Polymer-Carbon Nanotube Composites, A Literature Review

DTIC Science & Technology

2004-08-01

have led to improvements in product controllability, yield, and cost . Other aspects of nanotube synthesis currently under scrutiny include study of...progress in many areas of characterization and applications was initially hindered by the high cost of production, as well as the requirement of...processing the nanotubes. In recent years, the production costs have decreased dramatically as a result of the development of new, high-throughput

Cost-effectiveness analysis of malaria chemoprophylaxis for travellers to West-Africa

PubMed Central

2010-01-01

Background The importation of malaria to non-endemic countries remains a major cause of travel-related morbidity and a leading cause of travel-related hospitalizations. Currently they are three priority medications for malaria prophylaxis to West Africa: mefloquine, atovaquone/proguanil and doxycycline. We investigate the cost effectiveness of a partial reimbursement of the cheapest effective malaria chemoprophylaxis (mefloquine) for travellers to high risk areas of malaria transmission compared with the current situation of no reimbursement. Methods This study is a cost-effectiveness analysis based on malaria cases imported from West Africa to Switzerland from the perspective of the Swiss health system. We used a decision tree model and made a literature research on the components of travel related malaria. The main outcome measure was the cost effectiveness of malaria chemoprophylaxis reimbursement based on malaria and deaths averted. Results Using a program where travellers would be reimbursed for 80% of the cost of the cheapest malaria chemoprophylaxis is dominant (i.e. cost saving and more effective than the current situation) using the assumption that currently 68.7% of travellers to West Africa use malaria chemoprophylaxis. If the current usage of malaria chemoprophylaxis would be higher, 82.4%, the incremental cost per malaria case averted is € 2'302. The incremental cost of malaria death averted is € 191'833. The most important factors influencing the model were: the proportion of travellers using malaria chemoprophylaxis, the probability of contracting malaria without malaria chemoprophylaxis, the cost of the mefloquine regimen, the decrease in the number of travellers without malaria chemoprophylaxis in the reimbursement strategy. Conclusions This study suggests that a reimbursement of 80% of the cost of the cheapest effective malaria chemoprophylaxis (mefloquine) for travellers from Switzerland to West Africa is highly effective in terms of malaria cases averted and is cost effective to the Swiss health system. These data are relevant to discussions about the cost effectiveness of malaria chemoprophylaxis reimbursement for vulnerable groups such as those visiting friends and relatives who have the highest risk of malaria, who are least likely to use chemoprophylaxis. PMID:20860809

The Economics of Medicare Accountable Care Organizations

PubMed Central

Blackstone, Erwin A.; Fuhr, Joseph P.

2016-01-01

Background Accountable care organizations (ACOs) have been created to improve patient care, enhance population health, and reduce costs. Medicare in particular has focused on ACOs as a primary device to improve quality and reduce costs. Objective To examine whether the current Medicare ACOs are likely to be successful. Discussion Patients receiving care in ACOs have little incentive to use low-cost quality providers. Furthermore, the start-up costs of ACOs for providers are high, contributing to the minimal financial success of ACOs. We review issues such as reducing readmissions, palliative care, and the difficulty in coordinating care, which are major cost drivers. There are mixed incentives facing hospital-controlled ACOs, whereas physician-controlled ACOs could play hospitals against each other to obtain high quality and cost reductions. This discussion also considers whether the current structure of ACOs is likely to be successful. Conclusion The question remains whether Medicare ACOs can achieve the Triple Aim of “improving the experience of care, improving the health of populations, and reducing per capita costs of health care.” Care coordination in ACOs and information technology are proving more complicated and expensive to implement than anticipated. Even if ACOs can decrease healthcare costs and increase quality, it is unclear if the current incentives system can achieve these objectives. A better public policy may be to implement a system that encompasses the best practices of successful private integrated systems rather than promoting ACOs. PMID:27066191

The Economics of Medicare Accountable Care Organizations.

PubMed

Blackstone, Erwin A; Fuhr, Joseph P

2016-02-01

Accountable care organizations (ACOs) have been created to improve patient care, enhance population health, and reduce costs. Medicare in particular has focused on ACOs as a primary device to improve quality and reduce costs. To examine whether the current Medicare ACOs are likely to be successful. Patients receiving care in ACOs have little incentive to use low-cost quality providers. Furthermore, the start-up costs of ACOs for providers are high, contributing to the minimal financial success of ACOs. We review issues such as reducing readmissions, palliative care, and the difficulty in coordinating care, which are major cost drivers. There are mixed incentives facing hospital-controlled ACOs, whereas physician-controlled ACOs could play hospitals against each other to obtain high quality and cost reductions. This discussion also considers whether the current structure of ACOs is likely to be successful. The question remains whether Medicare ACOs can achieve the Triple Aim of "improving the experience of care, improving the health of populations, and reducing per capita costs of health care." Care coordination in ACOs and information technology are proving more complicated and expensive to implement than anticipated. Even if ACOs can decrease healthcare costs and increase quality, it is unclear if the current incentives system can achieve these objectives. A better public policy may be to implement a system that encompasses the best practices of successful private integrated systems rather than promoting ACOs.

Contrasting benefits of different artemisinin combination therapies as first-line malaria treatments using model-based cost-effectiveness analysis

PubMed Central

Okell, Lucy C.; Cairns, Matthew; Griffin, Jamie T.; Ferguson, Neil M.; Tarning, Joel; Jagoe, George; Hugo, Pierre; Baker, Mark; D’Alessandro, Umberto; Bousema, Teun; Ubben, David; Ghani, Azra C.

2014-01-01

There are currently several recommended drug regimens for uncomplicated falciparum malaria in Africa. Each has different properties that determine its impact on disease burden. Two major antimalarial policy options are artemether–lumefantrine (AL) and dihydroartemisinin–piperaquine (DHA–PQP). Clinical trial data show that DHA–PQP provides longer protection against reinfection, while AL is better at reducing patient infectiousness. Here we incorporate pharmacokinetic-pharmacodynamic factors, transmission-reducing effects and cost into a mathematical model and simulate malaria transmission and treatment in Africa, using geographically explicit data on transmission intensity and seasonality, population density, treatment access and outpatient costs. DHA–PQP has a modestly higher estimated impact than AL in 64% of the population at risk. Given current higher cost estimates for DHA–PQP, there is a slightly greater cost per case averted, except in areas with high, seasonally varying transmission where the impact is particularly large. We find that a locally optimized treatment policy can be highly cost effective for reducing clinical malaria burden. PMID:25425081

Cost-effectiveness analysis of different types of human papillomavirus vaccination combined with a cervical cancer screening program in mainland China.

PubMed

Mo, Xiuting; Gai Tobe, Ruoyan; Wang, Lijie; Liu, Xianchen; Wu, Bin; Luo, Huiwen; Nagata, Chie; Mori, Rintaro; Nakayama, Takeo

2017-07-18

China has a high prevalence of human papillomavirus (HPV) and a consequently high burden of disease with respect to cervical cancer. The HPV vaccine has proved to be effective in preventing cervical cancer and is now a part of routine immunization programs worldwide. It has also proved to be cost effective. This study aimed to assess the cost-effectiveness of 2-, 4-, and 9-valent HPV vaccines (hereafter, HPV2, 4 or 9) combined with current screening strategies in China. A Markov model was developed for a cohort of 100,000 HPV-free girls to simulate the natural history to HPV infection. Three recommended screening methods (1. liquid-based cytology test + HPV DNA test; 2. pap smear cytology test + HPV DNA test; 3. visual inspection with acetic acid) and three types of HPV vaccination program (HPV2/4/9) were incorporated into 15 intervention options, and the incremental cost-effectiveness ratio (ICER) was calculated to determine the dominant strategies. Costs, transition probabilities and utilities were obtained from a review of the literature and national databases. One-way sensitivity analyses and threshold analyses were performed for key variables in different vaccination scenarios. HPV9 combined with screening showed the highest health impact in terms of reducing HPV-related diseases and increasing the number of quality-adjusted life years (QALYs). Under the current thresholds of willingness to pay (WTP, 3 times the per capita GDP or USD$ 23,880), HPV4/9 proved highly cost effective, while HPV2 combined with screening cost more and was less cost effective. Only when screening coverage increased to 60% ~ 70% did the HPV2 and screening combination strategy become economically feasible. The combination of the HPV4/9 vaccine with current screening strategies for adolescent girls was highly cost-effective and had a significant impact on reducing the HPV infection-related disease burden in Mainland China.

Enabling cost-effective high-current burst-mode operation in superconducting accelerators

DOE PAGES

Sheffield, Richard L.

2015-06-01

Superconducting (SC) accelerators are very efficient for CW or long-pulse operation, and normal conducting (NC) accelerators are cost effective for short-pulse operation. The addition of a short NC linac section to a SC linac can correct for the energy droop that occurs when pulsed high-current operation is required that exceeds the capability of the klystrons to replenish the cavity RF fields due to the long field fill-times of SC structures, or a requirement to support a broad range of beam currents results in variable beam loading. This paper describes the implementation of this technique to enable microseconds of high beam-current,more » 90 mA or more, in a 12 GeV SC long-pulse accelerator designed for the MaRIE 42-keV XFEL proposed for Los Alamos National Laboratory.« less

NASA Affordable Vehicle Avionics (AVA). Common Modular Avionics System for Nanolaunchers Offering Affordable Access to Space; [Space Technology: Game Changing Development

NASA Technical Reports Server (NTRS)

Aquilina, Rudy

2017-01-01

Small satellites are becoming ever more capable of performing valuable missions for both government and commercial customers. However, currently these satellites can be launched affordably only as secondary payloads. This makes it difficult for the small satellite mission to launch when needed, to the desired orbit, and with acceptable risk. What is needed is a class of low-cost launchers, so that launch costs to low-Earth orbit (LEO) are commensurate with payload costs. Several private and government-sponsored launch vehicle developers are working toward just that-the ability to affordably insert small payloads into LEO. But until now, cost of the complex avionics remained disproportionately high. AVA (Affordable Vehicle Avionics) solves this problem. Significant contributors to the cost of launching nanosatellites to orbit are the avionics and software systems that steer and control the launch vehicles, sequence stage separation, deploy payloads, and telemeter data. The high costs of these guidance, navigation and control (GNC) avionics systems are due in part to the current practice of developing unique, single-use hardware and software for each launch. High-performance, high-reliability inertial sensors components with heritage from legacy launchers also contribute to costs-but can low-cost commercial inertial sensors work just as well? NASA Ames Research Center has developed and tested a prototype low-cost avionics package for space launch vehicles that provides complete GNC functionality in a package smaller than a tissue box (100 millimeters by 120 millimeters by 69 millimeters; 4 inches by 4.7 inches by 2.7 inches), with a mass of less than 0.84 kilogram (2 pounds. AVA takes advantage of commercially available, low-cost, mass-produced, miniaturized sensors, filtering their more noisy inertial data with real-time GPS (Global Positioning Satellite) data. The goal of the AVA project is to produce and light-verify a common suite of avionics and software that deliver affordable, capable GNC and telemetry avionics with application to multiple nanolaunch vehicles at 1 percent of the cost of current state-of-the-art avionics.

The Cost-Effectiveness of Vedolizumab for Inflammatory Bowel Disease: A Review of the Current Literature

PubMed Central

Saumoy, Monica; Cohen-Mekelburg, Shirley; Steinlauf, Adam F.; Scherl, Ellen J.

2016-01-01

The United States spends a greater share per gross domestic product on health care than any other developed country in the world. Cost-conscious, high-value care has an important role in the practice of medicine. Inflammatory bowel disease (IBD) affects 1.6 million people in the United States and is responsible for significant health care costs, with estimates as high as $31.6 billion annually, a large portion of which is attributable to the use of biologic therapies. As the number of therapeutic targets for IBD expands, gastroenterologists can anticipate the arrival of novel therapeutic agents on the market, and these may carry significant costs. Vedolizumab, a monoclonal antibody directed against the gut-selective integrin α4β7, is a novel biologic agent approved for the treatment of Crohn’s disease and ulcerative colitis. Cost-effectiveness is an area of research that aims to assess the added value (in terms of both cost and utility) of diagnostic or therapeutic interventions. This article reviews the current literature evaluating the cost-effectiveness of vedolizumab for the treatment of IBD. PMID:27917076

Integrated Testing, Simulation and Analysis of Electric Drive Options for Medium-Duty Parcel Delivery Vehicles: Preprint

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

Ramroth, L. A.; Gonder, J.; Brooker, A.

2012-09-01

The National Renewable Energy Laboratory verified diesel-conventional and diesel-hybrid parcel delivery vehicle models to evaluate petroleum reduction and cost implications of plug-in hybrid gasoline and diesel variants. These variants are run on a field-data-derived design matrix to analyze the effects of drive cycle, distance, battery replacements, battery capacity, and motor power on fuel consumption and lifetime cost. Two cost scenarios using fuel prices corresponding to forecasted highs for 2011 and 2030 and battery costs per kilowatt-hour representing current and long-term targets compare plug-in hybrid lifetime costs with diesel conventional lifetime costs. Under a future cost scenario of $100/kWh battery energymore » and $5/gal fuel, plug-in hybrids are cost effective. Assuming a current cost of $700/kWh and $3/gal fuel, they rarely recoup the additional motor and battery cost. The results highlight the importance of understanding the application's drive cycle, daily driving distance, and kinetic intensity. For instances in the current-cost scenario where the additional plug-in hybrid cost is regained in fuel savings, the combination of kinetic intensity and daily distance travelled does not coincide with the usage patterns observed in the field data. If the usage patterns were adjusted, the hybrids could become cost effective.« less

Following the Money: Factors Associated with the Cost of Treating High-Cost Medicare Beneficiaries

PubMed Central

Reschovsky, James D; Hadley, Jack; Saiontz-Martinez, Cynthia B; Boukus, Ellyn R

2011-01-01

Objective To identify factors associated with the cost of treating high-cost Medicare beneficiaries. Data Sources A national sample of 1.6 million elderly, Medicare beneficiaries linked to 2004–2005 Community Tracking Study Physician Survey respondents and local market data from secondary sources. Study Design Using 12 months of claims data from 2005 to 2006, the sample was divided into predicted high-cost (top quartile) and lower cost beneficiaries using a risk-adjustment model. For each group, total annual standardized costs of care were regressed on beneficiary, usual source of care physician, practice, and market characteristics. Principal Findings Among high-cost beneficiaries, health was the predominant predictor of costs, with most physician and practice and many market factors (including provider supply) insignificant or weakly related to cost. Beneficiaries whose usual physician was a medical specialist or reported inadequate office visit time, medical specialist supply, provider for-profit status, care fragmentation, and Medicare fees were associated with higher costs. Conclusions Health reform policies currently envisioned to improve care and lower costs may have small effects on high-cost patients who consume most resources. Instead, developing interventions tailored to improve care and lowering cost for specific types of complex and costly patients may hold greater potential for “bending the cost curve.” PMID:21306368

The Sponge Pump: The Role of Current Induced Flow in the Design of the Sponge Body Plan

PubMed Central

Leys, Sally P.; Yahel, Gitai; Reidenbach, Matthew A.; Tunnicliffe, Verena; Shavit, Uri; Reiswig, Henry M.

2011-01-01

Sponges are suspension feeders that use flagellated collar-cells (choanocytes) to actively filter a volume of water equivalent to many times their body volume each hour. Flow through sponges is thought to be enhanced by ambient current, which induces a pressure gradient across the sponge wall, but the underlying mechanism is still unknown. Studies of sponge filtration have estimated the energetic cost of pumping to be <1% of its total metabolism implying there is little adaptive value to reducing the cost of pumping by using “passive” flow induced by the ambient current. We quantified the pumping activity and respiration of the glass sponge Aphrocallistes vastus at a 150 m deep reef in situ and in a flow flume; we also modeled the glass sponge filtration system from measurements of the aquiferous system. Excurrent flow from the sponge osculum measured in situ and in the flume were positively correlated (r>0.75) with the ambient current velocity. During short bursts of high ambient current the sponges filtered two-thirds of the total volume of water they processed daily. Our model indicates that the head loss across the sponge collar filter is 10 times higher than previously estimated. The difference is due to the resistance created by a fine protein mesh that lines the collar, which demosponges also have, but was so far overlooked. Applying our model to the in situ measurements indicates that even modest pumping rates require an energetic expenditure of at least 28% of the total in situ respiration. We suggest that due to the high cost of pumping, current-induced flow is highly beneficial but may occur only in thin walled sponges living in high flow environments. Our results call for a new look at the mechanisms underlying current-induced flow and for reevaluation of the cost of biological pumping and its evolutionary role, especially in sponges. PMID:22180779

Acceleration of the Enzymatic Hydrolysis of Cotton Waste Celluloses by Low Intensity Uniform Ultrasound Field

USDA-ARS?s Scientific Manuscript database

The cost-competitive production of bio-ethanol and other biofuels is currently impeded, mostly by high cost and low efficiency of enzymatic hydrolysis of feedstock biomass and especially plant celluloses. Despite substantial reduction in the cost of production of cellulolytic enzymes in recent times...

High-resolution wavefront control of high-power laser systems

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

Brase, J; Brown, C; Carrano, C

1999-07-08

Nearly every new large-scale laser system application at LLNL has requirements for beam control which exceed the current level of available technology. For applications such as inertial confinement fusion, laser isotope separation, laser machining, and laser the ability to transport significant power to a target while maintaining good beam quality is critical. There are many ways that laser wavefront quality can be degraded. Thermal effects due to the interaction of high-power laser or pump light with the internal optical components or with the ambient gas are common causes of wavefront degradation. For many years, adaptive optics based on thing deformablemore » glass mirrors with piezoelectric or electrostrictive actuators have be used to remove the low-order wavefront errors from high-power laser systems. These adaptive optics systems have successfully improved laser beam quality, but have also generally revealed additional high-spatial-frequency errors, both because the low-order errors have been reduced and because deformable mirrors have often introduced some high-spatial-frequency components due to manufacturing errors. Many current and emerging laser applications fall into the high-resolution category where there is an increased need for the correction of high spatial frequency aberrations which requires correctors with thousands of degrees of freedom. The largest Deformable Mirrors currently available have less than one thousand degrees of freedom at a cost of approximately $1M. A deformable mirror capable of meeting these high spatial resolution requirements would be cost prohibitive. Therefore a new approach using a different wavefront control technology is needed. One new wavefront control approach is the use of liquid-crystal (LC) spatial light modulator (SLM) technology for the controlling the phase of linearly polarized light. Current LC SLM technology provides high-spatial-resolution wavefront control, with hundreds of thousands of degrees of freedom, more than two orders of magnitude greater than the best Deformable Mirrors currently made. Even with the increased spatial resolution, the cost of these devices is nearly two orders of magnitude less than the cost of the largest deformable mirror.« less

Economic analysis of prenatal screening strategies for Down syndrome in singleton pregnancies in Turkey.

PubMed

Ökem, Zeynep Güldem; Örgül, Gökçen; Kasnakoglu, Berna Tari; Çakar, Mehmet; Beksaç, M Sinan

2017-12-01

To examine the costs and outcomes of different screening strategies for Down Syndrome (DS) in singleton pregnancies. A decision-analytic model was developed to compare the costs and the outcomes of different prenatal screening strategies. Five strategies were compared for women under 35-year of age: 1A) triple test (TT), 2A); combined test (CT), 3A) Non-invasive Prenatal Screening Test by using cell free fetal DNA (NIPT), 4A) and 5A) NIPT as a second-step screening for high-risk patients detected by either TT, or CT respectively. For women ≥35-year of age, 1B) implementing invasive test (amniocentesis -AC) and 2B) NIPT for all women were compared. Data was analyzed to obtain the outcomes, total costs, the cost per women and the incremental cost-effectiveness ratios (ICERs) for screening strategies. Among the current strategies for women under 35 years old, CT is clearly dominated to TT, as it is more effective and less costly. Although, the current routine practice (2A) is the least-costly strategy, implementing NIPT as a second step screening to high-risk women identified by CT (5A) would be more effective than 2A; leading to a 10.2% increase in the number of detected DS cases and a 96.3% reduction in procedural related losses (PRL). However, its cost to the Social Security Institution that is a public entity would be 17 times higher and increase screening costs by 1.5 times. Strategy 5A would result in an incremental cost effectiveness of 6,873,082 (PPP) US$ when compared to the current one (2A). Strategy 1B-for offering AC to all women ≥35-year of age is dominated over NIPT (2B), as it would detect more DS cases and would be less costly. On the other hand, there would be 206 PRL associated with AC, but NIPT provides clear clinical benefits as there would be no PRL with NIPT. NIPT leads to very high costs despite its high effectiveness in terms of detecting DS cases and avoiding PRL. The cost of NIPT should be decreased, otherwise, only individuals who can afford to pay from out-of-pocket could benefit. We believe that reliable cost-effective prenatal screening policies are essential in countries with low and smiddle income and high birth rates as well. Copyright © 2017 Elsevier B.V. All rights reserved.

Impact of Patient and Procedure Mix on Finances of Perinatal Centres – Theoretical Models for Economic Strategies in Perinatal Centres

PubMed Central

Hildebrandt, T.; Kraml, F.; Wagner, S.; Hack, C. C.; Thiel, F. C.; Kehl, S.; Winkler, M.; Frobenius, W.; Faschingbauer, F.; Beckmann, M. W.; Lux, M. P.

2013-01-01

Introduction: In Germany, cost and revenue structures of hospitals with defined treatment priorities are currently being discussed to identify uneconomic services. This discussion has also affected perinatal centres (PNCs) and represents a new economic challenge for PNCs. In addition to optimising the time spent in hospital, the hospital management needs to define the “best” patient mix based on costs and revenues. Method: Different theoretical models were proposed based on the cost and revenue structures of the University Perinatal Centre for Franconia (UPF). Multi-step marginal costing was then used to show the impact on operating profits of changes in services and bed occupancy rates. The current contribution margin accounting used by the UPF served as the basis for the calculations. The models demonstrated the impact of changes in services on costs and revenues of a level 1 PNC. Results: Contribution margin analysis was used to calculate profitable and unprofitable DRGs based on average inpatient cost per day. Nineteen theoretical models were created. The current direct costing used by the UPF and a theoretical model with a 100 % bed occupancy rate were used as reference models. Significantly higher operating profits could be achieved by doubling the number of profitable DRGs and halving the number of less profitable DRGs. Operating profits could be increased even more by changing the rates of profitable DRGs per bed occupancy. The exclusive specialisation on pathological and high-risk pregnancies resulted in operating losses. All models which increased the numbers of caesarean sections or focused exclusively on c-sections resulted in operating losses. Conclusion: These theoretical models offer a basis for economic planning. They illustrate the enormous impact potential changes can have on the operating profits of PNCs. Level 1 PNCs require high bed occupancy rates and a profitable patient mix to cover the extremely high costs incurred due to the services they are legally required to offer. Based on our theoretical models it must be stated that spontaneous vaginal births (not caesarean sections) were the most profitable procedures in the current DRG system. Overall, it currently makes economic sense for level I PNCs to treat as many low-risk pregnancies and neonates as possible to cover costs. PMID:24771932

Advanced development of TFA-MOD coated conductors

NASA Astrophysics Data System (ADS)

Rupich, M. W.; Li, X.; Sathyamurthy, S.; Thieme, C.; Fleshler, S.

2011-11-01

American Superconductor is manufacturing 2G wire for initial commercial applications. The 2G wire properties satisfy the requirements for these initial projects; however, improvements in the critical current, field performance and cost are required to address the broad range of potential commercial and military applications. In order to meet the anticipated the performance and cost requirements, AMSC's R&D effort is focused on two major areas: (1) higher critical current and (2) enhanced flux pinning. AMSC's current 2G production wire, designed around a 0.8 μm thick YBCO layer deposited by a Metal Organic Deposition (MOD) process, carries a critical current in the range of 200-300 A/cm-w (77 K, sf). Achieving higher critical current requires increasing the thickness of the YBCO layer. This paper describes recent progress at AMSC on increasing the critical current of MOD-YBCO films using processes compatible with low-cost, high-rate manufacturing.

Technology of Performance Improvement Brushless DC Motors and Inverter for Air conditioning

NASA Astrophysics Data System (ADS)

Baba, Kazuhiko; Matsuoka, Atsushi; Shinomoto, Yosuke; Arisawa, Koichi

High efficiency motors are demanded because of the viewpoint of environmental preservation. It is necessary to develop the technology of the energy conservation that can be achieved at low cost so that we may expand high efficiency motors onto the world. In this paper, the current status of the brushless DC motors and invertors to satisfy high efficiency, small size, high power and low cost is reviewed.

Supply of reactants for Redox bulk energy storage systems

NASA Technical Reports Server (NTRS)

Gahn, R. F.

1978-01-01

World resources, reserves, production, and costs of reactant materials, iron, chromium, titanium and bromine for proposed redox cell bulk energy storage systems are reviewed. Supplying required materials for multimegawatt hour systems appears to be feasible even at current production levels. Iron and chromium ores are the most abundant and lowest cost of four reactants. Chromium is not a domestic reserve, but redox system installations would represent a small fraction of U.S. imports. Vast quantities of bromine are available, but present production is low and therefore cost is high. Titanium is currently available at reasonable cost, with ample reserves available for the next fifty years.

Occupational injury costs and alternative employment in construction trades.

PubMed

Waehrer, Geetha M; Dong, Xiuwen S; Miller, Ted; Men, Yurong; Haile, Elizabeth

2007-11-01

To present the costs of fatal and non-fatal days-away-from-work injuries in 50 construction occupations. Our results also provide indirect evidence on the cost exposure of alternative construction workers such as independent contractors, on-call or day labor, contract workers, and temporary workers. We combine data from the Bureau of Labor Statistics on average annual incidence from 2000 to 2002 with updated per-case costs from an existing cost model for occupational injuries. The Current Population Survey provides data on the percentage of alternative construction workers. Construction laborers and carpenters were the two costliest occupations, with 40% of the industry's injury costs. The 10 costliest construction occupations also have a high percentage of alternative workers. The construction industry has both a high rate of alternative employment and high costs of work injury. Alternative workers, often lacking workers' compensation, are especially exposed to injury costs.

The role of satisfaction and switching costs in Medicare Part D choices.

PubMed

Han, Jayoung; Ko, Dong Woo; Urmie, Julie M

2014-01-01

Most U.S. states had over 50 Medicare Prescription Drug Plans (PDPs) in 2007. Medicare beneficiaries are expected to switch Part D plans based on their health and financial needs; however, the switching rate has been low. Such consumer inertia potentially has negative effects on both beneficiaries and the insurance market, resulting in a critical need to investigate its cause. To 1) describe how Medicare beneficiaries who were satisfied with their current Part D plan differed from those who were not satisfied; 2) examine the effect of switching costs on consideration of switching among Medicare beneficiaries who were dissatisfied with their current Part D plan. Data from the 2007 Prescription Drug Study supplement to the Health and Retirement Study (HRS) survey were used in this study. The satisfied and dissatisfied groups were compared in terms of cost variables, switching costs, and perception of Part D complexity. Structural equation modeling was used to examine relationships among switching costs, Part D complexity, cost variables, and consideration of switching for beneficiaries who were dissatisfied with their current Part D coverage. Out of 467 participants, a total of 255 (54.6%) were satisfied with their current Part D plan. The satisfied group paid lower out-of-pocket costs ($50.63 vs. $114.60) and premiums ($30.88 vs. $40.77) than the dissatisfied group. They also had lower switching costs. Only 11.3% of the dissatisfied beneficiaries switched plans. Among respondents who were dissatisfied with their current plan, those who perceived Part D as complex had high switching costs and were less likely to consider switching plans. Out-of-pocket cost did not have a statistically significant association with consideration of switching. Medicare beneficiaries who were satisfied with their current Part D plans had lower out-of-pocket costs and premiums as well as higher switching costs. Among beneficiaries who were dissatisfied with their current Part D plan, those who had higher switching costs were less likely to consider switching Part D plans. Copyright © 2014 Elsevier Inc. All rights reserved.

A feasibility study to determine if there is a market for automatic meter-reading devices

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

Hilberg, G.R.

1996-08-01

For many utilities the cost of manually reading meters is increasing due to personnel expenses and equipment costs. The current system of manual meters provides little ability for the utility to reduce costs. To reduce meter reading costs the utility must automate the manual system and reduce personnel expenses. A water utility in San Diego county was studied to calculate the cost of reading individual water meters. This would allow for the selective replacement of {open_quotes}high-cost{close_quotes} meters to quickly reduce meter-reading costs while limiting the necessary capital investments. As the {open_quotes}high-cost{close_quotes} meters are selectively replaced, a utility with a significantmore » difference in individual meter reading costs could save three to five dollars per meter per year. This study showed that the {open_quotes}high-cost{close_quotes} meters were six times more expensive to read than the average meter. Additionally, AMR systems increase the information available to consumers and to the utility on usage patterns and problems. The challenge was to cost effectively identify the {open_quotes}high-cost{close_quotes} meters. The costs to collect these data were less than $500.« less

Middle Income Students and the Cost of Postsecondary Education.

ERIC Educational Resources Information Center

Froomkin, Joseph; And Others

Current proposals to assist middle-income groups with college costs and estimates of the burden to parents in different income groups are considered. Reasons for discontent by middle-income and upper-income groups regarding college costs are considered in relation to the following issues: the demographic squeeze, the temptation to choose high-cost…

Acceleration of the Enzymatic Hydrolysis of Corn Stover and Sugar Cane Bagasse Celluloses by Low Intensity Uniform Ultrasound

USDA-ARS?s Scientific Manuscript database

The cost-competitive production of bio-ethanol and other biofuels is currently impeded, mostly by high cost and low efficiency of enzymatic hydrolysis of feedstock biomass and especially plant celluloses. Despite substantial reduction in the cost of production of cellulolytic enzymes in recent times...

Present status and future prospects of heavy ion beams as drivers for ICF

NASA Astrophysics Data System (ADS)

Godlove, Terry F.

1986-01-01

A candidate driver for a practical inertial fusion reactor system must, among other characteristics, be cost effective and reliable for the parameters required by the fusion target and the remainder of the system. Although the history of large particle accelerators provides abundant evidence of their reliability at high repetition rates, their capital cost for the fusion application has been open to question. Attempts to design cost effective systems began with accelerators based on currently available technology such as RF linacs and storage rings. The West German HIBALL and the Japanese HIBLIC are examples of this initial effort. These designs are sufficiently credible that a strong argument can be made for the heavy ion method in general, but to reduce the cost per unit power it was found necessary to design for large scale, hence high capital cost. Emphasis in the U.S. shifted to newer technologies which offer hope of significant improvement in cost. In this paper the status of various heavy ion driver designs are compared with currently perceived requirements in order to illustrate their potential and assess their development needs.

Can we afford to offer pre-exposure prophylaxis to MSM in Catalonia? Cost-effectiveness analysis and budget impact assessment.

PubMed

Reyes-Urueña, J; Campbell, C; Diez, E; Ortún, V; Casabona, J

2018-06-01

Pre-exposure prophylaxis (PrEP) effectiveness has been well established. This study aims to assess the cost-effectiveness of providing PrEP, estimate the number of eligible MSM, and its budget impact in Catalonia. Cost-effectiveness analysis compared costs of on daily basis and "on demand" PrEP to prevent one infection with lifetime costs of one HIV infection. We estimated the total cost of providing PrEP by estimating number of eligible MSM, and included in the budget impact assessment antiretroviral and laboratory costs. Costs were lower for the on-demand PrEP group by €64015.1 and the incremental benefit was nearly 15 life-years and 17 quality-adjusted life-years gained. The incremental cost-effectiveness ratio (ICER) was cost-effective at €6281.62 when undiscounted PrEP was given daily. On-demand PrEP can be considered cost-saving in 20 years if the price is reduced by 90%. The number of eligible MSM in Catalonia ranges from 5,989 to 10,972. At current antiretroviral costs, the annual cost would range between €25.3-46.7 million/year (on demand PrEP), and €42.9-78.7 million/year (daily basis PrEP). PrEP is most cost-effective if targeted towards groups with high incidence rates of over 3%/year. Beneficial ICER depends on reducing the current price of Truvada® and ensuring that effectiveness is maintained at high levels.

Critical operations capabilities in a high cost environment: a multiple case study

NASA Astrophysics Data System (ADS)

Sansone, C.; Hilletofth, P.; Eriksson, D.

2018-04-01

Operations capabilities have been a popular research area for many years and several frameworks have been proposed in the literature. The current frameworks do not take specific contexts into consideration, for instance a high cost environment. This research gap is of particular interest since a manufacturing relocation process has been ongoing the last decades, leading to a huge amount of manufacturing being moved from high to low cost environments. The purpose of this study is to identify critical operations capabilities in a high cost environment. The two research questions were: What are the critical operations capabilities dimensions in a high cost environment? What are the critical operations capabilities in a high cost environment? A multiple case study was conducted and three Swedish manufacturing firms were selected. The study was based on the investigation of an existing framework of operations capabilities. The main dimensions of operations capabilities included in the framework were: cost, quality, delivery, flexibility, service, innovation and environment. Each of the dimensions included two or more operations capabilities. The findings confirmed the validity of the framework and its usefulness in a high cost environment and a new operations capability was revealed (employee flexibility).

Cost-effectiveness of interventions to prevent alcohol-related disease and injury in Australia.

PubMed

Cobiac, Linda; Vos, Theo; Doran, Christopher; Wallace, Angela

2009-10-01

To evaluate cost-effectiveness of eight interventions for reducing alcohol-attributable harm and determine the optimal intervention mix. Interventions include volumetric taxation, advertising bans, an increase in minimum legal drinking age, licensing controls on operating hours, brief intervention (with and without general practitioner telemarketing and support), drink driving campaigns, random breath testing and residential treatment for alcohol dependence (with and without naltrexone). Cost-effectiveness is modelled over the life-time of the Australian population in 2003, with all costs and health outcomes evaluated from an Australian health sector perspective. Each intervention is compared with current practice, and the most cost-effective options are then combined to determine the optimal intervention mix. Cost-effectiveness is measured in 2003 Australian dollars per disability adjusted life year averted. Although current alcohol intervention in Australia (random breath testing) is cost-effective, if the current spending of $71 million could be invested in a more cost-effective combination of interventions, more than 10 times the amount of health gain could be achieved. Taken as a package of interventions, all seven preventive interventions would be a cost-effective investment that could lead to substantial improvement in population health; only residential treatment is not cost-effective. Based on current evidence, interventions to reduce harm from alcohol are highly recommended. The potential reduction in costs of treating alcohol-related diseases and injuries mean that substantial improvements in population health can be achieved at a relatively low cost to the health sector. © 2009 The Authors. Journal compilation © 2009 Society for the Study of Addiction.

Highly Proficient Bilinguals Implement Inhibition: Evidence from N-2 Language Repetition Costs

ERIC Educational Resources Information Center

Declerck, Mathieu; Thoma, Aniella M.; Koch, Iring; Philipp, Andrea M.

2015-01-01

Several, but not all, models of language control assume that highly proficient bilinguals implement little to no inhibition during bilingual language production. In the current study, we tested this assumption with a less equivocal marker of inhibition (i.e., n-2 language repetition costs) than previous language switching studies have. N-2…

Cost-effectiveness and resource implications of aggressive action on tuberculosis in China, India, and South Africa: a combined analysis of nine models.

PubMed

Menzies, Nicolas A; Gomez, Gabriela B; Bozzani, Fiammetta; Chatterjee, Susmita; Foster, Nicola; Baena, Ines Garcia; Laurence, Yoko V; Qiang, Sun; Siroka, Andrew; Sweeney, Sedona; Verguet, Stéphane; Arinaminpathy, Nimalan; Azman, Andrew S; Bendavid, Eran; Chang, Stewart T; Cohen, Ted; Denholm, Justin T; Dowdy, David W; Eckhoff, Philip A; Goldhaber-Fiebert, Jeremy D; Handel, Andreas; Huynh, Grace H; Lalli, Marek; Lin, Hsien-Ho; Mandal, Sandip; McBryde, Emma S; Pandey, Surabhi; Salomon, Joshua A; Suen, Sze-Chuan; Sumner, Tom; Trauer, James M; Wagner, Bradley G; Whalen, Christopher C; Wu, Chieh-Yin; Boccia, Delia; Chadha, Vineet K; Charalambous, Salome; Chin, Daniel P; Churchyard, Gavin; Daniels, Colleen; Dewan, Puneet; Ditiu, Lucica; Eaton, Jeffrey W; Grant, Alison D; Hippner, Piotr; Hosseini, Mehran; Mametja, David; Pretorius, Carel; Pillay, Yogan; Rade, Kiran; Sahu, Suvanand; Wang, Lixia; Houben, Rein M G J; Kimerling, Michael E; White, Richard G; Vassall, Anna

2016-11-01

The post-2015 End TB Strategy sets global targets of reducing tuberculosis incidence by 50% and mortality by 75% by 2025. We aimed to assess resource requirements and cost-effectiveness of strategies to achieve these targets in China, India, and South Africa. We examined intervention scenarios developed in consultation with country stakeholders, which scaled up existing interventions to high but feasible coverage by 2025. Nine independent modelling groups collaborated to estimate policy outcomes, and we estimated the cost of each scenario by synthesising service use estimates, empirical cost data, and expert opinion on implementation strategies. We estimated health effects (ie, disability-adjusted life-years averted) and resource implications for 2016-35, including patient-incurred costs. To assess resource requirements and cost-effectiveness, we compared scenarios with a base case representing continued current practice. Incremental tuberculosis service costs differed by scenario and country, and in some cases they more than doubled existing funding needs. In general, expansion of tuberculosis services substantially reduced patient-incurred costs and, in India and China, produced net cost savings for most interventions under a societal perspective. In all three countries, expansion of access to care produced substantial health gains. Compared with current practice and conventional cost-effectiveness thresholds, most intervention approaches seemed highly cost-effective. Expansion of tuberculosis services seems cost-effective for high-burden countries and could generate substantial health and economic benefits for patients, although substantial new funding would be required. Further work to determine the optimal intervention mix for each country is necessary. Bill & Melinda Gates Foundation. Copyright © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license. Published by Elsevier Ltd.. All rights reserved.

Highly reusable space transportation: Approaches for reducing ETO launch costs to $100 - $200 per pound of payload

NASA Technical Reports Server (NTRS)

Olds, John R.

1995-01-01

The Commercial Space Transportation Study (CSTS) suggests that considerable market expansion in earth-to-orbit transportation would take place if current launch prices could be reduced to around $400 per pound of payload. If these low prices can be achieved, annual payload delivered to low earth orbit (LEO) is predicted to reach 6.7 million pounds. The primary market growth will occur in communications, government missions, and civil transportation. By establishing a cost target of $100-$200 per pound of payload for a new launch system, the Highly Reusable Space Transportation (HRST) program has clearly set its sights on removing the current restriction on market growth imposed by today's high launch costs. In particular, achieving the goal of $100-$200 per pound of payload will require significant coordinated efforts in (1) marketing strategy development, (2) business planning, (3) system operational strategy, (4) vehicle technical design, and (5) vehicle maintenance strategy.

Efficiency and cost advantages of an advanced-technology nuclear electrolytic hydrogen-energy production facility

NASA Technical Reports Server (NTRS)

Donakowski, T. D.; Escher, W. J. D.; Gregory, D. P.

1977-01-01

The concept of an advanced-technology (viz., 1985 technology) nuclear-electrolytic water electrolysis facility was assessed for hydrogen production cost and efficiency expectations. The facility integrates (1) a high-temperature gas-cooled nuclear reactor (HTGR) operating a binary work cycle, (2) direct-current (d-c) electricity generation via acyclic generators, and (3) high-current-density, high-pressure electrolyzers using a solid polymer electrolyte (SPE). All subsystems are close-coupled and optimally interfaced for hydrogen production alone (i.e., without separate production of electrical power). Pipeline-pressure hydrogen and oxygen are produced at 6900 kPa (1000 psi). We found that this advanced facility would produce hydrogen at costs that were approximately half those associated with contemporary-technology nuclear electrolysis: $5.36 versus $10.86/million Btu, respectively. The nuclear-heat-to-hydrogen-energy conversion efficiency for the advanced system was estimated as 43%, versus 25% for the contemporary system.

Cost analysis of open radical cystectomy versus robot-assisted radical cystectomy.

PubMed

Mmeje, Chinedu O; Martin, Aaron D; Nunez-Nateras, Rafael; Parker, Alexander S; Thiel, David D; Castle, Erik P

2013-02-01

Bladder cancer is the fourth and ninth most common malignancy in males and females, respectively, in the U.S. and one of the most costly cancers to manage. With the current economic condition, physicians will need to become more aware of cost-effective therapies for the treatment of various malignancies. Robot-assisted radical cystectomy (RARC) is the latest minimally invasive surgical option for muscle-invasive bladder cancer. Current reports have shown less blood loss, a shorter hospital stay, and a lower morbidity with RARC, as compared with the traditional open radical cystectomy (ORC), although long-term oncologic results of RARC are still maturing. There are few studies that have assessed the cost outcomes of RARC as compared with ORC. Currently, ORC appears to offer a direct cost advantage due to the high purchase and maintenance cost of the robotic platform, although when the indirect costs of complications and extended hospital stay with ORC are considered, RARC may be less expensive than the traditional open procedure. In order to accurately evaluate the cost effectiveness of RARC versus ORC, prospective randomized trials between the two surgical techniques with long-term oncologic efficacy are needed.

Preventing pressure ulcers in long-term care: a cost-effectiveness analysis.

PubMed

Pham, Ba'; Stern, Anita; Chen, Wendong; Sander, Beate; John-Baptiste, Ava; Thein, Hla-Hla; Gomes, Tara; Wodchis, Walter P; Bayoumi, Ahmed; Machado, Márcio; Carcone, Steven; Krahn, Murray

2011-11-14

Pressure ulcers are common in many care settings, with adverse health outcomes and high treatment costs. We evaluated the cost-effectiveness of evidence-based strategies to improve current prevention practice in long-term care facilities. We used a validated Markov model to compare current prevention practice with the following 4 quality improvement strategies: (1) pressure redistribution mattresses for all residents, (2) oral nutritional supplements for high-risk residents with recent weight loss, (3) skin emollients for high-risk residents with dry skin, and (4) foam cleansing for high-risk residents requiring incontinence care. Primary outcomes included lifetime risk of stage 2 to 4 pressure ulcers, quality-adjusted life-years (QALYs), and lifetime costs, calculated according to a single health care payer's perspective and expressed in 2009 Canadian dollars (Can$1 = US$0.84). Strategies cost on average $11.66 per resident per week. They reduced lifetime risk; the associated number needed to treat was 45 (strategy 1), 63 (strategy 4), 158 (strategy 3), and 333 (strategy 2). Strategy 1 and 4 minimally improved QALYs and reduced the mean lifetime cost by $115 and $179 per resident, respectively. The cost per QALY gained was approximately $78 000 for strategy 3 and $7.8 million for strategy 2. If decision makers are willing to pay up to $50 000 for 1 QALY gained, the probability that improving prevention is cost-effective is 94% (strategy 4), 82% (strategy 1), 43% (strategy 3), and 1% (strategy 2). The clinical and economic evidence supports pressure redistribution mattresses for all long-term care residents. Improving prevention with perineal foam cleansers and dry skin emollients appears to be cost-effective, but firm conclusions are limited by the available clinical evidence.

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

Hess, J. Richard; Lamers, Patrick; Roni, Mohammad S.

Logistical barrier are tied to feedstock harvesting, collection, storage and distribution. Current crop harvesting machinery is unable to selectively harvest preferred components of cellulosic biomass while maintaining acceptable levels of soil carbon and minimizing erosion. Actively managing biomass variability imposes additional functional requirements on biomass harvesting equipment. A physiological variation in biomass arises from differences in genetics, degree of crop maturity, geographical location, climatic events, and harvest methods. This variability presents significant cost and performance risks for bioenergy systems. Currently, processing standards and specifications for cellulosic feedstocks are not as well-developed as for mature commodities. Biomass that is stored withmore » high moisture content or exposed to moisture during storage is susceptible to spoilage, rotting, spontaneous combustion, and odor problems. Appropriate storage methods and strategies are needed to better define storage requirements to preserve the volume and quality of harvested biomass over time and maintain its conversion yield. Raw herbaceous biomass is costly to collect, handle, and transport because of its low density and fibrous nature. Existing conventional, bale-based handling equipment and facilities cannot cost-effectively deliver and store high volumes of biomass, even with improved handling techniques. Current handling and transportation systems designed for moving woodchips can be inefficient for bioenergy processes due to the costs and challenges of transporting, storing, and drying high-moisture biomass. The infrastructure for feedstock logistics has not been defined for the potential variety of locations, climates, feedstocks, storage methods, processing alternatives, etc., which will occur at a national scale. When setting up biomass fuel supply chains, for large-scale biomass systems, logistics are a pivotal part in the system. Various studies have shown that long-distance international transport by ship is feasible in terms of energy use and transportation costs, but availability of suitable vessels and meteorological conditions (e.g., winter time in Scandinavia and Russia) need to be considered. However, local transportation by truck (both in biomass exporting and importing countries) may be a high-cost factor, which can influence the overall energy balance and total biomass costs.« less

How much is it going to cost me? Bidirectional relations between adolescents' moral personality and prosocial behavior.

PubMed

Padilla-Walker, Laura M; Fraser, Ashley M

2014-10-01

The current study examined bidirectional relations between adolescents' moral personality (prosocial values, self-regulation, and sympathy) and low- and high-cost prosocial behavior toward strangers. Participants included 682 adolescents (M age of child = 14.31, SD = 1.07, 50% female) who participated at two time points, approximately one year apart. Cross-lag analyses suggested that adolescents' values were associated with both low- and high-cost prosocial behavior one year later, self-regulation was associated with high-cost prosocial behavior, and sympathy was associated with low-cost prosocial behavior. Findings also suggested that low-cost prosocial behavior was associated with sympathy one year later, and high-cost prosocial behavior was associated with values. Discussion focuses on reciprocal relations between moral personality and prosocial behavior, and the need to consider a more multidimensional approach to prosocial development during adolescence. Copyright © 2014 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

Current trends in health insurance systems: OECD countries vs. Japan.

PubMed

Sasaki, Toshiyuki; Izawa, Masahiro; Okada, Yoshikazu

2015-01-01

Over the past few decades, the longest extension in life expectancy in the world has been observed in Japan. However, the sophistication of medical care and the expansion of the aging society, leads to continuous increase in health-care costs. Medical expenses as a part of gross domestic product (GDP) in Japan are exceeding the current Organization for Economic Co-operation and Development (OECD) average, challenging the universally, equally provided low cost health care existing in the past. A universal health insurance system is becoming a common system currently in developed countries, currently a similar system is being introduced in the United States. Medical care in Japan is under a social insurance system, but the injection of public funds for medical costs becomes very expensive for the Japanese society. In spite of some urgently decided measures to cover the high cost of advanced medical treatment, declining birthrate and aging population and the tendency to reduce hospital and outpatients' visits numbers and shorten hospital stays, medical expenses of Japan continue to be increasing.

Design and development of a low-cost biphasic charge-balanced functional electric stimulator and its clinical validation.

PubMed

Shendkar, Chandrashekhar; Lenka, Prasanna K; Biswas, Abhishek; Kumar, Ratnesh; Mahadevappa, Manjunatha

2015-10-01

Functional electric stimulators that produce near-ideal, charge-balanced biphasic stimulation waveforms with interphase delay are considered safer and more efficacious than conventional stimulators. An indigenously designed, low-cost, portable FES device named InStim is developed. It features a charge-balanced biphasic single channel. The authors present the complete design, mathematical analysis of the circuit and the clinical evaluation of the device. The developed circuit was tested on stroke patients affected by foot drop problems. It was tested both under laboratory conditions and in clinical settings. The key building blocks of this circuit are low dropout regulators, a DC-DC voltage booster and a single high-power current source OP-Amp with current-limiting capabilities. This allows the device to deliver high-voltage, constant current, biphasic pulses without the use of a bulky step-up transformer. The advantages of the proposed design over the currently existing devices include improved safety features (zero DC current, current-limiting mechanism and safe pulses), waveform morphology that causes less muscle fatigue, cost-effectiveness and compact power-efficient circuit design with minimal components. The device is also capable of producing appropriate ankle dorsiflexion in patients having foot drop problems of various Medical Research Council scale grades.

Innovative manufacturing and materials for low cost lithium ion batteries

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

Carlson, Steven

2015-12-29

This project demonstrated entirely new manufacturing process options for lithium ion batteries with major potential for improved cost and performance. These new manufacturing approaches are based on the use of the new electrode-coated separators instead of the conventional electrode-coated metal current collector foils. The key enabler to making these electrode-coated separators is a new and unique all-ceramic separator with no conventional porous plastic separator present. A simple, low cost, and high speed manufacturing process of a single coating of a ceramic pigment and polymer binder onto a re-usable release film, followed by a subsequent delamination of the all-ceramic separator andmore » any layers coated over it, such as electrodes and metal current collectors, was utilized. A suitable all-ceramic separator was developed that demonstrated the following required features needed for making electrode-coated separators: (1) no pores greater than 100 nanometer (nm) in diameter to prevent any penetration of the electrode pigments into the separator; (2) no shrinkage of the separator when heated to the high oven heats needed for drying of the electrode layer; and (3) no significant compression of the separator layer by the high pressure calendering step needed to densify the electrodes by about 30%. In addition, this nanoporous all-ceramic separator can be very thin at 8 microns thick for increased energy density, while providing all of the performance features provided by the current ceramic-coated plastic separators used in vehicle batteries: improved safety, longer cycle life, and stability to operate at voltages up to 5.0 V in order to obtain even more energy density. The thin all-ceramic separator provides a cost savings of at least 50% for the separator component and by itself meets the overall goal of this project to reduce the cell inactive component cost by at least 20%. The all-ceramic separator also enables further cost savings by its excellent heat stability with no shrinkage at up to 220oC. This allows vacuum drying of the dry cell just before filling with the electrolyte and thereby can reduce the size of the cell assembly dry room by 50%. Once the electrode-coated separator is produced, there are many different approaches for adding the metal current collector layers and making and connecting the tabs of the cells. These approaches include: (1) laminating the electrode side of the electrode-coated separator to both sides of a metal current collector; and (2) making a full coated electrode stack by coating or depositing a current collector layer on the electrode side and then coating a second electrode layer onto the current collector. Further cost savings are available from using lower cost and/or thinner and lighter current collectors and from using a separator coating manufacturing process at widths of 1.5 meters (m) or more and at high production line speeds of up to 125 meters per minute (mpm), both of which are well above the conventional coating widths and line speeds presently used in manufacturing electrodes for lithium ion batteries.« less

NASA Human Spaceflight Scenarios - Do All Our Models Still Say 'No'?

NASA Technical Reports Server (NTRS)

Zapata, Edgar

2017-01-01

We analyze the potential life cycle cost of assorted NASA human spaceflight architectures an architecture as a sum of individual systems, working together. With the prior questions of high costs, limited budgets and uncertainties in mind, public private partnerships are central in these architectures. The cost data for current commercial public private partnerships is encouraging, as are cost estimates for future partnership approaches beyond low Earth orbit.

Fuel cycle cost reduction through Westinghouse fuel design and core management

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

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

1985-11-01

This paper describes advances in Westinghouse nuclear fuel and their impact on fuel cycle cost. Recent fabrication development has been aimed at maintaining high integrity, increased operating flexibility, longer operating cycles, and improved core margins. Development efforts at Westinghouse toward meeting these directions have culminated in VANTAGE 5 fuel. The current trend toward longer operating cycles provides a further driving force to minimize the resulting inherent increase in fuel cycle costs by further increases in region discharge burnup. Westinghouse studies indicate the capability of currently offered products to meet cycle lengths up to 24 months.

Do Heat Pump Clothes Dryers Make Sense for the U.S. Market

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

Meyers, Steve; Franco, Victor; Lekov, Alex

Heat pump clothes dryers (HPCDs) can be as much as 50percent more energy-efficient than conventional electric resistance clothes dryers, and therefore have the potential to save substantial amounts of electricity. While not currently available in the U.S., there are manufacturers in Europe and Japan that produce units for those markets. Drawing on analysis conducted for the U.S. Department of Energy's (DOE) current rulemaking on amended standards for clothes dryers, this paper evaluates the cost-effectiveness of HPCDs in American homes, as well as the national impact analysis for different market share scenarios. In order to get an accurate measurement of realmore » energy savings potential, the paper offers a new energy use calculation methodology that takes into account the most current data on clothes washer cycles, clothes dryer usage frequency, remaining moisture content, and load weight per cycle, which is very different from current test procedure values. Using the above methodology along with product cost estimates developed by DOE, the paper presents the results of a life-cycle cost analysis of the adoption of HPCDs in a representative sample of American homes. The results show that HPCDs have positive economic benefits only for households with high clothes dryer usage or for households with high electricity prices and moderately high utilization.« less

Personalizing health care: feasibility and future implications.

PubMed

Godman, Brian; Finlayson, Alexander E; Cheema, Parneet K; Zebedin-Brandl, Eva; Gutiérrez-Ibarluzea, Inaki; Jones, Jan; Malmström, Rickard E; Asola, Elina; Baumgärtel, Christoph; Bennie, Marion; Bishop, Iain; Bucsics, Anna; Campbell, Stephen; Diogene, Eduardo; Ferrario, Alessandra; Fürst, Jurij; Garuoliene, Kristina; Gomes, Miguel; Harris, Katharine; Haycox, Alan; Herholz, Harald; Hviding, Krystyna; Jan, Saira; Kalaba, Marija; Kvalheim, Christina; Laius, Ott; Lööv, Sven-Ake; Malinowska, Kamila; Martin, Andrew; McCullagh, Laura; Nilsson, Fredrik; Paterson, Ken; Schwabe, Ulrich; Selke, Gisbert; Sermet, Catherine; Simoens, Steven; Tomek, Dominik; Vlahovic-Palcevski, Vera; Voncina, Luka; Wladysiuk, Magdalena; van Woerkom, Menno; Wong-Rieger, Durhane; Zara, Corrine; Ali, Raghib; Gustafsson, Lars L

2013-08-13

Considerable variety in how patients respond to treatments, driven by differences in their geno- and/ or phenotypes, calls for a more tailored approach. This is already happening, and will accelerate with developments in personalized medicine. However, its promise has not always translated into improvements in patient care due to the complexities involved. There are also concerns that advice for tests has been reversed, current tests can be costly, there is fragmentation of funding of care, and companies may seek high prices for new targeted drugs. There is a need to integrate current knowledge from a payer's perspective to provide future guidance. Multiple findings including general considerations; influence of pharmacogenomics on response and toxicity of drug therapies; value of biomarker tests; limitations and costs of tests; and potentially high acquisition costs of new targeted therapies help to give guidance on potential ways forward for all stakeholder groups. Overall, personalized medicine has the potential to revolutionize care. However, current challenges and concerns need to be addressed to enhance its uptake and funding to benefit patients.

Personalizing health care: feasibility and future implications

PubMed Central

2013-01-01

Considerable variety in how patients respond to treatments, driven by differences in their geno- and/ or phenotypes, calls for a more tailored approach. This is already happening, and will accelerate with developments in personalized medicine. However, its promise has not always translated into improvements in patient care due to the complexities involved. There are also concerns that advice for tests has been reversed, current tests can be costly, there is fragmentation of funding of care, and companies may seek high prices for new targeted drugs. There is a need to integrate current knowledge from a payer’s perspective to provide future guidance. Multiple findings including general considerations; influence of pharmacogenomics on response and toxicity of drug therapies; value of biomarker tests; limitations and costs of tests; and potentially high acquisition costs of new targeted therapies help to give guidance on potential ways forward for all stakeholder groups. Overall, personalized medicine has the potential to revolutionize care. However, current challenges and concerns need to be addressed to enhance its uptake and funding to benefit patients. PMID:23941275

Application of the Critical Success Factor Methodology to DoD Organization.

DTIC Science & Technology

1984-09-01

high technology manufacturing, banking, airline, insurance, railway, and automobile . Sullen (6t22-25) lists the current CSFs of the 14 S automobile ...industry as image, quality dealer system, cost control, and meting energy standards. However, in 1981 the automobile CSFs included only styling, quality...bearing on current car purchases as well as future car buys. And finally cost control influenced the auto industry as a CSF, since profit per automobile had

A low-cost, scalable, current-sensing digital headstage for high channel count μECoG.

PubMed

Trumpis, Michael; Insanally, Michele; Zou, Jialin; Elsharif, Ashraf; Ghomashchi, Ali; Sertac Artan, N; Froemke, Robert C; Viventi, Jonathan

2017-04-01

High channel count electrode arrays allow for the monitoring of large-scale neural activity at high spatial resolution. Implantable arrays featuring many recording sites require compact, high bandwidth front-end electronics. In the present study, we investigated the use of a small, light weight, and low cost digital current-sensing integrated circuit for acquiring cortical surface signals from a 61-channel micro-electrocorticographic (μECoG) array. We recorded both acute and chronic μECoG signal from rat auditory cortex using our novel digital current-sensing headstage. For direct comparison, separate recordings were made in the same anesthetized preparations using an analog voltage headstage. A model of electrode impedance explained the transformation between current- and voltage-sensed signals, and was used to reconstruct cortical potential. We evaluated the digital headstage using several metrics of the baseline and response signals. The digital current headstage recorded neural signal with similar spatiotemporal statistics and auditory frequency tuning compared to the voltage signal. The signal-to-noise ratio of auditory evoked responses (AERs) was significantly stronger in the current signal. Stimulus decoding based on true and reconstructed voltage signals were not significantly different. Recordings from an implanted system showed AERs that were detectable and decodable for 52 d. The reconstruction filter mitigated the thermal current noise of the electrode impedance and enhanced overall SNR. We developed and validated a novel approach to headstage acquisition that used current-input circuits to independently digitize 61 channels of μECoG measurements of the cortical field. These low-cost circuits, intended to measure photo-currents in digital imaging, not only provided a signal representing the local cortical field with virtually the same sensitivity and specificity as a traditional voltage headstage but also resulted in a small, light headstage that can easily be scaled to record from hundreds of channels.

A low-cost, scalable, current-sensing digital headstage for high channel count μECoG

NASA Astrophysics Data System (ADS)

Trumpis, Michael; Insanally, Michele; Zou, Jialin; Elsharif, Ashraf; Ghomashchi, Ali; Sertac Artan, N.; Froemke, Robert C.; Viventi, Jonathan

2017-04-01

Objective. High channel count electrode arrays allow for the monitoring of large-scale neural activity at high spatial resolution. Implantable arrays featuring many recording sites require compact, high bandwidth front-end electronics. In the present study, we investigated the use of a small, light weight, and low cost digital current-sensing integrated circuit for acquiring cortical surface signals from a 61-channel micro-electrocorticographic (μECoG) array. Approach. We recorded both acute and chronic μECoG signal from rat auditory cortex using our novel digital current-sensing headstage. For direct comparison, separate recordings were made in the same anesthetized preparations using an analog voltage headstage. A model of electrode impedance explained the transformation between current- and voltage-sensed signals, and was used to reconstruct cortical potential. We evaluated the digital headstage using several metrics of the baseline and response signals. Main results. The digital current headstage recorded neural signal with similar spatiotemporal statistics and auditory frequency tuning compared to the voltage signal. The signal-to-noise ratio of auditory evoked responses (AERs) was significantly stronger in the current signal. Stimulus decoding based on true and reconstructed voltage signals were not significantly different. Recordings from an implanted system showed AERs that were detectable and decodable for 52 d. The reconstruction filter mitigated the thermal current noise of the electrode impedance and enhanced overall SNR. Significance. We developed and validated a novel approach to headstage acquisition that used current-input circuits to independently digitize 61 channels of μECoG measurements of the cortical field. These low-cost circuits, intended to measure photo-currents in digital imaging, not only provided a signal representing the local cortical field with virtually the same sensitivity and specificity as a traditional voltage headstage but also resulted in a small, light headstage that can easily be scaled to record from hundreds of channels.

A low-cost, scalable, current-sensing digital headstage for high channel count μECoG

PubMed Central

Trumpis, Michael; Insanally, Michele; Zou, Jialin; Elsharif, Ashraf; Ghomashchi, Ali; Artan, N. Sertac; Froemke, Robert C.; Viventi, Jonathan

2017-01-01

Objective High channel count electrode arrays allow for the monitoring of large-scale neural activity at high spatial resolution. Implantable arrays featuring many recording sites require compact, high bandwidth front-end electronics. In the present study, we investigated the use of a small, light weight, and low cost digital current-sensing integrated circuit for acquiring cortical surface signals from a 61-channel micro-electrocorticographic (μECoG) array. Approach We recorded both acute and chronic μECoG signal from rat auditory cortex using our novel digital current-sensing headstage. For direct comparison, separate recordings were made in the same anesthetized preparations using an analog voltage headstage. A model of electrode impedance explained the transformation between current- and voltage-sensed signals, and was used to reconstruct cortical potential. We evaluated the digital headstage using several metrics of the baseline and response signals. Main results The digital current headstage recorded neural signal with similar spatiotemporal statistics and auditory frequency tuning compared to the voltage signal. The signal-to-noise ratio of auditory evoked responses (AERs) was significantly stronger in the current signal. Stimulus decoding based on true and reconstructed voltage signals were not significantly different. Recordings from an implanted system showed AERs that were detectable and decodable for 52 days. The reconstruction filter mitigated the thermal current noise of the electrode impedance and enhanced overall SNR. Significance We developed and validated a novel approach to headstage acquisition that used current-input circuits to independently digitize 61 channels of μECoG measurements of the cortical field. These low-cost circuits, intended to measure photo-currents in digital imaging, not only provided a signal representing the local cortical field with virtually the same sensitivity and specificity as a traditional voltage headstage but also resulted in a small, light headstage that can easily be scaled to record from hundreds of channels. PMID:28102827

Cost Effectiveness of Field Trauma Triage among Injured Adults Served by Emergency Medical Services

PubMed Central

Newgard, Craig D; Yang, Zhuo; Nishijima, Daniel; McConnell, K John; Trent, Stacy; Holmes, James F; Daya, Mohamud; Mann, N Clay; Hsia, Renee Y; Rea, Tom; Wang, N Ewen; Staudenmayer, Kristan; Delgado, M Kit

2016-01-01

Background The American College of Surgeons Committee on Trauma sets national targets for the accuracy of field trauma triage at ≥ 95% sensitivity and ≥ 65% specificity, yet the cost-effectiveness of realizing these goals is unknown. We evaluated the cost-effectiveness of current field trauma triage practices compared to triage strategies consistent with the national targets. Study Design This was a cost-effectiveness analysis using data from 79,937 injured adults transported by 48 emergency medical services (EMS) agencies to 105 trauma and non-trauma hospitals in 6 regions of the Western U.S. from 2006 through 2008. Incremental differences in survival, quality adjusted life years (QALYs), costs, and the incremental cost-effectiveness ratio (ICER; costs per QALY gained) were estimated for each triage strategy over a 1-year and lifetime horizon using a decision analytic Markov model. We considered an ICER threshold of less than $100,000 to be cost-effective. Results For these 6 regions, a high sensitivity triage strategy consistent with national trauma policy (sensitivity 98.6%, specificity 17.1%) would cost $1,317,333 per QALY gained, while current triage practices (sensitivity 87.2%, specificity 64.0%) cost $88,000 per QALY gained compared to a moderate sensitivity strategy (sensitivity 71.2%, specificity 66.5%). Refining EMS transport patterns by triage status improved cost-effectiveness. At the trauma system level, a high-sensitivity triage strategy would save 3.7 additional lives per year at a 1-year cost of $8.78 million, while a moderate sensitivity approach would cost 5.2 additional lives and save $781,616 each year. Conclusions A high-sensitivity approach to field triage consistent with national trauma policy is not cost effective. The most cost effective approach to field triage appears closely tied to triage specificity and adherence to triage-based EMS transport practices. PMID:27178369

The association of smoking status with healthcare utilisation, productivity loss and resulting costs: results from the population-based KORA F4 study.

PubMed

Wacker, Margarethe; Holle, Rolf; Heinrich, Joachim; Ladwig, Karl-Heinz; Peters, Annette; Leidl, Reiner; Menn, Petra

2013-07-17

Smoking is seen as the most important single risk to health today, and is responsible for a high financial burden on healthcare systems and society. This population-based cross-sectional study compares healthcare utilisation, direct medical costs, and costs of productivity losses for different smoking groups: current smokers, former smokers, and never smokers. Using a bottom-up approach, data were taken from the German KORA F4 study (2006/2008) on self-reported healthcare utilisation and work absence due to illness for 3,071 adults aged 32-81 years. Unit costs from a societal perspective were applied to utilisation. Utilisation and resulting costs were compared across different smoking groups using generalised linear models to adjust for age, sex, education, alcohol consumption and physical activity. Average annual total costs per survey participant were estimated as €3,844 [95% confidence interval: 3,447-4,233], and differed considerably between smoking groups with never smokers showing €3,237 [2,802-3,735] and former smokers causing €4,398 [3,796-5,058]. There was a positive effect of current and former smoking on the utilisation of healthcare services and on direct and indirect costs. Total annual costs were more than 20% higher (p<0.05) for current smokers and 35% higher (p<0.01) for former smokers compared with never smokers, which corresponds to annual excess costs of €743 and €1,108 per current and former smoker, respectively. Results indicate that excess costs for current and former smokers impose a large burden on society, and that previous top-down cost approaches produced lower estimates for the costs of care for smoking-related diseases. Efforts must be focused on prevention of smoking to achieve sustainable containment on behalf of the public interest.

Is Conflict Adaptation Due to Active Regulation or Passive Carry-Over? Evidence from Eye Movements

ERIC Educational Resources Information Center

Hubbard, Jason; Kuhns, David; Schäfer, Theo A. J.; Mayr, Ulrich

2017-01-01

Conflict-adaptation effects (i.e., reduced response-time costs on high-conflict trials following high-conflict trials) supposedly represent our cognitive system's ability to regulate itself according to current processing demands. However, currently it is not clear whether these effects reflect conflict-triggered, active regulation, or passive…

Research on scheme of applying ASON to current networks

NASA Astrophysics Data System (ADS)

Mao, Y. F.; Li, J. R.; Deng, L. J.

2008-10-01

Automatically Switched Optical Network (ASON) is currently a new and hot research subject in the world. It can provide high bandwidth, high assembly flexibility, high network security and reliability, but with a low management cost. It is presented to meet the requirements for high-throughput optical access with stringent Quality of Service (QoS). But as a brand new technology, ASON can not be supported by the traditional protocol software and network equipments. And the approach to build a new ASON network on the basis of completely abandoning the traditional optical network facilities is not desirable, because it costs too much and wastes a lot of network resources can also be used. So how to apply ASON to the current networks and realize the smooth transition between the existing network and ASON has been a serious problem to many network operators. In this research, the status in quo of ASON is introduced first and then the key problems should be considered when applying ASON to current networks are discussed. Based on this, the strategies should be complied with to overcome these key problems are listed. At last, the approach to apply ASON to the current optical networks is proposed and analyzed.

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

Junhua Jiang; Ted Aulich

An electrolytic renewable nitrogen fertilizer process that utilizes wind-generated electricity, N{sub 2} extracted from air, and syngas produced via the gasification of biomass to produce nitrogen fertilizer ammonia was developed at the University of North Dakota Energy & Environmental Research Center. This novel process provides an important way to directly utilize biosyngas generated mainly via the biomass gasification in place of the high-purity hydrogen which is required for Haber Bosch-based production of the fertilizer for the production of the widely used nitrogen fertilizers. Our preliminary economic projection shows that the economic competitiveness of the electrochemical nitrogen fertilizer process strongly dependsmore » upon the cost of hydrogen gas and the cost of electricity. It is therefore expected the cost of nitrogen fertilizer production could be considerably decreased owing to the direct use of cost-effective 'hydrogen-equivalent' biosyngas compared to the high-purity hydrogen. The technical feasibility of the electrolytic process has been proven via studying ammonia production using humidified carbon monoxide as the hydrogen-equivalent vs. the high-purity hydrogen. Process optimization efforts have been focused on the development of catalysts for ammonia formation, electrolytic membrane systems, and membrane-electrode assemblies. The status of the electrochemical ammonia process is characterized by a current efficiency of 43% using humidified carbon monoxide as a feedstock to the anode chamber and a current efficiency of 56% using high-purity hydrogen as the anode gas feedstock. Further optimization of the electrolytic process for higher current efficiency and decreased energy consumption is ongoing at the EERC.« less

Empirically observed learning rates for concentrating solar power and their responses to regime change

NASA Astrophysics Data System (ADS)

Lilliestam, Johan; Labordena, Mercè; Patt, Anthony; Pfenninger, Stefan

2017-07-01

Concentrating solar power (CSP) capacity has expanded slower than other renewable technologies and its costs are still high. Until now, there have been too few CSP projects to derive robust conclusions about its cost development. Here we present an empirical study of the cost development of all operating CSP stations and those under construction, examining the roles of capacity growth, industry continuity, and policy support design. We identify distinct CSP expansion phases, each characterized by different cost pressure in the policy regime and different industry continuity. In 2008-2011, with low cost pressure and following industry discontinuity, costs increased. In the current phase, with high cost pressure and continuous industry development, costs decreased rapidly, with learning rates exceeding 20%. Data for projects under construction suggest that this trend is continuing and accelerating. If support policies and industrial structure are sustained, we see no near-term factors that would hinder further cost decreases.

Metal-free supercapacitor with aqueous electrolyte and low-cost carbon materials

NASA Astrophysics Data System (ADS)

Blomquist, Nicklas; Wells, Thomas; Andres, Britta; Bäckström, Joakim; Forsberg, Sven; Olin, Håkan

2017-01-01

Electric double-layer capacitors (EDLCs) or supercapacitors (SCs) are fast energy storage devices with high pulse efficiency and superior cyclability, which makes them useful in various applications including electronics, vehicles and grids. Aqueous SCs are considered to be more environmentally friendly than those based on organic electrolytes. Because of the corrosive nature of the aqueous environment, however, expensive electrochemically stable materials are needed for the current collectors and electrodes in aqueous SCs. This results in high costs for a given energy-storage capacity. To address this, we developed a novel low-cost aqueous SC using graphite foil as the current collector and a mix of graphene, nanographite, simple water-purification carbons and nanocellulose as electrodes. The electrodes were coated directly onto the graphite foil by using casting frames and the SCs were assembled in a pouch cell design. With this approach, we achieved a material cost reduction of greater than 90% while maintaining approximately one-half of the specific capacitance of a commercial unit, thus demonstrating that the proposed SC can be an environmentally friendly, low-cost alternative to conventional SCs.

Refractory Materials for Flame Deflector Protection System Corrosion Control: Flame Deflector Protection System Life Cycle Cost Analysis Report

NASA Technical Reports Server (NTRS)

Calle, Luz Marina; Hintze, Paul E.; Parlier, Christopher R.; Coffman, Brekke E.; Kolody, Mark R.; Curran, Jerome P.; Trejo, David; Reinschmidt, Ken; Kim, Hyung-Jin

2009-01-01

A 20-year life cycle cost analysis was performed to compare the operational life cycle cost, processing/turnaround timelines, and operations manpower inspection/repair/refurbishment requirements for corrosion protection of the Kennedy Space Center launch pad flame deflector associated with the existing cast-in-place materials and a newer advanced refractory ceramic material. The analysis compared the estimated costs of(1) continuing to use of the current refractory material without any changes; (2) completely reconstructing the flame trench using the current refractory material; and (3) completely reconstructing the flame trench with a new high-performance refractory material. Cost estimates were based on an analysis of the amount of damage that occurs after each launch and an estimate of the average repair cost. Alternative 3 was found to save $32M compared to alternative 1 and $17M compared to alternative 2 over a 20-year life cycle.

The Impact of Oregon's Pension Legacy Costs on New Teacher Turnover and Quality. CEDR Working Paper. WP #2016-5

ERIC Educational Resources Information Center

Cahill, Kevin E.; Dyke, Andrew; Tapogna, John

2016-01-01

Pension legacy costs can restrict the amount of resources available for current public education, potentially making it more difficult to attract and retain high-quality teachers. Oregon provides a useful case study in pension legacy costs because many school districts in the state are now reallocating General Fund expenditures to cover sizeable…

Validated Feasibility Study of Integrally Stiffened Metallic Fuselage Panels for Reducing Manufacturing Costs: Cost Assessment of Manufacturing/Design Concepts

NASA Technical Reports Server (NTRS)

Metschan, S.

2000-01-01

The objective of the Integral Airframe Structures (IAS) program was to demonstrate, for an integrally stiffened structural concept, performance and weight equal to "built-up" structure with lower manufacturing cost. This report presents results of the cost assessment for several design configuration/manufacturing method combinations. The attributes of various cost analysis models were evaluated and COSTRAN selected for this study. A process/design cost evaluation matrix was developed based on material, forming, machining, and assembly of structural sub-elements and assembled structure. A hybrid design, made from high-speed machined extruded frames that are mechanically fastened to high-speed machined plate skin/stringer panels, was identified as the most cost-effective manufacturing solution. Recurring labor and material costs of the hybrid design are up to 61 percent less than the current built-up technology baseline. This would correspond to a total cost reduction of $1.7 million per ship set for a 777-sized airplane. However, there are important outstanding issues with regard to the cost of capacity of high technology machinery, and the ability to cost-effectively provide surface finish acceptable to the commercial aircraft industry. The projected high raw material cost of large extrusions also played an important role in the trade-off between plate and extruded concepts.

The potential cost-effectiveness of infant pneumococcal vaccines in Australia.

PubMed

Newall, Anthony T; Creighton, Prudence; Philp, David J; Wood, James G; MacIntyre, C Raina

2011-10-19

Over the last decade infant pneumococcal vaccination has been adopted as part of routine immunisation schedules in many developed countries. Although highly successful in many settings such as Australia and the United States, rapid serotype replacement has occurred in some European countries. Recently two pneumococcal conjugate vaccines (PCVs) with extended serotype coverage have been licensed for use, a 10-valent (PHiD-CV) and a 13-valent (PCV-13) vaccine, and offer potential replacements for the existing vaccine (PCV-7) in Australia. To evaluate the cost-effectiveness of PCV programs we developed a static, deterministic state-transition model. The perspective for costs included those to the government and healthcare system. When compared to current practice (PCV-7) both vaccines offered potential benefits, with those estimated for PHiD-CV due primarily to prevention of otitis media and PCV-13 due to a further reduction in invasive disease in Australia. At equivalent total cost to vaccinate an infant, compared to no PCV the base-case cost per QALY saved were estimated at A$64,900 (current practice, PCV-7; 3+0), A$50,200 (PHiD-CV; 3+1) and A$55,300 (PCV-13; 3+0), respectively. However, assumptions regarding herd protection, serotype protection, otitis media efficacy, and vaccination cost changed the relative cost-effectiveness of alternative PCV programs. The high proportion of current invasive disease caused by serotype 19A (as included in PCV-13) may be a decisive factor in determining vaccine policy in Australia. Copyright © 2011 Elsevier Ltd. All rights reserved.

