Can custom-made biomechanic shoe orthoses prevent problems in the back and lower extremities? A randomized, controlled intervention trial of 146 military conscripts.

PubMed

Larsen, Kristian; Weidich, Flemming; Leboeuf-Yde, Charlotte

2002-06-01

Shock-absorbing and biomechanic shoe orthoses are frequently used in the prevention and treatment of back and lower extremity problems. One review concludes that the former is clinically effective in relation to prevention, whereas the latter has been tested in only 1 randomized clinical trial, concluding that stress fractures could be prevented. To investigate if biomechanic shoe orthoses can prevent problems in the back and lower extremities and if reducing the number of days off-duty because of back or lower extremity problems is possible. Prospective, randomized, controlled intervention trial. One female and 145 male military conscripts (aged 18 to 24 years), representing 25% of all new conscripts in a Danish regiment. Health data were collected by questionnaires at initiation of the study and 3 months later. Custom-made biomechanic shoe orthoses to be worn in military boots were provided to all in the study group during the 3-month intervention period. No intervention was provided for the control group. Differences between the 2 groups were tested with the chi-square test, and statistical significance was accepted at P <.05. Risk ratio (RR), risk difference (ARR), numbers needed to prevent (NNP), and cost per successfully prevented case were calculated. Outcome variables included self-reported back and/or lower extremity problems; specific problems in the back or knees or shin splints, Achilles tendonitis, sprained ankle, or other problems in the lower extremity; number of subjects with at least 1 day off-duty because of back or lower extremity problems and total number of days off-duty within the first 3 months of military service because of back or lower extremity problems. Results were significantly better in an actual-use analysis in the intervention group for total number of subjects with back or lower extremity problems (RR 0.7, ARR 19%, NNP 5, cost 98 US dollars); number of subjects with shin splints (RR 0.2, ARR 19%, NNP 5, cost 101 US dollars); number of off-duty days because of back or lower extremity problems (RR 0.6, ARR < 1%, NNP 200, cost 3750 US dollars). In an intention-to-treat analysis, a significant difference was found for only number of subjects with shin splints (RR 0.3, ARR 18%, NNP 6 cost 105 US dollars), whereas a worst-case analysis revealed no significant differences between the study groups. This study shows that it may be possible to prevent certain musculoskeletal problems in the back or lower extremities among military conscripts by using custom-made biomechanic shoe orthoses. However, because care-seeking for lower extremity problems is rare, using this method of prevention in military conscripts would be too costly. We also noted that the choice of statistical approach determined the outcome.

Safety belt usage attitude study

DOT National Transportation Integrated Search

1979-02-01

Despite increasing evidence that occupant restraint laws are effective in getting people to wear safety belts and an extremely cost-effective measure for reducing highway deaths and injuries, strong opposition at the state-level has prevented passage...

Cost Effectiveness Study of Wastewater Management Systems for Selected U.S. Coast Guard Vessels. Volume I. Results of Cost and Effectiveness Analyses and Selection of Optimum Candidate Systems

DTIC Science & Technology

1977-04-01

extreme is the viewpoint that such analyses are modern types of witchcraft , or numerology, practiced by a priestly cast. Results and con- clusions...simplistic approach is often respon- sible for imparting a bad reputation to an entire field of analysis - and deserves the label of witchcraft or

Dampening Effects Of Food Importation On Climate Change-Induced Conflict In Africa

DTIC Science & Technology

2017-12-01

The validity of those claims, however, remains in question.47 Abundance theory, on the other hand, relies on a similar cost - benefit calculation but...FDRs). These resource fluctuations have the potential to reach levels extreme enough, as indicated in Table 9 results, to alter the cost - benefit ...NAVAL POSTGRADUATE SCHOOL MONTEREY, CALIFORNIA THESIS Approved for public release. Distribution is unlimited. DAMPENING EFFECTS

JPRS Report, Science & Technology. Europe: Economic Competitiveness

DTIC Science & Technology

1991-08-09

cost . Under the current funding scheme, support is only available through a system of reimbursable interest-free loans. With the currently proposed... system , basic indus- trial research will henceforth be financed by subsidies (of up to 50 percent of gross costs ). Small- and medium- sized...extremely cost -effective installations. • To market the MD110 as a foundation for office automation facilities. • To target very large system

Forest operations, extreme flooding events, and considerations for hydrologic modeling in the Appalachians--A review

Treesearch

M.A. Eisenbies; W.M. Aust; J.A. Burger; M.B. Adams

2007-01-01

The connection between forests and water resources is well established, but the relationships among controlling factors are only partly understood. Concern over the effects of forestry operations, particularly harvesting, on extreme flooding events is a recurrent issue in forest and watershed management. Due to the complexity of the system, and the cost of installing...

Michigan School Privatization Survey 2012

ERIC Educational Resources Information Center

Hohman, James M.; Kollmeyer, Josiah M.

2013-01-01

Michigan's School Aid fund increased once more this year, but many school administrators in the state continue to hunt for effective measures to reduce spending due to increased pension costs and phased-out stimulus money. Many options available for trimming costs, such as enacting pay-to-play for sports, are extremely unpopular for districts and…

Natural Gas as an Instrument of Russian State Power (Letort Paper)

DTIC Science & Technology

2011-10-01

effects the price increase had on the Ukrainian industry as a whole; and does not account for the costs to the Ukrainian economy of the 2006 and...a political consideration); and the differential cost of sanctions among the senders (largely an economic factor). First, allies hardly ever agree...sanctions is extremely hard to realize. 5 Second, the cost of imposing sanctions is sim- ply greater for some sender states than the potential

Cumulative hazard: The case of nuisance flooding

NASA Astrophysics Data System (ADS)

Moftakhari, Hamed R.; AghaKouchak, Amir; Sanders, Brett F.; Matthew, Richard A.

2017-02-01

The cumulative cost of frequent events (e.g., nuisance floods) over time may exceed the costs of the extreme but infrequent events for which societies typically prepare. Here we analyze the likelihood of exceedances above mean higher high water and the corresponding property value exposure for minor, major, and extreme coastal floods. Our results suggest that, in response to sea level rise, nuisance flooding (NF) could generate property value exposure comparable to, or larger than, extreme events. Determining whether (and when) low cost, nuisance incidents aggregate into high cost impacts and deciding when to invest in preventive measures are among the most difficult decisions for policymakers. It would be unfortunate if efforts to protect societies from extreme events (e.g., 0.01 annual probability) left them exposed to a cumulative hazard with enormous costs. We propose a Cumulative Hazard Index (CHI) as a tool for framing the future cumulative impact of low cost incidents relative to infrequent extreme events. CHI suggests that in New York, NY, Washington, DC, Miami, FL, San Francisco, CA, and Seattle, WA, a careful consideration of socioeconomic impacts of NF for prioritization is crucial for sustainable coastal flood risk management.

Effect of poverty reduction program on nutritional status of the extreme poor in Bangladesh.

PubMed

Jalal, Chowdhury S B; Frongillo, Edward A

2013-12-01

Poverty alleviation programs for the extreme poor improve participants' economic status and may impact other important outcomes that are seldom evaluated. A program targeted to the extreme poor by BRAG, a development organization in Bangladesh, has been successful in significantly alleviating extreme poverty. We hypothesized that the program also improved the nutritional status of women and preschool children. A nonequivalent control, pre- and posttest quasi-experimental design that was longitudinal at the village level was used to test the hypotheses. Data were collected from a random sample of 4,131 children and 3,551 women from 3,409 households in 159 villages of 3 northern districts of Bangladesh in 2002 and 2006. Linear mixed random-intercept models accounted for clustering effects and potential confounders. The weight-for-height of children between 24 and 35 months of age from program households was significantly higher (p < .05) than that of children from control households. We found no significant differences between control and program households in three other growth and body-composition indicators in three other age categories of preschool children or in women. These results are important, as this is a large-scale program that has already been extended to more than half the country. The findings will contribute to judging the cost-benefit and cost-effectiveness of the program and in garnering support for the expansion of such programs.

Remediation of negative side effects of an on-going response-cost system with chronic mental patients.

PubMed

Doty, D W; McInnis, T; Paul, G L

1974-01-01

Response-cost procedures within a token economy with extremely regressed residents excluded many residents from access to positive reinforcement. Procedures allowing residents to "purchase eligibility" to obtain backup reinforcers through contingent payment on standing fines, combined with proportional fine payoff schedules contingent upon time without new fines, increased payment on fines, reduced incidence of new fines, and increased utilization of backup reinforcers. These modifications removed adverse side effects while retaining the benefits associated with response costs. Failures or adverse effects of elements of token systems should not occasion abandonment of token economies, but rather encourage their continual evaluation and modification.

Economic Burden of Hospitalizations for Heat-Related Illnesses in the United States, 2001-2010.

PubMed

Schmeltz, Michael T; Petkova, Elisaveta P; Gamble, Janet L

2016-09-08

Understanding how heat waves affect morbidity and mortality, as well as the associated economic costs, is essential for characterizing the human health impacts of extreme heat under a changing climate. Only a handful of studies have examined healthcare costs associated with exposures to high temperatures. This research explores costs associated with hospitalizations for heat-related illness (HRI) in the United States using the 2001 to 2010 Nationwide Inpatient Sample (NIS). Descriptive statistics of patient data for HRI hospitalizations were examined and costs of hospitalizations were reported using the all-payer inpatient cost-to-charge ratio. Costs were examined using a log-gamma model with patient and hospital characteristics included as fixed effects. Adjusted mean costs were then compared across racial groups. The mean costs of HRI hospitalizations were higher among racial/ethnic minorities compared to Whites, who accounted for almost 65% of all HRI hospitalizations. Observed differences in costs based on income, insurance, and gender were also significant. These results suggest that these populations are suffering disproportionately from health inequity, thus, they could shoulder greater disease and financial burdens due to climate change. These findings may have important implications in understanding the economic impact public health planning and interventions will have on preventing hospitalizations related to extreme heat.

Extreme lightweight ZERODUR mirrors (ELZM): supporting characteristics for spaceborne applications

NASA Astrophysics Data System (ADS)

Hull, Tony; Westerhoff, Thomas

2014-08-01

Extreme Lightweight ZERODUR® Mirrors (ELZM) have been developed expressly to provide architects of spaceborne missions a new, cost-effective, option for implementation of medium and large Optical Telescope Assemblies (OTAs, up to 4+ meters in diameter). ZERODUR® is a traditional material in space with over a 30 year heritage. We will discuss the attributes of the material and fabrication methods to aggressively reduce weight to an extent now routinely available. Recent and emerging independent measurements of material properties will confirm the utility of this approach for new generations of OTAs. Data on dimensional stability over a broad practical temperature range will be referenced, as will recent mechanical strength data. Other data confirming suitability for use in space will be referenced. We will discuss how this data can be used for the architecture of a ELZM based cost-effective spaceborne OTA.

To compare growth outcomes and cost-effectiveness of "Kangaroo ward care" with "intermediate intensive care" in stable extremely low birth weight infants: randomized control trial.

PubMed

Sharma, Deepak; Murki, Srinivas; Pratap, Oleti Tejo

2017-07-01

To compare growth outcome and cost-effectiveness of "Kangaroo ward care" (KWC) with "Intermediate intensive care" (IIC) in stable extremely low birth weight (ELBW) infants. This is secondary analysis of the study and we analyzed 62 ELBW infants, 33 were randomized to KWC and 29 to IIC once the infant reached a weight of 1150 g. Infants in the KWC group were shifted to the Kangaroo ward immediately after randomization and in the IIC group received IIC care till they attain a weight of 1250 g before shifting to Kangaroo ward. The gain in weight (g/day), length (cm/week), and head circumference (cm/week) were comparable between the two groups. The mean weight, length, and head circumference were comparable at term gestational age. The infants in KWC group were shifted five days earlier to Kangaroo ward when compared to IIC group. The cost-effective analysis using "top-down" and "bottom-up" accounting method showed that there was significant reduction of hospital and parents expenditure in KWC group (p < 0.001) with approximate saving of 452 USD for each patient in the KWC group. Early shifting of ELBW infants for KWC is very efficacious and cost-effective intervention when compared to IIC. (CTRI/2014/05/004625).

Extreme Cost Reductions with Multi-Megawatt Centralized Inverter Systems

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

Schwabe, Ulrich; Fishman, Oleg

2015-03-20

The objective of this project was to fully develop, demonstrate, and commercialize a new type of utility scale PV system. Based on patented technology, this includes the development of a truly centralized inverter system with capacities up to 100MW, and a high voltage, distributed harvesting approach. This system promises to greatly impact both the energy yield from large scale PV systems by reducing losses and increasing yield from mismatched arrays, as well as reduce overall system costs through very cost effective conversion and BOS cost reductions enabled by higher voltage operation.

[Direct medical costs of hospital treatment of fractures of the upper extremity of the femur].

PubMed

El Ayoubi, Abdelghani; Bouhelo, Kevin Parfait Bienvenu; Chafik, Hachem; Nasri, Mohammed; El Idrissi, Mohammed; Shimi, Mohammed; El Ibrahimi, Abdelhalim; Elmrini, Abdelmajid

2017-01-01

Fractures of the upper extremity of the femur are serious because of their morbidity and social and/or economic consequences. They have been the subject of several studies of world literature concerning their hospital treatment, evolution and prevention. The increase in the incidence of this pathology seems unavoidable due to population ageing and to the lengthening life expectancy; it is posing a real long-term public health problem whose importance will be further increased by the need to control health care costs. The results of this study show that the average age of onset of fracture of the proximal extremity of the femur is 68,13 ± 16.9 years, with a male predominance and a sex ratio of 1.14. In our study pertrochanterian fractures represented 69.4% of cases. Direct medical costs of the hospital treatment of fractures of the upper extremity of the femur at the Hassan II University Hospital were £387 714,38 in 222 cases, with an average cost of £1757,4 , including costs for patient's stay in hospital, which represented the majority of expenses ( 77% of total costs). It is desirable to raise staff awareness of the costs of consumables in order to reduce treatment costs and to adopt cost-oriented behaviour. Length of stay should be limited to the maximum extent because it only allows to reduce staff and accommodation costs.

Using Effective Professional Development Sessions to Implement Change in Curriculum and Classroom Practices: My Story as a Teacher at Exmouth District High School, WA's Remotest District High

ERIC Educational Resources Information Center

Bedford, Susie

2005-01-01

Teaching in a remote town has its drawbacks with regard to Professional Development (PD), which becomes extremely costly, so each staff member is probably limited to one decent PD once a year. This means choosing PD extremely carefully to ensure "value for money" and hopefully that it will provide the teacher concerned with…

Using community partners to deliver low-cost and effective emergency management and business continuity services.

PubMed

Thomas, Joan; Roggiero, Jean Paul; Silva, Brian

2010-11-01

Small to medium-sized organisations enhance their business mission as well as their communities by continuing to offer services in extreme circumstances. Developing emergency preparedness and business continuity plans that are cost-effective, comprehensive and operational for small to medium-sized organisations with limited resources requires a consistent, supportive, hands-on approach over time with professionals to create appropriate and sustainable strategies. Using a unique, multi-layered and applied approach to emergency preparedness training, organisations have successfully created plans that are effective and sustainable.

U. S. Navy Special Operations (1140) Community Diving and Salvage Functional Area

DTIC Science & Technology

1993-04-01

to $72,000, but were rejected by the Commandant, Marc Island Navy Yard because the costs were too great. Instead, he attempted to use the new, 21,000...throughout Southeast Asia as well as battle damage and recovery operations. This concept proved to be extremely successfu and cost elfectivt.. In theater...mission by contractor personnel and equipment, or Navy sal.vage ships and assets, to provide cost effective and rapid solutions to a variety of salvage

Cost Effectiveness of Two versus Three Levels of Maintenance for Turbine Engines in the Air Force Inventory

DTIC Science & Technology

1990-09-01

increasing 2 complexity of Air Force weapon systems makes the estimation of LCC an extremely difficult task. To accomplish this, mathematical models are...maintenance is nearly horizontal. A reduction in this rate from 2.8 to 2.6 (approx. 7%j resulted in cost savings of around 0.1% for the three lvel concept. The

External human factors in incident management team decisionmaking and their effect on large fire suppression expenditures

Treesearch

Janie Canton-Tompson; Krista M. Gebert; Brooke Thompson; Greg Jones; David Calkin; Geoff Donovan

2008-01-01

Large wildland fires are complex, costly events influenced by a vast array of physical, climatic, and social factors. Changing climate, fuel buildup due to past suppression, and increasing populations in the wildland-urban interface have all been blamed for the extreme fire seasons and rising suppression expenditures of recent years. With each high-cost year comes a...

Potential impact of legislation mandating breast density notification: benefits, harms, and cost effectiveness of supplemental ultrasound screening

PubMed Central

Sprague, Brian L.; Stout, Natasha K.; Schechter, Clyde; van Ravesteyn, Nicolien T.; Cevik, Mucahit; Alagoz, Oguzhan; Lee, Christoph I.; van den Broek, Jeroen J.; Miglioretti, Diana L.; Mandelblatt, Jeanne S.; de Koning, Harry J.; Kerlikowske, Karla; Lehman, Constance D.; Tosteson, Anna N. A.

2014-01-01

Background At least nineteen states have laws that require telling women with dense breasts and a negative screening mammogram to consider supplemental screening. The most readily available supplemental screening modality is ultrasound, yet little is known about its effectiveness. Objective To evaluate the benefits, harms, and cost-effectiveness of supplemental ultrasound screening for women with dense breasts. Design Comparative modeling with 3 validated simulation models. Data Sources Surveillance, Epidemiology, and End Results Program; Breast Cancer Surveillance Consortium; the medical literature. Target Population A contemporary cohort of women eligible for routine screening. Time Horizon Lifetime. Perspective Payer. Interventions Supplemental ultrasound screening for women with dense breasts following a negative screening mammogram. Outcome Measures Breast cancer deaths averted, quality-adjusted life years (QALYs) gained, false positive ultrasound biopsy recommendations, costs, costs per QALY gained. Results of Base-Case Analysis Supplemental ultrasound screening after a negative mammogram for women aged 50–74 with heterogeneously or extremely dense breasts averted 0.36 additional breast cancer deaths (range across models: 0.14–0.75), gained 1.7 QALYs (0.9–4.7), and resulted in 354 false-positive ultrasound biopsy recommendations (345–421) per 1000 women with dense breasts compared with biennial screening by mammography alone. The cost-effectiveness ratio was $325,000 per QALY gained ($112,000-$766,000). Restricting supplemental ultrasound screening to women with extremely dense breasts cost $246,000 per QALY gained ($74,000-$535,000). Results of Sensitivity Analysis The conclusions were not sensitive to ultrasound performance characteristics, screening frequency, or starting age. Limitations Provider costs for coordinating supplemental ultrasound were not considered. Conclusions Supplemental ultrasound screening for women with dense breasts undergoing screening mammography would substantially increase costs while producing relatively small benefits in breast cancer deaths averted and QALYs gained. Primary Funding Source National Institutes of Health PMID:25486550

Ethical objections against including life-extension costs in cost-effectiveness analysis: a consistent approach.

PubMed

Gandjour, Afschin; Müller, Dirk

2014-10-01

One of the major ethical concerns regarding cost-effectiveness analysis in health care has been the inclusion of life-extension costs ("it is cheaper to let people die"). For this reason, many analysts have opted to rule out life-extension costs from the analysis. However, surprisingly little has been written in the health economics literature regarding this ethical concern and the resulting practice. The purpose of this work was to present a framework and potential solution for ethical objections against life-extension costs. This work found three levels of ethical concern: (i) with respect to all life-extension costs (disease-related and -unrelated); (ii) with respect to disease-unrelated costs only; and (iii) regarding disease-unrelated costs plus disease-related costs not influenced by the intervention. Excluding all life-extension costs for ethical reasons would require-for reasons of consistency-a simultaneous exclusion of savings from reducing morbidity. At the other extreme, excluding only disease-unrelated life-extension costs for ethical reasons would require-again for reasons of consistency-the exclusion of health gains due to treatment of unrelated diseases. Therefore, addressing ethical concerns regarding the inclusion of life-extension costs necessitates fundamental changes in the calculation of cost effectiveness.

Production of ELZM mirrors: performance coupled with attractive schedule, cost, and risk factors

NASA Astrophysics Data System (ADS)

Leys, Antoine; Hull, Tony; Westerhoff, Thomas

2016-08-01

Extreme light weighted ZERODUR Mirrors (ELZM) have been developed to exploit the superb thermal characteristics of ZERODUR. Coupled with up to date mechanical and optical fabrication methods this becomes an attractive technical approach. However the process of making mirror substrates has demonstrated to be unusually rapid and especially cost-effective. ELZM is aimed at the knee of the cost as a function of light weighting curve. ELZM mirrors are available at 88% light weighted. Together with their low risk, low cost production methods, this is presented as a strong option for NASA Explorer and Probe class missions.

OPPORTUNITY COSTS OF REWARD DELAYS AND THE DISCOUNTING OF HYPOTHETICAL MONEY AND CIGARETTES

PubMed Central

Johnson, Patrick S.; Herrmann, Evan S.; Johnson, Matthew W.

2015-01-01

Humans are reported to discount delayed rewards at lower rates than nonhumans. However, nonhumans are studied in tasks that restrict reinforcement during delays, whereas humans are typically studied in tasks that do not restrict reinforcement during delays. In nonhuman tasks, the opportunity cost of restricted reinforcement during delays may increase delay discounting rates. The present within-subjects study used online crowdsourcing (Amazon Mechanical Turk, or MTurk) to assess the discounting of hypothetical delayed money (and cigarettes in smokers) under four hypothetical framing conditions differing in the availability of reinforcement during delays. At one extreme, participants were free to leave their computer without returning, and engage in any behavior during reward delays (modeling typical human tasks). At the opposite extreme, participants were required to stay at their computer and engage in little other behavior during reward delays (modeling typical nonhuman tasks). Discounting rates increased as an orderly function of opportunity cost. Results also indicated predominantly hyperbolic discounting, the “magnitude effect,” steeper discounting of cigarettes than money, and positive correlations between discounting rates of these commodities. This is the first study to test the effects of opportunity costs on discounting, and suggests that procedural differences may partially account for observed species differences in discounting. PMID:25388973

Opportunity costs of reward delays and the discounting of hypothetical money and cigarettes.

PubMed

Johnson, Patrick S; Herrmann, Evan S; Johnson, Matthew W

2015-01-01

Humans are reported to discount delayed rewards at lower rates than nonhumans. However, nonhumans are studied in tasks that restrict reinforcement during delays, whereas humans are typically studied in tasks that do not restrict reinforcement during delays. In nonhuman tasks, the opportunity cost of restricted reinforcement during delays may increase delay discounting rates. The present within-subjects study used online crowdsourcing (Amazon Mechanical Turk, or MTurk) to assess the discounting of hypothetical delayed money (and cigarettes in smokers) under four hypothetical framing conditions differing in the availability of reinforcement during delays. At one extreme, participants were free to leave their computer without returning, and engage in any behavior during reward delays (modeling typical human tasks). At the opposite extreme, participants were required to stay at their computer and engage in little other behavior during reward delays (modeling typical nonhuman tasks). Discounting rates increased as an orderly function of opportunity cost. Results also indicated predominantly hyperbolic discounting, the "magnitude effect," steeper discounting of cigarettes than money, and positive correlations between discounting rates of these commodities. This is the first study to test the effects of opportunity costs on discounting, and suggests that procedural differences may partially account for observed species differences in discounting. © Society for the Experimental Analysis of Behavior.

