormack, Ruaidhri; Clifford, Margaret; Conroy, Marian

2012-01-01

To review studies over a 20-year period that assess the attitudes of UK doctors concerning active, voluntary euthanasia (AVE) and physician-assisted suicide (PAS), assess efforts to minimise bias in included studies, determine the effect of subgroup variables (e.g. age, gender) on doctors' attitudes, and make recommendations for future research. Three electronic databases, four pertinent journals, reference lists of included studies. Literature search of English articles between January 1990 and April 2010. Studies were excluded if they did not present independent data (e.g. commentaries) or if they related to doctors outside the UK, patients younger than 18 years old, terminal sedation, withdrawing or withholding treatment, or double-effect. Quantitative and qualitative data were extracted. Following study selection and data extraction, 15 studies were included. UK doctors oppose the introduction of both AVE and PAS in the majority of studies. Degree of religiosity appeared as a statistically significant factor in influencing doctors' attitudes. The top three themes in the qualitative analysis were the provision of palliative care, adequate safeguards in the event of AVE or PAS being introduced, and a profession to facilitate AVE or PAS that does not include doctors. UK doctors appear to oppose the introduction of AVE and PAS, even when one considers the methodological limitations of included studies. Attempts to minimise bias in included studies varied. Further studies are necessary to establish if subgroup variables other than degree of religiosity influence attitudes, and to thoroughly explore the qualitative themes that appeared.

Minimising back reflections from the common path objective in a fundus camera

NASA Astrophysics Data System (ADS)

Swat, A.

2016-11-01

Eliminating back reflections is critical in the design of a fundus camera with internal illuminating system. As there is very little light reflected from the retina, even excellent antireflective coatings are not sufficient suppression of ghost reflections, therefore the number of surfaces in the common optics in illuminating and imaging paths shall be minimised. Typically a single aspheric objective is used. In the paper an alternative approach, an objective with all spherical surfaces, is presented. As more surfaces are required, more sophisticated method is needed to get rid of back reflections. Typically back reflections analysis, comprise treating subsequent objective surfaces as mirrors, and reflections from the objective surfaces are traced back through the imaging path. This approach can be applied in both sequential and nonsequential ray tracing. It is good enough for system check but not very suitable for early optimisation process in the optical system design phase. There are also available standard ghost control merit function operands in the sequential ray-trace, for example in Zemax system, but these don't allow back ray-trace in an alternative optical path, illumination vs. imaging. What is proposed in the paper, is a complete method to incorporate ghost reflected energy into the raytracing system merit function for sequential mode which is more efficient in optimisation process. Although developed for the purpose of specific case of fundus camera, the method might be utilised in a wider range of applications where ghost control is critical.

Linked electronic medication systems in community pharmacies for preventing pseudoephedrine diversion: a review of international practice and analysis of results in Australia.

PubMed

Berbatis, Constantine G; Sunderland, Vivian Bruce; Dhaliwal, Satvinder S

2009-11-01

Pseudoephedrine is a precursor often diverted into the illegal manufacture of amphetamine type substances (ATS). The aim of this study was to evaluate the effectiveness of a linked electronic medication recording system (LEMS) established in Australian pharmacies in 2005 for preventing the diversion of pseudoephedrine. The number of illegal ATS laboratories detected in each jurisdiction of Australia from 1996-1997 to 2004-2005 were analysed by linear regression nationally and by each jurisdiction. The statistical significance of seizures in 2005-2006 was based on the comparison of the observed value to the 95% prediction confidence intervals calculated from the historical data for each jurisdiction and nationally. Pharmacies in Queensland commenced an LEMS in late 2005 to minimise retail pseudoephedrine diversion. The number of ATS laboratories seized in 2005-2006 in Queensland was significantly lower (P < 0.05) than predicted by historical data. For all other jurisdictions and nationally the totals of laboratories seized in 2005-2006 were not significantly different from predicted values. The significant decline in ATS illegal laboratories seized in Queensland in 2005-2006 suggests the effective use of LEMS in pharmacies to minimise pseudoephedrine diversion. In order to evaluate a national LEMS, more frequent data on numbers of linked pharmacies, ATS laboratories seized and indicators of pseudoephedrine sales and misuse are required. Testing the use of LEMS by pharmacies for preventing the diversion of other medicines seems appropriate.

Iron plaque formed under aerobic conditions efficiently immobilizes arsenic in Lupinus albus L roots.

PubMed

Fresno, Teresa; Peñalosa, Jesús M; Santner, Jakob; Puschenreiter, Markus; Prohaska, Thomas; Moreno-Jiménez, Eduardo

2016-09-01

Arsenic is a non-threshold carcinogenic metalloid. Thus, human exposure should be minimised, e.g. by chemically stabilizing As in soil. Since iron is a potential As immobiliser, it was investigated whether root iron plaque, formed under aerobic conditions, affects As uptake, metabolism and distribution in Lupinus albus plants. White lupin plants were cultivated in a continuously aerated hydroponic culture containing Fe/EDDHA or FeSO4 and exposed to arsenate (5 or 20 μM). Only FeSO4 induced surficial iron plaque in roots. LA-ICP-MS analysis accomplished on root sections corroborated the association of As to this surficial Fe. Additionally, As(V) was the predominant species in FeSO4-treated roots, suggesting less efficient As uptake in the presence of iron plaque. Fe/EDDHA-exposed roots neither showed such surficial FeAs co-localisation nor As(V) accumulation; in contrast As(III) was the predominant species in root tissue. Furthermore, FeSO4-treated plants showed reduced shoot-to-root As ratios, which were >10-fold lower compared to Fe/EDDHA treatment. Our results highlight the role of an iron plaque formed in roots of white lupin under aerobic conditions on As immobilisation. These findings, to our knowledge, have not been addressed before for this plant and have potential implications on soil remediation (phytostabilisation) and food security (minimising As in crops). Copyright © 2016 Elsevier Ltd. All rights reserved.

A joint technique for sidelobe suppression and peak-to-average power ratio reduction in non-contiguous OFDM-based cognitive radio networks

NASA Astrophysics Data System (ADS)

Sivadas, Namitha Arackal; Mohammed, Sameer Saheerudeen

2017-02-01

In non-contiguous orthogonal frequency division multiplexing (NC-OFDM)-based interweave cognitive radio networks, the sidelobe power of secondary users (SUs) must be strictly controlled to avoid the interference between the SUs and the primary users (PUs) of the adjacent bands. Similarly, the inherent issue of high peak-to-average power ratio (PAPR) of the OFDM signal is another drawback of the cognitive radio communication system based on the NC-OFDM technology. A few methods are available in the literature to solve either of these problems individually, while in this paper, we propose a new method for the joint minimisation of sidelobe power and PAPR in NC-OFDM-based cognitive radio networks using Zadoff-Chu (ZC) sequence. In this method, the sidelobe power suppression of SUs is benefited by PUs and the PAPR is reduced for SUs. We modelled a new optimisation problem for minimising the sidelobe power with a constraint on the maximum tolerable PAPR and sidelobe power. The proper selection of ZC sequence, which is crucial for minimising both the issues simultaneously, is achieved by solving the proposed optimisation problem. The proposed technique is shown to provide 7 dB and 20 dB reduction in PAPR and sidelobe power, respectively, without causing any signal distortion along with the improvement in bit error rate (BER) performance.