Corticosterone mediated costs of reproduction link current to future breeding.

PubMed

Crossin, Glenn T; Phillips, Richard A; Lattin, Christine R; Romero, L Michael; Williams, Tony D

2013-11-01

Life-history theory predicts that costs are associated with reproduction. One possible mediator of costs involves the secretion of glucocorticoid hormones, which in birds can be measured in feathers grown during the breeding period. Glucocorticoids mediate physiological responses to unpredictable environmental or other stressors, but they can also function as metabolic regulators during more predictable events such as reproduction. Here we show that corticosterone ("Cort") in feathers grown during the breeding season reflects reproductive effort in two Antarctic seabird species (giant petrels, Macronectes spp.). In females of both species, but not males, feather Cort ("fCort") was nearly 1.5-fold higher in successful than failed breeders (those that lost their eggs/chicks), suggesting a cost of successful reproduction, i.e., high fCort levels in females reflect the elevated plasma Cort levels required to support high metabolic demands of chick-rearing. Successful breeding also led to delayed moult prior to winter migration. The fCort levels and pre-migration moult score that we measured at the end of current breeding were predictive of subsequent reproductive effort in the following year. Birds with high fCort and a delayed initiation of moult were much more likely to defer breeding in the following year. Cort levels and the timing of moult thus provide a potential mechanism for the tradeoff between current and future reproduction. Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.

Economic Burden of Hepatitis C Virus Infection in Different Stages of Disease: A Report From Southern Iran.

PubMed

Zare, Fatemeh; Fattahi, Mohammad Reza; Sepehrimanesh, Masood; Safarpour, Ali Reza

2016-04-01

Hepatitis C virus (HCV) infection is a major blood-borne infection which imposes high economic cost on the patients. The current study aimed to evaluate the total annual cost due to chronic HCV related diseases imposed on each patient and their family in Southern Iran. Economic burden of chronic hepatitis C-related liver diseases (chronic hepatitis C, cirrhosis and hepatocellular carcinoma) were examined. The current retrospective study evaluated 200 Iranian patients for their socioeconomic status, utilization (direct and indirect costs) and treatment costs and work days lost due to illness by a structured questionnaire in 2015. Costs of hospital admissions were extracted from databases of Nemazee hospital, Shiraz, Iran. The outpatient expenditure per patient was measured through the rate of outpatient visits and average cost per visit reported by the patients; while the inpatient costs were calculated through annual rate of hospital admissions and average expenditure. Self-medication and direct non-medical costs were also reported. The human capital approach was used to measure the work loss cost. The total annual cost per patient for chronic hepatitis C, cirrhosis and hepatocellular carcinoma (HCC) based on purchasing power parity (PPP) were USD 1625.50, USD 6117.2, and USD 11047.2 in 2015, respectively. Chronic hepatitis C-related liver diseases impose a substantial economic burden on patients, families and the society. The current study provides useful information on cost of treatment and work loss for different disease states, which can be further used in cost-effectiveness evaluations.

Inflation Fighters.

ERIC Educational Resources Information Center

Cohen, Sheldon H., Ed.

1983-01-01

Describes a low-cost, high-voltage, two-terminal, constant-current source for student use in electrophoresis experiments (includes circuit diagram) and a simple device for the continuous registering of gas flows. Also lists seven cost-saving tips for chemical reagent, including use decorative stones (purchased from nursery stores) in place of…

Low cost carbon fiber technology development for carbon fiber composite applications : phase 1.

DOT National Transportation Integrated Search

2008-01-01

The main goals of this research program at UTSI were: 1) to produce low cost carbon fibers and 2) to develop specific carbonbased : material technologies to meet current and future high performance fiber-reinforced composite needs of FTA and other : ...

ADAPTING THE MEDAKA EMBRYO ASSAY TO A HIGH-THROUGHPUT APPROACH FOR DEVELOPMENTAL TOXICITY TESTING.

EPA Science Inventory

Chemical exposure during embryonic development may cause persistent effects, yet developmental toxicity data exist for very few chemicals. Current testing procedures are time consuming and costly, underlining the need for rapid and low cost screening strategies. While in vitro ...

Low Cost, Low Power, High Sensitivity Magnetometer

DTIC Science & Technology

2008-12-01

which are used to measure the small magnetic signals from brain. Other types of vector magnetometers are fluxgate , coil based, and magnetoresistance...concentrator with the magnetometer currently used in Army multimodal sensor systems, the Brown fluxgate . One sees the MEMS fluxgate magnetometer is...Guedes, A.; et al., 2008: Hybrid - LOW COST, LOW POWER, HIGH SENSITIVITY MAGNETOMETER A.S. Edelstein*, James E. Burnette, Greg A. Fischer, M.G

Canadian Children and Youth in Care: The Cost of Fetal Alcohol Spectrum Disorder

ERIC Educational Resources Information Center

Popova, Svetlana; Lange, Shannon; Burd, Larry; Rehm, Jürgen

2014-01-01

Background: A high prevalence of prenatal alcohol exposure has been reported among children in care and thus, the risk of fetal alcohol spectrum disorder (FASD) in this population is high. Objective: The purpose of the current study was to estimate the number of children (0-18 years) in care with FASD and to determine the associated cost by age…

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

Elgowainy, Amgad; Han, Jeongwoo; Ward, Jacob

This study provides a comprehensive lifecycle analysis (LCA), or cradle-to-grave (C2G) analysis, of the cost and greenhouse gas (GHG) emissions of a variety of vehicle-fuel pathways, as well as the levelized cost of driving (LCD) and cost of avoided GHG emissions. This study also estimates the technology readiness levels (TRLs) of key fuel and vehicle technologies along the pathways. The C2G analysis spans a full portfolio of midsize light-duty vehicles (LDVs), including conventional internal combustion engine vehicles (ICEVs), flexible fuel vehicles (FFVs), hybrid electric vehicles (HEVs), plug-in hybrid electric vehicles (PHEVs), battery electric vehicles (BEVs), and fuel cell electric vehiclesmore » (FCEVs). In evaluating the vehicle-fuel combinations, this study considers both low-volume and high-volume “CURRENT TECHNOLOGY” cases (nominally 2015) and a high-volume “FUTURE TECHNOLOGY” lower-carbon case (nominally 2025–2030). For the CURRENT TECHNOLOGY case, low-volume vehicle and fuel production pathways are examined to determine costs in the near term.« less

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

Elgowainy, Amgad; Han, Jeongwoo; Ward, Jacob

This study provides a comprehensive life-cycle analysis (LCA), or cradle-to-grave (C2G) analysis, of the cost and greenhouse gas (GHG) emissions of a variety of vehicle-fuel pathways, as well as the levelized cost of driving (LCD) and cost of avoided GHG emissions. This study also estimates the technology readiness levels (TRLs) of key fuel and vehicle technologies along the pathways. The C2G analysis spans a full portfolio of midsize light-duty vehicles (LDVs), including conventional internal combustion engine vehicles (ICEVs), flexible fuel vehicles (FFVs), hybrid electric vehicles (HEVs), plug-in hybrid electric vehicles (PHEVs), battery electric vehicles (BEVs), and fuel cell electric vehiclesmore » (FCEVs). In evaluating the vehicle-fuel combinations, this study considers both low-volume and high-volume “CURRENT TECHNOLOGY” cases (nominally 2015) and a high-volume “FUTURE TECHNOLOGY” lower-carbon case (nominally 2025–2030). For the CURRENT TECHNOLOGY case, low-volume vehicle and fuel production pathways are examined to determine costs in the near term.« less

Case studies from three states: breaking down silos between health care and criminal justice.

PubMed

Bechelli, Matthew J; Caudy, Michael; Gardner, Tracie M; Huber, Alice; Mancuso, David; Samuels, Paul; Shah, Tanya; Venters, Homer D

2014-03-01

The jail-involved population-people with a history of arrest in the previous year-has high rates of illness, which leads to high costs for society. A significant percentage of jail-involved people are estimated to become newly eligible for coverage through the Affordable Care Act's expansion of Medicaid, including coverage of substance abuse treatment and mental health care. In this article we explore the need to break down the current policy silos between health care and criminal justice, to benefit both sectors and reduce unnecessary costs resulting from lack of coordination. To draw attention to the hidden costs of the current system, we review three case studies, from Washington State, Los Angeles County in California, and New York City. Each case study addresses different aspects of care needed by or provided to the jail-involved population, including mental health and substance abuse, emergency care, and coordination of care transitions. Ultimately, bending the cost curve for health care and criminal justice will require greater integration of the two systems.

Introducing Pathogen Reduction Technology in Poland: A Cost-Utility Analysis

PubMed Central

Agapova, Maria; Lachert, Elzbieta; Brojer, Ewa; Letowska, Magdalena; Grabarczyk, Piotr; Custer, Brian

2015-01-01

Background Mirasol® pathogen reduction technology (PRT) uses UV light and riboflavin to chemically inactivate pathogens and white blood cells in blood components. In the EU, Mirasol PRT is CE-marked for both plasma and platelet treatment. In Poland, the decision to introduce PRT treatment of the national supply of fresh frozen plasma has spurred interest in evaluating the cost-effectiveness of this strategy. Methods A decision-analytic model evaluated the incremental costs and benefits of introducing PRT to the existing blood safety protocols in Poland. Results Addition of PRT treatment of plasma to current screening in Poland is estimated to cost 2.595 million PLN per quality-adjusted life year (QALY) (610,000 EUR/QALY); treating both plasma and platelet components in addition to current safety interventions had a lower cost of 1.480 million PLN/QALY (348,000 EUR/QALY). Conclusions The results suggest that in Poland the cost per QALY of PRT is high albeit lower than found in previous economic analyses of PRT and nucleic acid testing in North America. Treating both platelets and plasma components is more cost-effective than treating plasma alone. Wide confidence intervals indicate high uncertainty; to improve the precision of the health economic evaluation of PRT, additional hemovigilance data are needed. PMID:26195929

The cost and cost-effectiveness of rapid testing strategies for yaws diagnosis and surveillance.

PubMed

Fitzpatrick, Christopher; Asiedu, Kingsley; Sands, Anita; Gonzalez Pena, Tita; Marks, Michael; Mitja, Oriol; Meheus, Filip; Van der Stuyft, Patrick

2017-10-01

Yaws is a non-venereal treponemal infection caused by Treponema pallidum subspecies pertenue. The disease is targeted by WHO for eradication by 2020. Rapid diagnostic tests (RDTs) are envisaged for confirmation of clinical cases during treatment campaigns and for certification of the interruption of transmission. Yaws testing requires both treponemal (trep) and non-treponemal (non-trep) assays for diagnosis of current infection. We evaluate a sequential testing strategy (using a treponemal RDT before a trep/non-trep RDT) in terms of cost and cost-effectiveness, relative to a single-assay combined testing strategy (using the trep/non-trep RDT alone), for two use cases: individual diagnosis and community surveillance. We use cohort decision analysis to examine the diagnostic and cost outcomes. We estimate cost and cost-effectiveness of the alternative testing strategies at different levels of prevalence of past/current infection and current infection under each use case. We take the perspective of the global yaws eradication programme. We calculate the total number of correct diagnoses for each strategy over a range of plausible prevalences. We employ probabilistic sensitivity analysis (PSA) to account for uncertainty and report 95% intervals. At current prices of the treponemal and trep/non-trep RDTs, the sequential strategy is cost-saving for individual diagnosis at prevalence of past/current infection less than 85% (81-90); it is cost-saving for surveillance at less than 100%. The threshold price of the trep/non-trep RDT (below which the sequential strategy would no longer be cost-saving) is US$ 1.08 (1.02-1.14) for individual diagnosis at high prevalence of past/current infection (51%) and US$ 0.54 (0.52-0.56) for community surveillance at low prevalence (15%). We find that the sequential strategy is cost-saving for both diagnosis and surveillance in most relevant settings. In the absence of evidence assessing relative performance (sensitivity and specificity), cost-effectiveness is uncertain. However, the conditions under which the combined test only strategy might be more cost-effective than the sequential strategy are limited. A cheaper trep/non-trep RDT is needed, costing no more than US$ 0.50-1.00, depending on the use case. Our results will help enhance the cost-effectiveness of yaws programmes in the 13 countries known to be currently endemic. It will also inform efforts in the much larger group of 71 countries with a history of yaws, many of which will have to undertake surveillance to confirm the interruption of transmission.

Impact and cost-effectiveness of chlamydia testing in Scotland: a mathematical modelling study.

PubMed

Looker, Katharine J; Wallace, Lesley A; Turner, Katherine M E

2015-01-15

Chlamydia is the most common sexually transmitted bacterial infection in Scotland, and is associated with potentially serious reproductive outcomes, including pelvic inflammatory disease (PID) and tubal factor infertility (TFI) in women. Chlamydia testing in Scotland is currently targeted towards symptomatic individuals, individuals at high risk of existing undetected infection, and young people. The cost-effectiveness of testing and treatment to prevent PID and TFI in Scotland is uncertain. A compartmental deterministic dynamic model of chlamydia infection in 15-24 year olds in Scotland was developed. The model was used to estimate the impact of a change in testing strategy from baseline (16.8% overall testing coverage; 0.4 partners notified and tested/treated per treated positive index) on PID and TFI cases. Cost-effectiveness calculations informed by best-available estimates of the quality-adjusted life years (QALYs) lost due to PID and TFI were also performed. Increasing overall testing coverage by 50% from baseline to 25.2% is estimated to result in 21% fewer cases in young women each year (PID: 703 fewer; TFI: 88 fewer). A 50% decrease to 8.4% would result in 20% more PID (669 additional) and TFI (84 additional) cases occurring annually. The cost per QALY gained of current testing activities compared to no testing is £40,034, which is above the £20,000-£30,000 cost-effectiveness threshold. However, calculations are hampered by lack of reliable data. Any increase in partner notification from baseline would be cost-effective (incremental cost per QALY gained for a partner notification efficacy of 1 compared to baseline: £5,119), and would increase the cost-effectiveness of current testing strategy compared to no testing, with threshold cost-effectiveness reached at a partner notification efficacy of 1.5. However, there is uncertainty in the extent to which partner notification is currently done, and hence the amount by which it could potentially be increased. Current chlamydia testing strategy in Scotland is not cost-effective under the conservative model assumptions applied. However, with better data enabling some of these assumptions to be relaxed, current coverage could be cost-effective. Meanwhile, increasing partner notification efficacy on its own would be a cost-effective way of preventing PID and TFI from current strategy.

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

PubMed

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

2017-01-26

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

Metal current collect protected by oxide film

DOEpatents

Jacobson, Craig P.; Visco, Steven J.; DeJonghe, Lutgard C.

2004-05-25

Provided are low-cost, mechanically strong, highly electronically conductive current collects and associated structures for solid-state electrochemical devices, techniques for forming these structures, and devices incorporating the structures. The invention provides solid state electrochemical devices having as current interconnects a ferritic steel felt or screen coated with a protective oxide film.

Electron-processing technology: A promising application for the viscose industry

NASA Astrophysics Data System (ADS)

Stepanik, T. M.; Rajagopal, S.; Ewing, D.; Whitehouse, R.

1998-06-01

In marketing its IMPELA ® line of high power, high-throughput industrial accelerators, Atomic Energy of Canada Limited (AECL) is working with viscose (rayon) companies world-wide to integrate electron-processing technology as part of the viscose manufacturing process. The viscose industry converts cellulose wood pulp into products such as staple fiber, filament, cord, film, packaging, and non-edible sausage casings. This multibillion dollar industry is currently suffering from high production costs, and is facing increasingly stringent environmental regulations. The use of electron-treated pulp can significantly lower production costs and can provide equally significant environmental benefits. This paper describes our current understanding of the benefits of using electron-treated pulp in this process, and AECL's efforts in developing this technology.

Cost-effectiveness and affordability of community mobilisation through women's groups and quality improvement in health facilities (MaiKhanda trial) in Malawi.

PubMed

Colbourn, Tim; Pulkki-Brännström, Anni-Maria; Nambiar, Bejoy; Kim, Sungwook; Bondo, Austin; Banda, Lumbani; Makwenda, Charles; Batura, Neha; Haghparast-Bidgoli, Hassan; Hunter, Rachael; Costello, Anthony; Baio, Gianluca; Skordis-Worrall, Jolene

2015-01-01

Understanding the cost-effectiveness and affordability of interventions to reduce maternal and newborn deaths is critical to persuading policymakers and donors to implement at scale. The effectiveness of community mobilisation through women's groups and health facility quality improvement, both aiming to reduce maternal and neonatal mortality, was assessed by a cluster randomised controlled trial conducted in rural Malawi in 2008-2010. In this paper, we calculate intervention cost-effectiveness and model the affordability of the interventions at scale. Bayesian methods are used to estimate the incremental cost-effectiveness of the community and facility interventions on their own (CI, FI), and together (FICI), compared to current practice in rural Malawi. Effects are estimated with Monte Carlo simulation using the combined full probability distributions of intervention effects on stillbirths, neonatal deaths and maternal deaths. Cost data was collected prospectively from a provider perspective using an ingredients approach and disaggregated at the intervention (not cluster or individual) level. Expected Incremental Benefit, Cost-effectiveness Acceptability Curves and Expected Value of Information (EVI) were calculated using a threshold of $780 per disability-adjusted life-year (DALY) averted, the per capita gross domestic product of Malawi in 2013 international $. The incremental cost-effectiveness of CI, FI, and combined FICI was $79, $281, and $146 per DALY averted respectively, compared to current practice. FI is dominated by CI and FICI. Taking into account uncertainty, both CI and combined FICI are highly likely to be cost effective (probability 98% and 93%, EVI $210,423 and $598,177 respectively). Combined FICI is incrementally cost effective compared to either intervention individually (probability 60%, ICER $292, EIB $9,334,580 compared to CI). Future scenarios also found FICI to be the optimal decision. Scaling-up to the whole of Malawi, CI is of greatest value for money, potentially averting 13.0% of remaining annual DALYs from stillbirths, neonatal and maternal deaths for the equivalent of 6.8% of current annual expenditure on maternal and neonatal health in Malawi. Community mobilisation through women's groups is a highly cost-effective and affordable strategy to reduce maternal and neonatal mortality in Malawi. Combining community mobilisation with health facility quality improvement is more effective, more costly, but also highly cost-effective and potentially affordable in this context.

Prevention, screening and treatment of colorectal cancer: a global and regional generalized cost effectiveness analysis

PubMed Central

2010-01-01

Background Regional generalized cost-effectiveness estimates of prevention, screening and treatment interventions for colorectal cancer are presented. Methods Standardised WHO-CHOICE methodology was used. A colorectal cancer model was employed to provide estimates of screening and treatment effectiveness. Intervention effectiveness was determined via a population state-transition model (PopMod) that simulates the evolution of a sub-regional population accounting for births, deaths and disease epidemiology. Economic costs of procedures and treatment were estimated, including programme overhead and training costs. Results In regions characterised by high income, low mortality and high existing treatment coverage, the addition of screening to the current high treatment levels is very cost-effective, although no particular intervention stands out in cost-effectiveness terms relative to the others. In regions characterised by low income, low mortality with existing treatment coverage around 50%, expanding treatment with or without screening is cost-effective or very cost-effective. Abandoning treatment in favour of screening (no treatment scenario) would not be cost effective. In regions characterised by low income, high mortality and low treatment levels, the most cost-effective intervention is expanding treatment. Conclusions From a cost-effectiveness standpoint, screening programmes should be expanded in developed regions and treatment programmes should be established for colorectal cancer in regions with low treatment coverage. PMID:20236531

Superconducting technology for overcurrent limiting in a 25 kA current injection system

NASA Astrophysics Data System (ADS)

Heydari, Hossein; Faghihi, Faramarz; Sharifi, Reza; Poursoltanmohammadi, Amir Hossein

2008-09-01

Current injection transformer (CIT) systems are within the major group of the standard type test of high current equipment in the electrical industry, so their performance becomes very important. When designing high current systems, there are many factors to be considered from which their overcurrent protection must be ensured. The output of a CIT is wholly dependent on the impedance of the equipment under test (EUT). Therefore current flow beyond the allowable limit can occur. The present state of the art provides an important guide to developing current limiters not only for the grid application but also in industrial equipment. This paper reports the state of the art in the technology available that could be developed into an application of superconductivity for high current equipment (CIT) protection with no test disruption. This will result in a greater market choice and lower costs for equipment protection solutions, reduced costs and improved system reliability. The paper will also push the state of the art by using two distinctive circuits, closed-core and open-core, for overcurrent protection of a 25 kA CIT system, based on a flux-lock-type superconducting fault current limiter (SFCL) and magnetic properties of high temperature superconducting (HTS) elements. An appropriate location of the HTS element will enhance the rate of limitation with the help of the magnetic field generated by the CIT output busbars. The calculation of the HTS parameters for overcurrent limiting is also performed to suit the required current levels of the CIT.

A top-down approach to heliostat cost reduction

NASA Astrophysics Data System (ADS)

Larmuth, James N.; Landamn, Willem A.; Gauché, Paul

2016-05-01

The Technology Innovation Agency (TIA) has funded a South African central receiver collector technology development project, called Helio100. The project aims to provide South Africa's first commercially viable heliostat technology, which is both low in cost and offers high local content potential. A top-down approach is employed for heliostat cost reduction. This approach incorporates interlinked tools which move from high level cost analyses based on qualitative data during early stages of conceptual design, to detailed quantitative analyses in the final stages of design. Low cost heliostat designs are realized by the incorporation of both a top-down and bottom-up method. The current H100 design results in heliostat costs of 155/m2 at 20 000 units p.a. while further industrialisation results in heliostat costs of 126/m2 at 20 000 units.

High efficiency low cost monolithic module for SARSAT distress beacons

NASA Technical Reports Server (NTRS)

Petersen, Wendell C.; Siu, Daniel P.

1992-01-01

The program objectives were to develop a highly efficient, low cost RF module for SARSAT beacons; achieve significantly lower battery current drain, amount of heat generated, and size of battery required; utilize MMIC technology to improve efficiency, reliability, packaging, and cost; and provide a technology database for GaAs based UHF RF circuit architectures. Presented in viewgraph form are functional block diagrams of the SARSAT distress beacon and beacon RF module as well as performance goals, schematic diagrams, predicted performances, and measured performances for the phase modulator and power amplifier.

Toward Low-Cost, High-Energy Density, and High-Power Density Lithium-Ion Batteries

DOE PAGES

Li, Jianlin; Du, Zhijia; Ruther, Rose E.; ...

2017-06-12

Reducing cost and increasing energy density are two barriers for widespread application of lithium-ion batteries in electric vehicles. Although the cost of electric vehicle batteries has been reduced by ~70% from 2008 to 2015, the current battery pack cost (268/kWh in 2015) is still >2 times what the USABC targets (125/kWh). Even though many advancements in cell chemistry have been realized since the lithium-ion battery was first commercialized in 1991, few major breakthroughs have occurred in the past decade. Therefore, future cost reduction will rely on cell manufacturing and broader market acceptance. Here, this article discusses three major aspects formore » cost reduction: (1) quality control to minimize scrap rate in cell manufacturing; (2) novel electrode processing and engineering to reduce processing cost and increase energy density and throughputs; and (3) material development and optimization for lithium-ion batteries with high-energy density. Insights on increasing energy and power densities of lithium-ion batteries are also addressed.« less

Toward Low-Cost, High-Energy Density, and High-Power Density Lithium-Ion Batteries

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

Li, Jianlin; Du, Zhijia; Ruther, Rose E.

Reducing cost and increasing energy density are two barriers for widespread application of lithium-ion batteries in electric vehicles. Although the cost of electric vehicle batteries has been reduced by ~70% from 2008 to 2015, the current battery pack cost (268/kWh in 2015) is still >2 times what the USABC targets (125/kWh). Even though many advancements in cell chemistry have been realized since the lithium-ion battery was first commercialized in 1991, few major breakthroughs have occurred in the past decade. Therefore, future cost reduction will rely on cell manufacturing and broader market acceptance. Here, this article discusses three major aspects formore » cost reduction: (1) quality control to minimize scrap rate in cell manufacturing; (2) novel electrode processing and engineering to reduce processing cost and increase energy density and throughputs; and (3) material development and optimization for lithium-ion batteries with high-energy density. Insights on increasing energy and power densities of lithium-ion batteries are also addressed.« less

Toward Low-Cost, High-Energy Density, and High-Power Density Lithium-Ion Batteries

NASA Astrophysics Data System (ADS)

Li, Jianlin; Du, Zhijia; Ruther, Rose E.; AN, Seong Jin; David, Lamuel Abraham; Hays, Kevin; Wood, Marissa; Phillip, Nathan D.; Sheng, Yangping; Mao, Chengyu; Kalnaus, Sergiy; Daniel, Claus; Wood, David L.

2017-09-01

Reducing cost and increasing energy density are two barriers for widespread application of lithium-ion batteries in electric vehicles. Although the cost of electric vehicle batteries has been reduced by 70% from 2008 to 2015, the current battery pack cost (268/kWh in 2015) is still >2 times what the USABC targets (125/kWh). Even though many advancements in cell chemistry have been realized since the lithium-ion battery was first commercialized in 1991, few major breakthroughs have occurred in the past decade. Therefore, future cost reduction will rely on cell manufacturing and broader market acceptance. This article discusses three major aspects for cost reduction: (1) quality control to minimize scrap rate in cell manufacturing; (2) novel electrode processing and engineering to reduce processing cost and increase energy density and throughputs; and (3) material development and optimization for lithium-ion batteries with high-energy density. Insights on increasing energy and power densities of lithium-ion batteries are also addressed.

Electrochemical treatment of cetrimonium chloride with boron-doped diamond anodes. A technical and economical approach.

PubMed

de Araújo, Brenda R S; Linares León, José J

2018-05-15

This study presents the results of the electrochemical degradation of the emulsifier cetrimonium chloride (CTAC) on a boron-doped diamond (BDD) anode under different current densities and flow rates. Higher values of these parameters result in a more rapid removal. Nevertheless, operation at low current reduces the required applied charge and increases the chemical oxygen demand (COD) removal efficiency, as there is less development of ineffective parasitic reactions. On the other hand, high flow rates reduce the required volumetric applied charge and increase the COD removal current efficiency. In order to assist and enrich the study, an economic analysis has been performed. For short expected plant lifespans, operation at low current is advantageous due to the lower investment required, whereas for longer expected lifespans, the operational costs make the lower current densities less costly. High flow rates are always advantageous from a financial point of view. Copyright © 2018 Elsevier Ltd. All rights reserved.

Current Trends in Health Insurance Systems: OECD Countries vs. Japan

PubMed Central

SASAKI, Toshiyuki; IZAWA, Masahiro; OKADA, Yoshikazu

2015-01-01

Over the past few decades, the longest extension in life expectancy in the world has been observed in Japan. However, the sophistication of medical care and the expansion of the aging society, leads to continuous increase in health-care costs. Medical expenses as a part of gross domestic product (GDP) in Japan are exceeding the current Organization for Economic Co-operation and Development (OECD) average, challenging the universally, equally provided low cost health care existing in the past. A universal health insurance system is becoming a common system currently in developed countries, currently a similar system is being introduced in the United States. Medical care in Japan is under a social insurance system, but the injection of public funds for medical costs becomes very expensive for the Japanese society. In spite of some urgently decided measures to cover the high cost of advanced medical treatment, declining birthrate and aging population and the tendency to reduce hospital and outpatients’ visits numbers and shorten hospital stays, medical expenses of Japan continue to be increasing. PMID:25797778

The economics of new age arthroplasty: can we afford it?

PubMed

Sculco, Thomas P

2010-09-07

New technology in joint replacement design and materials adds cost that must be documented by improved outcomes. This is not always the case as the recent metal/metal data has shown. The current economics of arthroplasty have put increasing financial pressure on hospitals and will progress under new health care legislation. New technology must be cost-effective and this will be increasingly difficult in an era of outstanding long-term results with current designs. Cost may necessitate less expensive alternatives, eg, generic implants, in arthroplasty patients. Joint replacement surgery has evolved over the past 4 decades into a highly successful surgical procedure. Earlier designs and materials that demonstrated inferior functional and long-term results have disappeared in a Darwinian fashion. Through this evolutionary process many of the current designs have proven efficacy and durability. Current outcome data indicates that hip and knee designs demonstrate 90% to 95% success rates at 15-year follow-up. Technologic advances are necessary to improve implant design and materials, however, only in an environment of reduced reimbursement to hospitals can the increase cost be justified. Copyright 2010, SLACK Incorporated.

The economics of fishing the high seas.

PubMed

Sala, Enric; Mayorga, Juan; Costello, Christopher; Kroodsma, David; Palomares, Maria L D; Pauly, Daniel; Sumaila, U Rashid; Zeller, Dirk

2018-06-01

While the ecological impacts of fishing the waters beyond national jurisdiction (the "high seas") have been widely studied, the economic rationale is more difficult to ascertain because of scarce data on the costs and revenues of the fleets that fish there. Newly compiled satellite data and machine learning now allow us to track individual fishing vessels on the high seas in near real time. These technological advances help us quantify high-seas fishing effort, costs, and benefits, and assess whether, where, and when high-seas fishing makes economic sense. We characterize the global high-seas fishing fleet and report the economic benefits of fishing the high seas globally, nationally, and at the scale of individual fleets. Our results suggest that fishing at the current scale is enabled by large government subsidies, without which as much as 54% of the present high-seas fishing grounds would be unprofitable at current fishing rates. The patterns of fishing profitability vary widely between countries, types of fishing, and distance to port. Deep-sea bottom trawling often produces net economic benefits only thanks to subsidies, and much fishing by the world's largest fishing fleets would largely be unprofitable without subsidies and low labor costs. These results support recent calls for subsidy and fishery management reforms on the high seas.

The economics of fishing the high seas

PubMed Central

Mayorga, Juan; Costello, Christopher; Pauly, Daniel

2018-01-01

While the ecological impacts of fishing the waters beyond national jurisdiction (the “high seas”) have been widely studied, the economic rationale is more difficult to ascertain because of scarce data on the costs and revenues of the fleets that fish there. Newly compiled satellite data and machine learning now allow us to track individual fishing vessels on the high seas in near real time. These technological advances help us quantify high-seas fishing effort, costs, and benefits, and assess whether, where, and when high-seas fishing makes economic sense. We characterize the global high-seas fishing fleet and report the economic benefits of fishing the high seas globally, nationally, and at the scale of individual fleets. Our results suggest that fishing at the current scale is enabled by large government subsidies, without which as much as 54% of the present high-seas fishing grounds would be unprofitable at current fishing rates. The patterns of fishing profitability vary widely between countries, types of fishing, and distance to port. Deep-sea bottom trawling often produces net economic benefits only thanks to subsidies, and much fishing by the world’s largest fishing fleets would largely be unprofitable without subsidies and low labor costs. These results support recent calls for subsidy and fishery management reforms on the high seas. PMID:29881780

A low-cost hierarchical nanostructured beta-titanium alloy with high strength

PubMed Central

Devaraj, Arun; Joshi, Vineet V.; Srivastava, Ankit; Manandhar, Sandeep; Moxson, Vladimir; Duz, Volodymyr A.; Lavender, Curt

2016-01-01

Lightweighting of automobiles by use of novel low-cost, high strength-to-weight ratio structural materials can reduce the consumption of fossil fuels and in turn CO2 emission. Working towards this goal we achieved high strength in a low cost β-titanium alloy, Ti–1Al–8V–5Fe (Ti185), by hierarchical nanostructure consisting of homogenous distribution of micron-scale and nanoscale α-phase precipitates within the β-phase matrix. The sequence of phase transformation leading to this hierarchical nanostructure is explored using electron microscopy and atom probe tomography. Our results suggest that the high number density of nanoscale α-phase precipitates in the β-phase matrix is due to ω assisted nucleation of α resulting in high tensile strength, greater than any current commercial titanium alloy. Thus hierarchical nanostructured Ti185 serves as an excellent candidate for replacing costlier titanium alloys and other structural alloys for cost-effective lightweighting applications. PMID:27034109

Second Generation Novel High Temperature Commercial Receiver & Low Cost High Performance Mirror Collector for Parabolic Solar Trough

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

Stettenheim, Joel

Norwich Technologies (NT) is developing a disruptively superior solar field for trough concentrating solar power (CSP). Troughs are the leading CSP technology (85% of installed capacity), being highly deployable and similar to photovoltaic (PV) systems for siting. NT has developed the SunTrap receiver, a disruptive alternative to vacuum-tube concentrating solar power (CSP) receivers, a market currently dominated by the Schott PTR-70. The SunTrap receiver will (1) operate at higher temperature (T) by using an insulated, recessed radiation-collection system to overcome the energy losses that plague vacuum-tube receivers at high T, (2) decrease acquisition costs via simpler structure, and (3) dramaticallymore » increase reliability by eliminating vacuum. It offers comparable optical efficiency with thermal loss reduction from ≥ 26% (at presently standard T) to ≥ 55% (at high T), lower acquisition costs, and near-zero O&M costs.« less

Cost analysis of gentamicin-impregnated collagen sponges in preventing sternal wound infection post cardiac surgery.

PubMed

Joshi, V; Vaja, R; Richens, D

2016-01-01

The use of antibiotic-impregnated sponges (Collatamp) during cardiac surgery is controversial. We analysed the cost-effectiveness of its selective use in patients at high-risk of sternal wound infection (SWI). Postoperative costs were analysed in two groups of patients undergoing heart surgery between 2011 and 2013: those with SWI (group 1) and in high-risk patients without SWI (group 2). The potential cost of gentamicin-impregnated collagen sponges (GCS) use in high-risk patients was compared with our current practice. We identified 1,251 patients with at least one recognised risk factor for developing SWI in this period. Of these, 18 developed SWI (incidence 1.4%). The median postoperative cost per patient without SWI was £9,617. The additional cost per patient incurred by SWI was £4,860.75. The annual additional cost for treating patients with SWI was £43,749. With a 50% reduction in SWI, the annual additional cost of treating these patients would be reduced to £21,873. The cost of GCS is £80 per patient. Adding this to £21,873 gives a potential total cost of £71,913 in the treated high-risk cohort. In our practice the annual cost of treating SWI in high-risk patients without use of GCS is lower than the annual cost of using GCS in all high-risk patients (£43,749 versus £71,913) if it produces a 50% reduction in SWI. The reduction in the incidence of SWI poses no economic benefit when the cost of the product is factored in.

The financial impact of increasing home-based high dose haemodialysis and peritoneal dialysis.

PubMed

Liu, Frank Xiaoqing; Treharne, Catrin; Culleton, Bruce; Crowe, Lydia; Arici, Murat

2014-10-02

Evidence suggests that high dose haemodialysis (HD) may be associated with better health outcomes and even cost savings (if conducted at home) versus conventional in-centre HD (ICHD). Home-based regimens such as peritoneal dialysis (PD) are also associated with significant cost reductions and are more convenient for patients. However, the financial impact of increasing the use of high dose HD at home with an increased tariff is uncertain. A budget impact analysis was performed to investigate the financial impact of increasing the proportion of patients receiving home-based dialysis modalities from the perspective of the England National Health Service (NHS) payer. A Markov model was constructed to investigate the 5 year budget impact of increasing the proportion of dialysis patients receiving home-based dialysis, including both high dose HD at home and PD, under the current reimbursement tariff and a hypothetically increased tariff for home HD (£575/week). Five scenarios were compared with the current England dialysis modality distribution (prevalent patients, 14.1% PD, 82.0% ICHD, 3.9% conventional home HD; incident patients, 22.9% PD, 77.1% ICHD) with all increases coming from the ICHD population. Under the current tariff of £456/week, increasing the proportion of dialysis patients receiving high dose HD at home resulted in a saving of £19.6 million. Conducting high dose HD at home under a hypothetical tariff of £575/week was associated with a budget increase (£19.9 million). The costs of high dose HD at home were totally offset by increasing the usage of PD to 20-25%, generating savings of £40.0 million - £94.5 million over 5 years under the increased tariff. Conversely, having all patients treated in-centre resulted in a £172.6 million increase in dialysis costs over 5 years. This analysis shows that performing high dose HD at home could allow the UK healthcare system to capture the clinical and humanistic benefits associated with this therapy while limiting the impact on the dialysis budget. Increasing the usage of PD to 20-25%, the levels observed in 2005-2008, will totally offset the additional costs and generate further savings.

Measuring risk-adjusted value using Medicare and ACS-NSQIP: is high-quality, low-cost surgical care achievable everywhere?

PubMed

Lawson, Elise H; Zingmond, David S; Stey, Anne M; Hall, Bruce L; Ko, Clifford Y

2014-10-01

To evaluate the relationship between risk-adjusted cost and quality for colectomy procedures and to identify characteristics of "high value" hospitals (high quality, low cost). Policymakers are currently focused on rewarding high-value health care. Hospitals will increasingly be held accountable for both quality and cost. Records (2005-2008) for all patients undergoing colectomy procedures in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) were linked to Medicare inpatient claims. Cost was derived from hospital payments by Medicare. Quality was derived from the occurrence of 30-day postoperative major complications and/or death as recorded in ACS-NSQIP. Risk-adjusted cost and quality metrics were developed using hierarchical multivariable modeling, consistent with a National Quality Forum-endorsed colectomy measure. The study population included 14,745 colectomy patients in 169 hospitals. Average hospitalization cost was $21,350 (SD $20,773, median $16,092, interquartile range $14,341-$24,598). Thirty-four percent of patients had a postoperative complication and/or death. Higher hospital quality was significantly correlated with lower cost (correlation coefficient 0.38, P < 0.001). Among hospitals classified as high quality, 52% were found to be low cost (representing highest value hospitals) whereas 14% were high cost (P = 0.001). Forty-one percent of low-quality hospitals were high cost. Highest "value" hospitals represented a mix of teaching/nonteaching affiliation, small/large bed sizes, and regional locations. Using national ACS-NSQIP and Medicare data, this study reports an association between higher quality and lower cost surgical care. These results suggest that high-value surgical care is being delivered in a wide spectrum of hospitals and hospital types.

Evolution of Cost-Free Resistance under Fluctuating Drug Selection in Pseudomonas aeruginosa

PubMed Central

McCloskey, Nicholas; Hinz, Aaron J.; Dettman, Jeremy; Kassen, Rees

2017-01-01

ABSTRACT Antibiotic resistance evolves rapidly in response to drug selection, but it can also persist at appreciable levels even after the removal of the antibiotic. This suggests that many resistant strains can both be resistant and have high fitness in the absence of antibiotics. To explore the conditions under which high-fitness, resistant strains evolve and the genetic changes responsible, we used a combination of experimental evolution and whole-genome sequencing to track the acquisition of ciprofloxacin resistance in the opportunistic pathogen Pseudomonas aeruginosa under conditions of constant and fluctuating antibiotic delivery patterns. We found that high-fitness, resistant strains evolved readily under fluctuating but not constant antibiotic conditions and that their evolution was underlain by a trade-off between resistance and fitness. Whole-genome sequencing of evolved isolates revealed that resistance was gained through mutations in known resistance genes and that second-site mutations generally compensated for costs associated with resistance in the fluctuating treatment, leading to the evolution of cost-free resistance. Our results suggest that current therapies involving intermittent administration of antibiotics are contributing to the maintenance of antibiotic resistance at high levels in clinical settings. IMPORTANCE Antibiotic resistance is a global problem that greatly impacts human health. How resistance persists, even in the absence of antibiotic treatment, is thus a public health problem of utmost importance. In this study, we explored the antibiotic treatment conditions under which cost-free resistance arises, using experimental evolution of the bacterium Pseudomonas aeruginosa and the quinolone antibiotic ciprofloxacin. We found that intermittent antibiotic treatment led to the evolution of cost-free resistance and demonstrate that compensatory evolution is the mechanism responsible for cost-free resistance. Our results suggest that discontinuous administration of antibiotic may be contributing to the high levels of antibiotic resistance currently found worldwide. PMID:28744479

Circuit For Current-vs.-Voltage Tests Of Semiconductors

NASA Technical Reports Server (NTRS)

Huston, Steven W.

1991-01-01

Circuit designed for measurement of dc current-versus-voltage characteristics of semiconductor devices. Operates in conjunction with x-y pen plotter or digital storage oscilloscope, which records data. Includes large feedback resistors to prevent high currents damaging device under test. Principal virtues: low cost, simplicity, and compactness. Also used to evaluate diodes and transistors.

The minimal cost of life in space.

PubMed

Drysdale, A E; Rutkze, C J; Albright, L D; LaDue, R L

2004-01-01

The cost of keeping people alive in space is assessed from a theoretical viewpoint and using two actual designs for plant growth systems. While life support is theoretically not very demanding, our ability to implement life support is well below theoretical limits. A theoretical limit has been calculated from requirements and the state of the art for plant growth has been calculated using data from the BIO-Plex PDR and from the Cornell CEA prototype system. The very low efficiency of our current approaches results in a high mission impact, though we can still see how to get a significant reduction in cost of food when compared to supplying it from Earth. Seeing the distribution of costs should allow us to improve our current designs. c2004 COSPAR. Published by Elsevier Ltd. All rights reserved.

The minimal cost of life in space

NASA Technical Reports Server (NTRS)

Drysdale, A. E.; Rutkze, C. J.; Albright, L. D.; LaDue, R. L.

2004-01-01

The cost of keeping people alive in space is assessed from a theoretical viewpoint and using two actual designs for plant growth systems. While life support is theoretically not very demanding, our ability to implement life support is well below theoretical limits. A theoretical limit has been calculated from requirements and the state of the art for plant growth has been calculated using data from the BIO-Plex PDR and from the Cornell CEA prototype system. The very low efficiency of our current approaches results in a high mission impact, though we can still see how to get a significant reduction in cost of food when compared to supplying it from Earth. Seeing the distribution of costs should allow us to improve our current designs. c2004 COSPAR. Published by Elsevier Ltd. All rights reserved.

Advanced COPD patients under home mechanical ventilation and/or long term oxygen therapy: Italian healthcare costs.

PubMed

Vitacca, M; Bianchi, L; Bazza, A; Clini, E M

2011-12-01

Little information is available on healthcare costs for patients with very severe chronic obstructive pulmonary disease. The aim of the current work was to evaluate Italian healthcare costs in these patients. Prospective 1-year analysis was assessed in three subgroups of patients; non-invasively ventilated (n=30); invasively-ventilated (n=12) and on long-term oxygen therapy (n=41). Acute costs for care were a sum of fees for doctor's consultations, admissions to hospital (ward and intensive care units) and emergency drugs. Chronic costs were the sum of costs for pharmacotherapy and home ventilation and/or oxygen care. Mean cost/day/patient was 96 +/- 112 Euro (range 9-526 Euro), with acute costs accounting for 72% and chronic costs for 28% of the total cost burden, with no significant differences in costs associated with the three subgroups. Acute costs had a non-normal distribution (range 0 to 510 Euro) being cost for hospitalisation the highest cost burden with more than 30% of acute care costs attributed to only a small segment of patients. Chronic care costs were also unevenly distributed among the various groups (ANOVA p = 0.006), being home oxygen supply the highest cost burden. The current Health Care System is in urgent need for a reassessment of the high cost burden associated with hospitalisations and home oxygen supply.

An energy and cost analysis of residential heat pumps in northern climates

NASA Astrophysics Data System (ADS)

Martin, J. K.; Oneal, D. L.

1980-04-01

Lack of natural gas and high oil prices, combined with the large energy costs of electric resistance heat have forced renewed attention to the heat pump in colder climates. The diversity in heating energy use and cost effectiveness of forty-one currently retailed heat pumps in three northern cities, Boston, Denver, and Minneapolis, were examined. Heat pump heating energy use and annualized life cycle costs were compared with other forms of space heating equipment in those same cities.

Cost analysis of advanced turbine blade manufacturing processes

NASA Technical Reports Server (NTRS)

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

1977-01-01

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

Economic Burden of Hepatitis C Virus Infection in Different Stages of Disease: A Report From Southern Iran

PubMed Central

Zare, Fatemeh; Fattahi, Mohammad Reza; Sepehrimanesh, Masood; Safarpour, Ali Reza

2016-01-01

Background Hepatitis C virus (HCV) infection is a major blood-borne infection which imposes high economic cost on the patients. Objectives The current study aimed to evaluate the total annual cost due to chronic HCV related diseases imposed on each patient and their family in Southern Iran. Patients and Methods Economic burden of chronic hepatitis C-related liver diseases (chronic hepatitis C, cirrhosis and hepatocellular carcinoma) were examined. The current retrospective study evaluated 200 Iranian patients for their socioeconomic status, utilization (direct and indirect costs) and treatment costs and work days lost due to illness by a structured questionnaire in 2015. Costs of hospital admissions were extracted from databases of Nemazee hospital, Shiraz, Iran. The outpatient expenditure per patient was measured through the rate of outpatient visits and average cost per visit reported by the patients; while the inpatient costs were calculated through annual rate of hospital admissions and average expenditure. Self-medication and direct non-medical costs were also reported. The human capital approach was used to measure the work loss cost. Results The total annual cost per patient for chronic hepatitis C, cirrhosis and hepatocellular carcinoma (HCC) based on purchasing power parity (PPP) were USD 1625.50, USD 6117.2, and USD 11047.2 in 2015, respectively. Conclusions Chronic hepatitis C-related liver diseases impose a substantial economic burden on patients, families and the society. The current study provides useful information on cost of treatment and work loss for different disease states, which can be further used in cost-effectiveness evaluations. PMID:27257424

Methods and Costs to Achieve Ultra Reliable Life Support

NASA Technical Reports Server (NTRS)

Jones, Harry W.

2012-01-01

A published Mars mission is used to explore the methods and costs to achieve ultra reliable life support. The Mars mission and its recycling life support design are described. The life support systems were made triply redundant, implying that each individual system will have fairly good reliability. Ultra reliable life support is needed for Mars and other long, distant missions. Current systems apparently have insufficient reliability. The life cycle cost of the Mars life support system is estimated. Reliability can be increased by improving the intrinsic system reliability, adding spare parts, or by providing technically diverse redundant systems. The costs of these approaches are estimated. Adding spares is least costly but may be defeated by common cause failures. Using two technically diverse systems is effective but doubles the life cycle cost. Achieving ultra reliability is worth its high cost because the penalty for failure is very high.

Comparing the net cost of CSP-TES to PV deployed with battery storage

NASA Astrophysics Data System (ADS)

Jorgenson, Jennie; Mehos, Mark; Denholm, Paul

2016-05-01

Concentrated solar power with thermal energy storage (CSP-TES) is a unique source of renewable energy in that its energy can be shifted over time and it can provide the electricity system with dependable generation capacity. In this study, we provide a framework to determine if the benefits of CSP-TES (shiftable energy and the ability to provide firm capacity) exceed the benefits of PV and firm capacity sources such as long-duration battery storage or conventional natural gas combustion turbines (CTs). The results of this study using current capital cost estimates indicate that a combination of PV and conventional gas CTs provides a lower net cost compared to CSP-TES and PV with batteries. Some configurations of CSP-TES have a lower net cost than PV with batteries for even the lowest battery cost estimate. Using projected capital cost targets, however, some configurations of CSP-TES have a lower net cost than PV with either option for even the lowest battery cost estimate. The net cost of CSP-TES varies with configuration, and lower solar multiples coupled with less storage are more attractive at current cost levels, due to high component costs. However, higher solar multiples show a lower net cost using projected future costs for heliostats and thermal storage materials.

Rocket Design for the Future

NASA Technical Reports Server (NTRS)

Follett, William W.; Rajagopal, Raj

2001-01-01

The focus of the AA MDO team is to reduce product development cost through the capture and automation of best design and analysis practices and through increasing the availability of low-cost, high-fidelity analysis. Implementation of robust designs reduces costs associated with the Test-Fall-Fix cycle. RD is currently focusing on several technologies to improve the design process, including optimization and robust design, expert and rule-based systems, and collaborative technologies.

The cost-effectiveness of removing television advertising of high-fat and/or high-sugar food and beverages to Australian children.

PubMed

Magnus, A; Haby, M M; Carter, R; Swinburn, B

2009-10-01

To model the health benefits and cost-effectiveness of banning television (TV) advertisements in Australia for energy-dense, nutrient-poor food and beverages during children's peak viewing times. Benefits were modelled as changes in body mass index (BMI) and disability-adjusted life years (DALYs) saved. Intervention costs (AUD$) were compared with future health-care cost offsets from reduced prevalence of obesity-related health conditions. Changes in BMI were assumed to be maintained through to adulthood. The comparator was current practice, the reference year was 2001, and the discount rate for costs and benefits was 3%. The impact of the withdrawal of non-core food and beverage advertisements on children's actual food consumption was drawn from the best available evidence (a randomized controlled trial of advertisement exposure and food consumption). Supporting evidence was found in ecological relationships between TV advertising and childhood obesity, and from the effects of marketing bans on other products. A Working Group of stakeholders provided input into decisions surrounding the modelling assumptions and second-stage filters of 'strength of evidence', 'equity', 'acceptability to stakeholders', 'feasibility of implementation', 'sustainability' and 'side-effects'. The intervention had a gross incremental cost-effectiveness ratio of AUD$ 3.70 (95% uncertainty interval (UI) $2.40, $7.70) per DALY. Total DALYs saved were 37 000 (95% UI 16,000, 59,000). When the present value of potential savings in future health-care costs was considered (AUD$ 300m (95% UI $130m, $480m), the intervention was 'dominant', because it resulted in both a health gain and a cost offset compared with current practice. Although recognizing the limitations of the available evidence, restricting TV food advertising to children would be one of the most cost-effective population-based interventions available to governments today. Despite its economic credentials from a public health perspective, the initiative is strongly opposed by food and advertising industries and is under review by the current Australian government.

Cost-Effectiveness Analysis of Hepatitis B Vaccination Strategies to Prevent Perinatal Transmission in North Korea: Selective Vaccination vs. Universal Vaccination.

PubMed

Lee, Donghoon; Park, Sang Min

2016-01-01

To tackle the high prevalence of Hepatitis B virus (HBV) infection in North Korea, it is essential that birth doses of HBV vaccines should be administered within 24 hours of birth. As the country fails to provide a Timely Birth Dose (TBD) of HBV vaccine, the efforts of reducing the high prevalence of HBV have been significantly hampered. To examine the cost-effectiveness of vaccination strategies to prevent perinatal transmission of HBV in North Korea, we established a decision tree with a Markov model consisting of selective, universal, and the country's current vaccination program against HBV. The cost-effectiveness analysis was performed from societal and payer's perspectives and evaluated by Disability Adjusted Life Year (DALY). The results suggest that introducing the universal vaccination would prevent 1,866 cases of perinatal infections per 100,000 of the birth cohort of 2013. Furthermore, 900 cases of perinatal infections per 100,000 could be additionally averted if switching to the selective vaccination. The current vaccination is a dominated strategy both from the societal and payer's perspective. The Incremental Cost-Effectiveness Ratio (ICER) between universal and selective vaccination is $267 from the societal perspective and is reported as $273 from the payer's perspective. Based on the assumption that the 2012 Gross Domestic Product (GDP) per capita in North Korea, $582.6 was set for cost-effectiveness criteria, the result of this study indicates that selective vaccination may be a highly cost-effective strategy compared to universal vaccination.

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

PubMed

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

2009-08-10

Advances in early detection, prevention, and treatment have resulted in consistently falling cancer death rates in the United States. In parallel with these advances have come significant increases in the cost of cancer care. It is well established that the cost of health care (including cancer care) in the United States is growing more rapidly than the overall economy. In part, this is a result of the prices and rapid uptake of new agents and other technologies, including advances in imaging and therapeutic radiology. Conventional understanding suggests that high prices may reflect the costs and risks associated with the development, production, and marketing of new drugs and technologies, many of which are valued highly by physicians, patients, and payers. The increasing cost of cancer care impacts many stakeholders who play a role in a complex health care system. Our patients are the most vulnerable because they often experience uneven insurance coverage, leading to financial strain or even ruin. Other key groups include pharmaceutical manufacturers that pass along research, development, and marketing costs to the consumer; providers of cancer care who dispense increasingly expensive drugs and technologies; and the insurance industry, which ultimately passes costs to consumers. Increasingly, the economic burden of health care in general, and high-quality cancer care in particular, will be less and less affordable for an increasing number of Americans unless steps are taken to curb current trends. The American Society of Clinical Oncology (ASCO) is committed to improving cancer prevention, diagnosis, and treatment and eliminating disparities in cancer care through support of evidence-based and cost-effective practices. To address this goal, ASCO established a Cost of Care Task Force, which has developed this Guidance Statement on the Cost of Cancer Care. This Guidance Statement provides a concise overview of the economic issues facing stakeholders in the cancer community. It also recommends that the following steps be taken to address immediate needs: recognition that patient-physician discussions regarding the cost of care are an important component of high-quality care; the design of educational and support tools for oncology providers to promote effective communication about costs with patients; and the development of resources to help educate patients about the high cost of cancer care to help guide their decision making regarding treatment options. Looking to the future, this Guidance Statement also recommends that ASCO develop policy positions to address the underlying factors contributing to the increased cost of cancer care. Doing so will require a clear understanding of the factors that drive these costs, as well as potential modifications to the current cancer care system to ensure that all Americans have access to high-quality, cost-effective care.

CRADA Final Report: Application of Dual-Mode Inverter Control to Commercially Available Radial-Gap Mermanent Magnet Motors - Vol. I

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

McKeever, John W; Lawler, Jack; Downing, Mark

2006-05-01

John Deere and Company (Deere), their partner, UQM Technologies, Inc. (UQM), and the Oak Ridge National Laboratory's (ORNL's) Power Electronics and Electric Machinery Research Center (PEEMRC) recently completed work on the cooperative research and development agreement (CRADA) Number ORNL 04-0691 outlined in this report. CRADA 04-0691 addresses two topical issues of interest to Deere: (1) Improved characterization of hydrogen storage and heat-transfer management; and (2) Potential benefits from advanced electric motor traction-drive technologies. This report presents the findings of the collaborative examination of potential operational and cost benefits from using ORNL/PEEMRC dual-mode inverter control (DMIC) to drive permanent magnet (PM)more » motors in applications of interest to Deere. DMIC was initially developed and patented by ORNL to enable PM motors to be driven to speeds far above base speed where the back-electromotive force (emf) equals the source voltage where it is increasingly difficult to inject current into the motor. DMIC is a modification of conventional phase advance (CPA). DMIC's dual-speed modes are below base speed, where traditional pulse-width modulation (PWM) achieves maximum torque per ampere (amp), and above base speed, where six-step operation achieves maximum power per amp. The modification that enables DMIC adds two anti-parallel thyristors in each of the three motor phases, which consequently adds the cost of six thyristors. Two features evaluated in this collaboration with potential to justify the additional thyristor cost were a possible reduction in motor cost and savings during operation because of higher efficiency, both permitted because of lower current. The collaborative analysis showed that the reduction of motor cost and base cost of the inverter was small, while the cost of adding six thyristors was greater than anticipated. Modeling the DMIC control displayed inverter efficiency gains due to reduced current, especially under light load and higher speed. This current reduction, which is the salient feature of DMIC, may be significant when operating duty cycles have low loads at high frequencies. Reduced copper losses make operation more efficient thereby reducing operating costs. In the Deere applications selected for this study, the operating benefit was overshadowed by the motor's rotational losses. Rotational losses of Deere 1 and Deere 2 dominate the overall drive efficiency so that their reduction has the greatest potential to improve performance. A good follow-up project would be to explore cost erective ways to reduce the rotational losses buy 66%. During this analysis it has been shown that, for a PM synchronous motor (PMSM), the DMIC's salient feature is its ability to minimize the current required to deliver a given power. The root-mean-square (rms) current of a motor is determined by the speed, power, motor drive parameters, and controls as I{sub rms} = (n, P, motor drive parameters, controls), where n is the relative speed, {omega}/{omega}{sub base} = {Omega}/{Omega}{sub base}, {omega} is the mechanical frequency, {Omega} is the electrical frequency, and P is the power. The characteristic current is the rms current at infinite speed, when all resistance and rotational losses are neglected. Expressions have been derived for the characteristic currents of PMSMs when the motor is controlled by CPA and by DMIC. The expression for CPA characteristic current is I{sub n{yields}{infinity}}{sup CPA} = nE{sub base}/X = nE{sub base}/n{Omega}{sub b}L = E{sub base}/{Omega}{sub b}L, which is strictly a function of the machine parameters, back-emf at base speed, base speed electrical frequency, and inductance. At high speeds, the rms current tends to remain constant even when the load-power requirements are reduced. The expression for DMIC characteristic current is I{sub n{yields}{infinity}}{sup DMIC} = P/3V{sub max} = P{pi}/3{radical}2V{sub dc}, which has nothing to do with machine parameters. This interesting result shows that at high speeds under DMIC control, the rms current diminishes as the load-power requirements are reduced. It also shows that the DMIC characteristic current can be further reduced by increasing the dc supply voltage. This explains the main benefit of DMIC; its ability to minimize the current required to meet a required load.« less

Method and apparatus for energy efficient self-aeration in chemical, biochemical, and wastewater treatment processes

DOEpatents

Gao, Johnway [Richland, WA; Skeen, Rodney S [Pendleton, OR

2002-05-28

The present invention is a pulse spilling self-aerator (PSSA) that has the potential to greatly lower the installation, operation, and maintenance cost associated with aerating and mixing aqueous solutions. Currently, large quantities of low-pressure air are required in aeration systems to support many biochemical production processes and wastewater treatment plants. Oxygen is traditionally supplied and mixed by a compressor or blower and a mechanical agitator. These systems have high-energy requirements and high installation and maintenance costs. The PSSA provides a mixing and aeration capability that can increase operational efficiency and reduce overall cost.

The cost-effectiveness of HIV pre-exposure prophylaxis in men who have sex with men and transgender women at high risk of HIV infection in Brazil.

PubMed

Luz, Paula M; Osher, Benjamin; Grinsztejn, Beatriz; Maclean, Rachel L; Losina, Elena; Stern, Madeline E; Struchiner, Claudio J; Parker, Robert A; Freedberg, Kenneth A; Mesquita, Fabio; Walensky, Rochelle P; Veloso, Valdilea G; Paltiel, A David

2018-03-01

Men who have sex with men (MSM) and transgender women (TGW) in Brazil experience high rates of HIV infection. We examined the clinical and economic outcomes of implementing a pre-exposure prophylaxis (PrEP) programme in these populations. We used the Cost-Effectiveness of Preventing AIDS Complications (CEPAC)-International model of HIV prevention and treatment to evaluate two strategies: the current standard of care (SOC) in Brazil, including universal ART access (No PrEP strategy); and the current SOC plus daily tenofovir/emtracitabine PrEP (PrEP strategy) until age 50. Mean age (31 years, SD 8.4 years), age-stratified annual HIV incidence (age ≤ 40 years: 4.3/100 PY; age > 40 years: 1.0/100 PY), PrEP effectiveness (43% HIV incidence reduction) and PrEP drug costs ($23/month) were from Brazil-based sources. The analysis focused on direct medical costs of HIV care. We measured the comparative value of PrEP in 2015 United States dollars (USD) per year of life saved (YLS). Willingness-to-pay threshold was based on Brazil's annual per capita gross domestic product (GDP; 2015: $8540 USD). Lifetime HIV infection risk among high-risk MSM and TGW was 50.5% with No PrEP and decreased to 40.1% with PrEP. PrEP increased per-person undiscounted (discounted) life expectancy from 36.8 (20.7) years to 41.0 (22.4) years and lifetime discounted HIV-related medical costs from $4100 to $8420, which led to an incremental cost-effectiveness ratio (ICER) of $2530/YLS. PrEP remained cost-effective (<1x GDP) under plausible variation in key parameters, including PrEP effectiveness and cost, initial cohort age and HIV testing frequency on/off PrEP. Daily tenofovir/emtracitabine PrEP among MSM and TGW at high risk of HIV infection in Brazil would increase life expectancy and be highly cost-effective. © 2018 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society.

Solar variability datalogger

DOE PAGES

Lave, Matthew; Stein, Joshua; Smith, Ryan

2016-07-28

To address the lack of knowledge of local solar variability, we have developed and deployed a low-cost solar variability datalogger (SVD). While most currently used solar irradiance sensors are expensive pyranometers with high accuracy (relevant for annual energy estimates), low-cost sensors display similar precision (relevant for solar variability) as high-cost pyranometers, even if they are not as accurate. In this work, we present evaluation of various low-cost irradiance sensor types, describe the SVD, and present validation and comparison of the SVD collected data. In conclusion, the low cost and ease of use of the SVD will enable a greater understandingmore » of local solar variability, which will reduce developer and utility uncertainty about the impact of solar photovoltaic (PV) installations and thus will encourage greater penetrations of solar energy.« less

Efficient Coding and Energy Efficiency Are Promoted by Balanced Excitatory and Inhibitory Synaptic Currents in Neuronal Network

PubMed Central

Yu, Lianchun; Shen, Zhou; Wang, Chen; Yu, Yuguo

2018-01-01

Selective pressure may drive neural systems to process as much information as possible with the lowest energy cost. Recent experiment evidence revealed that the ratio between synaptic excitation and inhibition (E/I) in local cortex is generally maintained at a certain value which may influence the efficiency of energy consumption and information transmission of neural networks. To understand this issue deeply, we constructed a typical recurrent Hodgkin-Huxley network model and studied the general principles that governs the relationship among the E/I synaptic current ratio, the energy cost and total amount of information transmission. We observed in such a network that there exists an optimal E/I synaptic current ratio in the network by which the information transmission achieves the maximum with relatively low energy cost. The coding energy efficiency which is defined as the mutual information divided by the energy cost, achieved the maximum with the balanced synaptic current. Although background noise degrades information transmission and imposes an additional energy cost, we find an optimal noise intensity that yields the largest information transmission and energy efficiency at this optimal E/I synaptic transmission ratio. The maximization of energy efficiency also requires a certain part of energy cost associated with spontaneous spiking and synaptic activities. We further proved this finding with analytical solution based on the response function of bistable neurons, and demonstrated that optimal net synaptic currents are capable of maximizing both the mutual information and energy efficiency. These results revealed that the development of E/I synaptic current balance could lead a cortical network to operate at a highly efficient information transmission rate at a relatively low energy cost. The generality of neuronal models and the recurrent network configuration used here suggest that the existence of an optimal E/I cell ratio for highly efficient energy costs and information maximization is a potential principle for cortical circuit networks. Summary We conducted numerical simulations and mathematical analysis to examine the energy efficiency of neural information transmission in a recurrent network as a function of the ratio of excitatory and inhibitory synaptic connections. We obtained a general solution showing that there exists an optimal E/I synaptic ratio in a recurrent network at which the information transmission as well as the energy efficiency of this network achieves a global maximum. These results reflect general mechanisms for sensory coding processes, which may give insight into the energy efficiency of neural communication and coding. PMID:29773979

Efficient Coding and Energy Efficiency Are Promoted by Balanced Excitatory and Inhibitory Synaptic Currents in Neuronal Network.

PubMed

Yu, Lianchun; Shen, Zhou; Wang, Chen; Yu, Yuguo

2018-01-01

Selective pressure may drive neural systems to process as much information as possible with the lowest energy cost. Recent experiment evidence revealed that the ratio between synaptic excitation and inhibition (E/I) in local cortex is generally maintained at a certain value which may influence the efficiency of energy consumption and information transmission of neural networks. To understand this issue deeply, we constructed a typical recurrent Hodgkin-Huxley network model and studied the general principles that governs the relationship among the E/I synaptic current ratio, the energy cost and total amount of information transmission. We observed in such a network that there exists an optimal E/I synaptic current ratio in the network by which the information transmission achieves the maximum with relatively low energy cost. The coding energy efficiency which is defined as the mutual information divided by the energy cost, achieved the maximum with the balanced synaptic current. Although background noise degrades information transmission and imposes an additional energy cost, we find an optimal noise intensity that yields the largest information transmission and energy efficiency at this optimal E/I synaptic transmission ratio. The maximization of energy efficiency also requires a certain part of energy cost associated with spontaneous spiking and synaptic activities. We further proved this finding with analytical solution based on the response function of bistable neurons, and demonstrated that optimal net synaptic currents are capable of maximizing both the mutual information and energy efficiency. These results revealed that the development of E/I synaptic current balance could lead a cortical network to operate at a highly efficient information transmission rate at a relatively low energy cost. The generality of neuronal models and the recurrent network configuration used here suggest that the existence of an optimal E/I cell ratio for highly efficient energy costs and information maximization is a potential principle for cortical circuit networks. We conducted numerical simulations and mathematical analysis to examine the energy efficiency of neural information transmission in a recurrent network as a function of the ratio of excitatory and inhibitory synaptic connections. We obtained a general solution showing that there exists an optimal E/I synaptic ratio in a recurrent network at which the information transmission as well as the energy efficiency of this network achieves a global maximum. These results reflect general mechanisms for sensory coding processes, which may give insight into the energy efficiency of neural communication and coding.

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

Jorgenson, Jennie; Mehos, Mark; Denholm, Paul

Concentrated solar power with thermal energy storage (CSP-TES) is a unique source of renewable energy in that its energy can be shifted over time and it can provide the electricity system with dependable generation capacity. In this study, we provide a framework to determine if the benefits of CSP-TES (shiftable energy and the ability to provide firm capacity) exceed the benefits of PV and firm capacity sources such as long-duration battery storage or conventional natural gas combustion turbines (CTs). The results of this study using current capital cost estimates indicate that a combination of PV and conventional gas CTs providesmore » a lower net cost compared to CSP-TES and PV with batteries. Some configurations of CSP-TES have a lower net cost than PV with batteries for even the lowest battery cost estimate. Using projected capital cost targets, however, some configurations of CSP-TES have a lower net cost than PV with either option for even the lowest battery cost estimate. The net cost of CSP-TES varies with configuration, and lower solar multiples coupled with less storage are more attractive at current cost levels, due to high component costs. However, higher solar multiples show a lower net cost using projected future costs for heliostats and thermal storage materials.« less

Prediction of SFL Interruption Performance from the Results of Arc Simulation during High-Current Phase

NASA Astrophysics Data System (ADS)

Lee, Jong-Chul; Lee, Won-Ho; Kim, Woun-Jea

2015-09-01

The design and development procedures of SF6 gas circuit breakers are still largely based on trial and error through testing although the development costs go higher every year. The computation cannot cover the testing satisfactorily because all the real processes arc not taken into account. But the knowledge of the arc behavior and the prediction of the thermal-flow inside the interrupters by numerical simulations are more useful than those by experiments due to the difficulties to obtain physical quantities experimentally and the reduction of computational costs in recent years. In this paper, in order to get further information into the interruption process of a SF6 self-blast interrupter, which is based on a combination of thermal expansion and the arc rotation principle, gas flow simulations with a CFD-arc modeling are performed during the whole switching process such as high-current period, pre-current zero period, and current-zero period. Through the complete work, the pressure-rise and the ramp of the pressure inside the chamber before current zero as well as the post-arc current after current zero should be a good criterion to predict the short-line fault interruption performance of interrupters.

Identification of effective screening strategies for cardiovascular disease prevention in a developing country: using cardiovascular risk-estimation and risk-reduction tools for policy recommendations.

PubMed

Selvarajah, Sharmini; Haniff, Jamaiyah; Kaur, Gurpreet; Guat Hiong, Tee; Bujang, Adam; Chee Cheong, Kee; Bots, Michiel L

2013-02-25

Recent increases in cardiovascular risk-factor prevalences have led to new national policy recommendations of universal screening for primary prevention of cardiovascular disease in Malaysia. This study assessed whether the current national policy recommendation of universal screening was optimal, by comparing the effectiveness and impact of various cardiovascular screening strategies. Data from a national population based survey of 24 270 participants aged 30 to 74 was used. Five screening strategies were modelled for the overall population and by gender; universal and targeted screening (four age cut-off points). Screening strategies were assessed based on the ability to detect high cardiovascular risk populations (effectiveness), incremental effectiveness, impact on cardiovascular event prevention and cost of screening. 26.7% (95% confidence limits 25.7, 27.7) were at high cardiovascular risk, men 34.7% (33.6, 35.8) and women 18.9% (17.8, 20). Universal screening identified all those at high-risk and resulted in one high-risk individual detected for every 3.7 people screened, with an estimated cost of USD60. However, universal screening resulted in screening an additional 7169 persons, with an incremental cost of USD115,033 for detection of one additional high-risk individual in comparison to targeted screening of those aged ≥35 years. The cost, incremental cost and impact of detection of high-risk individuals were more for women than men for all screening strategies. The impact of screening women aged ≥45 years was similar to universal screening in men. Targeted gender- and age-specific screening strategies would ensure more optimal utilisation of scarce resources compared to the current policy recommendations of universal screening.

Identification of effective screening strategies for cardiovascular disease prevention in a developing country: using cardiovascular risk-estimation and risk-reduction tools for policy recommendations

PubMed Central

2013-01-01

Background Recent increases in cardiovascular risk-factor prevalences have led to new national policy recommendations of universal screening for primary prevention of cardiovascular disease in Malaysia. This study assessed whether the current national policy recommendation of universal screening was optimal, by comparing the effectiveness and impact of various cardiovascular screening strategies. Methods Data from a national population based survey of 24 270 participants aged 30 to 74 was used. Five screening strategies were modelled for the overall population and by gender; universal and targeted screening (four age cut-off points). Screening strategies were assessed based on the ability to detect high cardiovascular risk populations (effectiveness), incremental effectiveness, impact on cardiovascular event prevention and cost of screening. Results 26.7% (95% confidence limits 25.7, 27.7) were at high cardiovascular risk, men 34.7% (33.6, 35.8) and women 18.9% (17.8, 20). Universal screening identified all those at high-risk and resulted in one high-risk individual detected for every 3.7 people screened, with an estimated cost of USD60. However, universal screening resulted in screening an additional 7169 persons, with an incremental cost of USD115,033 for detection of one additional high-risk individual in comparison to targeted screening of those aged ≥35 years. The cost, incremental cost and impact of detection of high-risk individuals were more for women than men for all screening strategies. The impact of screening women aged ≥45 years was similar to universal screening in men. Conclusions Targeted gender- and age-specific screening strategies would ensure more optimal utilisation of scarce resources compared to the current policy recommendations of universal screening. PMID:23442728

Potential uses for peroxymonosulfate in pulping and bleaching

Treesearch

Edward L. Springer

1992-01-01

Practical and cost-effective uses for peroxymonosulfate can be developed in pulping and bleaching. Peroxymonosulfate pulping produces strong pulps, has lower capital requirements, and is less environmentally troublesome compared with current pulping processes. The cost of oxidant may, however, be somewhat too high for practical use. We discuss means for reducing the...

Preliminary design of a high speed civil transport: The Opus 0-001

NASA Technical Reports Server (NTRS)

1992-01-01

Based on research into the technology and issues surrounding the design, development, and operation of a second generation High Speed Civil Transport, HSCT, the Opus 0-001 team completed the preliminary design of a sixty passenger, three engine aircraft. The design of this aircraft was performed using a computer program which the team wrote. This program automatically computed the geometric, aerodynamic, and performance characteristic of an aircraft whose preliminary geometry was specified. The Opus 0-001 aircraft was designed for a cruise Mach number of 2.2, a range of 4,700 nautical miles and its design was based in current or very near term technology. Its small size was a consequence of an emphasis on a profitable, low cost program, capable of delivering tomorrow's passengers in style and comfort at prices that make it an attractive competitor to both current and future subsonic transport aircraft. Several hundred thousand cases of Cruise Mach number, aircraft size and cost breakdown were investigated to obtain costs and revenues for which profit was calculated. The projected unit flyaway cost was $92.0 million per aircraft.

Current practice and usual care of major cervical disorders in Korea

PubMed Central

Choi, A Ryeon; Shin, Joon-Shik; Lee, Jinho; Lee, Yoon Jae; Kim, Me-riong; Oh, Min-seok; Lee, Eun-Jung; Kim, Sungchul; Kim, Mia; Ha, In-Hyuk

2017-01-01

Abstract Neck pain is a highly common condition and is the 4th major cause of years lived with disability. Previous literature has focused on the effect of specific treatments, and observations of actual practice are lacking to date. This study examined Korean health insurance review and assessment service (HIRA) claims data to the aim of assessing prevalence and comparing current medical practice and costs of cervical disorders in Korea. Current practice trends were determined through assessment of prevalence, total expenses, per-patient expense, average days in care, average days of visits, sociodemographic characteristics, distribution of medical costs, and frequency of treatment types of high frequency cervical disorders (cervical sprain/strain, cervical intervertebral disc displacement [IDD], and cervicalgia). Although the number of cervical IDD patients was few, total expenses, per-patient expense, average days in care, and average days of visits were highest. The proportion of women was higher than men in all 3 groups with highest prevalence in the ≥50s middle-aged population for IDD compared to sprain/strain. Primary care settings were commonly used for ambulatory care, of which approximately 70% chose orthopedic specialist treatment. In analysis of medical expenditure distribution, costs of visit (consultation) (22%–34%) and physical therapy (14%–16%) were in the top 3 for all 3 disorders. Although heat and electrical therapies were the most frequently used physical therapies, traction use was high in the cervical IDD group. In nonnarcotics, aceclofenac and diclofenac were the most commonly used NSAIDs, and pethidine was their counterpart in narcotics. This study investigated practice trends and cost distribution of treatment regimens for major cervical disorders, providing current usage patterns to healthcare policy decision makers, and the detailed treatment reports are expected to be of use to clinicians and researchers in understanding current usual care. PMID:29145327

Current practice and usual care of major cervical disorders in Korea: A cross-sectional study of Korean health insurance review and assessment service national patient sample data.