Cost effectiveness of a pharmacist-led information technology intervention for reducing rates of clinically important errors in medicines management in general practices (PINCER).

PubMed

Elliott, Rachel A; Putman, Koen D; Franklin, Matthew; Annemans, Lieven; Verhaeghe, Nick; Eden, Martin; Hayre, Jasdeep; Rodgers, Sarah; Sheikh, Aziz; Avery, Anthony J

2014-06-01

We recently showed that a pharmacist-led information technology-based intervention (PINCER) was significantly more effective in reducing medication errors in general practices than providing simple feedback on errors, with cost per error avoided at £79 (US$131). We aimed to estimate cost effectiveness of the PINCER intervention by combining effectiveness in error reduction and intervention costs with the effect of the individual errors on patient outcomes and healthcare costs, to estimate the effect on costs and QALYs. We developed Markov models for each of six medication errors targeted by PINCER. Clinical event probability, treatment pathway, resource use and costs were extracted from literature and costing tariffs. A composite probabilistic model combined patient-level error models with practice-level error rates and intervention costs from the trial. Cost per extra QALY and cost-effectiveness acceptability curves were generated from the perspective of NHS England, with a 5-year time horizon. The PINCER intervention generated £2,679 less cost and 0.81 more QALYs per practice [incremental cost-effectiveness ratio (ICER): -£3,037 per QALY] in the deterministic analysis. In the probabilistic analysis, PINCER generated 0.001 extra QALYs per practice compared with simple feedback, at £4.20 less per practice. Despite this extremely small set of differences in costs and outcomes, PINCER dominated simple feedback with a mean ICER of -£3,936 (standard error £2,970). At a ceiling 'willingness-to-pay' of £20,000/QALY, PINCER reaches 59 % probability of being cost effective. PINCER produced marginal health gain at slightly reduced overall cost. Results are uncertain due to the poor quality of data to inform the effect of avoiding errors.

Transit and climate change adaptation : synthesis of FTA-funded pilot projects.

DOT National Transportation Integrated Search

2014-08-01

Public transit agencies play a critical role in providing safe, reliable, and cost-effective transportation to the communities they serve. In : the face of increased frequency and intensity of extreme weather events, several public transit and other ...

The design, development, fabrication and testing of two (2) Non-Spin Platforms, (NSP)

NASA Technical Reports Server (NTRS)

1975-01-01

The non spin platform is a means for achieving the very low acceleration requirements for cost effective space processing experiments on research rocket flights. These platforms have a low initial cost, are re-usable and have extremely low refurbishment cost. In order to attain this goal, commercially available components were used and only the necessary quality control standards were imposed. A detailed system description, the very few design problems encountered, the operational procedures (both pre-flight and post-flight), and the maintenance requirements are described.

Cost-effective optical switch matrix for microwave phased-array

NASA Technical Reports Server (NTRS)

Pan, J. J.; Chia, S. L.; Li, W. Z.; Grove, C. H.

1991-01-01

An all-fiber (6x6) optical shutter switch matrix with the control system for microwave phased array has been demonstrated. The device offers the advantages of integrated configuration, low cost, low power consumption, small size, and light weight. The maximum extinction ratio (among 36 individual pixel) of this switch matrix at 840 nm is 24.2 dB, and the switching time is less than 120 microsec. In addition to phased array application, this low cost switch matrix is extremely attractive for fiber optic switching networks.

Applying Cost-Sensitive Extreme Learning Machine and Dissimilarity Integration to Gene Expression Data Classification.

PubMed

Liu, Yanqiu; Lu, Huijuan; Yan, Ke; Xia, Haixia; An, Chunlin

2016-01-01

Embedding cost-sensitive factors into the classifiers increases the classification stability and reduces the classification costs for classifying high-scale, redundant, and imbalanced datasets, such as the gene expression data. In this study, we extend our previous work, that is, Dissimilar ELM (D-ELM), by introducing misclassification costs into the classifier. We name the proposed algorithm as the cost-sensitive D-ELM (CS-D-ELM). Furthermore, we embed rejection cost into the CS-D-ELM to increase the classification stability of the proposed algorithm. Experimental results show that the rejection cost embedded CS-D-ELM algorithm effectively reduces the average and overall cost of the classification process, while the classification accuracy still remains competitive. The proposed method can be extended to classification problems of other redundant and imbalanced data.

Estimation of in-situ bioremediation system cost using a hybrid Extreme Learning Machine (ELM)-particle swarm optimization approach

NASA Astrophysics Data System (ADS)

Yadav, Basant; Ch, Sudheer; Mathur, Shashi; Adamowski, Jan

2016-12-01

In-situ bioremediation is the most common groundwater remediation procedure used for treating organically contaminated sites. A simulation-optimization approach, which incorporates a simulation model for groundwaterflow and transport processes within an optimization program, could help engineers in designing a remediation system that best satisfies management objectives as well as regulatory constraints. In-situ bioremediation is a highly complex, non-linear process and the modelling of such a complex system requires significant computational exertion. Soft computing techniques have a flexible mathematical structure which can generalize complex nonlinear processes. In in-situ bioremediation management, a physically-based model is used for the simulation and the simulated data is utilized by the optimization model to optimize the remediation cost. The recalling of simulator to satisfy the constraints is an extremely tedious and time consuming process and thus there is need for a simulator which can reduce the computational burden. This study presents a simulation-optimization approach to achieve an accurate and cost effective in-situ bioremediation system design for groundwater contaminated with BTEX (Benzene, Toluene, Ethylbenzene, and Xylenes) compounds. In this study, the Extreme Learning Machine (ELM) is used as a proxy simulator to replace BIOPLUME III for the simulation. The selection of ELM is done by a comparative analysis with Artificial Neural Network (ANN) and Support Vector Machine (SVM) as they were successfully used in previous studies of in-situ bioremediation system design. Further, a single-objective optimization problem is solved by a coupled Extreme Learning Machine (ELM)-Particle Swarm Optimization (PSO) technique to achieve the minimum cost for the in-situ bioremediation system design. The results indicate that ELM is a faster and more accurate proxy simulator than ANN and SVM. The total cost obtained by the ELM-PSO approach is held to a minimum while successfully satisfying all the regulatory constraints of the contaminated site.

Cost-Effectiveness of Antibiotic Prophylaxis Strategies for Transrectal Prostate Biopsy in an Era of Increasing Antimicrobial Resistance.

PubMed

Lee, Kyueun; Drekonja, Dimitri M; Enns, Eva A

2018-03-01

To determine the optimal antibiotic prophylaxis strategy for transrectal prostate biopsy (TRPB) as a function of the local antibiotic resistance profile. We developed a decision-analytic model to assess the cost-effectiveness of four antibiotic prophylaxis strategies: ciprofloxacin alone, ceftriaxone alone, ciprofloxacin and ceftriaxone in combination, and directed prophylaxis selection based on susceptibility testing. We used a payer's perspective and estimated the health care costs and quality-adjusted life-years (QALYs) associated with each strategy for a cohort of 66-year-old men undergoing TRPB. Costs and benefits were discounted at 3% annually. Base-case resistance prevalence was 29% to ciprofloxacin and 7% to ceftriaxone, reflecting susceptibility patterns observed at the Minneapolis Veterans Affairs Health Care System. Resistance levels were varied in sensitivity analysis. In the base case, single-agent prophylaxis strategies were dominated. Directed prophylaxis strategy was the optimal strategy at a willingness-to-pay threshold of $50,000/QALY gained. Relative to the directed prophylaxis strategy, the incremental cost-effectiveness ratio of the combination strategy was $123,333/QALY gained over the lifetime time horizon. In sensitivity analysis, single-agent prophylaxis strategies were preferred only at extreme levels of resistance. Directed or combination prophylaxis strategies were optimal for a wide range of resistance levels. Facilities using single-agent antibiotic prophylaxis strategies before TRPB should re-evaluate their strategies unless extremely low levels of antimicrobial resistance are documented. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

A Bayesian model averaging approach with non-informative priors for cost-effectiveness analyses.

PubMed

Conigliani, Caterina

2010-07-20

We consider the problem of assessing new and existing technologies for their cost-effectiveness in the case where data on both costs and effects are available from a clinical trial, and we address it by means of the cost-effectiveness acceptability curve. The main difficulty in these analyses is that cost data usually exhibit highly skew and heavy-tailed distributions, so that it can be extremely difficult to produce realistic probabilistic models for the underlying population distribution. Here, in order to integrate the uncertainty about the model into the analysis of cost data and into cost-effectiveness analyses, we consider an approach based on Bayesian model averaging (BMA) in the particular case of weak prior informations about the unknown parameters of the different models involved in the procedure. The main consequence of this assumption is that the marginal densities required by BMA are undetermined. However, in accordance with the theory of partial Bayes factors and in particular of fractional Bayes factors, we suggest replacing each marginal density with a ratio of integrals that can be efficiently computed via path sampling. Copyright (c) 2010 John Wiley & Sons, Ltd.

Effects on Storm-Water Management for Three Major US Cities Using Location Specific Extreme Precipitation Dynamical Downscaling

NASA Astrophysics Data System (ADS)

Pelle, A.; Allen, M.; Fu, J. S.

2013-12-01

With rising population and increasing urban density, it is of pivotal importance for urban planners to plan for increasing extreme precipitation events. Climate models indicate that an increase in global mean temperature will lead to increased frequency and intensity of storms of a variety of types. Analysis of results from the Coupled Model Intercomparison Project, Phase 5 (CMIP5) has demonstrated that global climate models severely underestimate precipitation, however. Preliminary results from dynamical downscaling indicate that Philadelphia, Pennsylvania is expected to experience the greatest increase of precipitation due to an increase in annual extreme events in the US. New York City, New York and Chicago, Illinois are anticipated to have similarly large increases in annual extreme precipitation events. In order to produce more accurate results, we downscale Philadelphia, Chicago, and New York City using the Weather Research and Forecasting model (WRF). We analyze historical precipitation data and WRF output utilizing a Log Pearson Type III (LP3) distribution for frequency of extreme precipitation events. This study aims to determine the likelihood of extreme precipitation in future years and its effect on the of cost of stormwater management for these three cities.

Advanced Lubrication for Energy Efficiency, Durability and Lower Maintenance Costs of Advanced Naval Components and Systems

DTIC Science & Technology

2010-08-20

for transmitting the required power and torque. The proper gear set has also been sized to insure life expectancy of the test rig. The shaft design ...these at minimal cost and great environmental safety. These materials specifically designed on antiwear and extreme pressure chemistries can...nanolubricant additives are designed as surface-stabilized nanomaterials that are dispersed in a hydrocarbon medium for maximum effectiveness. This

Optical phased array configuration for an extremely large telescope.

PubMed

Meinel, Aden Baker; Meinel, Marjorie Pettit

2004-01-20

Extremely large telescopes are currently under consideration by several groups in several countries. Extrapolation of current technology up to 30 m indicates a cost of over dollars 1 billion. Innovative concepts are being explored to find significant cost reductions. We explore the concept of an Optical Phased Array (OPA) telescope. Each element of the OPA is a separate Cassegrain telescope. Collimated beams from the array are sent via an associated set of delay lines to a central beam combiner. This array of small telescope elements offers the possibility of starting with a low-cost array of a few rings of elements, adding structure and additional Cass elements until the desired diameter telescope is attained. We address the salient features of such an extremely large telescope and cost elements relative to more conventional options.

Vibration Damping Workshop Proceedings Held at Long Beach, California on 27-29 February 1984.

DTIC Science & Technology

1984-11-11

control system with a sensing accelerometer plus a differentiating network is an extremely effective damping system, if - the magnitude of the... devopment /operating cost by 340M UU -2 p 0 i -L . ..’ - . , ,.. . ,, _,_ ... . .-; .. :: -- _. . , .:... : . -.. .*. - - -.- 2 -,-i-. . i

Costs, benefits and effectiveness of worksite physical activity counseling from the employer's perspective.

PubMed

Proper, Karin I; de Bruyne, Martine C; Hildebrandt, Vincent H; van der Beek, Allard J; Meerding, Willem Jan; van Mechelen, Willem

2004-02-01

This study evaluated the impact of worksite physical activity counseling using cost-benefit and cost-effectiveness analyses. Civil servants (N = 299) were randomly assigned to an intervention (N = 131) or control (N = 168) group for 9 months. The intervention costs were compared with the monetary benefits gained from reduced sick leave. In addition, the intervention costs minus the monetary benefits from sick leave reduction were compared with the effects (percentage meeting the public health recommendation for moderate-intensity physical activity, energy expenditure, cardiorespiratory fitness, and upper extremity symptoms). The intervention costs were EUR 430 per participant, and the benefits were EUR 125 due to sick leave during the intervention period, for net total costs of EUR 305 for the intervention. During the same 9-month period the year after the intervention, the benefits from sick leave reduction were EUR 635. No statistically significant differences in costs and benefits were found between the groups. As to the cost-effectiveness, improvement in energy expenditure and cardiorespiratory fitness was observed at higher costs. The point estimates of the cost-effectiveness ratios were EUR 5.2 (without imputation of effect data) and EUR 2.7 (with imputation of effect data) per extra kilocalorie of energy expenditure per day and EUR 235 (without imputation of effect data) and EUR 45.9 (with imputation of effect data) per beat per minute of decrease in submaximal heart rate. This study does not provide a financial reason for implementing worksite counseling intervention on physical activity on the short-term. However, positive effects were shown for energy expenditure and cardiorespiratory fitness.

Financial Toxicity of Cancer Care: It's Time to Intervene.

PubMed

Zafar, S Yousuf

2016-05-01

Evidence suggests that a considerably large proportion of cancer patients are affected by treatment-related financial harm. As medical debt grows for some with cancer, the downstream effects can be catastrophic, with a recent study suggesting a link between extreme financial distress and worse mortality. At least three factors might explain the relationship between extreme financial distress and greater risk of mortality: 1) overall poorer well-being, 2) impaired health-related quality of life, and 3) sub-par quality of care. While research has described the financial harm associated with cancer treatment, little has been done to effectively intervene on the problem. Long-term solutions must focus on policy changes to reduce unsustainable drug prices and promote innovative insurance models. In the mean time, patients continue to struggle with high out-of-pocket costs. For more immediate solutions, we should look to the oncologist and patient. Oncologists should focus on the value of care delivered, encourage patient engagement on the topic of costs, and be better educated on financial resources available to patients. For their part, patients need improved cost-related health literacy so they are aware of potential costs and resources, and research should focus on how patients define high-value care. With a growing list of financial side effects induced by cancer treatment, the time has come to intervene on the "financial toxicity" of cancer care. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Lymphatic filariasis and onchocerciasis prevention, treatment, and control costs across diverse settings: a systematic review.

PubMed

Keating, Joseph; Yukich, Joshua O; Mollenkopf, Sarah; Tediosi, Fabrizio

2014-07-01

The control and eventual elimination of neglected tropical disease (NTD) requires the expansion of interventions such as mass drug administration (MDA), vector control, diagnostic testing, and effective treatment. The purpose of this paper is to present the evidence base for decision-makers on the cost and cost-effectiveness of lymphatic filariasis (LF) and onchocerciasis prevention, treatment, and control. A systematic review of the published literature was conducted. All studies that contained primary or secondary data on costs or cost-effectiveness of prevention and control were considered. A total of 52 papers were included for LF and 24 papers were included for onchocerciasis. Large research gaps exist on the synergies and cost of integrating NTD prevention and control programs, as well as research on the role of health information systems, human resource systems, service delivery, and essential medicines and technology for elimination. The literature available on costs and cost-effectiveness of interventions is also generally older, extremely focal geographically and of limited usefulness for developing estimates of the global economic burden of these diseases and prioritizing among various intervention options. Up to date information on the costs and cost-effectiveness of interventions for LF and onchocerciasis prevention are needed given the vastly expanded funding base for the control and elimination of these diseases. Copyright © 2014 Elsevier B.V. All rights reserved.

Transit climate change adaptation assessment/asset management pilot for the Metropolitan Atlanta Rapid Transit Authority.

DOT National Transportation Integrated Search

2013-08-01

Public transit agencies play an important role in the provision of safe, reliable, and cost-effective transportation for the communities they serve. With the growing intensity and frequency of extreme weather events, such as hurricanes Irene and Sand...

Tandem anchoring: informational and politeness effects of range offers in social exchange.

PubMed

Ames, Daniel R; Mason, Malia F

2015-02-01

We examined whether and why range offers (e.g., "I want $7,200 to $7,600 for my car") matter in negotiations. A selective-attention account predicts that motivated and skeptical offer-recipients focus overwhelmingly on the attractive endpoint (i.e., a buyer would hear, in effect, "I want $7,200"). In contrast, we propose a tandem anchoring account, arguing that offer-recipients are often influenced by both endpoints as they judge the offer-maker's reservation price (i.e., bottom line) as well as how polite they believe an extreme (nonaccommodating) counteroffer would be. In 5 studies, featuring scripted negotiation scenarios and live dyadic negotiations, we find that certain range offers yield improved settlement terms for offer-makers without relational costs, whereas others may yield relationship benefits without deal costs. We clarify the types of range offers that evoke these benefits and identify boundaries to their impact, including range width and extremity. In addition, our studies reveal evidence consistent with 2 proposed mechanisms, one involving an informational effect (both endpoints of range offers can be taken as signals of an offer-maker's reservation price) and another involving a politeness effect (range offers can make extreme counteroffers seem less polite). Our results have implications for models of negotiation behavior and outcomes and, more broadly, for the nature of social exchange. (PsycINFO Database Record (c) 2015 APA, all rights reserved). PsycINFO Database Record (c) 2015 APA, all rights reserved.

Extreme habitats as refuge from parasite infections? Evidence from an extremophile fish

NASA Astrophysics Data System (ADS)

Tobler, Michael; Schlupp, Ingo; García de León, Francisco J.; Glaubrecht, Matthias; Plath, Martin

2007-05-01

Living in extreme habitats typically requires costly adaptations of any organism tolerating these conditions, but very little is known about potential benefits that trade off these costs. We suggest that extreme habitats may function as refuge from parasite infections, since parasites can become locally extinct either directly, through selection by an extreme environmental parameter on free-living parasite stages, or indirectly, through selection on other host species involved in its life cycle. We tested this hypothesis in a small freshwater fish, the Atlantic molly ( Poecilia mexicana) that inhabits normal freshwaters as well as extreme habitats containing high concentrations of toxic hydrogen sulfide. Populations from such extreme habitats are significantly less parasitized by the trematode Uvulifer sp. than a population from a non-sulfidic habitat. We suggest that reduced parasite prevalence may be a benefit of living in sulfidic habitats.

The Effect of Infrastructure Sharing in Estimating Operations Cost of Future Space Transportation Systems

NASA Technical Reports Server (NTRS)

Sundaram, Meenakshi

2005-01-01

NASA and the aerospace industry are extremely serious about reducing the cost and improving the performance of launch vehicles both manned or unmanned. In the aerospace industry, sharing infrastructure for manufacturing more than one type spacecraft is becoming a trend to achieve economy of scale. An example is the Boeing Decatur facility where both Delta II and Delta IV launch vehicles are made. The author is not sure how Boeing estimates the costs of each spacecraft made in the same facility. Regardless of how a contractor estimates the cost, NASA in its popular cost estimating tool, NASA Air force Cost Modeling (NAFCOM) has to have a method built in to account for the effect of infrastructure sharing. Since there is no provision in the most recent version of NAFCOM2002 to take care of this, it has been found by the Engineering Cost Community at MSFC that the tool overestimates the manufacturing cost by as much as 30%. Therefore, the objective of this study is to develop a methodology to assess the impact of infrastructure sharing so that better operations cost estimates may be made.

Novel use of the Nintendo Wii board as a measure of reaction time: a study of reproducibility in older and younger adults.

PubMed

Jorgensen, Martin Gronbech; Paramanathan, Sentha; Ryg, Jesper; Masud, Tahir; Andersen, Stig

2015-07-10

Reaction time (RT) has been associated with falls in older adults, but is not routinely tested in clinical practice. A simple, portable, inexpensive and reliable method for measuring RT is desirable for clinical settings. We therefore developed a custom software, which utilizes the portable and low-cost standard Nintendo Wii board (NWB) to record RT. The aims in the study were to (1) explore if the test could differentiate old and young adults, and (2) to study learning effects between test-sessions, and (3) to examine reproducibility. A young (n = 25, age 20-35 years, mean BMI of 22.6) and an old (n = 25, age ≥65 years, mean BMI of 26.3) study-population were enrolled in this within- and between-day reproducibility study. A standard NWB was used along with the custom software to obtain RT from participants in milliseconds. A mixed effect model was initially used to explore systematic differences associated with age, and test-session. Reproducibility was then expressed by Intraclass Correlation Coefficients (ICC), Coefficient of Variance (CV), and Typical Error (TE). The RT tests was able to differentiate the old group from the young group in both the upper extremity test (p < 0.001; -170.7 ms (95%CI -209.4; -132.0)) and the lower extremity test (p < 0.001; -224.3 ms (95%CI -274.6; -173.9)). Moreover, the mixed effect model showed no significant learning effect between sessions with exception of the lower extremity test between session one and three for the young group (-35,5 ms; 4.6%; p = 0.02). A good within- and between-day reproducibility (ICC: 0.76-0.87; CV: 8.5-12.9; TE: 45.7-95.1 ms) was achieved for both the upper and lower extremity test with the fastest of three trials in both groups. A low-cost and portable reaction test utilizing a standard Nintendo wii board showed good reproducibility, no or little systematic learning effects across test-sessions, and could differentiate between young and older adults in both upper and lower extremity tests.

Adaption to Extreme Rainfall with Open Urban Drainage System: An Integrated Hydrological Cost-Benefit Analysis

NASA Astrophysics Data System (ADS)

Zhou, Qianqian; Panduro, Toke Emil; Thorsen, Bo Jellesmark; Arnbjerg-Nielsen, Karsten

2013-03-01

This paper presents a cross-disciplinary framework for assessment of climate change adaptation to increased precipitation extremes considering pluvial flood risk as well as additional environmental services provided by some of the adaptation options. The ability of adaptation alternatives to cope with extreme rainfalls is evaluated using a quantitative flood risk approach based on urban inundation modeling and socio-economic analysis of corresponding costs and benefits. A hedonic valuation model is applied to capture the local economic gains or losses from more water bodies in green areas. The framework was applied to the northern part of the city of Aarhus, Denmark. We investigated four adaptation strategies that encompassed laissez-faire, larger sewer pipes, local infiltration units, and open drainage system in the urban green structure. We found that when taking into account environmental amenity effects, an integration of open drainage basins in urban recreational areas is likely the best adaptation strategy, followed by pipe enlargement and local infiltration strategies. All three were improvements compared to the fourth strategy of no measures taken.

Adaption to extreme rainfall with open urban drainage system: an integrated hydrological cost-benefit analysis.