A case for clean conferences in gambling research.

PubMed

Livingstone, Charles

2018-02-14

Gambling research is characterised by widespread gambling industry involvement. It is likely (as with alcohol and tobacco industry influence) that this will delay or divert effective harm prevention or minimisation measures. Gambling harms are known to be significant and widespread. Effective action to reduce these harms requires concomitant efforts to eliminate industry influence. Gambling industry influence and activity in three research forums is described. The influence of tobacco and alcohol industry involvement in research directions and outcomes is discussed. Aspects of the discursive elements of industry funded and/or directed research outputs are analysed in the context of industry-friendly discourse and its effects. Industry activity and participation at representative research forums is outlined. The examples and background provided demonstrate that specific material and discursive effects of gambling industry involvement can be discerned in the gambling literature. The consequences of this for the gambling evidence base around harm prevention and minimisation are presented. Industry influence operates at multiple levels within the gambling research field. There is increasing awareness of this, and of the effects it may have on the development and deployment of effective harm prevention and minimisation efforts. Key reforms are proposed: (i) the elimination of industry participation and sponsorship of gambling research associations and forums; and (ii) the establishment where necessary of new research forums and international scholarly associations. © 2018 Australasian Professional Society on Alcohol and other Drugs.

Leptokurtic portfolio theory

NASA Astrophysics Data System (ADS)

Kitt, R.; Kalda, J.

2006-03-01

The question of optimal portfolio is addressed. The conventional Markowitz portfolio optimisation is discussed and the shortcomings due to non-Gaussian security returns are outlined. A method is proposed to minimise the likelihood of extreme non-Gaussian drawdowns of the portfolio value. The theory is called Leptokurtic, because it minimises the effects from “fat tails” of returns. The leptokurtic portfolio theory provides an optimal portfolio for investors, who define their risk-aversion as unwillingness to experience sharp drawdowns in asset prices. Two types of risks in asset returns are defined: a fluctuation risk, that has Gaussian distribution, and a drawdown risk, that deals with distribution tails. These risks are quantitatively measured by defining the “noise kernel” — an ellipsoidal cloud of points in the space of asset returns. The size of the ellipse is controlled with the threshold parameter: the larger the threshold parameter, the larger return are accepted for investors as normal fluctuations. The return vectors falling into the kernel are used for calculation of fluctuation risk. Analogously, the data points falling outside the kernel are used for the calculation of drawdown risks. As a result the portfolio optimisation problem becomes three-dimensional: in addition to the return, there are two types of risks involved. Optimal portfolio for drawdown-averse investors is the portfolio minimising variance outside the noise kernel. The theory has been tested with MSCI North America, Europe and Pacific total return stock indices.

Inverse dynamic investigation of voluntary trunk movements in weightlessness: a new microgravity-specific strategy.

PubMed

Pedrocchi, Alessandra; Pedotti, Antonio; Baroni, Guido; Massion, Jean; Ferrigno, Giancarlo

2003-11-01

Present investigation faces the question of quantitative assessment of exchanged forces and torques at the restraints during whole body posture exercises in long-term microgravity. Inverse dynamic modelling and total angular momentum at the ankle joint were used in order to reconstruct movement dynamics at the restraining point, represented by the ankle joint. The hypothesis is that the minimisation of the torques at the interface point assumes a key role in movement planning in 0 g. This hypothesis would respond to an optimisation of muscles activity, a minimisation of energy expenditure and therefore an accurate control of body movement. Results show that the 0 g movement strategy adopted ensures that the integral of the net ankle moment between the beginning and the end of the movement is zero. This expected mechanical constraint is not satisfied when 0 g movement dynamics is simulated using terrestrial kinematics. This accounts for a significant imposed change of movement strategy. Particularly, the efficient compensation of the inertial effects of the segments in terms of total angular momentum at the ankle joint was evidenced. These results explain the exaggerated axial synergies, observed on kinematics and which moved centre of mass (CM) backward from its already backward initial positioning, as a tool for enhancing the compensation and achieving the desired minimisation of the torques exchanges at the restraints.

Drug policy in sport: hidden assumptions and inherent contradictions.

PubMed

Smith, Aaron C T; Stewart, Bob

2008-03-01

This paper considers the assumptions underpinning the current drugs-in-sport policy arrangements. We examine the assumptions and contradictions inherent in the policy approach, paying particular attention to the evidence that supports different policy arrangements. We find that the current anti-doping policy of the World Anti-Doping Agency (WADA) contains inconsistencies and ambiguities. WADA's policy position is predicated upon four fundamental principles; first, the need for sport to set a good example; secondly, the necessity of ensuring a level playing field; thirdly, the responsibility to protect the health of athletes; and fourthly, the importance of preserving the integrity of sport. A review of the evidence, however, suggests that sport is a problematic institution when it comes to setting a good example for the rest of society. Neither is it clear that sport has an inherent or essential integrity that can only be sustained through regulation. Furthermore, it is doubtful that WADA's anti-doping policy is effective in maintaining a level playing field, or is the best means of protecting the health of athletes. The WADA anti-doping policy is based too heavily on principals of minimising drug use, and gives insufficient weight to the minimisation of drug-related harms. As a result drug-related harms are being poorly managed in sport. We argue that anti-doping policy in sport would benefit from placing greater emphasis on a harm minimisation model.

Excessive force during removal of immigration detainees.

PubMed

Granville-Chapman, Charlotte; Smith, Ellie; Moloney, Neil

2005-08-01

Use of force against immigration detainees during attempts to expel them from the UK must be limited to that which is strictly necessary and proportionate under the circumstances, using accepted methods of restraint designed to minimise injury risk to all concerned. Fourteen cases are reported after failed removal attempts, where there were allegations that excessive force had been employed. Collective analysis of the 14 cases reveals a misuse of handcuffs in 11 cases with resulting nerve injury in 4 cases, the use of inappropriate and unsafe methods of force, such as blows to the head and compression of the trunk and/or neck, and continued use of force even after termination of the deportation attempt, occurring inside security company vehicles out of sight of witnesses. An analysis of the legal implications for the government and recommendations aimed at eradication of abusive practices are given.

Disjunction and conjunction fallacies in episodic memory.

PubMed

Nakamura, K; Brainerd, C J

2017-09-01

It has recently been found that episodic memory displays analogues of the well-known disjunction and conjunction fallacies of probability judgement. The aim of the present research was, for the first time, to study these memory fallacies together under the same conditions, and test theoretical predictions about the reasons for each. The focus was on predictions about the influence of semantic gist, target versus context recollection, and proactive versus retroactive interference. Disjunction and conjunction fallacies increased in conditions in which subjects were able to form semantic connections among list words. In addition, disjunction fallacies were increased by manipulations that minimised proactive interference, whereas conjunction fallacies were increased by manipulations that minimised retroactive interference. That pattern suggests that disjunction fallacies are more dependent on target recollection, whereas conjunction fallacies are more dependent on context recollection.