PubMed

Choi, A Ryeon; Shin, Joon-Shik; Lee, Jinho; Lee, Yoon Jae; Kim, Me-Riong; Oh, Min-Seok; Lee, Eun-Jung; Kim, Sungchul; Kim, Mia; Ha, In-Hyuk

2017-11-01

Neck pain is a highly common condition and is the 4th major cause of years lived with disability. Previous literature has focused on the effect of specific treatments, and observations of actual practice are lacking to date. This study examined Korean health insurance review and assessment service (HIRA) claims data to the aim of assessing prevalence and comparing current medical practice and costs of cervical disorders in Korea.Current practice trends were determined through assessment of prevalence, total expenses, per-patient expense, average days in care, average days of visits, sociodemographic characteristics, distribution of medical costs, and frequency of treatment types of high frequency cervical disorders (cervical sprain/strain, cervical intervertebral disc displacement [IDD], and cervicalgia).Although the number of cervical IDD patients was few, total expenses, per-patient expense, average days in care, and average days of visits were highest. The proportion of women was higher than men in all 3 groups with highest prevalence in the ≥50s middle-aged population for IDD compared to sprain/strain. Primary care settings were commonly used for ambulatory care, of which approximately 70% chose orthopedic specialist treatment. In analysis of medical expenditure distribution, costs of visit (consultation) (22%-34%) and physical therapy (14%-16%) were in the top 3 for all 3 disorders. Although heat and electrical therapies were the most frequently used physical therapies, traction use was high in the cervical IDD group. In nonnarcotics, aceclofenac and diclofenac were the most commonly used NSAIDs, and pethidine was their counterpart in narcotics.This study investigated practice trends and cost distribution of treatment regimens for major cervical disorders, providing current usage patterns to healthcare policy decision makers, and the detailed treatment reports are expected to be of use to clinicians and researchers in understanding current usual care.

Design and development of a low cost, high current density power supply for streamer free atmospheric pressure DBD plasma generation in air.

PubMed

Jain, Vishal; Visani, Anand; Srinivasan, R; Agarwal, Vivek

2018-03-01

This paper presents a new power supply architecture for generating a uniform dielectric barrier discharge (DBD) plasma in air medium at atmospheric pressure. It is quite a challenge to generate atmospheric pressure uniform glow discharge plasma, especially in air. This is because air plasma needs very high voltage for initiation of discharge. If the high voltage is used along with high current density, it leads to the formation of streamers, which is undesirable for most applications like textile treatment, etc. Researchers have tried to generate high-density plasma using a RF source, nanosecond pulsed DC source, and medium frequency AC source. However, these solutions suffer from low current discharge and low efficiency due to the addition of an external resistor to control the discharge current. Moreover, they are relatively costly and bulky. This paper presents a new power supply configuration which is very compact and generates high average density (∼0.28 W/cm 2 ) uniform glow DBD plasma in air at atmospheric pressure. The efficiency is also higher as no external resistor is required to control the discharge current. An inherent feature of this topology is that it can drive higher current oscillations (∼50 A peak and 2-3 MHz frequency) into the plasma that damp out due to the plasma dissipation only. A newly proposed model has been used with experimental validation in this paper. Simulations and experimental validation of the proposed topology are included. Also, the application of the generated plasma for polymer film treatment is demonstrated.

Design and development of a low cost, high current density power supply for streamer free atmospheric pressure DBD plasma generation in air

NASA Astrophysics Data System (ADS)

Jain, Vishal; Visani, Anand; Srinivasan, R.; Agarwal, Vivek

2018-03-01

This paper presents a new power supply architecture for generating a uniform dielectric barrier discharge (DBD) plasma in air medium at atmospheric pressure. It is quite a challenge to generate atmospheric pressure uniform glow discharge plasma, especially in air. This is because air plasma needs very high voltage for initiation of discharge. If the high voltage is used along with high current density, it leads to the formation of streamers, which is undesirable for most applications like textile treatment, etc. Researchers have tried to generate high-density plasma using a RF source, nanosecond pulsed DC source, and medium frequency AC source. However, these solutions suffer from low current discharge and low efficiency due to the addition of an external resistor to control the discharge current. Moreover, they are relatively costly and bulky. This paper presents a new power supply configuration which is very compact and generates high average density (˜0.28 W/cm2) uniform glow DBD plasma in air at atmospheric pressure. The efficiency is also higher as no external resistor is required to control the discharge current. An inherent feature of this topology is that it can drive higher current oscillations (˜50 A peak and 2-3 MHz frequency) into the plasma that damp out due to the plasma dissipation only. A newly proposed model has been used with experimental validation in this paper. Simulations and experimental validation of the proposed topology are included. Also, the application of the generated plasma for polymer film treatment is demonstrated.

Novel circuits for energizing manganin stress gauges

NASA Astrophysics Data System (ADS)

Tasker, Douglas G.

2017-01-01

This paper describes the design of a novel MOSFET pulsed constant current supplies for low impedance Manganin stress gauges. The design emphasis has been on high accuracy, low noise, simple, low cost, disposable supplies that can be used to energize multiple gauges in explosive or shock experiments. The Manganin gauges used to measure stresses in detonating explosive experiments have typical resistances of 50 mΩ and are energized with pulsed currents of 50 A. Conventional pulsed, constant current supplies for these gauges are high voltage devices with outputs as high as 500 V. Common problems with the use of high voltage supplies at explosive firing sites are: erroneous signals caused by ground loops; overdrive of oscilloscopes on gauge failure; gauge signal crosstalk; cost; and errors due to changing load impedances. The new circuit corrects these issues. It is an 18-V circuit, powered by 9-V alkaline batteries, and features an optically isolated trigger, and single-point grounding. These circuits have been successfully tested at the Los Alamos National Laboratory in explosive experiments. [LA-UR-15-24819

High-Tc superconducting materials for electric power applications.

PubMed

Larbalestier, D; Gurevich, A; Feldmann, D M; Polyanskii, A

2001-11-15

Large-scale superconducting electric devices for power industry depend critically on wires with high critical current densities at temperatures where cryogenic losses are tolerable. This restricts choice to two high-temperature cuprate superconductors, (Bi,Pb)2Sr2Ca2Cu3Ox and YBa2Cu3Ox, and possibly to MgB2, recently discovered to superconduct at 39 K. Crystal structure and material anisotropy place fundamental restrictions on their properties, especially in polycrystalline form. So far, power applications have followed a largely empirical, twin-track approach of conductor development and construction of prototype devices. The feasibility of superconducting power cables, magnetic energy-storage devices, transformers, fault current limiters and motors, largely using (Bi,Pb)2Sr2Ca2Cu3Ox conductor, is proven. Widespread applications now depend significantly on cost-effective resolution of fundamental materials and fabrication issues, which control the production of low-cost, high-performance conductors of these remarkable compounds.

Opportunities for Success: Cost Effective Programs for Children Update, 1988. A Report of the Select Committee on Children, Youth and Families, U.S. House of Representatives, One Hundredth Congress, Second Session.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. House Select Committee on Children, Youth, and Families.

Based on findings of the most current and highly regarded evaluations and research reviews available, this committee print provides an update of a prior committee report (August, 1985) on eight cost-effective federal programs for children. Described in terms of program participation, characteristics, benefits for children, cost effectiveness, and…

Guide for Transitioning Army Missile Systems From Development to Production.

DTIC Science & Technology

1981-07-01

cost reduction ideas. 3 e! M. atumtion0 !eM . One missile system currently In fall *"I* develoluft, MM9 bee foregone the traditional engineering... costs , delivery schedules and deployment dates. Because of these difficulties and a desire to improve the weapon systems acquisition process, the...tered during the transition of new missile systems into production include: 1. High production unit costs - Occasionally the number of systems to be

Advanced Extremely High Frequency Satellite (AEHF)

DTIC Science & Technology

2015-12-01

control their tactical and strategic forces at all levels of conflict up to and including general nuclear war, and it supports the attainment of...10195.1 10622.2 Confidence Level Confidence Level of cost estimate for current APB: 50% The ICE) that supports the AEHF SV 1-4, like all life-cycle cost...mathematically the precise confidence levels associated with life-cycle cost estimates prepared for MDAPs. Based on the rigor in methods used in building

Site Selection of Ocean Current Power Generation from Drifter Measurements

DTIC Science & Technology

2014-12-01

power from a fluid’s momentum (e.g. a 48 tidal turbine or wind turbine ) can realistically reach an efficiency up to 50% (the Betz 49 limit is a bit...exceptionally high resource include the UK, Italy, Philippines, and 52 Japan [4]. But strong tidal currents only last for a short time period, and cannot...require less cost of construction and 91 maintenance. High and stable flow speeds can provide the great and steady power in 92 comparison tidal current

Low-Cost Composite Materials and Structures for Aircraft Applications

NASA Technical Reports Server (NTRS)

Deo, Ravi B.; Starnes, James H., Jr.; Holzwarth, Richard C.

2003-01-01

A survey of current applications of composite materials and structures in military, transport and General Aviation aircraft is presented to assess the maturity of composites technology, and the payoffs realized. The results of the survey show that performance requirements and the potential to reduce life cycle costs for military aircraft and direct operating costs for transport aircraft are the main reasons for the selection of composite materials for current aircraft applications. Initial acquisition costs of composite airframe components are affected by high material costs and complex certification tests which appear to discourage the widespread use of composite materials for aircraft applications. Material suppliers have performed very well to date in developing resin matrix and fiber systems for improved mechanical, durability and damage tolerance performance. The next challenge for material suppliers is to reduce material costs and to develop materials that are suitable for simplified and inexpensive manufacturing processes. The focus of airframe manufacturers should be on the development of structural designs that reduce assembly costs by the use of large-scale integration of airframe components with unitized structures and manufacturing processes that minimize excessive manual labor.

A multidisciplinary approach to the development of low-cost high-performance lightwave networks

NASA Technical Reports Server (NTRS)

Maitan, Jacek; Harwit, Alex

1991-01-01

Our research focuses on high-speed distributed systems. We anticipate that our results will allow the fabrication of low-cost networks employing multi-gigabit-per-second data links for space and military applications. The recent development of high-speed low-cost photonic components and new generations of microprocessors creates an opportunity to develop advanced large-scale distributed information systems. These systems currently involve hundreds of thousands of nodes and are made up of components and communications links that may fail during operation. In order to realize these systems, research is needed into technologies that foster adaptability and scaleability. Self-organizing mechanisms are needed to integrate a working fabric of large-scale distributed systems. The challenge is to fuse theory, technology, and development methodologies to construct a cost-effective, efficient, large-scale system.

Building America Case Study: Simple Retrofit High-Efficiency Natural Gas Water Heater Field Test, Minneapolis, Minnesota

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

High performance water heaters are typically more time consuming and costly to install in retrofit applications, making high performance water heaters difficult to justify economically. However, recent advancements in high performance water heaters have targeted the retrofit market, simplifying installations and reducing costs. Four high efficiency natural gas water heaters designed specifically for retrofit applications were installed in single-family homes along with detailed monitoring systems to characterize their savings potential, their installed efficiencies, and their ability to meet household demands. The water heaters tested for this project were designed to improve the cost-effectiveness and increase market penetration of high efficiencymore » water heaters in the residential retrofit market. The retrofit high efficiency water heaters achieved their goal of reducing costs, maintaining savings potential and installed efficiency of other high efficiency water heaters, and meeting the necessary capacity in order to improve cost-effectiveness. However, the improvements were not sufficient to achieve simple paybacks of less than ten years for the incremental cost compared to a minimum efficiency heater. Significant changes would be necessary to reduce the simple payback to six years or less. Annual energy savings in the range of $200 would also reduce paybacks to less than six years. These energy savings would require either significantly higher fuel costs (greater than $1.50 per therm) or very high usage (around 120 gallons per day). For current incremental costs, the water heater efficiency would need to be similar to that of a heat pump water heater to deliver a six year payback.« less

Simple Retrofit High-Efficiency Natural Gas Water Heater Field Test

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

Schoenbauer, Ben

High-performance water heaters are typically more time consuming and costly to install in retrofit applications, making high performance water heaters difficult to justify economically. However, recent advancements in high performance water heaters have targeted the retrofit market, simplifying installations and reducing costs. Four high efficiency natural gas water heaters designed specifically for retrofit applications were installed in single-family homes along with detailed monitoring systems to characterize their savings potential, their installed efficiencies, and their ability to meet household demands. The water heaters tested for this project were designed to improve the cost-effectiveness and increase market penetration of high efficiency watermore » heaters in the residential retrofit market. The retrofit high efficiency water heaters achieved their goal of reducing costs, maintaining savings potential and installed efficiency of other high efficiency water heaters, and meeting the necessary capacity in order to improve cost-effectiveness. However, the improvements were not sufficient to achieve simple paybacks of less than ten years for the incremental cost compared to a minimum efficiency heater. Significant changes would be necessary to reduce the simple payback to six years or less. Annual energy savings in the range of $200 would also reduce paybacks to less than six years. These energy savings would require either significantly higher fuel costs (greater than $1.50 per therm) or very high usage (around 120 gallons per day). For current incremental costs, the water heater efficiency would need to be similar to that of a heat pump water heater to deliver a six year payback.« less

Simple Retrofit High-Efficiency Natural Gas Water Heater Field Test

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

Schoenbauer, Ben

High performance water heaters are typically more time consuming and costly to install in retrofit applications, making high performance water heaters difficult to justify economically. However, recent advancements in high performance water heaters have targeted the retrofit market, simplifying installations and reducing costs. Four high efficiency natural gas water heaters designed specifically for retrofit applications were installed in single-family homes along with detailed monitoring systems to characterize their savings potential, their installed efficiencies, and their ability to meet household demands. The water heaters tested for this project were designed to improve the cost-effectiveness and increase market penetration of high efficiencymore » water heaters in the residential retrofit market. The retrofit high efficiency water heaters achieved their goal of reducing costs, maintaining savings potential and installed efficiency of other high efficiency water heaters, and meeting the necessary capacity in order to improve cost-effectiveness. However, the improvements were not sufficient to achieve simple paybacks of less than ten years for the incremental cost compared to a minimum efficiency heater. Significant changes would be necessary to reduce the simple payback to six years or less. Annual energy savings in the range of $200 would also reduce paybacks to less than six years. These energy savings would require either significantly higher fuel costs (greater than $1.50 per therm) or very high usage (around 120 gallons per day). For current incremental costs, the water heater efficiency would need to be similar to that of a heat pump water heater to deliver a six year payback.« less

Design Methodology for Multi-Element High-Lift Systems on Subsonic Civil Transport Aircraft

NASA Technical Reports Server (NTRS)

Pepper, R. S.; vanDam, C. P.

1996-01-01

The choice of a high-lift system is crucial in the preliminary design process of a subsonic civil transport aircraft. Its purpose is to increase the allowable aircraft weight or decrease the aircraft's wing area for a given takeoff and landing performance. However, the implementation of a high-lift system into a design must be done carefully, for it can improve the aerodynamic performance of an aircraft but may also drastically increase the aircraft empty weight. If designed properly, a high-lift system can improve the cost effectiveness of an aircraft by increasing the payload weight for a given takeoff and landing performance. This is why the design methodology for a high-lift system should incorporate aerodynamic performance, weight, and cost. The airframe industry has experienced rapid technological growth in recent years which has led to significant advances in high-lift systems. For this reason many existing design methodologies have become obsolete since they are based on outdated low Reynolds number wind-tunnel data and can no longer accurately predict the aerodynamic characteristics or weight of current multi-element wings. Therefore, a new design methodology has been created that reflects current aerodynamic, weight, and cost data and provides enough flexibility to allow incorporation of new data when it becomes available.

Cost analysis of school-based intermittent screening and treatment of malaria in Kenya

PubMed Central

2011-01-01

Background The control of malaria in schools is receiving increasing attention, but there remains currently no consensus as to the optimal intervention strategy. This paper analyses the costs of intermittent screening and treatment (IST) of malaria in schools, implemented as part of a cluster-randomized controlled trial on the Kenyan coast. Methods Financial and economic costs were estimated using an ingredients approach whereby all resources required in the delivery of IST are quantified and valued. Sensitivity analysis was conducted to investigate how programme variation affects costs and to identify potential cost savings in the future implementation of IST. Results The estimated financial cost of IST per child screened is US$ 6.61 (economic cost US$ 6.24). Key contributors to cost were salary costs (36%) and malaria rapid diagnostic tests (RDT) (22%). Almost half (47%) of the intervention cost comprises redeployment of existing resources including health worker time and use of hospital vehicles. Sensitivity analysis identified changes to intervention delivery that can reduce programme costs by 40%, including use of alternative RDTs and removal of supervised treatment. Cost-effectiveness is also likely to be highly sensitive to the proportion of children found to be RDT-positive. Conclusion In the current context, school-based IST is a relatively expensive malaria intervention, but reducing the complexity of delivery can result in considerable savings in the cost of intervention. (Costs are reported in US$ 2010). PMID:21933376

High-Efficiency, Multijunction Solar Cells for Large-Scale Solar Electricity Generation

NASA Astrophysics Data System (ADS)

Kurtz, Sarah

2006-03-01

A solar cell with an infinite number of materials (matched to the solar spectrum) has a theoretical efficiency limit of 68%. If sunlight is concentrated, this limit increases to about 87%. These theoretical limits are calculated using basic physics and are independent of the details of the materials. In practice, the challenge of achieving high efficiency depends on identifying materials that can effectively use the solar spectrum. Impressive progress has been made with the current efficiency record being 39%. Today's solar market is also showing impressive progress, but is still hindered by high prices. One strategy for reducing cost is to use lenses or mirrors to focus the light on small solar cells. In this case, the system cost is dominated by the cost of the relatively inexpensive optics. The value of the optics increases with the efficiency of the solar cell. Thus, a concentrator system made with 35%- 40%-efficient solar cells is expected to deliver 50% more power at a similar cost when compare with a system using 25%-efficient cells. Today's markets are showing an opportunity for large concentrator systems that didn't exist 5-10 years ago. Efficiencies may soon pass 40% and ultimately may reach 50%, providing a pathway to improved performance and decreased cost. Many companies are currently investigating this technology for large-scale electricity generation. The presentation will cover the basic physics and more practical considerations to achieving high efficiency as well as describing the current status of the concentrator industry. This work has been authored by an employee of the Midwest Research Institute under Contract No. DE- AC36-99GO10337 with the U.S. Department of Energy. The United States Government retains and the publisher, by accepting the article for publication, acknowledges that the United States Government retains a non-exclusive, paid-up, irrevocable, worldwide license to publish or reproduce the published form of this work, or allow others to do so, for United States Government purposes.

Near-Blackbody Enclosed Particle-Receiver Development

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

Ma, Zhiwen; Sakadjian, Bartev

2015-12-01

This 3-year project develops a technology using gas/solid, two-phase flow as a heat-transfer fluid and separated, stable, solid particles as a thermal energy storage (TES) medium for a concentrating solar power (CSP) plant, to address the temperature, efficiency, and cost barriers associated with current molten-salt CSP systems. This project focused on developing a near-blackbody particle receiver and an integrated fluidized-bed heat exchanger with auxiliary components to achieve greater than 20% cost reduction over current CSP plants, and to provide the ability to drive high-efficiency power cycles.

How much is tuberculosis screening worth? Estimating the value of active case finding for tuberculosis in South Africa, China, and India.

PubMed

Azman, Andrew S; Golub, Jonathan E; Dowdy, David W

2014-10-30

Current approaches are unlikely to achieve the aggressive global tuberculosis (TB) control targets set for 2035 and beyond. Active case finding (ACF) may be an important tool for augmenting existing strategies, but the cost-effectiveness of ACF remains uncertain. Program evaluators can often measure the cost of ACF per TB case detected, but how this accessible measure translates into traditional metrics of cost-effectiveness, such as the cost per disability-adjusted life year (DALY), remains unclear. We constructed dynamic models of TB in India, China, and South Africa to explore the medium-term impact and cost-effectiveness of generic ACF activities, conceptualized separately as discrete (2-year) campaigns and as continuous activities integrated into ongoing TB control programs. Our primary outcome was the cost per DALY, measured in relationship to the cost per TB case actively detected and started on treatment. Discrete campaigns costing up to $1,200 (95% uncertainty range [UR] 850-2,043) per case actively detected and started on treatment in India, $3,800 (95% UR 2,706-6,392) in China, and $9,400 (95% UR 6,957-13,221) in South Africa were all highly cost-effective (cost per DALY averted less than per capita gross domestic product). Prolonged integration was even more effective and cost-effective. Short-term assessments of ACF dramatically underestimated potential longer term gains; for example, an assessment of an ACF program at 2 years might find a non-significant 11% reduction in prevalence, but a 10-year evaluation of that same intervention would show a 33% reduction. ACF can be a powerful and highly cost-effective tool in the fight against TB. Given that short-term assessments may dramatically underestimate medium-term effectiveness, current willingness to pay may be too low. ACF should receive strong consideration as a basic tool for TB control in most high-burden settings, even when it may cost over $1,000 to detect and initiate treatment for each extra case of active TB.

Global risk management in type 2 diabetes: blood glucose, blood pressure, and lipids--update on the background of the current guidelines.

PubMed

Clemens, A; Siegel, E; Gallwitz, B

2004-10-01

Diabetes mellitus presents a significant public health burden based on its increased morbidity, mortality, and economic cost. The high comorbidity and prevalence of concomitant diseases like hypertension and dyslipidemia in diabetic patients cause the high risk in developing secondary, cost intensive, and for the patient often disastrous late complications (nephropathy, retinopathy, neuropathy, and cardiovascular disease). Therefore, patients with diabetes mellitus need a global risk management that takes the various individual clinical problems into account. The current global standards of therapy in patients with diabetes mellitus are focused on the control of glycemia, blood pressure, and lipid levels, as well as aspirin therapy and avoiding of smoking. There are a number of guidelines and recommendations to manage these global issues. Our review will summarize current recommendations and consolidate therapeutic goals and treatments that are of vital importance in the global risk management in diabetic patients.

Economic impact of thermostable vaccines.

PubMed

Lee, Bruce Y; Wedlock, Patrick T; Haidari, Leila A; Elder, Kate; Potet, Julien; Manring, Rachel; Connor, Diana L; Spiker, Marie L; Bonner, Kimberly; Rangarajan, Arjun; Hunyh, Delphine; Brown, Shawn T

2017-05-25

While our previous work has shown that replacing existing vaccines with thermostable vaccines can relieve bottlenecks in vaccine supply chains and thus increase vaccine availability, the question remains whether this benefit would outweigh the additional cost of thermostable formulations. Using HERMES simulation models of the vaccine supply chains for the Republic of Benin, the state of Bihar (India), and Niger, we simulated replacing different existing vaccines with thermostable formulations and determined the resulting clinical and economic impact. Costs measured included the costs of vaccines, logistics, and disease outcomes averted. Replacing a particular vaccine with a thermostable version yielded cost savings in many cases even when charging a price premium (two or three times the current vaccine price). For example, replacing the current pentavalent vaccine with a thermostable version without increasing the vaccine price saved from $366 to $10,945 per 100 members of the vaccine's target population. Doubling the vaccine price still resulted in cost savings that ranged from $300 to $10,706, and tripling the vaccine price resulted in cost savings from $234 to $10,468. As another example, a thermostable rotavirus vaccine (RV) at its current (year) price saved between $131 and $1065. Doubling and tripling the thermostable rotavirus price resulted in cost savings ranging from $102 to $936 and $73 to $808, respectively. Switching to thermostable formulations was highly cost-effective or cost-effective in most scenarios explored. Medical cost and productivity savings could outweigh even significant price premiums charged for thermostable formulations of vaccines, providing support for their use. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Estimating the cost of compensating victims of medical negligence.

PubMed Central

Fenn, P.; Hermans, D.; Dingwall, R.

1994-01-01

The current system in Britain for compensating victims of medical injury depends on an assessment of negligence. Despite the sporadic pressure on the government to adopt a "no fault" approach, such as exists in Sweden, the negligence system will probably remain for the immediate future. The cost of this system was estimated to be 52.3m pounds for England 1990-1. The problem for the future, however, is one of forecasting accuracy at provider level: too high a guess and current patient care will suffer; too low a guess and future patient care will suffer. The introduction of a mutual insurance scheme may not resolve these difficulties, as someone will have to set the rates. Moreover, the figures indicate that if a no fault scheme was introduced the cost might be four times that of the current system, depending on the type of scheme adopted. PMID:8081145

High-Voltage, High-Power Gaseous Electronics Switch For Electric Grid Power Conversion

NASA Astrophysics Data System (ADS)

Sommerer, Timothy J.

2014-05-01

We are developing a high-voltage, high-power gas switch for use in low-cost power conversion terminals on the electric power grid. Direct-current (dc) power transmission has many advantages over alternating current (ac) transmission, but at present the high cost of ac-dc power interconversion limits the use of dc. The gas switch we are developing conducts current through a magnetized cold cathode plasma in hydrogen or helium to reach practical current densities > 1 A/cm2. Thermal and sputter damage of the cathode by the incident ion flux is a major technical risk, and is being addressed through use of a ``self-healing'' liquid metal cathode (eg, gallium). Plasma conditions and cathode sputtering loss are estimated by analyzing plasma spectral emission. A particle-in-cell plasma model is used to understand various aspects of switch operation, including the conduction phase (where plasma densities can exceed 1013 cm-3), the switch-open phase (where the high-voltage must be held against gas breakdown on the left side of Paschen's curve), and the switching transitions (especially the opening process, which is initiated by forming an ion-matrix sheath adjacent to a control grid). The information, data, or work presented herein was funded in part by the Advanced Research Projects Agency-Energy (ARPA-E), U.S. Department of Energy, under Award Number DE-AR0000298.

Fast Entanglement Establishment via Local Dynamics for Quantum Repeater Networks

NASA Astrophysics Data System (ADS)

Gyongyosi, Laszlo; Imre, Sandor

Quantum entanglement is a necessity for future quantum communication networks, quantum internet, and long-distance quantum key distribution. The current approaches of entanglement distribution require high-delay entanglement transmission, entanglement swapping to extend the range of entanglement, high-cost entanglement purification, and long-lived quantum memories. We introduce a fundamental protocol for establishing entanglement in quantum communication networks. The proposed scheme does not require entanglement transmission between the nodes, high-cost entanglement swapping, entanglement purification, or long-lived quantum memories. The protocol reliably establishes a maximally entangled system between the remote nodes via dynamics generated by local Hamiltonians. The method eliminates the main drawbacks of current schemes allowing fast entanglement establishment with a minimized delay. Our solution provides a fundamental method for future long-distance quantum key distribution, quantum repeater networks, quantum internet, and quantum-networking protocols. This work was partially supported by the GOP-1.1.1-11-2012-0092 project sponsored by the EU and European Structural Fund, by the Hungarian Scientific Research Fund - OTKA K-112125, and by the COST Action MP1006.

A low-cost hierarchical nanostructured beta-titanium alloy with high strength

DOE PAGES

Devaraj, Arun; Joshi, Vineet V.; Srivastava, Ankit; ...

2016-04-01

Lightweighting of automobiles by use of novel low-cost, high strength-to-weight ratio structural materials can reduce the consumption of fossil fuels and in turn CO 2 emission. Working towards this goal we achieved high strength in a low cost β-titanium alloy, Ti-1Al-8V-5Fe (Ti185), by hierarchical nanostructure consisting of homogenous distribution of micron-scale and nanoscale α-phase precipitates within the β-phase matrix. The sequence of phase transformation leading to this hierarchical nanostructure is explored using electron microscopy and atom probe tomography. Our results suggest that the high number density of nanoscale α-phase precipitates in the β-phase matrix is due to ω assisted nucleationmore » of α resulting in high tensile strength, greater than any current commercial titanium alloy. Furthermore hierarchical nanostructured Ti185 serves as an excellent candidate for replacing costlier titanium alloys and other structural alloys for cost-effective lightweighting applications.« less

A low-cost hierarchical nanostructured beta-titanium alloy with high strength

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

Devaraj, Arun; Joshi, Vineet V.; Srivastava, Ankit

Lightweighting of automobiles by use of novel low-cost, high strength-to-weight ratio structural materials can reduce the consumption of fossil fuels and in turn CO 2 emission. Working towards this goal we achieved high strength in a low cost β-titanium alloy, Ti-1Al-8V-5Fe (Ti185), by hierarchical nanostructure consisting of homogenous distribution of micron-scale and nanoscale α-phase precipitates within the β-phase matrix. The sequence of phase transformation leading to this hierarchical nanostructure is explored using electron microscopy and atom probe tomography. Our results suggest that the high number density of nanoscale α-phase precipitates in the β-phase matrix is due to ω assisted nucleationmore » of α resulting in high tensile strength, greater than any current commercial titanium alloy. Furthermore hierarchical nanostructured Ti185 serves as an excellent candidate for replacing costlier titanium alloys and other structural alloys for cost-effective lightweighting applications.« less

Real-time control system for adaptive resonator

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

Flath, L; An, J; Brase, J

2000-07-24

Sustained operation of high average power solid-state lasers currently requires an adaptive resonator to produce the optimal beam quality. We describe the architecture of a real-time adaptive control system for correcting intra-cavity aberrations in a heat capacity laser. Image data collected from a wavefront sensor are processed and used to control phase with a high-spatial-resolution deformable mirror. Our controller takes advantage of recent developments in low-cost, high-performance processor technology. A desktop-based computational engine and object-oriented software architecture replaces the high-cost rack-mount embedded computers of previous systems.

Cost of improving Access to Psychological Therapies (IAPT) programme: an analysis of cost of session, treatment and recovery in selected Primary Care Trusts in the East of England region.

PubMed

Radhakrishnan, Muralikrishnan; Hammond, Geoffrey; Jones, Peter B; Watson, Alison; McMillan-Shields, Fiona; Lafortune, Louise

2013-01-01

Recent literature on Improving Access to Psychological Therapies (IAPT) has reported on improvements in clinical outcomes, changes in employment status and the concept of recovery attributable to IAPT treatment, but not on the costs of the programme. This article reports the costs associated with a single session, completed course of treatment and recovery for four treatment courses (i.e., remaining in low or high intensity treatment, stepping up or down) in IAPT services in 5 East of England region Primary Care Trusts. Costs were estimated using treatment activity data and gross financial information, along with assumptions about how these financial data could be broken down. The estimated average cost of a high intensity session was £177 and the average cost for a low intensity session was £99. The average cost of treatment was £493 (low intensity), £1416 (high intensity), £699 (stepped down), £1514 (stepped up) and £877 (All). The cost per recovered patient was £1043 (low intensity), £2895 (high intensity), £1653 (stepped down), £2914 (stepped up) and £1766 (All). Sensitivity analysis revealed that the costs are sensitive to cost ratio assumptions, indicating that inaccurate ratios are likely to influence overall estimates. Results indicate the cost per session exceeds previously reported estimates, but cost of treatment is only marginally higher. The current cost estimates are supportive of the originally proposed IAPT model on cost-benefit grounds. The study also provides a framework to estimate costs using financial data, especially when programmes have block contract arrangements. Replication and additional analyses along with evidence-based discussion regarding alternative, cost-effective methods of intervention is recommended. Copyright © 2012 Elsevier Ltd. All rights reserved.

Is implementation of the 2013 Australian treatment guidelines for posttraumatic stress disorder cost-effective compared to current practice? A cost-utility analysis using QALYs and DALYs.

PubMed

Mihalopoulos, Cathrine; Magnus, Anne; Lal, Anita; Dell, Lisa; Forbes, David; Phelps, Andrea

2015-04-01

To assess, from a health sector perspective, the incremental cost-effectiveness of three treatment recommendations in the most recent Australian Clinical Practice Guidelines for posttraumatic stress disorder (PTSD). The interventions assessed are trauma-focused cognitive behavioural therapy (TF-CBT) and selective serotonin reuptake inhibitors (SSRIs) for the treatment of PTSD in adults and TF-CBT in children, compared to current practice in Australia. Economic modelling, using existing databases and published information, was used to assess cost-effectiveness. A cost-utility framework using both quality-adjusted life-years (QALYs) gained and disability-adjusted life-years (DALYs) averted was used. Costs were tracked for the duration of the respective interventions and applied to the estimated 12 months prevalent cases of PTSD in the Australian population of 2012. Simulation modelling was used to provide 95% uncertainty around the incremental cost-effectiveness ratios. Consideration was also given to factors not considered in the quantitative analysis but could determine the likely uptake of the proposed intervention guidelines. TF-CBT is highly cost-effective compared to current practice at $19,000/QALY, $16,000/DALY in adults and $8900/QALY, $8000/DALY in children. In adults, 100% of uncertainty iterations fell beneath the $50,000/QALY or DALY value-for-money threshold. Using SSRIs in people already on medications is cost-effective at $200/QALY, but has considerable uncertainty around the costs and benefits. While there is a 13% chance of health loss there is a 27% chance of the intervention dominating current practice by both saving dollars and improving health in adults. The three Guideline recommended interventions evaluated in this study are likely to have a positive impact on the economic efficiency of the treatment of PTSD if adopted in full. While there are gaps in the evidence base, policy-makers can have considerable confidence that the recommendations assessed in the current study are likely to improve the efficiency of the mental health care sector. © The Royal Australian and New Zealand College of Psychiatrists 2014.

Implementation of an optical diagnosis strategy saves costs and does not impair clinical outcomes of a fecal immunochemical test-based colorectal cancer screening program.

PubMed

Vleugels, Jasper L A; Greuter, Marjolein J E; Hazewinkel, Yark; Coupé, Veerle M H; Dekker, Evelien

2017-12-01

 In an optical diagnosis strategy, diminutive polyps that are endoscopically characterized with high confidence are removed without histopathological analysis and distal hyperplastic polyps are left in situ. We evaluated the effectiveness and costs of optical diagnosis.  Using the Adenoma and Serrated pathway to Colorectal CAncer (ASCCA) model, we simulated biennial fecal immunochemical test (FIT) screening in individuals aged 55 - 75 years. In this program, we compared an optical diagnosis strategy with current histopathology assessment of all diminutive polyps. Base-case assumptions included 76 % high-confidence predictions and sensitivities of 88 %, 91 %, and 88 % for endoscopically characterizing adenomas, sessile serrated polyps, and hyperplastic polyps, respectively. Outcomes were colorectal cancer burden, number of colonoscopies, life-years, and costs.  Both the histopathology strategy and the optical diagnosis strategy resulted in 21 life-days gained per simulated individual compared with no screening. For optical diagnosis, €6 per individual was saved compared with the current histopathology strategy. These cost savings were related to a 31 % reduction in colonoscopies in which histopathology was needed for diminutive polyps. Projecting these results onto the Netherlands (17 million inhabitants), assuming a fully implemented FIT-based screening program, resulted in an annual undiscounted cost saving of € 1.7 - 2.2 million for optical diagnosis.  Implementation of optical diagnosis in a FIT-based screening program saves costs without decreasing program effectiveness when compared with current histopathology analysis of all diminutive polyps. Further work is required to evaluate how endoscopists participating in a screening program should be trained, audited, and monitored to achieve adequate competence in optical diagnosis.

Financial viability of perinatal centers in the longer term, taking legislative requirements into account. An examination of the cost-revenue structure of a Level I perinatal center.

PubMed

Lux, Michael P; Kraml, Florian; Wagner, Stefanie; Hack, Carolin C; Schulze, Christine; Faschingbauer, Florian; Winkler, Mathias; Fasching, Peter A; Beckmann, Matthias W; Hildebrandt, Thomas

2013-01-01

Debate is currently taking place over minimum case numbers for the care of premature infants and neonates in Germany. As a result of the Federal Joint Committee (Gemeinsamer Bundesauschuss, G-BA) guidelines for the quality of structures, processes, and results, requiring high levels of staffing resources, Level I perinatal centers are increasingly becoming the focus for health-economics questions, specifically, debating whether Level I structures are financially viable. Using a multistep contribution margin analysis, the operating results for the Obstetrics Section at the University Perinatal Center of Franconia (Universitäts-Perinatalzentrum Franken) were calculated for the year 2009. Costs arising per diagnosis-related group (DRG) (separated into variable costs and fixed costs) and the corresponding revenue generated were compared for 4,194 in-patients and neonates, as well as for 3,126 patients in the outpatient ultrasound and pregnancy clinics. With a positive operating result of € 374,874.81, a Level I perinatal center on the whole initially appears to be financially viable, from the obstetrics point of view (excluding neonatology), with a high bed occupancy rate and a profitable case mix. By contrast, the costs of prenatal diagnostics, with a negative contribution margin II of € 50,313, cannot be covered. A total of 79.4% of DRG case numbers were distributed to five DRGs, all of which were associated with pregnancies and neonates with the lowest risk profiles. A Level I perinatal center is currently capable of covering its costs. However, the cost-revenue ratio is fragile due to the high requirements for staffing resources and numerous economic, social, and regional influencing factors.

Perspectives on Open Access Opportunities for IS Research Publication: Potential Benefits for Researchers, Educators, and Students

ERIC Educational Resources Information Center

Woszczynski, Amy B.; Whitman, Michael E.

2016-01-01

Access to current research materials, pedagogical best practices, and relevant knowledge has become problematic as journal subscription costs have increased. Increasing delays in the traditional publication timeline, coupled with high subscription costs, have resulted in a diminished ability for IS faculty and their students to access the most…

High or Low Target Prevalence Increases the Dual-Target Cost in Visual Search

ERIC Educational Resources Information Center

Menneer, Tamaryn; Donnelly, Nick; Godwin, Hayward J.; Cave, Kyle R.

2010-01-01

Previous studies have demonstrated a dual-target cost in visual search. In the current study, the relationship between search for one and search for two targets was investigated to examine the effects of target prevalence and practice. Color-shape conjunction stimuli were used with response time, accuracy and signal detection measures. Performance…

Cost-effectiveness of the implantable cardioverter defibrillator: a review of current evidence.

PubMed

Lynd, Larry D; O'Brien, Bernie J

2003-09-01

Implantable cardioverter defibrillator (ICD) therapy is indicated for patients at risk for sudden cardiac death (SCD) due to ventricular tachycardia (VT) or ventricular fibrillation (VF). The high relative cost of therapy with the ICD versus antiarrhythmic drugs has raised questions regarding its cost-effectiveness. To address these questions, we review the literature on ICD cost-effectiveness. MEDLINE and other databases were searched for articles published since 1980 reporting original data on the cost-effectiveness of ICD versus drug therapy for patients at risk for SCD. Data on costs and life-years were abstracted and studies grouped into decision analysis models and trial-based analyses. Cost-effectiveness ratios were inflated to 2002 US dollars. Thirteen economic studies were included in this review: 6 decision-analytic models, 4 economic analysis alongside randomized controlled trials, and 1 observational study. Two additional studies evaluated the cost-effectiveness of ICDs stratified by mortality risk. Studies varied in time horizon, and in all but one study ICD therapy was more costly than drug therapy. Early models assumed larger survival benefits than were observed in subsequent trials; therefore, ICDs appeared to be more cost-effective (i.e., US dollars 28000-US dollars 60000 per life-year gained). Three large clinical trial-based studies estimated that the cost per life-year gained was between US dollars 30181 and US dollars 185000. Stratified analyses show that patients at higher risk for mortality due to structural heart disease (e.g., left ventricular ejection fraction <35%) benefit more from ICD therapy, resulting in lower cost-effectiveness ratios. ICD therapy continues to evolve with changing methods of implantation and improving technology. Current evidence suggests that ICDs may be a cost-effective option in patients at high risk for VT/VF. The cost-effectiveness of ICD therapy for primary and secondary prevention of SCD depends upon patient characteristics that influence their prior risk of mortality. Further research on patient selection criteria and the measurement of health-related quality of life is required.

Planar junctionless phototransistor: A potential high-performance and low-cost device for optical-communications

NASA Astrophysics Data System (ADS)

Ferhati, H.; Djeffal, F.

2017-12-01

In this paper, a new junctionless optical controlled field effect transistor (JL-OCFET) and its comprehensive theoretical model is proposed to achieve high optical performance and low cost fabrication process. Exhaustive study of the device characteristics and comparison between the proposed junctionless design and the conventional inversion mode structure (IM-OCFET) for similar dimensions are performed. Our investigation reveals that the proposed design exhibits an outstanding capability to be an alternative to the IM-OCFET due to the high performance and the weak signal detection benefit offered by this design. Moreover, the developed analytical expressions are exploited to formulate the objective functions to optimize the device performance using Genetic Algorithms (GAs) approach. The optimized JL-OCFET not only demonstrates good performance in terms of derived drain current and responsivity, but also exhibits superior signal to noise ratio, low power consumption, high-sensitivity, high ION/IOFF ratio and high-detectivity as compared to the conventional IM-OCFET counterpart. These characteristics make the optimized JL-OCFET potentially suitable for developing low cost and ultrasensitive photodetectors for high-performance and low cost inter-chips data communication applications.

Cost-Effectiveness Analysis of Hepatitis B Vaccination Strategies to Prevent Perinatal Transmission in North Korea: Selective Vaccination vs. Universal Vaccination

PubMed Central

Lee, Donghoon; Park, Sang Min

2016-01-01

Background To tackle the high prevalence of Hepatitis B virus (HBV) infection in North Korea, it is essential that birth doses of HBV vaccines should be administered within 24 hours of birth. As the country fails to provide a Timely Birth Dose (TBD) of HBV vaccine, the efforts of reducing the high prevalence of HBV have been significantly hampered. Methods To examine the cost-effectiveness of vaccination strategies to prevent perinatal transmission of HBV in North Korea, we established a decision tree with a Markov model consisting of selective, universal, and the country’s current vaccination program against HBV. The cost-effectiveness analysis was performed from societal and payer’s perspectives and evaluated by Disability Adjusted Life Year (DALY). Results The results suggest that introducing the universal vaccination would prevent 1,866 cases of perinatal infections per 100,000 of the birth cohort of 2013. Furthermore, 900 cases of perinatal infections per 100,000 could be additionally averted if switching to the selective vaccination. The current vaccination is a dominated strategy both from the societal and payer’s perspective. The Incremental Cost-Effectiveness Ratio (ICER) between universal and selective vaccination is $267 from the societal perspective and is reported as $273 from the payer’s perspective. Conclusion Based on the assumption that the 2012 Gross Domestic Product (GDP) per capita in North Korea, $582.6 was set for cost-effectiveness criteria, the result of this study indicates that selective vaccination may be a highly cost-effective strategy compared to universal vaccination. PMID:27802340

Validation of an effective, low cost, Free/open access 3D-printed stethoscope

PubMed Central

Pavlosky, Alexander; Glauche, Jennifer; Chambers, Spencer; Al-Alawi, Mahmoud; Yanev, Kliment

2018-01-01

The modern acoustic stethoscope is a useful clinical tool used to detect subtle, pathological changes in cardiac, pulmonary and vascular sounds. Currently, brand-name stethoscopes are expensive despite limited innovations in design or fabrication in recent decades. Consequently, the high cost of high quality, brand name models serves as a barrier to clinicians practicing in various settings, especially in low- and middle-income countries. In this publication, we describe the design and validation of a low-cost open-access (Free/Libre) 3D-printed stethoscope which is comparable to the Littmann Cardiology III for use in low-access clinics. PMID:29538426

Current challenges in the recognition, prevention and treatment of perioperative pulmonary atelectasis.

PubMed

Restrepo, Ruben D; Braverman, Jane

2015-02-01

Innovations in surgery have significantly increased the number of procedures performed every year. While more individuals benefit from better surgical techniques and technology, a larger group of patients previously deemed ineligible for surgery now undergo high-complexity surgical procedures. Despite continuous improvements in the operating room and post-operative care, post-operative pulmonary complications (PPCs) continue to pose a serious threat to successful outcomes. PPCs are common, serious and costly. Growing awareness of the impact of PPCs has led to intensified efforts to understand the underlying causes. Current evidence demonstrates that a high proportion of PPCs are directly traceable to the pre-operative risk for and perioperative development of atelectasis. The substantial costs and losses associated with PPCs demand strategies to reduce their prevalence and impact. Effective interventions will almost certainly produce cost savings that significantly offset current economic and human resource expenditures. The purpose of this review is to describe the most common challenges encountered in the recognition, prevention and management of perioperative atelectasis. Expanding awareness and understanding of the role of atelectasis as a cause of PPCs can reduce their prevalence, impact important clinical outcomes and reduce the financial burden associated with treating these complications.

Cost-Effectiveness of High-Risk Human Papillomavirus Testing With Messenger RNA Versus DNA Under United States Guidelines for Cervical Cancer Screening.

PubMed

Ting, Jie; Smith, Jennifer S; Myers, Evan R

2015-10-01

To compare the cost-effectiveness of high-risk human papillomavirus (hrHPV) testing using a hrHPV DNA and a hrHPV messenger RNA (mRNA) assay under current US cervical cancer screening guidelines. We constructed a Markov model for stochastic cost-effectiveness analysis using published data. We compared screening efficiency using DNA and mRNA testing for the following: (1) cotesting with cytology in women 30 to 65 years, and (2) triage of women with mild cervical cytological abnormalities (atypical squamous cells of undetermined significance [ASC-US]) in the United States. Screening end point is histologically confirmed high-grade lesions (cervical intraepithelial neoplasia grade 2, 3, or invasive cancer). Sensitivity and specificity estimates of DNA and mRNA testing to detect cervical intraepithelial neoplasia grade 2, 3, or invasive cancer were obtained from 2 published trials: the US Clinical Evaluation of APTIMA mRNA (CLEAR) study for ASC-US triage and the French APTIMA Screening Evaluation (FASE) study for cotesting. Costs of DNA and mRNA testing were assumed identical. Costs of screening, diagnosis, and treatment of cervical neoplasia and cancer were from previously published estimates, adjusted to 2012 US dollars. Inputs were modeled as distributions for Monte Carlo probabilistic sensitivity analysis. Model outcomes were costs per life-year saved for each strategy, discounted at 3% annually. For both cotesting and ASC-US triage, mRNA testing cost less than DNA testing, whereas life expectancies were widely overlapping. There was a 100% probability that DNA testing was not cost-effective at $100,000/life-year saved threshold for ASC-US triage and a 55% probability that DNA testing was not cost-effective at the same threshold for cotesting. Based on the available evidence, mRNA testing for cotesting or ASC-US triage is likely to be more efficient than DNA testing under current US cervical cancer screening guidelines.

Wildfire Suppression Costs for Canada under a Changing Climate

PubMed Central

Stocks, Brian J.; Gauthier, Sylvie

2016-01-01

Climate-influenced changes in fire regimes in northern temperate and boreal regions will have both ecological and economic ramifications. We examine possible future wildfire area burned and suppression costs using a recently compiled historical (i.e., 1980–2009) fire management cost database for Canada and several Intergovernmental Panel on Climate Change (IPCC) climate projections. Area burned was modelled as a function of a climate moisture index (CMI), and fire suppression costs then estimated as a function of area burned. Future estimates of area burned were generated from projections of the CMI under two emissions pathways for four General Circulation Models (GCMs); these estimates were constrained to ecologically reasonable values by incorporating a minimum fire return interval of 20 years. Total average annual national fire management costs are projected to increase to just under $1 billion (a 60% real increase from the 1980–2009 period) under the low greenhouse gas emissions pathway and $1.4 billion (119% real increase from the base period) under the high emissions pathway by the end of the century. For many provinces, annual costs that are currently considered extreme (i.e., occur once every ten years) are projected to become commonplace (i.e., occur once every two years or more often) as the century progresses. It is highly likely that evaluations of current wildland fire management paradigms will be necessary to avoid drastic and untenable cost increases as the century progresses. PMID:27513660

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

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

Paul, Ryan Michael; Naskar, Amit

GrafTech International Holdings Inc. (GTI), under Award No. DE-EE0005779, worked with Oak Ridge National Laboratory (ORNL) under CRADA No. NFE-15-05807 to develop lignin-based carbon fiber (LBCF) technology and to demonstrate LBCF performance in high-temperature products and applications. This work was unique and different from other reported LBCF work in that this study was application-focused and scalability-focused. Accordingly, the executed work was based on meeting criteria based on technology development, cost, and application suitability. High-temperature carbon fiber based insulation is used in energy intensive industries, such as metal heat treating and ceramic and semiconductor material production. Insulation plays a critical rolemore » in achieving high thermal and process efficiency, which is directly related to energy usage, cost, and product competitiveness. Current high temperature insulation is made with petroleum based carbon fibers, and one goal of this protect was to develop and demonstrate an alternative lignin (biomass) based carbon fiber that would achieve lower cost, CO2 emissions, and energy consumption and result in insulation that met or exceeded the thermal efficiency of current commercial insulation. In addition, other products were targeted to be evaluated with LBCF. As the project was designed to proceed in stages, the initial focus of this work was to demonstrate lab-scale LBCF from at least 4 different lignin precursor feedstock sources that could meet the estimated production cost of $5.00/pound and have ash level of less than 500 ppm in the carbonized insulation-grade fiber. Accordingly, a preliminary cost model was developed based on publicly available information. The team demonstrated that 4 lignin samples met the cost criteria. In addition, the ash level for the 4 carbonized lignin samples was below 500 ppm. Processing as-received lignin to produce a high purity lignin fiber was a significant accomplishment in that most industrial lignin, prior to purification, had greater than 4X the ash level needed for this project, and prior to this work there was not a clear path of how to achieve the purity target. The lab scale development of LBCF was performed with a specific functional application in mind, specifically for high temperature rigid insulation. GTI is a consumer of foreign-sourced pitch and rayon based carbon fibers for use in its high temperature insulation products, and the motivation was that LBCF had potential to decrease costs and increase product competitiveness in the marketplace through lowered raw material costs, lowered energy costs, and decreased environmental footprint. At the end of this project, the Technology Readiness Level (TRL) remained at 5 for LBCF in high temperature insulation.« less

Interleaved power converter

DOEpatents

Zhu, Lizhi

2007-11-13

A power converter architecture interleaves full bridge converters to alleviate thermal management problems in high current applications, and may, for example, double the output power capability while reducing parts count and costs. For example, one phase of a three phase inverter is shared between two transformers, which provide power to a rectifier such as a current doubler rectifier to provide two full bridge DC/DC converters with three rather than four high voltage inverter legs.

Low-Cost, High-Performance Hall Thruster Support System

NASA Technical Reports Server (NTRS)

Hesterman, Bryce

2015-01-01

Colorado Power Electronics (CPE) has built an innovative modular PPU for Hall thrusters, including discharge, magnet, heater and keeper supplies, and an interface module. This high-performance PPU offers resonant circuit topologies, magnetics design, modularity, and a stable and sustained operation during severe Hall effect thruster current oscillations. Laboratory testing has demonstrated discharge module efficiency of 96 percent, which is considerably higher than current state of the art.

Cost-effectiveness of drug-eluting coronary stents in Quebec, Canada.

PubMed

Brophy, James M; Erickson, Lonny J

2005-01-01

The aim of this investigation was to assess the incremental cost-effectiveness of replacing bare metal coronary stents (BMS) with drug-eluting stents (DES) in the Province of Quebec, Canada. The strategy used was a cost-effectiveness analysis from the perspective of the health-care provider, in the province of Quebec, Canada (population 7.5 million). The main outcome measure was the cost per avoided revascularization intervention. Based on the annual Quebec rate of 14,000 angioplasties with an average of 1.7 stents per procedure and a purchase cost of $2,600 Canadian dollar (CDN) for DES, 100 percent substitution of BMS with DES would require an additional $45.1 million CDN of funding. After the benefits of reduced repeat revascularization interventions are included, the incremental cost would be $35.2 million CDN. The cost per avoided revascularization intervention (18 percent coronary artery bypass graft, 82 percent percutaneous coronary intervention [PCI]) would be $23,067 CDN. If DES were offered selectively to higher risk populations, for example, a 20 percent subgroup with a relative restenosis risk of 2.5 times the current bare metal rate, the incremental cost of the program would be $4.9 million CDN at a cost of $7,800 per avoided revascularization procedure. Break-even costs for the program would occur at DES purchase cost of $1,161 for 100 percent DES use and $1,627 for selective 20 percent DES use for high-risk patients for restenosis (RR = 2.5). Univariate and Monte Carlo sensitivity analyses indicate that the parameters most affecting the analysis are the capacity to select patients at high risk of restenosis, the average number of stents used per PCI, baseline restenosis rates for BMS, the effectiveness ratio of restenosis prevention for DES versus BMS, the cost of DES, and the revascularization rate after initial PCI. Sensitivity analyses suggest little additional health benefits but escalating cost-effectiveness ratios once a DES penetration of 40 percent has been attained. Under current conditions in Quebec, Canada, selective use of DES in high-risk patients is the most acceptable strategy in terms of cost-effectiveness. Results of such an analysis would be expected to be similar in other countries with key model parameters similar to those used in this model. This model provides an example of how to evaluate the cost-effectiveness of selective use of a new technology in high-risk patients.

A model for studying the energetics of sustained high frequency firing

PubMed Central

Morris, Catherine E.

2018-01-01

Regulating membrane potential and synaptic function contributes significantly to the energetic costs of brain signaling, but the relative costs of action potentials (APs) and synaptic transmission during high-frequency firing are unknown. The continuous high-frequency (200-600Hz) electric organ discharge (EOD) of Eigenmannia, a weakly electric fish, underlies its electrosensing and communication. EODs reflect APs fired by the muscle-derived electrocytes of the electric organ (EO). Cholinergic synapses at the excitable posterior membranes of the elongated electrocytes control AP frequency. Based on whole-fish O2 consumption, ATP demand per EOD-linked AP increases exponentially with AP frequency. Continual EOD-AP generation implies first, that ion homeostatic processes reliably counteract any dissipation of posterior membrane ENa and EK and second that high frequency synaptic activation is reliably supported. Both of these processes require energy. To facilitate an exploration of the expected energy demands of each, we modify a previous excitability model and include synaptic currents able to drive APs at frequencies as high as 600 Hz. Synaptic stimuli are modeled as pulsatile cation conductance changes, with or without a small (sustained) background conductance. Over the full species range of EOD frequencies (200–600 Hz) we calculate frequency-dependent “Na+-entry budgets” for an electrocyte AP as a surrogate for required 3Na+/2K+-ATPase activity. We find that the cost per AP of maintaining constant-amplitude APs increases nonlinearly with frequency, whereas the cost per AP for synaptic input current is essentially constant. This predicts that Na+ channel density should correlate positively with EOD frequency, whereas AChR density should be the same across fish. Importantly, calculated costs (inferred from Na+-entry through Nav and ACh channels) for electrocyte APs as frequencies rise are much less than expected from published whole-fish EOD-linked O2 consumption. For APs at increasingly high frequencies, we suggest that EOD-related costs external to electrocytes (including packaging of synaptic transmitter) substantially exceed the direct cost of electrocyte ion homeostasis. PMID:29708986

DC-Compensated Current Transformer.

PubMed

Ripka, Pavel; Draxler, Karel; Styblíková, Renata

2016-01-20

Instrument current transformers (CTs) measure AC currents. The DC component in the measured current can saturate the transformer and cause gross error. We use fluxgate detection and digital feedback compensation of the DC flux to suppress the overall error to 0.15%. This concept can be used not only for high-end CTs with a nanocrystalline core, but it also works for low-cost CTs with FeSi cores. The method described here allows simultaneous measurements of the DC current component.

The cost-effectiveness of parasitologic diagnosis for malaria-suspected patients in an era of combination therapy.

PubMed

Lubell, Yoel; Reyburn, Hugh; Mbakilwa, Hilda; Mwangi, Rose; Chonya, Kini; Whitty, Christopher J M; Mills, Anne

2007-12-01

The introduction of artemisinin-based combination therapy in sub-Saharan Africa has prompted calls for increased use of parasitologic diagnosis for malaria. We evaluated the cost-effectiveness of rapid diagnostic tests (RDTs) in comparison to microscopy in guiding treatment of non-severe febrile illness at varying levels of malaria endemicity using data on test accuracy and costs collected as part of a Tanzanian trial. If prescribers complied with current guidelines, microscopy would give rise to lower average costs per patient correctly treated than RDTs in areas of both high and low transmission. RDT introduction would result in an additional 2.3% and 9.4% of patients correctly treated, at an incremental cost of $25 and $7 in the low and high transmission settings, respectively. Cost-effectiveness would be worse if prescribers do not comply with test results. The cost of this additional benefit may be higher than many countries can afford without external assistance or lower RDT prices.

Recycling Strategy for Fabricating Low-Cost and High-Performance Carbon Nanotube TFT Devices.

PubMed

Yu, Xiaoqin; Liu, Dan; Kang, Lixing; Yang, Yi; Zhang, Xiaopin; Lv, Qianjin; Qiu, Song; Jin, Hehua; Song, Qijun; Zhang, Jin; Li, Qingwen

2017-05-10

High-purity semiconducting single-walled carbon nanotubes (s-SWNTs) can be obtained by conjugated polymer wrapping. However, further purification of sorted s-SWNTs and high costs of raw materials are still challenges to practical applications. It is inevitable that a lot of polymers still cover the surface of s-SWNTs after separation, and the cost of the polymer is relatively higher than that of SWNTs. Here, we demonstrated a facile isolated process to improve the quality of s-SWNT solutions and films significantly. Compared with the untreated s-SWNTs, the contact resistance between the s-SWNT and the electrode is reduced by 20 times, and the thin-film transistors show 300% enhancement of current density. In this process, most of the polymers can be recycled and reused directly without any purification, which can greatly decrease the cost for s-SWNT separation. The results presented herein demonstrate a new scalable and low-cost approach for large-scale application of s-SWNTs in the electronics industry.

Scaling up family planning in Sierra Leone: A prospective cost-benefit analysis.

PubMed

Keen, Sarah; Begum, Hashina; Friedman, Howard S; James, Chris D

2017-12-01

Family planning is commonly regarded as a highly cost-effective health intervention with wider social and economic benefits. Yet use of family planning services in Sierra Leone is currently low and 25.0% of married women have an unmet need for contraception. This study aims to estimate the costs and benefits of scaling up family planning in Sierra Leone. Using the OneHealth Tool, two scenarios of scaling up family planning coverage to currently married women in Sierra Leone over 2013-2035 were assessed and compared to a 'no-change' counterfactual. Our costing included direct costs of drugs, supplies and personnel time, programme costs and a share of health facility overhead costs. To monetise the benefits, we projected the cost savings of the government providing five essential social services - primary education, child immunisation, malaria prevention, maternal health services and improved drinking water - in the scale-up scenarios compared to the counterfactual. The total population, estimated at 6.1 million in 2013, is projected to reach 8.3 million by 2035 in the high scenario compared to a counterfactual of 9.6 million. We estimate that by 2035, there will be 1400 fewer maternal deaths and 700 fewer infant deaths in the high scenario compared to the counterfactual. Our modelling suggests that total costs of the family planning programme in Sierra Leone will increase from US$4.2 million in 2013 to US$10.6 million a year by 2035 in the high scenario. For every dollar spent on family planning, Sierra Leone is estimated to save US$2.10 in expenditure on the five selected social sector services over the period. There is a strong investment case for scaling up family planning services in Sierra Leone. The ambitious scale-up scenarios have historical precedent in other sub-Saharan African countries, but the extent to which they will be achieved depends on a commitment from both the government and donors to strengthening Sierra Leone's health system post-Ebola.

High-Speed Machining (HSM) of Space Shuttle External Tank (ET) panels

NASA Astrophysics Data System (ADS)

Miller, J. A.

1983-02-01

The External Fuel Tank (ET) of the Space Shuttle is not recovered after launch and a new one must be provided for each launch. Currently, the external ""skin'' panels of the tank are produced by machining from solid wrought 2219-T87 aluminum plate stock approximately 1-3/4 inch thick. The reduction of costs in producing External Fuel Tank panels is obviously of increasing production rates and decreasing costs of the panels through the application of high-speed machining (HSM) techniques was conducted.

Bioconvective Assay As Alternative To Draize Test

NASA Technical Reports Server (NTRS)

Noever, David A.; Matsos, Helen C.

1993-01-01

Protocol to determine toxicities of chemicals implemented relatively cheaply by use of equipment and materials packaged in convenient kit form. Tests involve observation of macroscopic patterns formed at high concentrations of free-swimming protozoan species Tetrahymena pyriformis in liquid media. Provides more-sensitive indication of toxicity and costs less. Given that there are no data on toxicities of 70 to 80 percent of commercial chemicals, high cost of, and current opposition to, testing on higher animals, new protocol helps meet pressing need.

High-Speed Machining (HSM) of Space Shuttle External Tank (ET) panels

NASA Technical Reports Server (NTRS)

Miller, J. A.

1983-01-01

The External Fuel Tank (ET) of the Space Shuttle is not recovered after launch and a new one must be provided for each launch. Currently, the external ""skin'' panels of the tank are produced by machining from solid wrought 2219-T87 aluminum plate stock approximately 1-3/4 inch thick. The reduction of costs in producing External Fuel Tank panels is obviously of increasing production rates and decreasing costs of the panels through the application of high-speed machining (HSM) techniques was conducted.

U.S. Nuclear Power Plants: Continued Life or Replacement After 60? (released in AEO2010)

EIA Publications

2010-01-01

Nuclear power plants generate approximately 20% of U.S. electricity, and the plants in operation today are often seen as attractive assets in the current environment of uncertainty about future fossil fuel prices, high construction costs for new power plants (particularly nuclear plants), and the potential enactment of greenhouse gas regulations. Existing nuclear power plants have low fuel costs and relatively high power output. However, there is uncertainty about how long they will be allowed to continue operating.

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

PubMed

Fleurence, Rachael L

2005-01-01

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

Addressing value in surgical oncology: Why and how.

PubMed

Abbott, Daniel E

2016-09-01

Value, or outcome per cost, is increasingly emphasized in the current health care climate. With more sophisticated and expensive therapies available, treating a population with growing longevity, sustainability of current trends in health care spending is a significant challenge. And all too often, our devices and therapies are implemented without understanding the value that they offer; policy solutions for these issues are lagging. Certainly, cancer patients, in particular, are at the center of these value conundrums. A majority of patients with malignancy are elderly, with accumulated co-morbidities, and are disproportionately costly. To address these contemporary issues, we must first identify opportunities to maximize value through improved outcomes and/or decreased costs. Doing so in the setting of evolving delivery and payment models will provide providers, health systems and insurers an opportunity to flourish with demonstration of high quality, low cost care. J. Surg. Oncol. 2016;114:263-267. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Solid state laser applications in photovoltaics manufacturing

NASA Astrophysics Data System (ADS)

Dunsky, Corey; Colville, Finlay

2008-02-01

Photovoltaic energy conversion devices are on a rapidly accelerating growth path driven by increasing government and societal pressure to use renewable energy as part of an overall strategy to address global warming attributed to greenhouse gas emissions. Initially supported in several countries by generous tax subsidies, solar cell manufacturers are relentlessly pushing the performance/cost ratio of these devices in a quest to reach true cost parity with grid electricity. Clearly this eventual goal will result in further acceleration in the overall market growth. Silicon wafer based solar cells are currently the mainstay of solar end-user installations with a cost up to three times grid electricity. But next-generation technology in the form of thin-film devices promises streamlined, high-volume manufacturing and greatly reduced silicon consumption, resulting in dramatically lower per unit fabrication costs. Notwithstanding the modest conversion efficiency of thin-film devices compared to wafered silicon products (around 6-10% versus 15-20%), this cost reduction is driving existing and start-up solar manufacturers to switch to thin-film production. A key aspect of these devices is patterning large panels to create a monolithic array of series-interconnected cells to form a low current, high voltage module. This patterning is accomplished in three critical scribing processes called P1, P2, and P3. Lasers are the technology of choice for these processes, delivering the desired combination of high throughput and narrow, clean scribes. This paper examines these processes and discusses the optimization of industrial lasers to meet their specific needs.

Assessment of global guidelines for preventive chemotherapy against schistosomiasis and soil-transmitted helminthiasis: a cost-effectiveness modelling study.

PubMed

Lo, Nathan C; Lai, Ying-Si; Karagiannis-Voules, Dimitrios-Alexios; Bogoch, Isaac I; Coulibaly, Jean T; Bendavid, Eran; Utzinger, Jürg; Vounatsou, Penelope; Andrews, Jason R

2016-09-01

WHO guidelines recommend annual treatment for schistosomiasis or soil-transmitted helminthiasis when prevalence in school-aged children is at or above a threshold of 50% and 20%, respectively. Separate treatment guidelines are used for these two helminthiases, and integrated community-wide treatment is not recommended. We assessed the cost-effectiveness of changing prevalence thresholds and treatment guidelines under an integrated delivery framework. We developed a dynamic, age-structured transmission and cost-effectiveness model that simulates integrated preventive chemotherapy programmes against schistosomiasis and soil-transmitted helminthiasis. We assessed a 5-year treatment programme with praziquantel (40 mg/kg per treatment) against schistosomiasis and albendazole (400 mg per treatment) against soil-transmitted helminthiasis at 75% coverage. We defined strategies as highly cost-effective if the incremental cost-effectiveness ratio was less than the World Bank classification for a low-income country (gross domestic product of US$1045 per capita). We calculated the prevalence thresholds for cost-effective preventive chemotherapy of various strategies, and estimated treatment needs for sub-Saharan Africa. Annual preventive chemotherapy against schistosomiasis was highly cost-effective in treatment of school-aged children at a prevalence threshold of 5% (95% uncertainty interval [UI] 1·7-5·2; current guidelines recommend treatment at 50% prevalence) and for community-wide treatment at a prevalence of 15% (7·3-18·5; current recommendation is unclear, some community treatment recommended at 50% prevalence). Annual preventive chemotherapy against soil-transmitted helminthiasis was highly cost-effective in treatment of school-aged children at a prevalence of 20% (95% UI 5·4-30·5; current guidelines recommend treatment at 20% prevalence) and the entire community at 60% (35·3-85·1; no guidelines available). When both helminthiases were co-endemic, prevalence thresholds using integrated delivery were lower. Using this revised treatment framework, we estimated that treatment needs would be six times higher than WHO guidelines for praziquantel and two times higher for albendazole. An additional 21·3% (95% Bayesian credible interval 20·4-22·2) of the population changed from receiving non-integrated treatment under WHO guidelines to integrated treatment (both praziquantel and albendazole). Country-specific economic differences resulted in heterogeneity around these prevalence thresholds. Annual preventive chemotherapy programmes against schistosomiasis and soil-transmitted helminthiasis are likely to be highly cost-effective at prevalences lower than WHO recommendations. These findings support substantial treatment scale-up, community-wide coverage, integrated treatment in co-endemic settings that yield substantial cost synergies, and country-specific treatment guidelines. Doris Duke Charitable Foundation, Mount Sinai Hospital-University Health Network AMO Innovation Fund, and Stanford University Medical Scholars Programme. Copyright © 2016 Elsevier Ltd. All rights reserved.

Cost effectiveness of strategies to combat chronic obstructive pulmonary disease and asthma in sub-Saharan Africa and South East Asia: mathematical modelling study.

PubMed

Stanciole, Anderson E; Ortegón, Mónica; Chisholm, Dan; Lauer, Jeremy A

2012-03-02

To determine the population level costs, effects, and cost effectiveness of selected, individual based interventions to combat chronic obstructive pulmonary disease (COPD) and asthma in the context of low and middle income countries. Sectoral cost effectiveness analysis using a lifetime population model. Two World Health Organization sub-regions of the world: countries in sub-Saharan Africa with very high adult and high child mortality (AfrE); and countries in South East Asia with high adult and high child mortality (SearD). Disease rates and profiles were taken from the WHO Global Burden of Disease study; estimates of intervention effects and resource needs were drawn from clinical trials, observational studies, and treatment guidelines. Unit costs were taken from a WHO price database. Cost per disability adjusted life year (DALY) averted, expressed in international dollars ($Int) for the year 2005. In both regions low dose inhaled corticosteroids for mild persistent asthma was considered the most cost effective intervention, with average cost per DALY averted about $Int2500. The next best value strategies were influenza vaccine for COPD in Sear-D (incremental cost $Int4950 per DALY averted) and low dose inhaled corticosteroids plus long acting β agonists for moderate persistent asthma in Afr-E (incremental cost $Int9112 per DALY averted). COPD is irreversible and progressive, and current treatment options produce relatively little gains relative to the cost. The treatment options available for asthma, however, generally decrease chronic respiratory disease burden at a relatively low cost.

Prospective casemix-based funding, analysis and financial impact of cost outliers in all-patient refined diagnosis related groups in three Belgian general hospitals.

PubMed

Pirson, Magali; Martins, Dimitri; Jackson, Terri; Dramaix, Michèle; Leclercq, Pol

2006-03-01

This study examined the impact of cost outliers in term of hospital resources consumption, the financial impact of the outliers under the Belgium casemix-based system, and the validity of two "proxies" for costs: length of stay and charges. The cost of all hospital stays at three Belgian general hospitals were calculated for the year 2001. High resource use outliers were selected according to the following rule: 75th percentile +1.5 xinter-quartile range. The frequency of cost outliers varied from 7% to 8% across hospitals. Explanatory factors were: major or extreme severity of illness, longer length of stay, and intensive care unit stay. Cost outliers account for 22-30% of hospital costs. One-third of length-of-stay outliers are not cost outliers, and nearly one-quarter of charges outliers are not cost outliers. The current funding system in Belgium does not penalize hospitals having a high percentage of outliers. The billing generated by these patients largely compensates for costs generated. Length of stay and charges are not a good approximation to select cost outliers.

Value-based insurance design: embracing value over cost alone.

PubMed

Fendrick, A Mark; Chernew, Michael E; Levi, Gary W

2009-12-01

The US healthcare system is in crisis, with documented gaps in quality, safety, access, and affordability. Many believe the solution to unsustainable cost increases is increased patient cost-sharing. From an overall cost perspective, reduced consumption of certain essential services may yield short-term savings but lead to worse health and markedly higher costs down the road--in complications, hospitalizations, and increased utilization. Value-based insurance design (VBID) can help plug the inherent shortfalls in "across-the-board" patient cost-sharing. Instead of focusing on cost or quality alone, VBID focuses on value, aligning the financial and nonfinancial incentives of the various stakeholders and complementing other current initiatives to improve quality and subdue costs, such as high-deductible consumer-directed health plans, pay-for-performance programs, and disease management. Mounting evidence, both peer-reviewed and empirical, indicates not only that VBID can be implemented, but also leads to desired changes in behavior. For all its documented successes and recognized promise, VBID is in its infancy and is not a panacea for the current healthcare crisis. However, the available research and documented experiences indicate that as an overall approach, and in its fully evolved and widely adopted form, VBID will promote a healthier population and therefore support cost-containment efforts by producing better health at any price point.

A second-generation high speed civil transport: Stingray

NASA Technical Reports Server (NTRS)

Engdahl, Sean; Lopes, Kevin; Ngan, Angelen; Perrin, Joseph; Phipps, Marcus; Westman, Blake; Yeo, Urn

1992-01-01

The Stingray is the second-generation High Speed Civil Transport (HSCT) designed for the 21st Century. This aircraft is designed to be economically viable and environmentally sound transportation competitive in markets currently dominated by subsonic aircraft such as the Boeing 747 and upcoming McDonnell Douglas MD-12. With the Stringray coming into service in 2005, a ticket price of 21 percent over current subsonic airlines will cover operational costs with a 10 percent return on investment. The cost per aircraft will be $202 million with the Direct Operating Cost equal to $0.072 per mile per seat. This aircraft has been designed to be a realistic aircraft that can be built within the next ten to fifteen years. There was only one main technological improvement factor used in the design, that being for the engine specific fuel consumption. The Stingray, therefore, does not rely on technology that does not exist. The Stingray will be powered by four mixed flow turbofans that meet both nitrous oxide emissions and FAR 36 Stage 3 noise regulations. It will carry 250 passengers a distance of 5200 nautical miles at a speed of Mach 2.4. The shape of the Stingray, while optimized for supersonic flight, is compatible with all current airline facilities in airports around the world. As the demand for economical, high-speed flight increases, the Stingray will be ready and able to meet those demands.

Lung cancer deaths from indoor radon and the cost effectiveness and potential of policies to reduce them

PubMed Central

Read, Simon; McGale, Paul; Darby, Sarah

2009-01-01

Objective To determine the number of deaths from lung cancer related to radon in the home and to explore the cost effectiveness of alternative policies to control indoor radon and their potential to reduce lung cancer mortality. Design Cost effectiveness analysis. Setting United Kingdom. Data sources Epidemiological data on risks from indoor radon and from smoking, vital statistics on deaths from lung cancer, survey information on effectiveness and costs of radon prevention and remediation. Main outcome measures Estimated number of deaths from lung cancer related to indoor radon, lifetime risks of death from lung cancer before and after various potential interventions to control radon, the cost per quality adjusted life year (QALY) gained from different policies for control of radon, and the potential of those policies to reduce lung cancer mortality. Results The mean radon concentration in UK homes is 21 becquerels per cubic metre (Bq/m3). Each year around 1100 deaths from lung cancer (3.3% of all deaths from lung cancer) are related to radon in the home. Over 85% of these arise from radon concentrations below 100 Bq/m3 and most are caused jointly by radon and active smoking. Current policy requiring basic measures to prevent radon in new homes in selected areas is highly cost effective, and such measures would remain cost effective if extended to the entire UK, with a cost per QALY gained of £11 400 ( €12 200; $16 913). Current policy identifying and remediating existing homes with high radon levels is, however, neither cost effective (cost per QALY gained £36 800) nor effective in reducing lung cancer mortality. Conclusions Policies requiring basic preventive measures against radon in all new homes throughout the UK would be cost effective and could complement existing policies to reduce smoking. Policies involving remedial work on existing homes with high radon levels cannot prevent most radon related deaths, as these are caused by moderate exposure in many homes. These conclusions are likely to apply to most developed countries, many with higher mean radon concentrations than the UK. PMID:19129153

Lung cancer deaths from indoor radon and the cost effectiveness and potential of policies to reduce them.

PubMed

Gray, Alastair; Read, Simon; McGale, Paul; Darby, Sarah

2009-01-06

To determine the number of deaths from lung cancer related to radon in the home and to explore the cost effectiveness of alternative policies to control indoor radon and their potential to reduce lung cancer mortality. Cost effectiveness analysis. United Kingdom. Epidemiological data on risks from indoor radon and from smoking, vital statistics on deaths from lung cancer, survey information on effectiveness and costs of radon prevention and remediation. Estimated number of deaths from lung cancer related to indoor radon, lifetime risks of death from lung cancer before and after various potential interventions to control radon, the cost per quality adjusted life year (QALY) gained from different policies for control of radon, and the potential of those policies to reduce lung cancer mortality. The mean radon concentration in UK homes is 21 becquerels per cubic metre (Bq/m(3)). Each year around 1100 deaths from lung cancer (3.3% of all deaths from lung cancer) are related to radon in the home. Over 85% of these arise from radon concentrations below 100 Bq/m(3) and most are caused jointly by radon and active smoking. Current policy requiring basic measures to prevent radon in new homes in selected areas is highly cost effective, and such measures would remain cost effective if extended to the entire UK, with a cost per QALY gained of pound11,400 ( euro12 200; $16,913). Current policy identifying and remediating existing homes with high radon levels is, however, neither cost effective (cost per QALY gained pound36,800) nor effective in reducing lung cancer mortality. Policies requiring basic preventive measures against radon in all new homes throughout the UK would be cost effective and could complement existing policies to reduce smoking. Policies involving remedial work on existing homes with high radon levels cannot prevent most radon related deaths, as these are caused by moderate exposure in many homes. These conclusions are likely to apply to most developed countries, many with higher mean radon concentrations than the UK.