PubMed

Zhou, Qianqian; Panduro, Toke Emil; Thorsen, Bo Jellesmark; Arnbjerg-Nielsen, Karsten

2013-03-01

This paper presents a cross-disciplinary framework for assessment of climate change adaptation to increased precipitation extremes considering pluvial flood risk as well as additional environmental services provided by some of the adaptation options. The ability of adaptation alternatives to cope with extreme rainfalls is evaluated using a quantitative flood risk approach based on urban inundation modeling and socio-economic analysis of corresponding costs and benefits. A hedonic valuation model is applied to capture the local economic gains or losses from more water bodies in green areas. The framework was applied to the northern part of the city of Aarhus, Denmark. We investigated four adaptation strategies that encompassed laissez-faire, larger sewer pipes, local infiltration units, and open drainage system in the urban green structure. We found that when taking into account environmental amenity effects, an integration of open drainage basins in urban recreational areas is likely the best adaptation strategy, followed by pipe enlargement and local infiltration strategies. All three were improvements compared to the fourth strategy of no measures taken.

Excessive heat and respiratory hospitalizations in New York State: estimating current and future public health burden related to climate change.

PubMed

Lin, Shao; Hsu, Wan-Hsiang; Van Zutphen, Alissa R; Saha, Shubhayu; Luber, George; Hwang, Syni-An

2012-11-01

Although many climate-sensitive environmental exposures are related to mortality and morbidity, there is a paucity of estimates of the public health burden attributable to climate change. We estimated the excess current and future public health impacts related to respiratory hospitalizations attributable to extreme heat in summer in New York State (NYS) overall, its geographic regions, and across different demographic strata. On the basis of threshold temperature and percent risk changes identified from our study in NYS, we estimated recent and future attributable risks related to extreme heat due to climate change using the global climate model with various climate scenarios. We estimated effects of extreme high apparent temperature in summer on respiratory admissions, days hospitalized, direct hospitalization costs, and lost productivity from days hospitalized after adjusting for inflation. The estimated respiratory disease burden attributable to extreme heat at baseline (1991-2004) in NYS was 100 hospital admissions, US$644,069 in direct hospitalization costs, and 616 days of hospitalization per year. Projections for 2080-2099 based on three different climate scenarios ranged from 206-607 excess hospital admissions, US$26-$76 million in hospitalization costs, and 1,299-3,744 days of hospitalization per year. Estimated impacts varied by geographic region and population demographics. We estimated that excess respiratory admissions in NYS due to excessive heat would be 2 to 6 times higher in 2080-2099 than in 1991-2004. When combined with other heat-associated diseases and mortality, the potential public health burden associated with global warming could be substantial.

Indoor Temperatures in Low Cost Housing in Johannesburg, South Africa.

PubMed

Naicker, Nisha; Teare, June; Balakrishna, Yusentha; Wright, Caradee Yael; Mathee, Angela

2017-11-18

Ambient and indoor temperature affects thermal comfort and human health. In a changing climate with a predicted change in temperature extremes, understanding indoor temperatures, both hot and cold, of different housing types is important. This study aimed to assess the hourly, daily and monthly variation in indoor temperatures in different housing types, namely formal houses, informal houses, flats, government-built low-cost houses and old, apartheid era low-cost housing, in five impoverished urban communities in Johannesburg, South Africa. During the cross-sectional survey of the Health, Environment and Development study data loggers were installed in 100 homes (20 per suburb) from February to May 2014. Indoor temperature and relative humidity were recorded on an hourly basis. Ambient outdoor temperatures were obtained from the nearest weather station. Indoor and outdoor temperature and relative humidity levels were compared; and an inter-comparison between the different housing types were also made. Apparent temperature was calculated to assess indoor thermal comfort. Data from 59 retrieved loggers showed a significant difference in monthly mean indoor temperature between the five different housing types ( p < 0.0001). Low cost government-built houses and informal settlement houses had the greatest variation in temperature and experienced temperatures between 4 and 5 °C warmer than outdoor temperatures. Housing types occupied by poor communities experienced indoor temperature fluctuations often greater than that observed for ambient temperatures. Families living in government-built low-cost and informally-constructed homes are the most at risk for indoor temperature extremes. These types of housing should be prioritised for interventions aimed at assisting families to cope with extreme temperatures, gaining optimal thermal comfort and preventing temperature-related health effects.

Optimized extreme learning machine for urban land cover classification using hyperspectral imagery

NASA Astrophysics Data System (ADS)

Su, Hongjun; Tian, Shufang; Cai, Yue; Sheng, Yehua; Chen, Chen; Najafian, Maryam

2017-12-01

This work presents a new urban land cover classification framework using the firefly algorithm (FA) optimized extreme learning machine (ELM). FA is adopted to optimize the regularization coefficient C and Gaussian kernel σ for kernel ELM. Additionally, effectiveness of spectral features derived from an FA-based band selection algorithm is studied for the proposed classification task. Three sets of hyperspectral databases were recorded using different sensors, namely HYDICE, HyMap, and AVIRIS. Our study shows that the proposed method outperforms traditional classification algorithms such as SVM and reduces computational cost significantly.

Is the Venner-PneuX Endotracheal Tube System A Cost-Effective Option For Post Cardiac Surgery Care?

PubMed

Andronis, Lazaros; Oppong, Raymond A; Manga, Na'ngono; Senanayake, Eshan; Gopal, Shameer; Charman, Susan; Giri, Ramesh; Luckraz, Heyman

2018-04-27

Ventilator-associated pneumonia (VAP) is common and costly. In a recent randomized controlled trial, the Venner-PneuX (VPX) endotracheal tube system was found to be superior to standard endotracheal tubes (SET) in preventing VAP. However, VPX is considerably more expensive. We evaluated the costs and benefits of VPX to determine whether replacing SET with VPX is a cost-effective option for intensive care units. We developed a decision analytic model to compare intubation with VPX or SET for patients requiring mechanical ventilation post cardiac surgery. The model was populated with existing evidence on costs, effectiveness and quality of life. Cost-effectiveness and cost-utility analyses were conducted from an NHS hospital perspective. Uncertainty was assessed through deterministic and probabilistic sensitivity analyses. Compared to SET, VPX is associated with an expected cost saving of £738 per patient. VPX led to a small increase in quality-adjusted life years (QALYs), indicating that the device is overall less costly and more effective than SET. The probability of VPX being cost-effective at £30,000 per QALY is 97%. VPX would cease to be cost-effective if (i) it led to a risk reduction smaller than 0.02 compared to SET, (ii) the acquisition cost of VPX was as high as £890 or, (iii) the cost of treating a case of VAP was lower than £1,450. VPX resulted in improved outcomes and savings which far offset the cost of the device, suggesting that replacing SET with VPX is overall beneficial. Findings were robust to extreme values of key parameters. Copyright © 2018. Published by Elsevier Inc.

Cost and mortality data of a regional limb salvage and hyperbaric medicine program for Wagner Grade 3 or 4 diabetic foot ulcers.

PubMed

Eggert, J V; Worth, E R; Van Gils, C C

2016-01-01

We obtained costs and mortality data in two retrospective cohorts totaling 159 patients who have diabetes mellitus and onset of a diabetic foot ulcer (DFU). Data were collected from 2005 to 2013, with a follow-up period through September 30, 2014. A total of 106 patients entered an evidence-based limb salvage protocol (LSP) for Wagner Grade 3 or 4 (WG3/4) DFU and intention-to-treat adjunctive hyperbaric oxygen (HBO₂) therapy. A second cohort of 53 patients had a primary lower extremity amputation (LEA), either below the knee (BKA) or above the knee (AKA) and were not part of the LSP. Ninety-six of 106 patients completed the LSP/HBO₂with an average cost of USD $33,100. Eighty-eight of 96 patients (91.7%) who completed the LSP/HBO₂had intact lower extremities at one year. Thirty-four of the 96 patients (35.4%) died during the follow-up period. Costs for a historical cohort of 53 patients having a primary major LEA range from USD $66,300 to USD $73,000. Twenty-five of the 53 patients (47.2%) died. The difference in cost of care and mortality between an LSP with adjunctive HBO₂therapy vs. primary LEA is staggering. We conclude that an aggressive limb salvage program that includes HBO₂ therapy is cost-effective.

Analysis of extreme values of the economic efficiency indicators of transport infrastructure projects

NASA Astrophysics Data System (ADS)

Korytárová, J.; Vaňková, L.

2017-10-01

Paper builds on previous research of the authors into the evaluation of economic efficiency of transport infrastructure projects evaluated by the economic efficiency ratio - NPV, IRR and BCR. Values of indicators and subsequent outputs of the sensitivity analysis show extremely favourable values in some cases. The authors dealt with the analysis of these indicators down to the level of the input variables and examined which inputs have a larger share of these extreme values. NCF for the calculation of above mentioned ratios is created by benefits that arise as the difference between zero and investment options of the project (savings in travel and operating costs, savings in travel time costs, reduction in accident costs and savings in exogenous costs) as well as total agency costs. Savings in travel time costs which contribute to the overall utility of projects by more than 70% appear to be the most important benefits in the long term horizon. This is the reason why this benefit emphasized. The outcome of the article has resulted how the particular basic variables contributed to the total robustness of economic efficiency of these project.

Economic Evaluations of the Health Impacts of Weather-Related Extreme Events: A Scoping Review

PubMed Central

Schmitt, Laetitia H. M.; Graham, Hilary M.; White, Piran C. L.

2016-01-01

The frequency and severity of extreme events is expected to increase under climate change. There is a need to understand the economic consequences of human exposure to these extreme events, to underpin decisions on risk reduction. We undertook a scoping review of economic evaluations of the adverse health effects from exposure to weather-related extreme events. We searched PubMed, Embase and Web of Science databases with no restrictions to the type of evaluations. Twenty studies were included, most of which were recently published. Most studies have been undertaken in the U.S. (nine studies) or Asia (seven studies), whereas we found no studies in Africa, Central and Latin America nor the Middle East. Extreme temperatures accounted for more than a third of the pool of studies (seven studies), closely followed by flooding (six studies). No economic study was found on drought. Whilst studies were heterogeneous in terms of objectives and methodology, they clearly indicate that extreme events will become a pressing public health issue with strong welfare and distributional implications. The current body of evidence, however, provides little information to support decisions on the allocation of scarce resources between risk reduction options. In particular, the review highlights a significant lack of research attention to the potential cost-effectiveness of interventions that exploit the capacity of natural ecosystems to reduce our exposure to, or ameliorate the consequences of, extreme events. PMID:27834843

Minimum-Cost Aircraft Descent Trajectories with a Constrained Altitude Profile

NASA Technical Reports Server (NTRS)

Wu, Minghong G.; Sadovsky, Alexander V.

2015-01-01

An analytical formula for solving the speed profile that accrues minimum cost during an aircraft descent with a constrained altitude profile is derived. The optimal speed profile first reaches a certain speed, called the minimum-cost speed, as quickly as possible using an appropriate extreme value of thrust. The speed profile then stays on the minimum-cost speed as long as possible, before switching to an extreme value of thrust for the rest of the descent. The formula is applied to an actual arrival route and its sensitivity to winds and airlines' business objectives is analyzed.

Greedy algorithms in disordered systems

NASA Astrophysics Data System (ADS)

Duxbury, P. M.; Dobrin, R.

1999-08-01

We discuss search, minimal path and minimal spanning tree algorithms and their applications to disordered systems. Greedy algorithms solve these problems exactly, and are related to extremal dynamics in physics. Minimal cost path (Dijkstra) and minimal cost spanning tree (Prim) algorithms provide extremal dynamics for a polymer in a random medium (the KPZ universality class) and invasion percolation (without trapping) respectively.

Educational Management within a Young Offender Institution.

ERIC Educational Resources Information Center

Fryer, Winny; Fryer, Paul

1992-01-01

Examines educational theory and objectives within prisons and relates these to the real-time case study of the Young Offender Institution at Whatton, in Nottinghamshire, England. Measuring success and cost effectiveness is extremely difficult in the prison education field, and a significant gap exists between the theoretical model and everyday…

School Size Does Make a Difference.

ERIC Educational Resources Information Center

Turner, Claude C.; Thrasher, James M.

Since the purpose of the schools is education, school size becomes important if it affects the educational opportunities available to students or the effectiveness of the educational program. The rationale for an extremely large secondary school rests on two assumptions--a large school can offer a broader educational program, and costs per student…

Power Controller

NASA Technical Reports Server (NTRS)

1983-01-01

The power factor controller (PFC) senses shifts in the relationship between voltage and current, and matches them with a motor's need. This prevents waste as motors do not need a high voltage when they are not operating at full load conditions. PFC is manufactured by Nordic Controls Company, among others, and has proved extremely cost effective.

SOI N-Channel Field Effect Transistors, CHT-NMOS80, for Extreme Temperatures

NASA Technical Reports Server (NTRS)

Patterson, Richard L.; Hammoud, Almad

2009-01-01

Extreme temperatures, both hot and cold, are anticipated in many of NASA space exploration missions as well as in terrestrial applications. One can seldom find electronics that are capable of operation under both regimes. Even for operation under one (hot or cold) temperature extreme, some thermal controls need to be introduced to provide appropriate ambient temperatures so that spacecraft on-board or field on-site electronic systems work properly. The inclusion of these controls, which comprise of heating elements and radiators along with their associated structures, adds to the complexity in the design of the system, increases cost and weight, and affects overall reliability. Thus, it would be highly desirable and very beneficial to eliminate these thermal measures in order to simplify system's design, improve efficiency, reduce development and launch costs, and improve reliability. These requirements can only be met through the development of electronic parts that are designed for proper and efficient operation under extreme temperature conditions. Silicon-on-insulator (SOI) based devices are finding more use in harsh environments due to the benefits that their inherent design offers in terms of reduced leakage currents, less power consumption, faster switching speeds, good radiation tolerance, and extreme temperature operability. Little is known, however, about their performance at cryogenic temperatures and under wide thermal swings. The objective of this work was to evaluate the performance of a new commercial-off-the-shelf (COTS) SOI parts over an extended temperature range and to determine the effects of thermal cycling on their performance. The results will establish a baseline on the suitability of such devices for use in space exploration missions under extreme temperatures, and will aid mission planners and circuit designers in the proper selection of electronic parts and circuits. The electronic part investigated in this work comprised of a CHT-NMOS80 high temperature N-channel MOSFET (metal-oxide semiconductor field-effect transistor) device that was manufactured by CISSOID. This high voltage, medium-power transistor is fabricated using SOI processes and is designed for extreme wide temperature applications such as geothermal well logging, aerospace and avionics, and automotive industry. It has a high DC current capability and is specified for operation in the temperature range of -55 C to +225 C

Solar Weather Ice Monitoring Station (SWIMS). A low cost, extreme/harsh environment, solar powered, autonomous sensor data gathering and transmission system

NASA Astrophysics Data System (ADS)

Chetty, S.; Field, L. A.

2013-12-01

The Arctic ocean's continuing decrease of summer-time ice is related to rapidly diminishing multi-year ice due to the effects of climate change. Ice911 Research aims to develop environmentally respectful materials that when deployed will increase the albedo, enhancing the formation and/preservation of multi-year ice. Small scale deployments using various materials have been done in Canada, California's Sierra Nevada Mountains and a pond in Minnesota to test the albedo performance and environmental characteristics of these materials. SWIMS is a sophisticated autonomous sensor system being developed to measure the albedo, weather, water temperature and other environmental parameters. The system (SWIMS) employs low cost, high accuracy/precision sensors, high resolution cameras, and an extreme environment command and data handling computer system using satellite and terrestrial wireless communication. The entire system is solar powered with redundant battery backup on a floating buoy platform engineered for low temperature (-40C) and high wind conditions. The system also incorporates tilt sensors, sonar based ice thickness sensors and a weather station. To keep the costs low, each SWIMS unit measures incoming and reflected radiation from the four quadrants around the buoy. This allows data from four sets of sensors, cameras, weather station, water temperature probe to be collected and transmitted by a single on-board solar powered computer. This presentation covers the technical, logistical and cost challenges in designing, developing and deploying these stations in remote, extreme environments. Image captured by camera #3 of setting sun on the SWIMS station One of the images captured by SWIMS Camera #4

Health economic impacts and cost-effectiveness of aflatoxin-reduction strategies in Africa: case studies in biocontrol and post-harvest interventions.

PubMed

Wu, F; Khlangwiset, P

2010-04-01

Advances in health economics have proven useful in evaluating the cost-effectiveness of interventions, where the benefit usually takes the form of improved health outcomes rather than market outcomes. The paper performs health-based cost-effectiveness analyses of two potential aflatoxin control strategies in Africa: (1) pre-harvest biocontrol, using atoxigenic strains of Aspergillus flavus competitively to exclude toxigenic strains from colonizing maize in Nigeria; and (2) post-harvest interventions in a package to reduce aflatoxin accumulation in groundnuts in Guinea. It is described how health benefits gained from each intervention, in terms of fewer aflatoxin-induced hepatocellular carcinoma cases, can be compared with the costs of implementing the interventions. It is found that both interventions would be extremely cost-effective if applied widely in African agriculture. That is, the monetized value of lives saved and quality of life gained by reducing aflatoxin-induced hepatocellular carcinoma far exceeds the cost of either biocontrol or the post-harvest intervention package to achieve those health benefits. The estimated cost-effectiveness ratio (CER; gross domestic product multiplied by disability-adjusted life years saved per unit cost) for biocontrol in Nigerian maize ranged from 5.10 to 24.8; while the estimated CER for the post-harvest intervention package in Guinean groundnuts ranged from 0.21 to 2.08. Any intervention with a CER > 1 is considered by the World Health Organization (WHO) to be 'very cost-effective', while an intervention with a CER > 0.33 is considered 'cost-effective'. Aside from cost-effectiveness, public health interventions must be readily accepted by the public, and must have financial and infrastructural support to be feasible in the parts of the world where they are most needed.

Resource utilization and disability outcome assessment of combat casualties from Operation Iraqi Freedom and Operation Enduring Freedom.

PubMed

Masini, Brendan D; Waterman, Scott M; Wenke, Joseph C; Owens, Brett D; Hsu, Joseph R; Ficke, James R

2009-04-01

Injuries are common during combat operations. The high costs of extremity injuries both in resource utilization and disability are well known in the civilian sector. We hypothesized that, similarly, combat-related extremity injuries, when compared with other injures from the current conflicts in Iraq and Afghanistan, require the largest percentage of medical resources, account for the greatest number of disabled soldiers, and have greater costs of disability benefits. Descriptive epidemiologic study and cost analysis. The Department of Defense Medical Metrics (M2) database was queried for the hospital admissions and billing data of a previously published cohort of soldiers injured in Iraq and Afghanistan between October 2001 and January 2005 and identified from the Joint Theater Trauma Registry. The US Army Physical Disability Administration database was also queried for Physical Evaluation Board outcomes for these soldiers, allowing calculation of disability benefit cost. Primary body region injured was assigned using billing records that gave a primary diagnosis International Classification of Diseases Ninth Edition code, which was corroborated with Joint Theater Trauma Registry injury mechanisms and descriptions for accuracy. A total of 1333 soldiers had complete admission data and were included from 1566 battle injuries not returned to duty of 3102 total casualties. Extremity-injured patients had the longest average inpatient stay at 10.7 days, accounting for 65% of the $65.3-million total inpatient resource utilization, 64% of the 464 patients found "unfit for duty," and 64% of the $170-million total projected disability benefit costs. Extrapolation of data yields total disability costs for this conflict, approaching $2 billion. Combat-related extremity injuries require the greatest utilization of resources for inpatient treatment in the initial postinjury period, cause the greatest number of disabled soldiers, and have the greatest projected disability benefit costs. This study highlights the need for continued or increased funding and support for military orthopaedic surgeons and extremity trauma research efforts.

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

PubMed Central

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

2013-01-01

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

Development of novel 3D-printed robotic prosthetic for transradial amputees.

PubMed

Gretsch, Kendall F; Lather, Henry D; Peddada, Kranti V; Deeken, Corey R; Wall, Lindley B; Goldfarb, Charles A

2016-06-01

Upper extremity myoelectric prostheses are expensive. The Robohand demonstrated that three-dimensional printing reduces the cost of a prosthetic extremity. The goal of this project was to develop a novel, inexpensive three-dimensional printed prosthesis to address limitations of the Robohand. The prosthesis was designed for patients with transradial limb amputation. It is shoulder-controlled and externally powered with an anthropomorphic terminal device. The user can open and close all five fingers, and move the thumb independently. The estimated cost is US$300. After testing on a patient with a traumatic transradial amputation, several advantages were noted. The independent thumb movement facilitated object grasp, the device weighed less than most externally powered prostheses, and the size was easily scalable. Limitations of the new prosthetic include low grip strength and decreased durability compared to passive prosthetics. Most children with a transradial congenital or traumatic amputation do not use a prosthetic. A three-dimensional printed shoulder-controlled robotic prosthesis provides a cost effective, easily sized and highly functional option which has been previously unavailable. © The International Society for Prosthetics and Orthotics 2015.

Evaluation of extreme temperature events in northern Spain based on process control charts

NASA Astrophysics Data System (ADS)

Villeta, M.; Valencia, J. L.; Saá, A.; Tarquis, A. M.

2018-02-01

Extreme climate events have recently attracted the attention of a growing number of researchers because these events impose a large cost on agriculture and associated insurance planning. This study focuses on extreme temperature events and proposes a new method for their evaluation based on statistical process control tools, which are unusual in climate studies. A series of minimum and maximum daily temperatures for 12 geographical areas of a Spanish region between 1931 and 2009 were evaluated by applying statistical process control charts to statistically test whether evidence existed for an increase or a decrease of extreme temperature events. Specification limits were determined for each geographical area and used to define four types of extreme anomalies: lower and upper extremes for the minimum and maximum anomalies. A new binomial Markov extended process that considers the autocorrelation between extreme temperature events was generated for each geographical area and extreme anomaly type to establish the attribute control charts for the annual fraction of extreme days and to monitor the occurrence of annual extreme days. This method was used to assess the significance of changes and trends of extreme temperature events in the analysed region. The results demonstrate the effectiveness of an attribute control chart for evaluating extreme temperature events. For example, the evaluation of extreme maximum temperature events using the proposed statistical process control charts was consistent with the evidence of an increase in maximum temperatures during the last decades of the last century.