Non-radiation induced signals in TL dosimetry.

PubMed

German, U; Weinstein, M

2002-01-01

One source of background signals, which are non-radiation related, is the reader system and it includes dark current, external contaminants and electronic spikes. These factors can induce signals equivalent to several hundredths of mSv. Mostly, the effects are minimised by proper design of the TLD reader, but some effects are dependent on proper operation of the system. The other main group of background signals originates in the TL crystal and is due to tribothermoluminescence, dirt, chemical reactions and stimulation by visible or UV light. These factors can have a significant contribution, equivalent to over several mSv, depending on whether the crystal is bare or protected by PTFE. Working in clean environments, monitoring continuously the glow curves and performing glow curve deconvolution are suggested to minimise non-radiation induced spurious signals.

In vitro activity of minimised hammerhead ribozymes.

PubMed Central

Hendry, P; McCall, M J; Santiago, F S; Jennings, P A

1995-01-01

A number of minimised hammerhead ribozymes (minizymes) which lack stem II have been kinetically characterised. These minizymes display optimal cleavage activity at temperatures around 37 degrees C. The cleavage reactions of the minizymes are first order in hydroxide ion concentration up to around pH 9.3 above which the cleavage rate constants decline rapidly. The reactions show a biphasic dependence on magnesium-ion concentration; one of the interactions has an apparent dissociation constant of around 20 mM while the other appears to be very weak, showing no sign of saturation at 200 mM MgCl2. The minizymes are significantly less active than comparable, full-size ribozymes when cleaving short substrates. However, at a particular site in a transcribed TAT gene from HIV-1, minizymes are more effective than ribozymes. PMID:7479037

Optimising mechanical properties of hot forged nickel superalloy 625 components

NASA Astrophysics Data System (ADS)

Singo, Nthambe; Coles, John; Rosochowska, Malgorzata; Lalvani, Himanshu; Hernandez, Jose; Ion, William

2018-05-01

Hot forging and subsequent heat treatment were resulting in substandard mechanical properties of nickel superalloy, Alloy 625, components. The low strength was found to be due to inadequate deformation during forging, excessive grain growth and precipitation of carbides during subsequent heat treatment. Experimentation in a drop forging company and heat treatment facility led to the establishment of optimal parameters to minimise grain size and mitigate the adverse effects of carbide precipitation, leading to successful fulfilment of mechanical property specifications. This was achieved by reducing the number of operations, maximising the extent of deformation by changing the slug dimensions and its orientation in the die, and minimising the time of exposure to elevated temperatures in both the forging and subsequent heat treatment processes to avoid grain growth.

Segmental maxillary distraction with a novel device for closure of a wide alveolar cleft

PubMed Central

Bousdras, Vasilios A.; Liyanage, Chandra; Mars, Michael; Ayliffe, Peter R

2014-01-01

Treatment of a wide alveolar cleft with initial application of segmental distraction osteogenesis is reported, in order to minimise cleft size prior to secondary alveolar bone grafting. The lesser maxillary segment was mobilised with osteotomy at Le Fort I level and, a novel distractor, facilitated horizontal movement of the dental/alveolar segment along the curvature of the maxillary dental arch. Following a latency period of 4 days distraction was applied for 7 days at a rate of 0.5 mm twice daily. Radiographic, ultrasonographic and clinical assessment revealed new bone and soft tissue formation 8 weeks after completion of the distraction phase. Overall the maxillary segment did move minimising the width of the cleft, which allowed successful closure with a secondary alveolar bone graft. PMID:24987601

Segmental maxillary distraction with a novel device for closure of a wide alveolar cleft.

PubMed

Bousdras, Vasilios A; Liyanage, Chandra; Mars, Michael; Ayliffe, Peter R

2014-01-01

Treatment of a wide alveolar cleft with initial application of segmental distraction osteogenesis is reported, in order to minimise cleft size prior to secondary alveolar bone grafting. The lesser maxillary segment was mobilised with osteotomy at Le Fort I level and, a novel distractor, facilitated horizontal movement of the dental/alveolar segment along the curvature of the maxillary dental arch. Following a latency period of 4 days distraction was applied for 7 days at a rate of 0.5 mm twice daily. Radiographic, ultrasonographic and clinical assessment revealed new bone and soft tissue formation 8 weeks after completion of the distraction phase. Overall the maxillary segment did move minimising the width of the cleft, which allowed successful closure with a secondary alveolar bone graft.

Hydrological and thermal effects of hydropeaking on early life stages of salmonids: A modelling approach for implementing mitigation strategies.

PubMed

Casas-Mulet, Roser; Saltveit, Svein Jakob; Alfredsen, Knut Tore

2016-12-15

Alterations in hydrological and thermal regimes can potentially affect salmonid early life stages development and survival. The dewatering of salmon spawning redds due to hydropeaking can lead to mortality in early life stages, with higher impact on the alevins as they have lower tolerance to dewatering than the eggs. Flow-related mitigation measures can reduce early life stage mortality. We present a set of modelling tools to assess impacts and mitigation options to minimise the risk of mortality in early life stages in hydropeaking rivers. We successfully modelled long-term hydrological and thermal alterations and consequences for development rates. We estimated the risk of early life stages mortality and assessed the cost-effectiveness of implementing three release-related mitigation options (A,B,C). The economic cost of mitigation was low and ranged between 0.7% and 2.6% of the annual hydropower production. Options reducing the flow during spawning (B and C) in addition to only release minimum flows during development (A) were considered more effective for egg and alevin survival. Options B and C were however constraint by water availability in the system for certain years, and therefore only option A was always feasible. The set of modelling tools used in this study were satisfactory and their applications can be useful especially in systems where little field data is available. Targeted measures built on well-informed modelling tools can be tested on their effectiveness to mitigate dewatering effects vs. the hydropower system capacity to release or conserve water for power production. Environmental flow releases targeting specific ecological objectives can provide better cost-effective options than conventional operational rules complying with general legislation. Copyright © 2016 Elsevier B.V. All rights reserved.

Assessment of the Availability, Cost, and Motivations for Use over Time of the New Psychoactive Substances-Benzodiazepines Diclazepam, Flubromazepam, and Pyrazolam-in the UK.