Breaking the Bank: Three Financing Models for Addressing the Drug Innovation Cost Crisis.

PubMed

Kleinke, J D; McGee, Nancy

2015-05-01

The introduction of innovative specialty pharmaceuticals with high prices has renewed efforts by public and private healthcare payers to constrain their utilization, increase patient cost-sharing, and compel government intervention on pricing. These efforts, although rational for individual payers, have the potential to undermine the public health impact and overall economic value of these innovations for society. The emerging archetypal example is the outcry over the cost of sofosbuvir, a drug proved to cure hepatitis C infection at a cost of $84,000 per person for a course of treatment (or $1000 per tablet). This represents a radical medical breakthrough for public health, with great promise for the long-term costs associated with this disease, but with major short-term cost implications for the budgets of healthcare payers. To propose potential financing models to provide a workable and lasting solution that directly addresses the misalignment of incentives between healthcare payers confronted with the high upfront costs of innovative specialty drugs and the rest of the US healthcare system, and to articulate these in the context of the historic struggle over paying for innovation. We describe 3 innovative financing models to manage expensive specialty drugs that will significantly reduce the direct, immediate cost burden of these drugs to public and private healthcare payers. The 3 financing models include high-cost drug mortgages, high-cost drugs reinsurance, and high-cost drug patient rebates. These models have been proved successful in other areas and should be adopted into healthcare to mitigate the high-cost of specialty drugs. We discuss the distribution of this burden over time and across the healthcare system, and we match the financial burden of medical innovations to the healthcare stakeholders who capture their overall value. All 3 models work within or replicate the current healthcare marketplace mechanisms for distributing immediate high-cost events across multiple at-risk stakeholders, and/or encouraging active participation by patients as consumers. The adoption of these 3 models for the financing of high-cost drugs would ameliorate decades-long economic conflict in the healthcare system over the value of, and financial responsibility for, drug innovation.

Breaking the Bank: Three Financing Models for Addressing the Drug Innovation Cost Crisis

PubMed Central

Kleinke, J.D.; McGee, Nancy

2015-01-01

Background The introduction of innovative specialty pharmaceuticals with high prices has renewed efforts by public and private healthcare payers to constrain their utilization, increase patient cost-sharing, and compel government intervention on pricing. These efforts, although rational for individual payers, have the potential to undermine the public health impact and overall economic value of these innovations for society. The emerging archetypal example is the outcry over the cost of sofosbuvir, a drug proved to cure hepatitis C infection at a cost of $84,000 per person for a course of treatment (or $1000 per tablet). This represents a radical medical breakthrough for public health, with great promise for the long-term costs associated with this disease, but with major short-term cost implications for the budgets of healthcare payers. Objectives To propose potential financing models to provide a workable and lasting solution that directly addresses the misalignment of incentives between healthcare payers confronted with the high upfront costs of innovative specialty drugs and the rest of the US healthcare system, and to articulate these in the context of the historic struggle over paying for innovation. Discussion We describe 3 innovative financing models to manage expensive specialty drugs that will significantly reduce the direct, immediate cost burden of these drugs to public and private healthcare payers. The 3 financing models include high-cost drug mortgages, high-cost drugs reinsurance, and high-cost drug patient rebates. These models have been proved successful in other areas and should be adopted into healthcare to mitigate the high-cost of specialty drugs. We discuss the distribution of this burden over time and across the healthcare system, and we match the financial burden of medical innovations to the healthcare stakeholders who capture their overall value. All 3 models work within or replicate the current healthcare marketplace mechanisms for distributing immediate high-cost events across multiple at-risk stakeholders, and/or encouraging active participation by patients as consumers. Conclusion The adoption of these 3 models for the financing of high-cost drugs would ameliorate decades-long economic conflict in the healthcare system over the value of, and financial responsibility for, drug innovation. PMID:26085900

Early prevention of pressure ulcers among elderly patients admitted through emergency departments: a cost-effectiveness analysis.

PubMed

Pham, Ba'; Teague, Laura; Mahoney, James; Goodman, Laurie; Paulden, Mike; Poss, Jeff; Li, Jianli; Ieraci, Luciano; Carcone, Steven; Krahn, Murray

2011-11-01

Every year, approximately 6.2 million hospital admissions through emergency departments (ED) involve elderly patients who are at risk of developing pressure ulcers. We evaluated the cost-effectiveness of pressure-redistribution foam mattresses on ED stretchers and beds for early prevention of pressure ulcers in elderly admitted ED patients. Using a Markov model, we evaluated the incremental effectiveness (quality-adjusted life-days) and incremental cost (hospital and home care costs) between early prevention and current practice (with standard hospital mattresses) from a health care payer perspective during a 1-year time horizon. The projected incidence of ED-acquired pressure ulcers was 1.90% with current practice and 1.48% with early prevention, corresponding to a number needed to treat of 238 patients. The average upgrading cost from standard to pressure-redistribution mattresses was $0.30 per patient. Compared with current practice, early prevention was more effective, with 0.0015 quality-adjusted life-days gained, and less costly, with a mean cost saving of $32 per patient. If decisionmakers are willing to pay $50,000 per quality-adjusted life-year gained, early prevention was cost-effective even for short ED stay (ie, 1 hour), low hospital-acquired pressure ulcer risk (1% prevalence), and high unit price of pressure-redistribution mattresses ($3,775). Taking input uncertainty into account, early prevention was 81% likely to be cost-effective. Expected value-of-information estimates supported additional randomized controlled trials of pressure-redistribution mattresses to eliminate the remaining decision uncertainty. The economic evidence supports early prevention with pressure-redistribution foam mattresses in the ED. Early prevention is likely to improve health for elderly patients and save hospital costs. Copyright © 2011 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

Lung transplantation in the spotlight: Reasons for high-cost procedures.

PubMed

Vogl, Matthias; Warnecke, Gregor; Haverich, Axel; Gottlieb, Jens; Welte, Tobias; Hatz, Rudolf; Hunger, Matthias; Leidl, Reiner; Lingner, Heidrun; Behr, Juergen; Winter, Hauke; Schramm, Rene; Zwissler, Bernhard; Hagl, Christian; Strobl, Nicole; Jaeger, Cornelius; Preissler, Gerhard

2016-10-01

Hospital treatment costs of lung transplantation are insufficiently analyzed. Accordingly, it remains unknown, whether current Diagnosis Related Groups, merely accounting for 3 ventilation time intervals and length of hospital stay, reproduce costs properly, even when an increasing number of complex recipients are treated. Therefore, in this cost determination study, actual costs were calculated and cost drivers identified. A standardized microcosting approach allowed for individual cost calculations in 780 lung transplant patients taken care of at Hannover Medical School and University of Munich from 2009 to 2013. A generalized linear model facilitated the determination of characteristics predictive for inpatient costs. Lung transplantation costs varied substantially by major diagnosis, with a mean of €85,946 (median €52,938 ± 3,081). Length of stay and ventilation time properly reproduced costs in many cases. However, complications requiring prolonged ventilation or reinterventions were identified as additional significant cost drivers, responsible for high costs. Diagnosis Related Groups properly reproduce actual lung transplantation costs in straightforward cases, but costs in complex cases may remain underestimated. Improved grouping should consider major diagnosis, a higher gradation of ventilation time, and the number of reinterventions to allow for more reasonable reimbursement. Copyright © 2016 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

Benefits, Harms, and Costs of Osteoporosis Screening in Male Veterans

DTIC Science & Technology

men; cost effectiveness analysis was not completed due to the overall lack of benefit of DXA testing. We conclude that current VADXA testing practices...and adherence in those meeting treatment thresholds (12 of follow-up time). Mortality was 21 lower in DXA tested men, also likely related to...VA guideline risk factors (0.91, 0.87-0.95);and high FRAX- BMI (0.90, 0.86-0.95). Total costs were slightly higher for DXA treated men than untested

Research of low cost wind generator rotors

NASA Technical Reports Server (NTRS)

Fertis, D. G.; Ross, R. S.

1978-01-01

A feasibility program determined that it would be possible to significantly reduce the cost of manufacturing wind generator rotors by making them of cast urethane. Several high modulus urethanes which were structurally tested were developed. A section of rotor was also cast and tested showing the excellent aerodynamic surface which results. A design analysis indicated that a cost reduction of almost ten to one can be achieved with a small weight increase to achieve the same structural integrity as expected of current rotor systems.

Launch vehicle systems design analysis

NASA Technical Reports Server (NTRS)

Ryan, Robert; Verderaime, V.

1993-01-01

Current launch vehicle design emphasis is on low life-cycle cost. This paper applies total quality management (TQM) principles to a conventional systems design analysis process to provide low-cost, high-reliability designs. Suggested TQM techniques include Steward's systems information flow matrix method, quality leverage principle, quality through robustness and function deployment, Pareto's principle, Pugh's selection and enhancement criteria, and other design process procedures. TQM quality performance at least-cost can be realized through competent concurrent engineering teams and brilliance of their technical leadership.

Sterilization in the United States

PubMed Central

Bartz, Deborah; Greenberg, James A

2008-01-01

Unintended pregnancies are expensive for patients and for society in terms of medical costs, the cost of caring for more children, and the cost to personal and professional goals. Sterilization is the most common contraceptive method utilized by couples in the United States. Given technological advances over the past few decades, male and female surgical sterilization has become a safe, convenient, easy, and highly effective birth control method for the long term. This article reviews current male and female sterilization options. PMID:18701927

Development of seals for a geothermal downhole intensifier. Progress report

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

Captain, K.M.; Harvey, A.C.; Caskey, B.C.

1985-08-01

A system using high-velocity fluid jets in conjunction with a rotary diamond bit is currently considered as the best candidate for reducing the cost of drilling geothermal wells. Technical, safety and cost considerations indicate that the required jet supply pressure can best be established by a downhole pressure intensifier. Key intensifier components are the check valve and plunger seals, which must prevent leakage of the high-pressure, high-temperature abrasive fluid (drilling mud). To achieve the required performance, novel ceramic seals are currently being developed. The check valve seal includes a tapered polymeric plug and ceramic stop acting against a ceramic seat.more » The ceramic plunger seal is a variant of the ''stepped-joint'' piston ring and is designed to minimize contact pressure and abrasive wear. Initial testing of these seals in the laboratory shows encouraging results; design refinement and further testing is in progress. 2 refs., 6 figs., 3 tabs.« less

A high-throughput colorimetric assay for glucose detection based on glucose oxidase-catalyzed enlargement of gold nanoparticles

NASA Astrophysics Data System (ADS)

Xiong, Yanmei; Zhang, Yuyan; Rong, Pengfei; Yang, Jie; Wang, Wei; Liu, Dingbin

2015-09-01

We developed a simple high-throughput colorimetric assay to detect glucose based on the glucose oxidase (GOx)-catalysed enlargement of gold nanoparticles (AuNPs). Compared with the currently available glucose kit method, the AuNP-based assay provides higher clinical sensitivity at lower cost, indicating its great potential to be a powerful tool for clinical screening of glucose.We developed a simple high-throughput colorimetric assay to detect glucose based on the glucose oxidase (GOx)-catalysed enlargement of gold nanoparticles (AuNPs). Compared with the currently available glucose kit method, the AuNP-based assay provides higher clinical sensitivity at lower cost, indicating its great potential to be a powerful tool for clinical screening of glucose. Electronic supplementary information (ESI) available: Experimental section and additional figures. See DOI: 10.1039/c5nr03758a

High-frequency, long-duration water sampling in acid mine drainage studies: a short review of current methods and recent advances in automated water samplers

USGS Publications Warehouse

Chapin, Thomas

2015-01-01

Hand-collected grab samples are the most common water sampling method but using grab sampling to monitor temporally variable aquatic processes such as diel metal cycling or episodic events is rarely feasible or cost-effective. Currently available automated samplers are a proven, widely used technology and typically collect up to 24 samples during a deployment. However, these automated samplers are not well suited for long-term sampling in remote areas or in freezing conditions. There is a critical need for low-cost, long-duration, high-frequency water sampling technology to improve our understanding of the geochemical response to temporally variable processes. This review article will examine recent developments in automated water sampler technology and utilize selected field data from acid mine drainage studies to illustrate the utility of high-frequency, long-duration water sampling.

Cost of biologics in the treatment of juvenile idiopathic arthritis: a factor not to be overlooked.

PubMed

Prince, Femke H M; van Suijlekom-Smit, Lisette W A

2013-08-01

Biologics are a promising treatment option for juvenile idiopathic arthritis (JIA) but drug costs are very high compared to conventional treatment. From a socioeconomic view the additional costs of new interventions should be weighed against their incremental health benefits compared to standard care. Therefore we evaluated data on cost-effectiveness of biologics in JIA. We searched Medline, Embase, and The York Centre for Reviews and Dissemination database for relevant literature. Current data show that biologics are reducing direct and indirect healthcare costs if one excludes the costs of the drug itself. The costs of biologics are more than ten times as high as conventional drug treatment. As a result of limited data, no comparison on cost-effectiveness between biologics could be performed. Although data on long-term cost-effectiveness of biologics are lacking, the expectation is that they will be cost-effective in the long-term. The idea behind this is that biologic treatment should be administered to patients that without these drugs would incur high direct and indirect costs due to continuous severe disease resulting in irreversible disabilities. In our opinion the best cost benefit could be gained if these patients receive biologic treatment introduced early in the disease. This is in order to minimize irreversible damage to the joints and minimize need for long-term biologic therapy by early suppression of the disease. To support these hypotheses future research is needed on long-term cost-effectiveness of all biologics used in JIA.

Ceramic automotive Stirling engine study

NASA Technical Reports Server (NTRS)

Musikant, S.; Chiu, W.; Darooka, D.; Mullings, D. M.; Johnson, C. A.

1985-01-01

A conceptual design study for a Ceramic Automotive Stirling Engine (CASE) is performed. Year 1990 structural ceramic technology is assumed. Structural and performance analyses of the conceptual design are performed as well as a manufacturing and cost analysis. The general conclusions from this study are that such an engine would be 10-26% more efficient over its performance map than the current metal Automotive Stirling Reference Engine (ASRE). Cost of such a ceramic engine is likely to be somewhat higher than that of the ASRE but engine cost is very sensitive to the ultimate cost of the high purity, ceramic powder raw materials required to fabricate high performance parts. When the design study is projected to the year 2000 technology, substantinal net efficiency improvements, on the order of 25 to 46% over the ASRE, are computed.

Inefficiencies and high-value improvements in U.S. cervical cancer screening practice: A cost-effectiveness analysis

PubMed Central

Kim, Jane J.; Campos, Nicole G.; Sy, Stephen; Burger, Emily A.; Cuzick, Jack; Castle, Philip E.; Hunt, William C.; Waxman, Alan; Wheeler, Cosette M.

2016-01-01

Background Studies suggest that cervical cancer screening practice in the United States is inefficient. The cost and health implications of non-compliance in the screening process compared to recommended guidelines are uncertain. Objective To estimate the benefits, costs, and cost-effectiveness of current cervical cancer screening practice and assess the value of screening improvements. Design Model-based cost-effectiveness analysis. Data Sources New Mexico HPV Pap Registry; medical literature. Target Population Cohort of women eligible for routine screening. Time Horizon Lifetime. Perspective Societal. Interventions Current cervical cancer screening practice; improved compliance to guidelines-based screening interval, triage testing, diagnostic referrals, and precancer treatment referrals. Outcome Measures Reductions in lifetime cervical cancer risk, quality-adjusted life-years (QALYs), lifetime costs, incremental cost-effectiveness ratios (ICERs), incremental net monetary benefits (INMBs Results of Base-Case Analysis Current screening practice was associated with lower health benefit and was not cost-effective relative to guidelines-based strategies. Improvements in the screening process were associated with higher QALYs and small changes in costs. Perfect c4mpliance to a 3-yearly screening interval and to colposcopy/biopsy referrals were associated with the highest INMBs ($759 and $741, respectively, at a willingness-to-pay threshold of $100,000 per QALY gained); together, the INMB increased to $1,645. Results of Sensitivity Analysis Current screening practice was inefficient in 100% of simulations. The rank ordering of screening improvements according to INMBs was stable over a range of screening inputs and willingness-to-pay thresholds. Limitations The impact of HPV vaccination was not considered. Conclusions The added health benefit of improving compliance to guidelines, especially the 3-yearly interval for cytology screening and diagnostic follow-up, may justify additional investments in interventions to improve U.S. cervical cancer screening practice. Funding Source U.S. National Cancer Institute. PMID:26414147

Costs on the Mind: the Influence of the Financial Burden of College on Academic Performance and Cognitive Functioning

ERIC Educational Resources Information Center

Destin, Mesmin; Svoboda, Ryan C.

2018-01-01

The current studies test the hypothesis that the financial burden of college can initiate a psychological process that has a negative influence on academic performance for students at selective colleges and universities. Prior studies linking high college costs and student loans to academic outcomes have not been grounded within relevant social…

Investigation on the Factors Influencing Construction Time and Cost Overrun for High-Rise Building Projects In Penang

NASA Astrophysics Data System (ADS)

Nor Haslinda, A.; Xian, T. Wei; Norfarahayu, K.; Muhamad Hanafi, R.; Fikri, H. Muhammad

2018-04-01

Time and cost overruns have become one prominent issue for most construction projects around the world. Project costing and timeframe extension had been causing a lot of wastage and loss of opportunity for many parties involved. Therefore, this research was carried out to investigate the factors influencing time and cost overruns for high-rise construction projects in Penang, Malaysia. A set of questionnaires survey was distributed to the project managers who had been or currently involved in the high-rise building projects in Penang to get their input and perceptions for each factor identified as well as its frequency of occurrence. In order to rank all the factors gathered, the mean index of the most distinguishing factors and its frequency of occurrence were multiplied to get the severity index. The results revealed that for time overrun, the most predominant causes were due to design changes, inadequate planning and scheduling and poor labor productivity. Meanwhile, the predominant causes of cost overrun were poor pre-construction budget and material cost planning, inaccurate quantity take-off and materials cost increased by inflation. The significance of establishing the issues related to time and cost overruns for the high-rise building construction project is to provide a greater insight and understanding on the causes of delays, particularly among the main project players: contractors, client, and consultants.

Specific net present value: an improved method for assessing modularisation costs in water services with growing demand.

PubMed

Maurer, M

2009-05-01

A specific net present value (SNPV) approach is introduced as a criterion in economic engineering decisions. The SNPV expresses average costs, including the growth rate and plant utilisation over the planning horizon, factors that are excluded from a standard net present value approach. The use of SNPV favours alternatives that are cheaper per service unit and are therefore closer to the costs that a user has to cover. It also shows that demand growth has a similar influence on average costs as an economy of scale. In a high growth scenario, solutions providing less idle capacity can have higher present value costs and still be economically favourable. The SNPV approach is applied in two examples to calculate acceptable additional costs for modularisation and comparable costs for on-site treatment (OST) as an extreme form of modularisation. The calculations show that: (i) the SNPV approach is suitable for quantifying the comparable costs of an OST system in a different scenario; (ii) small systems with projected high demand growth rates and high real interest rates are the most probable entry market for OST water treatment systems; (iii) operating expenses are currently the main economic weakness of membrane-based wastewater OST systems; and (iv) when high growth in demand is expected, up to 100% can be additionally invested in modularisation and staging the expansion of a treatment plant.

Carbon footprint and cost-effectiveness of cataract surgery.

PubMed

Venkatesh, Rengaraj; van Landingham, Suzanne W; Khodifad, Ashish M; Haripriya, Aravind; Thiel, Cassandra L; Ramulu, Pradeep; Robin, Alan L

2016-01-01

This article raises awareness about the cost-effectiveness and carbon footprint of various cataract surgery techniques, comparing their relative carbon emissions and expenses: manual small-incision cataract surgery (MSICS), phacoemulsification, and femtosecond laser-assisted cataract surgery. As the most commonly performed surgical procedure worldwide, cataract surgery contributes significantly to global climate change. The carbon footprint of a single phacoemulsification cataract surgery is estimated to be comparable to that of a typical person's life for 1 week. Phacoemulsification has been estimated to be between 1.4 and 4.7 times more expensive than MSICS; however, given the lower degree of postoperative astigmatism and other potential complications, phacoemulsification may still be preferable to MSICS in relatively resource-rich settings requiring high levels of visual function. Limited data are currently available regarding the environmental and financial impact of femtosecond laser-assisted cataract surgery; however, in its current form, it appears to be the least cost-effective option. Cataract surgery has a high value to patients. The relative environmental impact and cost of different types of cataract surgery should be considered as this treatment becomes even more broadly available globally and as new technologies are developed and implemented.

DC-Compensated Current Transformer †

PubMed Central

Ripka, Pavel; Draxler, Karel; Styblíková, Renata

2016-01-01

Instrument current transformers (CTs) measure AC currents. The DC component in the measured current can saturate the transformer and cause gross error. We use fluxgate detection and digital feedback compensation of the DC flux to suppress the overall error to 0.15%. This concept can be used not only for high-end CTs with a nanocrystalline core, but it also works for low-cost CTs with FeSi cores. The method described here allows simultaneous measurements of the DC current component. PMID:26805830

Nanowire-nanopore transistor sensor for DNA detection during translocation

NASA Astrophysics Data System (ADS)

Xie, Ping; Xiong, Qihua; Fang, Ying; Qing, Quan; Lieber, Charles

2011-03-01

Nanopore sequencing, as a promising low cost, high throughput sequencing technique, has been proposed more than a decade ago. Due to the incompatibility between small ionic current signal and fast translocation speed and the technical difficulties on large scale integration of nanopore for direct ionic current sequencing, alternative methods rely on integrated DNA sensors have been proposed, such as using capacitive coupling or tunnelling current etc. But none of them have been experimentally demonstrated yet. Here we show that for the first time an amplified sensor signal has been experimentally recorded from a nanowire-nanopore field effect transistor sensor during DNA translocation. Independent multi-channel recording was also demonstrated for the first time. Our results suggest that the signal is from highly localized potential change caused by DNA translocation in none-balanced buffer condition. Given this method may produce larger signal for smaller nanopores, we hope our experiment can be a starting point for a new generation of nanopore sequencing devices with larger signal, higher bandwidth and large-scale multiplexing capability and finally realize the ultimate goal of low cost high throughput sequencing.

Cost effectiveness of brief interventions for reducing alcohol consumption.

PubMed

Wutzke, S E; Shiell, A; Gomel, M K; Conigrave, K M

2001-03-01

The direct costs and health effects of a primary-care-based brief intervention for hazardous alcohol consumption were examined. The total cost of the intervention was calculated from costs associated with: marketing the intervention programme; providing training and support in the use of the intervention materials; physician time required for providing brief advice for 'at-risk' drinkers. The effect of the intervention on health outcomes was expressed in terms of number of life years saved by preventing alcohol-related deaths. This was derived by combining estimates of the impact of the programme if it were implemented nationally with available evidence on the health effects of excess alcohol consumption. Results are based on international trial evidence showing the physical resources required by the intervention and its effectiveness combined with Australian price data. The costs associated with screening and brief advice using the current intervention programme range from Aus$19.14 to Aus$21.50. The marginal costs per additional life year saved were below Aus$1873. The robustness of the model used is supported by an extensive sensitivity analysis. In comparison with existing health promotion strategies the costs and effects of the current intervention are highly encouraging.

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

PubMed

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

2013-01-01

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

Solar thermal technology development: Estimated market size and energy cost savings. Volume 2: Assumptions, methodology and results

NASA Astrophysics Data System (ADS)

Gates, W. R.

1983-02-01

Estimated future energy cost savings associated with the development of cost-competitive solar thermal technologies (STT) are discussed. Analysis is restricted to STT in electric applications for 16 high-insolation/high-energy-price states. Three fuel price scenarios and three 1990 STT system costs are considered, reflecting uncertainty over future fuel prices and STT cost projections. Solar thermal technology research and development (R&D) is found to be unacceptably risky for private industry in the absence of federal support. Energy cost savings were projected to range from $0 to $10 billion (1990 values in 1981 dollars), depending on the system cost and fuel price scenario. Normal R&D investment risks are accentuated because the Organization of Petroleum Exporting Countries (OPEC) cartel can artificially manipulate oil prices and undercut growth of alternative energy sources. Federal participation in STT R&D to help capture the potential benefits of developing cost-competitive STT was found to be in the national interest. Analysis is also provided regarding two federal incentives currently in use: The Federal Business Energy Tax Credit and direct R&D funding.

Solar thermal technology development: Estimated market size and energy cost savings. Volume 2: Assumptions, methodology and results

NASA Technical Reports Server (NTRS)

Gates, W. R.

1983-01-01

Estimated future energy cost savings associated with the development of cost-competitive solar thermal technologies (STT) are discussed. Analysis is restricted to STT in electric applications for 16 high-insolation/high-energy-price states. Three fuel price scenarios and three 1990 STT system costs are considered, reflecting uncertainty over future fuel prices and STT cost projections. Solar thermal technology research and development (R&D) is found to be unacceptably risky for private industry in the absence of federal support. Energy cost savings were projected to range from $0 to $10 billion (1990 values in 1981 dollars), depending on the system cost and fuel price scenario. Normal R&D investment risks are accentuated because the Organization of Petroleum Exporting Countries (OPEC) cartel can artificially manipulate oil prices and undercut growth of alternative energy sources. Federal participation in STT R&D to help capture the potential benefits of developing cost-competitive STT was found to be in the national interest. Analysis is also provided regarding two federal incentives currently in use: The Federal Business Energy Tax Credit and direct R&D funding.

Development of a simple, low cost, indirect ion beam fluence measurement system for ion implanters, accelerators

NASA Astrophysics Data System (ADS)

Suresh, K.; Balaji, S.; Saravanan, K.; Navas, J.; David, C.; Panigrahi, B. K.

2018-02-01

We developed a simple, low cost user-friendly automated indirect ion beam fluence measurement system for ion irradiation and analysis experiments requiring indirect beam fluence measurements unperturbed by sample conditions like low temperature, high temperature, sample biasing as well as in regular ion implantation experiments in the ion implanters and electrostatic accelerators with continuous beam. The system, which uses simple, low cost, off-the-shelf components/systems and two distinct layers of in-house built softwarenot only eliminates the need for costly data acquisition systems but also overcomes difficulties in using properietry software. The hardware of the system is centered around a personal computer, a PIC16F887 based embedded system, a Faraday cup drive cum monitor circuit, a pair of Faraday Cups and a beam current integrator and the in-house developed software include C based microcontroller firmware and LABVIEW based virtual instrument automation software. The automatic fluence measurement involves two important phases, a current sampling phase lasting over 20-30 seconds during which the ion beam current is continuously measured by intercepting the ion beam and the averaged beam current value is computed. A subsequent charge computation phase lasting 700-900 seconds is executed making the ion beam to irradiate the samples and the incremental fluence received by the sampleis estimated usingthe latest averaged beam current value from the ion beam current sampling phase. The cycle of current sampling-charge computation is repeated till the required fluence is reached. Besides simplicity and cost-effectiveness, other important advantages of the developed system include easy reconfiguration of the system to suit customisation of experiments, scalability, easy debug and maintenance of the hardware/software, ability to work as a standalone system. The system was tested with different set of samples and ion fluences and the results were verified using Rutherford backscattering technique which showed the satisfactory functioning of the system. The accuracy of the fluence measurements is found to be less than 2% which meets the demands of the irradiation experiments undertaken using the developed set up. The system was incorporated for regular use at the existing ultra high vacuum (UHV) ion irradiation chamber of 1.7 MV Tandem accelerator and several ion implantation experiments on a variety of samples like SS304, D9, ODS alloys have been successfully carried out.

Evaluation of resource recovery from waste incineration residues--the case of zinc.

PubMed

Fellner, J; Lederer, J; Purgar, A; Winterstetter, A; Rechberger, H; Winter, F; Laner, D

2015-03-01

Solid residues generated at European Waste to Energy plants contain altogether about 69,000 t/a of Zn, of which more than 50% accumulates in air pollution control residues, mainly boiler and filter ashes. Intensive research activities aiming at Zn recovery from such residues recently resulted in a technical scale Zn recovery plant at a Swiss waste incinerator. By acidic leaching and subsequent electrolysis this technology (FLUREC) allows generating metallic Zn of purity>99.9%. In the present paper the economic viability of the FLUREC technology with respect to Zn recovery from different solid residues of waste incineration has been investigated and subsequently been categorised according to the mineral resource classification scheme of McKelvey. The results of the analysis demonstrate that recovery costs for Zn are highly dependent on the costs for current fly ash disposal (e.g. cost for subsurface landfilling). Assuming current disposal practice costs of 220€/ton fly ash, resulting recovery costs for Zn are generally higher than its current market price of 1.6€/kg Zn. With respect to the resource classification this outcome indicates that none of the identified Zn resources present in incineration residues can be economically extracted and thus cannot be classified as a reserve. Only for about 4800 t/a of Zn an extraction would be marginally economic, meaning that recovery costs are only slightly (less than 20%) higher than the current market price for Zn. For the remaining Zn resources production costs are between 1.5 and 4 times (7900 t/a Zn) and 10-80 times (55,300 t/a Zn) higher than the current market value. The economic potential for Zn recovery from waste incineration residues is highest for filter ashes generated at grate incinerators equipped with wet air pollution control. Copyright © 2014 Elsevier Ltd. All rights reserved.

Low-cost in vitro fertilization: current insights

PubMed Central

Teoh, Pek Joo; Maheshwari, Abha

2014-01-01

Despite the development of in vitro fertilization (IVF) more than 30 years ago, the cost of treatment remains high. Furthermore, over the years, more sophisticated technologies and expensive medications have been introduced, making IVF increasingly inaccessible despite the increasing need. Globally, the option to undergo IVF is only available to a privileged few. In recent years, there has been growing interest in exploring strategies to reduce the cost of IVF treatment, which would allow the service to be provided in low-resource settings. In this review, we explore the various ways in which the cost of this treatment can be reduced. PMID:25187741

High Accuracy Temperature Measurements Using RTDs with Current Loop Conditioning

NASA Technical Reports Server (NTRS)

Hill, Gerald M.

1997-01-01

To measure temperatures with a greater degree of accuracy than is possible with thermocouples, RTDs (Resistive Temperature Detectors) are typically used. Calibration standards use specialized high precision RTD probes with accuracies approaching 0.001 F. These are extremely delicate devices, and far too costly to be used in test facility instrumentation. Less costly sensors which are designed for aeronautical wind tunnel testing are available and can be readily adapted to probes, rakes, and test rigs. With proper signal conditioning of the sensor, temperature accuracies of 0.1 F is obtainable. For reasons that will be explored in this paper, the Anderson current loop is the preferred method used for signal conditioning. This scheme has been used in NASA Lewis Research Center's 9 x 15 Low Speed Wind Tunnel, and is detailed.

Novel Circuits for Energizing Manganin Stress Gauges

NASA Astrophysics Data System (ADS)

Tasker, Douglas

2015-06-01

This paper describes the design, manufacture and testing of novel MOSFET pulsed constant current supplies for low impedance Manganin stress gauges. The design emphasis has been on high accuracy, low noise, simple, low cost, disposable supplies that can be used to energize multiple gauges in explosive or shock experiments. Manganin gauges used to measure stresses in detonating explosive experiments have typical resistances of 50 m Ω and are energized with pulsed currents of 50 A. Conventional pulsed current supplies for these gauges are high voltage devices with outputs as high as 500 V. Common problems with the use of high voltage supplies at explosive firing sites are: erroneous signals caused by ground loops; overdrive of oscilloscopes on gauge failure; gauge signal crosstalk; cost; and errors due to finite and changing source impedances. To correct these issues a novel MOSFET circuit was designed and will be described. It is an 18-V circuit, powered by 9-V alkaline batteries, and features an optically isolated trigger, and single-point grounding. These circuits have been successfully tested at the Los Alamos National Laboratory and selected explosive tests will be described together with their results. LA-UR-15-20613.

Cost-effectiveness Analysis of Nutritional Support for the Prevention of Pressure Ulcers in High-Risk Hospitalized Patients.

PubMed

Tuffaha, Haitham W; Roberts, Shelley; Chaboyer, Wendy; Gordon, Louisa G; Scuffham, Paul A

2016-06-01

To evaluate the cost-effectiveness of nutritional support compared with standard care in preventing pressure ulcers (PrUs) in high-risk hospitalized patients. An economic model using data from a systematic literature review. A meta-analysis of randomized controlled trials on the efficacy of nutritional support in reducing the incidence of PrUs was conducted. Modeled cohort of hospitalized patients at high risk of developing PrUs and malnutrition simulated during their hospital stay and up to 1 year. Standard care included PrU prevention strategies, such as redistribution surfaces, repositioning, and skin protection strategies, along with standard hospital diet. In addition to the standard care, the intervention group received nutritional support comprising patient education, nutrition goal setting, and the consumption of high-protein supplements. The analysis was from a healthcare payer perspective. Key outcomes of the model included the average costs and quality-adjusted life years. Model results were tested in univariate sensitivity analyses, and decision uncertainty was characterized using a probabilistic sensitivity analysis. Compared with standard care, nutritional support was cost saving at AU $425 per patient and marginally more effective with an average 0.005 quality-adjusted life years gained. The probability of nutritional support being cost-effective was 87%. Nutritional support to prevent PrUs in high-risk hospitalized patients is cost-effective with substantial cost savings predicted. Hospitals should implement the recommendations from the current PrU practice guidelines and offer nutritional support to high-risk patients.

High current polarized electron source for future eRHIC

NASA Astrophysics Data System (ADS)

Wang, Erdong

2018-05-01

The high current and high bunch charge polarized electron source is essential for cost reduction of Linac-Ring (L-R) eRHIC. In the baseline design, electron beam from multiple guns (probably 4-8) will be combined using deflection plates or accumulate ring. Each gun aims to deliver electron beam with 10 mA average current and 5.3 nC bunch charge. With total 50 mA and 5.3 nC electron beam, this beam combining design could use for generating positron too. The gun has been designed, fabricated and expected to start commissioning by the mid of this year. In this paper, we will present the DC gun design parameters and beam combine schemes. Also, we will describe the details of gun design and the strategies to demonstrate high current high charge polarized electron beam from this source.

Drying and decontamination of pistachios with sequential infrared drying, tempering and hot air drying

USDA-ARS?s Scientific Manuscript database

The pistachio industry is in need of improved drying technology as the current hot air drying has low energy efficiency and drying rate and high labor cost and also does not produce safe products against microbial contamination. In the current study, dehulled and water- sorted pistachios with a mois...

A Cost-Utility Analysis of Lung Cancer Screening and the Additional Benefits of Incorporating Smoking Cessation Interventions

PubMed Central

Villanti, Andrea C.; Jiang, Yiding; Abrams, David B.; Pyenson, Bruce S.

2013-01-01

Background A 2011 report from the National Lung Screening Trial indicates that three annual low-dose computed tomography (LDCT) screenings for lung cancer reduced lung cancer mortality by 20% compared to chest X-ray among older individuals at high risk for lung cancer. Discussion has shifted from clinical proof to financial feasibility. The goal of this study was to determine whether LDCT screening for lung cancer in a commercially-insured population (aged 50–64) at high risk for lung cancer is cost-effective and to quantify the additional benefits of incorporating smoking cessation interventions in a lung cancer screening program. Methods and Findings The current study builds upon a previous simulation model to estimate the cost-utility of annual, repeated LDCT screenings over 15 years in a high risk hypothetical cohort of 18 million adults between age 50 and 64 with 30+ pack-years of smoking history. In the base case, the lung cancer screening intervention cost $27.8 billion over 15 years and yielded 985,284 quality-adjusted life years (QALYs) gained for a cost-utility ratio of $28,240 per QALY gained. Adding smoking cessation to these annual screenings resulted in increases in both the costs and QALYs saved, reflected in cost-utility ratios ranging from $16,198 per QALY gained to $23,185 per QALY gained. Annual LDCT lung cancer screening in this high risk population remained cost-effective across all sensitivity analyses. Conclusions The findings of this study indicate that repeat annual lung cancer screening in a high risk cohort of adults aged 50–64 is highly cost-effective. Offering smoking cessation interventions with the annual screening program improved the cost-effectiveness of lung cancer screening between 20% and 45%. The cost-utility ratios estimated in this study were in line with other accepted cancer screening interventions and support inclusion of annual LDCT screening for lung cancer in a high risk population in clinical recommendations. PMID:23940744

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

PubMed

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

2009-10-09

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

No "Drop" in the Bucket: The High Costs of Dropping Out. Lessons in Learning

ERIC Educational Resources Information Center

Canadian Council on Learning, 2009

2009-01-01

Despite recent declines in high school dropout rates, thousands of young Canadians continue to leave high school every year without a diploma. Currently, approximately 20% of Canadians aged 20 years and over have never completed high school. Most Canadians recognize the link between educational attainment and quality of life, and know that…

A Current Sensor Based on the Giant Magnetoresistance Effect: Design and Potential Smart Grid Applications

PubMed Central

Ouyang, Yong; He, Jinliang; Hu, Jun; Wang, Shan X.

2012-01-01

Advanced sensing and measurement techniques are key technologies to realize a smart grid. The giant magnetoresistance (GMR) effect has revolutionized the fields of data storage and magnetic measurement. In this work, a design of a GMR current sensor based on a commercial analog GMR chip for applications in a smart grid is presented and discussed. Static, dynamic and thermal properties of the sensor were characterized. The characterizations showed that in the operation range from 0 to ±5 A, the sensor had a sensitivity of 28 mV·A−1, linearity of 99.97%, maximum deviation of 2.717%, frequency response of −1.5 dB at 10 kHz current measurement, and maximum change of the amplitude response of 0.0335%·°C−1 with thermal compensation. In the distributed real-time measurement and monitoring of a smart grid system, the GMR current sensor shows excellent performance and is cost effective, making it suitable for applications such as steady-state and transient-state monitoring. With the advantages of having a high sensitivity, high linearity, small volume, low cost, and simple structure, the GMR current sensor is promising for the measurement and monitoring of smart grids. PMID:23202221

A current sensor based on the giant magnetoresistance effect: design and potential smart grid applications.

PubMed

Ouyang, Yong; He, Jinliang; Hu, Jun; Wang, Shan X

2012-11-09

Advanced sensing and measurement techniques are key technologies to realize a smart grid. The giant magnetoresistance (GMR) effect has revolutionized the fields of data storage and magnetic measurement. In this work, a design of a GMR current sensor based on a commercial analog GMR chip for applications in a smart grid is presented and discussed. Static, dynamic and thermal properties of the sensor were characterized. The characterizations showed that in the operation range from 0 to ±5 A, the sensor had a sensitivity of 28 mV·A(-1), linearity of 99.97%, maximum deviation of 2.717%, frequency response of −1.5 dB at 10 kHz current measurement, and maximum change of the amplitude response of 0.0335%·°C(-1) with thermal compensation. In the distributed real-time measurement and monitoring of a smart grid system, the GMR current sensor shows excellent performance and is cost effective, making it suitable for applications such as steady-state and transient-state monitoring. With the advantages of having a high sensitivity, high linearity, small volume, low cost, and simple structure, the GMR current sensor is promising for the measurement and monitoring of smart grids.

A Novel High-Efficiency Rear-Contact Solar Cell with Bifacial Sensitivity

NASA Astrophysics Data System (ADS)

Hezel, R.

At present, wafer-based silicon solar cells have a share of more than 90% of the photovoltaic market. Despite rapid growth in the manufacturing volume, accompanied by a significant drop in the module selling price, the high costs currently associated with photovoltaic power generation are one of the most important obstacles to widespread global use of solar electricity. Up to a certain level, a higher production volume is a key driver in cost reduction. However, apart from a drastic reduction of the silicon wafer thickness in conjunction with improved light-trapping schemes, innovative processing sequences combining very high solar cell efficiencies with simple and cost-effective fabrication techniques are needed to become competitive with conventional energy sources and thus to move solar energy from niche to mainstream.

Integrated Power Adapter: Isolated Converter with Integrated Passives and Low Material Stress

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

None

2010-09-01

ADEPT Project: CPES at Virginia Tech is developing an extremely efficient power converter that could be used in power adapters for small, lightweight laptops and other types of mobile electronic devices. Power adapters convert electrical energy into useable power for an electronic device, and they currently waste a lot of energy when they are plugged into an outlet to power up. CPES at Virginia Tech is integrating high-density capacitors, new magnetic materials, high-frequency integrated circuits, and a constant-flux transformer to create its efficient power converter. The high-density capacitors enable the power adapter to store more energy. The new magnetic materialsmore » also increase energy storage, and they can be precisely dispensed using a low-cost ink-jet printer which keeps costs down. The high-frequency integrated circuits can handle more power, and they can handle it more efficiently. And, the constant-flux transformer processes a consistent flow of electrical current, which makes the converter more efficient.« less

Cost-utility of universal hepatitis A vaccination in Canada.

PubMed

Bauch, C T; Anonychuk, A M; Pham, B Z; Gilca, V; Duval, B; Krahn, M D

2007-12-12

Hepatitis A (HA) vaccination in Canada is currently targeted toward high-risk groups. The cost-effectiveness and expected health outcomes of universal vaccination relative to targeted vaccination in low-incidence countries such as Canada are currently unknown. Here, we conducted a cost-utility analysis for this situation, with Canada as the study population. We included vaccine costs, time costs, infection costs, and public health costs. We assessed a range of possible universal vaccination strategies over an 80-year time horizon using multiple cost perspectives. A dynamic model was used to account for herd immunity. Aggregate health gains from switching to universal vaccination are modest (10-30 QALYs per year). However, a "9+9" strategy that replaces two doses of monovalent hepatitis B (HB) vaccine at 9/10 years (universally administered in most provinces) with two doses of bivalent HA/HB vaccine is cost-saving from the societal perspective. At a willingness to pay threshold of $50,000/QALY, mean net benefit is +49.4 QALYs (S.D. 12.6) from the societal perspective and +3.8 QALYS (S.D. 3.0) from the payer perspective for the "9+9" strategy. Net benefit from the payer perspective is sensitive to the marginal cost of HA/HB vaccine relative to HB vaccine. Similar conclusions may apply in other countries with low incidence and a targeted vaccination policy.

Commercial Motion Sensor Based Low-Cost and Convenient Interactive Treadmill.

PubMed

Kim, Jonghyun; Gravunder, Andrew; Park, Hyung-Soon

2015-09-17

Interactive treadmills were developed to improve the simulation of overground walking when compared to conventional treadmills. However, currently available interactive treadmills are expensive and inconvenient, which limits their use. We propose a low-cost and convenient version of the interactive treadmill that does not require expensive equipment and a complicated setup. As a substitute for high-cost sensors, such as motion capture systems, a low-cost motion sensor was used to recognize the subject's intention for speed changing. Moreover, the sensor enables the subject to make a convenient and safe stop using gesture recognition. For further cost reduction, the novel interactive treadmill was based on an inexpensive treadmill platform and a novel high-level speed control scheme was applied to maximize performance for simulating overground walking. Pilot tests with ten healthy subjects were conducted and results demonstrated that the proposed treadmill achieves similar performance to a typical, costly, interactive treadmill that contains a motion capture system and an instrumented treadmill, while providing a convenient and safe method for stopping.

Cost effectiveness of human papilloma virus vaccination in low and middle income countries: a systematic review of literature.

PubMed

Silas, Olugbenga Akindele; Achenbach, Chad J; Murphy, Robert Leo; Hou, Lifang; Sagay, Solomon Atiene; Banwat, Edmund; Adoga, Adeyi A; Musa, Jonah; French, Dustin Douglas

2018-01-01

Low and middle income countries (LMICs) bear more than 50% of the current cervical cancer burden over the last decade with linkages to lack of HPV vaccination, high levels of poverty, illiteracy and nonexistent or poor screening programs. Governments of LMICs need enough convincing evidence that HPV vaccination will be more cost-effective in reducing the scourge of cervical cancer. Area covered: A systematic review to identify suitable studies from MEDLINE(via PubMed), EMBASE and Electronic search through GOOGLE for original and review articles from 2007 to 2014 on cost-effectiveness of human papilloma virus vaccination of pre-adolescent girls in LMICs was conducted. A total of 19 full articles were finally selected and reviewed after screening out those not consistent with the inclusion and exclusion criteria. Expert commentary: Most studies on cost-effectiveness of HPV vaccine in LMICs show that lowering cost of HPV vaccination with or without Pap smear screening is cost-effective in areas with high incidence of cervical cancer.

Sacrificing power for more cost-effective treatment: A techno-economic approach for engineering microbial fuel cells.

PubMed

Stoll, Zachary A; Ma, Zhaokun; Trivedi, Christopher B; Spear, John R; Xu, Pei

2016-10-01

Microbial fuel cells (MFCs) are a promising energy-positive wastewater treatment technology, however, the system's cost-effectiveness has been overlooked. In this study, two new anode materials - hard felt (HF) and carbon foam (CF) - were evaluated against the standard graphite brush (GB) to determine if using inexpensive materials with less than ideal properties can achieve more cost-effective treatment than high-cost, high-performing materials. Using domestic wastewater as the substrate, power densities for the GB, HF and CF-MFCs were 393, 339 and 291 mW m(-2) normalized by cathodic surface area, respectively. Higher power densities correlated with larger anodic surface areas and anodic current densities but not with electrical conductivity. Cyclic voltammetry revealed that redox systems used for extracellular electron transport in the GB, HF and CF-MFCs were similar (-0.143 ± 0.046, -0.158 ± 0.004 and -0.100 ± 0.014 V vs. Ag/AgCl) and that the electrochemical kinetics of the MFCs showed no correlation with their respective electrical conductivity. 16S rRNA sequencing showed the GB, HF and CF microbial community compositions were not statistically different while organic removal rates were nearly identical for all MFCs. The HF-MFC generated a power output to electrode cost (W $(-1)) 1.9 times greater than the GB-MFC, despite producing 14% less power and 15% less anodic current, while having 2.6 times less anodic surface area, 2.1 times larger charge transfer resistance and an electrical conductivity three orders of magnitude lower. The results demonstrate that inexpensive materials are capable of achieving more cost-effective treatment than high-performing materials despite generating lower power when treating real wastewater. Copyright © 2016 Elsevier Ltd. All rights reserved.

Hybrid and Mixed Matrix Membranes for Separations from Fermentations

PubMed Central

Davey, Christopher John; Leak, David; Patterson, Darrell Alec

2016-01-01

Fermentations provide an alternative to fossil fuels for accessing a number of biofuel and chemical products from a variety of renewable and waste substrates. The recovery of these dilute fermentation products from the broth, however, can be incredibly energy intensive as a distillation process is generally involved and creates a barrier to commercialization. Membrane processes can provide a low energy aid/alternative for recovering these dilute fermentation products and reduce production costs. For these types of separations many current polymeric and inorganic membranes suffer from poor selectivity and high cost respectively. This paper reviews work in the production of novel mixed-matrix membranes (MMMs) for fermentative separations and those applicable to these separations. These membranes combine a trade-off of low-cost and processability of polymer membranes with the high selectivity of inorganic membranes. Work within the fields of nanofiltration, reverse osmosis and pervaporation has been discussed. The review shows that MMMs are currently providing some of the most high-performing membranes for these separations, with three areas for improvement identified: Further characterization and optimization of inorganic phase(s), Greater understanding of the compatibility between the polymer and inorganic phase(s), Improved methods for homogeneously dispersing the inorganic phase. PMID:26938567

Is the current standard of care leading to cost-effective outcomes for patients with type 2 diabetes requiring insulin? A long-term health economic analysis for the UK.

PubMed

Valentine, W J; Curtis, B H; Pollock, R F; Van Brunt, K; Paczkowski, R; Brändle, M; Boye, K S; Kendall, D M

2015-07-01

The aim of the analysis was to investigate whether insulin intensification, based on the use of intensive insulin regimens as recommended by the current standard of care in routine clinical practice, would be cost-effective for patients with type 2 diabetes in the UK. Clinical data were derived from a retrospective analysis of 3185 patients with type 2 diabetes on basal insulin in The Health Improvement Network (THIN) general practice database. In total, 48% (614 patients) intensified insulin therapy, defined by adding bolus or premix insulin to a basal regimen, which was associated with a reduction in HbA1c and an increase in body mass index. Projections of clinical outcomes and costs (2011 GBP) over patients' lifetimes were made using a recently validated type 2 diabetes model. Immediate insulin intensification was associated with improvements in life expectancy, quality-adjusted life expectancy and time to onset of complications versus no intensification or delaying intensification by 2, 4, 6, or 8 years. Direct costs were higher with the insulin intensification strategy (due to the acquisition costs of insulin). Incremental cost-effectiveness ratios for insulin intensification were GBP 32,560, GBP 35,187, GBP 40,006, GBP 48,187 and GBP 55,431 per QALY gained versus delaying intensification 2, 4, 6 and 8 years, and no intensification, respectively. Although associated with improved clinical outcomes, insulin intensification as practiced in the UK has a relatively high cost per QALY and may not lead to cost-effective outcomes for patients with type 2 diabetes as currently defined by UK cost-effectiveness thresholds. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

High-throughput, non-invasive prenatal testing for fetal Rhesus D genotype to guide antenatal prophylaxis with anti-D immunoglobulin: a cost-effectiveness analysis.

PubMed

Saramago, P; Yang, H; Llewellyn, A; Palmer, S; Simmonds, M; Griffin, S

2018-02-07

To evaluate the cost-effectiveness of high-throughput, non-invasive prenatal testing (HT-NIPT) for fetal Rhesus D (RhD) genotype to guide antenatal prophylaxis with anti-D immunoglobulin compared with routine antenatal anti-D immunoglobulin prophylaxis (RAADP). Cost-effectiveness decision-analytic modelling. Primary care. A simulated population of 100 000 RhD-negative women not known to be sensitised to the RhD antigen. A decision tree model was used to characterise the antenatal care pathway in England and the long-term consequences of sensitisation events. The diagnostic accuracy of HT-NIPT was derived from a systematic review and bivariate meta-analysis; estimates of other inputs were derived from relevant literature sources and databases. Women in whom the HT-NIPT was positive or inconclusive continued to receive RAADP, whereas women with a negative result received none. Five alternative strategies in which the use of HT-NIPT may affect the existing postpartum care pathway were considered. Costs expressed in 2015GBP and impact on health outcomes expressed in terms of quality-adjusted life-years over a lifetime. The results suggested that HT-NIPT appears cost saving but also less effective than current practice, irrespective of the postpartum strategy evaluated. A postpartum strategy in which inconclusive test results are distinguished from positive results performed best. HT-NIPT is only cost-effective when the overall test cost is £26.60 or less. HT-NIPT would reduce unnecessary treatment with routine anti-D immunoglobulin and is cost saving when compared with current practice. The extent of any savings and cost-effectiveness is sensitive to the overall test cost. HT-NIPT is cost saving compared with providing anti-D to all RhD-negative pregnant women. © 2018 Royal College of Obstetricians and Gynaecologists.

Flow cytometry for enrichment and titration in massively parallel DNA sequencing

PubMed Central

Sandberg, Julia; Ståhl, Patrik L.; Ahmadian, Afshin; Bjursell, Magnus K.; Lundeberg, Joakim

2009-01-01

Massively parallel DNA sequencing is revolutionizing genomics research throughout the life sciences. However, the reagent costs and labor requirements in current sequencing protocols are still substantial, although improvements are continuously being made. Here, we demonstrate an effective alternative to existing sample titration protocols for the Roche/454 system using Fluorescence Activated Cell Sorting (FACS) technology to determine the optimal DNA-to-bead ratio prior to large-scale sequencing. Our method, which eliminates the need for the costly pilot sequencing of samples during titration is capable of rapidly providing accurate DNA-to-bead ratios that are not biased by the quantification and sedimentation steps included in current protocols. Moreover, we demonstrate that FACS sorting can be readily used to highly enrich fractions of beads carrying template DNA, with near total elimination of empty beads and no downstream sacrifice of DNA sequencing quality. Automated enrichment by FACS is a simple approach to obtain pure samples for bead-based sequencing systems, and offers an efficient, low-cost alternative to current enrichment protocols. PMID:19304748

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

PubMed

Ostovar, Mohamad; Amiri, Mohamad

2013-12-01

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

Novel bidirectional DC-DC converters based on the three-state switching cell

NASA Astrophysics Data System (ADS)

da Silva Júnior, José Carlos; Robles Balestero, Juan Paulo; Lessa Tofoli, Fernando

2016-05-01

It is well known that there is an increasing demand for bidirectional DC-DC converters for applications that range from renewable energy sources to electric vehicles. Within this context, this work proposes novel DC-DC converter topologies that use the three-state switching cell (3SSC), whose well-known advantages over conventional existing structures are ability to operate at high current levels, while current sharing is maintained by a high frequency transformer; reduction of cost and dimensions of magnetics; improved distribution of losses, with consequent increase of global efficiency and reduction of cost associated to the need of semiconductors with lower current ratings. Three distinct topologies can be derived from the 3SSC: one DC-DC converter with reversible current characteristic able to operate in the first and second quadrants; one DC-DC converter with reversible voltage characteristic able to operate in the first and third quadrants and one DC-DC converter with reversible current and voltage characteristics able to operate in four quadrants. Only the topology with bidirectional current characteristic is analysed in detail in terms of the operating stages in both nonoverlapping and overlapping modes, while the design procedure of the power stage elements is obtained. In order to validate the theoretical assumptions, an experimental prototype is also implemented, so that relevant issues can be properly discussed.

The value of daily money management: an analysis of outcomes and costs.

PubMed

Sacks, Debra; Das, Dhiman; Romanick, Raquel; Caron, Matt; Morano, Carmen; Fahs, Marianne C

2012-01-01

For vulnerable and frail older adults, management of daily financial obligations can become an overwhelming burden spiraling into at-risk situations. Social service agencies have developed community-based Daily Money Management programs to assist these adults in protecting their financial security. Through this study the authors present the first economic estimates of the costs of Daily Money Management programs which, along with case management programs, save $60,000 per individual when compared with the cost of nursing home placement, making them highly cost effective. Most importantly, individuals are able to remain in their homes. The authors address the current gap between cost-effective community-based practice and public policy support.

Comparative Cost-Effectiveness of Conservative or Intensive Blood Pressure Treatment Guidelines in Adults Aged 35-74 Years: The Cardiovascular Disease Policy Model.

PubMed

Moise, Nathalie; Huang, Chen; Rodgers, Anthony; Kohli-Lynch, Ciaran N; Tzong, Keane Y; Coxson, Pamela G; Bibbins-Domingo, Kirsten; Goldman, Lee; Moran, Andrew E

2016-07-01

The population health effect and cost-effectiveness of implementing intensive blood pressure goals in high-cardiovascular disease (CVD) risk adults have not been described. Using the CVD Policy Model, CVD events, treatment costs, quality-adjusted life years, and drug and monitoring costs were simulated over 2016 to 2026 for hypertensive patients aged 35 to 74 years. We projected the effectiveness and costs of hypertension treatment according to the 2003 Joint National Committee (JNC)-7 or 2014 JNC8 guidelines, and then for adults aged ≥50 years, we assessed the cost-effectiveness of adding an intensive goal of systolic blood pressure <120 mm Hg for patients with CVD, chronic kidney disease, or 10-year CVD risk ≥15%. Incremental cost-effectiveness ratios <$50 000 per quality-adjusted life years gained were considered cost-effective. JNC7 strategies treat more patients and are more costly to implement compared with JNC8 strategies. Adding intensive systolic blood pressure goals for high-risk patients prevents an estimated 43 000 and 35 000 annual CVD events incremental to JNC8 and JNC7, respectively. Intensive strategies save costs in men and are cost-effective in women compared with JNC8 alone. At a willingness-to-pay threshold of $50 000 per quality-adjusted life years gained, JNC8+intensive had the highest probability of cost-effectiveness in women (82%) and JNC7+intensive the highest probability of cost-effectiveness in men (100%). Assuming higher drug and monitoring costs, adding intensive goals for high-risk patients remained consistently cost-effective in men, but not always in women. Among patients aged 35 to 74 years, adding intensive blood pressure goals for high-risk groups to current national hypertension treatment guidelines prevents additional CVD deaths while saving costs provided that medication costs are controlled. © 2016 American Heart Association, Inc.

Flame oxidation of stainless steel felt enhances anodic biofilm formation and current output in bioelectrochemical systems.

PubMed

Guo, Kun; Donose, Bogdan C; Soeriyadi, Alexander H; Prévoteau, Antonin; Patil, Sunil A; Freguia, Stefano; Gooding, J Justin; Rabaey, Korneel

2014-06-17

Stainless steel (SS) can be an attractive material to create large electrodes for microbial bioelectrochemical systems (BESs), due to its low cost and high conductivity. However, poor biocompatibility limits its successful application today. Here we report a simple and effective method to make SS electrodes biocompatible by means of flame oxidation. Physicochemical characterization of electrode surface indicated that iron oxide nanoparticles (IONPs) were generated in situ on an SS felt surface by flame oxidation. IONPs-coating dramatically enhanced the biocompatibility of SS felt and consequently resulted in a robust electroactive biofilm formation at its surface in BESs. The maximum current densities reached at IONPs-coated SS felt electrodes were 16.5 times and 4.8 times higher than the untreated SS felts and carbon felts, respectively. Furthermore, the maximum current density achieved with the IONPs-coated SS felt (1.92 mA/cm(2), 27.42 mA/cm(3)) is one of the highest current densities reported thus far. These results demonstrate for the first time that flame oxidized SS felts could be a good alternative to carbon-based electrodes for achieving high current densities in BESs. Most importantly, high conductivity, excellent mechanical strength, strong chemical stability, large specific surface area, and comparatively low cost of flame oxidized SS felts offer exciting opportunities for scaling-up of the anodes for BESs.

Turning up the heat on aircraft structures. [design and analysis for high-temperature conditions

NASA Technical Reports Server (NTRS)

Dobyns, Alan; Saff, Charles; Johns, Robert

1992-01-01

An overview is presented of the current effort in design and development of aircraft structures to achieve the lowest cost for best performance. Enhancements in this area are focused on integrated design, improved design analysis tools, low-cost fabrication techniques, and more sophisticated test methods. 3D CAD/CAM data are becoming the method through which design, manufacturing, and engineering communicate.

Regenerative Carbonate-Based Thermochemical Energy Storage System for Concentrating Solar Power

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

Gangwal, Santosh; Muto, Andrew

Southern Research has developed a thermochemical energy storage (TCES) technology that utilizes the endothermic-exothermic reversible carbonation of calcium oxide (lime) to store thermal energy at high-temperatures, such as those achieved by next generation concentrating solar power (CSP) facilities. The major challenges addressed in the development of this system include refining a high capacity, yet durable sorbent material and designing a low thermal resistance low-cost heat exchanger reactor system to move heat between the sorbent and a heat transfer fluid under conditions relevant for CSP operation (e.g., energy density, reaction kinetics, heat flow). The proprietary stabilized sorbent was developed by Precisionmore » Combustion, Inc. (PCI). A factorial matrix of sorbent compositions covering the design space was tested using accelerated high throughput screening in a thermo-gravimetric analyzer. Several promising formulations were selected for more thorough evaluation and one formulation with high capacity (0.38 g CO 2/g sorbent) and durability (>99.7% capacity retention over 100 cycles) was chosen as a basis for further development of the energy storage reactor system. In parallel with this effort, a full range of currently available commercial and developmental heat exchange reactor systems and sorbent loading methods were examined through literature research and contacts with commercial vendors. Process models were developed to examine if a heat exchange reactor system and balance of plant can meet required TCES performance and cost targets, optimizing tradeoffs between thermal performance, exergetic efficiency, and cost. Reactor types evaluated included many forms, from microchannel reactor, to diffusion bonded heat exchanger, to shell and tube heat exchangers. The most viable design for application to a supercritical CO 2 power cycle operating at 200-300 bar pressure and >700°C was determined to be a combination of a diffusion bonded heat exchanger with a shell and tube reactor. A bench scale reactor system was then designed and constructed to test sorbent performance under more commercially relevant conditions. This system utilizes a tube-in tube reactor design containing approximately 250 grams sorbent and is able to operate under a wide range of temperature, pressure and flow conditions as needed to explore system performance under a variety of operating conditions. A variety of sorbent loading methods may be tested using the reactor design. Initial bench test results over 25 cycles showed very high sorbent stability (>99%) and sufficient capacity (>0.28 g CO 2/g sorbent) for an economical commercial-scale system. Initial technoeconomic evaluation of the proposed storage system show that the sorbent cost should not have a significant impact on overall system cost, and that the largest cost impacts come from the heat exchanger reactor and balance of plant equipment, including compressors and gas storage, due to the high temperatures for sCO 2 cycles. Current estimated system costs are $47/kWhth based on current material and equipment cost estimates.« less

Design and market considerations for axial flux superconducting electric machine design

NASA Astrophysics Data System (ADS)

Ainslie, M. D.; George, A.; Shaw, R.; Dawson, L.; Winfield, A.; Steketee, M.; Stockley, S.

2014-05-01

In this paper, the authors investigate a number of design and market considerations for an axial flux superconducting electric machine design that uses high temperature superconductors. The axial flux machine design is assumed to utilise high temperature superconductors in both wire (stator winding) and bulk (rotor field) forms, to operate over a temperature range of 65-77 K, and to have a power output in the range from 10s of kW up to 1 MW (typical for axial flux machines), with approximately 2-3 T as the peak trapped field in the bulk superconductors. The authors firstly investigate the applicability of this type of machine as a generator in small- and medium-sized wind turbines, including the current and forecasted market and pricing for conventional turbines. Next, a study is also carried out on the machine's applicability as an in-wheel hub motor for electric vehicles. Some recommendations for future applications are made based on the outcome of these two studies. Finally, the cost of YBCO-based superconducting (2G HTS) wire is analysed with respect to competing wire technologies and compared with current conventional material costs and current wire costs for both 1G and 2G HTS are still too great to be economically feasible for such superconducting devices.

An improved classification tree analysis of high cost modules based upon an axiomatic definition of complexity

NASA Technical Reports Server (NTRS)

Tian, Jianhui; Porter, Adam; Zelkowitz, Marvin V.

1992-01-01

Identification of high cost modules has been viewed as one mechanism to improve overall system reliability, since such modules tend to produce more than their share of problems. A decision tree model was used to identify such modules. In this current paper, a previously developed axiomatic model of program complexity is merged with the previously developed decision tree process for an improvement in the ability to identify such modules. This improvement was tested using data from the NASA Software Engineering Laboratory.

Discovery of high-performance low-cost n-type Mg3Sb2-based thermoelectric materials with multi-valley conduction bands

PubMed Central

Zhang, Jiawei; Song, Lirong; Pedersen, Steffen Hindborg; Yin, Hao; Hung, Le Thanh; Iversen, Bo Brummerstedt

2017-01-01

Widespread application of thermoelectric devices for waste heat recovery requires low-cost high-performance materials. The currently available n-type thermoelectric materials are limited either by their low efficiencies or by being based on expensive, scarce or toxic elements. Here we report a low-cost n-type material, Te-doped Mg3Sb1.5Bi0.5, that exhibits a very high figure of merit zT ranging from 0.56 to 1.65 at 300−725 K. Using combined theoretical prediction and experimental validation, we show that the high thermoelectric performance originates from the significantly enhanced power factor because of the multi-valley band behaviour dominated by a unique near-edge conduction band with a sixfold valley degeneracy. This makes Te-doped Mg3Sb1.5Bi0.5 a promising candidate for the low- and intermediate-temperature thermoelectric applications. PMID:28059069

The cost-effectiveness of influenza vaccination for people aged 50 to 64 years: an international model.

PubMed

Aballéa, Samuel; Chancellor, Jeremy; Martin, Monique; Wutzler, Peter; Carrat, Fabrice; Gasparini, Roberto; Toniolo-Neto, Joao; Drummond, Michael; Weinstein, Milton

2007-01-01

Routine influenza vaccination is currently recommended in several countries for people aged more than 60 or 65 years or with high risk of complications. A lower age threshold of 50 years has been recommended in the United States since 1999. To help policymakers consider whether such a policy should be adopted more widely, we conducted an economic evaluation of lowering the age limit for routine influenza vaccination to 50 years in Brazil, France, Germany, and Italy. The probabilistic model was designed to compare in a single season the costs and clinical outcomes associated with two alternative vaccination policies for persons aged 50 to 64 years: reimbursement only for people at high risk of complications (current policy), and reimbursement for all individuals in this age group (proposed policy). Two perspectives were considered: third-party payer (TPP) and societal. Model inputs were obtained primarily from the published literature and validated through expert opinion. The historical distribution of annual influenza-like illness (ILI) incidence was used to simulate the uncertain incidence in any given season. We estimated gains in unadjusted and quality-adjusted life expectancy, and the cost per quality-adjusted life-year (QALY) gained. Deterministic and probabilistic sensitivity analyses were conducted. Comparing the proposed to the current policy, the estimated mean costs per QALY gained were R$4,100, EURO 13,200, EURO 31,400 and EURO 15,700 for Brazil, France, Germany, and Italy, respectively, from a TPP perspective. From the societal perspective, the age-based policy is predicted to yield net cost savings in Germany and Italy, whereas the cost per QALY decreased to R$2800 for Brazil and EURO 8000 for France. The results were particularly sensitive to the ILI incidence rate, vaccine uptake, influenza fatality rate, and the costs of administering vaccination. Assuming a cost-effectiveness threshold ratio of EURO 50,000 per QALY gained, the probabilities of the new policy being cost-effective were 94% and 95% for France, 72% and near 100% for Germany, and 89% and 99% for Italy, from the TPP and societal perspectives, respectively. Extending routine influenza vaccination to people more than 50 years of age is likely to be cost-effective in all four countries studied.

Low Cost Structures, but How Much are we Paying for Them?

NASA Astrophysics Data System (ADS)

Gomez Molinero, Vincent

2014-06-01

Based on more than 37 years developing spacecraft structures - both for launchers starting with Ariane-1 up to the most modern ones and for satellites of any type - a critical review of the current trends, aiming specially to low cost solutions, will be presented.Airbus Defence and Space (CASA Espacio previously) has been developing structures for launchers and satellites during more than 4 decades. All types of spacecraft structures - primary and secondary ones, high stability ones and special critical cases like antenna reflectors, high stiffness structures and load carrying ones - have been developed using different types of materials and structural constructions. Although our main expertise is concentrated on composite structures, we have also developed many types of metallic ones, when the best solution was that one, not necessarily only based on pure technical reasons.From that perspective and experience, this paper tries to review the current trend of imposing the low cost as the main requirement for the development of satellites and launchers and its intrinsic characteristic of being a non- ending process: the spacecraft structures are never sufficiently cheaper.The main ways used today to justify low cost spacecraft structures will be reviewed trying to understand their rationale and some prejudices always present when the trade-off studies are performed. Some of the reviewed cost-killing factors will be (non-exhaustive list) Material type (i.e.: metallic vs composite). Low cost materials in general. Manufacturing process (i.e.: autoclave curing vs out-of-autoclave one). Automation in manufacturing. Automation in assembly. Automation in inspection and verification. Lean manufacturing techniques. Standardization. Some insight about how to solve this problem without losing our distinctive nature (we are developing high performance systems many of them unique prototypes and thought to work in environments not perfectly known and highly unknown in some cases) will be provided from the author's point of view.

Effect of management strategies and clinical status on costs of care for advanced HIV.

PubMed

Barnett, Paul G; Chow, Adam; Joyce, Vilija R; Bayoumi, Ahmed M; Griffin, Susan C; Sun, Huiying; Holodniy, Mark; Brown, Sheldon T; Cameron, William; Sculpher, Mark; Youle, Mike; Anis, Aslam H; Owens, Douglas K

2014-05-01

To determine the association between preexisting characteristics and current health and the cost of different types of advanced human immunodeficiency virus (HIV) care. Treatment-experienced patients failing highly active antiretroviral treatment (ART) in the United States, Canada, and the United Kingdom were factorial randomized to an antiretroviral-free period and ART intensification. Cost was estimated by multiplying patient-reported utilization by a unit cost. A total of 367 participants were followed for a mean of 15.3 quarters (range 1-26). Medication accounted for most (61.8%) of the $26,832 annual cost. Cost averaged $4147 per quarter for ART, $1981 for inpatient care, $580 for outpatient care, and $346 for other medications. Cost for inpatient stays, outpatient visits, and other medications was 171% higher (P <.01) and cost of ART was 32% lower (P <.01) when cluster of differentiation 4 (CD4) count was <50 cells/μL compared with periods when CD4 count was >200 cells/μL. Some baseline characteristics, including low CD4 count, high viral load, and HIV from injection drug use with hepatitis C coinfection, had a sustained effect on cost. The association between health status and cost depended on the type of care. Indicators of poor health were associated with higher inpatient and concomitant medication costs and lower cost for ART medication. Although ART has supplanted hospitalization as the most important cost in HIV care, some patients continue to incur high hospitalization costs in periods when they are using less ART. The cost of interventions to improve the use of ART might be offset by the reduction of other costs.

An Al-doped ZnO electrode grown by highly efficient cylindrical rotating magnetron sputtering for low cost organic photovoltaics

NASA Astrophysics Data System (ADS)

Park, Jun-Hyuk; Ahn, Kyung-Jun; Park, Kang-Il; Na, Seok-In; Kim, Han-Ki

2010-03-01

We report the characteristics of Al-doped zinc oxide (AZO) films prepared by a highly efficient cylindrical rotating magnetron sputtering (CRMS) system for use as a transparent conducting electrode in cost-efficient bulk hetero-junction organic solar cells (OSCs). Using a rotating cylindrical type cathode with an AZO target, whose usage was above 80%, we were able to obtain a low cost and indium free AZO electrode with a low sheet resistance of ~4.59 Ω/sq, a high transparency of 85% in the visible wavelength region and a work function of 4.9 eV at a substrate temperature of 230 °C. Moreover, the neutral poly(3,4-ethylenedioxythiophene) : poly(styrenesulfonate) based OSC fabricated on the CRMS-grown AZO electrode at 230 °C showed an open circuit voltage of 0.5 V, a short circuit current of 8.94 mA cm-2, a fill factor of 45% and power conversion efficiency of 2.01%, indicating that CRMS is a promising cost-efficient AZO deposition technique for low cost OSCs.

Summarized Costs, Placement Of Quality Stars, And Other Online Displays Can Help Consumers Select High-Value Health Plans.

PubMed

Greene, Jessica; Hibbard, Judith H; Sacks, Rebecca M

2016-04-01

Starting in 2017, all state and federal health insurance exchanges will present quality data on health plans in addition to cost information. We analyzed variations in the current design of information on state exchanges to identify presentation approaches that encourage consumers to take quality as well as cost into account when selecting a health plan. Using an online sample of 1,025 adults, we randomly assigned participants to view the same comparative information on health plans, displayed in different ways. We found that consumers were much more likely to select a high-value plan when cost information was summarized instead of detailed, when quality stars were displayed adjacent to cost information, when consumers understood that quality stars signified the quality of medical care, and when high-value plans were highlighted with a check mark or blue ribbon. These approaches, which were equally effective for participants with higher and lower numeracy, can inform the development of future displays of plan information in the exchanges. Project HOPE—The People-to-People Health Foundation, Inc.

Cost-effectiveness of national mandatory screening of all admissions to English National Health Service hospitals for meticillin-resistant Staphylococcus aureus: a mathematical modelling study.

PubMed

Robotham, Julie V; Deeny, Sarah R; Fuller, Chris; Hopkins, Susan; Cookson, Barry; Stone, Sheldon

2016-03-01

In December, 2010, National Health Service (NHS) England introduced national mandatory screening of all admissions for meticillin-resistant Staphylococcus aureus (MRSA). We aimed to assess the effectiveness and cost-effectiveness of this policy, from a regional or national health-care decision makers' perspective, compared with alternative screening strategies. We used an individual-based dynamic transmission model parameterised with national MRSA audit data to assess the effectiveness and cost-effectiveness of admission screening of patients in English NHS hospitals compared with five alternative strategies (including no screening, checklist-activated screening, and high-risk specialty-based screening), accompanied by patient isolation and decolonisation, over a 5 year time horizon. We evaluated strategies for different NHS hospital types (acute, teaching, and specialist), MRSA prevalence, and transmission potentials using probabilistic sensitivity analyses. Compared with no screening, mean cost per quality-adjusted life-year (QALY) of screening all admissions was £89,000-148,000 (range £68,000-222,000), and this strategy was consistently more costly and less effective than alternatives for all hospital types. At a £30,000/QALY willingness-to-pay threshold and current prevalence, only the no-screening strategy was cost effective. The next best strategies were, in acute and teaching hospitals, targeting of high-risk specialty admissions (30-40% chance of cost-effectiveness; mean incremental cost-effectiveness ratios [ICERs] £45,200 [range £35,300-61,400] and £48,000/QALY [£34,600-74,800], respectively) and, in specialist hospitals, screening these patients plus risk-factor-based screening of low-risk specialties (a roughly 20% chance of cost-effectiveness; mean ICER £62,600/QALY [£48,000-89,400]). As prevalence and transmission increased, targeting of high-risk specialties became the optimum strategy at the NHS willingness-to-pay threshold (£30,000/QALY). Switching from screening all admissions to only high-risk specialty admissions resulted in a mean reduction in total costs per year (not considering uncertainty) of £2·7 million per acute hospital, £2·9 million per teaching, and £474,000 per specialist hospital for a minimum rise in infections (about one infection per year per hospital). Our results show that screening all admissions for MRSA is unlikely to be cost effective in England at the current NHS willingness-to-pay threshold, and our findings informed modified guidance to NHS England in 2014. Screening admissions to high-risk specialties is likely to represent better resource use in terms of cost per QALY gained. UK Department of Health. Copyright © 2016 Elsevier Ltd. All rights reserved.

Cost-Effectiveness of Interventions to Promote Physical Activity: A Modelling Study

PubMed Central

Cobiac, Linda J.; Vos, Theo; Barendregt, Jan J.