Excessive Heat and Respiratory Hospitalizations in New York State: Estimating Current and Future Public Health Burden Related to Climate Change

PubMed Central

Hsu, Wan-Hsiang; Van Zutphen, Alissa R.; Saha, Shubhayu; Luber, George; Hwang, Syni-An

2012-01-01

Background: Although many climate-sensitive environmental exposures are related to mortality and morbidity, there is a paucity of estimates of the public health burden attributable to climate change. Objective: We estimated the excess current and future public health impacts related to respiratory hospitalizations attributable to extreme heat in summer in New York State (NYS) overall, its geographic regions, and across different demographic strata. Methods: On the basis of threshold temperature and percent risk changes identified from our study in NYS, we estimated recent and future attributable risks related to extreme heat due to climate change using the global climate model with various climate scenarios. We estimated effects of extreme high apparent temperature in summer on respiratory admissions, days hospitalized, direct hospitalization costs, and lost productivity from days hospitalized after adjusting for inflation. Results: The estimated respiratory disease burden attributable to extreme heat at baseline (1991–2004) in NYS was 100 hospital admissions, US$644,069 in direct hospitalization costs, and 616 days of hospitalization per year. Projections for 2080–2099 based on three different climate scenarios ranged from 206–607 excess hospital admissions, US$26–$76 million in hospitalization costs, and 1,299–3,744 days of hospitalization per year. Estimated impacts varied by geographic region and population demographics. Conclusions: We estimated that excess respiratory admissions in NYS due to excessive heat would be 2 to 6 times higher in 2080–2099 than in 1991–2004. When combined with other heat-associated diseases and mortality, the potential public health burden associated with global warming could be substantial. PMID:22922791

Assessing the Operational Effectiveness of a Small Surface Combat Ship in an Anti-Surface Warfare Environment

DTIC Science & Technology

2013-06-01

realistically representing the world in a simulation environment. A screenshot of the combat model used for this research is shown below. There are six...changes in use of technology (Ryan & Jons, 1992). Cost effectiveness and operational effectiveness are important, and it is extremely hard to achieve...effectiveness of ships using simulation and analytical models, to create a ship synthesis model, and most importantly, to develop decision making tools

Multidisciplinary and participatory workshops with stakeholders in a community of extreme poverty in the Peruvian Amazon: Development of priority concerns and potential health, nutrition and education interventions

PubMed Central

Casapia, Martin; Joseph, Serene A; Gyorkos, Theresa W

2007-01-01

Background Communities of extreme poverty suffer disproportionately from a wide range of adverse outcomes, but are often neglected or underserved by organized services and research attention. In order to target the first Millennium Development Goal of eradicating extreme poverty, thereby reducing health inequalities, participatory research in these communities is needed. Therefore, the purpose of this study was to determine the priority problems and respective potential cost-effective interventions in Belen, a community of extreme poverty in the Peruvian Amazon, using a multidisciplinary and participatory focus. Methods Two multidisciplinary and participatory workshops were conducted with important stakeholders from government, non-government and community organizations, national institutes and academic institutions. In Workshop 1, participants prioritized the main health and health-related problems in the community of Belen. Problem trees were developed to show perceived causes and effects for the top six problems. In Workshop 2, following presentations describing data from recently completed field research in school and household populations of Belen, participants listed potential interventions for the priority problems, including associated barriers, enabling factors, costs and benefits. Results The top ten priority problems in Belen were identified as: 1) infant malnutrition; 2) adolescent pregnancy; 3) diarrhoea; 4) anaemia; 5) parasites; 6) lack of basic sanitation; 7) low level of education; 8) sexually transmitted diseases; 9) domestic violence; and 10) delayed school entry. Causes and effects for the top six problems, proposed interventions, and factors relating to the implementation of interventions were multidisciplinary in nature and included health, nutrition, education, social and environmental issues. Conclusion The two workshops provided valuable insight into the main health and health-related problems facing the community of Belen. The participatory focus of the workshops ensured the active involvement of important stakeholders from Belen. Based on the results of the workshops, effective and essential interventions are now being planned which will contribute to reducing health inequalities in the community. PMID:17623093

A Large-Telescope Natural Guide Star AO System

NASA Technical Reports Server (NTRS)

Redding, David; Milman, Mark; Needels, Laura

1994-01-01

None given. From overview and conclusion:Keck Telescope case study. Objectives-low cost, good sky coverage. Approach--natural guide star at 0.8um, correcting at 2.2um.Concl- Good performance is possible for Keck with natural guide star AO system (SR>0.2 to mag 17+).AO-optimized CCD should b every effective. Optimizing td is very effective.Spatial Coadding is not effective except perhaps at extreme low light levels.

Space station needs, attributes and architectural options. Volume 4, task 2 and 3: Mission implementation and cost

NASA Technical Reports Server (NTRS)

1983-01-01

An overview of the basic space station infrastructure is presented. A strong case is made for the evolution of the station using the basic Space Transportation System (STS) to achieve a smooth transition and cost effective implementation. The integrated logistics support (ILS) element of the overall station infrastructure is investigated. The need for an orbital transport system capability that is the key to servicing and spacecraft positioning scenarios and associated mission needs is examined. Communication is also an extremely important element and the basic issue of station autonomy versus ground support effects the system and subsystem architecture.

Using extreme phenotype sampling to identify the rare causal variants of quantitative traits in association studies.

PubMed

Li, Dalin; Lewinger, Juan Pablo; Gauderman, William J; Murcray, Cassandra Elizabeth; Conti, David

2011-12-01

Variants identified in recent genome-wide association studies based on the common-disease common-variant hypothesis are far from fully explaining the hereditability of complex traits. Rare variants may, in part, explain some of the missing hereditability. Here, we explored the advantage of the extreme phenotype sampling in rare-variant analysis and refined this design framework for future large-scale association studies on quantitative traits. We first proposed a power calculation approach for a likelihood-based analysis method. We then used this approach to demonstrate the potential advantages of extreme phenotype sampling for rare variants. Next, we discussed how this design can influence future sequencing-based association studies from a cost-efficiency (with the phenotyping cost included) perspective. Moreover, we discussed the potential of a two-stage design with the extreme sample as the first stage and the remaining nonextreme subjects as the second stage. We demonstrated that this two-stage design is a cost-efficient alternative to the one-stage cross-sectional design or traditional two-stage design. We then discussed the analysis strategies for this extreme two-stage design and proposed a corresponding design optimization procedure. To address many practical concerns, for example measurement error or phenotypic heterogeneity at the very extremes, we examined an approach in which individuals with very extreme phenotypes are discarded. We demonstrated that even with a substantial proportion of these extreme individuals discarded, an extreme-based sampling can still be more efficient. Finally, we expanded the current analysis and design framework to accommodate the CMC approach where multiple rare-variants in the same gene region are analyzed jointly. © 2011 Wiley Periodicals, Inc.

Using Extreme Phenotype Sampling to Identify the Rare Causal Variants of Quantitative Traits in Association Studies

PubMed Central

Li, Dalin; Lewinger, Juan Pablo; Gauderman, William J.; Murcray, Cassandra Elizabeth; Conti, David

2014-01-01

Variants identified in recent genome-wide association studies based on the common-disease common-variant hypothesis are far from fully explaining the hereditability of complex traits. Rare variants may, in part, explain some of the missing hereditability. Here, we explored the advantage of the extreme phenotype sampling in rare-variant analysis and refined this design framework for future large-scale association studies on quantitative traits. We first proposed a power calculation approach for a likelihood-based analysis method. We then used this approach to demonstrate the potential advantages of extreme phenotype sampling for rare variants. Next, we discussed how this design can influence future sequencing-based association studies from a cost-efficiency (with the phenotyping cost included) perspective. Moreover, we discussed the potential of a two-stage design with the extreme sample as the first stage and the remaining nonextreme subjects as the second stage. We demonstrated that this two-stage design is a cost-efficient alternative to the one-stage cross-sectional design or traditional two-stage design. We then discussed the analysis strategies for this extreme two-stage design and proposed a corresponding design optimization procedure. To address many practical concerns, for example measurement error or phenotypic heterogeneity at the very extremes, we examined an approach in which individuals with very extreme phenotypes are discarded. We demonstrated that even with a substantial proportion of these extreme individuals discarded, an extreme-based sampling can still be more efficient. Finally, we expanded the current analysis and design framework to accommodate the CMC approach where multiple rare-variants in the same gene region are analyzed jointly. PMID:21922541

[Cost and Revenue Relationship in Orthopaedic and Trauma Surgery Patients in Relation to Body Mass Index].

PubMed

Schmelz, Helmut A; Geraedts, Max

2018-06-14

Growing numbers of patients in orthopaedic and trauma surgery are obese. The risks involved are e.g. surgical complications, higher costs for longer hospital stays or special operating tables. It is a moot point whether revenues in the German DRG system cover the individual costs in relation to patients' body mass index (BMI) and in which area of hospital care potentially higher costs occur. Data related to BMI, individual costs and revenues were extracted from the hospital information system for 13,833 patients of a large hospital who were operated in 2007 to 2010 on their upper or lower extremities. We analysed differences in cost revenue relations dependent on patients' BMI and surgical site, and differences in the distribution of hospital cost areas in relation to patients' BMI by t and U tests. Individual costs of morbidly obese (BMI ≥ 40) and underweight patients (BMI < 18.5) significantly (p < 0.05) exceeded individual DRG revenues. Significantly higher cost revenue relations were detected for all operations on the lower and upper extremities except for ankle joint surgeries in which arthroscopical procedures predominate. Most of the incremental costs resulted from higher spending for nursing care, medication and special appliances. Costs for doctors and medical ancillary staff did not increase in relation to patients' BMI. To avoid BMI related patient discrimination, supplementary fees to cover extra costs for morbidly obese or underweight patients with upper or lower extremities operations should raise DRG revenues. Moreover, hospitals should be organisationally prepared for these patients. Georg Thieme Verlag KG Stuttgart · New York.

Extremophiles and biotechnology: current uses and prospects

PubMed Central

Coker, James A.

2016-01-01

Biotechnology has almost unlimited potential to change our lives in very exciting ways. Many of the chemical reactions that produce these products can be fully optimized by performing them at extremes of temperature, pressure, salinity, and pH for efficient and cost-effective outcomes. Fortunately, there are many organisms (extremophiles) that thrive in extreme environments found in nature and offer an excellent source of replacement enzymes in lieu of mesophilic ones currently used in these processes. In this review, I discuss the current uses and some potential new applications of extremophiles and their products, including enzymes, in biotechnology. PMID:27019700

Impact of the Fit and Strong Intervention on Older Adults with Osteoarthritis

ERIC Educational Resources Information Center

Hughes, Susan L.; Seymour, Rachel B.; Campbell, Richard; Pollak, Naomi; Huber, Gail; Sharma, Leena

2004-01-01

Purpose: This study assessed the impact of a low cost, multicomponent physical activity intervention for older adults with lower extremity osteoarthritis. Design and Methods: A randomized controlled trial compared the effects of a facility-based multiple-component training program followed by home-based adherence (n = 80) to a wait list control…

Changing Fonts in Education: How the Benefits Vary with Ability and Dyslexia

ERIC Educational Resources Information Center

French, M. M. J.; Blood, Arabella; Bright, N. D.; Futak, Dez; Grohmann, M. J.; Hasthorpe, Alex; Heritage, John; Poland, Remy L.; Reece, Simon; Tabor, Jennifer

2013-01-01

Previous research has shown that presenting educational materials in slightly harder to read fonts than is typical engenders deeper processing. This leads to better retention and subsequent recall of information. Before this extremely simple-to-implement and cost-effective adaptation can be made routinely to educational materials, it needs to be…

Mind the wind: microclimate effects on incubation effort of an arctic seabird.

PubMed

Høyvik Hilde, Christoffer; Pélabon, Christophe; Guéry, Loreleï; Gabrielsen, Geir Wing; Descamps, Sébastien

2016-04-01

The energetic costs of reproduction in birds strongly depend on the climate experienced during incubation. Climate change and increasing frequency of extreme weather events may severely affect these costs, especially for species incubating in extreme environments. In this 3-year study, we used an experimental approach to investigate the effects of microclimate and nest shelter on the incubation effort of female common eiders (Somateria mollissima) in a wild Arctic population. We added artificial shelters to a random selection of nesting females, and compared incubation effort, measured as body mass loss during incubation, between females with and without shelter. Nonsheltered females had a higher incubation effort than females with artificial shelters. In nonsheltered females, higher wind speeds increased the incubation effort, while artificially sheltered females experienced no effect of wind. Although increasing ambient temperatures tended to decrease incubation effort, this effect was negligible in the absence of wind. Humidity had no marked effect on incubation effort. This study clearly displays the direct effect of a climatic variable on an important aspect of avian life-history. By showing that increasing wind speed counteracts the energetic benefits of a rising ambient temperature, we were able to demonstrate that a climatic variable other than temperature may also affect wild populations and need to be taken into account when predicting the effects of climate change.

Cost-Utility of Competing Strategies to Prevent Endoscopic Transmission of Carbapenem-Resistant Enterobacteriaceae

PubMed Central

Almario, Christopher V.; May, Folasade P.; Shaheen, Nicholas J.; Murthy, Rekha; Gupta, Kapil; Jamil, Laith H.; Lo, Simon K.; Spiegel, Brennan M.R.

2015-01-01

OBJECTIVES Prior reports have linked patient transmission of carbapenem-resistant Enterobacteriaceae (CRE, or “superbug”) to endoscopes used during endoscopic retrograde cholangiopancreatography (ERCP). We performed a decision analysis to measure the cost-effectiveness of four competing strategies for CRE risk management. METHODS We used decision analysis to calculate the cost-effectiveness of four approaches to reduce the risk of CRE transmission among patients presenting to the hospital for symptomatic common bile duct stones. The strategies included: (1) perform ERCP followed by U.S. Food and Drug Administration (FDA)-recommended endoscope reprocessing procedures; (2) perform ERCP followed by “endoscope culture and hold”; (3) perform ERCP followed by ethylene oxide (EtO) sterilization of the endoscope; and (4) stop performing ERCP in lieu of laparoscopic cholecystectomy (LC) with common bile duct exploration (CBDE). Our outcome was incremental cost per quality-adjusted life year (QALY) gained. RESULTS In the base-case scenario, ERCP with FDA-recommended endoscope reprocessing was the most cost-effective strategy. Both the ERCP with culture and hold ($4,228,170/QALY) and ERCP with EtO sterilization ($50,572,348/QALY) strategies had unacceptable incremental costs per QALY gained. LC with CBDE was dominated, being both more costly and marginally less effective versus the alternatives. In sensitivity analysis, ERCP with culture and hold became the most cost-effective approach when the pretest probability of CRE exceeded 24%. CONCLUSIONS In institutions with a low CRE prevalence, ERCP with FDA-recommended reprocessing is the most cost-effective approach for mitigating CRE transmission risk. Only in settings with an extremely high CRE prevalence did ERCP with culture and hold become cost-effective. PMID:26526083

Validation of extremes within the Perfect-Predictor Experiment of the COST Action VALUE

NASA Astrophysics Data System (ADS)

Hertig, Elke; Maraun, Douglas; Wibig, Joanna; Vrac, Mathieu; Soares, Pedro; Bartholy, Judith; Pongracz, Rita; Mares, Ileana; Gutierrez, Jose Manuel; Casanueva, Ana; Alzbutas, Robertas

2016-04-01

Extreme events are of widespread concern due to their damaging consequences on natural and anthropogenic systems. From science to applications the statistical attributes of rare and infrequent occurrence and low probability become connected with the socio-economic aspect of strong impact. Specific end-user needs regarding information about extreme events depend on the type of application, but as a joining element there is always the request for easily accessible climate change information with a clear description of their uncertainties and limitations. Within the Perfect-Predictor Experiment of the COST Action VALUE extreme indices modelled from a wide range of downscaling methods are compared to reference indices calculated from observational data. The experiment uses reference data from a selection of 86 weather stations representative of the different climates in Europe. Results are presented for temperature and precipitation extremes and include aspects of the marginal distribution as well as spell-length related aspects.

Extremely Cost-Effective and Efficient Solar Vapor Generation under Nonconcentrated Illumination Using Thermally Isolated Black Paper.

PubMed

Liu, Zhejun; Song, Haomin; Ji, Dengxin; Li, Chenyu; Cheney, Alec; Liu, Youhai; Zhang, Nan; Zeng, Xie; Chen, Borui; Gao, Jun; Li, Yuesheng; Liu, Xiang; Aga, Diana; Jiang, Suhua; Yu, Zongfu; Gan, Qiaoqiang

2017-02-27

Passive solar vapor generation represents a promising and environmentally benign method of water purification/desalination. However, conventional solar steam generation techniques usually rely on costly and cumbersome optical concentration systems and have relatively low efficiency due to bulk heating of the entire liquid volume. Here, an efficient strategy using extremely low-cost materials, i.e., carbon black (powder), hydrophilic porous paper, and expanded polystyrene foam is reported. Due to the excellent thermal insulation between the surface liquid and the bulk volume of the water and the suppressed radiative and convective losses from the absorber surface to the adjacent heated vapor, a record thermal efficiency of ≈88% is obtained under 1 sun without concentration, corresponding to the evaporation rate of 1.28 kg (m 2 h) -1 . When scaled up to a 100 cm 2 array in a portable solar water still system and placed in an outdoor environment, the freshwater generation rate is 2.4 times of that of a leading commercial product. By simultaneously addressing both the need for high-efficiency operation as well as production cost limitations, this system can provide an approach for individuals to purify water for personal needs, which is particularly suitable for undeveloped regions with limited/no access to electricity.

Resuscitation of neonates at 23 weeks' gestational age: a cost-effectiveness analysis.

PubMed

Partridge, J Colin; Robertson, Kathryn R; Rogers, Elizabeth E; Landman, Geri Ottaviano; Allen, Allison J; Caughey, Aaron B

2015-01-01

Resuscitation of infants at 23 weeks' gestation remains controversial; clinical practices vary. We sought to investigate the cost effectiveness of resuscitation of infants born 23 0/7-23 6/7 weeks' gestation. Decision-analytic modeling comparing universal and selective resuscitation to non-resuscitation for 5176 live births at 23 weeks in a theoretic U.S. cohort. Estimates of death (77%) and disability (64-86%) were taken from the literature. Maternal and combined maternal-neonatal utilities were applied to discounted life expectancy to generate QALYs. Incremental cost-effectiveness ratios were calculated, discounting costs and QALYs. Main outcomes included number of survivors, their outcome status and incremental cost-effectiveness ratios for the three strategies. A cost-effectiveness threshold of $100 000/QALY was utilized. Universal resuscitation would save 1059 infants: 138 severely disabled, 413 moderately impaired and 508 without significant sequelae. Selective resuscitation would save 717 infants: 93 severely disabled, 279 moderately impaired and 343 without significant sequelae. For mothers, non-resuscitation is less expensive ($19.9 million) and more effective (127 844 mQALYs) than universal resuscitation ($1.2 billion; 126 574 mQALYs) or selective resuscitation ($845 million; 125 966 mQALYs). For neonates, both universal and selective resuscitation were cost-effective, resulting in 22 256 and 15 134 nQALYS, respectively, versus 247 nQALYs for non-resuscitation. In sensitivity analyses, universal resuscitation was cost-effective from a maternal perspective only at utilities for neonatal death <0.42. When analyzed from a maternal-neonatal perspective, universal resuscitation was cost-effective when the probability of neonatal death was <0.95. Over wide ranges of probabilities for survival and disability, universal and selective resuscitation strategies were not cost-effective from a maternal perspective. Both strategies were cost-effective from a maternal-neonatal perspective. This study offers a metric for counseling and decision-making for extreme prematurity. Our results could support a more permissive response to parental requests for aggressive intervention at 23 weeks' gestation.

Internet & branding: a perfect match or a fatal attraction? Analysis of fifty states of the U.S. official tourism websites

Treesearch

Gyehee Lee; Liping A. Cai; Everette Mills; Joseph T. O' Leary

2002-01-01

Internet plays a significant role in generating new business and facilitating customers' need for a better way to plan and book their trips. From a marketers' perspective, one of the seemingly "fatal attractions" of the Internet for DMOs is that it can be an extremely effective tool in terms of both cost effectiveness and market penetration compared...

Gas-Centered Swirl Coaxial Liquid Injector Evaluations

NASA Technical Reports Server (NTRS)

Cohn, A. K.; Strakey, P. A.; Talley, D. G.

2005-01-01

Development of Liquid Rocket Engines is expensive. Extensive testing at large scales usually required. In order to verify engine lifetime, large number of tests required. Limited Resources available for development. Sub-scale cold-flow and hot-fire testing is extremely cost effective. Could be a necessary (but not sufficient) condition for long engine lifetime. Reduces overall costs and risk of large scale testing. Goal: Determine knowledge that can be gained from sub-scale cold-flow and hot-fire evaluations of LRE injectors. Determine relationships between cold-flow and hot-fire data.

Quantifying the daily economic impact of extreme space weather due to failure in electricity transmission infrastructure

NASA Astrophysics Data System (ADS)

Oughton, Edward J.; Skelton, Andrew; Horne, Richard B.; Thomson, Alan W. P.; Gaunt, Charles T.

2017-01-01

Extreme space weather due to coronal mass ejections has the potential to cause considerable disruption to the global economy by damaging the transformers required to operate electricity transmission infrastructure. However, expert opinion is split between the potential outcome being one of a temporary regional blackout and of a more prolonged event. The temporary blackout scenario proposed by some is expected to last the length of the disturbance, with normal operations resuming after a couple of days. On the other hand, others have predicted widespread equipment damage with blackout scenarios lasting months. In this paper we explore the potential costs associated with failure in the electricity transmission infrastructure in the U.S. due to extreme space weather, focusing on daily economic loss. This provides insight into the direct and indirect economic consequences of how an extreme space weather event may affect domestic production, as well as other nations, via supply chain linkages. By exploring the sensitivity of the blackout zone, we show that on average the direct economic cost incurred from disruption to electricity represents only 49% of the total potential macroeconomic cost. Therefore, if indirect supply chain costs are not considered when undertaking cost-benefit analysis of space weather forecasting and mitigation investment, the total potential macroeconomic cost is not correctly represented. The paper contributes to our understanding of the economic impact of space weather, as well as making a number of key methodological contributions relevant for future work. Further economic impact assessment of this threat must consider multiday, multiregional events.

How to deal with climate change uncertainty in the planning of engineering systems

NASA Astrophysics Data System (ADS)

Spackova, Olga; Dittes, Beatrice; Straub, Daniel

2016-04-01

The effect of extreme events such as floods on the infrastructure and built environment is associated with significant uncertainties: These include the uncertain effect of climate change, uncertainty on extreme event frequency estimation due to limited historic data and imperfect models, and, not least, uncertainty on future socio-economic developments, which determine the damage potential. One option for dealing with these uncertainties is the use of adaptable (flexible) infrastructure that can easily be adjusted in the future without excessive costs. The challenge is in quantifying the value of adaptability and in finding the optimal sequence of decision. Is it worth to build a (potentially more expensive) adaptable system that can be adjusted in the future depending on the future conditions? Or is it more cost-effective to make a conservative design without counting with the possible future changes to the system? What is the optimal timing of the decision to build/adjust the system? We develop a quantitative decision-support framework for evaluation of alternative infrastructure designs under uncertainties, which: • probabilistically models the uncertain future (trough a Bayesian approach) • includes the adaptability of the systems (the costs of future changes) • takes into account the fact that future decisions will be made under uncertainty as well (using pre-posterior decision analysis) • allows to identify the optimal capacity and optimal timing to build/adjust the infrastructure. Application of the decision framework will be demonstrated on an example of flood mitigation planning in Bavaria.

Nonlinear Impact of Temperature on Mortality in France

NASA Astrophysics Data System (ADS)

Zhang, A. T.