PubMed

Abouchedid, Rachelle; Gilks, Thea; Dargan, Paul I; Archer, John R H; Wood, David M

2018-06-01

There has been increasing interest in the availability of non-prescription benzodiazepines and their sale as new psychoactive substances. We wanted to determine UK availability from Internet suppliers and motivations for use of three benzodiazepines (diclazepam, flubromazepam, and pyrazolam). In November 2014 and March 2016, using the European Monitoring Centre for Drugs and Drug Addiction Snapshot Methodology, Internet search engines ( google.co.uk , uk. yahoo.com and ask.com.uk ) were searched using the terms 'buy diclazepam', 'buy flubromazepam' and 'buy pyrazolam'. Threads from drug-user forums ( bluelight.org , drugs-forum.com , erowid.org , legalhighsforum.com ) were analysed using a general inductive approach. Data were converted into price per gram/pellet to allow cost comparisons and to determine motivations for use. There was an increase in websites selling these benzodiazepines between 2014 and 2016: diclazepam (49 in 2014 to 55 in 2016), pyrazolam (33 to 35), and flubromazepam (39 to 45). Thirty-eight (63.3%) sites were based in the UK/Europe. Drugs were sold as pellets (49 websites, 81.7%), powder (19, 31.7%), and blotters (1, 1.7%). Pill forms were not available, and one (1.7%) website sold diclazepam/flubromazepam in liquid form. The cost reduced with increasing purchase quantities. Main motivations for use included anxiolysis, management of benzodiazepine withdrawal, sedation/sleep aid, and management of stimulant withdrawal. These three benzodiazepines are widely available online, most commonly as pellets, and are (mis)used for a number of reasons. This study could be used to support triangulation of data from other sources to inform harm minimisation strategies.

Integrated treatment and recycling of stormwater: a review of Australian practice.

PubMed

Hatt, Belinda E; Deletic, Ana; Fletcher, Tim D

2006-04-01

With the use of water approaching, and in some cases exceeding, the limits of sustainability in many locations, there is an increasing recognition of the need to utilise stormwater for non-potable requirements, thus reducing the demand on potable sources. This paper presents a review of Australian stormwater treatment and recycling practices as well as a discussion of key lessons and identified knowledge gaps. Where possible, recommendations for overcoming these knowledge gaps are given. The review of existing stormwater recycling systems focussed primarily on the recycling of general urban runoff (runoff generated from all urban surfaces) for non-potable purposes. Regulations and guidelines specific to stormwater recycling need to be developed to facilitate effective design of such systems, and to minimise risks of failure. There is a clear need for the development of innovative techniques for the collection, treatment and storage of stormwater. Existing stormwater recycling practice is far ahead of research, in that there are no technologies designed specifically for stormwater recycling. Instead, technologies designed for general stormwater pollution control are frequently utilised, which do not guarantee the necessary reliability of treatment. Performance modelling for evaluation purposes also needs further research, so that industry can objectively assess alternative approaches. Just as many aspects of these issues may have impeded adoption of stormwater, another impediment to adoption has been the lack of a practical and widely accepted method for assessing the many financial, social and ecological costs and benefits of stormwater recycling projects against traditional alternatives. Such triple-bottom-line assessment methodologies need to be trialled on stormwater recycling projects. If the costs and benefits of recycling systems can be shown to compare favourably with the costs and benefits of conventional practices this will provide an incentive to overcome other obstacles to widespread adoption of stormwater recycling.

The Pharmaceutical Benefits Scheme 2003–2004

PubMed Central

Harvey, Ken J

2005-01-01

The Pharmaceutical Benefits Scheme (PBS) grew by 8% in 2003–04; a slower rate than the 12.0% pa average growth over the last decade. Nevertheless, the sustainability of the Scheme remained an ongoing concern given an aging population and the continued introduction of useful (but increasingly expensive) new medicines. There was also concern that the Australia-United States Free Trade Agreement could place further pressure on the Scheme. In 2003, as in 2002, the government proposed a 27% increase in PBS patient co-payments and safety-net thresholds in order to transfer more of the cost of the PBS from the government to consumers. While this measure was initially blocked by the Senate, the forthcoming election resulted in the Labor Party eventually supporting this policy. Recommendations of the Pharmaceutical Benefits Advisory Committee to list, not list or defer a decision to list a medicine on the PBS were made publicly available for the first time and the full cost of PBS medicines appeared on medicine labels if the price was greater than the co-payment. Pharmaceutical reform in Victorian public hospitals designed to minimise PBS cost-shifting was evaluated and extended to other States and Territories. Programs promoting the quality use of medicines were further developed coordinated by the National Prescribing Service, Australian Divisions of General Practice and the Pharmacy Guild of Australia. The extensive uptake of computerised prescribing software by GPs produced benefits but also problems. The latter included pharmaceutical promotion occurring at the time of prescribing, failure to incorporate key sources of objective therapeutic information in the software and gross variation in the ability of various programs to detect important drug-drug interactions. These issues remain to be tackled. PMID:15679896

A Low Cost Automated Monitoring System for Landslides Using Dual Frequency GPS

NASA Astrophysics Data System (ADS)

Mills, H.; Edwards, S.

2006-12-01

Landslides are an existing and permanent threat to societies across the globe, generating financial and human losses whenever and wherever they occur. Drawing together the strands of science that provide increased understanding of landslide triggers through accurate modelling is therefore vital for the development of mitigation and management strategies. Together with climatic and geomorphological data a key input here is information on the precise location and timing of landslide events. However, the detailed monitoring of landslides and precursor movements is generally limited to episodic campaigns where limiting factors include equipment and mobilisation costs, time constraints and spatial resolution. This research has developed a geodetic tool of benefit to scientists involved in the development of closely coupled models that seek to explain trigger mechanisms such as rainfall duration and intensity and changes in groundwater pressure to actual real land movements. A fully automated low cost dual frequency GPS station for the continuous in-situ monitoring of landslide sites has been developed. System configuration combines a dual frequency GPS receiver, PC board with a GPRS modem and power supply to deliver 24hr/365day operation capability. Individual components have been chosen to provide the highest accuracies while minimising power consumption resulting in a system around half that of equivalent commercial systems. Measurement point-costs can be further reduced through the use of antenna switching and multi antenna arrays. Continuous data is delivered via mobile phone uplink and processed automatically using geodetic software. The developed system has been extensively tested on a purpose built platform capable of simulating ground movements. Co-mounted antennas have allowed direct comparisons with more expensive geodetic GPS receivers. The system is capable of delivering precise 3D coordinates with a 9 mm rms. The system can be up-scaled resulting in the increased spatial density of monitoring and yielding more detailed information on landslide movements for improved downstream modelling and monitoring.

Health effects associated with exposure to anaesthetic gases in Ontario hospital personnel.

PubMed Central

Guirguis, S S; Pelmear, P L; Roy, M L; Wong, L

1990-01-01

In a retrospective study (by questionnaire) of 8032 personnel exposed to anaesthetic gases in operating and recovery rooms in Ontario hospitals, and 2525 non-exposed hospital staff, the response was 78.8% for the exposed and 87.2% for the unexposed personnel during the period 1981-5. Logistic regression analysis, with age and smoking standardised, showed that women in the exposed group had significantly increased frequencies of spontaneous abortion and their children had significantly more congenital abnormalities (p less than 0.05). No chronic disease was significantly associated with the exposed group. These findings, together with similar ones from other studies, suggest that it is prudent to minimise exposure to waste anaesthetic gases. PMID:2383519

Use of iris recognition camera technology for the quantification of corneal opacification in mucopolysaccharidoses.