2009-01-01

Background Physical inactivity is a key risk factor for chronic disease, but a growing number of people are not achieving the recommended levels of physical activity necessary for good health. Australians are no exception; despite Australia's image as a sporting nation, with success at the elite level, the majority of Australians do not get enough physical activity. There are many options for intervention, from individually tailored advice, such as counselling from a general practitioner, to population-wide approaches, such as mass media campaigns, but the most cost-effective mix of interventions is unknown. In this study we evaluate the cost-effectiveness of interventions to promote physical activity. Methods and Findings From evidence of intervention efficacy in the physical activity literature and evaluation of the health sector costs of intervention and disease treatment, we model the cost impacts and health outcomes of six physical activity interventions, over the lifetime of the Australian population. We then determine cost-effectiveness of each intervention against current practice for physical activity intervention in Australia and derive the optimal pathway for implementation. Based on current evidence of intervention effectiveness, the intervention programs that encourage use of pedometers (Dominant) and mass media-based community campaigns (Dominant) are the most cost-effective strategies to implement and are very likely to be cost-saving. The internet-based intervention program (AUS$3,000/DALY), the GP physical activity prescription program (AUS$12,000/DALY), and the program to encourage more active transport (AUS$20,000/DALY), although less likely to be cost-saving, have a high probability of being under a AUS$50,000 per DALY threshold. GP referral to an exercise physiologist (AUS$79,000/DALY) is the least cost-effective option if high time and travel costs for patients in screening and consulting an exercise physiologist are considered. Conclusions Intervention to promote physical activity is recommended as a public health measure. Despite substantial variability in the quantity and quality of evidence on intervention effectiveness, and uncertainty about the long-term sustainability of behavioural changes, it is highly likely that as a package, all six interventions could lead to substantial improvement in population health at a cost saving to the health sector. Please see later in the article for Editors' Summary PMID:19597537

Should Israel screen all mothers-to-be to prevent early-onset of neonatal group B streptococcal disease? A cost-utility analysis.

PubMed

Ginsberg, Gary M; Eidelman, Arthur I; Shinwell, Eric; Anis, Emilia; Peyser, Reuven; Lotan, Yoram

2013-02-20

In Israel, an average of 37 children are born each year with sepsis and another four with meningitis as a result of Group B Streptococcal (GBS) disease. Israel currently only screens mothers with defined risk factors (around 15% of all pregnancies) in order to identify candidates for Intrapartum Antiobiotic Prophyhlaxis (IAP) of GBS. This paper presents a cost-utility analysis of implementing an alternative strategy, which would expand the current protocol to one aiming to screen all pregnant women at 35-37 weeks gestation based on taking a vaginal culture for GBS. A spreadsheet model was built incorporating technical, epidemiological, health service costs, demographic and economic data based primarily on Israeli sources. The intervention of universal screening (compared with the current scenario) would increase screening costs from 580,000 NIS to 3,278,000 million NIS. In addition, the intervention would also increase penicillin costs from 39,000 NIS to 221,000 NIS. Current culture screening of approximately 15% of mothers-to-be with high risk factors resulted in 42 GBS births in 2008-9 (0.253/1000 births). Expanding culture screening to 85% of mothers-to-be, will decrease the number of GBS births to 17.3 (0.104/1000 births). The initial 2.9 million NIS incremental intervention costs are offset by decreased treatment costs of 1.9 million NIS and work productivity gains of 811,000 NIS as a result of a decrease in neurological sequelae from GBS caused meningitis. Thus the resultant net cost of the intervention is only around 134,000 NIS. Culture based screening will reduce the burden of disease by 12.6 discounted Quality Adjusted Life Years (QALYS), giving a very cost effective baseline incremental cost per QALY (cf. risk factor screening) of 10,641 NIS per QALY. The data was very sensitive to rates of anaphylactic shock and changes in the percentage of meningitis cases that had associated long term-sequelae. It is recommended that Israel adopt universal culture-based GBS screening.

Improving health care costing with resource consumption accounting.

PubMed

Ozyapici, Hasan; Tanis, Veyis Naci

2016-07-11

Purpose - The purpose of this paper is to explore the differences between a traditional costing system (TCS) and resource consumption accounting (RCA) based on a case study carried out in a hospital. Design/methodology/approach - A descriptive case study was first carried out to identify the current costing system of the case hospital. An exploratory case study was then conducted to reveal how implementing RCA within the case hospital assigns costs differently to gallbladder surgeries than the current costing system (i.e. a TCS). Findings - The study showed that, in contrast to a TCS, RCA considers the unused capacity, which is the difference between the work that can be performed based on current resources and the work that is actually being performed. Therefore, it assigns lower total costs to open and laparoscopic gallbladder surgeries. The study also showed that by separating costs into fixed and variable RCA allows managers to benefit from a pricing strategy based on the difference between the service's selling price and variable costs incurred in providing that service. Research limitations/implications - The limitation of this study is that, because of time constraints, the implementation was performed in the general surgery department only. However, since RCA is an advanced system that has the same application procedures for any department inside in a hospital, managers need only time gaps to implement this system to all parts of the hospital. Practical implications - This study concluded that RCA is better than a TCS for use in health care settings that have high overhead costs because it accurately assigns overhead costs to services by considering unused capacities incurred by a hospital. Consequently, this study provides insight into both measuring and managing unused capacities within the health care sector. This study also concluded that RCA helps health care administrators increase their competitive advantage by allowing them to determine the lowest service price. Originality/value - Since the literature review found no study comparing RCA with TCS in a real-life health care setting, little is known about differences arising from applying these systems in this context. Thus, the current study fills this gap in the literature by comparing RCA with TCS for both open and laparoscopic gallbladder surgeries.

Costs of occupational injury and illness across industries.

PubMed

Leigh, J Paul; Waehrer, Geetha; Miller, Ted R; Keenan, Craig

2004-06-01

This study has ranked industries using estimated total costs and costs per worker. This incidence study of nationwide data was carried out in 1993. The main outcome measure was total cost for medical care, lost productivity, and pain and suffering for the entire United States (US). The analysis was conducted using fatal and nonfatal injury and illness data recorded in large data sets from the US Bureau of Labor Statistics. Cost data were derived from workers' compensation records, estimates of lost wages, and jury awards. Current-value calculations were used to express all costs in 1993 in US dollars. The following industries were at the top of the list for average cost (cost per worker): taxicabs, bituminous coal and lignite mining, logging, crushed stone, oil field services, water transportation services, sand and gravel, and trucking. Industries high on the total-cost list were trucking, eating and drinking places, hospitals, grocery stores, nursing homes, motor vehicles, and department stores. Industries at the bottom of the cost-per-worker list included legal services, security brokers, mortgage bankers, security exchanges, and labor union offices. Detailed methodology was developed for ranking industries by total cost and cost per worker. Ranking by total costs provided information on total burden of hazards, and ranking by cost per worker provided information on risk. Industries that ranked high on both lists deserve increased research and regulatory attention.

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

Liu, Tianbiao L.; Wei, Xiaoliang; Nie, Zimin

The worldwide increasing energy demands and rising CO2 emissions motivate a search of new technologies to take advantage of renewable energy such as solar and wind. Rechargeable redox flow batteries (RFBs) with their high power density, high energy efficiency, scalability (up to MW and MWh), and safety features are one suitable option for integrating such energy sources and overcoming their intermittency. Source limitation and forbidden high system costs of current RFBs technologies impede wide implementation. Here we report a total organic aqueous redox flow battery (OARFB), using low cost and sustainable MV (anolyte) and 4-HO-TEMPO (catholyte), and benign NaCl supportingmore » electrolyte. The electrochemical properties of the organic redox active materials were studied using cyclic voltammetry and rotating disk electrode voltammetry. The MV/4-HO-TEMPO ARFB has an exceptionally high cell voltage, 1.25 V. Prototypes of the organic ARFB can be operated at high current densities ranging from 20 to 100 mA/cm2, and deliver stable capacity for 100 cycles with nearly 100% coulombic efficiency. The overall technical characters of the MV/4-HO-TEMPO ARFB are very attractive for continuous technic development.« less

Flow Cells for Scalable Energy Conversion and Storage

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

Mukundan, Rangachary

2017-10-26

This project is a response to current flow systems that are V-aqueous and not cost effective. It will hopefully enable high energy/ power density flow cells through rational materials and system design.

Application of Motion Induced Remote-Field Eddy-Current effect to online inspection and quality examination of rolling metallic strips

NASA Astrophysics Data System (ADS)

Sun, Yushi; Udpa, Satish; Lord, William; Udpa, Lalita; Ouyang, Tianhe

2001-04-01

The Motion Induced Remote-Field Eddy-Current (MIRFEC) effect was first observed in 1994. The effect was first exploited for detecting pipeline stress corrosion cracks as a part of a research project sponsored by the U.S. Department of Transportation. This paper presents a new application of the MIRFEC effect for online inspection of rolling metallic strips. Currently, rolled metallic strips and sheets are inspected off-line, which is costly, time consuming and not ideal for quality control. A well-designed online diagnostic and control system for metal rolling process may be able to reduce cost, improve quality, and hence enhance competitiveness of the product. The overall objective of this paper is to demonstrate the feasibility of a new nondestructive measurement system for on-line diagnostics and control of metallic rolling process using the MIRFEC effect. The system can be used to monitor, in real time, metallic strips/sheets for possible anomalies, inclusions, voids, bubbles, lamination, as well as variations in its magnetic and other properties. The potential advantages of the MIRFEC system include simplicity, robustness, low cost, high reliability, quick and accurate signal classification and characterization. Such systems can be used for real-time process control, or off-line data analysis. The technique also allows operation at high temperatures, tolerates large lift-off and vibration, and high rolling speed. Results of finite element modeling of the MIRFEC effect and experimental measurement data obtained from a prototype system are presented.

An investigation of promotional mix considerations for mail-order prescriptions: facilitating the market's acceptance of a partial health care-cost remedy.

PubMed

Strutton, D; Pelton, L E; True, S L

1993-01-01

While the U.S. health care system is confronted by a daunting assortment of problems, the foremost crisis almost certainly involves the excessive costs of health care. Mail-order prescriptions offer a modest, albeit worthwhile, measure of relief from high health care costs. This study investigates the information search behaviors and product perceptions that characterize current users and nonusers of mail-order prescriptions. Implications and recommendations concerned with the development of promotional strategies for mail-order prescriptions are derived from the findings.

Taguchi Approach to Design Optimization for Quality and Cost: An Overview

NASA Technical Reports Server (NTRS)

Unal, Resit; Dean, Edwin B.

1990-01-01

Calibrations to existing cost of doing business in space indicate that to establish human presence on the Moon and Mars with the Space Exploration Initiative (SEI) will require resources, felt by many, to be more than the national budget can afford. In order for SEI to succeed, we must actually design and build space systems at lower cost this time, even with tremendous increases in quality and performance requirements, such as extremely high reliability. This implies that both government and industry must change the way they do business. Therefore, new philosophy and technology must be employed to design and produce reliable, high quality space systems at low cost. In recognizing the need to reduce cost and improve quality and productivity, Department of Defense (DoD) and National Aeronautics and Space Administration (NASA) have initiated Total Quality Management (TQM). TQM is a revolutionary management strategy in quality assurance and cost reduction. TQM requires complete management commitment, employee involvement, and use of statistical tools. The quality engineering methods of Dr. Taguchi, employing design of experiments (DOE), is one of the most important statistical tools of TQM for designing high quality systems at reduced cost. Taguchi methods provide an efficient and systematic way to optimize designs for performance, quality, and cost. Taguchi methods have been used successfully in Japan and the United States in designing reliable, high quality products at low cost in such areas as automobiles and consumer electronics. However, these methods are just beginning to see application in the aerospace industry. The purpose of this paper is to present an overview of the Taguchi methods for improving quality and reducing cost, describe the current state of applications and its role in identifying cost sensitive design parameters.

Evaluating the cost implications of a radio frequency identification feeding system for early detection of bovine respiratory disease in feedlot cattle.

PubMed

Wolfger, Barbara; Manns, Braden J; Barkema, Herman W; Schwartzkopf-Genswein, Karen S; Dorin, Craig; Orsel, Karin

2015-03-01

New technologies to identify diseased feedlot cattle in early stages of illness have been developed to reduce costs and welfare impacts associated with bovine respiratory disease (BRD). However, the economic value of early BRD detection has never been assessed. The objective was to simulate cost differences between two BRD detection methods during the first 61 d on feed (DOF) applied in moderate- to large-sized feedlots using an automated recording system (ARS) for feeding behavior and the current industry standard, pen-checking (visual appraisal confirmed by rectal temperature). Economic impact was assessed with a cost analysis in a simple decision model. Scenarios for Canadian and US feedlots with high- and low-risk cattle were modeled, and uncertainty was estimated using extensive sensitivity analyses. Input costs and probabilities were mainly extracted from publicly accessible market observations and a large-scale US feedlot study. In the baseline scenario, we modeled high-risk cattle with a treatment rate of 20% within the first 61 DOF in a feedlot of >8000 cattle in Canada. Early BRD detection was estimated to result in a relative risk of 0.60 in retreatment and 0.66 in mortality compared to pen-checking (based on previously published estimates). The additional cost of monitoring health with ARS in Canadian dollar (CAD) was 13.68 per steer. Scenario analysis for similar sized US feedlots and low-risk cattle with a treatment rate of 8% were included to account for variability in costs and probabilities in various cattle populations. Considering the cost of monitoring, all relevant treatment costs and sale price, ARS was more costly than visual appraisal during the first 61 DOF by CAD 9.61 and CAD 9.69 per steer in Canada and the US, respectively. This cost difference increased in low-risk cattle in Canada to CAD 12.45. Early BRD detection with ARS became less expensive if the costs for the system decreased to less than CAD 4.06/steer, or if the underlying true BRD incidence (not treatment rate) within the first 61 DOF exceeded 47%. The model was robust to variability in the remaining input variables. Some of the assumptions in the baseline analyses were conservative and may have underestimated the real value of early BRD detection. Systems such as ARS may reduce treatment costs in some scenarios, but the investment costs are currently too high to be cost-effective when used solely for BRD detection compared to pen-checking. Copyright © 2014 Elsevier B.V. All rights reserved.

Molecular Breeding to Create Optimized Crops: From Genetic Manipulation to Potential Applications in Plant Factories.

PubMed

Hiwasa-Tanase, Kyoko; Ezura, Hiroshi

2016-01-01

Crop cultivation in controlled environment plant factories offers great potential to stabilize the yield and quality of agricultural products. However, many crops are currently unsuited to these environments, particularly closed cultivation systems, due to space limitations, low light intensity, high implementation costs, and high energy requirements. A major barrier to closed system cultivation is the high running cost, which necessitates the use of high-margin crops for economic viability. High-value crops include those with enhanced nutritional value or containing additional functional components for pharmaceutical production or with the aim of providing health benefits. In addition, it is important to develop cultivars equipped with growth parameters that are suitable for closed cultivation. Small plant size is of particular importance due to the limited cultivation space. Other advantageous traits are short production cycle, the ability to grow under low light, and high nutriculture availability. Cost-effectiveness is improved from the use of cultivars that are specifically optimized for closed system cultivation. This review describes the features of closed cultivation systems and the potential application of molecular breeding to create crops that are optimized for cost-effectiveness and productivity in closed cultivation systems.

Molecular Breeding to Create Optimized Crops: From Genetic Manipulation to Potential Applications in Plant Factories

PubMed Central

Hiwasa-Tanase, Kyoko; Ezura, Hiroshi

2016-01-01

Crop cultivation in controlled environment plant factories offers great potential to stabilize the yield and quality of agricultural products. However, many crops are currently unsuited to these environments, particularly closed cultivation systems, due to space limitations, low light intensity, high implementation costs, and high energy requirements. A major barrier to closed system cultivation is the high running cost, which necessitates the use of high-margin crops for economic viability. High-value crops include those with enhanced nutritional value or containing additional functional components for pharmaceutical production or with the aim of providing health benefits. In addition, it is important to develop cultivars equipped with growth parameters that are suitable for closed cultivation. Small plant size is of particular importance due to the limited cultivation space. Other advantageous traits are short production cycle, the ability to grow under low light, and high nutriculture availability. Cost-effectiveness is improved from the use of cultivars that are specifically optimized for closed system cultivation. This review describes the features of closed cultivation systems and the potential application of molecular breeding to create crops that are optimized for cost-effectiveness and productivity in closed cultivation systems. PMID:27200016

The economics of pancreas surgery.

PubMed

Vollmer, Charles M

2013-06-01

Pancreas surgery is a paradigm for high-acuity surgical specialization. Given the current intrigue over containing health care expenditures, pancreas surgery provides an ideal model to investigate the cost of care. This article explores the economics of this field from literature accrued over the last 2 decades. The cost of performing a pancreatic resection is established and then embellished with a discussion of the effects of clinical care paths. Then the influence of complications on costs is explored. Next, cost is investigated as an emerging outcome metric regarding variations in pancreatic surgical care. Finally, the societal-level fiscal impact is considered. Copyright © 2013 Elsevier Inc. All rights reserved.

Validated Feasibility Study of Integrally Stiffened Metallic Fuselage Panels for Reducing Manufacturing Costs

NASA Technical Reports Server (NTRS)

Pettit, R. G.; Wang, J. J.; Toh, C.

2000-01-01

The continual need to reduce airframe cost and the emergence of high speed machining and other manufacturing technologies has brought about a renewed interest in large-scale integral structures for aircraft applications. Applications have been inhibited, however, because of the need to demonstrate damage tolerance, and by cost and manufacturing risks associated with the size and complexity of the parts. The Integral Airframe Structures (IAS) Program identified a feasible integrally stiffened fuselage concept and evaluated performance and manufacturing cost compared to conventional designs. An integral skin/stiffener concept was produced both by plate hog-out and near-net extrusion. Alloys evaluated included 7050-T7451 plate, 7050-T74511 extrusion, 6013-T6511 extrusion, and 7475-T7351 plate. Mechanical properties, structural details, and joint performance were evaluated as well as repair, static compression, and two-bay crack residual strength panels. Crack turning behavior was characterized through panel tests and improved methods for predicting crack turning were developed. Manufacturing cost was evaluated using COSTRAN. A hybrid design, made from high-speed machined extruded frames that are mechanically fastened to high-speed machined plate skin/stringer panels, was identified as the most cost-effective manufacturing solution. Recurring labor and material costs of the hybrid design are up to 61 percent less than the current technology baseline.

Post-treatment of molasses wastewater by electrocoagulation and process optimization through response surface analysis.

PubMed

Tsioptsias, C; Petridis, D; Athanasakis, N; Lemonidis, I; Deligiannis, A; Samaras, P

2015-12-01

Molasses wastewater is a high strength effluent of food industry such as distilleries, sugar and yeast production plants etc. It is characterized by a dark brown color and exhibits a high content in substances of recalcitrant nature such as melanoidins. In this study, electrocoagulation (EC) was studied as a post treatment step for biologically treated molasses wastewater with high nitrogen content obtained from a baker's yeast industry. Iron and copper electrodes were used in various forms; the influence and interaction of current density, molasses wastewater dilution, and reaction time, on COD, color, ammonium and nitrate removal rates and operating cost were studied and optimized through Box Behnken's response surface analysis. Reaction time varied from 0.5 to 4 h, current density varied from 5 to 40 mA/cm(2) and dilution from 0 to 90% (v/v expressed as water concentration). pH, conductivity and temperature measurements were also carried out during each experiment. From preliminary experiments, it was concluded that the application of aeration and sample dilution, considerably influenced the kinetics of the process. The obtained results showed that COD removal varied between 10 and 54%, corresponding to an operation cost ranging from 0.2 to 33 euro/kg COD removed. Significant removal rates were obtained for nitrogen as nitrate and ammonium (i.e. 70% ammonium removal). A linear relation of COD and ammonium to the design parameters was observed, while operation cost and nitrate removal responded in a curvilinear function. A low ratio of electrode surface to treated volume was used, associated to a low investment cost; in addition, iron wastes could be utilized as low cost electrodes i.e. iron fillings from lathes, aiming to a low operation cost due to electrodes replacement. In general, electrocoagulation proved to be an effective and low cost process for biologically treated molasses-wastewater treatment for additional removal of COD and nitrogen content and color reduction. Treated effluent samples with good quality were produced by EC, with COD, NH4-N and NO3-N concentrations of 180, 52 and 2 mg/l respectively. Response surface analysis revealed that optimized conditions could be established under moderate molasses wastewater dilution, (e.g. 45%), at 3.5 h treatment time and 33 mA/cm(2) current density. Copyright © 2015 Elsevier Ltd. All rights reserved.

An Inverter Packaging Scheme for an Integrated Segmented Traction Drive System

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

Su, Gui-Jia; Tang, Lixin; Ayers, Curtis William

The standard voltage source inverter (VSI), widely used in electric vehicle/hybrid electric vehicle (EV/HEV) traction drives, requires a bulky dc bus capacitor to absorb the large switching ripple currents and prevent them from shortening the battery s life. The dc bus capacitor presents a significant barrier to meeting inverter cost, volume, and weight requirements for mass production of affordable EVs/HEVs. The large ripple currents become even more problematic for the film capacitors (the capacitor technology of choice for EVs/HEVs) in high temperature environments as their ripple current handling capability decreases rapidly with rising temperatures. It is shown in previous workmore » that segmenting the VSI based traction drive system can significantly decrease the ripple currents and thus the size of the dc bus capacitor. This paper presents an integrated packaging scheme to reduce the system cost of a segmented traction drive.« less

Low-cost camera modifications and methodologies for very-high-resolution digital images

USDA-ARS?s Scientific Manuscript database

Aerial color and color-infrared photography are usually acquired at high altitude so the ground resolution of the photographs is < 1 m. Moreover, current color-infrared cameras and manned aircraft flight time are expensive, so the objective is the development of alternative methods for obtaining ve...

Getting to Yes.

ERIC Educational Resources Information Center

Krinsky, Ira W.; Rudiger, Charles W.

1997-01-01

Search committees should evaluate each candidate for the superintendency on the basis of 10 risk factors: (1) spouse with a career; (2) children in high school; (3) home ownership; (4) unfamiliarity with the community; (5) salary equal to or less than current compensation; (6) high-cost area; (7) candidate or spouse in school; (8) unattractive job…

Cost Optimal Design of a Power Inductor by Sequential Gradient Search

NASA Astrophysics Data System (ADS)

Basak, Raju; Das, Arabinda; Sanyal, Amarnath

2018-05-01

Power inductors are used for compensating VAR generated by long EHV transmission lines and in electronic circuits. For the EHV-lines, the rating of the inductor is decided upon by techno-economic considerations on the basis of the line-susceptance. It is a high voltage high current device, absorbing little active power and large reactive power. The cost is quite high- hence the design should be made cost-optimally. The 3-phase power inductor is similar in construction to a 3-phase core-type transformer with the exception that it has only one winding per phase and each limb is provided with an air-gap, the length of which is decided upon by the inductance required. In this paper, a design methodology based on sequential gradient search technique and the corresponding algorithm leading to cost-optimal design of a 3-phase EHV power inductor has been presented. The case-study has been made on a 220 kV long line of NHPC running from Chukha HPS to Birpara of Coochbihar.

High Density Thermal Energy Storage with Supercritical Fluids

NASA Technical Reports Server (NTRS)

Ganapathi, Gani B.; Wirz, Richard

2012-01-01

A novel approach to storing thermal energy with supercritical fluids is being investigated, which if successful, promises to transform the way thermal energy is captured and utilized. The use of supercritical fluids allows cost-affordable high-density storage with a combination of latent heat and sensible heat in the two-phase as well as the supercritical state. This technology will enhance penetration of several thermal power generation applications and high temperature water for commercial use if the overall cost of the technology can be demonstrated to be lower than the current state-of-the-art molten salt using sodium nitrate and potassium nitrate eutectic mixtures.

Green Fabrication of Ultrathin Co3O4 Nanosheets from Metal-Organic Framework for Robust High-Rate Supercapacitors.

PubMed

Xiao, Zhenyu; Fan, Lili; Xu, Ben; Zhang, Shanqing; Kang, Wenpei; Kang, Zixi; Lin, Huan; Liu, Xiuping; Zhang, Shiyu; Sun, Daofeng

2017-12-06

Two-dimensional cobalt oxide (Co 3 O 4 ) is a promising candidate for robust electrochemical capacitors with high performance. Herein, we use 2,3,5,6-tetramethyl-1,4-diisophthalate as a recyclable ligand to construct a Co-based metal-organic framework of UPC-9, and subsequently, we obtain ultrathin hierarchical Co 3 O 4 hexagonal nanosheets with a thickness of 3.5 nm through a hydrolysis and calcination process. A remarkable and excellent specific capacitance of 1121 F·g -1 at a current density of 1 A·g -1 and 873 F·g -1 at a current density of 25 A·g -1 were achieved for the as-prepared asymmetric supercapacitor, which can be attributed to the ultrathin 2D morphology and the rich macroporous and mesoporous structures of the ultrathin Co 3 O 4 nanosheets. This synthesis strategy is environmentally benign and economically viable due to the fact that the costly organic ligand molecules are recycled, reducing the materials cost as well as the environmental cost for the synthesis process.

The rise of low-cost sensing for managing air pollution in cities.

PubMed

Kumar, Prashant; Morawska, Lidia; Martani, Claudio; Biskos, George; Neophytou, Marina; Di Sabatino, Silvana; Bell, Margaret; Norford, Leslie; Britter, Rex

2015-02-01

Ever growing populations in cities are associated with a major increase in road vehicles and air pollution. The overall high levels of urban air pollution have been shown to be of a significant risk to city dwellers. However, the impacts of very high but temporally and spatially restricted pollution, and thus exposure, are still poorly understood. Conventional approaches to air quality monitoring are based on networks of static and sparse measurement stations. However, these are prohibitively expensive to capture tempo-spatial heterogeneity and identify pollution hotspots, which is required for the development of robust real-time strategies for exposure control. Current progress in developing low-cost micro-scale sensing technology is radically changing the conventional approach to allow real-time information in a capillary form. But the question remains whether there is value in the less accurate data they generate. This article illustrates the drivers behind current rises in the use of low-cost sensors for air pollution management in cities, while addressing the major challenges for their effective implementation. Copyright © 2014 Elsevier Ltd. All rights reserved.

Periodic Application of Stochastic Cost Optimization Methodology to Achieve Remediation Objectives with Minimized Life Cycle Cost

NASA Astrophysics Data System (ADS)

Kim, U.; Parker, J.

2016-12-01

Many dense non-aqueous phase liquid (DNAPL) contaminated sites in the U.S. are reported as "remediation in progress" (RIP). However, the cost to complete (CTC) remediation at these sites is highly uncertain and in many cases, the current remediation plan may need to be modified or replaced to achieve remediation objectives. This study evaluates the effectiveness of iterative stochastic cost optimization that incorporates new field data for periodic parameter recalibration to incrementally reduce prediction uncertainty and implement remediation design modifications as needed to minimize the life cycle cost (i.e., CTC). This systematic approach, using the Stochastic Cost Optimization Toolkit (SCOToolkit), enables early identification and correction of problems to stay on track for completion while minimizing the expected (i.e., probability-weighted average) CTC. This study considers a hypothetical site involving multiple DNAPL sources in an unconfined aquifer using thermal treatment for source reduction and electron donor injection for dissolved plume control. The initial design is based on stochastic optimization using model parameters and their joint uncertainty based on calibration to site characterization data. The model is periodically recalibrated using new monitoring data and performance data for the operating remediation systems. Projected future performance using the current remediation plan is assessed and reoptimization of operational variables for the current system or consideration of alternative designs are considered depending on the assessment results. We compare remediation duration and cost for the stepwise re-optimization approach with single stage optimization as well as with a non-optimized design based on typical engineering practice.

Cost-Effectiveness and Public Health Effect of Influenza Vaccine Strategies for U.S. Elderly Adults.

PubMed

Raviotta, Jonathan M; Smith, Kenneth J; DePasse, Jay; Brown, Shawn T; Shim, Eunha; Nowalk, Mary Patricia; Zimmerman, Richard K

2016-10-01

To compare the cost-effectiveness of four influenza vaccines available in the United States for persons aged 65 and older: trivalent inactivated influenza vaccine (IIV3), quadrivalent inactivated influenza vaccine (IIV4), a more-expensive high-dose IIV3, and a newly approved adjuvanted IIV3. Cost-effectiveness analysis using a Markov model and sensitivity analyses. A hypothetical influenza vaccination season modeled according to possible U.S. influenza vaccination policies. Hypothetical cohort of individuals aged 65 and older in the United States. Cost-effectiveness and public health benefits of available influenza vaccination strategies in U.S. elderly adults. IIV3 cost $3,690 per quality-adjusted life year (QALY) gained, IIV4 cost $20,939 more than IIV3 per QALY gained, and high-dose IIV3 cost $31,214 more per QALY than IIV4. The model projected 83,775 fewer influenza cases and 980 fewer deaths with high-dose IIV3 than with the next most-effective vaccine: IIV4. In a probabilistic sensitivity analysis, high-dose IIV3 was the favored strategy if willingness to pay is $25,000 or more per QALY gained. Adjuvanted IIV3 cost-effectiveness depends on its price and effectiveness (neither yet determined in the United States) but could be favored if its relative effectiveness is 15% greater than that of IIV3. From economic and public health standpoints, high-dose IIV3 for adults aged 65 years and older is likely to be favored over the other vaccines, based on currently available data. The cost-effectiveness of adjuvanted IIV3 should be reviewed after its effectiveness has been compared with that of other vaccines and its U.S. price is established. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Pattern of healthcare resource utilization and direct costs associated with manic episodes in Spain

PubMed Central

2010-01-01

Background Although some studies indicate that bipolar disorder causes high health care resources consumption, no study is available addressing a cost estimation of bipolar disorder in Spain. The aim of this observational study was to evaluate healthcare resource utilization and the associated direct cost in patients with manic episodes in the Spanish setting. Methods Retrospective descriptive study was carried out in a consecutive sample of patients with a DSM-IV diagnosis of bipolar type I disorder with or without psychotic symptoms, aged 18 years or older, and who were having an active manic episode at the time of inclusion. Information regarding the current manic episode was collected retrospectively from the medical record and patient interview. Results Seven hundred and eighty-four evaluable patients, recruited by 182 psychiatrists, were included in the study. The direct cost associated with healthcare resource utilization during the manic episode was high, with a mean cost of nearly €4,500 per patient, of which approximately 55% corresponded to the cost of hospitalization, 30% to the cost of psychopharmacological treatment and 10% to the cost of specialized care. Conclusions Our results show the high cost of management of the patient with a manic episode, which is mainly due to hospitalizations. In this regard, any intervention on the management of the manic patient that could reduce the need for hospitalization would have a significant impact on the costs of the disease. PMID:20426814

A PCT algorithm for discontinuation of antibiotic therapy is a cost-effective way to reduce antibiotic exposure in adult intensive care patients with sepsis.

PubMed

Kip, Michelle M A; Kusters, Ron; IJzerman, Maarten J; Steuten, Lotte M G

2015-01-01

Procalcitonin (PCT) is a specific marker for differentiating bacterial from non-infective causes of inflammation. It can be used to guide initiation and duration of antibiotic therapy in intensive care unit (ICU) patients with suspected sepsis, and might reduce the duration of hospital stay. Limiting antibiotic treatment duration is highly important because antibiotic over-use may cause patient harm, prolonged hospital stay, and resistance development. Several systematic reviews show that a PCT algorithm for antibiotic discontinuation is safe, but upfront investment required for PCT remains an important barrier against implementation. The current study investigates to what extent this PCT algorithm is a cost-effective use of scarce healthcare resources in ICU patients with sepsis compared to current practice. A decision tree was developed to estimate the health economic consequences of the PCT algorithm for antibiotic discontinuation from a Dutch hospital perspective. Input data were obtained from a systematic literature review. When necessary, additional information was gathered from open interviews with clinical chemists and intensivists. The primary effectiveness measure is defined as the number of antibiotic days, and cost-effectiveness is expressed as incremental costs per antibiotic day avoided. The PCT algorithm for antibiotic discontinuation is expected to reduce hospital spending by circa € 3503 per patient, indicating savings of 9.2%. Savings are mainly due to reductions in length of hospital stay, number of blood cultures performed, and, importantly, days on antibiotic therapy. Probabilistic and one-way sensitivity analyses showed the model outcome to be robust against changes in model inputs. Proven safe, a PCT algorithm for antibiotic discontinuation is a cost-effective means of reducing antibiotic exposure in adult ICU patients with sepsis, compared to current practice. Additional resources required for PCT are more than offset by downstream cost savings. This finding is highly important given the aim of preventing widespread antibiotic resistance.

Cost-effectiveness of posaconazole versus fluconazole or itraconazole in the prevention of invasive fungal infections among high-risk neutropenic patients in Spain

PubMed Central

2012-01-01

Background We evaluated the cost-effectiveness of posaconazole compared with standard azole therapy (SAT; fluconazole or itraconazole) for the prevention of invasive fungal infections (IFI) and the reduction of overall mortality in high-risk neutropenic patients with acute myelogenous leukaemia (AML) or myelodysplastic syndromes (MDS). The perspective was that of the Spanish National Health Service (NHS). Methods A decision-analytic model, based on a randomised phase III trial, was used to predict IFI avoided, life-years saved (LYS), total costs, and incremental cost-effectiveness ratio (ICER; incremental cost per LYS) over patients' lifetime horizon. Data for the analyses included life expectancy, procedures, and costs associated with IFI and the drugs (in euros at November 2009 values) which were obtained from the published literature and opinions of an expert committee. A probabilistic sensitivity analysis (PAS) was performed. Results Posaconazole was associated with fewer IFI (0.05 versus 0.11), increased LYS (2.52 versus 2.43), and significantly lower costs excluding costs of the underlying condition (€6,121 versus €7,928) per patient relative to SAT. There is an 85% probability that posaconazole is a cost-saving strategy compared to SAT and a 97% probability that the ICER for posaconazole relative to SAT is below the cost per LYS threshold of €30,000 currently accepted in Spain. Conclusions Posaconazole is a cost-saving prophylactic strategy (lower costs and greater efficacy) compared with fluconazole or itraconazole in high-risk neutropenic patients. PMID:22471553

Cost-Effectiveness of Opt-Out Chlamydia Testing for High-Risk Young Women in the U.S.

PubMed

Owusu-Edusei, Kwame; Hoover, Karen W; Gift, Thomas L

2016-08-01

In spite of chlamydia screening recommendations, U.S. testing coverage continues to be low. This study explored the cost-effectiveness of a patient-directed, universal, opportunistic Opt-Out Testing strategy (based on insurance coverage, healthcare utilization, and test acceptance probabilities) for all women aged 15-24 years compared with current Risk-Based Screening (30% coverage) from a societal perspective. Based on insurance coverage (80%); healthcare utilization (83%); and test acceptance (75%), the proposed Opt-Out Testing strategy would have an expected annual testing coverage of approximately 50% for sexually active women aged 15-24 years. A basic compartmental heterosexual transmission model was developed to account for population-level transmission dynamics. Two groups were assumed based on self-reported sexual activity. All model parameters were obtained from the literature. Costs and benefits were tracked over a 50-year period. The relative sensitivity of the estimated incremental cost-effectiveness ratios to the variables/parameters was determined. This study was conducted in 2014-2015. Based on the model, the Opt-Out Testing strategy decreased the overall chlamydia prevalence by >55% (2.7% to 1.2%). The Opt-Out Testing strategy was cost saving compared with the current Risk-Based Screening strategy. The estimated incremental cost-effectiveness ratio was most sensitive to the female pre-opt out prevalence, followed by the probability of female sequelae and discount rate. The proposed Opt-Out Testing strategy was cost saving, improving health outcomes at a lower net cost than current testing. However, testing gaps would remain because many women might not have health insurance coverage, or not utilize health care. Published by Elsevier Inc.

Comparing the cost-effectiveness of four novel risk markers for screening asymptomatic individuals to prevent cardiovascular disease (CVD) in the US population.

PubMed

van Kempen, Bob J H; Ferket, Bart S; Steyerberg, Ewout W; Max, Wendy; Myriam Hunink, M G; Fleischmann, Kirsten E

2016-01-15

High sensitivity CRP (hsCRP), coronary artery calcification on CT (CT calcium), carotid artery intima media thickness on ultrasound (cIMT) and ankle-brachial index (ABI) improve prediction of cardiovascular disease (CVD) risk, but the benefit of screening with these novel risk markers in the U.S. population is unclear. A microsimulation model evaluating lifelong cost-effectiveness for individuals aged 40-85 at intermediate risk of CVD, using 2003-2004 NHANES-III (N=3736), Framingham Heart Study, U.S. Vital Statistics, meta-analyses of independent predictive effects of the four novel risk markers and treatment effects was constructed. Using both an intention-to-treat (assumes adherence <100% and incorporates disutility from taking daily medications) and an as-treated (100% adherence and no disutility) analysis, quality adjusted life years (QALYs), lifetime costs (2014 US $), and incremental cost-effectiveness ratios (ICER in $/QALY gained) of screening with hsCRP, CT coronary calcium, cIMT and ABI were established compared with current practice, full adherence to current guidelines, and ubiquitous statin therapy. In the intention-to-treat analysis in men, screening with CT calcium was cost effective ($32,900/QALY) compared with current practice. In women, screening with hsCRP was cost effective ($32,467/QALY). In the as-treated analysis, statin therapy was both more effective and less costly than all other strategies for both men and women. When a substantial disutility from taking daily medication is assumed, screening men with CT coronary calcium is likely to be cost-effective whereas screening with hsCRP has value in women. The individual perceived disutility for taking daily medication should play a key role in the decision. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Medicare long-term CPAP coverage policy: a cost-utility analysis.

PubMed

Billings, Martha E; Kapur, Vishesh K

2013-10-15

CPAP is an effective treatment for OSA that may reduce health care utilization and costs. Medicare currently reimburses the costs of long-term CPAP therapy only if the patient is adherent during a 90-day trial. If not, Medicare requires a repeat polysomnogram (PSG) and another trial which seems empirically not cost-effective. We modeled the cost-effectiveness of current Medicare policy compared to an alternative policy (clinic-only) without the adherence criterion and repeat PSG. Cost-utility and cost-effectiveness analysis. U.S. Medicare Population. N/A. N/A. We created a decision tree modeling (1) clinic only follow-up vs. (2) current Medicare policy. Costs were assigned based on Medicare reimbursement rates in 2012. Sensitivity analyses were conducted to test our assumptions. We estimated cumulative costs, overall adherence, and QALY gained for a 5-year time horizon from the perspective of Medicare as the payer. Current Medicare policy is more costly than the clinic-only policy but has higher net adherence and improved utility. Current Medicare policy compared to clinic-only policy costs $30,544 more per QALY. Current CMS policy promotes early identification of those more likely to adhere to CPAP therapy by requiring strict adherence standards. The policy effect is to deny coverage to those unlikely to use CPAP long-term and prevent wasted resources. Future studies are needed to measure long-term adherence in an elderly population with and without current adherence requirements to verify the cost-effectiveness of a policy change.

Reproductive costs in terrestrial male vertebrates: insights from bird studies

PubMed Central

Gamelon, Marlène; Sæther, Bernt-Erik

2016-01-01

Reproduction requires resources that cannot be allocated to other functions resulting in direct reproductive costs (i.e. trade-offs between current reproduction and subsequent survival/reproduction). In wild vertebrates, direct reproductive costs have been widely described in females, but their occurrence in males remains to be explored. To fill this gap, we gathered 53 studies on 48 species testing direct reproductive costs in male vertebrates. We found a trade-off between current reproduction and subsequent performances in 29% of the species and in every clade. As 73% of the studied species are birds, we focused on that clade to investigate whether such trade-offs are associated with (i) levels of paternal care, (ii) polygyny or (iii) pace of life. More precisely for this third question, it is expected that fast species (i.e. short lifespan, early maturity, high fecundity) pay a cost in terms of survival, whereas slow species (with opposite characteristics) do so in terms of fecundity. Our findings tend to support this hypothesis. Finally, we pointed out the potential confounding effects that should be accounted for when investigating reproductive costs in males and strongly encourage the investigation of such costs in more clades to understand to what extent our results are relevant for other vertebrates. PMID:26791619

Insect-based protein: future promising protein source for fish cultured

NASA Astrophysics Data System (ADS)

Nugroho, R. A.; Nur, F. M.

2018-04-01

As one of the vital component feed used in fisheries, fishmeal (FM) is generally added to the fish diet to enhance fish growth, digestive performance and absorption of nutrients. This addition contributes significantly to the variable production cost in the aquaculture industry. Expanded production of carnivorous species requiring high protein, high-energy feeds will further tax global fish meal. Thus, research based on the low-cost budget for feed operating cost should be strategized to assist aquaculturists in enhancing fish productivity. Moreover, suitable alternative feed ingredients will have to be utilized to provide the essential nutrients and energy needed to fuel the growth of aquaculture production. To this effect, the use of insect-based protein sources to replace FM that often scarce, expensive, limited availability, and leads to high fish production costs is alternative ways and has been gaining momentum. Currently, Insects have been proposed as one of the potential future protein sources of protein because of the production of insects is highly sustainable. Farming insects is characterized by higher food conversion efficiencies, lower environmental impact, and higher potential to be grown on waste streams.

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.

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

Initial results for the silicon monolithically interconnected solar cell product

NASA Technical Reports Server (NTRS)

Dinetta, L. C.; Shreve, K. P.; Cotter, J. E.; Barnett, A. M.

1995-01-01

This proprietary technology is based on AstroPower's electrostatic bonding and innovative silicon solar cell processing techniques. Electrostatic bonding allows silicon wafers to be permanently attached to a thermally matched glass superstrate and then thinned to final thicknesses less than 25 micron. These devices are based on the features of a thin, light-trapping silicon solar cell: high voltage, high current, light weight (high specific power) and high radiation resistance. Monolithic interconnection allows the fabrication costs on a per watt basis to be roughly independent of the array size, power or voltage, therefore, the cost effectiveness to manufacture solar cell arrays with output powers ranging from milliwatts up to four watts and output voltages ranging from 5 to 500 volts will be similar. This compares favorably to conventionally manufactured, commercial solar cell arrays, where handling of small parts is very labor intensive and costly. In this way, a wide variety of product specifications can be met using the same fabrication techniques. Prototype solar cells have demonstrated efficiencies greater than 11%. An open-circuit voltage of 5.4 volts, fill factor of 65%, and short-circuit current density of 28 mA/sq cm at AM1.5 illumination are typical. Future efforts are being directed to optimization of the solar cell operating characteristics as well as production processing. The monolithic approach has a number of inherent advantages, including reduced cost per interconnect and increased reliability of array connections. These features make this proprietary technology an excellent candidate for a large number of consumer products.

LanzaTech- Capturing Carbon. Fueling Growth.

ScienceCinema

NONE

2018-01-16

LanzaTech will design a gas fermentation system that will significantly improve the rate at which methane gas is delivered to a biocatalyst. Current gas fermentation processes are not cost effective compared to other gas-to-liquid technologies because they are too slow for large-scale production. If successful, LanzaTech's system will process large amounts of methane at a high rate, reducing the energy inputs and costs associated with methane conversion.

Initial Approaches for Discovery of Undocumented Functionality in FPGAs

DTIC Science & Technology

2017-03-01

commercial pressures such as IP protection, support cost, and time to market , modern COTS devices contain many functions that are not exposed to the... market pressures have increased, industry increasingly uses the current generation device to do trial runs of next-generation architecture features...the product of industry operating in a highly cost competitive market , and are not inserted with malicious intent, however, this does not preclude

Operational Risk and the American Way of Warfare

DTIC Science & Technology

2011-12-01

tactical level. That conclusion however, fails to account for the entire context. The cumulative effect is one of operational complacency. The...largely come at the cost of any operational thinking about risk. The operational risk in the current fight is not easily discernible because it seems...traditional American answers to risk. This addiction to annihilation through firepower has come with a high cost . The culture of annihilation through

Impact of hydrogen refueling configurations and market parameters on the refueling cost of hydrogen

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

Reddi, Krishna; Elgowainy, Amgad; Rustagi, Neha

The cost of hydrogen in early fuel cell electric vehicle (FCEV) markets is dominated by the cost of refueling stations, mainly due to the high cost of refueling equipment, small station capacities, lack of economies of scale, and low utilization of the installed refueling capacity. Using the hydrogen delivery scenario analysis model (HDSAM), this study estimates the impacts of these factors on the refueling cost for different refueling technologies and configurations, and quantifies the potential reduction in future hydrogen refueling cost compared to today’s cost in the United States. The current hydrogen refueling station levelized cost, for a 200 kg/daymore » dispensing capacity, is in the range of 6–8 dollars/kg H 2 when supplied with gaseous hydrogen, and 8–9 dollars/kg H 2 for stations supplied with liquid hydrogen. After adding the cost of hydrogen production, packaging, and transportation to the station’s levelized cost, the current cost of hydrogen at dispensers for FCEVs in California is in the range of 13–15 dollars/kg H 2. The refueling station capacity utilization strongly influences the hydrogen refueling cost. The underutilization of station capacity in early FCEV markets, such as in California, results in a levelized station cost that is approximately 40% higher than it would be in a scenario where the station had been fully utilized since it began operating. In future mature hydrogen FCEV markets, with a large demand for hydrogen, the refueling station’s levelized cost can be reduced to 2 dollars/kg H 2 as a result of improved capacity utilization and reduced equipment cost via learning and economies of scale.« less

Opportunity cost of funding drugs for rare diseases: the cost-effectiveness of eculizumab in paroxysmal nocturnal hemoglobinuria.

PubMed

Coyle, Doug; Cheung, Matthew C; Evans, Gerald A

2014-11-01

Both ethical and economics concerns have been raised with respect to the funding of drugs for rare diseases. This article reports both the cost-effectiveness of eculizumab for the treatment of paroxysmal nocturnal hemoglobinuria (PNH) and its associated opportunity costs. Analysis compared eculizumab plus current standard of care v. current standard of care from a publicly funded health care system perspective. A Markov model covered the major consequences of PNH and treatment. Cost-effectiveness was assessed in terms of the incremental cost per life year and per quality-adjusted life year (QALY) gained. Opportunity costs were assessed by the health gains foregone and the alternative uses for the additional resources. Eculizumab is associated with greater life years (1.13), QALYs (2.45), and costs (CAN$5.24 million). The incremental cost per life year and per QALY gained is CAN$4.62 million and CAN$2.13 million, respectively. Based on established thresholds, the opportunity cost of funding eculizumab is 102.3 discounted QALYs per patient funded. Sensitivity and subgroup analysis confirmed the robustness of the results. If the acquisition cost of eculizumab was reduced by 98.5%, it could be considered cost-effective. The nature of rare diseases means that data are often sparse for the conduct of economic evaluations. When data were limited, assumptions were made that biased results in favor of eculizumab. This study demonstrates the feasibility of conducting economic evaluations in the context of rare diseases. Eculizumab may provide substantive benefits to patients with PNH in terms of life expectancy and quality of life but at a high incremental cost and a substantial opportunity cost. Decision makers should fully consider the opportunity costs before making positive reimbursement decisions. © The Author(s) 2014.

Impact of hydrogen refueling configurations and market parameters on the refueling cost of hydrogen

DOE PAGES

Reddi, Krishna; Elgowainy, Amgad; Rustagi, Neha; ...

2017-06-30

The cost of hydrogen in early fuel cell electric vehicle (FCEV) markets is dominated by the cost of refueling stations, mainly due to the high cost of refueling equipment, small station capacities, lack of economies of scale, and low utilization of the installed refueling capacity. Using the hydrogen delivery scenario analysis model (HDSAM), this study estimates the impacts of these factors on the refueling cost for different refueling technologies and configurations, and quantifies the potential reduction in future hydrogen refueling cost compared to today’s cost in the United States. The current hydrogen refueling station levelized cost, for a 200 kg/daymore » dispensing capacity, is in the range of 6–8 dollars/kg H 2 when supplied with gaseous hydrogen, and 8–9 dollars/kg H 2 for stations supplied with liquid hydrogen. After adding the cost of hydrogen production, packaging, and transportation to the station’s levelized cost, the current cost of hydrogen at dispensers for FCEVs in California is in the range of 13–15 dollars/kg H 2. The refueling station capacity utilization strongly influences the hydrogen refueling cost. The underutilization of station capacity in early FCEV markets, such as in California, results in a levelized station cost that is approximately 40% higher than it would be in a scenario where the station had been fully utilized since it began operating. In future mature hydrogen FCEV markets, with a large demand for hydrogen, the refueling station’s levelized cost can be reduced to 2 dollars/kg H 2 as a result of improved capacity utilization and reduced equipment cost via learning and economies of scale.« less

Review of Manganese Processing for Production of TRIP/TWIP Steels, Part 1: Current Practice and Processing Fundamentals

NASA Astrophysics Data System (ADS)

Elliott, R.; Coley, K.; Mostaghel, S.; Barati, M.

2018-02-01

The increasing demand for high-performance steel alloys has led to development of transformation-induced plasticity (TRIP) and twinning-induced plasticity (TWIP) alloys over the past three decades. These alloys offer exceptional combinations of high tensile strength and ductility. Thus, the mechanical behavior of these alloys has been a subject of significant work in recent years. However, the challenge of economically providing Mn in the quantity and purity required by these alloys has received considerably less attention. To enable commercial implementation of ultrahigh-Mn alloys, it is desirable to lower the high material costs associated with their production. Therefore, the present work reviews Mn processing routes in the context of the chemical requirements of these alloys. The aim of this review is to assess the current state of the art regarding reduction of manganese ores and provide a comprehensive reference for researchers working to mitigate material processing costs associated with Mn production. The review is presented in two parts: Part 1 introduces TRIP and TWIP alloys, current industrial practice, and pertinent thermodynamic fundamentals; Part 2 addresses available literature regarding reduction of Mn ores and oxides, and seeks to identify opportunities for future process development.

The latest developments and outlook for hydrogen liquefaction technology

NASA Astrophysics Data System (ADS)

Ohlig, K.; Decker, L.

2014-01-01

Liquefied hydrogen is presently mainly used for space applications and the semiconductor industry. While clean energy applications, for e.g. the automotive sector, currently contribute to this demand with a small share only, their demand may see a significant boost in the next years with the need for large scale liquefaction plants exceeding the current plant sizes by far. Hydrogen liquefaction for small scale plants with a maximum capacity of 3 tons per day (tpd) is accomplished with a Brayton refrigeration cycle using helium as refrigerant. This technology is characterized by low investment costs but lower process efficiency and hence higher operating costs. For larger plants, a hydrogen Claude cycle is used, characterized by higher investment but lower operating costs. However, liquefaction plants meeting the potentially high demand in the clean energy sector will need further optimization with regard to energy efficiency and hence operating costs. The present paper gives an overview of the currently applied technologies, including their thermodynamic and technical background. Areas of improvement are identified to derive process concepts for future large scale hydrogen liquefaction plants meeting the needs of clean energy applications with optimized energy efficiency and hence minimized operating costs. Compared to studies in this field, this paper focuses on application of new technology and innovative concepts which are either readily available or will require short qualification procedures. They will hence allow implementation in plants in the close future.

Cell-free DNA noninvasive prenatal screening for aneuploidy versus conventional screening: A systematic review of economic evaluations.

PubMed

Nshimyumukiza, L; Menon, S; Hina, H; Rousseau, F; Reinharz, D

2018-07-01

Although noninvasive prenatal testing (NIPT) for aneuploidies using cell-free fetal DNA in maternal blood has been reported to have a high accuracy, only little evidence about its cost-effectiveness is available. We systematically reviewed and assessed quality of economic evaluation studies published between January 1, 2009 and January 1, 2016 where NIPT was compared to the current screening practices consisting of biochemical markers with or without nuchal translucency (NT) and/or maternal age. We included 16 studies and we found that, at current level of NIPT prices, contingent NIPT provide the best value for money, especially for publicly funded screening programs. NIPT as first-line test was found not cost-effective in the majority of studies. The NIPT unit cost, the risk cut-offs for current screening practice, the screening uptake rates (first- and second-line screening) as well as the costs and uptake rates of invasive diagnostic screening were the most common uncertain variables. The overall quality of included studies was fair. Considering a possible drop in prices and an ongoing NIPT expansion to include other chromosomes abnormalities other than T21, T18, T13 and sex chromosomes aneuploidies, future research are needed to examine the potential cost-effectiveness of implementing NIPT as first-line test. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Economics of Inhaled Oxygen Use as an Acute Therapy for Cluster Headache in the United States of America.

PubMed

O'Brien, Megan; Ford, Janet H; Aurora, Sheena K; Govindan, Sriram; Tepper, Deborah E; Tepper, Stewart J

2017-10-01

Cluster headache (CH) is a primary headache disorder associated with low levels of diagnosis and high unmet medical need. The pain attacks, associated anxiety, and fear in anticipation of the attacks are extremely debilitating to a patient with CH. For acute therapy, treatment guidelines recommend inhalation of high flow oxygen during the period of an attack. However, the use of oxygen for treatment of CH remains largely underutilized. The objectives of the study, which covered each of the US states, were to map the current market landscape of medical grade oxygen for use in CH and to develop a cost simulator based on a patient's needs and geography. Desk research was undertaken to obtain price lists and product catalogs from wholesale and retail suppliers of medical grade oxygen across all US states. Base case scenarios for chronic and episodic forms of CH were assumed. A cost simulator was used to calculate the cost of oxygen use using inputs including the state in USA, tank size and price, exacerbations per year, duration of exacerbation, attacks per day, flow rate and duration of flow. Information was also collected to determine if healthcare insurers covered the costs of home oxygen use for CH. Out of the 42 US states where pricing information of medical grade oxygen was available from suppliers, in 38 states the annual cost of high-flow oxygen for a patient with episodic CH was estimated to be <$1000. In 39 states, the annual cost of high-flow oxygen for a patient with chronic CH was estimated to be <$5000. Most of the home oxygen suppliers were familiar with CH and stocked the special non-rebreather masks and regulators necessary for this condition. It was found that many of the private commercial healthcare insurance providers reimbursed the cost of oxygen use for CH. However, the US Centers for Medicare and Medicaid Services (CMS) maintains there is insufficient evidence for coverage and continues to deny coverage for US Medicare and Medicaid patients. Results from our study showed that the current costs for oxygen use as an acute therapy in CH are not prohibitively expensive for patients and healthcare insurance providers. Apart from CMS, many insurers do reimburse the cost of oxygen use for CH. Our study suggests that further research is needed to determine if a lack of physician awareness about treatments and ways to prescribe are barriers for patients to access the high-flow oxygen treatment. © 2017 American Headache Society.

Pharmaceutical high profits: the value of R&D, or oligopolistic rents?

PubMed

Spitz, Janet; Wickham, Mark

2012-01-01

Pharmaceutical firms attribute high prices and high profits to costs associated with researching and developing the next generation of life-saving drugs. Using data from annual reports, this article tests the validity of this claim. We find that while pharmaceutical firms do invest in R&D, they also enjoy strong rents; between 1988 and 2009, pharmaceuticals enjoyed profits of 3 to 37 times the all-industry average, depending on the years, while investing proportionately less in R&D than other high-R&D firms. Costs of pharmaceutical drugs have successfully flown below the radar in much of the current health care debate, with producers managing to obstruct alternative sourcing as well as payment cuts. While health care is examined for savings in other areas, sustained high pharmaceutical profits suggest that as a new health care policy develops in the U.S., the pharmaceutical industry should not be excluded from examination for significant savings in health care costs.

Observations of Near-Bottom Currents with Low-Cost SeaHorse Tilt Current Meters

DTIC Science & Technology

2010-09-30

DISTRIBUTION STATEMENT A. Approved for public release; distribution is unlimited. Observations of Near-Bottom Currents with Low-Cost SeaHorse Tilt...sheremet/ SeaHorse LONG-TERM GOALS The SeaHorse TCM is a low-cost, easy to use, robust current meter based on the drag principle. Use of a large...2010 2. REPORT TYPE 3. DATES COVERED 00-00-2010 to 00-00-2010 4. TITLE AND SUBTITLE Observations of Near-Bottom Currents with Low-Cost SeaHorse

Cost-effectiveness of a new urinary biomarker-based risk score compared to standard of care in prostate cancer diagnostics - a decision analytical model.

PubMed

Dijkstra, Siebren; Govers, Tim M; Hendriks, Rianne J; Schalken, Jack A; Van Criekinge, Wim; Van Neste, Leander; Grutters, Janneke P C; Sedelaar, John P Michiel; van Oort, Inge M

2017-11-01

To assess the cost-effectiveness of a new urinary biomarker-based risk score (SelectMDx; MDxHealth, Inc., Irvine, CA, USA) to identify patients for transrectal ultrasonography (TRUS)-guided biopsy and to compare this with the current standard of care (SOC), using only prostate-specific antigen (PSA) to select for TRUS-guided biopsy. A decision tree and Markov model were developed to evaluate the cost-effectiveness of SelectMDx as a reflex test vs SOC in men with a PSA level of >3 ng/mL. Transition probabilities, utilities and costs were derived from the literature and expert opinion. Cost-effectiveness was expressed in quality-adjusted life years (QALYs) and healthcare costs of both diagnostic strategies, simulating the course of patients over a time horizon representing 18 years. Deterministic sensitivity analyses were performed to address uncertainty in assumptions. A diagnostic strategy including SelectMDx with a cut-off chosen at a sensitivity of 95.7% for high-grade prostate cancer resulted in savings of €128 and a gain of 0.025 QALY per patient compared to the SOC strategy. The sensitivity analyses showed that the disutility assigned to active surveillance had a high impact on the QALYs gained and the disutility attributed to TRUS-guided biopsy only slightly influenced the outcome of the model. Based on the currently available evidence, the reduction of over diagnosis and overtreatment due to the use of the SelectMDx test in men with PSA levels of >3 ng/mL may lead to a reduction in total costs per patient and a gain in QALYs. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

Evaluating the economic viability of CdTe/CIS and CIGS/CIS tandem photovoltaic modules

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

Nanayakkara, Sanjini U.; Horowitz, Kelsey; Kanevce, Ana

In this paper, we analyze the potential cost competitiveness of two frameless, glass–glass thin-film tandem photovoltaic module structures, cadmium telluride (CdTe)/CuInSe 2 (CIS) and CuIn 0.3Ga 0.7Se 2 (CIGS)/CIS, based on the demonstrated cost of manufacturing the respective component cell technologies in high volume. To consider multiple economic scenarios, we base the CdTe/CIS module efficiency on the current industrial production of CdTe modules, while for CIGS/CIS, we use an aspirational estimate for CIGS efficiency. We focus on four-terminal mechanically stacked structures, thus avoiding the need to achieve current matching between the two cells. The top cell in such a tandemmore » must have a transparent back contact, which has not been successfully implemented to date. However, for the purpose of understanding the economic viability of both tandems, we assume that this can be implemented at a cost similar to that of sputtered indium tin oxide. The cost of both tandem module structures was found to be nearly identical on an equal-area basis and approximately $30/m 2 higher than the single-junction alternatives. Both tandem modules are about 4% (absolute) more efficient than a module by using the top-cell material alone. We find that these tandem modules might reduce total system cost by as much as 11% in applications having a high area-related balance-of-system cost, such as area-constrained residential systems; however, the relative advantage of tandems decreases in the cases where balance-of-system costs are lower, such as in commercial and utility scale systems.« less

Evaluating the economic viability of CdTe/CIS and CIGS/CIS tandem photovoltaic modules

DOE PAGES

Nanayakkara, Sanjini U.; Horowitz, Kelsey; Kanevce, Ana; ...

2017-01-20

In this paper, we analyze the potential cost competitiveness of two frameless, glass–glass thin-film tandem photovoltaic module structures, cadmium telluride (CdTe)/CuInSe 2 (CIS) and CuIn 0.3Ga 0.7Se 2 (CIGS)/CIS, based on the demonstrated cost of manufacturing the respective component cell technologies in high volume. To consider multiple economic scenarios, we base the CdTe/CIS module efficiency on the current industrial production of CdTe modules, while for CIGS/CIS, we use an aspirational estimate for CIGS efficiency. We focus on four-terminal mechanically stacked structures, thus avoiding the need to achieve current matching between the two cells. The top cell in such a tandemmore » must have a transparent back contact, which has not been successfully implemented to date. However, for the purpose of understanding the economic viability of both tandems, we assume that this can be implemented at a cost similar to that of sputtered indium tin oxide. The cost of both tandem module structures was found to be nearly identical on an equal-area basis and approximately $30/m 2 higher than the single-junction alternatives. Both tandem modules are about 4% (absolute) more efficient than a module by using the top-cell material alone. We find that these tandem modules might reduce total system cost by as much as 11% in applications having a high area-related balance-of-system cost, such as area-constrained residential systems; however, the relative advantage of tandems decreases in the cases where balance-of-system costs are lower, such as in commercial and utility scale systems.« less

The use of high-efficiency particulate air-filter respirators to protect hospital workers from tuberculosis. A cost-effectiveness analysis.

PubMed

Adal, K A; Anglim, A M; Palumbo, C L; Titus, M G; Coyner, B J; Farr, B M

1994-07-21

After outbreaks of multidrug-resistant tuberculosis, the Centers for Disease Control and Prevention proposed the use of respirators with high-efficiency particulate air filters (HEPA respirators) as part of isolation precautions against tuberculosis, along with a respiratory-protection program for health care workers that includes medical evaluation, training, and tests of the fit of the respirators. Each HEPA respirator costs between $7.51 and $9.08, about 10 times the cost of respirators currently used. We conducted a cost-effectiveness analysis using data from the University of Virginia Hospital on exposure to patients with tuberculosis and rates at which the purified-protein-derivative (PPD) skin test became positive in hospital workers. The costs of a respiratory-protection program were based on those of an existing program for workers dealing with hazardous substances. During 1992, 11 patients with documented tuberculosis were admitted to our hospital. Eight of 3852 workers (0.2 percent) had PPD tests that became positive. Five of these conversions were believed to be due to the booster phenomenon; one followed unprotected exposure to a patient not yet in isolation; the other two occurred in workers who had never entered a tuberculosis isolation room. These data suggest that it will take more than one year for the use of HEPA respirators to prevent a single conversion of the PPD test. Assuming that one conversion is prevented per year, however, it would take 41 years at out hospital to prevent one case of occupationally acquired tuberculosis, at a cost of $1.3 million to $18.5 million. Given the effectiveness of currently recommended measures to prevent nosocomial transmission of tuberculosis, the addition of HEPA respirators would offer negligible protective efficacy at great cost.

[Operational costs and control of performance in surgical clinics between marketing and planning economics. Risk or perhaps quadrature of the circle].

PubMed

Kraus, T W; Weber, W; Mieth, M; Funk, H; Klar, E; Herfarth, C

2000-03-01

Surgical hospitals can be seen as operational or even industrial production systems. Doctors have a major impact on both medical performance and costs. For active participation in the management process, knowledge of industrial controlling mechanisms is required. German hospitals currently receive no procedure-related financial revenues, such as prices or tariffs for defined medical treatment activities. Maximum clinical revenues are, furthermore, limited by principles of planned economy and can be increased only slightly by greater medical performance. Costs are the only target that can be autonomously influenced by the management. Operative controlling in hospitals aims at horizontal and vertical coordination of subunits and decentralization of process regulations. Hospital medical performance is not clearly defined, its quantitative measurement very problematic. Process-orientated clinical activities are not taken into account. A high percentage of hospital costs are fixed and can be influenced only by major structural interventions in the long term. Variable costs are primarily dependent on the quantity of clinical activities, but also heavily influenced by patient structure (comorbidity and risk profile). The various forms of industrial cost calculations, such as internal budgeting, internal markets or flexible plan-cost balancing, cannot be directly applied in hospital management. Based on these analyses, current operational concepts and strategic trends are listed to describe cost-management options in hospitals with focus on the German health reforms.

Development of a concentrating solar power system using fluidized-bed technology for thermal energy conversion and solid particles for thermal energy storage

DOE PAGES

Ma, Z.; Mehos, M.; Glatzmaier, G.; ...

2015-05-01

Concentrating solar power (CSP) is an effective way to convert solar energy into electricity with an economic energy-storage capability for grid-scale, dispatchable renewable power generation. However, CSP plants need to reduce costs to be competitive with other power generation methods. Two ways to reduce CSP cost are to increase solar-to-electric efficiency by supporting a high-efficiency power conversion system, and to use low-cost materials in the system. The current nitrate-based molten-salt systems have limited potential for cost reduction and improved power-conversion efficiency with high operating temperatures. Even with significant improvements in operating performance, these systems face challenges in satisfying the costmore » and performance targets. This paper introduces a novel CSP system with high-temperature capability that can be integrated into a high-efficiency CSP plant and that meets the low-cost, high-performance CSP targets. Unlike a conventional salt-based CSP plant, this design uses gas/solid, two-phase flow as the heat-transfer fluid (HTF); separated solid particles as storage media; and stable, inexpensive materials for the high-temperature receiver and energy storage containment. We highlight the economic and performance benefits of this innovative CSP system design, which has thermal energy storage capability for base-load power generation.« less

Gastric adenocarcinoma screening and prevention in the era of new biomarker and endoscopic technologies: a cost-effectiveness analysis.

PubMed

Yeh, Jennifer M; Hur, Chin; Ward, Zachary; Schrag, Deborah; Goldie, Sue J

2016-04-01

To estimate the cost-effectiveness of noncardia gastric adenocarcinoma (NCGA) screening strategies based on new biomarker and endoscopic technologies. Using an intestinal-type NCGA microsimulation model, we evaluated the following one-time screening strategies for US men: (1) serum pepsinogen to detect gastric atrophy (with endoscopic follow-up of positive screen results), (2) endoscopic screening to detect dysplasia and asymptomatic cancer (with endoscopic mucosal resection (EMR) treatment for detected lesions) and (3) Helicobacter pylori screening and treatment. Screening performance, treatment effectiveness, cancer and cost data were based on published literature and databases. Subgroups included current, former and never smokers. Outcomes included lifetime cancer risk and incremental cost-effectiveness ratios (ICERs), expressed as cost per quality-adjusted-life-year (QALY) gained. Screening the general population at age 50 years reduced the lifetime intestinal-type NCGA risk (0.24%) by 26.4% with serum pepsinogen screening, 21.2% with endoscopy and EMR and 0.2% with H. pylori screening/treatment. Targeting current smokers reduced the lifetime risk (0.35%) by 30.8%, 25.5%, and 0.1%, respectively. For all subgroups, serum pepsinogen screening was more effective and more cost-effective than all other strategies, although its ICER varied from $76,000/QALY (current smokers) to $105,400/QALY (general population). Results were sensitive to H. pylori prevalence, screen age and serum pepsinogen test sensitivity. Probabilistic sensitivity analysis found that at a $100,000/QALY willingness-to-pay threshold, the probability that serum pepsinogen screening was preferred was 0.97 for current smokers. Although not warranted for the general population, targeting high-risk smokers for serum pepsinogen screening may be a cost-effective strategy to reduce intestinal-type NCGA mortality. 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/

The cost of long-term follow-up of high-risk infants for research studies.

PubMed

Doyle, Lex W; Clucas, Luisa; Roberts, Gehan; Davis, Noni; Duff, Julianne; Callanan, Catherine; McDonald, Marion; Anderson, Peter J; Cheong, Jeanie L Y

2015-10-01

Neonatal intensive care is expensive, and thus it is essential that its long-term outcomes are measured. The costs of follow-up studies for high-risk children who survive are unknown. This study aims to determine current costs for the assessment of health and development of children followed up in our research programme. Costs were determined for children involved in the research follow-up programme at the Royal Women's Hospital, Melbourne, over the 6-month period between 1st January 2012 and 30th June 2012. The time required for health professionals involved in assessments in early and later childhood was estimated, and converted into dollar costs. Costs for equipment and data management were added. Estimated costs were compared with actual costs of running the research follow-up programme. A total of 134 children were assessed over the 6-month period. The estimated average cost per child assessed was $1184, much higher than was expected. The estimated cost to assess a toddler was $1149, whereas for an 11-year-old it was $1443, the difference attributable to the longer psychological and paediatric assessments. The actual average cost per child assessed was $1623. The shortfall of $439 between the actual and estimated average costs per child arose chiefly because of the need to pay staff even when participants were late or failed to attend. The average costs of assessing children at each age for research studies are much higher than expected. These data are useful for planning similar long-term follow-up assessments for high-risk children. © 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

On the Path to SunShot. Advancing Concentrating Solar Power Technology, Performance, and Dispatchability

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

Mehos, Mark; Turchi, Craig; Jorgenson, Jennie

2016-05-01

This report examines the remaining challenges to achieving the competitive concentrating solar power (CSP) costs and large-scale deployment envisioned under the U.S. Department of Energy's SunShot Initiative. Although CSP costs continue to decline toward SunShot targets, CSP acceptance and deployment have been hindered by inexpensive photovoltaics (PV). However, a recent analysis found that thermal energy storage (TES) could increase CSP's value--based on combined operational and capacity benefits--by up to 6 cents/kWh compared to variable-generation PV, under a 40% renewable portfolio standard in California. Thus, the high grid value of CSP-TES must be considered when evaluating renewable energy options. An assessmentmore » of net system cost accounts for the difference between the costs of adding new generation and the avoided cost from displacing other resources providing the same level of energy and reliability. The net system costs of several CSP configurations are compared with the net system costs of conventional natural-gas-fired combustion-turbine (CT) and combined-cycle plants. At today's low natural gas prices and carbon emission costs, the economics suggest a peaking configuration for CSP. However, with high natural gas prices and emission costs, each of the CSP configurations compares favorably against the conventional alternatives, and systems with intermediate to high capacity factors become the preferred alternatives. Another analysis compares net system costs for three configurations of CSP versus PV with batteries and PV with CTs. Under current technology costs, the least-expensive option is a combination of PV and CTs. However, under future cost assumptions, the optimal configuration of CSP becomes the most cost-effective option.« less

Eradication versus control for poliomyelitis: an economic analysis.

PubMed

Thompson, Kimberly M; Tebbens, Radboud J Duintjer

2007-04-21

Worldwide eradication of wild polioviruses is likely to yield substantial health and financial benefits, provided we finish the job. Challenges in the four endemic areas combined with continuing demands for financial resources for eradication have led some to question the goal of eradication and to suggest switching to a policy of control. We developed a dynamic model, based on modelling of the currently endemic areas in India, to show the importance of maintaining and increasing the immunisation intensity to complete eradication and to illustrate how policies based on perception about high short-term costs or cost-effectiveness ratios without consideration of long-term benefits could undermine any eradication effort. An extended model assesses the economic implications and disease burden of a change in policy from eradication to control. Our results suggest that the intensity of immunisation must be increased to achieve eradication, and that even small decreases in intensity could lead to large outbreaks. This finding implies the need to pay even higher short-run costs than are currently being spent, which will further exacerbate concerns about continued investment in interventions with high perceived cost-effectiveness ratios. We show that a wavering commitment leads to a failure to eradicate, greater cumulative costs, and a much larger number of cases. We further show that as long as it is technically achievable, eradication offers both lower cumulative costs and cases than control, even with the costs of achieving eradication exceeding several billion dollars more. A low-cost control policy that relies only on routine immunisation for 20 years with discounted costs of more than $3500 million could lead to roughly 200 000 expected paralytic poliomyelitis cases every year in low-income countries, whereas a low-case control policy that keeps the number of cases at about 1500 per year could cost around $10 000 million discounted over the 20 years. Focusing on the large costs for poliomyelitis eradication, without assessing the even larger potential benefits of eradication and the enormous long-term costs of effective control, might inappropriately affect commitments to the goal of eradication, and thus debate should include careful consideration of the options.

Prevalence, Employment Rate, and Cost of Schizophrenia in a High-Income Welfare Society: A Population-Based Study Using Comprehensive Health and Welfare Registers

PubMed Central

Evensen, Stig; Wisløff, Torbjørn; Lystad, June Ullevoldsæter; Bull, Helen; Ueland, Torill; Falkum, Erik

2016-01-01

Schizophrenia is associated with recurrent hospitalizations, need for long-term community support, poor social functioning, and low employment rates. Despite the wide- ranging financial and social burdens associated with the illness, there is great uncertainty regarding prevalence, employment rates, and the societal costs of schizophrenia. The current study investigates 12-month prevalence of patients treated for schizophrenia, employment rates, and cost of schizophrenia using a population-based top-down approach. Data were obtained from comprehensive and mandatory health and welfare registers in Norway. We identified a 12-month prevalence of 0.17% for the entire population. The employment rate among working-age individuals was 10.24%. The societal costs for the 12-month period were USD 890 million. The average cost per individual with schizophrenia was USD 106 thousand. Inpatient care and lost productivity due to high unemployment represented 33% and 29%, respectively, of the total costs. The use of mandatory health and welfare registers enabled a unique and informative analysis on true population-based datasets. PMID:26433216

Cost-effectiveness of digital subtraction angiography in the setting of computed tomographic angiography negative subarachnoid hemorrhage.

PubMed

Jethwa, Pinakin R; Punia, Vineet; Patel, Tapan D; Duffis, E Jesus; Gandhi, Chirag D; Prestigiacomo, Charles J

2013-04-01

Recent studies have documented the high sensitivity of computed tomography angiography (CTA) in detecting a ruptured aneurysm in the presence of acute subarachnoid hemorrhage (SAH). The practice of digital subtraction angiography (DSA) when CTA does not reveal an aneurysm has thus been called into question. We examined this dilemma from a cost-effectiveness perspective by using current decision analysis techniques. A decision tree was created with the use of TreeAge Pro Suite 2012; in 1 arm, a CTA-negative SAH was followed up with DSA; in the other arm, patients were observed without further imaging. Based on literature review, costs and utilities were assigned to each potential outcome. Base-case and sensitivity analyses were performed to determine the cost-effectiveness of each strategy. A Monte Carlo simulation was then conducted by sampling each variable over a plausible distribution to evaluate the robustness of the model. With the use of a negative predictive value of 95.7% for CTA, observation was found to be the most cost-effective strategy ($6737/Quality Adjusted Life Year [QALY] vs $8460/QALY) in the base-case analysis. One-way sensitivity analysis demonstrated that DSA became the more cost-effective option if the negative predictive value of CTA fell below 93.72%. The Monte Carlo simulation produced an incremental cost-effectiveness ratio of $83 083/QALY. At the conventional willingness-to-pay threshold of $50 000/QALY, observation was the more cost-effective strategy in 83.6% of simulations. The decision to perform a DSA in CTA-negative SAH depends strongly on the sensitivity of CTA, and therefore must be evaluated at each center treating these types of patients. Given the high sensitivity of CTA reported in the current literature, performing DSA on all patients with CTA negative SAH may not be cost-effective at every institution.

Gallium nitride vertical power devices on foreign substrates: a review and outlook

NASA Astrophysics Data System (ADS)

Zhang, Yuhao; Dadgar, Armin; Palacios, Tomás

2018-07-01

Vertical gallium nitride (GaN) power devices have attracted increased attention due to their superior high-voltage and high-current capacity as well as easier thermal management than lateral GaN high electron mobility transistors. Vertical GaN devices are promising candidates for next-generation power electronics in electric vehicles, data centers, smart grids and renewable energy process. The use of low-cost foreign substrates such as silicon (Si) substrates, instead of the expensive free-standing GaN substrates, could greatly trim material cost and enable large-diameter wafer processing while maintaining high device performance. This review illustrates recent progress in material epitaxy, device design, device physics and processing technologies for the development of vertical GaN power devices on low-cost foreign substrates. Although the device technologies are still at the early stage of development, state-of-the-art vertical GaN-on-Si power diodes have already shown superior Baliga’s figure of merit than commercial SiC and Si power devices at the voltage classes beyond 600 V. Furthermore, we unveil the design space of vertical GaN power devices on native and different foreign substrates, from the analysis of the impact of dislocation and defects on device performance. We conclude by identifying the application space, current challenges and exciting research opportunities in this very dynamic research field.