2016-12-01

Anthropogenic climate change is posing unprecedented challenges to human welfare, yet there is much uncertainty about the cost of its impact. Accurate quantification of the social cost of carbon is crucial for designing effective climate policies that reduce emissions and mitigate the adverse impact of global warming, and human health is an important component of the calculation. Despite a growing body of literature documenting the relationship between temperature and mortality in the U.S., similar results using nationwide data have not been clearly established in other countries. Using random monthly variations in temperature for over a decade, this paper finds a statistically significant nonlinear relationship between monthly mortality rate and daily temperature in France between 1998 and 2012. Extremely hot days are associated with significantly higher mortality rates: One additional day with a mean temperature above 30°C, relative to a day in the 12°C to 15°C range, leads to 10 extra all-age, all-gender monthly deaths per 100,000. The effect of cold temperatures is milder: An extremely cold day with an average temperature from -9 °C to -6 °C increases all-age, all-gender mortality rate by about 1.2 per 100,000 each month. There is also notable heterogeneity in the observed nonlinear relationship across age groups and gender, in which males and the elderly are generally more susceptible to extreme temperatures than females and the young. This highlights that children and youth may be well protected through adaptive behaviors, such as spending more time indoors in temperature-controlled rooms and staying hydrated. Compared to studies done in the U.S., extremely hot days >30°C leads to considerably more deaths in France. Preliminary evidence suggests that there has been very limited adaptation despite two prominent heat waves in 2003 and 2006, although further analysis of electricity consumption and air conditioning usage is needed to ascertain the extent to which protective behavior mitigates mortality risks from temperature extremes.

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

Is scorpion antivenom cost-effective as marketed in the United States?

PubMed

Armstrong, Edward P; Bakall, Maja; Skrepnek, Grant H; Boyer, Leslie V

2013-12-15

The purpose of this study was to analyze the cost-effectiveness of scorpion antivenom compared to no antivenom, in the United States, using a decision analysis framework. A decision analytic model was created to assess patient course with and without antivenom. Costs were determined from the perspective of a health care payer. Cost data used in the model were extracted from Arizona Medicaid. The probability of clinical events occurring with and without antivenom was obtained from the published literature, medical claims obtained from Arizona Medicaid, and results of recent clinical trials. Patients that became so ill that mechanical ventilator support was necessary were considered treatment failures. A Monte Carlo simulation was run 1000 times and sampled simultaneously across all variable distributions in the model. The mean success rate was 99.87% (95% CI 99.64%-99.98%) with scorpion antivenom and 94.31% (95% CI 91.10%-96.61%) without scorpion antivenom. The mean cost using scorpion antivenom was $10,708 (95% CI $10,556 - $11,010) and the mean cost without scorpion antivenom was $3178 (95% CI $1627 - $5184). Since the 95% CIs do not overlap for either the success or cost, use of the scorpion antivenom was significantly more effective and significantly more expensive than no antivenom. Cost-effectiveness analysis found that the scorpion antivenom was not cost-effective at its current price as marketed in the United States. The scorpion antivenom marketed in the United States is extremely effective, but too costly to justify its use in most clinical situations. Formulary committees should restrict the use of this antivenom to only the most severe scorpion envenomations. Copyright © 2013 Elsevier Ltd. All rights reserved.

Rabies control in rural Africa: Evaluating strategies for effective domestic dog vaccination

PubMed Central

Kaare, M.; Lembo, T.; Hampson, K.; Ernest, E.; Estes, A.; Mentzel, C.; Cleaveland, S.

2012-01-01

Effective vaccination campaigns need to reach a sufficient percentage of the population to eliminate disease and prevent future outbreaks, which for rabies is predicted to be 70%, at a cost that is economically and logistically sustainable. Domestic dog rabies has been increasing across most of sub-Saharan Africa indicating that dog vaccination programmes to date have been inadequate. We compare the effectiveness of a variety of dog vaccination strategies in terms of their cost and coverage in different community settings in rural Tanzania. Central-point (CP) vaccination was extremely effective in agro-pastoralist communities achieving a high coverage (>80%) at a low cost (US$5/dog) and inadequate (<20% coverage); combined approaches using CP and either house-to-house vaccination or trained community-based animal health workers were most effective with coverage exceeding 70%, although costs were still high (>US$6 and >US$4/dog, respectively). No single vaccination strategy is likely to be effective in all populations and therefore alternative approaches must be deployed under different settings. CP vaccination is cost-effective and efficient for the majority of dog populations in rural Tanzania and potentially elsewhere in sub-Saharan Africa, whereas a combination strategy is necessary in remote pastoralist communities. These results suggest that rabies control is logistically feasible across most of the developing world and that the annual costs of effective vaccination campaigns in Tanzania are likely to be affordable. PMID:18848595

Towards Individualized Instruction with Technology-Enabled Tools and Methods: An Exploratory Study. CRESST Report 854

ERIC Educational Resources Information Center

Chung, Gregory K. W. K.; Delacruz, Girlie C.; Dionne, Gary B.; Baker, Eva L.; Lee, John J.; Osmundson, Ellen

2016-01-01

This report addresses a renewed interest in individualized instruction, driven in part by advances in technology and assessment as well as a persistent desire to increase the access, efficiency, and cost effectiveness of training and education. Using computer-based instruction we delivered extremely efficient instruction targeted to low knowledge…

Some Theoretical Considerations Influencing Educational Finance in the 1980's.

ERIC Educational Resources Information Center

Atherton, Peter J.

The major problem to be faced in Canada in the next decade is resource allocation. Administrators must make conscious efforts to distinguish between changes in price levels that are the effect of inflationary pressures and increases in costs that are the result of changes in quality or quantity of inputs. A second area extremely important in…

"MYmind": Mindfulness Training for Youngsters with Autism Spectrum Disorders and Their Parents

ERIC Educational Resources Information Center

de Bruin, Esther I.; Blom, René; Smit, Franka M. A.; van Steensel, Francisca J. A.; Bögels, Susan M.

2015-01-01

Background: Despite the dramatic increase in autism spectrum disorder in youth and the extremely high costs, hardly any evidence-based interventions are available. The aim of this study is to examine the effects of mindfulness training for adolescents with autism spectrum disorder, combined with Mindful Parenting training. Method: A total of 23…

Trends and Cost-Analysis of Lower Extremity Nerve Injury Using the National Inpatient Sample.

PubMed

Foster, Chase H; Karsy, Michael; Jensen, Michael R; Guan, Jian; Eli, Ilyas; Mahan, Mark A

2018-06-08

Peripheral nerve injuries (PNIs) of the lower extremities have been assessed in small cohort studies; however, the actual incidence, national trends, comorbidities, and cost of care in lower extremity PNI are not defined. Lack of sufficient data limits discussion on national policies, payors, and other aspects fundamental to the delivery of care in the US. To establish estimates of lower extremity PNIs incidence, associated diagnoses, and cost in the US using a comprehensive database with a minimum of a decade of data. The National Inpatient Sample was utilized to evaluate International Classification of Disease codes for specific lower extremity PNIs (9560-9568) between 2001 and 2013. Lower extremity PNIs occurred with a mean incidence of 13.3 cases per million population annually, which declined minimally from 2001 to 2013. The mean ± SEM age was 41.6 ± 0.1 yr; 61.1% of patients were males. Most were admitted via the emergency department (56.0%). PNIs occurred to the sciatic (16.6%), femoral (10.7%), tibial (6.0%), peroneal (33.4%), multiple nerves (1.3%), and other (32.0%). Associated diagnoses included lower extremity fracture (13.4%), complications of care (11.2%), open wounds (10.3%), crush injury (9.7%), and other (7.2%). Associated procedures included tibial fixation (23.3%), closure of skin (20.1%), debridement of open fractures (15.4%), fixation of other bones (13.5%), and wound debridement (14.5%). The mean annual unadjusted compounded growth rate of charges was 8.8%. The mean ± SEM annual charge over the time period was $64 031.20 ± $421.10, which was associated with the number of procedure codes (β = 0.2), length of stay (β = 0.6), and year (β = 0.1) in a multivariable analysis (P = .0001). These data describe associations in the treatment of lower extremity PNIs, which are important for considering national policies, costs, research and the delivery of care.

An analysis of 72% chromated glycerin used for sclerotherapy: sterility, potency, and cost after extended shelf life.

PubMed

Ghaznavi, Amir M; Nakamura, Mio; Tepper, Donna

2015-01-01

Sclerotherapy is the treatment of reticular veins and telangiectasias of the lower extremities. Sclerosants destroy endothelial tissue and expose subendothelial collagen fibers, which lead to subsequent fibrosis of vessels, thus preventing recanalization. There are several available sclerosants including sodium tetradecyl sulfate (STS), polidocanol (POL), and chromated glycerin (CG) with varying efficacy, potency, side effect profile, and cost. To identify the possible bacterial contamination and potency of CG beyond the current recommended shelf life of 3 months and to prove if CG is as cost effective as other available sclerosants. Samples of 72% CG underwent bacterial endotoxin, sterility, and potency analysis at Days 0, 24, and 183. In addition, cost comparison was performed with other commercially available sclerosants including STS and POL. No samples of CG showed any bacterial contamination. All aliquots of glycerin remained sterile at Day 14. Potency at Day 24 was 99.2%, which was the same at Day 183. Cost comparison with other sclerosants revealed that CG is lower cost per milliliter than STS and POL. Seventy-two percent CG has no contamination and maintains its reported potency up to 6 months while comparable with the cost of other commercially available sclerosants.

Are quantitative trait-dependent sampling designs cost-effective for analysis of rare and common variants?

PubMed

Yilmaz, Yildiz E; Bull, Shelley B

2011-11-29

Use of trait-dependent sampling designs in whole-genome association studies of sequence data can reduce total sequencing costs with modest losses of statistical efficiency. In a quantitative trait (QT) analysis of data from the Genetic Analysis Workshop 17 mini-exome for unrelated individuals in the Asian subpopulation, we investigate alternative designs that sequence only 50% of the entire cohort. In addition to a simple random sampling design, we consider extreme-phenotype designs that are of increasing interest in genetic association analysis of QTs, especially in studies concerned with the detection of rare genetic variants. We also evaluate a novel sampling design in which all individuals have a nonzero probability of being selected into the sample but in which individuals with extreme phenotypes have a proportionately larger probability. We take differential sampling of individuals with informative trait values into account by inverse probability weighting using standard survey methods which thus generalizes to the source population. In replicate 1 data, we applied the designs in association analysis of Q1 with both rare and common variants in the FLT1 gene, based on knowledge of the generating model. Using all 200 replicate data sets, we similarly analyzed Q1 and Q4 (which is known to be free of association with FLT1) to evaluate relative efficiency, type I error, and power. Simulation study results suggest that the QT-dependent selection designs generally yield greater than 50% relative efficiency compared to using the entire cohort, implying cost-effectiveness of 50% sample selection and worthwhile reduction of sequencing costs.

Impacts of rainfall variability and expected rainfall changes on cost-effective adaptation of water systems to climate change.

PubMed

van der Pol, T D; van Ierland, E C; Gabbert, S; Weikard, H-P; Hendrix, E M T

2015-05-01

Stormwater drainage and other water systems are vulnerable to changes in rainfall and runoff and need to be adapted to climate change. This paper studies impacts of rainfall variability and changing return periods of rainfall extremes on cost-effective adaptation of water systems to climate change given a predefined system performance target, for example a flood risk standard. Rainfall variability causes system performance estimates to be volatile. These estimates may be used to recurrently evaluate system performance. This paper presents a model for this setting, and develops a solution method to identify cost-effective investments in stormwater drainage adaptations. Runoff and water levels are simulated with rainfall from stationary rainfall distributions, and time series of annual rainfall maxima are simulated for a climate scenario. Cost-effective investment strategies are determined by dynamic programming. The method is applied to study the choice of volume for a storage basin in a Dutch polder. We find that 'white noise', i.e. trend-free variability of rainfall, might cause earlier re-investment than expected under projected changes in rainfall. The risk of early re-investment may be reduced by increasing initial investment. This can be cost-effective if the investment involves fixed costs. Increasing initial investments, therefore, not only increases water system robustness to structural changes in rainfall, but could also offer insurance against additional costs that would occur if system performance is underestimated and re-investment becomes inevitable. Copyright © 2015 Elsevier Ltd. All rights reserved.

[Influence of three-level collaboration network of pediatric burns treatment in Anhui province on treatment effects of burn children].

PubMed

Xia, Z G; Zhou, X L; Kong, W C; Li, X Z; Song, J H; Fang, L S; Hu, D L; Cai, C; Tang, Y Z; Yu, Y X; Wang, C H; Xu, Q L

2018-03-20

Objective: To explore the influence of three-level collaboration network of pediatric burns in Anhui province on treatment effects of burn children. Methods: The data of medical records of pediatric burn children transferred from Lu'an People's Hospital and Fuyang People's Hospital to the First Affiliated Hospital of Anhui Medical University from January 2014 to December 2015 and January 2016 to September 2017 (before and after establishing three-level collaboration network of pediatric burns treatment) were analyzed: percentage of transferred burn children to hospitalized burn children in corresponding period, gender, age, burn degree, treatment method, treatment result, occurrence and treatment result of shock, and operative and non-operative treatment time and cost. Rehabilitation result of burn children transferred back to local hospitals in 2016 and 2017. Data were processed with t test, chi-square test, Mann-Whitney U test, and Fisher's exact test. Results: (1) Percentage of burn children transferred from January 2014 to December 2015 was 34.3% (291/848) of the total number of hospitalized burn children in the same period of time, which was close to 30.4% (210/691) of burn children transferred from January 2016 to September 2017 ( χ (2)=2.672, P >0.05). (2) Gender, age, burn degree, and treatment method of burn children transferred from the two periods of time were close ( χ (2)=3.382, Z =-1.917, -1.911, χ (2)=3.133, P >0.05). (3) Cure rates of children with mild, moderate, and severe burns transferred from January 2016 to September 2017 were significantly higher than those of burn children transferred from January 2014 to December 2015 ( χ (2)=11.777, 6.948, 4.310, P <0.05). Cure rates of children with extremely severe burns transferred from the two periods of time were close ( χ (2)=1.181, P >0.05). (4) Children with mild and moderate burns transferred from the two periods of time were with no shock. The incidence of shock of children with severe burns transferred from January 2014 to December 2015 was 6.0% (4/67), and 3 children among them were cured. The incidence of shock of children with severe burns transferred from January 2016 to September 2017 was 3.9% (2/51), and both children were cured. The incidences and cures of shock of children with severe burns transferred from the two periods of time were close ( χ (2)=0.006, P >0.05). Incidence of shock of children with extremely severe burns transferred from January 2014 to December 2015 was 57.1% (32/56), significantly higher than that of burn children transferred from January 2016 to September 2017 [34.5% (10/29), χ (2)=3.925, P <0.05]. Shock of 25 children with extremely severe burns transferred from January 2014 to December 2015 were cured, and shock of 9 children with extremely severe burns transferred from January 2016 to September 2017 were cured. The cures of shock of children with extremely severe burns transferred from the two periods of time were close ( χ (2)=0.139, P >0.05). (5) Time of operative treatment of children with moderate, severe, and extremely severe burns transferred from January 2014 to December 2015 was obviously longer than that of burn children transferred from January 2016 to September 2017 ( t =2.335, 2.065, 2.310, P <0.05). Time of operative treatment of children with mild burns transferred from the two periods of time was close ( Z =-0.417, P >0.05). Costs of operative treatment of children with moderate and severe burns transferred from January 2014 to December 2015 were significantly more than those of burn children transferred from January 2016 to September 2017 ( Z =-3.324, t =2.167, P <0.05). Costs of operative treatment of children with mild and extremely severe burns transferred from the two periods of time were close ( t =0.627, 0.808, P >0.05). (6)Time of non-operative treatment of children with mild, moderate, and severe burns transferred from January 2014 to December 2015 was obviously longer than that of burn children transferred from January 2016 to September 2017 ( t =2.335, Z =-2.095, t =2.152, P <0.05). Time of non-operative treatment of children with extremely severe burns transferred from the two periods of time was close ( t =0.450, P >0.05). Costs of non-operative treatment of children with moderate and severe burns transferred from January 2014 to December 2015 were obviously higher than those of burn children transferred from January 2016 to September 2017 ( Z =-2.164, t =2.040, P <0.05). Costs of non-operative treatment of children with mild and extremely severe burns transferred from the two periods of time were close ( t =0.146, 1.235, P >0.05). (7) Sixty-seven burn children transferred from January 2016 to September 2017 were transferred back to local hospitals for rehabilitation under the guidance of experts of the First Affiliated Hospital of Anhui Medical University, with 25 patients in 2016 and 42 patients in 2017. Effective rehabilitation rates of burn children transferred back to local hospitals for rehabilitation in 2016 and 2017 were both 100%. Conclusions: The three-level collaboration network of pediatric burns treatment in Anhui province can effectively increase cure rate of children with mild, moderate, and severe burns, reduce incidence of shock of children with extremely severe burns, shorten time of operative treatment of burn children with moderate, severe, and extremely severe burns, and time of non-operative treatment of children with mild, moderate, and severe burns, reduce treatment costs of children with moderate and severe burns, and improve rehabilitation effectiveness of children transferred from Lu'an People's Hospital and Fuyang People's Hospital to the the First Affiliated Hospital of Anhui Medical University.

Cost-effectiveness of traffic enforcement: case study from Uganda.

PubMed

Bishai, D; Asiimwe, B; Abbas, S; Hyder, A A; Bazeyo, W

2008-08-01

In October 2004, the Ugandan Police department deployed enhanced traffic safety patrols on the four major roads to the capital Kampala. To assess the costs and potential effectiveness of increasing traffic enforcement in Uganda. Record review and key informant interviews were conducted at 10 police stations along the highways that were patrolled. Monthly data on traffic citations and casualties were reviewed for January 2001 to December 2005; time series (ARIMA) regression was used to assess for a statistically significant change in traffic deaths. Costs were computed from the perspective of the police department in $US 2005. Cost offsets from savings to the health sector were not included. The annual cost of deploying the four squads of traffic patrols (20 officers, four vehicles, equipment, administration) is estimated at $72,000. Since deployment, the number of citations has increased substantially with a value of $327 311 annually. Monthly crash data pre- and post-intervention show a statistically significant 17% drop in road deaths after the intervention. The average cost-effectiveness of better road safety enforcement in Uganda is $603 per death averted or $27 per life year saved discounted at 3% (equivalent to 9% of Uganda's $300 GDP per capita). The costs of traffic safety enforcement are low in comparison to the potential number of lives saved and revenue generated. Increasing enforcement of existing traffic safety norms can prove to be an extremely cost-effective public health intervention in low-income countries, even from a government perspective.

Cost-effectiveness of cryotherapy versus salicylic acid for the treatment of plantar warts: economic evaluation alongside a randomised controlled trial (EVerT trial)

PubMed Central

2012-01-01

Abstract Background Plantar warts (verrucae) are extremely common. Although many will spontaneously disappear without treatment, treatment may be sought for a variety of reasons such as discomfort. There are a number of different treatments for cutaneous warts, with salicylic acid and cryotherapy using liquid nitrogen being two of the most common forms of treatment. To date, no full economic evaluation of either salicylic acid or cryotherapy has been conducted based on the use of primary data in a pragmatic setting. This paper describes the cost-effectiveness analysis which was conducted alongside a pragmatic multicentre, randomised trial evaluating the clinical effectiveness of cryotherapy versus 50% salicylic acid of the treatment of plantar warts. Methods A cost-effectiveness analysis was undertaken alongside a pragmatic multicentre, randomised controlled trial assessing the clinical effectiveness of 50% salicylic acid and cryotherapy using liquid nitrogen at 12 weeks after randomisation of patients. Cost-effectiveness outcomes were expressed as the additional cost required to completely cure the plantar warts of one additional patient. A NHS perspective was taken for the analysis. Results Cryotherapy costs on average £101.17 (bias corrected and accelerated (BCA) 95% CI: 85.09-117.26) more per participant over the 12 week time-frame, while there is no additional benefit, in terms of proportion of patients healed compared with salicylic acid. Conclusions Cryotherapy is more costly and no more effective than salicylic acid. Trial registration Current Controlled Trials ISRCTN18994246 [controlled-trials.com] and National Research Register N0484189151. PMID:22369511

Some ideas on the choice of designs and materials for cooled mirrors

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

Howells, M.R.

1994-12-01

This paper expresses some views on the fabrication of future synchrotron beam-line optics; more particularly the metallurgical issues in high-quality metal mirrors. A simple mirror with uniform cooling channels is first analyzed theoretically, followed by the cullular-pin-post system with complex coolant flow path. Choice of mirror material is next considered. For the most challenging situations (need for intensive cooling), the present practice is to use nickel-plated glidcop or silicon; for less severe challenges, Si carbide may be used and cooling may be direct or indirect; and for the mildest heat loads, fused silica or ulf are popular. For the highestmore » performance mirrors (extreme heat load), the glidcop developments should be continued perhaps to cellular-pin-post systems. For extreme distortion, Si is indicated and invar offers both improved performance and lower price. For less extreme challenges but still with cooling, Ni-plated metals have the cost advantage and SXA and other Al alloys can be added to glidcop and invar. For mirrors with mild cooling requirements, stainless steel would have many advantages. Once the internal cooling designs are established, they will be seen as more cost-effective and reliable than clamp-on schemes. Where no cooling is needed, Si, Si carbide, and the glasses can be used. For the future, the effect of electroless Ni layers on cooling design need study, and a way to finish nickel that is compatible with multilayers should be developed.« less

Cost-Effectiveness of Screening for Intermediate Age-Related Macular Degeneration during Diabetic Retinopathy Screening.

PubMed

Chan, Christina K W; Gangwani, Rita A; McGhee, Sarah M; Lian, JinXiao; Wong, David S H

2015-11-01

To determine whether screening for age-related macular degeneration (AMD) during a diabetic retinopathy (DR) screening program would be cost effective in Hong Kong. We compared and evaluated the impacts of screening, grading, and vitamin treatment for intermediate AMD compared with no screening using a Markov model. It was based on the natural history of AMD in a cohort with a mean age of 62 years, followed up until 100 years of age or death. Subjects attending a DR screening program were recruited. A cost-effectiveness analysis was undertaken from a public provider perspective. It included grading for AMD using the photographs obtained for DR screening and treatment with vitamin therapy for those with intermediate AMD. The measures of effectiveness were obtained largely from a local study, but the transition probabilities and utility values were from overseas data. Costs were all from local sources. The main assumptions and estimates were tested in sensitivity analyses. The outcome was cost per quality-adjusted life year (QALY) gained. Both costs and benefits were discounted at 3%. All costs are reported in United States dollars ($). The cost per QALY gained through screening for AMD and vitamin treatment for appropriate cases was $12,712 after discounting. This would be considered highly cost effective based on the World Health Organization's threshold of willingness to pay (WTP) for a QALY, that is, less than the annual per capita gross domestic product of $29,889. Because of uncertainty regarding the utility value for those with advanced AMD, we also tested an extreme, conservative value for utility under which screening remained cost effective. One-way sensitivity analyses revealed that, besides utility values, the cost per QALY was most sensitive to the progression rate from intermediate to advanced AMD. The cost-effectiveness acceptability curve showed a WTP for a QALY of $29,000 or more has a more than 86% probability of being cost effective compared with no screening. Our analysis demonstrated that AMD screening carried out simultaneously with DR screening for patients with diabetes would be cost effective in a Hong Kong public healthcare setting. Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Does morbid obesity negatively affect the hospital course of patients undergoing treatment of closed, lower-extremity diaphyseal long-bone fractures?