PubMed

Aslam, Tariq Mehmood; Shakir, Savana; Wong, James; Au, Leon; Ashworth, Jane

2012-12-01

Mucopolysaccharidoses (MPS) can cause corneal opacification that is currently difficult to objectively quantify. With newer treatments for MPS comes an increased need for a more objective, valid and reliable index of disease severity for clinical and research use. Clinical evaluation by slit lamp is very subjective and techniques based on colour photography are difficult to standardise. In this article the authors present evidence for the utility of dedicated image analysis algorithms applied to images obtained by a highly sophisticated iris recognition camera that is small, manoeuvrable and adapted to achieve rapid, reliable and standardised objective imaging in a wide variety of patients while minimising artefactual interference in image quality.

The financial and quality-of-life cost to patients living with a chronic wound in the community.

PubMed

Kapp, Suzanne; Santamaria, Nick

2017-12-01

Chronic wounds are associated with financial and personal costs. The system level expense associated with chronic wounds has been established, however, the out-of-pocket cost incurred by individuals who self-fund has not been the focus of extensive investigation. Recently, there has been renewed interest in evaluating quality of life, in line with the shift to patient enablement and self-care in chronic disease management. The objectives of this research were to describe the out-of-pocket wound treatment costs and the quality of life of people who have chronic wounds. A questionnaire incorporating the Cardiff Wound Impact Schedule and purpose-designed instruments was completed by a non-probability, convenience sample of 113 people in Australia and Wales. Data was analysed using descriptive statistics. The sample was on average 63·6 years of age and had wounds that were on an average 109 weeks duration. Participants had spent on average AU$2475 on wound dressing products since the wound started, and AU$121·82 in the most recent 28 days which represented 10% of their disposable income. Health-related quality of life was sub-optimal, 6/10 (ave) according to the Cardiff Wound Impact Schedule. Younger participants reported significantly poorer quality of life on all CWIS sub-scales when compared to older participants. This study found that chronic wounds present a significant financial cost to individuals who must self-fund their wound dressings and other wound treatment related expenses. Participants who had access to wound product subsidisation also experienced personal financial costs. People who have chronic wounds experience sub-optimal quality of life therefore this condition is also costly to the individual's well-being. The quality of life of younger people has not received adequate attention and requires further consideration given the many years that younger people may have to live with this debilitating and often recurrent condition. Continued action is required to reduce the financial and personal costs experienced by people who have chronic wounds. It is imperative that healthcare funding is directed to people who have chronic wounds, in particular to alleviate the out-of-pocket costs experienced by self-funders. Continued attention to the quality of life of people who have chronic wounds is required to minimise the negative effects of this condition and enhance well-being. © 2017 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Integration of environmental aspects in modelling and optimisation of water supply chains.

PubMed

Koleva, Mariya N; Calderón, Andrés J; Zhang, Di; Styan, Craig A; Papageorgiou, Lazaros G

2018-04-26

Climate change becomes increasingly more relevant in the context of water systems planning. Tools are necessary to provide the most economic investment option considering the reliability of the infrastructure from technical and environmental perspectives. Accordingly, in this work, an optimisation approach, formulated as a spatially-explicit multi-period Mixed Integer Linear Programming (MILP) model, is proposed for the design of water supply chains at regional and national scales. The optimisation framework encompasses decisions such as installation of new purification plants, capacity expansion, and raw water trading schemes. The objective is to minimise the total cost incurring from capital and operating expenditures. Assessment of available resources for withdrawal is performed based on hydrological balances, governmental rules and sustainable limits. In the light of the increasing importance of reliability of water supply, a second objective, seeking to maximise the reliability of the supply chains, is introduced. The epsilon-constraint method is used as a solution procedure for the multi-objective formulation. Nash bargaining approach is applied to investigate the fair trade-offs between the two objectives and find the Pareto optimality. The models' capability is addressed through a case study based on Australia. The impact of variability in key input parameters is tackled through the implementation of a rigorous global sensitivity analysis (GSA). The findings suggest that variations in water demand can be more disruptive for the water supply chain than scenarios in which rainfalls are reduced. The frameworks can facilitate governmental multi-aspect decision making processes for the adequate and strategic investments of regional water supply infrastructure. Copyright © 2018. Published by Elsevier B.V.

Intrahospital transfers and adverse patient outcomes: An analysis of administrative health data.

PubMed

Blay, Nicole; Roche, Michael; Duffield, Christine; Xu, Xiaoyue

2017-12-01

To determine whether there was an association between intra-hospital transfers and adverse outcomes. Transfers between clinical units and between beds on the same unit are routine aspects of an episode of care in acute hospitals. The rate of these transfers per episode has increased in response to high occupancy levels, a decline in bed numbers, and increased demand for hospital services. The impact of the number of transfers between both wards and beds on patient outcomes is not widely explored. Retrospective cross sectional design using hospital administrative data. Data were extracted from existing hospital administrative datasets for one large metropolitan hospital for the financial year 2008-09 in Australia (n = 14,133). Descriptive analyses and logistic regression models were developed for each of 3 selected patient outcomes. Nearly one-tenth of patients (9.2%) experienced a fall with injury, 3.8% of surgical patients a wound infection and 0.1% a complication from medication errors. For each bed or ward transfer, the odds of falls and wound infections increased. Medication errors were not associated with either bed or ward moves. Hospitals should minimise the number of bed and ward transfers per episode of care in order to reduce the likelihood of adverse patient outcomes. Current bed management policies and practices should be evaluated and further refined to address this need. Additional strategies include improving coordination and communication during and after transfer. Nurses must consider the potential cost of intrahospital transfers on patients, length of stay and bed availability. © 2017 John Wiley & Sons Ltd.

[Endovascular treatment in acute ischaemic stroke. A stroke care plan for the region of Madrid].

PubMed

Alonso de Leciñana, M; Díaz-Guzmán, J; Egido, J A; García Pastor, A; Martínez-Sánchez, P; Vivancos, J; Díez-Tejedor, E

2013-09-01

Endovascular therapies (intra-arterial thrombolysis and mechanical thrombectomy) after acute ischaemic stroke are being implemented in the clinical setting even as they are still being researched. Since we lack sufficient data to establish accurate evidence-based recommendations for use of these treatments, we must develop clinical protocols based on current knowledge and carefully monitor all procedures. After review of the literature and holding work sessions to reach a consensus among experts, we developed a clinical protocol including indications and contraindications for endovascular therapies use in acute ischaemic stroke. The protocol includes methodology recommendations for diagnosing and selecting patients, performing revascularisation procedures, and for subsequent patient management. Its objective is to increase the likelihood of efficacy and treatment benefit and minimise risk of complications and ineffective recanalisation. Based on an analysis of healthcare needs and available resources, a cooperative inter-hospital care system has been developed. This helps to ensure availability of endovascular therapies to all patients, a fast response time, and a good cost-to-efficacy ratio. It includes also a prospective register which serves to monitor procedures in order to identify any opportunities for improvement. Implementation of endovascular techniques for treating acute ischaemic stroke requires the elaboration of evidence-based clinical protocols and the establishment of appropriate cooperative healthcare networks guaranteeing both the availability and the quality of these actions. Such procedures must be monitored in order to improve methodology. Copyright © 2012 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

Post-marketing surveillance system for drugs in pregnancy--15 years experience of ENTIS.