Medicare Long-Term CPAP Coverage Policy: A Cost-Utility Analysis

PubMed Central

Billings, Martha E.; Kapur, Vishesh K.

2013-01-01

Study Objectives: CPAP is an effective treatment for OSA that may reduce health care utilization and costs. Medicare currently reimburses the costs of long-term CPAP therapy only if the patient is adherent during a 90-day trial. If not, Medicare requires a repeat polysomnogram (PSG) and another trial which seems empirically not cost-effective. We modeled the cost-effectiveness of current Medicare policy compared to an alternative policy (clinic-only) without the adherence criterion and repeat PSG. Design: Cost-utility and cost-effectiveness analysis. Setting: U.S. Medicare Population. Patients or Participants: N/A. Interventions: N/A. Measurements and Results: We created a decision tree modeling (1) clinic only follow-up vs. (2) current Medicare policy. Costs were assigned based on Medicare reimbursement rates in 2012. Sensitivity analyses were conducted to test our assumptions. We estimated cumulative costs, overall adherence, and QALY gained for a 5-year time horizon from the perspective of Medicare as the payer. Current Medicare policy is more costly than the clinic-only policy but has higher net adherence and improved utility. Current Medicare policy compared to clinic-only policy costs $30,544 more per QALY. Conclusions: Current CMS policy promotes early identification of those more likely to adhere to CPAP therapy by requiring strict adherence standards. The policy effect is to deny coverage to those unlikely to use CPAP long-term and prevent wasted resources. Future studies are needed to measure long-term adherence in an elderly population with and without current adherence requirements to verify the cost-effectiveness of a policy change. Citation: Billings ME; Kapur VK. Medicare long-term CPAP coverage policy: a cost-utility analysis. J Clin Sleep Med 2013;9(10):1023-1029. PMID:24127146

Silver Nanowire Transparent Conductive Electrodes for High-Efficiency III-Nitride Light-Emitting Diodes

PubMed Central

Oh, Munsik; Jin, Won-Yong; Jun Jeong, Hyeon; Jeong, Mun Seok; Kang, Jae-Wook; Kim, Hyunsoo

2015-01-01

Silver nanowires (AgNWs) have been successfully demonstrated to function as next-generation transparent conductive electrodes (TCEs) in organic semiconductor devices owing to their figures of merit, including high optical transmittance, low sheet resistance, flexibility, and low-cost processing. In this article, high-quality, solution-processed AgNWs with an excellent optical transmittance of 96.5% at 450 nm and a low sheet resistance of 11.7 Ω/sq were demonstrated as TCEs in inorganic III-nitride LEDs. The transmission line model applied to the AgNW contact to p-GaN showed that near ohmic contact with a specific contact resistance of ~10−3 Ωcm2 was obtained. The contact resistance had a strong bias-voltage (or current-density) dependence: namely, field-enhanced ohmic contact. LEDs fabricated with AgNW electrodes exhibited a 56% reduction in series resistance, 56.5% brighter output power, a 67.5% reduction in efficiency droop, and a approximately 30% longer current spreading length compared to LEDs fabricated with reference TCEs. In addition to the cost reduction, the observed improvements in device performance suggest that the AgNWs are promising for application as next-generation TCEs, to realise brighter, larger-area, cost-competitive inorganic III-nitride light emitters. PMID:26333768

Cogeneration Technology Alternatives Study (CTAS). Volume 3: Energy conversion system characteristics

NASA Technical Reports Server (NTRS)

1980-01-01

Six current and thirty-six advanced energy conversion systems were defined and combined with appropriate balance of plant equipment. Twenty-six industrial processes were selected from among the high energy consuming industries to serve as a frame work for the study. Each conversion system was analyzed as a cogenerator with each industrial plant. Fuel consumption, costs, and environmental intrusion were evaluated and compared to corresponding traditional values. The advanced energy conversion technologies indicated reduced fuel consumption, costs, and emissions. Fuel energy savings of 10 to 25 percent were predicted compared to traditional on site furnaces and utility electricity. With the variety of industrial requirements, each advanced technology had attractive applications. Fuel cells indicated the greatest fuel energy savings and emission reductions. Gas turbines and combined cycles indicated high overall annual savings. Steam turbines and gas turbines produced high estimated returns. In some applications, diesels were most efficient. The advanced technologies used coal derived fuels, or coal with advanced fluid bed combustion or on site gasifications. Data and information for both current and advanced energy conversion technology are presented. Schematic and physical descriptions, performance data, equipment cost estimates, and predicted emissions are included. Technical developments which are needed to achieve commercialization in the 1985-2000 period are identified.

Overview of NASA Studies on High-Temperature Ceramic Fibers

NASA Technical Reports Server (NTRS)

DiCarlo, James A.; Yun, Hee Mann

2001-01-01

NASA, DOD, and DOE are currently looking to the NASA UEET Program to develop ceramic matrix composites (CMC) for hot-section components in advanced power and propulsion systems - Success will depend strongly on developing ceramic fibers with a variety of key thermostructural properties, in particular, high as-produced tensile strength and retention of a large fraction of this strength for long times under the anticipated CMC service conditions. - Current UEET approach centers on selecting the optimum fiber type from commercially available fibers since the costs for development of advanced fibers are high and the markets for high-temperature CMC have yet to be established.

Replicated Wolter-I X-ray Optics for Lightweight, High Angular Resolution, Large Collecting Area X-Ray Telescopes

NASA Technical Reports Server (NTRS)

Joy, M.; Bilbro, J.; Elsner, R.; Jones, W.; Kolodziejczak, J.; Petruzzo, J.; ODell, S.; Weisskopf, M.

1997-01-01

The next generation of orbiting x-ray observatories will require high angular resolution telescopes that have an order of magnitude greater collecting area in the 0.1-10 keV spectral region than those currently under construction, but with a much lower weight and cost per unit area. Replicated Wolter-I x-ray optics have the potential to meet this requirement. The currently demonstrated capabilities of replicated Wolter-I optics will be described, and a development plan for creating lightweight, high angular resolution, large effective area x-ray telescopes will be presented.

A Single-Stranded DNA Aptamer That Selectively Binds to Staphylococcus aureus Enterotoxin B

PubMed Central

DeGrasse, Jeffrey A.

2012-01-01

The bacterium Staphylococcus aureus is a common foodborne pathogen capable of secreting a cocktail of small, stable, and strain-specific, staphylococcal enterotoxins (SEs). Staphylococcal food poisoning (SFP) results when improperly handled food contaminated with SEs is consumed. Gastrointestinal symptoms of SFP include emesis, diarrhea and severe abdominal pain, which manifest within hours of ingesting contaminated food. Immuno-affinity based methods directly detect, identify, and quantify several SEs within a food or clinical sample. However, the success of these assays depends upon the availability of a monoclonal antibody, the development of which is non-trivial and costly. The current scope of the available immuno-affinity based methods is limited to the classical SEs and does not encompass all of the known or emergent SEs. In contrast to antibodies, aptamers are short nucleic acids that exhibit high affinity and specificity for their targets without the high-costs and ethical concerns of animal husbandry. Further, researchers may choose to freely distribute aptamers and develop assays without the proprietary issues that increase the per-sample cost of immuno-affinity assays. This study describes a novel aptamer, selected in vitro, with affinity to staphylococcal enterotoxin B (SEB) that may be used in lieu of antibodies in SE detection assays. The aptamer, designated APTSEB1, successfully isolates SEB from a complex mixture of SEs with extremely high discrimination. This work sets the foundation for future aptamer and assay development towards the entire family of SEs. The rapid, robust, and low-cost identification and quantification of all of the SEs in S. aureus contaminated food is essential for food safety and epidemiological efforts. An in vitro generated library of SE aptamers could potentially allow for the comprehensive and cost-effective analysis of food samples that immuno-affinity assays currently cannot provide. PMID:22438927

A single-stranded DNA aptamer that selectively binds to Staphylococcus aureus enterotoxin B.

PubMed

DeGrasse, Jeffrey A

2012-01-01

The bacterium Staphylococcus aureus is a common foodborne pathogen capable of secreting a cocktail of small, stable, and strain-specific, staphylococcal enterotoxins (SEs). Staphylococcal food poisoning (SFP) results when improperly handled food contaminated with SEs is consumed. Gastrointestinal symptoms of SFP include emesis, diarrhea and severe abdominal pain, which manifest within hours of ingesting contaminated food. Immuno-affinity based methods directly detect, identify, and quantify several SEs within a food or clinical sample. However, the success of these assays depends upon the availability of a monoclonal antibody, the development of which is non-trivial and costly. The current scope of the available immuno-affinity based methods is limited to the classical SEs and does not encompass all of the known or emergent SEs. In contrast to antibodies, aptamers are short nucleic acids that exhibit high affinity and specificity for their targets without the high-costs and ethical concerns of animal husbandry. Further, researchers may choose to freely distribute aptamers and develop assays without the proprietary issues that increase the per-sample cost of immuno-affinity assays. This study describes a novel aptamer, selected in vitro, with affinity to staphylococcal enterotoxin B (SEB) that may be used in lieu of antibodies in SE detection assays. The aptamer, designated APT(SEB1), successfully isolates SEB from a complex mixture of SEs with extremely high discrimination. This work sets the foundation for future aptamer and assay development towards the entire family of SEs. The rapid, robust, and low-cost identification and quantification of all of the SEs in S. aureus contaminated food is essential for food safety and epidemiological efforts. An in vitro generated library of SE aptamers could potentially allow for the comprehensive and cost-effective analysis of food samples that immuno-affinity assays currently cannot provide.

Increasing Electrochemiluminescence Intensity of a Wireless Electrode Array Chip by Thousands of Times Using a Diode for Sensitive Visual Detection by a Digital Camera.

PubMed

Qi, Liming; Xia, Yong; Qi, Wenjing; Gao, Wenyue; Wu, Fengxia; Xu, Guobao

2016-01-19

Both a wireless electrochemiluminescence (ECL) electrode microarray chip and the dramatic increase in ECL by embedding a diode in an electromagnetic receiver coil have been first reported. The newly designed device consists of a chip and a transmitter. The chip has an electromagnetic receiver coil, a mini-diode, and a gold electrode array. The mini-diode can rectify alternating current into direct current and thus enhance ECL intensities by 18 thousand times, enabling a sensitive visual detection using common cameras or smart phones as low cost detectors. The detection limit of hydrogen peroxide using a digital camera is comparable to that using photomultiplier tube (PMT)-based detectors. Coupled with a PMT-based detector, the device can detect luminol with higher sensitivity with linear ranges from 10 nM to 1 mM. Because of the advantages including high sensitivity, high throughput, low cost, high portability, and simplicity, it is promising in point of care testing, drug screening, and high throughput analysis.

76 FR 68162 - Atlantic Highly Migratory Species; Advisory Panel

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-03

... listed. Rather, NMFS will aim toward having as diverse and balanced an AP as possible. Table 1--Current.... Depending on availability of funds, members may be reimbursed for travel costs related to the HMS AP...

76 FR 68164 - Atlantic Highly Migratory Species; Advisory Panel

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-03

... listed. Rather, NMFS will aim toward having as diverse and balanced an AP as possible. Table 1-- Current.... Depending on availability of funds, members may be reimbursed for travel costs related to the HMS AP...

Analysis of multigrid methods on massively parallel computers: Architectural implications

NASA Technical Reports Server (NTRS)

Matheson, Lesley R.; Tarjan, Robert E.

1993-01-01

We study the potential performance of multigrid algorithms running on massively parallel computers with the intent of discovering whether presently envisioned machines will provide an efficient platform for such algorithms. We consider the domain parallel version of the standard V cycle algorithm on model problems, discretized using finite difference techniques in two and three dimensions on block structured grids of size 10(exp 6) and 10(exp 9), respectively. Our models of parallel computation were developed to reflect the computing characteristics of the current generation of massively parallel multicomputers. These models are based on an interconnection network of 256 to 16,384 message passing, 'workstation size' processors executing in an SPMD mode. The first model accomplishes interprocessor communications through a multistage permutation network. The communication cost is a logarithmic function which is similar to the costs in a variety of different topologies. The second model allows single stage communication costs only. Both models were designed with information provided by machine developers and utilize implementation derived parameters. With the medium grain parallelism of the current generation and the high fixed cost of an interprocessor communication, our analysis suggests an efficient implementation requires the machine to support the efficient transmission of long messages, (up to 1000 words) or the high initiation cost of a communication must be significantly reduced through an alternative optimization technique. Furthermore, with variable length message capability, our analysis suggests the low diameter multistage networks provide little or no advantage over a simple single stage communications network.

Vertical organic transistors.

PubMed

Lüssem, Björn; Günther, Alrun; Fischer, Axel; Kasemann, Daniel; Leo, Karl

2015-11-11

Organic switching devices such as field effect transistors (OFETs) are a key element of future flexible electronic devices. So far, however, a commercial breakthrough has not been achieved because these devices usually lack in switching speed (e.g. for logic applications) and current density (e.g. for display pixel driving). The limited performance is caused by a combination of comparatively low charge carrier mobilities and the large channel length caused by the need for low-cost structuring. Vertical Organic Transistors are a novel technology that has the potential to overcome these limitations of OFETs. Vertical Organic Transistors allow to scale the channel length of organic transistors into the 100 nm regime without cost intensive structuring techniques. Several different approaches have been proposed in literature, which show high output currents, low operation voltages, and comparatively high speed even without sub-μm structuring technologies. In this review, these different approaches are compared and recent progress is highlighted.

Technology-based interventions for weight management: current randomized controlled trial evidence and future directions

PubMed Central

Buscemi, Joanna; Hawkins, Misty A. W.; Wang, Monica L.; Breland, Jessica Y.; Ross, Kathryn M.; Kommu, Anupama

2018-01-01

Obesity is a prevalent health care issue associated with disability, premature morality, and high costs. Behavioral weight management interventions lead to clinically significant weight losses in overweight and obese individuals; however, many individuals are not able to participate in these face-to-face treatments due to limited access, cost, and/or time constraints. Technological advances such as widespread access to the Internet, increased use of smartphones, and newer behavioral self-monitoring tools have resulted in the development of a variety of eHealth weight management programs. In the present paper, a summary of the most current literature is provided along with potential solutions to methodological challenges (e.g., high attrition, minimal participant racial/ethnic diversity, heterogeneity of technology delivery modes). Dissemination and policy implications will be highlighted as future directions for the field of eHealth weight management. PMID:27783259

Advances in utilization of renewable substrates for biosurfactant production

PubMed Central

2011-01-01

Biosurfactants are amphiphilic molecules that have both hydrophilic and hydrophobic moieties which partition preferentially at the interfaces such as liquid/liquid, gas/liquid or solid/liquid interfaces. Such characteristics enable emulsifying, foaming, detergency and dispersing properties. Their low toxicity and environmental friendly nature and the wide range of potential industrial applications in bioremediation, health care, oil and food processing industries makes them a highly sought after group of chemical compounds. Interest in them has also been encouraged because of the potential advantages they offer over their synthetic counterparts in many fields spanning environmental, food, biomedical, petrochemical and other industrial applications. Their large scale production and application however are currently restricted by the high cost of production and by the limited understanding of their interactions with cells and with the abiotic environment. In this paper, we review the current knowledge and latest advances in the search for cost effective renewable agro industrial alternative substrates for their production. PMID:21906330

Evidence on the cost of breast cancer drugs is required for rational decision making.

PubMed

Berghuis, Anne Margreet Sofie; Koffijberg, Hendrik; Terstappen, Leonardus Wendelinus Mathias Marie; Sleijfer, Stefan; IJzerman, Maarten Joost

2018-01-01

For rational decision making, assessing the cost-effectiveness and budget impact of new drugs and comparing the costs of drugs already on the market is required. In addition to value frameworks, such as the American Society of Clinical Oncology Value Framework and the European Society of Medical Oncology-Magnitude of Clinical benefit Scale, this also requires a transparent overview of actual drug prices. While list prices are available, evidence on treatment cost is not. This paper aims to synthesise evidence on the reimbursement and costs of high-cost breast cancer drugs in The Netherlands (NL). A literature review was performed to identify currently reimbursed breast cancer drugs in the NL. Treatment costs were determined by multiplying list prices with the average length of treatment and dosing schedule. Comparing list prices to the estimated treatment cost resulted in substantial differences in the ranking of costliness of the drugs. The average mean treatment length was unknown for 11/31 breast cancer drugs (26.2%). The differences in the 15 highest-cost drugs were largest for Bevacizumab, Lapatinib and everolimus, with list prices of €541, €158, €1,168 and estimated treatment cost of €174,400, €18,682 and €31,207, respectively. The lowest-cost (patented) targeted drug is €1,818 more expensive than the highest-cost (off-patent) generic drug according to the estimated drug treatment cost. A lack of evidence on the reimbursement and cost of high-cost breast cancer drugs complicates rapid and transparent evidence synthesis, necessary to focus strategies aiming to limit the increasing healthcare costs. Interestingly, the findings show that off-patent generics (such as paclitaxel or doxorubicin), although substantially cheaper than patented drugs, are still relatively costly. Extending standardisation and increasing European and national regulations on presenting information on costs per cancer drug is highly recommended.

Antibody Production in Plants and Green Algae.

PubMed

Yusibov, Vidadi; Kushnir, Natasha; Streatfield, Stephen J

2016-04-29

Monoclonal antibodies (mAbs) have a wide range of modern applications, including research, diagnostic, therapeutic, and industrial uses. Market demand for mAbs is high and continues to grow. Although mammalian systems, which currently dominate the biomanufacturing industry, produce effective and safe recombinant mAbs, they have a limited manufacturing capacity and high costs. Bacteria, yeast, and insect cell systems are highly scalable and cost effective but vary in their ability to produce appropriate posttranslationally modified mAbs. Plants and green algae are emerging as promising production platforms because of their time and cost efficiencies, scalability, lack of mammalian pathogens, and eukaryotic posttranslational protein modification machinery. So far, plant- and algae-derived mAbs have been produced predominantly as candidate therapeutics for infectious diseases and cancer. These candidates have been extensively evaluated in animal models, and some have shown efficacy in clinical trials. Here, we review ongoing efforts to advance the production of mAbs in plants and algae.

Bundled Payments in Total Joint Replacement: Keeping Our Care Affordable and High in Quality.

PubMed

McLawhorn, Alexander S; Buller, Leonard T

2017-09-01

The purpose of this review was to evaluate the literature regarding bundle payment reimbursement models for total joint arthroplasty (TJA). From an economic standpoint, TJA are cost-effective, but they represent a substantial expense to the Centers for Medicare & Medicaid Services (CMS). Historically, fee-for-service payment models resulted in highly variable cost and quality. CMS introduced Bundled Payments for Care Improvement (BPCI) in 2012 and subsequently the Comprehensive Care for Joint Replacement (CJR) reimbursement model in 2016 to improve the value of TJA from the perspectives of both CMS and patients, by improving quality via cost control. Early results of bundled payments are promising, but preserving access to care for patients with high comorbidity burdens and those requiring more complex care is a lingering concern. Hospitals, regardless of current participation in bundled payments, should develop care pathways for TJA to maximize efficiency and patient safety.

Development of a high temperature microbial fermentation process for butanol

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

Jeor, Jeffery D. St.; Reed, David W.; Daubaras, Dayna L.

2015-08-01

Transforming renewable biomass into cost-competitive high-performance biofuels and bioproducts is key to the U.S. future energy and chemical needs. Butanol production by microbial fermentation for chemical conversion to polyolefins, elastomers, drop-in jet or diesel fuel, and other chemicals is a promising solution. A high temperature fermentation process could decrease energy costs, capital cost, give higher butanol production, and allow for continuous fermentation. In this paper, we describe our approach to genetically transform Geobacillus caldoxylosiliticus, using a pUCG18 plasmid, for potential insertion of a butanol production pathway. Transformation methods tested were electroporation of electrocompetent cells, ternary conjugation with E. coli donormore » and helper strains, and protoplast fusion. These methods have not been successful using the current plasmid. Growth controls show cells survive the various methods tested, suggesting the possibility of transformation inhibition from a DNA restriction modification system in G. caldoxylosiliticus, as reported in the literature.« less

The cost of implementing rapid HIV testing in sexually transmitted disease clinics in the United States.

PubMed

Eggman, Ashley A; Feaster, Daniel J; Leff, Jared A; Golden, Matthew R; Castellon, Pedro C; Gooden, Lauren; Matheson, Tim; Colfax, Grant N; Metsch, Lisa R; Schackman, Bruce R

2014-09-01

Rapid HIV testing in high-risk populations can increase the number of persons who learn their HIV status and avoid spending clinic resources to locate persons identified as HIV infected. We determined the cost to sexually transmitted disease (STD) clinics of point-of-care rapid HIV testing using data from 7 public clinics that participated in a randomized trial of rapid testing with and without brief patient-centered risk reduction counseling in 2010. Costs included counselor and trainer time, supplies, and clinic overhead. We applied national labor rates and test costs. We calculated median clinic start-up costs and mean cost per patient tested, and projected incremental annual costs of implementing universal rapid HIV testing compared with current testing practices. Criteria for offering rapid HIV testing and methods for delivering nonrapid test results varied among clinics before the trial. Rapid HIV testing cost an average of US $22/patient without brief risk reduction counseling and US $46/patient with counseling in these 7 clinics. Median start-up costs per clinic were US $1100 and US $16,100 without and with counseling, respectively. Estimated incremental annual costs per clinic of implementing universal rapid HIV testing varied by whether or not brief counseling is conducted and by current clinic testing practices, ranging from a savings of US $19,500 to a cost of US $40,700 without counseling and a cost of US $98,000 to US $153,900 with counseling. Universal rapid HIV testing in STD clinics with same-day results can be implemented at relatively low cost to STD clinics, if brief risk reduction counseling is not offered.

Communication—Electrolysis at High Efficiency with Remarkable Hydrogen Production Rates

DOE PAGES

Wood, Anthony; He, Hongpeng; Joia, Tahir; ...

2016-01-20

Solid Oxide Electrolysis (SOE) can be used to produce hydrogen with very high efficiencies at remarkable hydrogen production rates. Through microstructural and compositional modification, conventional low cost Solid Oxide Fuel Cell (SOFC) materials have been used to create a Solid Oxide Electrolysis Cell (SOEC) that can achieve remarkable current density at cell voltages allowing higher conversion efficiency than current commercial electrolysers. Current densities in excess of 6 A/cm2 have been achieved at 800°C with a cell voltage of < 1.67 V. This cell shows a more than 3-fold increase in hydrogen production rate at higher efficiency than established commercial electrolysers.

High-grade, compact spectrometers for Earth observation from SmallSats

NASA Astrophysics Data System (ADS)

van der Wal, L. F.; de Goeij, B. T. G.; Jansen, R.; Oosterling, J. A. J.; Snijders, B.

2016-10-01

The market for nano- and microsatellites is developing rapidly. There is a strong focus on 2D imaging of the Earth's surface, with limited possibilities to obtain spectral information. More demanding applications, such as monitoring trace gases, aerosols or water quality still require advanced imaging instruments, which are large, heavy and expensive. In recent years TNO has investigated and developed different innovative designs to realize advanced spectrometers for space applications in a more compact and cost-effective manner. This offers multiple advantages: a compact instrument can be flown on a much smaller platform (nano- or microsatellite); a low-cost instrument opens up the possibility to fly multiple instruments in a satellite constellation, improving both global coverage and temporal sampling (e.g. to study diurnal processes); a constellation of low-cost instruments may provide added value to the larger scientific and operational satellite missions (e.g. the Copernicus Sentinel missions); and a small, lightweight spectrometer can also be mounted easily on a high-altitude UAV (offering high spatial resolution). Last but not least, a low-cost instrument may allow to break through the `cost spiral': lower cost will allow to take more risk and thus progress more quickly. This may lead to a much faster development cycle than customary for current Earth Observation instruments. To explore the potential of a constellation of low-cost instruments a consortium of Dutch partners was formed, which currently consists of Airbus Defence and Space Netherlands, ISISpace, S and T and TNO. In this paper we will illustrate this new design approach by using the most advanced design of a hyperspectral imaging spectrometer (named `Spectrolite') as an example. We will discuss the different design and manufacturing techniques that were used to realize this compact and low-cost design. Laboratory tests as well as the first preliminary results of airborne measurements with the Spectrolite breadboard will be presented and discussed. The design of Spectrolite offers the flexibility to tune its performance (spectral range, spectral resolution) to a specific application. Thus, based on the same basic system design, Spectrolite offers a range of applications to different clients. To illustrate this, we will present a mission concept to monitor NO2 concentrations over urban areas at high spatial resolution, based on a constellation of small satellites.

The use of pyro-polymeric catalysts and a new cylindrical cell design in oxygen-aluminum generators

NASA Astrophysics Data System (ADS)

Kiseleva, E. A.; Zhuk, A. Z.; Kleymenov, B. V.; Oudaltsov, V. G.

2018-01-01

The increase in energy consumption, the economic crisis, the development of certain areas of engineering and energy, as well as the related deterioration of the environmental situation, require the development of new electrochemical current sources with high specific characteristics. In the field of creating air-hydrogen fuel cells, the problems of safety and mobile storage of hydrogen have not been completely solved, stagnation in the development of lithium-ion, lithium-air and lithium-sulfur batteries has been outlined. All this requires searching for new technological solutions, ways to increase the energy and resource characteristics of electrochemical current sources (ECS), reducing their cost [1-2]. The use of metals (aluminum, zinc, magnesium) as an energy carrier is due to their high energy intensity (in combination with the lack of transport, storage and on-board storage problems) of the relatively low cost of metals, their availability, storage safety and the absence of harmful emissions when used. As in the chemical and electrochemical use of metals, safe products (oxides, hydroxides) are formed, which are reduced to metals within the framework of traditional production technologies. Thus, a closed cycle of energy use is organized. The task of this paper is to evaluate the possibility of reducing the cost and increasing the specific power of ECS using oxygen depolarization. The goal is achieved by using non-platinum catalysts and optimizing the design of the current source.

Woven TPS Enabling Missions Beyond Heritage Carbon Phenolic

NASA Technical Reports Server (NTRS)

Stackpoole, M.; Feldman, J.; Venkatapathy, E.

2013-01-01

WTPS is a new approach to producing TPS architectures that uses precisely engineered 3D weaving techniques to customize material characteristics needed to meet specific missions requirements for protecting space vehicles from the intense heating generated during atmospheric entry. Using WTPS, sustainable, scalable, mission-optimized TPS solutions can be achieved with relatively low life cycle costs compared with the high costs and long development schedules currently associated with material development and certification. WTPS leverages the mature state-of-the-art weaving technology that has evolved from the textile industry to design TPS materials with tailorable performance. Currently, missions anticipated encountering heat fluxes in the range of 1500 4000 Wcm2 and pressures greater than 1.5 atm are limited to using fully dense Carbon Phenolic. However, fully dense carbon phenolic is only mass efficient at higher heat fluxes greater than 4000 Wcm2), and current mission designs suffer this mass inefficiency for lack of an alternative mid-density TPS. WTPS not only bridges this mid-density TPS gap but also offers a replacement for carbon phenolic, which itself requires a significant and costly redevelopment effort to re-establish its capability for use in the high heat flux missions recently prioritized in the NRC Decadal survey, including probe missions to Venus, Saturn and Neptune. This presentation will overview the WTPS concept and present some results from initial testing completed comparing WTPS architectures to heritage carbon phenolic.

Energy conversion approaches and materials for high-efficiency photovoltaics.

PubMed

Green, Martin A; Bremner, Stephen P

2016-12-20

The past five years have seen significant cost reductions in photovoltaics and a correspondingly strong increase in uptake, with photovoltaics now positioned to provide one of the lowest-cost options for future electricity generation. What is becoming clear as the industry develops is that area-related costs, such as costs of encapsulation and field-installation, are increasingly important components of the total costs of photovoltaic electricity generation, with this trend expected to continue. Improved energy-conversion efficiency directly reduces such costs, with increased manufacturing volume likely to drive down the additional costs associated with implementing higher efficiencies. This suggests the industry will evolve beyond the standard single-junction solar cells that currently dominate commercial production, where energy-conversion efficiencies are fundamentally constrained by Shockley-Queisser limits to practical values below 30%. This Review assesses the overall prospects for a range of approaches that can potentially exceed these limits, based on ultimate efficiency prospects, material requirements and developmental outlook.

Castable Bulk Metallic Glass Strain Wave Gears: Towards Decreasing the Cost of High-Performance Robotics

PubMed Central

Hofmann, Douglas C.; Polit-Casillas, Raul; Roberts, Scott N.; Borgonia, John-Paul; Dillon, Robert P.; Hilgemann, Evan; Kolodziejska, Joanna; Montemayor, Lauren; Suh, Jong-ook; Hoff, Andrew; Carpenter, Kalind; Parness, Aaron; Johnson, William L.; Kennett, Andrew; Wilcox, Brian

2016-01-01

The use of bulk metallic glasses (BMGs) as the flexspline in strain wave gears (SWGs), also known as harmonic drives, is presented. SWGs are unique, ultra-precision gearboxes that function through the elastic flexing of a thin-walled cup, called a flexspline. The current research demonstrates that BMGs can be cast at extremely low cost relative to machining and can be implemented into SWGs as an alternative to steel. This approach may significantly reduce the cost of SWGs, enabling lower-cost robotics. The attractive properties of BMGs, such as hardness, elastic limit and yield strength, may also be suitable for extreme environment applications in spacecraft. PMID:27883054

Monolithically interconnected GaAs solar cells: A new interconnection technology for high voltage solar cell output

NASA Astrophysics Data System (ADS)

Dinetta, L. C.; Hannon, M. H.

1995-10-01

Photovoltaic linear concentrator arrays can benefit from high performance solar cell technologies being developed at AstroPower. Specifically, these are the integration of thin GaAs solar cell and epitaxial lateral overgrowth technologies with the application of monolithically interconnected solar cell (MISC) techniques. This MISC array has several advantages which make it ideal for space concentrator systems. These are high system voltage, reliable low cost monolithically formed interconnections, design flexibility, costs that are independent of array voltage, and low power loss from shorts, opens, and impact damage. This concentrator solar cell will incorporate the benefits of light trapping by growing the device active layers over a low-cost, simple, PECVD deposited silicon/silicon dioxide Bragg reflector. The high voltage-low current output results in minimal 12R losses while properly designing the device allows for minimal shading and resistance losses. It is possible to obtain open circuit voltages as high as 67 volts/cm of solar cell length with existing technology. The projected power density for the high performance device is 5 kW/m for an AMO efficiency of 26% at 1 5X. Concentrator solar cell arrays are necessary to meet the power requirements of specific mission platforms and can supply high voltage power for electric propulsion systems. It is anticipated that the high efficiency, GaAs monolithically interconnected linear concentrator solar cell array will enjoy widespread application for space based solar power needs. Additional applications include remote man-portable or ultra-light unmanned air vehicle (UAV) power supplies where high power per area, high radiation hardness and a high bus voltage or low bus current are important. The monolithic approach has a number of inherent advantages, including reduced cost per interconnect and increased reliability of array connections. There is also a high potential for a large number of consumer products. Dual-use applications can include battery chargers and remote power supplies for consumer electronics products such as portable telephones/beepers, portable radios, CD players, dashboard radar detectors, remote walkway lighting, etc.

Monolithically interconnected GaAs solar cells: A new interconnection technology for high voltage solar cell output

NASA Technical Reports Server (NTRS)

Dinetta, L. C.; Hannon, M. H.

1995-01-01

Photovoltaic linear concentrator arrays can benefit from high performance solar cell technologies being developed at AstroPower. Specifically, these are the integration of thin GaAs solar cell and epitaxial lateral overgrowth technologies with the application of monolithically interconnected solar cell (MISC) techniques. This MISC array has several advantages which make it ideal for space concentrator systems. These are high system voltage, reliable low cost monolithically formed interconnections, design flexibility, costs that are independent of array voltage, and low power loss from shorts, opens, and impact damage. This concentrator solar cell will incorporate the benefits of light trapping by growing the device active layers over a low-cost, simple, PECVD deposited silicon/silicon dioxide Bragg reflector. The high voltage-low current output results in minimal 12R losses while properly designing the device allows for minimal shading and resistance losses. It is possible to obtain open circuit voltages as high as 67 volts/cm of solar cell length with existing technology. The projected power density for the high performance device is 5 kW/m for an AMO efficiency of 26% at 1 5X. Concentrator solar cell arrays are necessary to meet the power requirements of specific mission platforms and can supply high voltage power for electric propulsion systems. It is anticipated that the high efficiency, GaAs monolithically interconnected linear concentrator solar cell array will enjoy widespread application for space based solar power needs. Additional applications include remote man-portable or ultra-light unmanned air vehicle (UAV) power supplies where high power per area, high radiation hardness and a high bus voltage or low bus current are important. The monolithic approach has a number of inherent advantages, including reduced cost per interconnect and increased reliability of array connections. There is also a high potential for a large number of consumer products. Dual-use applications can include battery chargers and remote power supplies for consumer electronics products such as portable telephones/beepers, portable radios, CD players, dashboard radar detectors, remote walkway lighting, etc.

Natural wind variability triggered drop in German redispatch volume and costs from 2015 to 2016.

PubMed

Wohland, Jan; Reyers, Mark; Märker, Carolin; Witthaut, Dirk

2018-01-01

Avoiding dangerous climate change necessitates the decarbonization of electricity systems within the next few decades. In Germany, this decarbonization is based on an increased exploitation of variable renewable electricity sources such as wind and solar power. While system security has remained constantly high, the integration of renewables causes additional costs. In 2015, the costs of grid management saw an all time high of about € 1 billion. Despite the addition of renewable capacity, these costs dropped substantially in 2016. We thus investigate the effect of natural climate variability on grid management costs in this study. We show that the decline is triggered by natural wind variability focusing on redispatch as a main cost driver. In particular, we find that 2016 was a weak year in terms of wind generation averages and the occurrence of westerly circulation weather types. Moreover, we show that a simple model based on the wind generation time series is skillful in detecting redispatch events on timescales of weeks and beyond. As a consequence, alterations in annual redispatch costs in the order of hundreds of millions of euros need to be understood and communicated as a normal feature of the current system due to natural wind variability.

Multicomponent targeted intervention to prevent delirium in hospitalized older patients: what is the economic value?

PubMed

Rizzo, J A; Bogardus , S T; Leo-Summers, L; Williams, C S; Acampora, D; Inouye, S K

2001-07-01

Delirium, or acute confusional state, is a common and serious occurrence among hospitalized older persons. Current estimates suggest that delirium complicates hospital stays for more than 2.3 million older persons each year, involving more than 17.5 million hospital days and accounting for more than $4 billion (1994 dollars) of Medicare expenditures. A 40% reduction was recently reported in the risk for delirium among hospitalized older persons receiving a multicomponent targeted risk factor intervention (MTI) strategy to prevent delirium, compared with subjects receiving usual hospital care.1 Before recommending that this preventive strategy be implemented in clinical practice, however, the cost implications must be thoroughly examined as well. The present analysis performs net cost evaluations of the MTI for the prevention of delirium among hospitalized patients. Hospital charge and cost-to-charge ratio data are linked to a database of 852 subjects, who were treated with MTI or usual care. Multivariable regression methods were used to help isolate the impact of MTI on hospital costs. These results were then combined with our earlier work on the impact of the MTI on delirium prevention to assess the cost effectiveness of this intervention. The MTI significantly reduced nonintervention costs among subjects at intermediate risk for developing delirium, but not among subjects at high risk. When MTI intervention costs were included, MTI had no significant effect on overall health care costs in the intermediate risk cohort, but raised overall costs in the high risk group. Because the MTI prevented delirium in the intermediate risk group without raising costs, the conclusion reached is that it is a cost effective treatment option for patients at intermediate risk for developing delirium. In contrast, the results suggest that the MTI is not cost effective for subjects at high risk.

The Cost-Effectiveness of the Integration of Nalmefene within the UK Healthcare System Treatment Pathway for Alcohol Dependence.

PubMed

Laramée, Philippe; Bell, Melissa; Irving, Adam; Brodtkorb, Thor-Henrik

2016-05-01

To assess the cost-effectiveness of integrating nalmefene within the treatment pathway for alcohol dependence recommended by the National Institute for Health and Care Excellence in the UK. A Markov model, taking a UK NHS perspective, followed a cohort with alcohol dependence and high/very high drinking risk levels (HVHDRLs), who do not require immediate detoxification and who continue at HVHDRLs after initial assessment, for 5 years. Costs and quality-adjusted life years (QALYs) from treatment with nalmefene plus psychosocial support versus psychosocial support alone were modelled. The consequent incidence of alcohol-attributable harmful events and disease progression, with the possibility of requiring other options or recurrent treatment, were captured. Nalmefene plus psychosocial support dominated psychosocial support alone, with lower costs and increased QALYs after 5 years. Savings are driven by the higher response to nalmefene, and the subsequent lower cost accumulation for alternatives. Nalmefene represents a highly cost-effective treatment option in this population. The analysis shows that integrating nalmefene within the current UK clinical treatment pathway for alcohol dependence could reduce the economic burden on the NHS by limiting harmful events and disease progression. © The Author 2016. Medical Council on Alcohol and Oxford University Press. All rights reserved.

Meeting the milestones. Strategies for including high-value care education in pulmonary and critical care fellowship training.

PubMed

Courtright, Katherine R; Weinberger, Steven E; Wagner, Jason

2015-04-01

Physician decision making is partially responsible for the roughly 30% of U.S. healthcare expenditures that are wasted annually on low-value care. In response to both the widespread public demand for higher-quality care and the cost crisis, payers are transitioning toward value-based payment models whereby physicians are rewarded for high-value, cost-conscious care. Furthermore, to target physicians in training to practice with cost awareness, the Accreditation Council for Graduate Medical Education has created both individual objective milestones and institutional requirements to incorporate quality improvement and cost awareness into fellowship training. Subsequently, some professional medical societies have initiated high-value care educational campaigns, but the overwhelming majority target either medical students or residents in training. Currently, there are few resources available to help guide subspecialty fellowship programs to successfully design durable high-value care curricula. The resource-intensive nature of pulmonary and critical care medicine offers unique opportunities for the specialty to lead in modeling and teaching high-value care. To ensure that fellows graduate with the capability to practice high-value care, we recommend that fellowship programs focus on four major educational domains. These include fostering a value-based culture, providing a robust didactic experience, engaging trainees in process improvement projects, and encouraging scholarship. In doing so, pulmonary and critical care educators can strive to train future physicians who are prepared to provide care that is both high quality and informed by cost awareness.

New strategies for lowering the costs of antiretroviral treatment and care for people with HIV/AIDS in the United Kingdom

PubMed Central

Gazzard, Brian; Moecklinghoff, Christiane; Hill, Andrew

2012-01-01

In the UK, the annual cost of treatment and care for people with human immunodeficiency virus (HIV)/acquired immune deficiency virus (AIDS) rose by over 600% from £104 million in 1997 to £762 million in 2010; approximately two-thirds of the £762 million cost of treatment and care in 2010 was for the procurement of antiretrovirals and other related drugs. The number of people accessing care for HIV/AIDS rose from 22,000 in 2000 to 65,000 in 2009. Adoption of “test and treat” guidelines for treating all HIV-infected people with antiretrovirals would further increase the burden of costs. Given the current economic situation, there is now a new focus on strategies for treatment and care of people with HIV-1 infection which can maintain efficacy but at a lower cost. In this review, we propose three strategies which could potentially lower the costs of treatment and care, ie, stopping testing CD4 counts for patients with full HIV RNA suppression on antiretroviral treatment and recent CD4 counts above 350 cells/μL; more widespread use of generic antiretrovirals as replacements for patients currently taking patented versions; and use of darunavir-ritonavir monotherapy as a switch option for patients with full HIV RNA suppression on other antiretrovirals and no history of virological failure. However, it is important that high standards of clinical care are maintained despite cost-saving measures. Antiretrovirals with generic alternatives may have toxicity issues, eg, zidovudine and nevirapine. There could be ethical issues in starting patients on these drugs if they are currently tolerating other treatments. The use of darunavir-ritonavir monotherapy is not consistently recommended in international HIV treatment guidelines. PMID:22888265

The Efficiency of Increasing the Capacity of Physiotherapy Screening Clinics or Traditional Medical Services to Address Unmet Demand in Orthopaedic Outpatients: A Practical Application of Discrete Event Simulation with Dynamic Queuing.

PubMed

Standfield, L; Comans, T; Raymer, M; O'Leary, S; Moretto, N; Scuffham, P

2016-08-01

Hospital outpatient orthopaedic services traditionally rely on medical specialists to assess all new patients to determine appropriate care. This has resulted in significant delays in service provision. In response, Orthopaedic Physiotherapy Screening Clinics and Multidisciplinary Services (OPSC) have been introduced to assess and co-ordinate care for semi- and non-urgent patients. To compare the efficiency of delivering increased semi- and non-urgent orthopaedic outpatient services through: (1) additional OPSC services; (2) additional traditional orthopaedic medical services with added surgical resources (TOMS + Surg); or (3) additional TOMS without added surgical resources (TOMS - Surg). A cost-utility analysis using discrete event simulation (DES) with dynamic queuing (DQ) was used to predict the cost effectiveness, throughput, queuing times, and resource utilisation, associated with introducing additional OPSC or TOMS ± Surg versus usual care. The introduction of additional OPSC or TOMS (±surgery) would be considered cost effective in Australia. However, OPSC was the most cost-effective option. Increasing the capacity of current OPSC services is an efficient way to improve patient throughput and waiting times without exceeding current surgical resources. An OPSC capacity increase of ~100 patients per month appears cost effective (A$8546 per quality-adjusted life-year) and results in a high level of OPSC utilisation (98 %). Increasing OPSC capacity to manage semi- and non-urgent patients would be cost effective, improve throughput, and reduce waiting times without exceeding current surgical resources. Unlike Markov cohort modelling, microsimulation, or DES without DQ, employing DES-DQ in situations where capacity constraints predominate provides valuable additional information beyond cost effectiveness to guide resource allocation decisions.

Fourfold increased detection of Lynch syndrome by raising age limit for tumour genetic testing from 50 to 70 years is cost-effective.

PubMed

Sie, A S; Mensenkamp, A R; Adang, E M M; Ligtenberg, M J L; Hoogerbrugge, N

2014-10-01

Recognising colorectal cancer (CRC) patients with Lynch syndrome (LS) can increase life expectancy of these patients and their close relatives. To improve identification of this under-diagnosed disease, experts suggested raising the age limit for CRC tumour genetic testing from 50 to 70 years. The present study evaluates the efficacy and cost-effectiveness of this strategy. Probabilistic efficacy and cost-effectiveness analyses were carried out comparing tumour genetic testing of CRC diagnosed at age 70 or below (experimental strategy) versus CRC diagnosed at age 50 or below (current practice). The proportions of LS patients identified and cost-effectiveness including cascade screening of relatives, were calculated by decision analytic models based on real-life data. Using the experimental strategy, four times more LS patients can be identified among CRC patients when compared with current practice. Both the costs to detect one LS patient (€9437/carrier versus €4837/carrier), and the number needed to test for detecting one LS patient (42 versus 19) doubled. When family cascade screening was included, the experimental strategy was found to be highly cost-effective according to Dutch standards, resulting in an overall ratio of €2703 per extra life-year gained in additionally tested patients. Testing all CRC tumours diagnosed at or below age 70 for LS is cost-effective. Implementation is important as relatives from the large number of LS patients that are missed by current practice, can benefit from life-saving surveillance. © The Author 2014. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

[Cost of an intraperitoneal chemohyperthermia (IPCH) related to cytoreductive surgery].

PubMed

Bonastre, J; Jan, P; de Pouvourville, G; Pocard, M; Estphan, G; Elias, D

2005-10-01

A complete cytoreductive surgery followed with an intraperitoneal chemohyperthermia (IPCH) is a new treatment allowing curing some patients with a peritoneal carcinomatosis. The cost of this treatment, evaluated in different countries, is high. In France, we do not have any cost evaluation of this therapy, and this state slows its diffusion in our country. The aim of this study is to evaluate the real cost of maximal cytoreductive surgery with IPCH, and to compare it with the financial support given by the Ministery of Health. The real cost of this therapy was established on the standard analytic accountancy of our Institute. The analysis of the financial support received was done after the classification of the patients in the current official diagnosis-related groups, and according to the current rates of reimbursing of these acts. Seventy-three patients were treated with IPCH in our Institute during 2002 and 2003. The real mean cost for our hospital was 39,358 euros per patient, with a mean hospital staying of 27.7 days. In counterpart, our hospital received a mean financial support of 20,485 euros, resulting in a deficit of 18,873 euros per patient (and close to 1.4 million of euros for the two years). Our current classification of diagnosis-related groups does not allow to describe the real importance of this therapy which combines a maximal cytoreductive surgery with IPCH. In our system of reimbursing, the hospital which offers this type of new therapy to its patients receives only half of the real rate. Two correctives measures are suitable: to describe this combining treatment in the official list of medical acts, and to determine its specific cost for reimbursing.

Survey of coatings for solar collectors. [ceramic enamels and chromium

NASA Technical Reports Server (NTRS)

Mcdonald, G. E.

1974-01-01

Ceramic enamel is found to be more solar selective, (i.e., has high solar absorptance in combination with low infrared emittance) than organic enamel, but neither is as solar selective as black chrome, black copper, black zinc, or black nickel. Ceramic enamel is matched only by black chrome in durability and wide availability. Ceramic enamel and organic enamel have approximately the same cost, and both are currently slightly lower in cost than black chrome, black copper, or black zinc. Black nickel is relatively unavailable and, because of that, realistic cost comparisons are not possible.

Impact of childhood obesity on employers.

PubMed

Sepulveda, Martin-J; Tait, Fan; Zimmerman, Edward; Edington, Dee

2010-01-01

The impact of childhood obesity on the workplace is not well understood. A study conducted for one large employer indicated that average per capita health insurance claims costs were as high as $2,907 in 2008 for an obese child and $10,789 for a child with type II diabetes. The average claims cost for children with type II diabetes actually exceeded the level of the average claims cost for adults with type II diabetes ($8,844). This paper reviews the evidence on the impact of childhood obesity on employers and discusses opportunities for business engagement-including two current examples of activities involving employers.

Lithium-antimony-lead liquid metal battery for grid-level energy storage

NASA Astrophysics Data System (ADS)

Wang, Kangli; Jiang, Kai; Chung, Brice; Ouchi, Takanari; Burke, Paul J.; Boysen, Dane A.; Bradwell, David J.; Kim, Hojong; Muecke, Ulrich; Sadoway, Donald R.

2014-10-01

The ability to store energy on the electric grid would greatly improve its efficiency and reliability while enabling the integration of intermittent renewable energy technologies (such as wind and solar) into baseload supply. Batteries have long been considered strong candidate solutions owing to their small spatial footprint, mechanical simplicity and flexibility in siting. However, the barrier to widespread adoption of batteries is their high cost. Here we describe a lithium-antimony-lead liquid metal battery that potentially meets the performance specifications for stationary energy storage applications. This Li||Sb-Pb battery comprises a liquid lithium negative electrode, a molten salt electrolyte, and a liquid antimony-lead alloy positive electrode, which self-segregate by density into three distinct layers owing to the immiscibility of the contiguous salt and metal phases. The all-liquid construction confers the advantages of higher current density, longer cycle life and simpler manufacturing of large-scale storage systems (because no membranes or separators are involved) relative to those of conventional batteries. At charge-discharge current densities of 275 milliamperes per square centimetre, the cells cycled at 450 degrees Celsius with 98 per cent Coulombic efficiency and 73 per cent round-trip energy efficiency. To provide evidence of their high power capability, the cells were discharged and charged at current densities as high as 1,000 milliamperes per square centimetre. Measured capacity loss after operation for 1,800 hours (more than 450 charge-discharge cycles at 100 per cent depth of discharge) projects retention of over 85 per cent of initial capacity after ten years of daily cycling. Our results demonstrate that alloying a high-melting-point, high-voltage metal (antimony) with a low-melting-point, low-cost metal (lead) advantageously decreases the operating temperature while maintaining a high cell voltage. Apart from the fact that this finding puts us on a desirable cost trajectory, this approach may well be more broadly applicable to other battery chemistries.

Lithium-antimony-lead liquid metal battery for grid-level energy storage.

PubMed

Wang, Kangli; Jiang, Kai; Chung, Brice; Ouchi, Takanari; Burke, Paul J; Boysen, Dane A; Bradwell, David J; Kim, Hojong; Muecke, Ulrich; Sadoway, Donald R

2014-10-16

The ability to store energy on the electric grid would greatly improve its efficiency and reliability while enabling the integration of intermittent renewable energy technologies (such as wind and solar) into baseload supply. Batteries have long been considered strong candidate solutions owing to their small spatial footprint, mechanical simplicity and flexibility in siting. However, the barrier to widespread adoption of batteries is their high cost. Here we describe a lithium-antimony-lead liquid metal battery that potentially meets the performance specifications for stationary energy storage applications. This Li||Sb-Pb battery comprises a liquid lithium negative electrode, a molten salt electrolyte, and a liquid antimony-lead alloy positive electrode, which self-segregate by density into three distinct layers owing to the immiscibility of the contiguous salt and metal phases. The all-liquid construction confers the advantages of higher current density, longer cycle life and simpler manufacturing of large-scale storage systems (because no membranes or separators are involved) relative to those of conventional batteries. At charge-discharge current densities of 275 milliamperes per square centimetre, the cells cycled at 450 degrees Celsius with 98 per cent Coulombic efficiency and 73 per cent round-trip energy efficiency. To provide evidence of their high power capability, the cells were discharged and charged at current densities as high as 1,000 milliamperes per square centimetre. Measured capacity loss after operation for 1,800 hours (more than 450 charge-discharge cycles at 100 per cent depth of discharge) projects retention of over 85 per cent of initial capacity after ten years of daily cycling. Our results demonstrate that alloying a high-melting-point, high-voltage metal (antimony) with a low-melting-point, low-cost metal (lead) advantageously decreases the operating temperature while maintaining a high cell voltage. Apart from the fact that this finding puts us on a desirable cost trajectory, this approach may well be more broadly applicable to other battery chemistries.

Miniature Reservoir Cathode: An Update

NASA Technical Reports Server (NTRS)

Vancil, Bernard K.; Wintucky, Edwin G.

2002-01-01

We report on recent work to produce a small low power, low cost reservoir cathode capable of long life (more than 100,000 hours) at high loading (> 5 A/sq cm). Our objective is a highly manufacturable, commercial device costing less than $30. Small highly loaded cathodes are needed, especially for millimeter wave tubes, where focusing becomes difficult when area convergence ratios are too high. We currently have 3 models ranging from .060-inch diameter to. 125-inch diameter. Reservoir type barium dispenser cathodes have a demonstrated capability for simultaneous high emission density and long life. Seven reservoir cathodes continue to operate on the cathode life test facility at NSWC, Crane, Indiana at 2 and 4 amps/sq cm. They have accumulated nearly 100,000 hours with practically no change in emission levels or knee temperature.

Cost-Effectiveness of Different Strategies to Monitor Adults on Antiretroviral Treatment: A Combined Analysis of Three Mathematical Models

PubMed Central

Keebler, Daniel; Revill, Paul; Braithwaite, Scott; Phillips, Andrew; Blaser, Nello; Borquez, Annick; Cambiano, Valentina; Ciaranello, Andrea; Estill, Janne; Gray, Richard; Hill, Andrew; Keiser, Olivia; Kessler, Jason; Menzies, Nicolas A; Nucifora, Kimberly A; Vizcaya, Luisa Salazar; Walker, Simon; Welte, Alex; Easterbrook, Philippa; Doherty, Meg; Hirnschall, Gottfried; Hallett, Timothy B

2015-01-01

Background The WHO’s 2013 revisions to its Consolidated Guidelines on ARVs will recommend routine viral load monitoring (VLM), rather than clinical or immunological monitoring, as the preferred monitoring approach on the basis of clinical evidence. However, HIV programmes in resource-limited settings require guidance on the most cost-effective use of resources given other competing priorities, including expansion of ART coverage. Here we assess the cost-effectiveness of alternative patient monitoring strategies. Methods A range of monitoring strategies was evaluated, including clinical, CD4 and viral load monitoring alone and together at different frequencies and with different criteria for switching to second-line therapies. Three independently-constructed and validated models were analysed simultaneously. Costs were estimated based on resource use projected in the models and associated unit costs; impact was quantified as disability-adjusted life years (DALYs) averted. Alternatives were compared using incremental cost-effectiveness analysis. Results All models show that clinical monitoring delivers significant benefit compared to a hypothetical baseline scenario with no monitoring or switching. Regular CD4 cell count monitoring confers a benefit over clinical monitoring alone, at an incremental cost that makes it affordable in more settings than VLM, which is currently more expensive. VLM without CD4 every six to 12 months provides the greatest reductions in morbidity and mortality, but incurs a high cost per DALY averted, resulting in lost opportunities to generate health gains if implemented instead of increasing ART coverage or expanding ART eligibility. Interpretation The priority for HIV programmes should be to expand ART coverage, firstly at CD4 <350 cells and then at CD4 <500, using lower-cost clinical or CD4 monitoring. At current costs, VLM should be considered only after high ART coverage has been achieved. Point-of-care technologies and other factors reducing costs may make VLM more affordable in future. Funding The HIV Modelling Consortium is funded by the Bill and Melinda Gates Foundation. Funding for this work was also provided by the World Health Organization. PMID:25104633

Distributional cost-effectiveness analysis in low- and middle-income countries: illustrative example of rotavirus vaccination in Ethiopia.

PubMed

Dawkins, Bryony R; Mirelman, Andrew J; Asaria, Miqdad; Johansson, Kjell Arne; Cookson, Richard A

2018-04-01

Reducing health inequality is a major policy concern for low- and middle-income countries (LMICs) on the path to universal health coverage. However, health inequality impacts are rarely quantified in cost-effectiveness analyses of health programmes. Distributional cost-effectiveness analysis (DCEA) is a method developed to analyse the expected social distributions of costs and health benefits, and the potential trade-offs that may exist between maximising total health and reducing health inequality. This is the first paper to show how DCEA can be applied in LMICs. Using the introduction of rotavirus vaccination in Ethiopia as an illustrative example, we analyse a hypothetical re-designed vaccination programme, which invests additional resources into vaccine delivery in rural areas, and compare this with the standard programme currently implemented in Ethiopia. We show that the re-designed programme has an incremental cost-effectiveness ratio of US$69 per health-adjusted life year (HALY) compared with the standard programme. This is potentially cost-ineffective when compared with current estimates of health opportunity cost in Ethiopia. However, rural populations are typically less wealthy than urban populations and experience poorer lifetime health. Prioritising such populations can thus be seen as being equitable. We analyse the trade-off between cost-effectiveness and equity using the Atkinson inequality aversion parameter, ε, representing the decision maker's strength of concern for reducing health inequality. We find that the more equitable programme would be considered worthwhile by a decision maker whose inequality concern is greater than ε = 5.66, which at current levels of health inequality in Ethiopia implies that health gains are weighted at least 3.86 times more highly in the poorest compared with the richest wealth quintile group. We explore the sensitivity of this conclusion to a range of assumptions and cost-per-HALY threshold values, to illustrate how DCEA can inform the thinking of decision makers and stakeholders about health equity trade-offs.

Cost-effectiveness of active transport for primary school children - Walking School Bus program.

PubMed

Moodie, Marjory; Haby, Michelle; Galvin, Leah; Swinburn, Boyd; Carter, Robert

2009-09-14

To assess from a societal perspective the incremental cost-effectiveness of the Walking School Bus (WSB) program for Australian primary school children as an obesity prevention measure. The intervention was modelled as part of the ACE-Obesity study, which evaluated, using consistent methods, thirteen interventions targeting unhealthy weight gain in Australian children and adolescents. A logic pathway was used to model the effects on body mass index [BMI] and disability-adjusted life years [DALYs] of the Victorian WSB program if applied throughout Australia. Cost offsets and DALY benefits were modelled until the eligible cohort reached 100 years of age or death. The reference year was 2001. Second stage filter criteria ('equity', 'strength of evidence', 'acceptability', feasibility', sustainability' and 'side-effects') were assessed to incorporate additional factors that impact on resource allocation decisions. The modelled intervention reached 7,840 children aged 5 to 7 years and cost $AUD22.8M ($16.6M; $30.9M). This resulted in an incremental saving of 30 DALYs (7:104) and a net cost per DALY saved of $AUD0.76M ($0.23M; $3.32M). The evidence base was judged as 'weak' as there are no data available documenting the increase in the number of children walking due to the intervention. The high costs of the current approach may limit sustainability. Under current modelling assumptions, the WSB program is not an effective or cost-effective measure to reduce childhood obesity. The attribution of some costs to non-obesity objectives (reduced traffic congestion and air pollution etc.) is justified to emphasise the other possible benefits. The program's cost-effectiveness would be improved by more comprehensive implementation within current infrastructure arrangements. The importance of active transport to school suggests that improvements in WSB or its variants need to be developed and fully evaluated.

Cost-effectiveness of active transport for primary school children - Walking School Bus program

PubMed Central

Moodie, Marjory; Haby, Michelle; Galvin, Leah; Swinburn, Boyd; Carter, Robert

2009-01-01

Background To assess from a societal perspective the incremental cost-effectiveness of the Walking School Bus (WSB) program for Australian primary school children as an obesity prevention measure. The intervention was modelled as part of the ACE-Obesity study, which evaluated, using consistent methods, thirteen interventions targeting unhealthy weight gain in Australian children and adolescents. Methods A logic pathway was used to model the effects on body mass index [BMI] and disability-adjusted life years [DALYs] of the Victorian WSB program if applied throughout Australia. Cost offsets and DALY benefits were modelled until the eligible cohort reached 100 years of age or death. The reference year was 2001. Second stage filter criteria ('equity', 'strength of evidence', 'acceptability', feasibility', sustainability' and 'side-effects') were assessed to incorporate additional factors that impact on resource allocation decisions. Results The modelled intervention reached 7,840 children aged 5 to 7 years and cost $AUD22.8M ($16.6M; $30.9M). This resulted in an incremental saving of 30 DALYs (7:104) and a net cost per DALY saved of $AUD0.76M ($0.23M; $3.32M). The evidence base was judged as 'weak' as there are no data available documenting the increase in the number of children walking due to the intervention. The high costs of the current approach may limit sustainability. Conclusion Under current modelling assumptions, the WSB program is not an effective or cost-effective measure to reduce childhood obesity. The attribution of some costs to non-obesity objectives (reduced traffic congestion and air pollution etc.) is justified to emphasise the other possible benefits. The program's cost-effectiveness would be improved by more comprehensive implementation within current infrastructure arrangements. The importance of active transport to school suggests that improvements in WSB or its variants need to be developed and fully evaluated. PMID:19747402

An early deployment strategy for carbon capture, utilisation, and storage

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

Carter, L.D.

2012-11-01

This report describes the current use of CO2 for EOR, and discusses potential expansion of EOR using CO2 from power plants. Analysis of potential EOR development in the USA, where most current CO2-based EOR production takes place, indicates that relatively low cost, traditional sources of CO2 for EOR (CO2 domes and CO2 from natural gas processing plants) are insufficient to exploit the full potential of EOR. To achieve that full potential will require use of CO2 from combustion and gasification systems, such as fossil fuel power plants, where capture of CO2 is more costly. The cost of current CCUS systems,more » even with the revenue stream for sale of the CO2 for EOR, is too high to result in broad deployment of the technology in the near term. In the longer term, research and development may be sufficient to reduce CO2 capture costs to a point where CCUS would be broadly deployed. This report describes a case study of conditions in the USA to explore a financial incentive to promote early deployment of CCUS, providing a range of immediate benefits to society, greater likelihood of reducing the long-term cost of CCUS, and greater likelihood of broad deployment of CCUS and CCS in the long term. Additionally, it may be possible to craft such an incentive in a manner that its cost is more than offset by taxes flowing from increased domestic oil production. An example of such an incentive is included in this report.« less

Cost-effectiveness and population outcomes of general population screening for hepatitis C.

PubMed

Coffin, Phillip O; Scott, John D; Golden, Matthew R; Sullivan, Sean D

2012-05-01

Current US guidelines recommend limiting hepatitis C virus (HCV) screening to high-risk individuals, and 50%-75% of infected persons remain unaware of their status. To estimate the cost-effectiveness and population-level impact of adding one-time HCV screening of US population aged 20-69 years to current guidelines, we developed a decision analytic model for the screening intervention and Markov model with annual transitions to estimate natural history. Subanalyses included protease inhibitor therapy and screening those at highest risk of infection (birth year 1945-1965). We relied on published literature and took a lifetime, societal perspective. Compared to current guidelines, incremental cost per quality-adjusted life year gained (ICER) was $7900 for general population screening and $4200 for screening by birth year, which dominated general population screening if cost, clinician uptake, and median age of diagnoses were assumed equivalent. General population screening remained cost-effective in all one-way sensitivity analyses, 30 000 Monte Carlo simulations, and scenarios in which background mortality was doubled, all genotype 1 patients were treated with protease inhibitors, and most parameters were set unfavorable to increased screening. ICER was lowest if screening was applied to a population with liver fibrosis similar to 2010 estimates. Approximately 1% of liver-related deaths would be averted per 15% of the general population screened; the impact would be greater with improved referral, treatment uptake, and cure. Broader screening for HCV would likely be cost-effective, but significantly reducing HCV-related morbidity and mortality would also require improved rates of referral, treatment, and cure.

Current trends in treatment of hypertension in Karachi and cost minimization possibilities.

PubMed

Hussain, Izhar M; Naqvi, Baqir S; Qasim, Rao M; Ali, Nasir

2015-01-01

This study finds out drug usage trends in Stage I Hypertensive Patients without any compelling indications in Karachi, deviations of current practices from evidence based antihypertensive therapeutic guidelines and looks for cost minimization opportunities. In the present study conducted during June 2012 to August 2012, two sets were used. Randomized stratified independent surveys were conducted in doctors and general population - including patients, using pretested questionnaires. Sample sizes for doctors and general population were 100 and 400 respectively. Statistical analysis was conducted on Statistical Package for Social Science (SPSS). Financial impact was also analyzed. On the basis of patients' doctors' feedback, Beta Blockers, and Angiotensin Converting Enzyme Inhibitors were used more frequently than other drugs. Thiazides and low-priced generics were hardly prescribed. Beta blockers were prescribed widely and considered cost effective. This trend increases cost by two to ten times. Feedbacks showed that therapeutic guidelines were not followed by the doctors practicing in the community and hospitals in Karachi. Thiazide diuretics were hardly used. Beta blockers were widely prescribed. High priced market leaders or expensive branded generics were commonly prescribed. Therefore, there are great opportunities for cost minimization by using evidence-based clinically effective and safe medicines.

Comparative analysis of the current payment system for hospital services in Serbia and projected payments under diagnostic related groups system in urology.

PubMed

Babić, Uroš; Soldatović, Ivan; Vuković, Dejana; Milićević, Milena Šantrić; Stjepanović, Mihailo; Kojić, Dejan; Argirović, Aleksandar; Vukotić, Vinka

2015-03-01

Global budget per calendar year is a traditional method of funding hospitals in Serbia. Diagnose related groups (DGR) is a method of hospital payment based on classification of patients into groups with clinically similar problems and similar utilization of hospital resources. The aim of this study was to compare current methods of hospital services payment with the projected costs by DRG payment method in urology. The data were obtained from the information system used in the Clinical Hospital Center "Dr. Dragiša Mišović"--Dedinje in Belgrade, Serbia. The implemented hospital information system was the main criterion for selection of healthcare institutions. The study included 994 randomly selected patients treated surgically and conservatively in 2012. Average costs under the current payment method were slightly higher than those projected by DRG, however, the variability was twice as high (54,111 ± 69,789 compared to 53,434 ± 32,509, p < 0.001) respectively. The univariate analysis showed that the highest correlation with the current payment method as well as with the projected one by DRG was observed in relation to the number of days of hospitalization (ρ = 0.842, p < 0.001, and ρ = 0.637, p < 0.001, respectively). Multivariate regression models confirmed the influence of the number of hospitalization days to costs under the current payment system (β = 0.843, p < 0.001) as well as under the projected DRG payment system (β = 0.737, p < 0.001). The same predictor was crucial for the difference in the current payment method and the pro- jected DRG payment methods (β = 0.501, p < 0.001). Payment under the DRG system is administratively more complex because it requires detailed and standardized coding of diagnoses and procedures, as well as the information on the average consumption of resources (costs) per DRG. Given that aggregate costs of treatment under two hospital payment methods compared in the study are not significantly different, the focus on minor surgeries both under the current hospital payment method and under the introduced DRG system would be far more cost-effective for a hospital as great variations in treatment performance (reductions of days of hospitalization and complications), and consequently invoiced amounts would be reduced.

Brominated Flame Retardants

EPA Science Inventory

Brominated flame retardants (BFRs) belong to a large class of compounds known as organohalogens. BFRs are currently the largest marketed flame retardant group due to their high performance efficiency and low cost. In the commercial market, more than 75 different BFRs are recogniz...

The cost-effectiveness of expanding intensive behavioural intervention to all autistic children in Ontario: in the past year, several court cases have been brought against provincial governments to increase funding for Intensive Behavioural Intervention (IBI). This economic evaluation examines the costs and consequences of expanding an IBI program.

PubMed

Motiwala, Sanober S; Gupta, Shamali; Lilly, Meredith B; Ungar, Wendy J; Coyte, Peter C

2006-01-01

Intensive Behavioural Intervention (IBI) describes behavioural therapies provided to autistic children to overcome intellectual and functional disabilities. The high cost of IBI has caused concern regarding access, and recently, several court cases have been brought against provincial governments to increase funding for this intervention. This economic evaluation assessed the costs and consequences of expanding an IBI program from current coverage for one-third of children to all autistic children aged two to five in Ontario, Canada. Data on the hours and costs of IBI, and costs of educational and respite services, were obtained from the government. Data on program efficacy were obtained from the literature. These data were modelled to determine the incremental cost savings and gains in dependency-free life years. Total savings from expansion of the current program were $45,133,011 in 2003 Canadian dollars. Under our model parameters, expansion of IBI to all eligible children represents a cost-saving policy whereby total costs of care for autistic individuals are lower and gains in dependency-free life years are higher. Sensitivity analyses carried out to address uncertainty and lack of good evidence for IBI efficacy and appropriate discount rates yielded mixed results: expansion was not cost saving with discount rates of 5% or higher and with lower IBI efficacy beyond a certain threshold. Further research on the efficacy of IBI is recommended.

Monitoring the quality of welding based on welding current and ste analysis

NASA Astrophysics Data System (ADS)

Mazlan, Afidatusshimah; Daniyal, Hamdan; Izzani Mohamed, Amir; Ishak, Mahadzir; Hadi, Amran Abdul

2017-10-01

Qualities of welding play an important part in industry especially in manufacturing field. Post-welding non-destructive test is one of the importance process to ensure the quality of welding but it is time consuming and costly. To reduce the chance of defects, online monitoring had been utilized by continuously sense some of welding parameters and predict welding quality. One of the parameters is welding current, which is rich of information but lack of study focus on extract them at signal analysis level. This paper presents the analysis of welding current using Short Time Energy (STE) signal processing to quantify the pattern of the current. GMAW set with carbon steel specimens are used in this experimental study with high-bandwidth and high sampling rate oscilloscope capturing the welding current. The results indicate welding current as signatures have high correlation with the welding process. Continue with STE analysis, the value below 5000 is declare as good welding, meanwhile the STE value more than 6000 is contained defect.

Clinical and economic impact of various strategies for varicella immunity screening and vaccination of health care personnel.

PubMed

Baracco, G J; Eisert, S; Saavedra, S; Hirsch, P; Marin, M; Ortega-Sanchez, I R

2015-10-01

Exposure to patients with varicella or herpes zoster causes considerable disruption to a health care facility's operations and has a significant health and economic impact. However, practices related to screening for immunity and immunization of health care personnel (HCP) for varicella vary widely. A decision tree model was built to evaluate the cost-effectiveness of 8 different strategies of screening and vaccinating HCP for varicella. The outcomes are presented as probability of acquiring varicella, economic impact of varicella per employee per year, and cost to prevent additional cases of varicella. Monte Carlo simulations and 1-way sensitivity analyses were performed to address the uncertainties inherent to the model. Alternative epidemiologic and technologic scenarios were also analyzed. Performing a clinical screening followed by serologic testing of HCP with negative history diminished the cost impact of varicella by >99% compared with not having a program. Vaccinating HCP with negative screen cost approximately $50,000 per case of varicella prevented at the current level of U.S. population immunity, but was projected to be cost-saving at 92% or lower immunity prevalence. Improving vaccine acceptance rates and using highly sensitive assays also optimize cost-effectiveness. Strategies relying on screening and vaccinating HCP for varicella on employment were shown to be cost-effective for health care facilities and are consistent with current national guidelines for varicella prevention. Published by Elsevier Inc.

Analysis of the costs of dialysis and the effects of an incentive mechanism for low-cost dialysis modalities.

PubMed

Cleemput, Irina; De Laet, Chris

2013-05-01

Treatment costs of end-stage renal disease with dialysis are high and vary between dialysis modalities. Public healthcare payers aim at stimulating the use of less expensive dialysis modalities, with maintenance of healthcare quality. This study examines the effects of Belgian financial incentive mechanisms for the use of low-cost dialysis treatments. First, the costs of different dialysis modalities were calculated from the hospital's perspective. Data were obtained through a hospital survey. The balance between costs and revenues was simulated for an average Belgian dialysis programme. Incremental profits were calculated in function of the proportion of patients on alternative dialysis modalities. Hospital haemodialysis is the most expensive modality per patient year, followed by peritoneal dialysis and finally satellite haemodialysis. Under current reimbursement rules mean profits of a dialysis programme are maximal if about 28% of patients are treated with a low-cost dialysis modality. This is only slightly lower than the observed percentage in Belgian dialysis centres in the same period. In Belgium, the financial incentives for the use of low-cost dialysis modalities only had a modest impact due to the continuing profits that could be generated by high-cost dialysis. Profit neutrality is crucial for the success of any financial incentive mechanism for low-cost dialysis modalities. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

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.

Cost effectiveness and value of information analyses of islet cell transplantation in the management of 'unstable' type 1 diabetes mellitus.

PubMed

Wallner, Klemens; Shapiro, A M James; Senior, Peter A; McCabe, Christopher

2016-04-09

Islet cell transplantation is a method to stabilize type 1 diabetes patients with hypoglycemia unawareness and unstable blood glucose levels by reducing insulin dependency and protecting against severe hypoglycemia through restoring endogenous insulin secretion. This study analyses the current cost-effectiveness of this technology and estimates the value of further research to reduce uncertainty around cost-effectiveness. We performed a cost-utility analysis using a Markov cohort model with a mean patient age of 49 to simulate costs and health outcomes over a life-time horizon. Our analysis used intensive insulin therapy (IIT) as comparator and took the provincial healthcare provider perspective. Cost and effectiveness data for up to four transplantations per patient came from the University of Alberta hospital. Costs are expressed in 2012 Canadian dollars and effectiveness in quality-adjusted life-years (QALYs) and life years. To characterize the uncertainty around expected outcomes, we carried out a probabilistic sensitivity analysis within the Bayesian decision-analytic framework. We performed a value-of-information analysis to identify priority areas for future research under various scenarios. We applied a structural sensitivity analysis to assess the dependence of outcomes on model characteristics. Compared to IIT, islet cell transplantation using non-generic (generic) immunosuppression had additional costs of $150,006 ($112,023) per additional QALY, an average gain of 3.3 life years, and a probability of being cost-effective of 0.5 % (28.3 %) at a willingness-to-pay threshold of $100,000 per QALY. At this threshold the non-generic technology has an expected value of perfect information (EVPI) of $260,744 for Alberta. This increases substantially in cost-reduction scenarios. The research areas with the highest partial EVPI are costs, followed by natural history, and effectiveness and safety. Current transplantation technology provides substantial improvements in health outcomes over conventional therapy for highly selected patients with 'unstable' type 1 diabetes. However, it is much more costly and so is not cost-effective. The value of further research into the cost-effectiveness is dependent upon treatment costs. Further, we suggest the value of information should not only be derived from current data alone when knowing that this data will most likely change in the future.

Cost-Effectiveness of High Dose Hemodialysis in Comparison to Conventional In-Center Hemodialysis in the Netherlands.

PubMed

Beby, Anna Trisia; Cornelis, Tom; Zinck, Raymund; Liu, Frank Xiaoqing

2016-11-01

In the Netherlands, the current standard of care for treating patients with end-stage renal disease is three sessions of in-center hemodialysis (conventional ICHD). However, the literature indicates that high dose hemodialysis (high dose HD) may provide better health outcome such as survival and quality of life. The objective of this study was to determine the cost-effectiveness of high dose HD, both in-center and at home, in comparison to conventional ICHD from a Dutch payer's perspective over a 5 year period. Additionally, the cost-effectiveness of conventional HD at home in comparison to conventional ICHD will be analysed. A Markov model was developed assuming 28-day treatment cycles and was populated with data from Dutch and international renal registries, official tariffs and medical literature. Univariable and probabilistic sensitivity analyses were performed to test the robustness of the results. Using publicly available tariffs from the Dutch Healthcare Authority (Nederlandse Zorgautoriteit) of 2015, doing high dose ICHD instead of conventional ICHD shows an incremental cost-effectiveness ratio (ICER) of €275,747 per quality-adjusted life year (QALY) gained. In contrast, the ICER of high dose HD at home in comparison to conventional ICHD is €3248 per gained QALY. The final analysis shows that conventional HD at home is less costly per patient (-€3063) than conventional ICHD and results in health benefit improvement (+0.249 QALYs), and is therefore regarded as cost saving. Treating dialysis patients with conventional HD at home shows to be cost saving in comparison to conventional ICHD. However, the magnitude of clinical benefit of high dose HD at home is over two times greater than the clinical benefit of conventional HD at home. According to our analysis, from a payer's perspective, high dose HD should be offered as a home therapy to obtain its clinical benefits in a cost-effective manner. Future research should consider our findings alongside societal factors, such as patient preference, monitoring cost for the home patient, productivity loss and capacity. Baxter BV, The Netherlands.