PubMed

Baldwin, Keith D; Matuszewski, Paul E; Namdari, Surena; Esterhai, John L; Mehta, Samir

2011-01-03

Obesity is prevalent in the developed world and is associated with significant costs to the health care system. The effect of morbid obesity in patients operatively treated for long-bone fractures of the lower extremity is largely unknown. The National Trauma Data Bank was accessed to determine if morbidly obese patients (body mass index >40) with lower extremity fractures have longer length of hospital stay, higher cost, greater rehabilitation admission rates, and more complications than nonobese patients. We identified patients with operatively treated diaphyseal femur (6920) and tibia (5190) fractures. Polytrauma patients and patients younger than 16 years were excluded. Morbidly obese patients were identified by ICD-9 and database comorbidity designation (femur, 131 morbidly obese; tibia, 75 morbidly obese). Patients meeting these criteria who were not morbidly obese were used as controls. Sensitivity analyses were performed to analyze patients with isolated trauma to the tibia or femur. Morbidly obese patients were more likely to be admitted to a subacute facility. Length of stay trended higher in morbidly obese patients. There was no significant relationship between obesity and inpatient mortality or inpatient complications. These trends held true when considering patients with multiple injuries and patients who had isolated long-bone injuries. Our study showed that morbidly obese patients may have greater rehabilitation needs following long-bone fractures in the lower extremity. Our study showed no difference in mortality or complications, although further studies are needed to confirm these findings. Copyright 2011, SLACK Incorporated.

Cost of Einstein-Podolsky-Rosen steering in the context of extremal boxes

NASA Astrophysics Data System (ADS)

Das, Debarshi; Datta, Shounak; Jebaratnam, C.; Majumdar, A. S.

2018-02-01

Einstein-Podolsky-Rosen steering is a form of quantum nonlocality, which is weaker than Bell nonlocality, but stronger than entanglement. Here we present a method to check Einstein-Podolsky-Rosen steering in the scenario where the steering party performs two black-box measurements and the trusted party performs projective qubit measurements corresponding to two arbitrary mutually unbiased bases. This method is based on decomposing the measurement correlations in terms of extremal boxes of the steering scenario. In this context, we propose a measure of steerability called steering cost. We show that our steering cost is a convex steering monotone. We illustrate our method to check steerability with two families of measurement correlations and find out their steering cost.

Hospital costs for patients with lower extremity cellulitis: a retrospective population-based study.

PubMed

Challener, Douglas; Marcelin, Jasmine; Visscher, Sue; Baddour, Larry

2017-12-01

Hospital admissions for non-purulent lower extremity cellulitis (NLEC) are common and can be prolonged and costly. Newer treatment options and preventive strategies are expected to result in cost savings before implementation, but few studies have quantified the cost of conventional treatment. Using the Rochester Epidemiology Project, the incidence of NLEC in Olmsted County, MN in 2013 was 176.6 per 100,000 persons. The subset of patients who required hospitalization for NLEC in 2013 was determined. Hospital admissions were analyzed retrospectively using standardized cost analysis within several relevant categories. Thirty-four patients had an average hospital length of stay of 4.7 days. The median total inpatient cost was $7,341. The median cost per day was $2,087, with 49% due to room and board. Antibiotics administered for treatment of NLEC contributed a median cost of $75 per day of hospitalization, and laboratory and imaging test costs were $73 and $44, respectively, per day of hospitalization. Hospitalizations for NLEC can be costly and prolonged with room and board accounting for much of the cost. Therefore, newer management strategies should seek to reduce hospital length of stay and/or avoid inpatient admission to reduce cost.

Synergy Effects in the Chemical Synthesis and Extensions of Multicomponent Reactions (MCRs)-The Low Energy Way to Ultra-Short Syntheses of Tailor-Made Molecules.

PubMed

Eckert, Heiner

2017-02-25

Several novel methods, catalysts and reagents have been developed to improve organic synthesis. Synergistic effects between reactions, reagents and catalysts can lead to minor heats of reaction and occur as an inherent result of multicomponent reactions (MCRs) and their extensions. They enable syntheses to be performed at a low energy level and the number of synthesis steps to be drastically reduced in comparison with 'classical' two-component reactions, fulfilling the rules of Green Chemistry . The very high potential for variability, diversity and complexity of MCRs additionally generates an extremely diverse range of products, thus bringing us closer to the aim of being able to produce tailor-made and extremely low-cost materials, drugs and compound libraries.

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.

Hell and High Water: Practice-Relevant Adaptation Science

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

Moss, Richard H.; Meehl, G.; Lemos, Maria Carmen

2013-11-08

Recent extreme weather such as Hurricane Sandy and the 2012 drought demonstrate the vulnerability of the United States to climate extremes in the present and point to the potential for increased future damages under a changing climate. They also provide lessons for reducing harm and realizing any potential benefits. Preparedness measures – also referred to as adaptation – can cost-effectively increase resilience today and in the future. The upfront costs will be more than offset by reductions in property damage, lives and livelihoods lost, and expensive post-disaster recovery processes. While others have addressed use of science for adaptation in specificmore » sectors including biodiversity (Heller and Zavaleta, 2009) and freshwater ecosystem management (Wilby et al., 2010), or by simply taking a more pragmatic approach to adaptation under uncertainty (Hallegatte, 2009), here the authors make the case that a new, comprehensive approach is needed to create and use science to inform adaptations with applicable and sound knowledge (Kerr et al., 2011).« less

Selective DNA Pooling for Determination of Linkage between a Molecular Marker and a Quantitative Trait Locus

PubMed Central

Darvasi, A.; Soller, M.

1994-01-01

Selective genotyping is a method to reduce costs in marker-quantitative trait locus (QTL) linkage determination by genotyping only those individuals with extreme, and hence most informative, quantitative trait values. The DNA pooling strategy (termed: ``selective DNA pooling'') takes this one step further by pooling DNA from the selected individuals at each of the two phenotypic extremes, and basing the test for linkage on marker allele frequencies as estimated from the pooled samples only. This can reduce genotyping costs of marker-QTL linkage determination by up to two orders of magnitude. Theoretical analysis of selective DNA pooling shows that for experiments involving backcross, F(2) and half-sib designs, the power of selective DNA pooling for detecting genes with large effect, can be the same as that obtained by individual selective genotyping. Power for detecting genes with small effect, however, was found to decrease strongly with increase in the technical error of estimating allele frequencies in the pooled samples. The effect of technical error, however, can be markedly reduced by replication of technical procedures. It is also shown that a proportion selected of 0.1 at each tail will be appropriate for a wide range of experimental conditions. PMID:7896115

Lower-extremity peripheral nerve blocks in the perioperative pain management of orthopaedic patients: AAOS exhibit selection.

PubMed

Stein, Benjamin E; Srikumaran, Umasuthan; Tan, Eric W; Freehill, Michael T; Wilckens, John H

2012-11-21

The utilization of peripheral nerve blocks in orthopaedic surgery has paralleled the rise in the number of ambulatory surgical procedures performed. Optimization of pain control in the perioperative orthopaedic patient contributes to improved patient satisfaction, early mobilization, decreased length of hospitalization, and decreased associated hospital and patient costs. Our purpose was to provide a concise, pertinent review of the use of peripheral nerve blocks in various orthopaedic procedures of the lower extremity, with specific focus on procedural anatomy, indications, patient outcome measures, and complications. We reviewed the literature and reference textbooks on commonly performed lower-extremity peripheral nerve block procedures in orthopaedic surgery, focusing on those most commonly used. The use of lower-extremity peripheral nerve blocks is a safe and effective approach to perioperative pain management. Different techniques and timing can have an important impact on patient satisfaction, and each technique has specific indications and complications. For major hip surgery, one of the most commonly used is the lumbar plexus block, which can result in early mobilization, reduced postoperative pain, and decreased opioid-associated adverse events. Associated complications include epidural spread of anesthesia, retroperitoneal hematoma formation, and postoperative falls. For arthroscopic and open knee procedures, the femoral nerve block is frequently used adjunctively. It provides improved early postoperative pain control, early mobilization with therapy, and increased patient satisfaction compared with intra-articular or intravenous opioids alone; it also provides cost savings. However, some studies have shown no significant difference in outcome measures compared with intra-articular opioids alone for arthroscopic anterior cruciate ligament reconstruction. Associated complications include nerve injury, intravascular injection, and postoperative falls. The use of peripheral nerve blocks in lower-extremity surgery is becoming a mainstay of perioperative pain management strategy.

A prospective, randomised, controlled, multi-centre comparative effectiveness study of healing using dehydrated human amnion/chorion membrane allograft, bioengineered skin substitute or standard of care for treatment of chronic lower extremity diabetic ulcers.

PubMed

Zelen, Charles M; Gould, Lisa; Serena, Thomas E; Carter, Marissa J; Keller, Jennifer; Li, William W

2015-12-01

A prospective, randomised, controlled, parallel group, multi-centre clinical trial was conducted at three sites to compare the healing effectiveness of treatment of chronic lower extremity diabetic ulcers with either weekly applications of Apligraf(®) (Organogenesis, Inc., Canton, MA), EpiFix(®) (MiMedx Group, Inc., Marietta, GA), or standard wound care with collagen-alginate dressing. The primary study outcome was the percent change in complete wound healing after 4 and 6 weeks of treatment. Secondary outcomes included percent change in wound area per week, velocity of wound closure and a calculation of the amount and cost of Apligraf or EpiFix used. A total of 65 subjects entered the 2-week run-in period and 60 were randomised (20 per group). The proportion of patients in the EpiFix group achieving complete wound closure within 4 and 6 weeks was 85% and 95%, significantly higher (all adjusted P-values ≤ 0·003) than for patients receiving Apligraf (35% and 45%), or standard care (30% and 35%). After 1 week, wounds treated with EpiFix had reduced in area by 83·5% compared with 53·1% for wounds treated with Apligraf. Median time to healing was significantly faster (all adjusted P-values ≤0·001) with EpiFix (13 days) compared to Apligraf (49 days) or standard care (49 days). The mean number of grafts used and the graft cost per patient were lower in the EpiFix group campared to the Apligraf group, at 2·15 grafts at a cost of $1669 versus 6·2 grafts at a cost of $9216, respectively. The results of this study demonstrate the clinical and resource utilisation superiority of EpiFix compared to Apligraf or standard of care, for the treatment of diabetic ulcers of the lower extremities. © 2014 The Authors. International Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Building an Effective and Affordable K-12 Geoscience Outreach Program from the Ground Up: A Simple Model for Universities

ERIC Educational Resources Information Center

Dahl, Robyn Mieko; Droser, Mary L.

2016-01-01

University earth science departments seeking to establish meaningful geoscience outreach programs often pursue large-scale, grant-funded programs. Although this type of outreach is highly successful, it is also extremely costly, and grant funding can be difficult to secure. Here, we present the Geoscience Education Outreach Program (GEOP), a…

A Semi-passive Planar Manipulandum for Upper-Extremity Rehabilitation.

PubMed

Chang, Chih-Kang; Washabaugh, Edward P; Gwozdziowski, Andrew; Remy, C David; Krishnan, Chandramouli

2018-07-01

Robotic rehabilitation is a promising approach to treat individuals with neurological or orthopedic disorders. However, despite significant advancements in the field of rehabilitation robotics, this technology has found limited traction in clinical practice. A key reason for this issue is that most robots are expensive, bulky, and not scalable for in-home rehabilitation. Here, we introduce a semi-passive rehabilitation robot (SepaRRo) that uses controllable passive actuators (i.e., brakes) to provide controllable resistances at the end-effector over a large workspace in a manner that is cost-effective and safe for in-home use. We also validated the device through theoretical analyses, hardware experiments, and human subject experiments. We found that by including kinematic redundancies in the robot's linkages, the device was able to provide controllable resistances to purely resist the movement of the end-effector, or to gently steer (i.e., perturb) its motion away from the intended path. When testing these capabilities on human subjects, we found that many of the upper-extremity muscles could be selectively targeted based on the forcefield prescribed to the user. These results indicate that SepaRRo could serve as a low-cost therapeutic tool for upper-extremity rehabilitation; however, further testing is required to evaluate its therapeutic benefits in patient population.

When Siberia came to the Netherlands: The response of continental black-tailed godwits to a rare spring weather event

USGS Publications Warehouse

Senner, Nathan R.; Verhoeven, Mo A.; Abad-Gómez, José M.; Gutiérrez, Jorge S.; Hooijmeijer, Jos C. E. W.; Kentie, Rosemarie; Masero, José A.; Tibbitts, T. Lee; Piersma, Theunis

2015-01-01

This suggests that populations with continued access to food, behavioural flexibility and time to dissipate the costs of the event can likely withstand the consequences of an extreme weather event. For populations constrained in one of these respects, though, extreme events may entail extreme ecological consequences.

A Perspective on the Use of Storable Propellants for Future Space Vehicle Propulsion

NASA Technical Reports Server (NTRS)

Boyd, William C.; Brasher, Warren L.

1989-01-01

Propulsion system configurations for future NASA and DOD space initiatives are driven by the continually emerging new mission requirements. These initiatives cover an extremely wide range of mission scenarios, from unmanned planetary programs, to manned lunar and planetary programs, to earth-oriented (Mission to Planet Earth) programs, and they are in addition to existing and future requirements for near-earth missions such as to geosynchronous earth orbit (GEO). Increasing space transportation costs, and anticipated high costs associated with space-basing of future vehicles, necessitate consideration of cost-effective and easily maintainable configurations which maximize the use of existing technologies and assets, and use budgetary resources effectively. System design considerations associated with the use of storable propellants to fill these needs are presented. Comparisons in areas such as complexity, performance, flexibility, maintainability, and technology status are made for earth and space storable propellants, including nitrogen tetroxide/monomethylhydrazine and LOX/monomethylhydrazine.

Placement and efficiency effects on radiative forcing of solar installations

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

Burg, Brian R.; Ruch, Patrick; Paredes, Stephan

2015-09-28

The promise for harnessing solar energy being hampered by cost, triggered efforts to reduce them. As a consequence low-efficiency, low-cost photovoltaics (PV) panels prevail. Conversely, in the traditional energy sector efficiency is extremely important due to the direct costs associated to fuels. This also affects solar energy due to the radiative forcing caused by the dark solar panels. In this paper we extend the concept of energy payback time by including the effect of albedo change, which gives a better assessment of the system sustainability. We present an analysis on the short and medium term climate forcing effects of differentmore » solar collectors in Riyadh, Saudi Arabia and demonstrate that efficiency is important to reduce the collector area and cost. This also influences the embodied energy and the global warming potential. We show that a placement of a high concentration photovoltaic thermal solar power station outside of the city using a district cooling system has a double beneficial effect since it improves the solar conversion efficiency and reduces the energy demand for cooling in the city. We also explain the mechanisms of the current economic development of solar technologies and anticipate changes.« less

Early Lessons on Bundled Payment at an Academic Medical Center.

PubMed

Jubelt, Lindsay E; Goldfeld, Keith S; Blecker, Saul B; Chung, Wei-Yi; Bendo, John A; Bosco, Joseph A; Errico, Thomas J; Frempong-Boadu, Anthony K; Iorio, Richard; Slover, James D; Horwitz, Leora I

2017-09-01

Orthopaedic care is shifting to alternative payment models. We examined whether New York University Langone Medical Center achieved savings under the Centers for Medicare and Medicaid Services Bundled Payments for Care Improvement initiative. This study was a difference-in-differences study of Medicare fee-for-service patients hospitalized from April 2011 to June 2012 and October 2013 to December 2014 for lower extremity joint arthroplasty, cardiac valve procedures, or spine surgery (intervention groups), or for congestive heart failure, major bowel procedures, medical peripheral vascular disorders, medical noninfectious orthopaedic care, or stroke (control group). We examined total episode costs and costs by service category. We included 2,940 intervention episodes and 1,474 control episodes. Relative to the trend in the control group, lower extremity joint arthroplasty episodes achieved the greatest savings: adjusted average episode cost during the intervention period decreased by $3,017 (95% confidence interval [CI], -$6,066 to $31). For cardiac procedures, the adjusted average episode cost decreased by $2,999 (95% CI, -$8,103 to $2,105), and for spinal fusion, it increased by $8,291 (95% CI, $2,879 to $13,703). Savings were driven predominantly by shifting postdischarge care from inpatient rehabilitation facilities to home. Spinal fusion index admission costs increased because of changes in surgical technique. Under bundled payment, New York University Langone Medical Center decreased total episode costs in patients undergoing lower extremity joint arthroplasty. For patients undergoing cardiac valve procedures, evidence of savings was not as strong, and for patients undergoing spinal fusion, total episode costs increased. For all three conditions, the proportion of patients referred to inpatient rehabilitation facilities upon discharge decreased. These changes were not associated with an increase in index hospital length of stay or readmission rate. Opportunities for savings under bundled payment may be greater for lower extremity joint arthroplasty than for other conditions.

Effects of Extremity Armor on Metabolic Cost and Gait Biomechanics

DTIC Science & Technology

2010-05-26

of prosthetics , orthotics, and exercise equipment could benefit from knowing the tipping point at which a mass on the limb begins to effect metabolic...measured. For this, you wear a nose clip and 4 breathe through a rubber mouthpiece and valve , similar to those found in scuba diving 5 equipment. The...32 33 Stress fractures , or breaks of bones in the foot and leg, have been associated with road 34 marching while carrying loads, especially

Pain Exposure Physical Therapy versus conventional treatment in complex regional pain syndrome type 1-a cost-effectiveness analysis alongside a randomized controlled trial.

PubMed

Barnhoorn, Karlijn; Staal, J Bart; van Dongen, Robert Tm; Frölke, Jan Paul M; Klomp, Frank P; van de Meent, Henk; Adang, Eddy; Nijhuis-van der Sanden, Maria Wg

2018-06-01

To analyze cost-effectiveness of Pain Exposure Physical Therapy compared to conventional treatment alongside a randomized controlled trial (NCT00817128) in patients with complex regional pain syndrome type 1, where no clinical difference was shown between the two groups in an intention-to-treat analysis. Randomized controlled trial with 9 months follow-up. Patients were recruited from hospitals and general practitioners in the region around a university hospital. A total of 56 patients, 45 (80.4%) female, were randomized. About 4 patients in the intervention and 11 patients in the conventional group switched groups. The mean (SD) age was 44.3 (16.6) years, and in 37 (66.1%) patients, the upper extremity was affected. Patients received either Pain Exposure Physical Therapy (maximum of five sessions), or conventional treatment conforming with the Dutch multidisciplinary guideline. For the economic evaluation difference between the groups in health-related quality of life (quality-adjusted life years (QALYs)), and the clinical outcomes Impairment level Sum Score-Restricted Version and Pain Disability was determined based on the intention-to-treat analysis as well as differences in both healthcare-related costs and travel expenses. Cost-effectiveness planes were constructed using bootstrapping to compare effects and costs. No significant effects were found for QALYs (mean difference = -0.02; 95% confidence interval (CI) -0.10 to 0.04) and clinical outcomes. A cost minimization analysis showed a significant difference in costs between groups. The conventional treatment was 64% more expensive than the Pain Exposure Physical Therapy. This economic analysis shows that Pain Exposure Physical Therapy compared to conventional treatment is cost-effective.

The cost-effectiveness of harm reduction.

PubMed

Wilson, David P; Donald, Braedon; Shattock, Andrew J; Wilson, David; Fraser-Hurt, Nicole

2015-02-01

HIV prevalence worldwide among people who inject drugs (PWID) is around 19%. Harm reduction for PWID includes needle-syringe programs (NSPs) and opioid substitution therapy (OST) but often coupled with antiretroviral therapy (ART) for people living with HIV. Numerous studies have examined the effectiveness of each harm reduction strategy. This commentary discusses the evidence of effectiveness of the packages of harm reduction services and their cost-effectiveness with respect to HIV-related outcomes as well as estimate resources required to meet global and regional coverage targets. NSPs have been shown to be safe and very effective in reducing HIV transmission in diverse settings; there are many historical and very recent examples in diverse settings where the absence of, or reduction in, NSPs have resulted in exploding HIV epidemics compared to controlled epidemics with NSP implementation. NSPs are relatively inexpensive to implement and highly cost-effective according to commonly used willingness-to-pay thresholds. There is strong evidence that substitution therapy is effective, reducing the risk of HIV acquisition by 54% on average among PWID. OST is relatively expensive to implement when only HIV outcomes are considered; other societal benefits substantially improve the cost-effectiveness ratios to be highly favourable. Many studies have shown that ART is cost-effective for keeping people alive but there is only weak supportive, but growing evidence, of the additional effectiveness and cost-effectiveness of ART as prevention among PWID. Packages of combined harm reduction approaches are highly likely to be more effective and cost-effective than partial approaches. The coverage of harm reduction programs remains extremely low across the world. The total annual costs of scaling up each of the harm reduction strategies from current coverage levels, by region, to meet WHO guideline coverage targets are high with ART greatest, followed by OST and then NSPs. But scale-up of all three approaches is essential. These interventions can be cost-effective by most thresholds in the short-term and cost-saving in the long-term. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.

When is critical care medicine cost-effective? A systematic review of the cost-effectiveness literature.

PubMed

Talmor, Daniel; Shapiro, Nathan; Greenberg, Dan; Stone, Patricia W; Neumann, Peter J

2006-11-01

Receiving care in an intensive care unit can greatly influence patients' survival and quality of life. Such treatments can, however, be extremely resource intensive. Therefore, it is increasingly important to understand the costs and consequences associated with interventions aimed at reducing mortality and morbidity of critically ill patients. Cost-effectiveness analyses (CEAs) have become increasingly common to aid decisions about the allocation of scarce healthcare resources. To identify published original CEAs presenting cost/quality-adjusted life year or cost/life-year ratios for treatments used in intensive care units, to summarize the results in an accessible format, and to identify areas in critical care medicine that merit further economic evaluation. We conducted a systematic search of the English-language literature for original CEAs of critical care interventions published from 1993 through 2003. We collected data on the target population, therapy or program, study results, analytic methods employed, and the cost-effectiveness ratios presented. We identified 19 CEAs published through 2003 with 48 cost-effectiveness ratios pertaining to treatment of severe sepsis, acute respiratory failure, and general critical care interventions. These ratios ranged from cost saving to 958,423 US dollars/quality-adjusted life year and from 1,150 to 575,054 US dollars/life year gained. Many studies reported favorable cost-effectiveness profiles (i.e., below 50,000 US dollars/life year or quality-adjusted life year). Specific interventions such as activated protein C for patients with severe sepsis have been shown to provide good value for money. However, overall there is a paucity of CEA literature on the management of the critically ill, and further high-quality CEA is needed. In particular, research should focus on costly interventions such as 24-hr intensivist availability, early goal-directed therapy, and renal replacement therapy. Recent guidelines for the conduct of CEAs in critical care may increase the number and improve the quality of future CEAs.

[Outlier cases in surgical disciplines. Micro-economic and macro-economic problems].

PubMed

Tecklenburg, A; Liebeneiner, J; Schaefer, O

2009-09-01

Postoperative complications will always occur and the negative impact puts strain on patients, relatives and the attending physicians. The conversion to a remuneration system based on flat rates (diagnosis-related groups) presents additional economic problems for hospitals in some resource-intensive treatments. This particularly pertains to extremely cost-intensive cases in which costs succeed revenue by the factor of 2 and are often surgical procedures. Here the economic risk increases with the number of interventions performed. Despite improvements in the remuneration system this problem persists. An improved payment for these treatments is desirable. To achieve this it is necessary to systematically analyze the extremely cost-intensive cases by experts of different medical disciplines to create a data basis for a proposal of a cost-covering payment.

Extremely costly intensifiers are stronger than quite costly ones.