PubMed

Schaefer, Christof; Hannemann, Doreen; Meister, Reinhard

2005-01-01

Teratology Information Services (TIS) provide the public and health professionals with tailor-made information on drug risks in pregnancy. TIS in Europe, Israel and Latin America collaborate in the European Network of Teratology Information Services (ENTIS) in order to optimise interpretation of risk data, risk communication and risk management as well as recommendations for drug treatment in pregnant women. In addition, efforts are undertaken to enhance and harmonise documentation of exposed pregnancies and their outcomes. These prospectively ascertained data are evaluated like controlled, observational cohort studies, where exposed pregnancies are compared to a non-exposed control group for various outcome variables such as (major) malformations, birth measures and the state of the new-born infant, spontaneous abortion. The prospective methodology minimises recall bias of the studied drugs. Evaluating the data collected according to standardised protocols with appropriate statisticals methods substantially improves risk assessment. The comparison of spontaneous abortions between coumarin exposed pregnancies and controls enrolled in the Berlin TIS demonstrates the benefit of the methodology of survival analysis within the framework of the proportional hazard model. The ENTIS multi-centre approach permits studying large exposed cohorts even with seldomly used medicinal products. In terms of post-marketing surveillance there are no alternatives to TIS data. Data collection by TIS uses an already established risk communication system, and has the advantage of low costs and motivated responders. As a TIS is contacted mainly for insufficiently documented drugs or those suspected of acting as developmental toxicants there is even a selection for products needing research.

Achieving dietary recommendations and reducing greenhouse gas emissions: modelling diets to minimise the change from current intakes.

PubMed

Horgan, Graham W; Perrin, Amandine; Whybrow, Stephen; Macdiarmid, Jennie I

2016-04-07

Average population dietary intakes do not reflect the wide diversity of dietary patterns across the population. It is recognised that most people in the UK do not meet dietary recommendations and have diets with a high environmental impact, but changing dietary habits has proved very difficult. The purpose of this study was to investigate the diversity in dietary changes needed to achieve a healthy diet and a healthy diet with lower greenhouse gas emissions (GHGE) (referred to as a sustainable diet) by taking into account each individual's current diet and then minimising the changes they need to make. Linear programming was used to construct two new diets for each adult in the UK National Diet and Nutrition Survey (n = 1491) by minimising the changes to their current intake. Stepwise changes were applied until (i) dietary recommendations were achieved and (ii) dietary recommendations and a GHGE target were met. First, gradual changes (≤50%) were made to the amount of any foods currently eaten. Second, new foods were added to the diet. Third, greater reductions (≤75%) were made to the amount of any food currently eaten and finally, foods were removed from the diet. One person out of 1491 in the sample met all the dietary requirements based on their reported dietary intake. Only 7.5 and 4.6 % of people achieved a healthy diet and a sustainable diet, respectively, by changing the amount of any food they currently ate by up to 50 %. The majority required changes to the amount of each food eaten plus the addition of new foods. Fewer than 5 % had to remove foods they ate to meet recommendations. Sodium proved the most difficult nutrient recommendation to meet. The healthy diets and sustainable diets produced a 15 and 27 % reduction in greenhouse gas emissions respectively. Since healthy diets alone do not produce substantial reductions in greenhouse gas emissions, dietary guidelines need to include recommendations for environmental sustainability. Minimising the shift from current dietary intakes is likely to make dietary change more realistic and achievable.

Paediatric x-ray radiation dose reduction and image quality analysis.

PubMed

Martin, L; Ruddlesden, R; Makepeace, C; Robinson, L; Mistry, T; Starritt, H

2013-09-01

Collaboration of multiple staff groups has resulted in significant reduction in the risk of radiation-induced cancer from radiographic x-ray exposure during childhood. In this study at an acute NHS hospital trust, a preliminary audit identified initial exposure factors. These were compared with European and UK guidance, leading to the introduction of new factors that were in compliance with European guidance on x-ray tube potentials. Image quality was assessed using standard anatomical criteria scoring, and visual grading characteristics analysis assessed the impact on image quality of changes in exposure factors. This analysis determined the acceptability of gradual radiation dose reduction below the European and UK guidance levels. Chest and pelvis exposures were optimised, achieving dose reduction for each age group, with 7%-55% decrease in critical organ dose. Clinicians confirmed diagnostic image quality throughout the iterative process. Analysis of images acquired with preliminary and final exposure factors indicated an average visual grading analysis result of 0.5, demonstrating equivalent image quality. The optimisation process and final radiation doses are reported for Carestream computed radiography to aid other hospitals in minimising radiation risks to children.

Clinical effectiveness, tolerability and cost-effectiveness of newer drugs for epilepsy in adults: a systematic review and economic evaluation.

PubMed

Wilby, J; Kainth, A; Hawkins, N; Epstein, D; McIntosh, H; McDaid, C; Mason, A; Golder, S; O'Meara, S; Sculpher, M; Drummond, M; Forbes, C