Hospital financing: calculating inpatient capital costs in Germany with a comparative view on operating costs and the English costing scheme.

PubMed

Vogl, Matthias

2014-04-01

The paper analyzes the German inpatient capital costing scheme by assessing its cost module calculation. The costing scheme represents the first separated national calculation of performance-oriented capital cost lump sums per DRG. The three steps in the costing scheme are reviewed and assessed: (1) accrual of capital costs; (2) cost-center and cost category accounting; (3) data processing for capital cost modules. The assessment of each step is based on its level of transparency and efficiency. A comparative view on operating costing and the English costing scheme is given. Advantages of the scheme are low participation hurdles, low calculation effort for G-DRG calculation participants, highly differentiated cost-center/cost category separation, and advanced patient-based resource allocation. The exclusion of relevant capital costs, nontransparent resource allocation, and unclear capital cost modules, limit the managerial relevance and transparency of the capital costing scheme. The scheme generates the technical premises for a change from dual financing by insurances (operating costs) and state (capital costs) to a single financing source. The new capital costing scheme will intensify the discussion on how to solve the current investment backlog in Germany and can assist regulators in other countries with the introduction of accurate capital costing. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Calculating when elective abdominal aortic aneurysm repair improves survival for individual patients: development of the Aneurysm Repair Decision Aid and economic evaluation.

PubMed

Grant, Stuart W; Sperrin, Matthew; Carlson, Eric; Chinai, Natasha; Ntais, Dionysios; Hamilton, Matthew; Dunn, Graham; Buchan, Iain; Davies, Linda; McCollum, Charles N

2015-04-01

Abdominal aortic aneurysm (AAA) repair aims to prevent premature death from AAA rupture. Elective repair is currently recommended when AAA diameter reaches 5.5 cm (men) and 5.0 cm (women). Applying population-based indications may not be appropriate for individual patient decisions, as the optimal indication is likely to differ between patients based on age and comorbidities. To develop an Aneurysm Repair Decision Aid (ARDA) to indicate when elective AAA repair optimises survival for individual patients and to assess the cost-effectiveness and associated uncertainty of elective repair at the aneurysm diameter recommended by the ARDA compared with current practice. The UK Vascular Governance North West and National Vascular Database provided individual patient data to develop predictive models for perioperative mortality and survival. Data from published literature were used to model AAA growth and risk of rupture. The cost-effectiveness analysis used data from published literature and from local and national databases. A combination of systematic review methods and clinical registries were used to provide data to populate models and inform the structure of the ARDA. Discrete event simulation (DES) was used to model the patient journey from diagnosis to death and synthesised data were used to estimate patient outcomes and costs for elective repair at alternative aneurysm diameters. Eight patient clinical scenarios (vignettes) were used as exemplars. The DES structure was validated by clinical and statistical experts. The economic evaluation estimated costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) from the NHS, social care provider and patient perspective over a lifetime horizon. Cost-effectiveness acceptability analyses and probabilistic sensitivity analyses explored uncertainty in the data and the value for money of ARDA-based decisions. The ARDA outcome measures include perioperative mortality risk, annual risk of rupture, 1-, 5- and 10-year survival, postoperative long-term survival, median life expectancy and predicted time to current threshold for aneurysm repair. The primary economic measure was the ICER using the QALY as the measure of health benefit. The analysis demonstrated it is feasible to build and run a complex clinical decision aid using DES. The model results support current guidelines for most vignettes but suggest that earlier repair may be effective in younger, fitter patients and ongoing surveillance may be effective in elderly patients with comorbidities. The model adds information to support decisions for patients with aneurysms outside current indications. The economic evaluation suggests that using the ARDA compared with current guidelines could be cost-effective but there is a high level of uncertainty. Lack of high-quality long-term data to populate all sections of the model meant that there is high uncertainty about the long-term clinical and economic consequences of repair. Modelling assumptions were necessary and the developed survival models require external validation. The ARDA provides detailed information on the potential consequences of AAA repair or a decision not to repair that may be helpful to vascular surgeons and their patients in reaching informed decisions. Further research is required to reduce uncertainty about key data, including reintervention following AAA repair, and assess the acceptability and feasibility of the ARDA for use in routine clinical practice. The National Institute for Health Research Health Technology Assessment programme.

Evaluation of the Mean Cost and Activity Based Cost in the Diagnosis of Pulmonary Tuberculosis in the Laboratory Routine of a High-Complexity Hospital in Brazil

PubMed Central

de Almeida, Isabela N.; de Assis Figueredo, Lida J.; Soares, Valéria M.; Vater, Maria C.; Alves, Suely; da Silva Carvalho, Wânia; Kritski, Afrânio L.; de Miranda, Silvana S.

2017-01-01

At a global level, with the increase in healthcare costs, there is a need to assess the economic impact of the incorporation of new technologies in different health disorders in different countries. There is scarce information regarding costs incurred with the use of current or new diagnostic tests for tuberculosis or from the vantage point of their incorporation within the healthcare systems of high-burden countries. The present study aimed to assess the mean cost and the activity based cost of the laboratory diagnosis for tuberculosis by means of conventional techniques and from the Detect TB®LabTest molecular test kit in a general high-complexity hospital of the public health system in Brazil. Cost analysis was performed by means of primary data, collected in the Mycobacteria and Molecular Biology Laboratory in 2013. The mean cost and activity based cost were, respectively, U$10.06/U$5.61 for centrifuged bacilloscopy by Ziehl Neelsen (ZN) and Auramine (AU); U$7.42/U$4.15 for direct bacilloscopy by ZN; U$27.38/U$16.50 for culture in a Loweinstein-Jensen solid medium; and U$115.74/U$73.46 for the Detect TB®LabTest Kit. The calculation of the ABC should be used in making decisions by administrators to be the best method of assessing the costs of conventional techniques and molecular method for providing the real value of the tests. So it is need to calculate the ABC, and not of the mean cost, in various scenarios before incorporating new technologies in health institutions. PMID:28261194

Costs of Extending the Noncontributory Pension Program for Elderly: The Mexican Case.

PubMed

Aguila, Emma; Mejia, Nelly; Perez-Arce, Francisco; Ramirez, Edgar; Rivera Illingworth, Alfonso

2016-01-01

Population aging coupled with high poverty rates among older persons and a lack of access to social-security benefits or traditional support systems have led governments in low and middle-income countries to introduce non-contributory pension programs for the elderly. This article reviews a non-contributory pension program introduced in Mexico in 2007 that has since expanded greatly. We use a variety of sources to estimate current and future costs of this program.

The latest developments and outlook for hydrogen liquefaction technology

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

Ohlig, K.; Decker, L.

2014-01-29

Liquefied hydrogen is presently mainly used for space applications and the semiconductor industry. While clean energy applications, for e.g. the automotive sector, currently contribute to this demand with a small share only, their demand may see a significant boost in the next years with the need for large scale liquefaction plants exceeding the current plant sizes by far. Hydrogen liquefaction for small scale plants with a maximum capacity of 3 tons per day (tpd) is accomplished with a Brayton refrigeration cycle using helium as refrigerant. This technology is characterized by low investment costs but lower process efficiency and hence highermore » operating costs. For larger plants, a hydrogen Claude cycle is used, characterized by higher investment but lower operating costs. However, liquefaction plants meeting the potentially high demand in the clean energy sector will need further optimization with regard to energy efficiency and hence operating costs. The present paper gives an overview of the currently applied technologies, including their thermodynamic and technical background. Areas of improvement are identified to derive process concepts for future large scale hydrogen liquefaction plants meeting the needs of clean energy applications with optimized energy efficiency and hence minimized operating costs. Compared to studies in this field, this paper focuses on application of new technology and innovative concepts which are either readily available or will require short qualification procedures. They will hence allow implementation in plants in the close future.« less

Fundamentals of fuel cell system integration

NASA Astrophysics Data System (ADS)

Krumpelt, Michael; Kumar, Romesh; Myles, Kevin M.

1994-04-01

Fuel cells are theoretically very efficient energy conversion devices that have the potential of becoming a commercial product for numerous uses in the civilian economy. We have analyzed several fuel cell system designs with regard to thermal and chemical integration of the fuel cell stack into the rest of the system. Thermal integration permits the use of the stack waste heat for the endothermic steps of fuel reforming. Chemical integration provides the steam needed for fuel reforming from the water produced by the electrochemical cell reaction. High-temperature fuel cells, such as the molten carbonate and the solid oxide fuel cells, permit this system integration in a relatively simple manner. Lower temperature fuel cells, such as the polymer electrolyte and phosphoric acid systems, require added system complexity to achieve such integration. The system economics are affected by capital and fuel costs and technical parameters, such as electrochemical fuel utilization, current density, and system complexity. At today's low fuel prices and the high fuel cell costs (in part, because of the low rates of production of the early prototypes), fuel cell systems are not cost competitive with conventional power generation. With the manufacture and sale of larger numbers of fuel cell systems, the total costs will decrease from the current several thousand dollars per kW, to perhaps less than $100 per kW as production volumes approa ch a million units per year.

Long-range, low-cost electric vehicles enabled by robust energy storage

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

Liu, Ping; Ross, Russel; Newman, Aron

2015-09-18

ABSTRACT A variety of inherently robust energy storage technologies hold the promise to increase the range and decrease the cost of electric vehicles (EVs). These technologies help diversify approaches to EV energy storage, complementing current focus on high specific energy lithium-ion batteries. The need for emission-free transportation and a decrease in reliance on imported oil has prompted the development of EVs. To reach mass adoption, a significant reduction in cost and an increase in range are needed. Using the cost per mile of range as the metric, we analyzed the various factors that contribute to the cost and weight ofmore » EV energy storage systems. Our analysis points to two primary approaches for minimizing cost. The first approach, of developing redox couples that offer higher specific energy than state-of-the-art lithium-ion batteries, dominates current research effort, and its challenges and potentials are briefly discussed. The second approach represents a new insight into the EV research landscape. Chemistries and architectures that are inherently more robust reduce the need for system protection and enables opportunities of using energy storage systems to simultaneously serve vehicle structural functions. This approach thus enables the use of low cost, lower specific energy chemistries without increasing vehicle weight. Examples of such systems include aqueous batteries, flow cells, and all solid-state batteries. Research progress in these technical areas is briefly reviewed. Potential research directions that can enable low-cost EVs using multifunctional energy storage technologies are described.« less

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

PubMed Central

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

2015-01-01

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

Cost-Effectiveness of Transcatheter Aortic Valve Replacement With a Self-Expanding Prosthesis Versus Surgical Aortic Valve Replacement

PubMed Central

Reynolds, Matthew R.; Lei, Yang; Wang, Kaijun; Chinnakondepalli, Khaja; Vilain, Katherine A.; Magnuson, Elizabeth A.; Galper, Benjamin Z.; Meduri, Christopher U.; Arnold, Suzanne V.; Baron, Suzanne J.; Reardon, Michael J.; Adams, David H.; Popma, Jeffrey J.; Cohen, David J.

2016-01-01

Background Prior studies of the cost-effectiveness of transcatheter aortic valve replacement (TAVR) have been based primarily on a single balloon-expandable system. Objectives The goal of this study was to evaluate the cost-effectiveness of TAVR with a self-expanding prosthesis compared with surgical aortic valve replacement (SAVR) for patients with severe aortic stenosis and high surgical risk. Methods We performed a formal economic analysis on the basis of individual, patient-level data from the CoreValve U.S. High Risk pivotal trial. Empirical data regarding survival and quality of life (QOL) over 2 years, and medical resource use and hospital costs through 12 months were used to project life expectancy, quality-adjusted life expectancy, and lifetime medical costs in order to estimate the incremental cost-effectiveness of TAVR versus SAVR from a U.S. perspective. Results Relative to SAVR, TAVR reduced initial length of stay an average of 4.4 days, decreased the need for rehabilitation services at discharge, and resulted in superior 1-month QOL. Index admission and projected lifetime costs were higher with TAVR than with SAVR (differences $11,260 and $17,849 per patient, respectively), whereas TAVR was projected to provide a lifetime gain of 0.32 quality-adjusted life-years (QALYs; 0.41 life-years [LYs]) with 3% discounting. Lifetime incremental cost-effectiveness ratios (ICERs) were $55,090 per QALY gained and $43,114 per LY gained. Sensitivity analyses indicated that a reduction in the initial cost of TAVR by ~$1,650 would lead to an ICER <$50,000/QALY gained. Conclusions In a high-risk clinical trial population, TAVR with a self-expanding prosthesis provided meaningful clinical benefits compared with SAVR, with incremental costs considered acceptable by current U.S. standards. With expected modest reductions in the cost of index TAVR admissions, the value of TAVR compared with SAVR in this patient population would become high. PMID:26764063

Using a Time-Driven Activity-Based Costing Model To Determine the Actual Cost of Services Provided by a Transgenic Core.

PubMed

Gerwin, Philip M; Norinsky, Rada M; Tolwani, Ravi J

2018-03-01

Laboratory animal programs and core laboratories often set service rates based on cost estimates. However, actual costs may be unknown, and service rates may not reflect the actual cost of services. Accurately evaluating the actual costs of services can be challenging and time-consuming. We used a time-driven activity-based costing (ABC) model to determine the cost of services provided by a resource laboratory at our institution. The time-driven approach is a more efficient approach to calculating costs than using a traditional ABC model. We calculated only 2 parameters: the time required to perform an activity and the unit cost of the activity based on employee cost. This method allowed us to rapidly and accurately calculate the actual cost of services provided, including microinjection of a DNA construct, microinjection of embryonic stem cells, embryo transfer, and in vitro fertilization. We successfully implemented a time-driven ABC model to evaluate the cost of these services and the capacity of labor used to deliver them. We determined how actual costs compared with current service rates. In addition, we determined that the labor supplied to conduct all services (10,645 min/wk) exceeded the practical labor capacity (8400 min/wk), indicating that the laboratory team was highly efficient and that additional labor capacity was needed to prevent overloading of the current team. Importantly, this time-driven ABC approach allowed us to establish a baseline model that can easily be updated to reflect operational changes or changes in labor costs. We demonstrated that a time-driven ABC model is a powerful management tool that can be applied to other core facilities as well as to entire animal programs, providing valuable information that can be used to set rates based on the actual cost of services and to improve operating efficiency.

Measuring molecular biomarkers in epidemiologic studies: laboratory techniques and biospecimen considerations.

PubMed

Erickson, Heidi S

2012-09-28

The future of personalized medicine depends on the ability to efficiently and rapidly elucidate a reliable set of disease-specific molecular biomarkers. High-throughput molecular biomarker analysis methods have been developed to identify disease risk, diagnostic, prognostic, and therapeutic targets in human clinical samples. Currently, high throughput screening allows us to analyze thousands of markers from one sample or one marker from thousands of samples and will eventually allow us to analyze thousands of markers from thousands of samples. Unfortunately, the inherent nature of current high throughput methodologies, clinical specimens, and cost of analysis is often prohibitive for extensive high throughput biomarker analysis. This review summarizes the current state of high throughput biomarker screening of clinical specimens applicable to genetic epidemiology and longitudinal population-based studies with a focus on considerations related to biospecimens, laboratory techniques, and sample pooling. Copyright © 2012 John Wiley & Sons, Ltd.

Mapping of Technological Opportunities-Labyrinth Seal Example

NASA Technical Reports Server (NTRS)

Clarke, Dana W., Sr.

2006-01-01

All technological systems evolve based on evolutionary sequences that have repeated throughout history and can be abstracted from the history of technology and patents. These evolutionary sequences represent objective patterns and provide considerable insights that can be used to proactively model future seal concepts. This presentation provides an overview of how to map seal technology into the future using a labyrinth seal example. The mapping process delivers functional descriptions of sequential changes in market/consumer demand, from today s current paradigm to the next major paradigm shift. The future paradigm is developed according to a simple formula: the future paradigm is free of all flaws associated with the current paradigm; it is as far into the future as we can see. Although revolutionary, the vision of the future paradigm is typically not immediately or completely realizable nor is it normally seen as practical. There are several reasons that prevent immediate and complete practical application, such as: 1) Some of the required technological or business resources and knowledge not being available; 2) Availability of other technological or business resources are limited; and/or 3) Some necessary knowledge has not been completely developed. These factors tend to drive the Total Cost of Ownership or Utilization out of an acceptable range and revealing the reasons for the high Total Cost of Ownership or Utilization which provides a clear understanding of research opportunities essential for future developments and defines the current limits of the immediately achievable improvements. The typical roots of high Total Cost of Ownership or Utilization lie in the limited availability or even the absence of essential resources and knowledge necessary for its realization. In order to overcome this obstacle, step-by-step modification of the current paradigm is pursued to evolve from the current situation toward the ideal future, i.e., evolution rather than revolution. A key point is that evolutionary stages are mapped to show step-by-step evolution from the current paradigm to the next major paradigm.

Hybrid Laser/GMAW of High Strength Steel Gas Transmission Pipelines

DOT National Transportation Integrated Search

2008-07-01

Pipelines will be an integral part of our energy distribution systems for the foreseeable future. Operators are currently considering the installation of tens of billions of dollars of pipeline infrastructure. In a number of cases, the cost of export...

Current and projected patient and insurer costs for the care of patients with non-small cell lung cancer in the United States through 2040.

PubMed

Hess, Lisa M; Cui, Zhanglin Lin; Wu, Yixun; Fang, Yun; Gaynor, Paula J; Oton, Ana B

2017-08-01

The objective of this study was to quantify the current and to project future patient and insurer costs for the care of patients with non-small cell lung cancer in the US. An analysis of administrative claims data among patients diagnosed with non-small cell lung cancer from 2007-2015 was conducted. Future costs were projected through 2040 based on these data using autoregressive models. Analysis of claims data found the average total cost of care during first- and second-line therapy was $1,161.70 and $561.80 for patients, and $45,175.70 and $26,201.40 for insurers, respectively. By 2040, the average total patient out-of-pocket costs are projected to reach $3,047.67 for first-line and $2,211.33 for second-line therapy, and insurance will pay an average of $131,262.39 for first-line and $75,062.23 for second-line therapy. Claims data are not collected for research purposes; therefore, there may be errors in entry and coding. Additionally, claims data do not contain important clinical factors, such as stage of disease at diagnosis, tumor histology, or data on disease progression, which may have important implications on the cost of care. The trajectory of the cost of lung cancer care is growing. This study estimates that the cost of care may double by 2040, with the greatest proportion of increase in patient out-of-pocket costs. Despite the average cost projections, these results suggest that a small sub-set of patients with very high costs could be at even greater risk in the future.

Low–Cost Bio-Based Carbon Fiber for High-Temperature Processing

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

Naskar, Amit K.; Akato, Kokouvi M.; Tran, Chau D.

GrafTech International Holdings Inc. (GTI), worked with Oak Ridge National Laboratory (ORNL) under CRADA No. NFE-15-05807 to develop lignin-based carbon fiber (LBCF) technology and to demonstrate LBCF performance in high-temperature products and applications. This work was unique and different from other reported LBCF work in that this study was application-focused and scalability-focused. Accordingly, the executed work was based on meeting criteria based on technology development, cost, and application suitability. The focus of this work was to demonstrate lab-scale LBCF from at least 4 different precursor feedstock sources that could meet the estimated production cost of $5.00/pound and have ash levelmore » of less than 500 ppm in the carbonized insulation-grade fiber. Accordingly, a preliminary cost model was developed based on publicly available information. The team demonstrated that 4 lignin samples met the cost criteria, as highlighted in Table 1. In addition, the ash level for the 4 carbonized lignin samples were below 500 ppm. Processing asreceived lignin to produce a high purity lignin fiber was a significant accomplishment in that most industrial lignin, prior to purification, had greater than 4X the ash level needed for this project, and prior to this work there was not a clear path of how to achieve the purity target. The lab scale development of LBCF was performed with a specific functional application in mind, specifically for high temperature rigid insulation. GTI is currently a consumer of foreignsourced pitch and rayon based carbon fibers for use in its high temperature insulation products, and the motivation was that LBCF had potential to decrease costs and increase product competitiveness in the marketplace through lowered raw material costs, lowered energy costs, and decreased environmental footprint. At the end of this project, the Technology Readiness Level (TRL) remained at 5 for LBCF in high temperature insulation.« less

2013 Cost of Wind Energy Review

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

Mone, C.; Smith, A.; Maples, B.

2015-02-01

This report uses representative project types to estimate the levelized cost of wind energy (LCOE) in the United States for 2013. Scheduled to be published on an annual basis, it relies on both market and modeled data to maintain a current understanding of wind generation cost trends and drivers. It is intended to provide insight into current component-level costs and a basis for understanding current component-level costs and a basis for understanding variability in the LCOE across the industry. Data and tools developed from this analysis are used to inform wind technology cost projections, goals, and improvement opportunities.

Single-graded CIGS with narrow bandgap for tandem solar cells.

PubMed

Feurer, Thomas; Bissig, Benjamin; Weiss, Thomas P; Carron, Romain; Avancini, Enrico; Löckinger, Johannes; Buecheler, Stephan; Tiwari, Ayodhya N

2018-01-01

Multi-junction solar cells show the highest photovoltaic energy conversion efficiencies, but the current technologies based on wafers and epitaxial growth of multiple layers are very costly. Therefore, there is a high interest in realizing multi-junction tandem devices based on cost-effective thin film technologies. While the efficiency of such devices has been limited so far because of the rather low efficiency of semitransparent wide bandgap top cells, the recent rise of wide bandgap perovskite solar cells has inspired the development of new thin film tandem solar devices. In order to realize monolithic, and therefore current-matched thin film tandem solar cells, a bottom cell with narrow bandgap (~1 eV) and high efficiency is necessary. In this work, we present Cu(In,Ga)Se 2 with a bandgap of 1.00 eV and a maximum power conversion efficiency of 16.1%. This is achieved by implementing a gallium grading towards the back contact into a CuInSe 2 base material. We show that this modification significantly improves the open circuit voltage but does not reduce the spectral response range of these devices. Therefore, efficient cells with narrow bandgap absorbers are obtained, yielding the high current density necessary for thin film multi-junction solar cells.

Mini-review: high rate algal ponds, flexible systems for sustainable wastewater treatment.

PubMed

Young, P; Taylor, M; Fallowfield, H J

2017-06-01

Over the last 20 years, there has been a growing requirement by governments around the world for organisations to adopt more sustainable practices. Wastewater treatment is no exception, with many currently used systems requiring large capital investment, land area and power consumption. High rate algal ponds offer a sustainable, efficient and lower cost option to the systems currently in use. They are shallow, mixed lagoon based systems, which aim to maximise wastewater treatment by creating optimal conditions for algal growth and oxygen production-the key processes which remove nitrogen and organic waste in HRAP systems. This design means they can treat wastewater to an acceptable quality within a fifth of time of other lagoon systems while using 50% less surface area. This smaller land requirement decreases both the construction costs and evaporative water losses, making larger volumes of treated water available for beneficial reuse. They are ideal for rural, peri-urban and remote communities as they require minimum power and little on-site management. This review will address the history of and current trends in high rate algal pond development and application; a comparison of their performance with other systems when treating various wastewaters; and discuss their potential for production of added-value products. Finally, the review will consider areas requiring further research.

Single-graded CIGS with narrow bandgap for tandem solar cells

PubMed Central

Avancini, Enrico; Buecheler, Stephan; Tiwari, Ayodhya N.

2018-01-01

Abstract Multi-junction solar cells show the highest photovoltaic energy conversion efficiencies, but the current technologies based on wafers and epitaxial growth of multiple layers are very costly. Therefore, there is a high interest in realizing multi-junction tandem devices based on cost-effective thin film technologies. While the efficiency of such devices has been limited so far because of the rather low efficiency of semitransparent wide bandgap top cells, the recent rise of wide bandgap perovskite solar cells has inspired the development of new thin film tandem solar devices. In order to realize monolithic, and therefore current-matched thin film tandem solar cells, a bottom cell with narrow bandgap (~1 eV) and high efficiency is necessary. In this work, we present Cu(In,Ga)Se2 with a bandgap of 1.00 eV and a maximum power conversion efficiency of 16.1%. This is achieved by implementing a gallium grading towards the back contact into a CuInSe2 base material. We show that this modification significantly improves the open circuit voltage but does not reduce the spectral response range of these devices. Therefore, efficient cells with narrow bandgap absorbers are obtained, yielding the high current density necessary for thin film multi-junction solar cells. PMID:29707066

The Role of Advocacy Organizations in Reducing Negative Externalities

PubMed Central

Biglan, Anthony

2009-01-01

An externality is a cost that a corporation’s actions impose on society. For example, a power plant may emit mercury, but might not pay for the cost of that pollution to the people living near the plant. It is possible to analyze a diverse range of problems of society in these terms, including the health effects of corporate practices, the unsustainability of manufacturing processes, and marketing of products contributing to environmental damage, and economic policies that maintain high levels of poverty due to effective lobbying by the business community. This paper examines the problem of externalities in terms of metacontingencies. Externalities continue precisely because there is no cost to the organizations for practices that impose these costs on third parties. The paper describes the cultural practices needed to influence governments are motivated to make corporations bear the true costs of their practices—costs that are currently imposed on others. PMID:20011073

The costs of future polio risk management policies.

PubMed

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

2006-12-01

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

The Cost-Effectiveness of High-Risk Lung Cancer Screening and Drivers of Program Efficiency.

PubMed

Cressman, Sonya; Peacock, Stuart J; Tammemägi, Martin C; Evans, William K; Leighl, Natasha B; Goffin, John R; Tremblay, Alain; Liu, Geoffrey; Manos, Daria; MacEachern, Paul; Bhatia, Rick; Puksa, Serge; Nicholas, Garth; McWilliams, Annette; Mayo, John R; Yee, John; English, John C; Pataky, Reka; McPherson, Emily; Atkar-Khattra, Sukhinder; Johnston, Michael R; Schmidt, Heidi; Shepherd, Frances A; Soghrati, Kam; Amjadi, Kayvan; Burrowes, Paul; Couture, Christian; Sekhon, Harmanjatinder S; Yasufuku, Kazuhiro; Goss, Glenwood; Ionescu, Diana N; Hwang, David M; Martel, Simon; Sin, Don D; Tan, Wan C; Urbanski, Stefan; Xu, Zhaolin; Tsao, Ming-Sound; Lam, Stephen

2017-08-01

Lung cancer risk prediction models have the potential to make programs more affordable; however, the economic evidence is limited. Participants in the National Lung Cancer Screening Trial (NLST) were retrospectively identified with the risk prediction tool developed from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. The high-risk subgroup was assessed for lung cancer incidence and demographic characteristics compared with those in the low-risk subgroup and the Pan-Canadian Early Detection of Lung Cancer Study (PanCan), which is an observational study that was high-risk-selected in Canada. A comparison of high-risk screening versus standard care was made with a decision-analytic model using data from the NLST with Canadian cost data from screening and treatment in the PanCan study. Probabilistic and deterministic sensitivity analyses were undertaken to assess uncertainty and identify drivers of program efficiency. Use of the risk prediction tool developed from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial with a threshold set at 2% over 6 years would have reduced the number of individuals who needed to be screened in the NLST by 81%. High-risk screening participants in the NLST had more adverse demographic characteristics than their counterparts in the PanCan study. High-risk screening would cost $20,724 (in 2015 Canadian dollars) per quality-adjusted life-year gained and would be considered cost-effective at a willingness-to-pay threshold of $100,000 in Canadian dollars per quality-adjusted life-year gained with a probability of 0.62. Cost-effectiveness was driven primarily by non-lung cancer outcomes. Higher noncurative drug costs or current costs for immunotherapy and targeted therapies in the United States would render lung cancer screening a cost-saving intervention. Non-lung cancer outcomes drive screening efficiency in diverse, tobacco-exposed populations. Use of risk selection can reduce the budget impact, and screening may even offer cost savings if noncurative treatment costs continue to rise. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

Criminal history systems: new technology and new directions

NASA Astrophysics Data System (ADS)

Threatte, James

1997-02-01

Many forces are driving states to improve their current Criminal History and On-Line Criminal Justice Information Systems. The predominate factors compelling this movement are (1) the deterioration and cost of supporting older legacy systems, (2) current generation high performance, low cost hardware and system software, and (3) funding programs, such as the National Criminal History Improvement Program, which are targeted specifically at improving these important systems. In early 1996, SAIC established an Internal Research and Development project devoted to Computerized Criminal History Systems (CCH). This project began with an assessment of current hardware, operating system, and relational database technology. Application software design and development approaches were then reviewed with a focus on object-oriented approaches, three tier client server architectures, and tools that enable the `right sizing' of systems. An operational prototype of a State CCH system was established based on the results of these investigations.

Satellite applications to electric-utility communications needs. [land mobile satellite service

NASA Technical Reports Server (NTRS)

Horstein, M.; Barnett, R.

1981-01-01

Significant changes in the Nation's electric power systems are expected to result from the integration of new technology, possible during the next decade. Digital communications for monitor and control, exclusive of protective relaying, are expected to double or triple current traffic. A nationwide estimate of 13 Mb/s traffic is projected. Of this total, 8 Mb/s is attributed to the bulk-power system as it is now being operated (4 Mb/s). This traffic could be accommodated by current communications satellites using 3- to 4.5-m-diameter ground terminals costing $35,000 to $70,000 each. The remaining 5-Mb/s traffic is attributed to new technology concepts integrated into the distribution system. Such traffic is not compatible with current satellite technology because it requires small, low-cost ground terminals. Therefore, a high effective isotropic radiated power satellite, such as the one being planned by NASA for the Land Mobile Satellite Service, is required.

Free standing Cu2Te, new anode material for sodium-ion battery

NASA Astrophysics Data System (ADS)

Sarkar, Ananta; Mallick, Md. Mofasser; Panda, Manas Ranjan; Vitta, Satish; Mitra, Sagar

2018-05-01

Sodium-ion battery is the most popular alternative to lithium-ion energy storage system due to its low cost and huge abundant resources throughout the world. Although recent literature showed cathode materials for sodium ion battery performs almost equivalent to lithium-ion counterpart but the anode of this sodium-ion battery is in premature state. Here, we introduced free-standing copper telluride (Cu2Te), a new anode materials for sodium-ion battery. For making the electrode we did not use any conductive carbon or current collector which increase the volumetric density as well as reduce the cost of the cell. This metallic Cu2Te alloy exhibited a high reversible capacity of ˜275 mAh g-1 at 50 mA g-1 current density and ˜200 mAh g-1 at higher current density of 100 mA g-1, operating between 0.1 to 2.0 V.

Investment Success in Public Health: An Analysis of the Cost-Effectiveness and Cost-Benefit of the Global Programme to Eliminate Lymphatic Filariasis.

PubMed

Turner, Hugo C; Bettis, Alison A; Chu, Brian K; McFarland, Deborah A; Hooper, Pamela J; Mante, Sunny D; Fitzpatrick, Christopher; Bradley, Mark H

2017-03-15

It has been estimated that $154 million per year will be required during 2015-2020 to continue the Global Programme to Eliminate Lymphatic Filariasis (GPELF). In light of this, it is important to understand the program's current value. Here, we evaluate the cost-effectiveness and cost-benefit of the preventive chemotherapy that was provided under the GPELF between 2000 and 2014. In addition, we also investigate the potential cost-effectiveness of hydrocele surgery. Our economic evaluation of preventive chemotherapy was based on previously published health and economic impact estimates (between 2000 and 2014). The delivery costs of treatment were estimated using a model developed by the World Health Organization. We also developed a model to investigate the number of disability-adjusted life years (DALYs) averted by a hydrocelectomy and identified the cost threshold under which it would be considered cost-effective. The projected cost-effectiveness and cost-benefit of preventive chemotherapy were very promising, and this was robust over a wide range of costs and assumptions. When the economic value of the donated drugs was not included, the GPELF would be classed as highly cost-effective. We projected that a typical hydrocelectomy would be classed as highly cost-effective if the surgery cost less than $66 and cost-effective if less than $398 (based on the World Bank's cost-effectiveness thresholds for low income countries). Both the preventive chemotherapy and hydrocele surgeries provided under the GPELF are incredibly cost-effective and offer a very good investment in public health. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America.

Investment Success in Public Health: An Analysis of the Cost-Effectiveness and Cost-Benefit of the Global Programme to Eliminate Lymphatic Filariasis

PubMed Central

Bettis, Alison A.; Chu, Brian K.; McFarland, Deborah A.; Hooper, Pamela J.; Mante, Sunny D.; Fitzpatrick, Christopher; Bradley, Mark H.

2017-01-01

Abstract Background. It has been estimated that $154 million per year will be required during 2015–2020 to continue the Global Programme to Eliminate Lymphatic Filariasis (GPELF). In light of this, it is important to understand the program’s current value. Here, we evaluate the cost-effectiveness and cost-benefit of the preventive chemotherapy that was provided under the GPELF between 2000 and 2014. In addition, we also investigate the potential cost-effectiveness of hydrocele surgery. Methods. Our economic evaluation of preventive chemotherapy was based on previously published health and economic impact estimates (between 2000 and 2014). The delivery costs of treatment were estimated using a model developed by the World Health Organization. We also developed a model to investigate the number of disability-adjusted life years (DALYs) averted by a hydrocelectomy and identified the cost threshold under which it would be considered cost-effective. Results. The projected cost-effectiveness and cost-benefit of preventive chemotherapy were very promising, and this was robust over a wide range of costs and assumptions. When the economic value of the donated drugs was not included, the GPELF would be classed as highly cost-effective. We projected that a typical hydrocelectomy would be classed as highly cost-effective if the surgery cost less than $66 and cost-effective if less than $398 (based on the World Bank’s cost-effectiveness thresholds for low income countries). Conclusions. Both the preventive chemotherapy and hydrocele surgeries provided under the GPELF are incredibly cost-effective and offer a very good investment in public health. PMID:27956460

Youth's Awareness of and Reactions to The Real Cost National Tobacco Public Education Campaign.

PubMed

Duke, Jennifer C; Alexander, Tesfa N; Zhao, Xiaoquan; Delahanty, Janine C; Allen, Jane A; MacMonegle, Anna J; Farrelly, Matthew C

2015-01-01

In 2014, the Food and Drug Administration (FDA) launched its first tobacco-focused public education campaign, The Real Cost, aimed at reducing tobacco use among 12- to 17-year-olds in the United States. This study describes The Real Cost message strategy, implementation, and initial evaluation findings. The campaign was designed to encourage youth who had never smoked but are susceptible to trying cigarettes (susceptible nonsmokers) and youth who have previously experimented with smoking (experimenters) to reassess what they know about the "costs" of tobacco use to their body and mind. The Real Cost aired on national television, online, radio, and other media channels, resulting in high awareness levels. Overall, 89.0% of U.S. youth were aware of at least one advertisement 6 to 8 months after campaign launch, and high levels of awareness were attained within the campaign's two targeted audiences: susceptible nonsmokers (90.5%) and experimenters (94.6%). Most youth consider The Real Cost advertising to be effective, based on assessments of ad perceived effectiveness (mean = 4.0 on a scale from 1.0 to 5.0). High levels of awareness and positive ad reactions are requisite proximal indicators of health behavioral change. Additional research is being conducted to assess whether potential shifts in population-level cognitions and/or behaviors are attributable to this campaign. Current findings demonstrate that The Real Cost has attained high levels of ad awareness which is a critical first step in achieving positive changes in tobacco-related attitudes and behaviors. These data can also be used to inform ongoing message and media strategies for The Real Cost and other U.S. youth tobacco prevention campaigns.

Cost effectiveness analysis of strategies for maternal and neonatal health in developing countries.

PubMed

Adam, Taghreed; Lim, Stephen S; Mehta, Sumi; Bhutta, Zulfiqar A; Fogstad, Helga; Mathai, Matthews; Zupan, Jelka; Darmstadt, Gary L

2005-11-12

To determine the costs and benefits of interventions for maternal and newborn health to assess the appropriateness of current strategies and guide future plans to attain the millennium development goals. Cost effectiveness analysis. Two regions classified by the World Health Organization according to their epidemiological grouping: Afr-E, those countries in sub-Saharan Africa with very high adult and high child mortality, and Sear-D, comprising countries in South East Asia with high adult and high child mortality. Effectiveness data from several sources, including trials, observational studies, and expert opinion. For resource inputs, quantities came from WHO guidelines, literature, and expert opinion, and prices from the WHO choosing interventions that are cost effective database. Cost per disability adjusted life year (DALY) averted in year 2000 international dollars. The most cost effective mix of interventions was similar in Afr-E and Sear-D. These were the community based newborn care package, followed by antenatal care (tetanus toxoid, screening for pre-eclampsia, screening and treatment of asymptomatic bacteriuria and syphilis); skilled attendance at birth, offering first level maternal and neonatal care around childbirth; and emergency obstetric and neonatal care around and after birth. Screening and treatment of maternal syphilis, community based management of neonatal pneumonia, and steroids given during the antenatal period were relatively less cost effective in Sear-D. Scaling up all of the included interventions to 95% coverage would halve neonatal and maternal deaths. Preventive interventions at the community level for newborn babies and at the primary care level for mothers and newborn babies are extremely cost effective, but the millennium development goals for maternal and child health will not be achieved without universal access to clinical services as well.

Ultrasmooth Quantum Dot Micropatterns by a Facile Controllable Liquid-Transfer Approach: Low-Cost Fabrication of High-Performance QLED.

PubMed

Zhang, Min; Hu, Binbin; Meng, Lili; Bian, Ruixin; Wang, Siyuan; Wang, Yunjun; Liu, Huan; Jiang, Lei

2018-06-26

Fabrication of a high quality quantum dot (QD) film is essentially important for a high-performance QD light emitting diode display (QLED) device. It is normally a high-cost and multiple-step solution-transfer process where large amounts of QDs were needed but with only limited usefulness. Thus, developing a simple, efficient, and low-cost approach to fabricate high-quality micropatterned QD film is urgently needed. Here, we proposed that the Chinese brush enables the controllable transfer of a QD solution directly onto a homogeneous and ultrasmooth micropatterned film in one step. It is proposed that the dynamic balance of QDs was enabled during the entire solution transfer process under the cooperative effect of Marangoni flow aroused by the asymmetric solvent evaporation and the Laplace pressure different by conical fibers. By this approach, QD nanoparticles were homogeneously transferred onto the desired area on the substrate. The as-prepared QLED devices show rather high performances with the current efficiencies of 72.38, 26.03, and 4.26 cd/A and external quantum efficiencies of 17.40, 18.96, and 6.20% for the green, red, and blue QLED devices, respectively. We envision that the result offers a low-cost, facile, and practically applicable solution-processing approach that works even in air for fabricating high-performance QLED devices.

Holographic spectrum-splitting optical systems for solar photovoltaics

NASA Astrophysics Data System (ADS)

Zhang, Deming

Solar energy is the most abundant source of renewable energy available. The relatively high cost prevents solar photovoltaic (PV) from replacing fossil fuel on a larger scale. In solar PV power generation the cost is reduced with more efficient PV technologies. In this dissertation, methods to improve PV conversion efficiency with holographic optical components are discussed. The tandem multiple-junction approach has achieved very high conversion efficiency. However it is impossible to manufacture tandem PV cells at a low cost due to stringent fabrication standards and limited material types that satisfy lattice compatibility. Current produced by the tandem multi-junction PV cell is limited by the lowest junction due to series connection. Spectrum-splitting is a lateral multi-junction concept that is free of lattice and current matching constraints. Each PV cell can be optimized towards full absorption of a spectral band with tailored light-trapping schemes. Holographic optical components are designed to achieve spectrum-splitting PV energy conversion. The incident solar spectrum is separated onto multiple PV cells that are matched to the corresponding spectral band. Holographic spectrum-splitting can take advantage of existing and future low-cost technologies that produces high efficiency thin-film solar cells. Spectrum-splitting optical systems are designed and analyzed with both transmission and reflection holographic optical components. Prototype holograms are fabricated and high optical efficiency is achieved. Light-trapping in PV cells increases the effective optical path-length in the semiconductor material leading to improved absorption and conversion efficiency. It has been shown that the effective optical path length can be increased by a factor of 4n2 using diffusive surfaces. Ultra-light-trapping can be achieved with optical filters that limit the escape angle of the diffused light. Holographic reflection gratings have been shown to act as angle-wavelength selective filters that can function as ultra-light-trapping filters. Results from an experimental reflection hologram are used to model the absorption enhancement factor for a silicon solar cell and light-trapping filter. The result shows a significant improvement in current generation for thin-film silicon solar cells under typical operating conditions.

Skin cancer has a large impact on our public hospitals but prevention programs continue to demonstrate strong economic credentials.

PubMed

Shih, Sophy T F; Carter, Rob; Heward, Sue; Sinclair, Craig

2017-08-01

While skin cancer is still the most common cancer in Australia, important information gaps remain. This paper addresses two gaps: i) the cost impact on public hospitals; and ii) an up-to-date assessment of economic credentials for prevention. A prevalence-based cost approach was undertaken in public hospitals in Victoria. Costs were estimated for inpatient admissions, using State service statistics, and outpatient services based on attendance at three hospitals in 2012-13. Cost-effectiveness for prevention was estimated from 'observed vs expected' analysis, together with program expenditure data. Combining inpatient and outpatient costs, total annual costs for Victoria were $48 million to $56 million. The SunSmart program is estimated to have prevented more than 43,000 skin cancers between 1988 and 2010, a net cost saving of $92 million. Skin cancer treatment in public hospitals ($9.20∼$10.39 per head/year) was 30-times current public funding in skin cancer prevention ($0.37 per head/year). At about $50 million per year for hospitals in Victoria alone, the cost burden of a largely preventable disease is substantial. Skin cancer prevention remains highly cost-effective, yet underfunded. Implications for public health: Increased funding for skin cancer prevention must be kept high on the public health agenda. Hospitals would also benefit from being able to redirect resources to non-preventable conditions. © 2017 The Authors.

Cost of influenza hospitalization at a tertiary care children's hospital and its impact on the cost-benefit analysis of the recommendation for universal influenza immunization in children age 6 to 23 months.

PubMed

Hall, Jennifer L; Katz, Ben Z

2005-12-01

To calculate the costs of influenza hospitalization at a tertiary care children's hospital as the basis of a cost-benefit analysis of the new influenza vaccine recommendation for children age 6 to 23 months. We reviewed the medical records of all patients admitted to Children's Memorial Hospital (CMH) in 2002 diagnosed with influenza. Total hospital costs were obtained from the Business Development Office. Thirty-five charts were analyzed. Both of the 2 patients requiring mechanical ventilation and 4 of 6 patients admitted to the intensive care unit had high-risk underlying medical conditions. Nine children were age 6 to 23 months; 4 of these 9 had no preexisting medical conditions. Had all 18 high-risk children over age 6 months been protected from influenza, approximately $350,000 in hospital charges could have been saved. Preventing the additional 4 hospitalizations in the otherwise low-risk children age 6 to 23 months for whom vaccine is currently recommended would have cost approximately $281,000 ($46/child) more than the hospital charges saved. When all children age 6 to 23 months are considered, influenza vaccination is less costly than other prophylactic measures. Addition of indirect costs, deaths, outpatient costs, and the cost of secondary cases would favor the cost:benefit ratio for influenza vaccination of all children age 6 to 23 months.

High-school seniors' college enrollment goals: Costs and benefits of ambitious expectations.

PubMed

Villarreal, Brandilynn J; Heckhausen, Jutta; Lessard, Jared; Greenberger, Ellen; Chen, Chuansheng

2015-12-01

High school students with high long-term educational expectations attain higher levels of education than those with lower expectations. Less studied is the role of students' short-term college enrollment expectations for the year after high school graduation. The purpose of the current study was to examine the costs and benefits of ambitious short-term expectations and the impact of falling short of these expectations on mental health, motivation, and educational outcomes. Over 1000 youth with expectations to attend college were surveyed during their senior year of high school, one year later, and four years later. Participants who did not achieve their short-term expectations had lower educational attainment four years later but were not less satisfied with their educational progress. The negative consequences of falling short of one's expectations were restricted to individuals with less ambitious short-term expectations. Thus, the benefits of ambitious short-term expectations for youth may outweigh the costs. Copyright © 2015 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

Chemically Crushed Wood Cellulose Fiber towards High-Performance Sodium-Ion Batteries

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

Shen, Fei; Zhu, Hongli; Luo, Wei

Carbon materials have attracted great interest as an anode for sodium-ion batteries (SIBs) due to their high performance and low cost. Here, we studied natural wood fiber derived hard carbon anodes for SIBs considering the abundance and low cost of wood. We discovered that a thermal carbonization of wood fiber led to a porous carbon with a high specific surface area of 586 m2 g–1, while a pretreatment with 2,2,6,6-tetramethylpiperidine-1-oxyl (TEMPO) could effectively decrease it to 126 m2 g–1. When evaluating them as anodes for SIBs, we observed that the low surface area carbon resulted in a high initial Coulombicmore » efficiency of 72% compared to 25% of the high surface area carbon. More importantly, the low surface area carbon exhibits an excellent cycling stability that a desodiation capacity of 196 mAh g–1 can be delivered over 200 cycles at a current density of 100 mA g–1, indicating a promising anode for low-cost SIBs.« less

High-Speed Current dq PI Controller for Vector Controlled PMSM Drive

PubMed Central

Reaz, Mamun Bin Ibne; Rahman, Labonnah Farzana; Chang, Tae Gyu

2014-01-01

High-speed current controller for vector controlled permanent magnet synchronous motor (PMSM) is presented. The controller is developed based on modular design for faster calculation and uses fixed-point proportional-integral (PI) method for improved accuracy. Current dq controller is usually implemented in digital signal processor (DSP) based computer. However, DSP based solutions are reaching their physical limits, which are few microseconds. Besides, digital solutions suffer from high implementation cost. In this research, the overall controller is realizing in field programmable gate array (FPGA). FPGA implementation of the overall controlling algorithm will certainly trim down the execution time significantly to guarantee the steadiness of the motor. Agilent 16821A Logic Analyzer is employed to validate the result of the implemented design in FPGA. Experimental results indicate that the proposed current dq PI controller needs only 50 ns of execution time in 40 MHz clock, which is the lowest computational cycle for the era. PMID:24574913

The indirect costs of multiple sclerosis: systematic review and meta-analysis.

PubMed

Stawowczyk, Ewa; Malinowski, Krzysztof Piotr; Kawalec, Paweł; Moćko, Paweł

2015-01-01

The aim of this systematic review is to collect and summarize all current data on the indirect costs related to absenteeism and presenteeism associated with multiple sclerosis. Searches were conducted using Medline, Embase and Centre for Reviews and Dissemination databases. All collected costs were recalculated to average annual cost per patient, expressed in 2014 prices US$ using the consumer price index and purchasing power parity (scenario 1) and expressed as proportion of specific gross domestic product in current local currency unit to adjust for country's development (scenario 2). Identified studies were then analyzed in order to assess their possible inclusion in the meta-analysis. The authors identified 63 records, of which 23 were eligible for meta-analysis. Overall indirect cost per patient calculated in scenario 1 was as high as US$20,167 with US$22,197 in Europe, US$17,382 in North America and US$153 in Asia. Overall indirect cost per patient calculated in scenario 2 was equal to US$16,939, with US$19,612 in Europe, US$11,592 in North America and US$899 in Asia. Overall indirect costs varied from US$3726 for patients with EDSS score less than 3 to US$19,264 for patients with Expanded Disability Status Scale score grater that 7. This review revealed the great economic burden of multiple sclerosis on society. The authors observed a great variety of the considered components of indirect costs and their definitions. Costs were higher for Europe than for other continents and were also higher for patients with a higher Expanded Disability Status Scale score.

Health Care Expenditures Attributable to Smoking in Military Veterans

PubMed Central

Hamlett-Berry, Kim; Sung, Hai-Yen; Max, Wendy

2015-01-01

Introduction: The health effects of cigarette smoking have been estimated to account for between 6%–8% of U.S. health care expenditures. We estimated Veterans Health Administration (VHA) health care costs attributable to cigarette smoking. Methods: VHA survey and administrative data provided the number of Veteran enrollees, current and former smoking prevalence, and the cost of 4 types of care for groups defined by age, gender, and region. Cost and smoking status could not be linked at the enrollee level, so we used smoking attributable fractions estimated in sample of U.S. residents where the linkage could be made. Results: The 7.7 million Veterans enrolled in VHA received $40.2 billion in VHA provided health services in 2010. We estimated that $2.7 billion in VHA costs were attributable to the health effects of smoking. This was 7.6% of the $35.3 billion spent on the types of care for which smoking-attributable fractions could be determined. The fraction of inpatient costs that was attributable to smoking (11.4%) was greater than the fraction of ambulatory care cost attributable to smoking (5.3%). More cost was attributable to current smokers ($1.7 billion) than to former smokers ($983 million). Conclusions: The fraction of VHA costs attributable to smoking is similar to that of other health care systems. Smoking among Veterans is slowly decreasing, but prevalence remains high in Veterans with psychiatric and substance use disorders, and in younger and female Veterans. VHA has adopted a number of smoking cessation programs that have the potential for reducing future smoking-attributable costs. PMID:25239960

Radon and lung cancer: a cost-effectiveness analysis.

PubMed Central

Ford, E S; Kelly, A E; Teutsch, S M; Thacker, S B; Garbe, P L

1999-01-01

OBJECTIVES: This study examined the cost-effectiveness of general and targeted strategies for residential radon testing and mitigation in the United States. METHODS: A decision-tree model was used to perform a cost-effectiveness analysis of preventing radon-associated deaths from lung cancer. RESULTS: For a radon threshold of 4 pCi/L, the estimated costs to prevent 1 lung cancer death are about $3 million (154 lung cancer deaths prevented), or $480,000 per life-year saved, based on universal radon screening and mitigation, and about $2 million (104 lung cancer deaths prevented), or $330,000 per life-year saved, if testing and mitigation are confined to geographic areas at high risk for radon exposure. For mitigation undertaken after a single screening test and after a second confirmatory test, the estimated costs are about $920,000 and $520,000, respectively, to prevent a lung cancer death with universal screening and $130,000 and $80,000 per life-year for high risk screening. The numbers of preventable lung cancer deaths are 811 and 527 for universal and targeted approaches, respectively. CONCLUSIONS: These data suggest possible alternatives to current recommendations. PMID:10076484

Next-generation multiple myeloma treatment: a pharmacoeconomic perspective

PubMed Central

Harousseau, Jean Luc

2016-01-01

Advances in the diagnosis and treatment of multiple myeloma have come at a rapid pace, especially with several new drugs entering the market in the last few years. However, access to and affordability of new treatments poses a major challenge, both in the United States and around the world. High costs of life-saving drugs are detrimental to both the personal finances of the individual patient, as well as society which must bear the increasing costs in terms of increased health insurance premiums, taxes, or both. The challenges are not unique to myeloma, but are commonly encountered in several other cancers as well. But to some extent these pharmacoeconomic concerns are amplified in myeloma due to the need for multidrug regimens that combine 2 or more expensive new drugs, continuous therapy, and the prolonged disease course in most patients. We examine current myeloma therapy from a pharmacoeconomic perspective, and discuss the costs involved. We outline the underlying reasons why cancer drugs are so expensive, the measures that are required to lower cost, and propose potential ways in which costs can be reduced while still delivering high-quality care. PMID:27742709

A low-cost inertial smoothing system for landing approach guidance

NASA Technical Reports Server (NTRS)

Niessen, F. R.

1973-01-01

Accurate position and velocity information with low noise content for instrument approaches and landings is required for both control and display applications. In a current VTOL automatic instrument approach and landing research program, radar-derived landing guidance position reference signals, which are noisy, have been mixed with acceleration information derived from low-cost onboard sensors to provide high-quality position and velocity information. An in-flight comparison of signal quality and accuracy has shown good agreement between the low-cost inertial smoothing system and an aided inertial navigation system. Furthermore, the low-cost inertial smoothing system has been proven to be satisfactory in control and display system applications for both automatic and pilot-in-the-loop instrument approaches and landings.

Phenomenological studies on sodium for CSP applications: A safety review

NASA Astrophysics Data System (ADS)

Armijo, Kenneth M.; Andraka, Charles E.

2016-05-01

Sodium Heat transfer fluids (HTF) such as sodium, can achieve temperatures above 700°C to obtain power cycle performance improvements for reducing large infrastructure costs of high-temperature systems. Current concentrating solar power (CSP) sensible HTF's (e.g. air, salts) have poor thermal conductivity, and thus low heat transfer capabilities, requiring a large receiver. The high thermal conductivity of sodium has demonstrated high heat transfer rates on dish and towers systems, which allow a reduction in receiver area by a factor of two to four, reducing re-radiation and convection losses and cost by a similar factor. Sodium produces saturated vapor at pressures suitable for transport starting at 600°C and reaches one atmosphere at 870°C, providing a wide range of suitable operating conditions that match proposed high temperature, isothermal power cycles. This advantage could increase the efficiency while lowering the cost of CSP tower systems. Although there are a number of desirable thermal performance advantages associated with sensible sodium, its propensity to rapidly oxidize presents safety challenges. This investigation presents a literature review that captures historical operations/handling lessons for advanced sodium receiver designs, and the current state-of-knowledge related to sodium combustion behavior. Technical and operational solutions addressing sodium safety and applications in CSP will be discussed, including unique safety hazards and advantages using latent sodium. Lessons obtained from the nuclear industry with sensible and latent systems will also be discussed in the context of safety challenges and risk mitigation solutions.

Intrathecal Drug Delivery Systems for Cancer Pain: A Health Technology Assessment

PubMed Central

2016-01-01

Background Intrathecal drug delivery systems can be used to manage refractory or persistent cancer pain. We investigated the benefits, harms, cost-effectiveness, and budget impact of these systems compared with current standards of care for adult patients with chronic pain due owing to cancer. Methods We searched Ovid MEDLINE, Ovid Embase, the Cochrane Library databases, National Health Service's Economic Evaluation Database, and Tufts Cost-Effectiveness Analysis Registry from January 1994 to April 2014 for evidence of effectiveness, harms, and cost-effectiveness. We used existing systematic reviews that had employed reliable search and screen methods and searched for studies published after the search date reported in the latest systematic review to identify studies. Two reviewers screened records and assessed study validity. The cost burden of publicly funding intrathecal drug delivery systems for cancer pain was estimated for a 5-year timeframe using a combination of published literature, information from the device manufacturer, administrative data, and expert opinion for the inputs. Results We included one randomized trial that examined effectiveness and harms, and one case series that reported an eligible economic evaluation. We found very low quality evidence that intrathecal drug delivery systems added to comprehensive pain management reduce overall drug toxicity; no significant reduction in pain scores was observed. Weak conclusions from economic evidence suggested that intrathecal drug delivery systems had the potential to be more cost-effective than high-cost oral therapy if administered for 7 months or longer. The cost burden of publicly funding this therapy is estimated to be $100,000 in the first year, increasing to $500,000 by the fifth year. Conclusions Current evidence could not establish the benefit, harm, or cost-effectiveness of intrathecal drug delivery systems compared with current standards of care for managing refractory cancer pain in adults. Publicly funding intrathecal drug delivery systems for cancer pain would result in a budget impact of several hundred thousand dollars per year. PMID:27026796

Prevention of HPV-related cancers in Norway: cost-effectiveness of expanding the HPV vaccination program to include pre-adolescent boys.

PubMed

Burger, Emily A; Sy, Stephen; Nygård, Mari; Kristiansen, Ivar S; Kim, Jane J

2014-01-01

Increasingly, countries have introduced female vaccination against human papillomavirus (HPV), causally linked to several cancers and genital warts, but few have recommended vaccination of boys. Declining vaccine prices and strong evidence of vaccine impact on reducing HPV-related conditions in both women and men prompt countries to reevaluate whether HPV vaccination of boys is warranted. A previously-published dynamic model of HPV transmission was empirically calibrated to Norway. Reductions in the incidence of HPV, including both direct and indirect benefits, were applied to a natural history model of cervical cancer, and to incidence-based models for other non-cervical HPV-related diseases. We calculated the health outcomes and costs of the different HPV-related conditions under a gender-neutral vaccination program compared to a female-only program. Vaccine price had a decisive impact on results. For example, assuming 71% coverage, high vaccine efficacy and a reasonable vaccine tender price of $75 per dose, we found vaccinating both girls and boys fell below a commonly cited cost-effectiveness threshold in Norway ($83,000/quality-adjusted life year (QALY) gained) when including vaccine benefit for all HPV-related diseases. However, at the current market price, including boys would not be considered 'good value for money.' For settings with a lower cost-effectiveness threshold ($30,000/QALY), it would not be considered cost-effective to expand the current program to include boys, unless the vaccine price was less than $36/dose. Increasing vaccination coverage to 90% among girls was more effective and less costly than the benefits achieved by vaccinating both genders with 71% coverage. At the anticipated tender price, expanding the HPV vaccination program to boys may be cost-effective and may warrant a change in the current female-only vaccination policy in Norway. However, increasing coverage in girls is uniformly more effective and cost-effective than expanding vaccination coverage to boys and should be considered a priority.

Intrathecal Drug Delivery Systems for Cancer Pain: A Health Technology Assessment.

PubMed

2016-01-01

Intrathecal drug delivery systems can be used to manage refractory or persistent cancer pain. We investigated the benefits, harms, cost-effectiveness, and budget impact of these systems compared with current standards of care for adult patients with chronic pain due owing to cancer. We searched Ovid MEDLINE, Ovid Embase, the Cochrane Library databases, National Health Service's Economic Evaluation Database, and Tufts Cost-Effectiveness Analysis Registry from January 1994 to April 2014 for evidence of effectiveness, harms, and cost-effectiveness. We used existing systematic reviews that had employed reliable search and screen methods and searched for studies published after the search date reported in the latest systematic review to identify studies. Two reviewers screened records and assessed study validity. The cost burden of publicly funding intrathecal drug delivery systems for cancer pain was estimated for a 5-year timeframe using a combination of published literature, information from the device manufacturer, administrative data, and expert opinion for the inputs. We included one randomized trial that examined effectiveness and harms, and one case series that reported an eligible economic evaluation. We found very low quality evidence that intrathecal drug delivery systems added to comprehensive pain management reduce overall drug toxicity; no significant reduction in pain scores was observed. Weak conclusions from economic evidence suggested that intrathecal drug delivery systems had the potential to be more cost-effective than high-cost oral therapy if administered for 7 months or longer. The cost burden of publicly funding this therapy is estimated to be $100,000 in the first year, increasing to $500,000 by the fifth year. Current evidence could not establish the benefit, harm, or cost-effectiveness of intrathecal drug delivery systems compared with current standards of care for managing refractory cancer pain in adults. Publicly funding intrathecal drug delivery systems for cancer pain would result in a budget impact of several hundred thousand dollars per year.

Economic and epidemiological impact of early antiretroviral therapy initiation in India

PubMed Central

Maddali, Manoj V; Dowdy, David W; Gupta, Amita; Shah, Maunank

2015-01-01

Introduction Recent WHO guidance advocates for early antiretroviral therapy (ART) initiation at higher CD4 counts to improve survival and reduce HIV transmission. We sought to quantify how the cost-effectiveness and epidemiological impact of early ART strategies in India are affected by attrition throughout the HIV care continuum. Methods We constructed a dynamic compartmental model replicating HIV transmission, disease progression and health system engagement among Indian adults. Our model of the Indian HIV epidemic compared implementation of early ART initiation (i.e. initiation above CD4 ≥350 cells/mm3) with delayed initiation at CD4 ≤350 cells/mm3; primary outcomes were incident cases, deaths, quality-adjusted-life-years (QALYs) and costs over 20 years. We assessed how costs and effects of early ART initiation were impacted by suboptimal engagement at each stage in the HIV care continuum. Results Assuming “idealistic” engagement in HIV care, early ART initiation is highly cost-effective ($442/QALY-gained) compared to delayed initiation at CD4 ≤350 cells/mm3 and could reduce new HIV infections to <15,000 per year within 20 years. However, when accounting for realistic gaps in care, early ART initiation loses nearly half of potential epidemiological benefits and is less cost-effective ($530/QALY-gained). We project 1,285,000 new HIV infections and 973,000 AIDS-related deaths with deferred ART initiation with current levels of care-engagement in India. Early ART initiation in this continuum resulted in 1,050,000 new HIV infections and 883,000 AIDS-related deaths, or 18% and 9% reductions (respectively), compared to current guidelines. Strengthening HIV screening increases benefits of earlier treatment modestly (1,001,000 new infections; 22% reduction), while improving retention in care has a larger modulatory impact (676,000 new infections; 47% reduction). Conclusions Early ART initiation is highly cost-effective in India but only has modest epidemiological benefits at current levels of care-engagement. Improved retention in care is needed to realize the full potential of earlier treatment. PMID:26434780

Lightweighting Impacts on Fuel Economy, Cost, and Component Losses

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

Brooker, A. D.; Ward, J.; Wang, L.

2013-01-01

The Future Automotive Systems Technology Simulator (FASTSim) is the U.S. Department of Energy's high-level vehicle powertrain model developed at the National Renewable Energy Laboratory. It uses a time versus speed drive cycle to estimate the powertrain forces required to meet the cycle. It simulates the major vehicle powertrain components and their losses. It includes a cost model based on component sizing and fuel prices. FASTSim simulated different levels of lightweighting for four different powertrains: a conventional gasoline engine vehicle, a hybrid electric vehicle (HEV), a plug-in hybrid electric vehicle (PHEV), and a battery electric vehicle (EV). Weight reductions impacted themore » conventional vehicle's efficiency more than the HEV, PHEV and EV. Although lightweighting impacted the advanced vehicles' efficiency less, it reduced component cost and overall costs more. The PHEV and EV are less cost effective than the conventional vehicle and HEV using current battery costs. Assuming the DOE's battery cost target of $100/kWh, however, the PHEV attained similar cost and lightweighting benefits. Generally, lightweighting was cost effective when it costs less than $6/kg of mass eliminated.« less

Redefining cancer: a new paradigm for better and faster treatment innovation.

PubMed

Stewart, David J; Batist, Gerald

2014-01-01

Common cancers may arise from several different mutations, and each causative mutation may require different treatment approaches. There are also several mechanisms by which malignancies may become resistant to therapy, and each mechanism will also require a different therapeutic strategy. Hence, the paradigm of devising therapies based on tumor type is suboptimal. Each common malignancy may now be regarded as a collection of morphologically similar but molecularly distinct orphan diseases, each requiring unique approaches. Current strategies that employ randomized clinical trials (RCTs) in unselected patients carry a high risk of misleading results. Available data suggest that it is reasonable to grant marketing approval for new anticancer agents based solely on high single-agent response rates in small phase I-II studies involving molecularly-defined patient groups where benefit from other therapies is unlikely. This could markedly speed patient access to important therapies while reducing health care costs by slashing drug development costs. Feasible post-approval surveillance procedures could provide ongoing monitoring of drug safety. While assessment of drug combinations would be more complex due to variable contributions of each component, new strategies have been proposed. In addition to savings from more efficient clinical trials methods, it is essential that we also markedly reduce costs of complying with clinical research regulations. Compliance is too cumbersome and expensive, and current regulatory inflexibility markedly slows progress while escalating health care costs. This requires urgent attention. Regulatory approaches intended to enhance safety may instead potentially cost far more life-years than they save by delaying approval of effective therapies. 

Many shades of gray—The context-dependent performance of organic agriculture

PubMed Central

Seufert, Verena; Ramankutty, Navin

2017-01-01

Organic agriculture is often proposed as a more sustainable alternative to current conventional agriculture. We assess the current understanding of the costs and benefits of organic agriculture across multiple production, environmental, producer, and consumer dimensions. Organic agriculture shows many potential benefits (including higher biodiversity and improved soil and water quality per unit area, enhanced profitability, and higher nutritional value) as well as many potential costs including lower yields and higher consumer prices. However, numerous important dimensions have high uncertainty, particularly the environmental performance when controlling for lower organic yields, but also yield stability, soil erosion, water use, and labor conditions. We identify conditions that influence the relative performance of organic systems, highlighting areas for increased research and policy support. PMID:28345054

Economic evaluation of type 2 diabetes prevention programmes: Markov model of low- and high-intensity lifestyle programmes and metformin in participants with different categories of intermediate hyperglycaemia.

PubMed

Roberts, Samantha; Craig, Dawn; Adler, Amanda; McPherson, Klim; Greenhalgh, Trisha

2018-01-30

National guidance on preventing type 2 diabetes mellitus (T2DM) in the UK recommends low-intensity lifestyle interventions for individuals with intermediate categories of hyperglycaemia defined in terms of impaired fasting glucose (IFG) or 'at-risk' levels of HbA1c. In a recent systematic review of economic evaluations of such interventions, most studies had evaluated intensive trial-based lifestyle programmes in participants with impaired glucose tolerance (IGT). This study examines the costs and effects of different intensity lifestyle programmes and metformin in participants with different categories of intermediate hyperglycaemia. We developed a decision tree and Markov model (50-year horizon) to compare four approaches, namely (1) a low-intensity lifestyle programme based on current NICE guidance, (2) a high-intensity lifestyle programme based on the US Diabetes Prevention Program, (3) metformin, and (4) no intervention, modelled for three different types of intermediate hyperglycaemia (IFG, IGT and HbA1c). A health system perspective was adopted and incremental analysis undertaken at an individual and population-wide level, taking England as a case study. Low-intensity lifestyle programmes were the most cost-effective (£44/QALY, £195/QALY and £186/QALY compared to no intervention in IGT, IFG and HbA1c, respectively). Intensive lifestyle interventions were also cost-effective compared to no intervention (£2775/QALY, £6820/QALY and £7376/QALY, respectively, in IGT, IFG and HbA1c). Metformin was cost-effective relative to no intervention (£5224/QALY, £6842/QALY and £372/QALY in IGT, IFG and HbA1c, respectively), but was only cost-effective relative to other treatments in participants identified with HbA1c. At a willingness-to-pay threshold of £20,000/QALY, low- and high-intensity lifestyle programmes were cost-effective 98%, 99% and 98% and 81%, 81% and 71% of the time in IGT, IFG and HbA1c, respectively. An England-wide programme for 50-59 year olds could reduce T2DM incidence by < 3.5% over 50 years and would cost 0.2-5.2% of the current diabetes budget for 2-9 years. This analysis suggests that current English national policy of low-intensity lifestyle programmes in participants with IFG or HbA1c will be cost-effective and have the most favourable budget impact, but will prevent only a fraction of cases of T2DM. Additional approaches to prevention need to be investigated urgently.

Cost awareness of physicians in intensive care units: a multicentric national study.

PubMed

Hernu, Romain; Cour, Martin; de la Salle, Sylvie; Robert, Dominique; Argaud, Laurent

2015-08-01

Physicians play an important role in strategies to control health care spending. Being aware of the cost of prescriptions is surely the first step to incorporating cost-consciousness into medical practice. The aim of this study was to evaluate current intensivists' knowledge of the costs of common prescriptions and to identify factors influencing the accuracy of cost estimations. Junior and senior physicians in 99 French intensive care units were asked, by questionnaire, to estimate the true hospital costs of 46 selected prescriptions commonly used in critical care practice. With an 83% response rate, 1092 questionnaires were examined, completed by 575 (53%) and 517 (47%) junior and senior intensivists, respectively. Only 315 (29%) of the overall estimates were within 50% of the true cost. Response errors included a 14,756 ± 301 € underestimation, i.e., -58 ± 1% of the total sum (25,595 €). High-cost drugs (>1000 €) were significantly (p < 0.001) the most underestimated prescriptions (-67 ± 1%). Junior grade physicians underestimated more costs than senior physicians (p < 0.001). Using multivariate analysis, junior physicians [odds ratio (OR), 2.1; 95% confidence interval (95% CI), 1.43-3.08; p = 0.0002] and female gender (OR, 1.4; 95% CI, 1.04-1.89; p = 0.02) were both independently associated with incorrect cost estimations. ICU physicians have a poor awareness of prescriptions costs, especially with regards to high-cost drugs. Considerable emphasis and effort are still required to integrate the cost-containment problem into the daily prescriptions in ICUs.

Electrocatalysts by atomic layer deposition for fuel cell applications

DOE PAGES

Cheng, Niancai; Shao, Yuyan; Liu, Jun; ...

2016-01-22

Here, fuel cells are a promising technology solution for reliable and clean energy because they offer high energy conversion efficiency and low emission of pollutants. However, high cost and insufficient durability are considerable challenges for widespread adoption of polymer electrolyte membrane fuel cells (PEMFCs) in practical applications. Current PEMFCs catalysts have been identified as major contributors to both the high cost and limited durability. Atomic layer deposition (ALD) is emerging as a powerful technique for solving these problems due to its exclusive advantages over other methods. In this review, we summarize recent developments of ALD in PEMFCs with a focusmore » on design of materials for improved catalyst activity and durability. New research directions and future trends have also been discussed.« less

The cost of atrial fibrillation in Italy: a five-year analysis of healthcare expenditure in the general population. From the Italian Survey of Atrial Fibrillation Management (ISAF) study.

PubMed

Zoni Berisso, M; Landolina, M; Ermini, G; Parretti, D; Zingarini, G L; Degli Esposti, L; Cricelli, C; Boriani, G

2017-01-01

Atrial fibrillation (AF) is a relevant item of expenditure for the National Healthcare systems. The aim of the study was to estimate the annual costs of AF in Italy. The Italian Survey of Atrial Fibrillation Management Study enrolled 6.036 patients with AF among 295.906 subjects representative of the Italian population. Data were collected by 233 General Practitioners (GPs) distributed across Italy. Quantities of resources used during the 5 years preceding the ISAF screening were inferred from the survey data and multiplied by the current Italian unit costs of 2015 in order to estimate the mean per patient annual cumulative cost of AF. Patients were subdivided on the basis of the number of hospitalizations, invasive/non-invasive diagnostic tests and invasive therapeutic procedures in 3 different clinical subsets: "low cost", " medium cost" and "high cost clinical scenario". The estimated mean costs per patient per year were 613 €, 891 € and 1213 € for the "Low cost", "Medium cost" and "High Cost Clinical Scenario" respectively. Hospitalizations and inpatient interventional procedures accounted for more than 80% of the cumulative annual costs. The mean annual costs among patients pursuing "Rhythm control" strategy was 956 €. In Italy, the estimated costs of AF per patient per year are lower than those reported in other developed countries and vary widely related to the different characteristics of AF patients. Hospitalizations and interventional procedures are the main drivers of costs. The mean annual cost of AF is mainly influenced by the duration of the period of observation and the patients' characteristics. Measures to reduce hospitalizations are needed.

Automated Expansion of Primary Human T Cells in Scalable and Cell-Friendly Hydrogel Microtubes for Adoptive Immunotherapy.

PubMed

Lin, Haishuang; Li, Qiang; Wang, Ou; Rauch, Jack; Harm, Braden; Viljoen, Hendrik J; Zhang, Chi; Van Wyk, Erika; Zhang, Chi; Lei, Yuguo

2018-05-11

Adoptive immunotherapy is a highly effective strategy for treating many human cancers, such as melanoma, cervical cancer, lymphoma, and leukemia. Here, a novel cell culture technology is reported for expanding primary human T cells for adoptive immunotherapy. T cells are suspended and cultured in microscale alginate hydrogel tubes (AlgTubes) that are suspended in the cell culture medium in a culture vessel. The hydrogel tubes protect cells from hydrodynamic stresses and confine the cell mass less than 400 µm (in radial diameter) to ensure efficient mass transport, creating a cell-friendly microenvironment for growing T cells. This system is simple, scalable, highly efficient, defined, cost-effective, and compatible with current good manufacturing practices. Under optimized culture conditions, the AlgTubes enable culturing T cells with high cell viability, low DNA damage, high growth rate (≈320-fold expansion over 14 days), high purity (≈98% CD3+), and high yield (≈3.2 × 10 8 cells mL -1 hydrogel). All offer considerable advantages compared to current T cell culturing approaches. This new culture technology can significantly reduce the culture volume, time, and cost, while increasing the production. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Development of neutral beam injection system by use of washer gun plasma source

NASA Astrophysics Data System (ADS)

Imanaka, Heizo; Kajiya, Hirotaka; Nemoto, Yuichi; Azuma, Akiyoshi; Asai, Tomoaki; Yamada, Takuma; Inomoto, Michiaki; Ono, Yasushi

2008-11-01

For the past ten years, we have been investigating high-beta Spherical Tokamaks (ST) formation using reconnection heating of their axial merging in the TS-4 experiment, University of Tokyo. The produced ST was observed to have the maximum beta of 50-60% right after the merging of two STs. A key issue after the formation is to maintain the produced high-beta ST over 100 Alfven times for its stability check. A new low-cost pulsed neutral beam injection (NBI) system has been arranged for its sustainment experiment. Its advantages are 1) low voltage (15kV for low-field side of ST) and high current (20A), 2) maintenance-free, 3) low-cost. The conventional filament plasma source was replaced by the washer gun to realize air-cooled and maintenance free NBI system. In its startup experiment, we already extracted the maximum beam current of 3.7A for then acceleration voltage of 10kV successfully. This result suggests that the increase in the acceleration voltage and several conditioning work will realize its designed beam parameters of 15kV, 20A.

PACS storage technology update: holographic storage.

PubMed

Colang, John E; Johnston, James N

2006-01-01

This paper focuses on the emerging technology of holographic storage and its effect on picture archiving and communication systems (PACS). A review of the emerging technology is presented, which includes a high level description of holographic drives and the associated substrate media, the laser and optical technology, and the spatial light modulator. The potential advantages and disadvantages of holographic drive and storage technology are evaluated. PACS administrators face myriad complex and expensive storage solutions and selecting an appropriate system is time-consuming and costly. Storage technology may become obsolete quickly because of the exponential nature of the advances in digital storage media. Holographic storage may turn out to be a low cost, high speed, high volume storage solution of the future; however, data is inconclusive at this early stage of the technology lifecycle. Despite the current lack of quantitative data to support the hypothesis that holographic technology will have a significant effect on PACS and standards of practice, it seems likely from the current information that holographic technology will generate significant efficiencies. This paper assumes the reader has a fundamental understanding of PACS technology.

CellProfiler and KNIME: open source tools for high content screening.

PubMed

Stöter, Martin; Niederlein, Antje; Barsacchi, Rico; Meyenhofer, Felix; Brandl, Holger; Bickle, Marc

2013-01-01

High content screening (HCS) has established itself in the world of the pharmaceutical industry as an essential tool for drug discovery and drug development. HCS is currently starting to enter the academic world and might become a widely used technology. Given the diversity of problems tackled in academic research, HCS could experience some profound changes in the future, mainly with more imaging modalities and smart microscopes being developed. One of the limitations in the establishment of HCS in academia is flexibility and cost. Flexibility is important to be able to adapt the HCS setup to accommodate the multiple different assays typical of academia. Many cost factors cannot be avoided, but the costs of the software packages necessary to analyze large datasets can be reduced by using Open Source software. We present and discuss the Open Source software CellProfiler for image analysis and KNIME for data analysis and data mining that provide software solutions which increase flexibility and keep costs low.