PubMed

Bennett, Erin D; Goodman, Noah D

2018-05-29

We show that the wide range in strengths of intensifying degree adverbs (e.g. very and extremely) can be partly explained by pragmatic inference based on differing cost, rather than differing semantics. The pragmatic theory predicts a linear relationship between the meaning of intensifiers and their length and log-frequency. We first test this prediction in three studies, using two different dependent measures, finding that higher utterance cost (i.e. higher word length or surprisal) does predict stronger meanings. In two additional studies we confirm that the relationship between length and meaning is present even for novel words. We discuss the implications for adverbial meaning and the more general question of how extensive non-arbitrary form-meaning association may be in language. Copyright © 2018 Elsevier B.V. All rights reserved.

The Effects of Diagnostic Definitions in Claims Data on Healthcare Cost Estimates: Evidence from a Large-Scale Panel Data Analysis of Diabetes Care in Japan.

PubMed

Fukuda, Haruhisa; Ikeda, Shunya; Shiroiwa, Takeru; Fukuda, Takashi

2016-10-01

Inaccurate estimates of diabetes-related healthcare costs can undermine the efficiency of resource allocation for diabetes care. The quantification of these costs using claims data may be affected by the method for defining diagnoses. The aims were to use panel data analysis to estimate diabetes-related healthcare costs and to comparatively evaluate the effects of diagnostic definitions on cost estimates. Monthly panel data analysis of Japanese claims data. The study included a maximum of 141,673 patients with type 2 diabetes who received treatment between 2005 and 2013. Additional healthcare costs associated with diabetes and diabetes-related complications were estimated for various diagnostic definition methods using fixed-effects panel data regression models. The average follow-up period per patient ranged from 49.4 to 52.3 months. The number of patients identified as having type 2 diabetes varied widely among the diagnostic definition methods, ranging from 14,743 patients to 141,673 patients. The fixed-effects models showed that the additional costs per patient per month associated with diabetes ranged from US$180 [95 % confidence interval (CI) 178-181] to US$223 (95 % CI 221-224). When the diagnostic definition excluded rule-out diagnoses, the diabetes-related complications associated with higher additional healthcare costs were ischemic heart disease with surgery (US$13,595; 95 % CI 13,568-13,622), neuropathy/extremity disease with surgery (US$4594; 95 % CI 3979-5208), and diabetic nephropathy with dialysis (US$3689; 95 % CI 3667-3711). Diabetes-related healthcare costs are sensitive to diagnostic definition methods. Determining appropriate diagnostic definitions can further advance healthcare cost research for diabetes and its applications in healthcare policies.

Low-cost method for producing extreme ultraviolet lithography optics

DOEpatents

Folta, James A [Livermore, CA; Montcalm, Claude [Fort Collins, CO; Taylor, John S [Livermore, CA; Spiller, Eberhard A [Mt. Kisco, NY

2003-11-21

Spherical and non-spherical optical elements produced by standard optical figuring and polishing techniques are extremely expensive. Such surfaces can be cheaply produced by diamond turning; however, the roughness in the diamond turned surface prevent their use for EUV lithography. These ripples are smoothed with a coating of polyimide before applying a 60 period Mo/Si multilayer to reflect a wavelength of 134 .ANG. and have obtained peak reflectivities close to 63%. The savings in cost are about a factor of 100.

Cost-effectiveness of diagnostic for malaria in Extra-Amazon Region, Brazil

PubMed Central

2012-01-01

Background Rapid diagnostic tests (RDT) for malaria have been demonstrated to be effective and they should replace microscopy in certain areas. Method The cost-effectiveness of five RDT and thick smear microscopy was estimated and compared. Data were collected on Brazilian Extra-Amazon Region. Data sources included the National Malaria Control Programme of the Ministry of Health, the National Healthcare System reimbursement table, laboratory suppliers and scientific literature. The perspective was that of the Brazilian public health system, the analytical horizon was from the start of fever until the diagnostic results provided to patient and the temporal reference was that of year 2010. Two costing methods were produced, based on exclusive-use microscopy or shared-use microscopy. The results were expressed in costs per adequately diagnosed cases in 2010 U.S. dollars. One-way sensitivity analysis was performed considering key model parameters. Results In the cost-effectiveness analysis with exclusive-use microscopy, the RDT CareStart™ was the most cost-effective diagnostic strategy. Microscopy was the most expensive and most effective, with an additional case adequately diagnosed by microscopy costing US$ 35,550.00 in relation to CareStart™. In opposite, in the cost-effectiveness analysis with shared-use microscopy, the thick smear was extremely cost-effective. Introducing into the analytic model with shared-use microscopy a probability for individual access to the diagnosis, assuming a probability of 100% of access for a public health system user to any RDT and, hypothetically, of 85% of access to microscopy, this test saw its effectiveness reduced and was dominated by the RDT CareStart™. Conclusion The analysis of cost-effectiveness of malaria diagnosis technologies in the Brazilian Extra-Amazon Region depends on the exclusive or shared use of the microscopy. Following the assumptions of this study, shared-use microscopy would be the most cost-effective strategy of the six technologies evaluated. However, if used exclusively for diagnosing malaria, microscopy would be the worst use of resources. Microscopy would not be the most cost-effective strategy, even when structure is shared with other programmes, when the probability of a patient having access to it was reduced. Under these circumstances, the RDT CareStart™ would be the most cost-effective strategy. PMID:23176717

Study on the effectiveness of Extreme Cold Mist MQL system on turning process of stainless steel AISI 316

NASA Astrophysics Data System (ADS)

Jamaludin, A. S.; Hosokawa, A.; Furumoto, T.; Koyano, T.; Hashimoto, Y.

2018-03-01

Cutting process of difficult-to-cut material such as stainless steel, generates immensely excessive heat, which is one of the major causes related to shortening tool life and lower quality of surface finish. It is proven that application of cutting fluid during the cutting process of difficult-to-cut material is able to improve the cutting performance, but excessive application of cutting fluid leads to another problem such as increasing processing cost and environmental hazardous pollution of workplace. In the study, Extreme Cold Mist system is designed and tested along with various Minimum Quantity Lubrication (MQL) systems on turning process of stainless steel AISI 316. In the study, it is obtained that, Extreme Cold Mist system is able to reduce cutting force up to 60N and improve the surface roughness of the machined surface significantly.

Subcutaneous narcotic infusions for cancer pain: treatment outcome and guidelines for use.

PubMed

Moulin, D E; Johnson, N G; Murray-Parsons, N; Geoghegan, M F; Goodwin, V A; Chester, M A

1992-03-15

To provide guidelines for the institution and maintenance of a continuous subcutaneous narcotic infusion program for cancer patients with chronic pain through an analysis of the narcotic requirements and treatment outcomes of patients who underwent such therapy and a comparison of the costs of two commonly used infusion systems. Retrospective study. Tertiary care facilities and patients' homes. Of 481 patients seen in consultation for cancer pain between July 1987 and April 1990, 60 (12%) met the eligibility criteria (i.e., standard medical management had failed, and they had adequate supervision at home). Continuous subcutaneous infusion with hydromorphone hydrochloride or morphine started on an inpatient basis and continued at home whenever possible. Patient selectivity, narcotic dosing requirements, discharge rate, patient preference for analgesic regimen, side effects, complications and cost-effectiveness. The mean initial maintenance infusion dose after dose titration was almost three times higher than the dose required before infusion (hydromorphone or equivalent 6.2 v. 2.1 mg/h). Eighteen patients died, and the remaining 42 were discharged home for a mean of 94.4 (standard deviation 128.3) days (extremes 12 and 741 days). The mean maximum infusion rate was 24.1 mg/h (extremes 0.5 and 180 mg/h). All but one of the patients preferred the infusion system to their previous oral analgesic regimen. Despite major dose escalations nausea and vomiting were well controlled in all cases. Twelve patients (20%) experienced serious systemic toxic effects or complications; six became encephalopathic, which necessitated dose reduction, five had a subcutaneous infection necessitating antibiotic treatment, and one had respiratory depression. The programmable computerized infusion pump was found to be more cost-effective than the disposable infusion device after a break-even point of 8 months. Continuous subcutaneous infusion of opioid drugs with the use of a portable programmable pump is safe and effective in selected patients who have failed to respond to standard medical treatment of their cancer pain. Dose titration may require rapid dose escalation, but this is usually well tolerated. For most communities embarking on such a program a programmable infusion system will be more cost-effective than a disposable system.

Economic Evidence on the Health Impacts of Climate Change in Europe

PubMed Central

Hutton, Guy; Menne, Bettina

2014-01-01

BACKGROUND In responding to the health impacts of climate change, economic evidence and tools inform decision makers of the efficiency of alternative health policies and interventions. In a time when sweeping budget cuts are affecting all tiers of government, economic evidence on health protection from climate change spending enables comparison with other public spending. METHODS The review included 53 countries of the World Health Organization (WHO) European Region. Literature was obtained using a Medline and Internet search of key terms in published reports and peer-reviewed literature, and from institutions working on health and climate change. Articles were included if they provided economic estimation of the health impacts of climate change or adaptation measures to protect health from climate change in the WHO European Region. Economic studies are classified under health impact cost, health adaptation cost, and health economic evaluation (comparing both costs and impacts). RESULTS A total of 40 relevant studies from Europe were identified, covering the health damage or adaptation costs related to the health effects of climate change and response measures to climate-sensitive diseases. No economic evaluation studies were identified of response measures specific to the impacts of climate change. Existing studies vary in terms of the economic outcomes measured and the methods for evaluation of health benefits. The lack of robust health impact data underlying economic studies significantly affects the availability and precision of economic studies. CONCLUSIONS Economic evidence in European countries on the costs of and response to climate-sensitive diseases is extremely limited and fragmented. Further studies are urgently needed that examine health impacts and the costs and efficiency of alternative responses to climate-sensitive health conditions, in particular extreme weather events (other than heat) and potential emerging diseases and other conditions threatening Europe. PMID:25452694

Economic evidence on the health impacts of climate change in europe.

PubMed

Hutton, Guy; Menne, Bettina

2014-01-01

In responding to the health impacts of climate change, economic evidence and tools inform decision makers of the efficiency of alternative health policies and interventions. In a time when sweeping budget cuts are affecting all tiers of government, economic evidence on health protection from climate change spending enables comparison with other public spending. The review included 53 countries of the World Health Organization (WHO) European Region. Literature was obtained using a Medline and Internet search of key terms in published reports and peer-reviewed literature, and from institutions working on health and climate change. Articles were included if they provided economic estimation of the health impacts of climate change or adaptation measures to protect health from climate change in the WHO European Region. Economic studies are classified under health impact cost, health adaptation cost, and health economic evaluation (comparing both costs and impacts). A total of 40 relevant studies from Europe were identified, covering the health damage or adaptation costs related to the health effects of climate change and response measures to climate-sensitive diseases. No economic evaluation studies were identified of response measures specific to the impacts of climate change. Existing studies vary in terms of the economic outcomes measured and the methods for evaluation of health benefits. The lack of robust health impact data underlying economic studies significantly affects the availability and precision of economic studies. Economic evidence in European countries on the costs of and response to climate-sensitive diseases is extremely limited and fragmented. Further studies are urgently needed that examine health impacts and the costs and efficiency of alternative responses to climate-sensitive health conditions, in particular extreme weather events (other than heat) and potential emerging diseases and other conditions threatening Europe.

The Science of Cost-Effective Materials Design - A Study in the Development of a High Strength, Impact Resistant Steel

NASA Astrophysics Data System (ADS)

Abrahams, Rachel

2017-06-01

Intermediate alloy steels are widely used in applications where both high strength and toughness are required for extreme/dynamic loading environments. Steels containing greater than 10% Ni-Co-Mo are amongst the highest strength martensitic steels, due to their high levels of solution strengthening, and preservation of toughness through nano-scaled secondary hardening, semi-coherent hcp-M2 C carbides. While these steels have high yield strengths (σy 0.2 % >1200 MPa) with high impact toughness values (CVN@-40 >30J), they are often cost-prohibitive due to the material and processing cost of nickel and cobalt. Early stage-I steels such as ES-1 (Eglin Steel) were developed in response to the high cost of nickel-cobalt steels and performed well in extreme shock environments due to the presence of analogous nano-scaled hcp-Fe2.4 C epsilon carbides. Unfortunately, the persistence of W-bearing carbides limited the use of ES-1 to relatively thin sections. In this study, we discuss the background and accelerated development cycle of AF96, an alternative Cr-Mo-Ni-Si stage-I temper steel using low-cost heuristic and Integrated Computational Materials Engineering (ICME)-assisted methods. The microstructure of AF96 was tailored to mimic that of ES-1, while reducing stability of detrimental phases and improving ease of processing in industrial environments. AF96 is amenable to casting and forging, deeply hardenable, and scalable to 100,000 kg melt quantities. When produced at the industrial scale, it was found that AF96 exhibits near-statistically identical mechanical properties to ES-1 at 50% of the cost.

Cost-effectiveness of cervical spine clearance interventions with litigation and long-term-care implications in obtunded adult patients following blunt injury.

PubMed

Ertel, Audrey E; Robinson, Bryce R H; Eckman, Mark H

2016-11-01

Recent guidelines from the Eastern Association for the Surgery of Trauma conditionally recommend cervical collar removal after a negative cervical computed tomography in obtunded adult blunt trauma patients. Although the rates of missed injury are extremely low, the impact of chronic care costs and litigation upon decision making remains unclear. We hypothesize that the cost-effectiveness of strategies that include additional imaging may contradict current guidelines. A cost-effectiveness analysis was performed for a base-case 40-year-old, obtunded man with a negative computed tomography. Strategies compared included adjunct imaging with cervical magnetic resonance imaging (MRI), collar maintenance for 6 weeks, or removal. Data on the probability for long-term collar complications, spine injury, imaging costs, complications associated with MRI, acute and chronic care, and litigation were obtained from published and Medicare data. Outcomes were expressed as 2014 US dollars and quality-adjusted life-years. Collar removal was more effective and less costly than collar use or MRI (19.99 vs. 19.35 vs. 18.70 quality-adjusted life-years; $675,359 vs. $685,546 vs. $685,848) in the base-case analysis. When the probability of missed cervical injury was greater than 0.04 adjunct imaging with MRI dominated, however, collar removal remained cost-effective until the probability of missed injury exceeded 0.113 at which point collar removal exceeded the $50,000 threshold. Collar removal remained the most cost-effective approach until the probability of complications from collar use was reduced to less than 0.009, at which point collar maintenance became the most cost-effective strategy. Early collar removal dominates all strategies until the risk of complications from MRI positioning is reduced to 0.03 and remained cost-effective even when the probability of complication was reduced to 0. Early collar removal in obtunded adult blunt trauma patients appears to be the most effective and least costly strategy for cervical clearance based on the current literature available. Economic evaluation, level III; therapeutic study, level IV.

Adding a Time-Series Design Element to the Success Case Method to Improve Methodological Rigor: An Application for Nonprofit Program Evaluation

ERIC Educational Resources Information Center

Coryn, Chris L. S.; Schroter, Daniela C.; Hanssen, Carl E.

2009-01-01

Brinkerhoff's Success Case Method (SCM) was developed with the specific purpose of assessing the impact of organizational interventions (e.g., training and coaching) on business goals by analyzing extreme groups using case study techniques and storytelling. As an efficient and cost-effective method of evaluative inquiry, SCM is attractive in other…

Remote Manipulator

NASA Technical Reports Server (NTRS)

1986-01-01

SPAR Aerospace Limited's "Canadarm," Canada's contribution to the space shuttle. It is a crane which can operate as a 50 foot extension of an astronaut's arm. It can lift 65,000 pounds in space and retrieve satellites for repair, etc. Redesigned versions have energy and mining applications. Some of its hardware has been redeveloped for use as a Hydro manipulator in a nuclear reactor where it is expected to be extremely cost effective.

U. S. Energy Sector Vulnerabilities to Climate Change and Extreme Weather

DTIC Science & Technology

2013-07-01

required for enhanced oil recovery, hydraulic fracturing , and refining • Renewable energy resources, particularly hydropower, bioenergy, and...regarding risks, vulnerabilities, and opportunities to build climate-resilient energy systems • Effective coordination mechanisms with federal, state and...oil via hydraulic fracturing faced higher water costs or were denied access to water for 6 weeks or more in several states, including Kansas, Texas

Pharmacoeconomic Analysis of Pain Medications Used to Treat Adult Patients with Chronic Back Pain in the United States.

PubMed

Shah, Drishti; Anupindi, Vamshi Ruthwik; Vaidya, Varun

2016-12-01

Chronic back pain is an extremely common health problem. The largest category for pain therapy costs includes nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids. However, there has been limited evidence outlining their effectiveness in terms of quality of life for the treatment of chronic back pain. The authors performed a comparative pharmacoeconomic analysis of chronic back pain patients using NSAIDs versus those using opioids alone or combination opioid analgesics. This pharmacoeconomic evaluation was conducted using the Medical Expenditure Panel Survey (MEPS). Adults ≥18 years with chronic back pain diagnosis were included in the study. Individuals using opioids were matched in 1:1 ratio with those using only NSAIDs using propensity scores. All direct medical costs were included, and utility scores from Short Form 6D (SF-6D) were used to calculate QALYs (quality-adjusted life years). Monte Carlo probabilistic simulation technique was employed to determine the cost-effectiveness acceptability curve. After matching, there were 1109 patients in each cohort. The total mean annual cost was found to be $6137.41 for NSAIDs and $8982.28 for opioids. The mean utility gain for NSAIDs was found to be 0.661, whereas for opioids it was 0.633. Probabilistic sensitivity analysis showed that at all willingness-to-pay thresholds, the probability of NSAIDs being cost-effective was higher than the probability of the opioids being cost-effective. The authors found NSAIDs to be a dominant strategy as compared with opioids. Considering the higher cost associated with opioids/combination opioid analgesics, it might be cost-effective if they are used in patients who did not respond to the NSAIDs.

A timeline for predicting durable medical equipment needs and interventions for amyotrophic lateral sclerosis patients.

PubMed

Bromberg, Mark B; Brownell, Alexander A; Forshew, Dallas A; Swenson, Michael

2010-01-01

ALS is progressive with increasing patient needs for durable medical equipment (DME) and interventions (gastric feeding tube - PEG, and non-invasive ventilation - NIV). We performed a chart review of deceased patients to determine the time-course of needs and their estimated costs. A timeline of needs was based on when clinic personnel felt an item was necessary. The point in time when an item or intervention was needed was expressed as a percentage of a patient's total disease duration. A wide range of DME and interventions was needed irrespective of site of ALS symptom onset (bulbar, upper, lower extremity), beginning at 10% of disease duration of lower extremity onset and increasing thereafter for all sites. The cumulative probability of costs of items and interventions began at 25%-50% of disease duration and increased to between $18,000 and $32,000 (USD), highest for lower extremity onset due to the cost of wheelchairs. We conclude that a high percentage of ALS patients will need a full spectrum of major DME items and interventions during the second half of disease duration. This results in a linear rise in costs over the second half of the disease duration.

Synthesis of 6-Substituted-2,4-Diamino-5,6,7,8-Tetrahydropyrimido (4-5-d) Pyrimidines. Revised.

DTIC Science & Technology

1981-07-01

SUPPLEMENTARY NOTES IS. KEY WOROSIUXau on avere aide Inocoeay end Identity by block acemb.,) Tetrahydropyrimido (4,!:-d) pyrimidines Phenylethylamines ...not see continuation of further members of the original target compounds as cost effective . Because of extreme dif- ficulties and time-consuming...have shown significant activity are the 4-Cl (3), 3,4-C1 2 (3,4) and CF3 (5). Spacers such as the Y = -CH2- (6) were also reported to be effective

Extremely Cost‐Effective and Efficient Solar Vapor Generation under Nonconcentrated Illumination Using Thermally Isolated Black Paper

PubMed Central

Liu, Zhejun; Song, Haomin; Ji, Dengxin; Li, Chenyu; Cheney, Alec; Liu, Youhai; Zhang, Nan; Zeng, Xie; Chen, Borui; Gao, Jun; Li, Yuesheng; Liu, Xiang; Aga, Diana; Jiang, Suhua; Yu, Zongfu

2017-01-01

Passive solar vapor generation represents a promising and environmentally benign method of water purification/desalination. However, conventional solar steam generation techniques usually rely on costly and cumbersome optical concentration systems and have relatively low efficiency due to bulk heating of the entire liquid volume. Here, an efficient strategy using extremely low‐cost materials, i.e., carbon black (powder), hydrophilic porous paper, and expanded polystyrene foam is reported. Due to the excellent thermal insulation between the surface liquid and the bulk volume of the water and the suppressed radiative and convective losses from the absorber surface to the adjacent heated vapor, a record thermal efficiency of ≈88% is obtained under 1 sun without concentration, corresponding to the evaporation rate of 1.28 kg (m2 h)−1. When scaled up to a 100 cm2 array in a portable solar water still system and placed in an outdoor environment, the freshwater generation rate is 2.4 times of that of a leading commercial product. By simultaneously addressing both the need for high‐efficiency operation as well as production cost limitations, this system can provide an approach for individuals to purify water for personal needs, which is particularly suitable for undeveloped regions with limited/no access to electricity. PMID:28616256

Cost-Effectiveness Analysis of Second-Line Chemotherapy Agents for Advanced Gastric Cancer.

PubMed

Lam, Simon W; Wai, Maya; Lau, Jessica E; McNamara, Michael; Earl, Marc; Udeh, Belinda

2017-01-01

Gastric cancer is the fifth most common malignancy and second leading cause of cancer-related mortality. Chemotherapy options for patients who fail first-line treatment are limited. Thus the objective of this study was to assess the cost-effectiveness of second-line treatment options for patients with advanced or metastatic gastric cancer. Cost-effectiveness analysis using a Markov model to compare the cost-effectiveness of six possible second-line treatment options for patients with advanced gastric cancer who have failed previous chemotherapy: irinotecan, docetaxel, paclitaxel, ramucirumab, paclitaxel plus ramucirumab, and palliative care. The model was performed from a third-party payer's perspective to compare lifetime costs and health benefits associated with studied second-line therapies. Costs included only relevant direct medical costs. The model assumed chemotherapy cycle lengths of 30 days and a maximum number of 24 cycles. Systematic review of literature was performed to identify clinical data sources and utility and cost data. Quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated. The primary outcome measure for this analysis was the ICER between different therapies, where the incremental cost was divided by the number of QALYs saved. The ICER was compared with a willingness-to-pay (WTP) threshold that was set at $50,000/QALY gained, and an exploratory analysis using $160,000/QALY gained was also used. The model's robustness was tested by using 1-way sensitivity analyses and a 10,000 Monte Carlo simulation probabilistic sensitivity analysis (PSA). Irinotecan had the lowest lifetime cost and was associated with a QALY gain of 0.35 year. Docetaxel, ramucirumab alone, and palliative care were dominated strategies. Paclitaxel and the combination of paclitaxel plus ramucirumab led to higher QALYs gained, at an incremental cost of $86,815 and $1,056,125 per QALY gained, respectively. Based on our prespecified WTP threshold, our base case analysis demonstrated that irinotecan alone is the most cost-effective regimen, and both paclitaxel alone and the combination of paclitaxel and ramucirumab were not cost-effective (ICER more than $50,000). Both 1-way sensitivity analyses and PSA demonstrated the model's robustness. PSA illustrated that paclitaxel plus ramucirumab was extremely unlikely to be cost-effective at a WTP threshold less than $400,000/QALY gained. Irinotecan alone appears to be the most cost-effective second-line regimen for patients with gastric cancer. Paclitaxel may be cost-effective if the WTP threshold was set at $160,000/QALY gained. © 2016 Pharmacotherapy Publications, Inc.