2005-04-01

To examine the clinical effectiveness, tolerability and cost-effectiveness of gabapentin (GBP), lamotrigine (LTG), levetiracetam (LEV), oxcarbazepine (OXC), tiagabine (TGB), topiramate (TPM) and vigabatrin (VGB) for epilepsy in adults. Electronic databases. Internet resources. Pharmaceutical company submissions. Selected studies were screened and quality assessed. Separate analyses assessed clinical effectiveness, serious, rare and long-term adverse events and cost-effectiveness. An integrated economic analysis incorporating information on costs and effects of newer and older antiepileptic drugs (AEDs) was performed to give direct comparisons of long-term costs and benefits. A total of 212 studies were included in the review. All included systematic reviews were Cochrane reviews and of good quality. The quality of randomised controlled trials (RCTs) was variable. Assessment was hampered by poor reporting of methods of randomisation, allocation concealment and blinding. Few of the non-randomised studies were of good quality. The main weakness of the economic evaluations was inappropriate use of the cost-minimisation design. The included systematic reviews reported that newer AEDs were effective as adjunctive therapy compared to placebo. For newer versus older drugs, data were available for all three monotherapy AEDs, although data for OXC and TPM were limited. There was limited, poor-quality evidence of a significant improvement in cognitive function with LTG and OXC compared with older AEDs. However, there were no consistent statistically significant differences in other clinical outcomes, including proportion of seizure-free patients. No studies assessed effectiveness of AEDs in people with intellectual disabilities or in pregnant women. There was very little evidence to assess the effectiveness of AEDs in the elderly; no significant differences were found between LTG and carbamazepine monotherapy. Sixty-seven RCTs compared adjunctive therapy with placebo, older AEDs or other newer AEDs. For newer AEDs versus placebo, a trend was observed in favour of newer drugs, and there was evidence of statistically significant differences in proportion of responders favouring newer drugs. However, it was not possible to assess long-term effectiveness. Most trials were conducted in patients with partial seizures. For newer AEDs versus older drugs, there was no evidence to assess the effectiveness of LEV, LTG or OXC, and evidence for other newer drugs was limited to single studies. Trials only included patients with partial seizures and follow-up was relatively short. There was no evidence to assess effectiveness of adjunctive LEV, OXC or TPM versus other newer drugs, and there were no time to event or cognitive data. No studies assessed the effectiveness of adjunctive AEDs in the elderly or pregnant women. There was some evidence from one study (GBP versus LTG) that both drugs have some beneficial effect on behaviour in people with learning disabilities. Eighty RCTs reported the incidence of adverse events. There was no consistent or convincing evidence to draw any conclusions concerning relative safety and tolerability of newer AEDs compared with each other, older AEDs or placebo. The integrated economic analysis for monotherapy for newly diagnosed patients with partial seizures showed that older AEDs were more likely to be cost-effective, although there was considerable uncertainty in these results. The integrated analysis suggested that newer AEDs used as adjunctive therapy for refractory patients with partial seizures were more effective and more costly than continuing with existing treatment alone. Combination therapy, involving new AEDs, may be cost-effective at a threshold willingness to pay per quality-adjusted life year (QALY) greater than 20,000 pounds, depending on patients' previous treatment history. There was, again, considerable uncertainty in these results. There were few data available to determine effectiveness of treatments for patients with generalised seizures. LTG and VPA showed similar health benefits when used as monotherapy. VPA was less costly and was likely to be cost-effective. The analysis indicated that TPM might be cost-effective when used as an adjunctive therapy, with an estimated incremental cost-effectiveness ratio of 34,500 pounds compared with continuing current treatment alone. There was little good-quality evidence from clinical trials to support the use of newer monotherapy or adjunctive therapy AEDs over older drugs, or to support the use of one newer AED in preference to another. In general, data relating to clinical effectiveness, safety and tolerability failed to demonstrate consistent and statistically significant differences between the drugs. The exception was comparisons between newer adjunctive AEDs and placebo, where significant differences favoured newer AEDs. However, trials often had relatively short-term treatment durations and often failed to limit recruitment to either partial or generalised onset seizures, thus limiting the applicability of the data. Newer AEDs, used as monotherapy, may be cost-effective for the treatment of patients who have experienced adverse events with older AEDs, who have failed to respond to the older drugs, or where such drugs are contraindicated. The integrated economic analysis also suggested that newer AEDs used as adjunctive therapy may be cost-effective compared with the continuing current treatment alone given a QALY of about 20,000 pounds. There is a need for more direct comparisons of the different AEDs within clinical trials, considering different treatment sequences within both monotherapy and adjunctive therapy. Length of follow-up also needs to be considered. Trials are needed that recruit patients with either partial or generalised seizures; that investigate effectiveness and cost-effectiveness in patients with generalised onset seizures and that investigate effectiveness in specific populations of epilepsy patients, as well as studies evaluating cognitive outcomes to use more stringent testing protocols and to adopt a more consistent approach in assessing outcomes. Further research is also required to assess the quality of life within trials of epilepsy therapy using preference-based measures of outcomes that generate cost-effectiveness data. Future RCTs should use CONSORT guidelines; and observational data to provide information on the use of AEDs in actual practice, including details of treatment sequences and doses.

Impact of Friedreich’s Ataxia on health-care resource utilization in the United Kingdom and Germany

PubMed Central

2013-01-01

Background Friedreich’s Ataxia (FRDA) is a neurodegenerative disorder that causes progressive damage to the central and peripheral nervous systems having a significant impact upon quality of life. With little information in the literature, cross-sectional observational studies were conducted in the UK and Germany to collect data on resource use and the burden of the disease on individuals and their caregivers. Methods Cross-sectional observational studies were conducted in the UK and Germany to estimate the burden of FRDA on individuals and on the respective healthcare systems. A total of 75 individuals in the UK and 28 in Germany were recruited to the study. Participants in both countries were asked to complete a Patient and Caregiver Information Form (PCIF), regarding access to, and use of, healthcare resources, and the impact FRDA has on their lifestyle. In Germany, doctors were asked to complete a Patient Record Form (PRF). Analyses of annual direct and indirect resource utilization were conducted for both countries while costs were calculated for the UK only. These figures were compared to the costs associated with Parkinson’s disease; one of the most common neurodegenerative conditions and the one most similar in terms of disease progression. Results The results showed that the annual burden of FRDA is significant and falls on the health and social care sectors, on society, on caregivers and on the individuals themselves. In the UK FRDA had a total annual cost per person of between £11,818 and £18,774 depending on whether the cost of long-term unemployment was included. Typically the largest component of direct costs is associated with professional care. Given the high proportion of children and young adults recruited and the long disease duration, (typically 40-50 years for FRDA, compared with 20 years for Parkinson’s disease), these figures may underestimate the true burden of the disease. Conclusion It is hoped that these estimates of resource utilization, can help in understanding the previously unquantified burden of FRDA. Given the long disease duration, management strategies should seek to minimise the impact of the condition on individuals and their caregivers, while maximising quality of life. PMID:23448170

New drugs from old.

PubMed

2006-10-01

The NHS spends over pound10 billion each year on medicines. The use of generic (patent-expired) medicines rather than branded equivalents has a key role in containing this expenditure and ensuring best value for money. On average, 4 years after the patent of a branded medicine has expired in the UK, generic equivalents will account for around half of the drug's market and cost about a quarter as much as the original brand. This represents a potentially large loss of income and, therefore, a major concern for companies that market branded products. Consequently, many use a long-term strategy known as 'lifecycle management' to minimise loss and to maximise returns from such products. This encompasses prioritising products for development, forming strategic alliances with other companies to share resourses, and utilising legal processes to protect products. One part of this strategy is the development and intensive marketing of new formulations or derivatives of existing medicines nearing the end of their patent life. Here we highlight some key examples of the impact the marketing of such products can have on patients, prescribers and the NHS.

The impact of manufacturing complexity drivers on performance-a preliminary study

NASA Astrophysics Data System (ADS)

Huah Leang, Suh; Mahmood, Wan Hasrulnizzam Wan; Rahman, Muhamad Arfauz A.

2018-03-01

Manufacturing systems, in pursuit of cost, time and flexibility optimisation are becoming more and more complex, exhibiting a dynamic and nonlinear behaviour. Unpredictability is a distinct characteristic of such behaviour and effects production planning significantly. Therefore, this study was undertaken to investigate the priority level and current achievement of manufacturing performance in Malaysia’s manufacturing industry and the complexity drivers on manufacturing productivity performance. The results showed that Malaysia’s manufacturing industry prioritised product quality and they managed to achieve a good on time delivery performance. However, for other manufacturing performance, there was a difference where the current achievement of manufacturing performances in Malaysia’s manufacturing industry is slightly lower than the priority given to them. The strong correlation of significant value for priority status was observed between efficient production levelling (finished goods) and finish product management while the strong correlation of significant value for current achievement was minimised the number of workstation and factory transportation system. This indicates that complexity drivers have an impact towards manufacturing performance. Consequently, it is necessary to identify complexity drivers to achieve well manufacturing performance.