Three-Dimensional (3-D) Printing: A Cost-Effective Solution for Improving Global Accessibility to Prostheses.

PubMed

Silva, Kyle; Rand, Stephanie; Cancel, David; Chen, Yuxi; Kathirithamby, Rani; Stern, Michelle

2015-12-01

The lack of access to prostheses is a global problem, partially caused by the high cost associated with the current manufacturing process. Three-dimensional printing is gaining use in the medical field, and one such area is prosthetics. In addition to using cost-effective materials, this technology allows for rapid prototyping, making it an efficient solution for the development of affordable prostheses. If the rehabilitation medicine community embraces this novel technology, we can help alleviate the global disparity of access to prostheses. Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Contracting for intensive care services.

PubMed

Dorman, S

1996-01-01

Purchasers will increasingly expect clinical services in the NHS internal market to provide objective measures of their benefits and cost effectiveness in order to maintain or develop current funding levels. There is limited scientific evidence to demonstrate the clinical effectiveness of intensive care services in terms of mortality/morbidity. Intensive care is a high-cost service and studies of cost-effectiveness need to take account of case-mix variations, differences in admission and discharge policies, and other differences between units. Decisions over development or rationalisation of intensive care services should be based on proper outcome studies of well defined patient groups. The purchasing function itself requires development in order to support effective contracting.

Cost-Effectiveness of Transcatheter Aortic Valve Replacement With a Self-Expanding Prosthesis Versus Surgical Aortic Valve Replacement.

PubMed

Reynolds, Matthew R; Lei, Yang; Wang, Kaijun; Chinnakondepalli, Khaja; Vilain, Katherine A; Magnuson, Elizabeth A; Galper, Benjamin Z; Meduri, Christopher U; Arnold, Suzanne V; Baron, Suzanne J; Reardon, Michael J; Adams, David H; Popma, Jeffrey J; Cohen, David J

2016-01-05

Previous studies of the cost-effectiveness of transcatheter aortic valve replacement (TAVR) have been based primarily on a single balloon-expandable system. The goal of this study was to evaluate the cost-effectiveness of TAVR with a self-expanding prosthesis compared with surgical aortic valve replacement (SAVR) for patients with severe aortic stenosis and high surgical risk. We performed a formal economic analysis on the basis of individual, patient-level data from the CoreValve U.S. High Risk Pivotal Trial. Empirical data regarding survival and quality of life over 2 years, and medical resource use and hospital costs through 12 months were used to project life expectancy, quality-adjusted life expectancy, and lifetime medical costs in order to estimate the incremental cost-effectiveness of TAVR versus SAVR from a U.S. Relative to SAVR, TAVR reduced initial length of stay an average of 4.4 days, decreased the need for rehabilitation services at discharge, and resulted in superior 1-month quality of life. Index admission and projected lifetime costs were higher with TAVR than with SAVR (differences $11,260 and $17,849 per patient, respectively), whereas TAVR was projected to provide a lifetime gain of 0.32 quality-adjusted life-years ([QALY]; 0.41 LY) with 3% discounting. Lifetime incremental cost-effectiveness ratios were $55,090 per QALY gained and $43,114 per LY gained. Sensitivity analyses indicated that a reduction in the initial cost of TAVR by ∼$1,650 would lead to an incremental cost-effectiveness ratio <$50,000/QALY gained. In a high-risk clinical trial population, TAVR with a self-expanding prosthesis provided meaningful clinical benefits compared with SAVR, with incremental costs considered acceptable by current U.S. With expected modest reductions in the cost of index TAVR admissions, the value of TAVR compared with SAVR in this patient population would become high. (Safety and Efficacy Study of the Medtronic CoreValve System in the Treatment of Symptomatic Severe Aortic Stenosis in High Risk and Very High Risk Subjects Who Need Aortic Valve Replacement [Medtronic CoreValve U.S. Pivotal Trial]; NCT01240902). Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Developing cost effective plans for low volume bridges

DOT National Transportation Integrated Search

2006-09-01

There is currently an escalating concern across the state of Kansas with respect to the age : and condition of low volume bridges and methods available to modify or replace them. A : high percentage of low volume bridges in the state of Kansas requir...

Development and Validation of a Computational Model for Androgen Receptor Activity

EPA Science Inventory

Testing thousands of chemicals to identify potential androgen receptor (AR) agonists or antagonists would cost millions of dollars and take decades to complete using current validated methods. High-throughput in vitro screening (HTS) and computational toxicology approaches can mo...

A Study of the Implementation of Current Cost Accounting in the Republic of Korea Army Procurement Systems.

DTIC Science & Technology

1986-06-01

financial reporting in Republic of Korea Army (ROKA) procurement. A discussion of the nature of the ROKA procurement system and two alternatives to historical cost financial statements are presented. The concepts, methods and procedures of the historical cost/constant dollars financial statements are described. The proposal for current cost/constant dollars financial statements is presented and emphasis is given to the description of four problems in existing ROKA procurement due to using inadequate accounting information. Keywords: Cost accounting, Procurement, Current

Current challenges and trends in the discovery of agrochemicals.

PubMed

Lamberth, Clemens; Jeanmart, Stephane; Luksch, Torsten; Plant, Andrew

2013-08-16

Crop protection chemistry has come a long way from its "alchemic" beginnings in the late 19th century to a high-tech science that supports the sustainable production of food, feed, and fiber for a rapidly growing population. Cutting-edge developments in the design and synthesis of agrochemicals help to tackle today's challenges of weed and pest resistance, higher regulatory safety margins, and higher cost of goods with the invention of selective, environmentally benign, low use rate, and cost-effective active ingredients.

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

PubMed

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

2008-02-01

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

Cost comparison of printed circuit heat exchanger to low cost periodic flow regenerator for use as recuperator in a s-CO 2 Brayton cycle

DOE PAGES

Hinze, Jacob F.; Nellis, Gregory F.; Anderson, Mark H.

2017-09-21

Supercritical Carbon Dioxide (sCO 2) power cycles have the potential to deliver high efficiency at low cost. However, in order for an sCO 2 cycle to reach high efficiency, highly effective recuperators are needed. These recuperative heat exchangers must transfer heat at a rate that is substantially larger than the heat transfer to the cycle itself and can therefore represent a significant portion of the power block costs. Regenerators are proposed as a cost saving alternative to high cost printed circuit recuperators for this application. A regenerator is an indirect heat exchanger which periodically stores and releases heat to themore » working fluid. The simple design of a regenerator can be made more inexpensively compared to current options. The objective of this paper is a detailed evaluation of regenerators as a competing technology for recuperators within an sCO 2 Brayton cycle. The level of the analysis presented here is sufficient to identify issues with the regenerator system in order to direct future work and also to clarify the potential advantage of pursuing this technology. A reduced order model of a regenerator is implemented into a cycle model of an sCO 2 Brayton cycle. An economic analysis investigates the cost savings that is possible by switching from recuperative heat exchangers to switched-bed regenerators. The cost of the regenerators was estimated using the amount of material required if the pressure vessel is sized using ASME Boiler Pressure Vessel Code (BPVC) requirements. The cost of the associated valves is found to be substantial for the regenerator system and is estimated in collaboration with an industrial valve supplier. The result of this analysis suggests that a 21.2% reduction in the contribution to the Levelized Cost of Electricity (LCoE) from the power block can be realized by switching to a regenerator-based system.« less

Cost comparison of printed circuit heat exchanger to low cost periodic flow regenerator for use as recuperator in a s-CO 2 Brayton cycle

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

Hinze, Jacob F.; Nellis, Gregory F.; Anderson, Mark H.

Supercritical Carbon Dioxide (sCO 2) power cycles have the potential to deliver high efficiency at low cost. However, in order for an sCO 2 cycle to reach high efficiency, highly effective recuperators are needed. These recuperative heat exchangers must transfer heat at a rate that is substantially larger than the heat transfer to the cycle itself and can therefore represent a significant portion of the power block costs. Regenerators are proposed as a cost saving alternative to high cost printed circuit recuperators for this application. A regenerator is an indirect heat exchanger which periodically stores and releases heat to themore » working fluid. The simple design of a regenerator can be made more inexpensively compared to current options. The objective of this paper is a detailed evaluation of regenerators as a competing technology for recuperators within an sCO 2 Brayton cycle. The level of the analysis presented here is sufficient to identify issues with the regenerator system in order to direct future work and also to clarify the potential advantage of pursuing this technology. A reduced order model of a regenerator is implemented into a cycle model of an sCO 2 Brayton cycle. An economic analysis investigates the cost savings that is possible by switching from recuperative heat exchangers to switched-bed regenerators. The cost of the regenerators was estimated using the amount of material required if the pressure vessel is sized using ASME Boiler Pressure Vessel Code (BPVC) requirements. The cost of the associated valves is found to be substantial for the regenerator system and is estimated in collaboration with an industrial valve supplier. The result of this analysis suggests that a 21.2% reduction in the contribution to the Levelized Cost of Electricity (LCoE) from the power block can be realized by switching to a regenerator-based system.« less

Natural wind variability triggered drop in German redispatch volume and costs from 2015 to 2016

PubMed Central

Reyers, Mark; Märker, Carolin; Witthaut, Dirk

2018-01-01

Avoiding dangerous climate change necessitates the decarbonization of electricity systems within the next few decades. In Germany, this decarbonization is based on an increased exploitation of variable renewable electricity sources such as wind and solar power. While system security has remained constantly high, the integration of renewables causes additional costs. In 2015, the costs of grid management saw an all time high of about € 1 billion. Despite the addition of renewable capacity, these costs dropped substantially in 2016. We thus investigate the effect of natural climate variability on grid management costs in this study. We show that the decline is triggered by natural wind variability focusing on redispatch as a main cost driver. In particular, we find that 2016 was a weak year in terms of wind generation averages and the occurrence of westerly circulation weather types. Moreover, we show that a simple model based on the wind generation time series is skillful in detecting redispatch events on timescales of weeks and beyond. As a consequence, alterations in annual redispatch costs in the order of hundreds of millions of euros need to be understood and communicated as a normal feature of the current system due to natural wind variability. PMID:29329349

Optimal nonimaging integrated evacuated solar collector

NASA Astrophysics Data System (ADS)

Garrison, John D.; Duff, W. S.; O'Gallagher, Joseph J.; Winston, Roland

1993-11-01

A non imaging integrated evacuated solar collector for solar thermal energy collection is discussed which has the lower portion of the tubular glass vacuum enveloped shaped and inside surface mirrored to optimally concentrate sunlight onto an absorber tube in the vacuum. This design uses vacuum to eliminate heat loss from the absorber surface by conduction and convection of air, soda lime glass for the vacuum envelope material to lower cost, optimal non imaging concentration integrated with the glass vacuum envelope to lower cost and improve solar energy collection, and a selective absorber for the absorbing surface which has high absorptance and low emittance to lower heat loss by radiation and improve energy collection efficiency. This leads to a very low heat loss collector with high optical collection efficiency, which can operate at temperatures up to the order of 250 degree(s)C with good efficiency while being lower in cost than current evacuated solar collectors. Cost estimates are presented which indicate a cost for this solar collector system which can be competitive with the cost of fossil fuel heat energy sources when the collector system is produced in sufficient volume. Non imaging concentration, which reduces cost while improving performance, and which allows efficient solar energy collection without tracking the sun, is a key element in this solar collector design.

Out-Of-Pocket Prescription Costs Under A Typical Silver Plan Are Twice As High As They Are In The Average Employer Plan.

PubMed

Thorpe, Kenneth E; Allen, Lindsay; Joski, Peter

2015-10-01

The health insurance Marketplaces created under the Affordable Care Act have attracted nearly ten million enrollees, including many people who were previously insured by an employer-sponsored plan. The most popular Marketplace plan--the silver plan--has significantly higher cost sharing than does a typical employer-sponsored plan, which may cause patients to reduce the use of cost-saving services that are essential for managing chronic conditions. We estimated the impact of higher cost sharing on drug and medical spending among patients with chronic conditions. Using national data, we compared cost sharing and prescription and medical spending for patients covered by employer-sponsored plans to the spending for those in a typical silver plan in the Marketplaces. Our results show that out-of-pocket expenses for medications in a typical silver plan are twice as high as they are in the average employer-sponsored plan, resulting in fewer prescriptions filled and refilled and in higher spending on other medical services. Maintaining the use of cost-effective prescription medications might require lower cost sharing for patients with chronic conditions than is currently found in the Marketplaces. Project HOPE—The People-to-People Health Foundation, Inc.

Economic evaluation of nivolumab as a second-line treatment for advanced renal cell carcinoma from US and Chinese perspectives.

PubMed

Wan, Xiao Min; Peng, Liu Bao; Ma, Jin An; Li, Yuan Jian

2017-07-15

Nivolumab is a new standard of care for patients with metastatic renal cell carcinoma (mRCC) and provides an overall survival benefit of 5.40 months in comparison with everolimus. This study evaluated the cost-effectiveness of nivolumab for the second-line treatment of mRCC from the perspective of US payers and identified the range of drug costs for which the addition of nivolumab to standard therapy could be considered cost-effective from a Chinese perspective. A partitioned survival model was constructed to estimate lifetime costs, life-years, and quality-adjusted life-years (QALYs). Costs were estimated for the US and Chinese health care systems. One-way and probabilistic sensitivity analyses were performed. Nivolumab provided an additional 0.29 QALYs at a cost of $151,676/QALY in the United States. The probabilistic sensitivity analysis showed that at a willingness-to-pay threshold of $100,000/QALY, at the current cost of nivolumab, the chance of nivolumab being cost-effective was 3.10%. For China, when nivolumab cost less than $7.90 or $9.70/mg, there was a nearly 90% likelihood that the incremental cost-effectiveness ratio for nivolumab would be less than $22,785 or $48,838/QALY, respectively. For the United States, nivolumab is unlikely to be a high-value treatment for mRCC at the current price, and a price reduction appears to be justified. In China, value-based prices for nivolumab are $7.90 and $9.70/mg for the country and Beijing City, respectively. This study could and should inform the multilateral drug-price negotiations in China that may be upcoming for nivolumab. Cancer 2017;123:2634-41. © 2017 American Cancer Society. © 2017 American Cancer Society.

The cost-effectiveness of Welcome to Medicare visual acuity screening and a possible alternative welcome to medicare eye evaluation among persons without diagnosed diabetes mellitus.

PubMed

Rein, David B; Wittenborn, John S; Zhang, Xinzhi; Hoerger, Thomas J; Zhang, Ping; Klein, Barbara Eden Kobrin; Lee, Kris E; Klein, Ronald; Saaddine, Jinan B

2012-05-01

To estimate the cost-effectiveness of visual acuity screening performed in primary care settings and of dilated eye evaluations performed by an eye care professional among new Medicare enrollees with no diagnosed eye disorders. Medicare currently reimburses visual acuity screening for new enrollees during their initial preventive primary care health check, but dilated eye evaluations may be a more cost-effective policy. Monte Carlo cost-effectiveness simulation model with a total of 50 000 simulated patients with demographic characteristics matched to persons 65 years of age in the US population. Compared with no screening policy, dilated eye evaluations increased quality-adjusted life-years(QALYs) by 0.008 (95% credible interval [CrI], 0.005-0.011) and increased costs by $94 (95% CrI, −$35 to$222). A visual acuity screening increased QALYs in less than 95% of the simulations (0.001 [95% CrI, −0.002 to 0.004) and increased total costs by $32 (95% CrI, −$97 to $159) per person. The incremental cost-effectiveness ratio of a visual acuity screening and an eye examination compared with no screening were $29 000 and$12 000 per QALY gained, respectively. At a willingness-to-pay value of $15 000 or more per QALY gained, a dilated eye evaluation was the policy option most likely to be cost-effective. The currently recommended visual acuity screening showed limited efficacy and cost-effectiveness compared with no screening. In contrast, anew policy of reimbursement for Welcome to Medicare dilated eye evaluations was highly cost-effective.

The Cost-effectiveness of Welcome to Medicare Visual Acuity Screening and a Possible Alternative Welcome to Medicare Eye Evaluation Among Persons Without Diagnosed Diabetes Mellitus

PubMed Central

Rein, David B.; Wittenborn, John S.; Zhang, Xinzhi; Hoerger, Thomas J.; Zhang, Ping; Klein, Barbara Eden Kobrin; Lee, Kris E.; Klein, Ronald; Saaddine, Jinan B.

2013-01-01

Objective To estimate the cost-effectiveness of visual acuity screening performed in primary care settings and of dilated eye evaluations performed by an eye care professional among new Medicare enrollees with no diagnosed eye disorders. Medicare currently reimburses visual acuity screening for new enrollees during their initial preventive primary care health check, but dilated eye evaluations may be a more cost-effective policy. Design Monte Carlo cost-effectiveness simulation model with a total of 50 000 simulated patients with demographic characteristics matched to persons 65 years of age in the US population. Results Compared with no screening policy, dilated eye evaluations increased quality-adjusted life-years (QALYs) by 0.008 (95% credible interval [CrI], 0.005–0.011) and increased costs by $94 (95% CrI, −$35 to $222). A visual acuity screening increased QALYs in less than 95% of the simulations (0.001 [95% CrI, −0.002 to 0.004) and increased total costs by $32 (95% CrI, −$97 to $159) per person. The incremental cost-effectiveness ratio of a visual acuity screening and an eye examination compared with no screening were $29 000 and $12 000 per QALY gained, respectively. At a willingness-to-pay value of $15 000 or more per QALY gained, a dilated eye evaluation was the policy option most likely to be cost-effective. Conclusions The currently recommended visual acuity screening showed limited efficacy and cost-effectiveness compared with no screening. In contrast, a new policy of reimbursement for Welcome to Medicare dilated eye evaluations was highly cost-effective. PMID:22232367

Inhaled alpha 1-antitrypsin: gauging patient interest in a new treatment.

PubMed

Monk, Richard; Graves, Michael; Williams, Pamela; Strange, Charlie

2013-08-01

Given the high cost of plasma derived intravenous alpha 1-antitrypsin (AAT), a more efficient method of delivery to the lungs is desirable. Inhaled AAT has been shown feasible for the treatment of alpha 1-antitrypsin deficiency (AATD) and is currently in clinical trials. To better understand patient preferences about possible inhaled AAT therapy, a survey was conducted to explore patient attitudes. We conducted an email based survey of patients in the Alpha-1 Foundation Research Registry with AATD on intravenous AAT replacement. Respondents were asked to rate their interest in hypothetical nebulized or dry powder inhaled AAT. Respondents reported high levels of interest in both dried powder inhaler and nebulizer delivered inhaled AAT. The interest in dried powder inhaled was higher than interest in nebulized AAT (71% vs 64%, p = 0.0001). The interest in dried powder inhaled AAT was particularly high in respondents currently on bronchodilator therapy (p = 0.0053). Patients were just as likely to use or not use the product if it required 20% more out of pocket cost. There is a high level of patient interest in the development of a commercially available inhaled AAT replacement product.

The Evolving Landscape of HIV Drug Resistance Diagnostics for Expanding Testing in Resource-Limited Settings.

PubMed

Inzaule, Seth C; Hamers, Ralph L; Paredes, Roger; Yang, Chunfu; Schuurman, Rob; Rinke de Wit, Tobias F

2017-01-01

Global scale-up of antiretroviral treatment has dramatically changed the prospects of HIV/AIDS disease, rendering life-long chronic care and treatment a reality for millions of HIV-infected patients. Affordable technologies to monitor antiretroviral treatment are needed to ensure long-term durability of limited available drug regimens. HIV drug resistance tests can complement existing strategies in optimizing clinical decision-making for patients with treatment failure, in addition to facilitating population-based surveillance of HIV drug resistance. This review assesses the current landscape of HIV drug resistance technologies and discusses the strengths and limitations of existing assays available for expanding testing in resource-limited settings. These include sequencing-based assays (Sanger sequencing assays and nextgeneration sequencing), point mutation assays, and genotype-free data-based prediction systems. Sanger assays are currently considered the gold standard genotyping technology, though only available at a limited number of resource-limited setting reference and regional laboratories, but high capital and test costs have limited their wide expansion. Point mutation assays present opportunities for simplified laboratory assays, but HIV genetic variability, extensive codon redundancy at or near the mutation target sites with limited multiplexing capability have restricted their utility. Next-generation sequencing, despite high costs, may have potential to reduce the testing cost significantly through multiplexing in high-throughput facilities, although the level of bioinformatics expertise required for data analysis is currently still complex and expensive and lacks standardization. Web-based genotype-free prediction systems may provide enhanced antiretroviral treatment decision-making without the need for laboratory testing, but require further clinical field evaluation and implementation scientific research in resource-limited settings.

Household costs among patients hospitalized with malaria: evidence from a national survey in Malawi, 2012.

PubMed

Hennessee, Ian; Chinkhumba, Jobiba; Briggs-Hagen, Melissa; Bauleni, Andy; Shah, Monica P; Chalira, Alfred; Moyo, Dubulao; Dodoli, Wilfred; Luhanga, Misheck; Sande, John; Ali, Doreen; Gutman, Julie; Lindblade, Kim A; Njau, Joseph; Mathanga, Don P

2017-10-02

With 71% of Malawians living on < $1.90 a day, high household costs associated with severe malaria are likely a major economic burden for low income families and may constitute an important barrier to care seeking. Nevertheless, few efforts have been made to examine these costs. This paper describes household costs associated with seeking and receiving inpatient care for malaria in health facilities in Malawi. A cross-sectional survey was conducted in a representative nationwide sample of 36 health facilities providing inpatient treatment for malaria from June-August, 2012. Patients admitted at least 12 h before study team visits who had been prescribed an antimalarial after admission were eligible to provide cost information for their malaria episode, including care seeking at previous health facilities. An ingredients-based approach was used to estimate direct costs. Indirect costs were estimated using a human capital approach. Key drivers of total household costs for illness episodes resulting in malaria admission were assessed by fitting a generalized linear model, accounting for clustering at the health facility level. Out of 100 patients who met the eligibility criteria, 80 (80%) provided cost information for their entire illness episode to date and were included: 39% of patients were under 5 years old and 75% had sought care for the malaria episode at other facilities prior to coming to the current facility. Total household costs averaged $17.48 per patient; direct and indirect household costs averaged $7.59 and $9.90, respectively. Facility management type, household distance from the health facility, patient age, high household wealth, and duration of hospital stay were all significant drivers of overall costs. Although malaria treatment is supposed to be free in public health facilities, households in Malawi still incur high direct and indirect costs for malaria illness episodes that result in hospital admission. Finding ways to minimize the economic burden of inpatient malaria care is crucial to protect households from potentially catastrophic health expenditures.

Current costing models: are they suitable for allocating health resources? The example of fall injury prevention in Australia.

PubMed

Moller, Jerry

2005-01-01

The example of fall injury among older people is used to define and illustrate how current Australian systems for allocation of health resources perform for funding emerging public health issues. While the examples are Australian, the allocation and priority setting methods are common in the health sector in all developed western nations. With an ageing population the number of falls injuries in Australia and the cost of treatment will rise dramatically over the next 20-50 years. Current methods of allocating funds within the health system are not well suited to meeting this coming epidemic. The information requirements for cost-benefit and cost-effectiveness measures cannot be met. Marginal approaches to health funding are likely to continue to fund already well-funded treatment or politically driven prevention processes and to miss the opportunity for new prevention initiatives in areas that do not have a high political profile. Fall injury is one of many emerging areas that struggle to make claims for funding because the critical mass of intervention and evidence of its impact is not available. The beneficiaries of allocation failure may be those who treat the disease burden that could have been easily prevented. Changes to allocation mechanisms, data systems and new initiative funding practices are required to ensure that preventative strategies are able to compete on an equal footing with treatment approaches for mainstream health funding.

Cost-effective Diagnostic Checklists for Meningitis in Resource Limited Settings

PubMed Central

Durski, Kara N.; Kuntz, Karen M.; Yasukawa, Kosuke; Virnig, Beth A.; Meya, David B.; Boulware, David R.

2013-01-01

Background Checklists can standardize patient care, reduce errors, and improve health outcomes. For meningitis in resource-limited settings, with high patient loads and limited financial resources, CNS diagnostic algorithms may be useful to guide diagnosis and treatment. However, the cost-effectiveness of such algorithms is unknown. Methods We used decision analysis methodology to evaluate the costs, diagnostic yield, and cost-effectiveness of diagnostic strategies for adults with suspected meningitis in resource limited settings with moderate/high HIV prevalence. We considered three strategies: 1) comprehensive “shotgun” approach of utilizing all routine tests; 2) “stepwise” strategy with tests performed in a specific order with additional TB diagnostics; 3) “minimalist” strategy of sequential ordering of high-yield tests only. Each strategy resulted in one of four meningitis diagnoses: bacterial (4%), cryptococcal (59%), TB (8%), or other (aseptic) meningitis (29%). In model development, we utilized prevalence data from two Ugandan sites and published data on test performance. We validated the strategies with data from Malawi, South Africa, and Zimbabwe. Results The current comprehensive testing strategy resulted in 93.3% correct meningitis diagnoses costing $32.00/patient. A stepwise strategy had 93.8% correct diagnoses costing an average of $9.72/patient, and a minimalist strategy had 91.1% correct diagnoses costing an average of $6.17/patient. The incremental cost effectiveness ratio was $133 per additional correct diagnosis for the stepwise over minimalist strategy. Conclusions Through strategically choosing the order and type of testing coupled with disease prevalence rates, algorithms can deliver more care more efficiently. The algorithms presented herein are generalizable to East Africa and Southern Africa. PMID:23466647

Effectiveness and cost effectiveness of television, radio and print advertisements in promoting the New York smokers' quitline.

PubMed

Farrelly, Matthew C; Hussin, Altijani; Bauer, Ursula E

2007-12-01

This study assessed the relative effectiveness and cost effectiveness of television, radio and print advertisements to generate calls to the New York smokers' quitline. Regression analysis was used to link total county level monthly quitline calls to television, radio and print advertising expenditures. Based on regression results, standardised measures of the relative effectiveness and cost effectiveness of expenditures were computed. There was a positive and statistically significant relation between call volume and expenditures for television (p<0.01) and radio (p<0.001) advertisements and a marginally significant effect for expenditures on newspaper advertisements (p<0.065). The largest effect was for television advertising. However, because of differences in advertising costs, for every $1000 increase in television, radio and newspaper expenditures, call volume increased by 0.1%, 5.7% and 2.8%, respectively. Television, radio and print media all effectively increased calls to the New York smokers' quitline. Although increases in expenditures for television were the most effective, their relatively high costs suggest they are not currently the most cost effective means to promote a quitline. This implies that a more efficient mix of media would place greater emphasis on radio than television. However, because the current study does not adequately assess the extent to which radio expenditures would sustain their effectiveness with substantial expenditure increases, it is not feasible to determine a more optimal mix of expenditures.

Engineered cost-effective growth of Co-based nanoflakes as a sustainable water oxidation electrocatalyst

NASA Astrophysics Data System (ADS)

Pourreza, M.; Naseri, N.

2017-11-01

Developing low-cost, scalable and reproducible synthesis methods for water oxidation reaction (WOR) catalysts is highly desirable and also challenging in energy, environmental and industrial applications. In this context, electrochemical deposition is known as an easy and cost-effective technique in nanomaterial growth. Herein, cobalt-based nanoflakes were grown on a flexible and commercially available steel mesh substrate by electrodeposition approach with a crystalline structure as a mixture of oxide, hydroxide and oxyhydroxide phases. For the first time, the correlation between electrodeposition parameters, time and current density, and morphological characteristics of the grown nanoflakes (density and aspect ratio based on SEM results) has been derived. According to a comprehensive study of the flakes’ electrocatalytic performance in WOR, the optimized sample fabricated with a moderate electrodeposition current density (7 mA cm-2) and duration time (2000 s) revealed the highest density (7.6  ×  108 cm-2) and aspect ratio (7.1) as well as the lowest values for overpotential (OP  =  324 mV) and charge transfer resistance (14 Ω). This designed array of Co-based nanoflakes also showed the lowest value of overpotential for bare cobalt-based WOR electrocatalysts reported yet. High and low values for deposition current density and/or deposition time had a negative effect on the sample surface, leaving some areas without any flakes or with incomplete and inefficient formation of nanoflakes with low densities and aspect ratios. A similar effect was observed for annealed samples in the range of 200-400 °C. Based on recorded overpotentials and extracted surface morphological parameters, a linear and logarithmic behavior in overpotential-flake density dependency was proposed for current density and time controlled systems, respectively.

Integrating Cellular and Bioprocess Engineering in the Non-Conventional Yeast Yarrowia lipolytica for Biodiesel Production: A Review

PubMed Central

Xie, Dongming

2017-01-01

As one of the major biofuels to replace fossil fuel, biodiesel has now attracted more and more attention due to its advantages in higher energy density and overall less greenhouse gas generation. Biodiesel (fatty acid alkyl esters) is produced by chemically or enzymatically catalyzed transesterification of lipids from microbial cells, microalgae, oil crops, or animal fats. Currently, plant oils or waste cooking oils/fats remain the major source for biodiesel production via enzymatic route, but the production capacity is limited either by the uncertain supplement of plant oils or by the low or inconsistent quality of waste oils/fats. In the past decades, significant progresses have been made on synthesis of microalgae oils directly from CO2 via a photosynthesis process, but the production cost from any current technologies is still too high to be commercialized due to microalgae’s slow growth rate on CO2, inefficiency in photo-bioreactors, lack of efficient contamination control methods, and high cost in downstream recovery. At the same time, many oleaginous microorganisms have been studied to produce lipids via the fatty acid synthesis pathway under aerobic fermentation conditions, among them one of the most studied is the non-conventional yeast, Yarrowia lipolytica, which is able to produce fatty acids at very high titer, rate, and yield from various economical substrates. This review summarizes the recent research progresses in both cellular and bioprocess engineering in Y. lipolytica to produce lipids at a low cost that may lead to commercial-scale biodiesel production. Specific technologies include the strain engineering for using various substrates, metabolic engineering in high-yield lipid synthesis, cell morphology study for efficient substrate uptake and product formation, free fatty acid formation and secretion for improved downstream recovery, and fermentation engineering for higher productivities and less operating cost. To further improve the economics of the microbial oil-based biodiesel, production of lipid-related or -derived high-value products are also discussed. PMID:29090211

Expert judgments about RD&D and the future of nuclear energy.

PubMed

Anadón, Laura D; Bosetti, Valentina; Bunn, Matthew; Catenacci, Michela; Lee, Audrey

2012-11-06

Probabilistic estimates of the cost and performance of future nuclear energy systems under different scenarios of government research, development, and demonstration (RD&D) spending were obtained from 30 U.S. and 30 European nuclear technology experts. We used a novel elicitation approach which combined individual and group elicitation. With no change from current RD&D funding levels, experts on average expected current (Gen. III/III+) designs to be somewhat more expensive in 2030 than they were in 2010, and they expected the next generation of designs (Gen. IV) to be more expensive still as of 2030. Projected costs of proposed small modular reactors (SMRs) were similar to those of Gen. IV systems. The experts almost unanimously recommended large increases in government support for nuclear RD&D (generally 2-3 times current spending). The majority expected that such RD&D would have only a modest effect on cost, but would improve performance in other areas, such as safety, waste management, and uranium resource utilization. The U.S. and E.U. experts were in relative agreement regarding how government RD&D funds should be allocated, placing particular focus on very high temperature reactors, sodium-cooled fast reactors, fuels and materials, and fuel cycle technologies.

A Sensorless Predictive Current Controlled Boost Converter by Using an EKF with Load Variation Effect Elimination Function

PubMed Central

Tong, Qiaoling; Chen, Chen; Zhang, Qiao; Zou, Xuecheng

2015-01-01

To realize accurate current control for a boost converter, a precise measurement of the inductor current is required to achieve high resolution current regulating. Current sensors are widely used to measure the inductor current. However, the current sensors and their processing circuits significantly contribute extra hardware cost, delay and noise to the system. They can also harm the system reliability. Therefore, current sensorless control techniques can bring cost effective and reliable solutions for various boost converter applications. According to the derived accurate model, which contains a number of parasitics, the boost converter is a nonlinear system. An Extended Kalman Filter (EKF) is proposed for inductor current estimation and output voltage filtering. With this approach, the system can have the same advantages as sensored current control mode. To implement EKF, the load value is necessary. However, the load may vary from time to time. This can lead to errors of current estimation and filtered output voltage. To solve this issue, a load variation elimination effect elimination (LVEE) module is added. In addition, a predictive average current controller is used to regulate the current. Compared with conventional voltage controlled system, the transient response is greatly improved since it only takes two switching cycles for the current to reach its reference. Finally, experimental results are presented to verify the stable operation and output tracking capability for large-signal transients of the proposed algorithm. PMID:25928061

Predicting hospital accounting costs

PubMed Central

Newhouse, Joseph P.; Cretin, Shan; Witsberger, Christina J.

1989-01-01

Two alternative methods to Medicare Cost Reports that provide information about hospital costs more promptly but less accurately are investigated. Both employ utilization data from current-year bills. The first attaches costs to utilization data using cost-charge ratios from the previous year's cost report; the second uses charges from current year's bills. The first method is the more accurate of the two, but even using it, only 40 percent of hospitals had predicted costs within plus or minus 5 percent of actual costs. The feasibility and cost of obtaining cost reports from a small, fast-track sample of hospitals should be investigated. PMID:10313352

Impact of DOTS expansion on tuberculosis related outcomes and costs in Haiti.

PubMed

Jacquet, Vary; Morose, Willy; Schwartzman, Kevin; Oxlade, Olivia; Barr, Graham; Grimard, Franque; Menzies, Dick

2006-08-15

Implementation of the World Health Organization's DOTS strategy (Directly Observed Treatment Short-course therapy) can result in significant reduction in tuberculosis incidence. We estimated potential costs and benefits of DOTS expansion in Haiti from the government, and societal perspectives. Using decision analysis incorporating multiple Markov processes (Markov modelling), we compared expected tuberculosis morbidity, mortality and costs in Haiti with DOTS expansion to reach all of the country, and achieve WHO benchmarks, or if the current situation did not change. Probabilities of tuberculosis related outcomes were derived from the published literature. Government health expenditures, patient and family costs were measured in direct surveys in Haiti and expressed in 2003 US$. Starting in 2003, DOTS expansion in Haiti is anticipated to cost $4.2 million and result in 63,080 fewer tuberculosis cases, 53,120 fewer tuberculosis deaths, and net societal savings of $131 million, over 20 years. Current government spending for tuberculosis is high, relative to the per capita income, and would be only slightly lower with DOTS. Societal savings would begin within 4 years, and would be substantial in all scenarios considered, including higher HIV seroprevalence or drug resistance, unchanged incidence following DOTS expansion, or doubling of initial and ongoing costs for DOTS expansion. A modest investment for DOTS expansion in Haiti would provide considerable humanitarian benefit by reducing tuberculosis-related morbidity, mortality and costs for patients and their families. These benefits, together with projected minimal Haitian government savings, argue strongly for donor support for DOTS expansion.

The current total economic burden of diabetes mellitus in the Netherlands.

PubMed

Peters, M L; Huisman, E L; Schoonen, M; Wolffenbuttel, B H R

2017-09-01

Insight into the total economic burden of diabetes mellitus (DM) is essential for decision makers and payers. Currently available estimates for the Netherlands only include part of the total burden or are no longer up-to-date. Therefore, this study aimed to determine the current total economic burden of DM and its complications in the Netherlands, by including all the relevant cost components. The study combined a systematic literature review to identify all relevant published information and a targeted review to identify relevant information in the grey literature. The identified evidence was then combined to estimate the current total economic burden. In 2016, there were an estimated 1.1 million DM patients in the Netherlands, of whom approximately 10% had type 1 and 90% had type 2 DM. The estimated current total economic burden of DM was € 6.8 billion in 2016. Healthcare costs (excluding costs of complications) were € 1.6 billion, direct costs of complications were € 1.3 billion and indirect costs due to productivity losses, welfare payments and complications were € 4.0 billion. DM and its complications pose a substantial economic burden to the Netherlands, which is expected to rise due to changing demographics and lifestyle. Indirect costs, such as welfare payments, accounted for a large portion of the current total economic burden of DM, while these cost components are often not included in cost estimations. Publicly available data for key cost drivers such as complications were scarce.

High efficiency single Ag nanowire/p-GaN substrate Schottky junction-based ultraviolet light emitting diodes

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

Wu, Y.; Li, X.; Xu, P.

2015-02-02

We report a high efficiency single Ag nanowire (NW)/p-GaN substrate Schottky junction-based ultraviolet light emitting diode (UV-LED). The device demonstrates deep UV free exciton electroluminescence at 362.5 nm. The dominant emission, detectable at ultralow (<1 μA) forward current, does not exhibit any shifts when the forward current is increased. External quantum efficiency (EQE) as high as 0.9% is achieved at 25 μA current at room temperature. Experiments and simulation analysis show that devices fabricated with thinner Ag NWs have higher EQE. However, for very thin Ag NWs (diameter < 250 nm), this trend breaks down due to heat accumulation in the NWs. Our simple device architecturemore » offers a potentially cost-effective scheme to fabricate high efficiency Schottky junction-based UV-LEDs.« less

Nickel supported on nitrogen-doped carbon nanotubes as hydrogen oxidation reaction catalyst in alkaline electrolyte

DOE PAGES

Zhuang, Zhongbin; Giles, Stephen A.; Zheng, Jie; ...

2016-01-14

The development of a low-cost, high-performance platinum-group-metal-free hydroxide exchange membrane fuel cell is hindered by the lack of a hydrogen oxidation reaction catalyst at the anode. Here we report that a composite catalyst, nickel nanoparticles supported on nitrogen-doped carbon nanotubes, has hydrogen oxidation activity similar to platinum-group metals in alkaline electrolyte. Although nitrogen-doped carbon nanotubes are a very poor hydrogen oxidation catalyst, as a support, it increases the catalytic performance of nickel nanoparticles by a factor of 33 (mass activity) or 21 (exchange current density) relative to unsupported nickel nanoparticles. Density functional theory calculations indicate that the nitrogen-doped support stabilizesmore » the nanoparticle against reconstruction, while nitrogen located at the edge of the nanoparticle tunes local adsorption sites by affecting the d-orbitals of nickel. Here, owing to its high activity and low cost, our catalyst shows significant potential for use in low-cost, high-performance fuel cells.« less

Nickel supported on nitrogen-doped carbon nanotubes as hydrogen oxidation reaction catalyst in alkaline electrolyte

PubMed Central

Zhuang, Zhongbin; Giles, Stephen A.; Zheng, Jie; Jenness, Glen R.; Caratzoulas, Stavros; Vlachos, Dionisios G.; Yan, Yushan

2016-01-01

The development of a low-cost, high-performance platinum-group-metal-free hydroxide exchange membrane fuel cell is hindered by the lack of a hydrogen oxidation reaction catalyst at the anode. Here we report that a composite catalyst, nickel nanoparticles supported on nitrogen-doped carbon nanotubes, has hydrogen oxidation activity similar to platinum-group metals in alkaline electrolyte. Although nitrogen-doped carbon nanotubes are a very poor hydrogen oxidation catalyst, as a support, it increases the catalytic performance of nickel nanoparticles by a factor of 33 (mass activity) or 21 (exchange current density) relative to unsupported nickel nanoparticles. Density functional theory calculations indicate that the nitrogen-doped support stabilizes the nanoparticle against reconstruction, while nitrogen located at the edge of the nanoparticle tunes local adsorption sites by affecting the d-orbitals of nickel. Owing to its high activity and low cost, our catalyst shows significant potential for use in low-cost, high-performance fuel cells. PMID:26762466

48 CFR 15.406-2 - Certificate of current cost or pricing data.

Code of Federal Regulations, 2013 CFR

2013-10-01

... cost or pricing data. 15.406-2 Section 15.406-2 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACTING METHODS AND CONTRACT TYPES CONTRACTING BY NEGOTIATION Contract Pricing 15.406-2 Certificate of current cost or pricing data. (a) When certified cost or pricing data are...

48 CFR 15.406-2 - Certificate of current cost or pricing data.

Code of Federal Regulations, 2010 CFR

2010-10-01

... cost or pricing data. 15.406-2 Section 15.406-2 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACTING METHODS AND CONTRACT TYPES CONTRACTING BY NEGOTIATION Contract Pricing 15.406-2 Certificate of current cost or pricing data. (a) When certified cost or pricing data are...

48 CFR 15.406-2 - Certificate of current cost or pricing data.

Code of Federal Regulations, 2014 CFR

2014-10-01

... cost or pricing data. 15.406-2 Section 15.406-2 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACTING METHODS AND CONTRACT TYPES CONTRACTING BY NEGOTIATION Contract Pricing 15.406-2 Certificate of current cost or pricing data. (a) When certified cost or pricing data are...

Review of technologies for oil and gas produced water treatment.

PubMed

Fakhru'l-Razi, Ahmadun; Pendashteh, Alireza; Abdullah, Luqman Chuah; Biak, Dayang Radiah Awang; Madaeni, Sayed Siavash; Abidin, Zurina Zainal

2009-10-30

Produced water is the largest waste stream generated in oil and gas industries. It is a mixture of different organic and inorganic compounds. Due to the increasing volume of waste all over the world in the current decade, the outcome and effect of discharging produced water on the environment has lately become a significant issue of environmental concern. Produced water is conventionally treated through different physical, chemical, and biological methods. In offshore platforms because of space constraints, compact physical and chemical systems are used. However, current technologies cannot remove small-suspended oil particles and dissolved elements. Besides, many chemical treatments, whose initial and/or running cost are high and produce hazardous sludge. In onshore facilities, biological pretreatment of oily wastewater can be a cost-effective and environmental friendly method. As high salt concentration and variations of influent characteristics have direct influence on the turbidity of the effluent, it is appropriate to incorporate a physical treatment, e.g., membrane to refine the final effluent. For these reasons, major research efforts in the future could focus on the optimization of current technologies and use of combined physico-chemical and/or biological treatment of produced water in order to comply with reuse and discharge limits.

A new composite consisting of electrosynthesized conducting polymers, graphene sheets and biosynthesized gold nanoparticles for biosensing acute lymphoblastic leukemia.

PubMed

Mazloum-Ardakani, Mohammad; Barazesh, Behnaz; Khoshroo, Alireza; Moshtaghiun, Mohammad; Sheikhha, Mohammad Hasan

2018-06-01

In this work we report the synthesis of a stable composite with excellent electrical properties, on the surface of a biosensor. Conductive polymers offer both high electrical conductivity and mechanical strength. Many reports have focused on synthesizing conductive polymers with the aid of high-cost enzymes. In the current work we introduce a novel electrochemical, one-step, facile and cost effective procedure for synthesizing poly (catechol), without using expensive enzymes. The poly (catechol) conductivity was enhanced by modification with graphene sheets and biosynthesized gold nanoparticles. Four different robust methods, DPV, EIS, CV and chronoamperometry, were used to monitor the biosensor modifications. The peak currents of the catechol (an electroactive probe) were linearly related to the logarithm of the concentrations of target DNA in the range 100.0 μM to 10.0 pM, with a detection limit of 1.0 pM for the DNA strand. The current work investigates a new, stable composite consisting of conductive polymers and nanoparticles, which was applied to the detection of acute lymphoblastic leukemia. Copyright © 2018 Elsevier B.V. All rights reserved.

Valuation of clean energy investments: The case of the Zero Emission Coal (ZEC) technology

NASA Astrophysics Data System (ADS)

Yeboah, Frank Ernest

Today, coal-fired power plants produce about 55% of the electrical energy output in the U.S. Demand for electricity is expected to grow in future. Coal can and will continue to play a substantial role in the future global energy supply, despite its high emission of greenhouse gases (e.g. CO2 etc.) and low thermal energy conversion efficiency of about 37%. This is due to the fact that, it is inexpensive and global reserves are abundant. Furthermore, cost competitive and environmentally acceptable energy alternatives are lacking. New technologies could also make coal-fired plants more efficient and environmentally benign. One such technology is the Zero Emission Carbon (ZEC) power plant, which is currently being proposed by the ZECA Corporation. How much will such a technology cost? How competitive will it be in the electric energy market when used as a technology for mitigating CO2 emission? If there were regulatory mechanisms, such as carbon tax to regulate CO2 emission, what would be the minimum carbon tax that should be imposed? How will changes in energy policy affect the implementation of the ZEC technology? How will the cost of the ZEC technology be affected, if a switch from coal (high emission-intensive fuel) to natural gas (low emission-intensive fuel) were to be made? This work introduces a model that can be used to analyze and assess the economic value of a ZEC investment using valuation techniques employed in the electric energy industry such as revenue requirement (e.g. cost-of-service). The study concludes that the cost of service for ZEC technology will be about 95/MWh at the current baseline scenario of using fuel cell as the power generation system and coal as the primary fuel, and hence will not be competitive in the energy markets. For the technology to be competitive, fuel cell capital cost should be as low as 500/kW with a lifetime of 20 years or more, the cost of capital should be around 10%, and a carbon tax of 30/t of CO2 should be in place. Under these conditions, the cost of service would be 54/MWh and ZEC technology would become as competitive as the highly efficient combined-cycle gas-turbine technology.

Certification Strategies using Run-Time Safety Assurance for Part 23 Autopilot Systems

NASA Technical Reports Server (NTRS)

Hook, Loyd R.; Clark, Matthew; Sizoo, David; Skoog, Mark A.; Brady, James

2016-01-01

Part 23 aircraft operation, and in particular general aviation, is relatively unsafe when compared to other common forms of vehicle travel. Currently, there exists technologies that could increase safety statistics for these aircraft; however, the high burden and cost of performing the requisite safety critical certification processes for these systems limits their proliferation. For this reason, many entities, including the Federal Aviation Administration, NASA, and the US Air Force, are considering new options for certification for technologies that will improve aircraft safety. Of particular interest, are low cost autopilot systems for general aviation aircraft, as these systems have the potential to positively and significantly affect safety statistics. This paper proposes new systems and techniques, leveraging run-time verification, for the assurance of general aviation autopilot systems, which would be used to supplement the current certification process and provide a viable path for near-term low-cost implementation. In addition, discussions on preliminary experimentation and building the assurance case for a system, based on these principles, is provided.

Fuel cells for automotive powertrains-A techno-economic assessment

NASA Astrophysics Data System (ADS)

Mock, Peter; Schmid, Stephan A.

With the objective of identifying the hurdles currently preventing a widespread application of fuel cell technology in passenger cars an assessment of technical and economic parameters is carried out. Patent and publication analysis is used to assess current status of fuel cell technology regarding its position on technology life cycle. S-curve methodology leads to the conclusion that further scientific activity is to be expected but for today's low-temperature PEM fuel cell technology might level by 2015. Technical analysis identifies power density and platinum loading as parameters for which further improvements are necessary in order to satisfy future customer needs. A detailed cost evaluation suggests that in future for high production volumes (approx. 1 million vehicles cumulative) significantly lower costs for fuel cell stacks (12-40 kW -1) and systems (35-83 kW -1) will be viable. Reducing costs to such a level will have to be the main focus for upcoming research activities in order to make fuel cell driven road vehicles a competitive alternative.

Developing cost effective plans for low volume bridges

DOT National Transportation Integrated Search

2006-09-01

There is currently an escalating concern across the state of Kansas with respect to the age and condition of low volume bridges and methods available to modify or replace them. A high percentage of low volume bridges in the state of Kansas require or...

Model-based analysis of costs and outcomes of non-invasive prenatal testing for Down's syndrome using cell free fetal DNA in the UK National Health Service.

PubMed

Morris, Stephen; Karlsen, Saffron; Chung, Nancy; Hill, Melissa; Chitty, Lyn S

2014-01-01

Non-invasive prenatal testing (NIPT) for Down's syndrome (DS) using cell free fetal DNA in maternal blood has the potential to dramatically alter the way prenatal screening and diagnosis is delivered. Before NIPT can be implemented into routine practice, information is required on its costs and benefits. We investigated the costs and outcomes of NIPT for DS as contingent testing and as first-line testing compared with the current DS screening programme in the UK National Health Service. We used a pre-existing model to evaluate the costs and outcomes associated with NIPT compared with the current DS screening programme. The analysis was based on a hypothetical screening population of 10,000 pregnant women. Model inputs were taken from published sources. The main outcome measures were number of DS cases detected, number of procedure-related miscarriages and total cost. At a screening risk cut-off of 1∶150 NIPT as contingent testing detects slightly fewer DS cases, has fewer procedure-related miscarriages, and costs the same as current DS screening (around UK£280,000) at a cost of £500 per NIPT. As first-line testing NIPT detects more DS cases, has fewer procedure-related miscarriages, and is more expensive than current screening at a cost of £50 per NIPT. When NIPT uptake increases, NIPT detects more DS cases with a small increase in procedure-related miscarriages and costs. NIPT is currently available in the private sector in the UK at a price of £400-£900. If the NHS cost was at the lower end of this range then at a screening risk cut-off of 1∶150 NIPT as contingent testing would be cost neutral or cost saving compared with current DS screening. As first-line testing NIPT is likely to produce more favourable outcomes but at greater cost. Further research is needed to evaluate NIPT under real world conditions.

The Clinical Impact and Cost-Effectiveness of Routine, Voluntary HIV Screening in South Africa

PubMed Central

Walensky, Rochelle P.; Wood, Robin; Fofana, Mariam O.; Martinson, Neil A.; Losina, Elena; April, Michael D.; Bassett, Ingrid V.; Morris, Bethany L.; Freedberg, Kenneth A.; Paltiel, A. David

2010-01-01

Background Although 900,000 HIV-infected South Africans receive antiretroviral therapy (ART), the majority of South Africans with HIV remain undiagnosed. Methods We use a published simulation model of HIV case detection and treatment to examine three HIV screening scenarios, in addition to current practice: 1) one-time; 2) every five years; and 3) annually. South African model input data include: 16.9% HIV prevalence, 1.3% annual incidence, 49% test acceptance rate, HIV testing costs of $6.49/patient, and a 47% linkage-to-care rate (including two sequential ART regimens) for identified cases. Outcomes include life expectancy, direct medical costs, and incremental cost-effectiveness. Results HIV screening one-time, every five years, and annually increase HIV-infected quality-adjusted life expectancy (mean age 33 years) from 180.6 months (current practice) to 184.9, 187.6 and 197.2 months. The incremental cost-effectiveness of one-time screening is dominated by screening every five years. Screening every five years and annually each have incremental cost-effectiveness ratios of $1,570/quality-adjusted life year (QALY) and $1,720/QALY. Screening annually is very cost-effective even in settings with the lowest incidence/prevalence, with test acceptance and linkage rates both as low as 20%, or when accounting for a stigma impact at least four-fold that of the base case. Conclusions In South Africa, annual voluntary HIV screening offers substantial clinical benefit and is very cost-effective, even with highly constrained access to care and treatment. PMID:21068674

A Survey of Cost Estimating Methodologies for Distributed Spacecraft Missions

NASA Technical Reports Server (NTRS)

Foreman, Veronica; Le Moigne, Jacqueline; de Weck, Oliver

2016-01-01

Satellite constellations present unique capabilities and opportunities to Earth orbiting and near-Earth scientific and communications missions, but also present new challenges to cost estimators. An effective and adaptive cost model is essential to successful mission design and implementation, and as Distributed Spacecraft Missions (DSM) become more common, cost estimating tools must become more representative of these types of designs. Existing cost models often focus on a single spacecraft and require extensive design knowledge to produce high fidelity estimates. Previous research has examined the shortcomings of existing cost practices as they pertain to the early stages of mission formulation, for both individual satellites and small satellite constellations. Recommendations have been made for how to improve the cost models for individual satellites one-at-a-time, but much of the complexity in constellation and DSM cost modeling arises from constellation systems level considerations that have not yet been examined. This paper constitutes a survey of the current state-of-the-art in cost estimating techniques with recommendations for improvements to increase the fidelity of future constellation cost estimates. To enable our investigation, we have developed a cost estimating tool for constellation missions. The development of this tool has revealed three high-priority weaknesses within existing parametric cost estimating capabilities as they pertain to DSM architectures: design iteration, integration and test, and mission operations. Within this paper we offer illustrative examples of these discrepancies and make preliminary recommendations for addressing them. DSM and satellite constellation missions are shifting the paradigm of space-based remote sensing, showing promise in the realms of Earth science, planetary observation, and various heliophysical applications. To fully reap the benefits of DSM technology, accurate and relevant cost estimating capabilities must exist; this paper offers insights critical to the future development and implementation of DSM cost estimating tools.

A Survey of Cost Estimating Methodologies for Distributed Spacecraft Missions

NASA Technical Reports Server (NTRS)

Foreman, Veronica L.; Le Moigne, Jacqueline; de Weck, Oliver

2016-01-01

Satellite constellations present unique capabilities and opportunities to Earth orbiting and near-Earth scientific and communications missions, but also present new challenges to cost estimators. An effective and adaptive cost model is essential to successful mission design and implementation, and as Distributed Spacecraft Missions (DSM) become more common, cost estimating tools must become more representative of these types of designs. Existing cost models often focus on a single spacecraft and require extensive design knowledge to produce high fidelity estimates. Previous research has examined the limitations of existing cost practices as they pertain to the early stages of mission formulation, for both individual satellites and small satellite constellations. Recommendations have been made for how to improve the cost models for individual satellites one-at-a-time, but much of the complexity in constellation and DSM cost modeling arises from constellation systems level considerations that have not yet been examined. This paper constitutes a survey of the current state-of-theart in cost estimating techniques with recommendations for improvements to increase the fidelity of future constellation cost estimates. To enable our investigation, we have developed a cost estimating tool for constellation missions. The development of this tool has revealed three high-priority shortcomings within existing parametric cost estimating capabilities as they pertain to DSM architectures: design iteration, integration and test, and mission operations. Within this paper we offer illustrative examples of these discrepancies and make preliminary recommendations for addressing them. DSM and satellite constellation missions are shifting the paradigm of space-based remote sensing, showing promise in the realms of Earth science, planetary observation, and various heliophysical applications. To fully reap the benefits of DSM technology, accurate and relevant cost estimating capabilities must exist; this paper offers insights critical to the future development and implementation of DSM cost estimating tools.

Faradic redox active material of Cu7S4 nanowires with a high conductance for flexible solid state supercapacitors

NASA Astrophysics Data System (ADS)

Javed, Muhammad Sufyan; Dai, Shuge; Wang, Mingjun; Xi, Yi; Lang, Qiang; Guo, Donglin; Hu, Chenguo

2015-08-01

The exploration of high Faradic redox active materials with the advantages of low cost and low toxicity has been attracting great attention for producing high energy storage supercapacitors. Here, the high Faradic redox active material of Cu7S4-NWs coated on a carbon fiber fabric (CFF) is directly used as a binder-free electrode for a high performance flexible solid state supercapacitor. The Cu7S4-NW-CFF supercapacitor exhibits excellent electrochemical performance such as a high specific capacitance of 400 F g-1 at the scan rate of 10 mV s-1 and a high energy density of 35 Wh kg-1 at a power density of 200 W kg-1, with the advantages of a light weight, high flexibility and long term cycling stability by retaining 95% after 5000 charge-discharge cycles at a constant current of 10 mA. The high Faradic redox activity and high conductance behavior of the Cu7S4-NWs result in a high pseudocapacitive performance with a relatively high specific energy and specific power. Such a new type of pseudocapacitive material of Cu7S4-NWs with its low cost is very promising for actual application in supercapacitors.The exploration of high Faradic redox active materials with the advantages of low cost and low toxicity has been attracting great attention for producing high energy storage supercapacitors. Here, the high Faradic redox active material of Cu7S4-NWs coated on a carbon fiber fabric (CFF) is directly used as a binder-free electrode for a high performance flexible solid state supercapacitor. The Cu7S4-NW-CFF supercapacitor exhibits excellent electrochemical performance such as a high specific capacitance of 400 F g-1 at the scan rate of 10 mV s-1 and a high energy density of 35 Wh kg-1 at a power density of 200 W kg-1, with the advantages of a light weight, high flexibility and long term cycling stability by retaining 95% after 5000 charge-discharge cycles at a constant current of 10 mA. The high Faradic redox activity and high conductance behavior of the Cu7S4-NWs result in a high pseudocapacitive performance with a relatively high specific energy and specific power. Such a new type of pseudocapacitive material of Cu7S4-NWs with its low cost is very promising for actual application in supercapacitors. Electronic supplementary information (ESI) available. See DOI: 10.1039/c5nr03363b

The cost-effectiveness of screening for hereditary hemochromatosis in Germany: a remodeling study.

PubMed

Rogowski, Wolf H

2009-01-01

Genetic tests for hereditary hemochromatosis (HH) are currently included in the German ambulatory care reimbursement scheme but only for symptomatic individuals and the offspring of HH patients. This study synthesizes the most current evidence to examine whether screening in the broader population is cost-effective and to identify the best choice of initial and follow-up screening tests. A probabilistic decision-analytic model was constructed to calculate cost per life year gained (LYG) for HH screening among male Caucasians aged 30. Three strategies were considered in both the general population and male offspring of HH patients: phenotypic (transferrin saturation, TS), genotypic (C282Y mutation), and sequential (genotype if TS is elevated) screening. The incremental cost-effectiveness of sequential screening among male offspring, sequential population-wide screening, and genotypic screening is 41000, 124000, and 161000 Eero/LYG, respectively. All other strategies were subject to simple or extended dominance. The results are subject to high uncertainty. The most influential parameters in the deterministic one-way sensitivity analysis are discounting of life years gained and the adherence of patients to preventive phlebotomy. The current German policy of only screening at-risk individuals is consistent with health economic decision making based on typically accepted thresholds. However, conducting the DNA test after the first elevated TS result is more cost-effective than waiting for a second TS result as recommended by the German guidelines. Further empirical work regarding adherence to long-term prevention recommendations and explicit and well-justified guidance for the choice of discount rates in German economic evaluation are needed.

Paying for family planning.

PubMed

Lande, R E; Geller, J S

1991-11-01

This report discusses the challenges and costs involved in meeting the future needs for family planning in developing countries. Estimates of current expenditures for family planning go as high as $4.5 billion. According to a UNFPA report, developing country governments contribute 75% of the payments for family planning, with donor agencies contributing 15%, and users paying for 10%. Although current expenditures cover the needs of about 315 million couples of reproductive age in developing countries, this number of couples accounts for only 44% of all married women of reproductive age. Meeting all current contraceptive needs would require an additional $1 to $1.4 billion. By the year 2000, as many as 600 million couples could require family planning, costing as much as $11 billion a year. While the brunt of the responsibility for covering these costs will remain in the hand of governments and donor agencies (governments spend only 0.4% of their total budget on family planning and only 1% of all development assistance goes towards family planning), a wide array of approaches can be utilized to help meet costs. The report provides detailed discussions on the following approaches: 1) retail sales and fee-for-services providers, which involves an expanded role for the commercial sector and an increased emphasis on marketing; 2) 3rd-party coverage, which means paying for family planning service through social security institutions, insurance plans, etc.; 3) public-private collaboration (social marketing, employment-based services, etc.); 4) cost recovery, such as instituting fees in public and private nonprofit family planning clinics; and 5) improvements in efficiency.

10 CFR Appendix D to Part 30 - Criteria Relating to Use of Financial Tests and Self-Guarantee for Providing Reasonable Assurance...

Code of Federal Regulations, 2012 CFR

2012-01-01

... will be available for decommissioning costs and on a demonstration that the company passes the... total current decommissioning cost estimate (or the current amount required if certification is used... percent of total assets or at least 10 times the total current decommissioning cost estimate (or the...

Robotic technology in surgery: current status in 2008.

PubMed

Murphy, Declan G; Hall, Rohan; Tong, Raymond; Goel, Rajiv; Costello, Anthony J

2008-12-01

There is increasing patient and surgeon interest in robotic-assisted surgery, particularly with the proliferation of da Vinci surgical systems (Intuitive Surgical, Sunnyvale, CA, USA) throughout the world. There is much debate over the usefulness and cost-effectiveness of these systems. The currently available robotic surgical technology is described. Published data relating to the da Vinci system are reviewed and the current status of surgical robotics within Australia and New Zealand is assessed. The first da Vinci system in Australia and New Zealand was installed in 2003. Four systems had been installed by 2006 and seven systems are currently in use. Most of these are based in private hospitals. Technical advantages of this system include 3-D vision, enhanced dexterity and improved ergonomics when compared with standard laparoscopic surgery. Most procedures currently carried out are urological, with cardiac, gynaecological and general surgeons also using this system. The number of patients undergoing robotic-assisted surgery in Australia and New Zealand has increased fivefold in the past 4 years. The most common procedure carried out is robotic-assisted laparoscopic radical prostatectomy. Published data suggest that robotic-assisted surgery is feasible and safe although the installation and recurring costs remain high. There is increasing acceptance of robotic-assisted surgery, especially for urological procedures. The da Vinci surgical system is becoming more widely available in Australia and New Zealand. Other surgical specialties will probably use this technology. Significant costs are associated with robotic technology and it is not yet widely available to public patients.

Sensor fusion to enable next generation low cost Night Vision systems

NASA Astrophysics Data System (ADS)

Schweiger, R.; Franz, S.; Löhlein, O.; Ritter, W.; Källhammer, J.-E.; Franks, J.; Krekels, T.

2010-04-01

The next generation of automotive Night Vision Enhancement systems offers automatic pedestrian recognition with a performance beyond current Night Vision systems at a lower cost. This will allow high market penetration, covering the luxury as well as compact car segments. Improved performance can be achieved by fusing a Far Infrared (FIR) sensor with a Near Infrared (NIR) sensor. However, fusing with today's FIR systems will be too costly to get a high market penetration. The main cost drivers of the FIR system are its resolution and its sensitivity. Sensor cost is largely determined by sensor die size. Fewer and smaller pixels will reduce die size but also resolution and sensitivity. Sensitivity limits are mainly determined by inclement weather performance. Sensitivity requirements should be matched to the possibilities of low cost FIR optics, especially implications of molding of highly complex optical surfaces. As a FIR sensor specified for fusion can have lower resolution as well as lower sensitivity, fusing FIR and NIR can solve performance and cost problems. To allow compensation of FIR-sensor degradation on the pedestrian detection capabilities, a fusion approach called MultiSensorBoosting is presented that produces a classifier holding highly discriminative sub-pixel features from both sensors at once. The algorithm is applied on data with different resolution and on data obtained from cameras with varying optics to incorporate various sensor sensitivities. As it is not feasible to record representative data with all different sensor configurations, transformation routines on existing high resolution data recorded with high sensitivity cameras are investigated in order to determine the effects of lower resolution and lower sensitivity to the overall detection performance. This paper also gives an overview of the first results showing that a reduction of FIR sensor resolution can be compensated using fusion techniques and a reduction of sensitivity can be compensated.

High-precision and low-cost vibration generator for low-frequency calibration system

NASA Astrophysics Data System (ADS)

Li, Rui-Jun; Lei, Ying-Jun; Zhang, Lian-Sheng; Chang, Zhen-Xin; Fan, Kuang-Chao; Cheng, Zhen-Ying; Hu, Peng-Hao

2018-03-01

Low-frequency vibration is one of the harmful factors that affect the accuracy of micro-/nano-measuring machines because its amplitude is significantly small and it is very difficult to avoid. In this paper, a low-cost and high-precision vibration generator was developed to calibrate an optical accelerometer, which is self-designed to detect low-frequency vibration. A piezoelectric actuator is used as vibration exciter, a leaf spring made of beryllium copper is used as an elastic component, and a high-resolution, low-thermal-drift eddy current sensor is applied to investigate the vibrator’s performance. Experimental results demonstrate that the vibration generator can achieve steady output displacement with frequency range from 0.6 Hz to 50 Hz, an analytical displacement resolution of 3.1 nm and an acceleration range from 3.72 mm s-2 to 1935.41 mm s-2 with a relative standard deviation less than 1.79%. The effectiveness of the high-precision and low-cost vibration generator was verified by calibrating our optical accelerometer.

High cost sharing and specialty drug initiation under Medicare Part D: a case study in patients with newly diagnosed chronic myeloid leukemia.

PubMed

Doshi, Jalpa A; Li, Pengxiang; Huo, Hairong; Pettit, Amy R; Kumar, Rishab; Weiss, Brenda M; Huntington, Scott F

2016-03-01

Specialty drugs often offer medical advances but are frequently subject to high cost sharing. This is particularly true with Medicare Part D, where after meeting a deductible, patients without low-income subsidies (non-LIS) typically face 25% to 33% coinsurance (initial coverage phase with "specialty tier" cost sharing), followed by ~50% coinsurance (coverage gap phase), and then 5% coinsurance (catastrophic phase). Yet, no studies have examined the impact of such high cost sharing on specialty drug initiation under Part D. Oral tyrosine kinase inhibitors (TKIs) have revolutionized the treatment of chronic myeloid leukemia (CML), making it an apt case study. A retrospective claims-based analysis utilizing 2011 to 2013 100% Medicare claims. TKI initiation rates and time to initiation were compared between fee-for-service non-LIS Part D patients newly diagnosed with CML and their LIS counterparts who faced nominal cost sharing of ≤ $5. The first 30-day TKI fill "straddled" benefit phases, for a mean out-of-pocket cost of $2600 or more for non-LIS patients. Non-LIS patients were less likely than LIS patients to have a TKI claim within 6 months of diagnosis (45.3% vs 66.9%; P < .001) and those initiating a TKI took twice as long to fill it (mean = 50.9 vs 23.7 days; P < .001). Cox regressions controlling for sociodemographic, clinical, and plan characteristics confirmed descriptive findings (hazard ratio, 0.59; 95% CI, 0.45-0.76). Extensive sensitivity analyses confirmed the robustness of our findings. High cost sharing was associated with reduced and/or delayed initiation of TKIs. We discuss policy strategies to reduce current financial barriers that adversely impact access to critical therapies under Medicare Part D.

Youth's Awareness of and Reactions to The Real Cost National Tobacco Public Education Campaign

PubMed Central

Duke, Jennifer C.; Alexander, Tesfa N.; Zhao, Xiaoquan; Delahanty, Janine C.; Allen, Jane A.; MacMonegle, Anna J.; Farrelly, Matthew C.

2015-01-01

In 2014, the Food and Drug Administration (FDA) launched its first tobacco-focused public education campaign, The Real Cost, aimed at reducing tobacco use among 12- to 17-year-olds in the United States. This study describes The Real Cost message strategy, implementation, and initial evaluation findings. The campaign was designed to encourage youth who had never smoked but are susceptible to trying cigarettes (susceptible nonsmokers) and youth who have previously experimented with smoking (experimenters) to reassess what they know about the “costs” of tobacco use to their body and mind. The Real Cost aired on national television, online, radio, and other media channels, resulting in high awareness levels. Overall, 89.0% of U.S. youth were aware of at least one advertisement 6 to 8 months after campaign launch, and high levels of awareness were attained within the campaign’s two targeted audiences: susceptible nonsmokers (90.5%) and experimenters (94.6%). Most youth consider The Real Cost advertising to be effective, based on assessments of ad perceived effectiveness (mean = 4.0 on a scale from 1.0 to 5.0). High levels of awareness and positive ad reactions are requisite proximal indicators of health behavioral change. Additional research is being conducted to assess whether potential shifts in population-level cognitions and/or behaviors are attributable to this campaign. Current findings demonstrate that The Real Cost has attained high levels of ad awareness which is a critical first step in achieving positive changes in tobacco-related attitudes and behaviors. These data can also be used to inform ongoing message and media strategies for The Real Cost and other U.S. youth tobacco prevention campaigns. PMID:26679504

[Ecological cost of grain production in gully area of Loess Plateau].

PubMed

Li, Xiao; Xie, Yong-sheng; Zhang, Ying-long; Li, Wen-zhuo

2010-12-01

Economic and ecological methods were applied to investigate the ecological cost of grain production in the gully area of Loess Plateau. In the study area in 2008, the ecological loss due to grain production was 7.2% of the total crop output, and the ecological cost reached 2.42 yuan x kg(-1) for wheat and 2.12 yuan x kg(-1) for corn. However, the per unit sales were 1.70 yuan x kg(-1) for wheat and 1.28 yuan x kg(-1) for corn. The combination of high production cost and low income affected the sustainable development of local ecological economy. The analysis of grey relationships among various factors affecting the ecological cost of grain production indicated that yield, sown area, and agricultural mechanical cost were the important factors affecting the ecological cost of grain production, while chemical fertilizer cost and organic fertilizer cost had less impact on the ecological cost of grain production. Under current production conditions, the ecological cost of grain production in the area could be reduced by raising the level of scientific and technological inputs, expanding the scale of family agricultural production, and improving the grain yield.

Development of Miniaturized Optimized Smart Sensors (MOSS) for space plasmas

NASA Technical Reports Server (NTRS)

Young, D. T.

1993-01-01

The cost of space plasma sensors is high for several reasons: (1) Most are one-of-a-kind and state-of-the-art, (2) the cost of launch to orbit is high, (3) ruggedness and reliability requirements lead to costly development and test programs, and (4) overhead is added by overly elaborate or generalized spacecraft interface requirements. Possible approaches to reducing costs include development of small 'sensors' (defined as including all necessary optics, detectors, and related electronics) that will ultimately lead to cheaper missions by reducing (2), improving (3), and, through work with spacecraft designers, reducing (4). Despite this logical approach, there is no guarantee that smaller sensors are necessarily either better or cheaper. We have previously advocated applying analytical 'quality factors' to plasma sensors (and spacecraft) and have begun to develop miniaturized particle optical systems by applying quantitative optimization criteria. We are currently designing a Miniaturized Optimized Smart Sensor (MOSS) in which miniaturized electronics (e.g., employing new power supply topology and extensive us of gate arrays and hybrid circuits) are fully integrated with newly developed particle optics to give significant savings in volume and mass. The goal of the SwRI MOSS program is development of a fully self-contained and functional plasma sensor weighing 1 lb and requiring 1 W. MOSS will require only a typical spacecraft DC power source (e.g., 30 V) and command/data interfaces in order to be fully functional, and will provide measurement capabilities comparable in most ways to current sensors.

Can low-cost VOR and Omega receivers suffice for RNAV - A new computer-based navigation technique

NASA Technical Reports Server (NTRS)

Hollaar, L. A.

1978-01-01

It is shown that although RNAV is particularly valuable for the personal transportation segment of general aviation, it has not gained complete acceptance. This is due, in part, to its high cost and the necessary special-handling air traffic control. VOR/DME RNAV calculations are ideally suited for analog computers, and the use of microprocessor technology has been suggested for reducing RNAV costs. Three navigation systems, VOR, Omega, and DR, are compared for common navigational difficulties, such as station geometry, siting errors, ground disturbances, and terminal area coverage. The Kalman filtering technique is described with reference to the disadvantages when using a system including standard microprocessors. An integrated navigation system, using input data from various low-cost sensor systems, is presented and current simulation studies are noted.

Value: A Framework for Radiation Oncology

PubMed Central

Teckie, Sewit; McCloskey, Susan A.; Steinberg, Michael L.

2014-01-01

In the current health care system, high costs without proportional improvements in quality or outcome have prompted widespread calls for change in how we deliver and pay for care. Value-based health care delivery models have been proposed. Multiple impediments exist to achieving value, including misaligned patient and provider incentives, information asymmetries, convoluted and opaque cost structures, and cultural attitudes toward cancer treatment. Radiation oncology as a specialty has recently become a focus of the value discussion. Escalating costs secondary to rapidly evolving technologies, safety breaches, and variable, nonstandardized structures and processes of delivering care have garnered attention. In response, we present a framework for the value discussion in radiation oncology and identify approaches for attaining value, including economic and structural models, process improvements, outcome measurement, and cost assessment. PMID:25113759

The ethical allocation of scarce resources in surgery: implants and cost

PubMed Central

Gross, Michael

1997-01-01

This paper is a discussion of the factors involved in instituting a bulk purchasing program for surgical supplies. An improved understanding of the surgical procedure of joint arthroplasty must relate to the variability in surgical methods that achieve patient outcomes. An understanding of the outcomes in relation to the expected duration of the success of an implant and the high costs associated with a revision earlier than expected must be factored into the budget and costs of implants. The ethical implications of choosing one implant over another are considered. A more uniform outcome assessment with respect to surgical activities is needed and potential savings related to other operating-room costs must be examined. Optimizing the implant to patient requirements is the goal within the framework of current fiscal constraints. PMID:9416251

Development of a low-energy and high-current pulsed neutral beam injector with a washer-gun plasma source for high-beta plasma experiments.

PubMed

Ii, Toru; Gi, Keii; Umezawa, Toshiyuki; Asai, Tomohiko; Inomoto, Michiaki; Ono, Yasushi

2012-08-01

We have developed a novel and economical neutral-beam injection system by employing a washer-gun plasma source. It provides a low-cost and maintenance-free ion beam, thus eliminating the need for the filaments and water-cooling systems employed conventionally. In our primary experiments, the washer gun produced a source plasma with an electron temperature of approximately 5 eV and an electron density of 5 × 10(17) m(-3), i.e., conditions suitable for ion-beam extraction. The dependence of the extracted beam current on the acceleration voltage is consistent with space-charge current limitation, because the observed current density is almost proportional to the 3/2 power of the acceleration voltage below approximately 8 kV. By optimizing plasma formation, we successfully achieved beam extraction of up to 40 A at 15 kV and a pulse length in excess of 0.25 ms. Its low-voltage and high-current pulsed-beam properties enable us to apply this high-power neutral beam injection into a high-beta compact torus plasma characterized by a low magnetic field.

Achieving High Current Density of Perovskite Solar Cells by Modulating the Dominated Facets of Room-Temperature DC Magnetron Sputtered TiO2 Electron Extraction Layer.

PubMed

Huang, Aibin; Lei, Lei; Zhu, Jingting; Yu, Yu; Liu, Yan; Yang, Songwang; Bao, Shanhu; Cao, Xun; Jin, Ping

2017-01-25

The short circuit current density of perovskite solar cell (PSC) was boosted by modulating the dominated plane facets of TiO 2 electron transport layer (ETL). Under optimized condition, TiO 2 with dominant {001} facets showed (i) low incident light loss, (ii) highly smooth surface and excellent wettability for precursor solution, (iii) efficient electron extraction, and (iv) high conductivity in perovskite photovoltaic application. A current density of 24.19 mA cm -2 was achieved as a value near the maximum limit. The power conversion efficiency was improved to 17.25%, which was the record value of PSCs with DC magnetron sputtered carrier transport layer. What is more, the room-temperature process had a great significance for the cost reduction and flexible application of PSCs.