A trans-cultural comparison of the organisation of care at headache centres world-wide.

PubMed

Bhola, Ria; Goadsby, Peter J

2011-02-01

The need to provide better outcomes for patients with headache, and to minimise the costs involved in doing so, has prompted the search for new modes of service delivery by exploring the service organisation and nursing role from various cultural, economic and global perspectives. This study was based on comparisons with the UK headache service up to 2007, the point at which this study was set up. This UK service was based at the National Hospital for Neurology and Neurosurgery (NHNN, UCLH Trust). Data were obtained from US headache centres in 2008 and from centres in Copenhagen, Bangkok, Sydney and Porto Alegre in 2009. A comparison shows the key components of services at all centres showing the team structure and size of service. Prominent features at the centres included: team-working, regular meetings, educational input, good access and communication among team members, headache-trained neurologists, specialist nursing at most centres, and the input of psychological and physical therapists at some centres. The problems of tertiary headache care are very similar throughout the world and seem to transcend ethnic, cultural and economic considerations.

Constrained non-linear multi-objective optimisation of preventive maintenance scheduling for offshore wind farms

NASA Astrophysics Data System (ADS)

Zhong, Shuya; Pantelous, Athanasios A.; Beer, Michael; Zhou, Jian

2018-05-01

Offshore wind farm is an emerging source of renewable energy, which has been shown to have tremendous potential in recent years. In this blooming area, a key challenge is that the preventive maintenance of offshore turbines should be scheduled reasonably to satisfy the power supply without failure. In this direction, two significant goals should be considered simultaneously as a trade-off. One is to maximise the system reliability and the other is to minimise the maintenance related cost. Thus, a non-linear multi-objective programming model is proposed including two newly defined objectives with thirteen families of constraints suitable for the preventive maintenance of offshore wind farms. In order to solve our model effectively, the nondominated sorting genetic algorithm II, especially for the multi-objective optimisation is utilised and Pareto-optimal solutions of schedules can be obtained to offer adequate support to decision-makers. Finally, an example is given to illustrate the performances of the devised model and algorithm, and explore the relationships of the two targets with the help of a contrast model.

Label-free offline versus online activity methods for nucleoside diphosphate kinase b using high performance liquid chromatography.

PubMed

Lima, Juliana Maria; Salmazo Vieira, Plínio; Cavalcante de Oliveira, Arthur Henrique; Cardoso, Carmen Lúcia

2016-08-07

Nucleoside diphosphate kinase from Leishmania spp. (LmNDKb) has recently been described as a potential drug target to treat leishmaniasis disease. Therefore, screening of LmNDKb ligands requires methodologies that mimic the conditions under which LmNDKb acts in biological systems. Here, we compare two label-free methodologies that could help screen LmNDKb ligands and measure NDKb activity: an offline LC-UV assay for soluble LmNDKb and an online two-dimensional LC-UV system based on LmNDKb immobilised on a silica capillary. The target enzyme was immobilised on the silica capillary via Schiff base formation (to give LmNDKb-ICER-Schiff) or affinity attachment (to give LmNDKb-ICER-His). Several aspects of the ICERs resulting from these procedures were compared, namely kinetic parameters, stability, and procedure steps. Both the LmNDKb immobilisation routes minimised the conformational changes and preserved the substrate binding sites. However, considering the number of steps involved in the immobilisation procedure, the cost of reagents, and the stability of the immobilised enzyme, immobilisation via Schiff base formation proved to be the optimal procedure.

A framework to create more mentally healthy workplaces: A viewpoint.

PubMed

Petrie, Katherine; Joyce, Sadhbh; Tan, Leona; Henderson, Max; Johnson, Anya; Nguyen, Helena; Modini, Matthew; Groth, Markus; Glozier, Nicholas; Harvey, Samuel B

2018-01-01

Mental illness is now the leading cause of long-term sickness absence among Australian workers, with significant costs to the individual, their employers and society more broadly. However, to date, there has been little evidence-informed guidance as to what workplaces should be doing to enhance their employees' mental health and wellbeing. In this article, we present a framework outlining the key strategies employers can implement to create more mentally healthy workplaces. The five key strategies outlined are as follows: (1) designing work to minimise harm, (2) building organisational resilience through good management, (3) enhancing personal resilience, (4) promoting early help-seeking and (5) supporting recovery and return to work. A narrative review is utilised to outline the theoretical evidence for this framework and to describe the available research evidence for a number of key example interventions for each of the five strategies. While each workplace needs to develop tailored solutions, the five strategy framework proposed in this review will hopefully provide a simple framework for employers and those advising them to use when judging the adequacy of existing services and considering opportunities for further enhancements.

Approximately adaptive neural cooperative control for nonlinear multiagent systems with performance guarantee

NASA Astrophysics Data System (ADS)

Wang, Jing; Yang, Tianyu; Staskevich, Gennady; Abbe, Brian

2017-04-01

This paper studies the cooperative control problem for a class of multiagent dynamical systems with partially unknown nonlinear system dynamics. In particular, the control objective is to solve the state consensus problem for multiagent systems based on the minimisation of certain cost functions for individual agents. Under the assumption that there exist admissible cooperative controls for such class of multiagent systems, the formulated problem is solved through finding the optimal cooperative control using the approximate dynamic programming and reinforcement learning approach. With the aid of neural network parameterisation and online adaptive learning, our method renders a practically implementable approximately adaptive neural cooperative control for multiagent systems. Specifically, based on the Bellman's principle of optimality, the Hamilton-Jacobi-Bellman (HJB) equation for multiagent systems is first derived. We then propose an approximately adaptive policy iteration algorithm for multiagent cooperative control based on neural network approximation of the value functions. The convergence of the proposed algorithm is rigorously proved using the contraction mapping method. The simulation results are included to validate the effectiveness of the proposed algorithm.

Water in the critical zone: soil, water and life from profile to planet

NASA Astrophysics Data System (ADS)

Kirkby, M. J.

2016-12-01

Earth is unique in the combination of abundant liquid water, plate tectonics and life, providing the broad context within which the critical zone exists, as the surface skin of the land. Global differences in the availability of water provide a major control on the balance of processes operating in the soil, allowing the development of environments as diverse as those dominated by organic soils, by salty deserts or by deeply weathered lateritic profiles. Within the critical zone, despite the importance of water, the complexity of its relationships with the soil material continue to provide many fundamental barriers to our improved understanding, at the scales of pore, hillslope and landscape. Water is also a vital resource for the survival of increasing human populations. Intensive agriculture first developed in semi-arid areas where the availability of solar energy could be combined with irrigation water from more humid areas, minimising the problems of weed control with primitive tillage techniques. Today the challenge to feed the world requires improved, and perhaps novel, ways to optimise the combination of solar energy and water at a sustainable economic and environmental cost.