Psychiatric Correlates of Medical Care Costs among Veterans Receiving Mental Health Care

ERIC Educational Resources Information Center

Simpson, Tracy L.; Moore, Sally A.; Luterek, Jane; Varra, Alethea A.; Hyerle, Lynne; Bush, Kristen; Mariano, Mary Jean; Liu, Chaun-Fen; Kivlahan, Daniel R.

2012-01-01

Research on increased medical care costs associated with posttraumatic sequelae has focused on posttraumatic stress disorder (PTSD). However, the provisional diagnosis of Disorders of Extreme Stress Not Otherwise Specified (DESNOS) encompasses broader trauma-related difficulties and may be uniquely related to medical costs. We investigated whether…

Hardness assurance testing and radiation hardening by design techniques for silicon-germanium heterojunction bipolar transistors and digital logic circuits

NASA Astrophysics Data System (ADS)

Sutton, Akil K.

Hydrocarbon exploration, global navigation satellite systems, computed tomography, and aircraft avionics are just a few examples of applications that require system operation at an ambient temperature, pressure, or radiation level outside the range covered by military specifications. The electronics employed in these applications are known as "extreme environment electronics." On account of the increased cost resulting from both process modifications and the use of exotic substrate materials, only a handful of semiconductor foundries have specialized in the production of extreme environment electronics. Protection of these electronic systems in an extreme environment may be attained by encapsulating sensitive circuits in a controlled environment, which provides isolation from the hostile ambient, often at a significant cost and performance penalty. In a significant departure from this traditional approach, system designers have begun to use commercial off-the-shelf technology platforms with built in mitigation techniques for extreme environment applications. Such an approach simultaneously leverages the state of the art in technology performance with significant savings in project cost. Silicon-germanium is one such commercial technology platform that demonstrates potential for deployment into extreme environment applications as a result of its excellent performance at cryogenic temperatures, remarkable tolerance to radiation-induced degradation, and monolithic integration with silicon-based manufacturing. In this dissertation the radiation response of silicon-germanium technology is investigated, and novel transistor-level layout-based techniques are implemented to improve the radiation tolerance of HBT digital logic.

Retrospective Review of Air Transportation Use for Upper Extremity Amputations at a Level-1 Trauma Center.

PubMed

Grantham, W Jeffrey; To, Philip; Watson, Jeffry T; Brywczynski, Jeremy; Lee, Donald H

2016-08-01

Air transportation to tertiary care centers of patients with upper extremity amputations has been utilized in hopes of reducing the time to potential replantation; however, this mode of transportation is expensive and not all patients will undergo replantation. The purpose of this study is to review the appropriateness and cost of air transportation in upper extremity amputations. Consecutive patients transported by aircraft with upper extremity amputations in a 7-year period at a level-1 trauma center were retrospectively reviewed. The distance traveled was recorded, along with the times of the injury, referral, transportation duration, arrival, and start of the operation. The results of the transfer were defined as replantation or revision amputation. Overall, 47 patients were identified with 43 patients going to the operating room, but only 14 patients (30%) undergoing replantation. Patients arrived at the tertiary hand surgery center with a mean time of 182.3 minutes following the injury, which includes 105.2 minutes of transportation time. The average distance traveled was 105.4 miles (range, 22-353 miles). The time before surgery of those who underwent replantation was 154.6 minutes. The average cost of transportation was $20,482. Air transportation for isolated upper extremity amputations is costly and is not usually the determining factor for replantation. The type of injury and patients' expectations often dictate the outcome, and these may be better determined at the time of referral with use of telecommunication photos, discussion with a hand surgeon, and patient counseling. III.

Optimal ventilatory patterns in periodic breathing.

PubMed

Ghazanshahi, S D; Khoo, M C

1993-01-01

The goal of this study was to determine whether periodic breathing (PB), which is highly prevalent during sleep at high altitudes, imposes physiological penalties on the respiratory system in the absence of any accompanying disease. Using a computer model of respiratory gas exchange, we compared the effects of a variety of PB patterns on the chemical and mechanical costs of breathing to those resulting from regular tidal breathing. Although PB produced considerable fluctuation in arterial blood gas tensions, for the same cycle-averaged ventilation, higher arterial oxygen saturation and lower arterial carbon dioxide levels were achieved. This result can be explained by the fact that the combination of large breaths and apnea in PB leads to a substantial reduction in dead space ventilation. At the same time, the savings in mechanical cost achieved by the respiratory muscles during apnea partially offset the increase during the breathing phase. Consequently, the "pressure cost," a criterion based on mean inspiratory pressure, was elevated only slightly, although the average work rate of breathing increased significantly. We found that, at extreme altitudes, PB patterns with clusters of 2 to 4 large breaths that alternate with apnea produce the highest arterial oxygenation levels and lowest pressure costs. The common occurrence of PB patterns with closely similar features has been reported in sleeping healthy sojourners at extreme altitudes. Taken together, these findings suggest that PB favors a reduction in the oxygen demands of the respiratory muscles and therefore may not be as detrimental as it is generally believed to be.

Cost-effectiveness analysis of additional bevacizumab to pemetrexed plus cisplatin for malignant pleural mesothelioma based on the MAPS trial.

PubMed

Zhan, Mei; Zheng, Hanrui; Xu, Ting; Yang, Yu; Li, Qiu

2017-08-01

Malignant pleural mesothelioma (MPM) is a rare malignancy, and pemetrexed/cisplatin (PC) is the gold standard first-line regime. This study evaluated the cost-effectiveness of the addition of bevacizumab to PC (with maintenance bevacizumab) for unresectable MPM based on a phase III trial that showed a survival benefit compared with chemotherapy alone. To estimate the incremental cost-effectiveness ratio (ICER) of the incorporation of bevacizumab, a Markov model based on the MAPS trial, including the disease states of progression-free survival, progressive disease and death, was used. Total costs were calculated from a Chinese payer perspective, and health outcomes were converted into quality-adjusted life year (QALY). Model robustness was explored in sensitivity analyses. The addition of bevacizumab to PC was estimated to increase the cost by $81446.69, with a gain of 0.112 QALYs, resulting in an ICER of $727202.589 per QALY. In both one-way sensitivity and probabilistic sensitivity analyses, the ICER exceeded the commonly accepted willingness-to-pay threshold of 3 times the gross domestic product per capita of China ($23970.00 per QALY). The cost of bevacizumab had the most important impact on the ICER. The combination of bevacizumab with PC chemotherapy is not a cost-effective treatment option for MPM in China. Given its positive clinical value and extremely low incidence of MPM, an appropriate price discount, assistance programs and medical insurance should be considered to make bevacizumab more affordable for this rare patient population. Copyright © 2017 Elsevier B.V. All rights reserved.

Cost Scaling of a Real-World Exhaust Waste Heat Recovery Thermoelectric Generator: A Deeper Dive

NASA Astrophysics Data System (ADS)

Hendricks, Terry J.; Yee, Shannon; LeBlanc, Saniya

2016-03-01

Cost is equally important to power density or efficiency for the adoption of waste heat recovery thermoelectric generators (TEG) in many transportation and industrial energy recovery applications. In many cases, the system design that minimizes cost (e.g., the /W value) can be very different than the design that maximizes the system's efficiency or power density, and it is important to understand the relationship between those designs to optimize TEG performance-cost compromises. Expanding on recent cost analysis work and using more detailed system modeling, an enhanced cost scaling analysis of a waste heat recovery TEG with more detailed, coupled treatment of the heat exchangers has been performed. In this analysis, the effect of the heat lost to the environment and updated relationships between the hot-side and cold-side conductances that maximize power output are considered. This coupled thermal and thermoelectric (TE) treatment of the exhaust waste heat recovery TEG yields modified cost scaling and design optimization equations, which are now strongly dependent on the heat leakage fraction, exhaust mass flow rate, and heat exchanger effectiveness. This work shows that heat exchanger costs most often dominate the overall TE system costs, that it is extremely difficult to escape this regime, and in order to achieve TE system costs of 1/W it is necessary to achieve heat exchanger costs of 1/(W/K). Minimum TE system costs per watt generally coincide with maximum power points, but preferred TE design regimes are identified where there is little cost penalty for moving into regions of higher efficiency and slightly lower power outputs. These regimes are closely tied to previously identified low cost design regimes. This work shows that the optimum fill factor F opt minimizing system costs decreases as heat losses increase, and increases as exhaust mass flow rate and heat exchanger effectiveness increase. These findings have profound implications on the design and operation of various TE waste heat recovery systems. This work highlights the importance of heat exchanger costs on the overall TEG system costs, quantifies the possible TEG performance-cost domain space based on heat exchanger effects, and provides a focus for future system research and development efforts.

Does cost-effectiveness of influenza vaccine choice vary across the U.S.? An agent-based modeling study.

PubMed

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

2017-07-13

In a prior agent-based modeling study, offering a choice of influenza vaccine type was shown to be cost-effective when the simulated population represented the large, Washington DC metropolitan area. This study calculated the public health impact and cost-effectiveness of the same four strategies: No Choice, Pediatric Choice, Adult Choice, or Choice for Both Age Groups in five United States (U.S.) counties selected to represent extremes in population age distribution. The choice offered was either inactivated influenza vaccine delivered intramuscularly with a needle (IIV-IM) or an age-appropriate needle-sparing vaccine, specifically, the nasal spray (LAIV) or intradermal (IIV-ID) delivery system. Using agent-based modeling, individuals were simulated as they interacted with others, and influenza was tracked as it spread through each population. Influenza vaccination coverage derived from Centers for Disease Control and Prevention (CDC) data, was increased by 6.5% (range 3.25%-11.25%) to reflect the effects of vaccine choice. Assuming moderate influenza infectivity, the number of averted cases was highest for the Choice for Both Age Groups in all five counties despite differing demographic profiles. In a cost-effectiveness analysis, Choice for Both Age Groups was the dominant strategy. Sensitivity analyses varying influenza infectivity, costs, and degrees of vaccine coverage increase due to choice, supported the base case findings. Offering a choice to receive a needle-sparing influenza vaccine has the potential to significantly reduce influenza disease burden and to be cost saving. Consistent findings across diverse populations confirmed these findings. Copyright © 2017 Elsevier Ltd. All rights reserved.

Improvements to information management systems simulator

NASA Technical Reports Server (NTRS)

Bilek, R. W.

1972-01-01

The performance of personnel in the augmentation and improvement of the interactive IMSIM information management simulation model is summarized. With this augmented model, NASA now has even greater capabilities for the simulation of computer system configurations, data processing loads imposed on these configurations, and executive software to control system operations. Through these simulations, NASA has an extremely cost effective capability for the design and analysis of computer-based data management systems.

Cost-effectiveness of population based BRCA testing with varying Ashkenazi Jewish ancestry.

PubMed

Manchanda, Ranjit; Patel, Shreeya; Antoniou, Antonis C; Levy-Lahad, Ephrat; Turnbull, Clare; Evans, D Gareth; Hopper, John L; Macinnis, Robert J; Menon, Usha; Jacobs, Ian; Legood, Rosa

2017-11-01

Population-based BRCA1/BRCA2 testing has been found to be cost-effective compared with family history-based testing in Ashkenazi-Jewish women were >30 years old with 4 Ashkenazi-Jewish grandparents. However, individuals may have 1, 2, or 3 Ashkenazi-Jewish grandparents, and cost-effectiveness data are lacking at these lower BRCA prevalence estimates. We present an updated cost-effectiveness analysis of population BRCA1/BRCA2 testing for women with 1, 2, and 3 Ashkenazi-Jewish grandparents. Decision analysis model. Lifetime costs and effects of population and family history-based testing were compared with the use of a decision analysis model. 56% BRCA carriers are missed by family history criteria alone. Analyses were conducted for United Kingdom and United States populations. Model parameters were obtained from the Genetic Cancer Prediction through Population Screening trial and published literature. Model parameters and BRCA population prevalence for individuals with 3, 2, or 1 Ashkenazi-Jewish grandparent were adjusted for the relative frequency of BRCA mutations in the Ashkenazi-Jewish and general populations. Incremental cost-effectiveness ratios were calculated for all Ashkenazi-Jewish grandparent scenarios. Costs, along with outcomes, were discounted at 3.5%. The time horizon of the analysis is "life-time," and perspective is "payer." Probabilistic sensitivity analysis evaluated model uncertainty. Population testing for BRCA mutations is cost-saving in Ashkenazi-Jewish women with 2, 3, or 4 grandparents (22-33 days life-gained) in the United Kingdom and 1, 2, 3, or 4 grandparents (12-26 days life-gained) in the United States populations, respectively. It is also extremely cost-effective in women in the United Kingdom with just 1 Ashkenazi-Jewish grandparent with an incremental cost-effectiveness ratio of £863 per quality-adjusted life-years and 15 days life gained. Results show that population-testing remains cost-effective at the £20,000-30000 per quality-adjusted life-years and $100,000 per quality-adjusted life-years willingness-to-pay thresholds for all 4 Ashkenazi-Jewish grandparent scenarios, with ≥95% simulations found to be cost-effective on probabilistic sensitivity analysis. Population-testing remains cost-effective in the absence of reduction in breast cancer risk from oophorectomy and at lower risk-reducing mastectomy (13%) or risk-reducing salpingo-oophorectomy (20%) rates. Population testing for BRCA mutations with varying levels of Ashkenazi-Jewish ancestry is cost-effective in the United Kingdom and the United States. These results support population testing in Ashkenazi-Jewish women with 1-4 Ashkenazi-Jewish grandparent ancestry. Copyright © 2017 Elsevier Inc. All rights reserved.

Cost-effectiveness analysis of a voucher scheme combined with obstetrical quality improvements: quasi experimental results from Uganda.

PubMed

Alfonso, Y Natalia; Bishai, David; Bua, John; Mutebi, Aloysius; Mayora, Crispus; Ekirapa-Kiracho, Elizabeth

2015-02-01

The maternal mortality ratio (MMR) in Uganda has declined significantly during the last 20 years, but Uganda is not on track to reach the millennium development goal of reducing MMR by 75% by 2015. More evidence on the cost-effectiveness of supply- and demand-side financing programs to reduce maternal mortality could inform future strategies. This study analyses the cost-effectiveness of a voucher scheme (VS) combined with health system strengthening in rural Uganda against the status quo. The VS, implemented in 2010, provided vouchers for delivery services at public and private health facilities (HF), as well as round-trip transportation provided by private sector workers (bicycles or motorcycles generally). The VS was part of a quasi-experimental non-randomized control trial. Improvements in institutional delivery coverage (IDC) rates can be estimated using a difference-in-difference impact evaluation method and the number of maternal lives saved is modelled using the evidence-based Lives Saved Tool. Costs were estimated from primary and secondary data. Results show that the demand for births at HFs enrolled in the VS increased by 52.3 percentage points. Out of this value, conservative estimates indicate that at least 9.4 percentage points are new HF users. This 9.4% bump in IDC implies 20 deaths averted, which is equivalent to 1356 disability-adjusted-life years (DALYs) averted. Cost-effectiveness analysis comparing the status quo and VS's most conservative effectiveness estimates shows that the VS had an incremental cost-effectiveness ratio per DALY averted of US$302 and per death averted of US$20 756. Although there are limitations in the data measures, a favourable cost-effectiveness ratio persists even under extreme assumptions. Demand-side vouchers combined with supply-side financing programs can increase attended deliveries and reduce maternal mortality at a cost that is acceptable. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

Electronics for Extreme Environments

NASA Astrophysics Data System (ADS)

Patel, J. U.; Cressler, J.; Li, Y.; Niu, G.

2001-01-01

Most of the NASA missions involve extreme environments comprising radiation and low or high temperatures. Current practice of providing friendly ambient operating environment to electronics costs considerable power and mass (for shielding). Immediate missions such as the Europa orbiter and lander and Mars landers require the electronics to perform reliably in extreme conditions during the most critical part of the mission. Some other missions planned in the future also involve substantial surface activity in terms of measurements, sample collection, penetration through ice and crust and the analysis of samples. Thus it is extremely critical to develop electronics that could reliably operate under extreme space environments. Silicon On Insulator (SOI) technology is an extremely attractive candidate for NASA's future low power and high speed electronic systems because it offers increased transconductance, decreased sub-threshold slope, reduced short channel effects, elimination of kink effect, enhanced low field mobility, and immunity from radiation induced latch-up. A common belief that semiconductor devices function better at low temperatures is generally true for bulk devices but it does not hold true for deep sub-micron SOI CMOS devices with microscopic device features of 0.25 micrometers and smaller. Various temperature sensitive device parameters and device characteristics have recently been reported in the literature. Behavior of state of the art technology devices under such conditions needs to be evaluated in order to determine possible modifications in the device design for better performance and survivability under extreme environments. Here, we present a unique approach of developing electronics for extreme environments to benefit future NASA missions as described above. This will also benefit other long transit/life time missions such as the solar sail and planetary outposts in which electronics is out open in the unshielded space at the ambient space temperatures and always exposed to radiation. Additional information is contained in the original extended abstract.

Exercise and the microbiota

PubMed Central

O’Sullivan, Orla; Cronin, Owen; Clarke, Siobhan F; Murphy, Eileen F; Molloy, Micheal G; Shanahan, Fergus; Cotter, Paul D

2015-01-01

Sedentary lifestyle is linked with poor health, most commonly obesity and associated disorders, the corollary being that exercise offers a preventive strategy. However, the scope of exercise biology extends well beyond energy expenditure and has emerged as a great ‘polypill’, which is safe, reliable and cost-effective not only in disease prevention but also treatment. Biological mechanisms by which exercise influences homeostasis are becoming clearer and involve multi-organ systemic adaptations. Most of the elements of a modern lifestyle influence the indigenous microbiota but few studies have explored the effect of increased physical activity. While dietary responses to exercise obscure the influence of exercise alone on gut microbiota, professional athletes operating at the extremes of performance provide informative data. We assessed the relationship between extreme levels of exercise, associated dietary habits and gut microbiota composition, and discuss potential mechanisms by which exercise may exert a direct or indirect influence on gut microbiota. PMID:25800089

Tales from the Paleoclimate Underground: Lessons Learned from Reconstructing Extreme Events

NASA Astrophysics Data System (ADS)

Frappier, A. E.

2017-12-01

Tracing patterns of paleoclimate extremes over the past two millennia is becoming ever more important in the effort to understand and predict costly weather hazards and their varied societal impacts. I present three paleoclimate vignettes from the past ten years of different paleotempestology projects I have worked on closely, illustrating our collective challenges and productive pathways in reconstructing rainfall extremes: temporal, spatial, and combining information from disparate proxies. Finally, I aim to share new results from modeling multiple extremes and hazards in Yucatan, a climate change hotspot.

Cost-effective accurate coarse-grid method for highly convective multidimensional unsteady flows

NASA Technical Reports Server (NTRS)

Leonard, B. P.; Niknafs, H. S.

1991-01-01

A fundamentally multidimensional convection scheme is described based on vector transient interpolation modeling rewritten in conservative control-volume form. Vector third-order upwinding is used as the basis of the algorithm; this automatically introduces important cross-difference terms that are absent from schemes using component-wise one-dimensional formulas. Third-order phase accuracy is good; this is important for coarse-grid large-eddy or full simulation. Potential overshoots or undershoots are avoided by using a recently developed universal limiter. Higher order accuracy is obtained locally, where needed, by the cost-effective strategy of adaptive stencil expansion in a direction normal to each control-volume face; this is controlled by monitoring the absolute normal gradient and curvature across the face. Higher (than third) order cross-terms do not appear to be needed. Since the wider stencil is used only in isolated narrow regions (near discontinuities), extremely high (in this case, seventh) order accuracy can be achieved for little more than the cost of a globally third-order scheme.

Challenging official health cost estimates: an alternative view that incorporates the behavioural and economic effects of policy changes.

PubMed

Robbins, A; Robbins, G

1992-01-01

Cost estimates of health care policy changes are extremely important. Historically, however, the US government has done a poor job in projecting the actual cost of new health care programmes. These projections have been inaccurate primarily because government forecasters use 'static' methods that fail to incorporate the change in people's behaviour as a direct result of a new policy. In contrast, 'dynamic' forecasts incorporate the behavioural effects of policy changes on individuals and the economy. Static and dynamic estimates can lead to different results for 4 areas of US health policy: (a) the Medicare Catastrophic Coverage Act; (b) mandated health benefits; (c) health insurance tax subsidies; and (d) national health insurance. Improving health care policy requires the adoption of dynamic estimation practices, periodic appraisals evaluating the accuracy of official estimates in relation to actual experience, and clear presentation of proposed policy changes and estimates to policymakers and the general public.

Cost of space-based laser ballistic missile defense.

PubMed

Field, G; Spergel, D

1986-03-21

Orbiting platforms carrying infrared lasers have been proposed as weapons forming the first tier of a ballistic missile defense system under the President's Strategic Defense Initiative. As each laser platform can destroy a limited number of missiles, one of several methods of countering such a system is to increase the number of offensive missiles. Hence it is important to know whether the cost-exchange ratio, defined as the ratio of the cost to the defense of destroying a missile to the cost to the offense of deploying an additional missile, is greater or less than 1. Although the technology to be used in a ballistic missile defense system is still extremely uncertain, it is useful to examine methods for calculating the cost-exchange ratio. As an example, the cost of an orbiting infrared laser ballistic missile defense system employed against intercontinental ballistic missiles launched simultaneously from a small area is compared to the cost of additional offensive missiles. If one adopts lower limits to the costs for the defense and upper limits to the costs for the offense, the cost-exchange ratio comes out substantially greater than 1. If these estimates are confirmed, such a ballistic missile defense system would be unable to maintain its effectiveness at less cost than it would take to proliferate the ballistic missiles necessary to overcome it and would therefore not satisfy the President's requirements for an effective strategic defense. Although the method is illustrated by applying it to a space-based infrared laser system, it should be straightforward to apply it to other proposed systems.

Cost of space-based laser ballistic missile defense

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

Field, G.; Spergel, D.

1986-03-21

Orbiting platforms carrying infrared lasers have been proposed as weapons forming the first tier of a ballistic missile defense system under the President's Strategic Defense Initiative. As each laser platform can destroy a limited number of missiles, one of several methods of countering such a system is to increase the number of offensive missiles. Hence it is important to know whether the cost-exchange ratio, defined as the ratio of the cost to the defense of destroying a missile to the cost to the offense of deploying an additional missile, is greater or less than 1. Although the technology to bemore » used in a ballistic missile defense system is still extremely uncertain, it is useful to examine methods for calculating the cost-exchange ration. As an example, the cost of an orbiting infrared laser ballistic missile defense system employed against intercontinental ballistic missiles launched simultaneously from a small area is compared to the cost of additional offensive missiles. If one adopts lower limits to the costs for the defense and upper limits to the costs for the offense, the cost-exchange ratio comes out substantially greater than 1. If these estimates are confirmed, such a ballistic missile defense system would be unable to maintain its effectiveness at less cost than it would take to proliferate the ballistic missiles necessary to overcome it and would therefore not satisfy the President's requirements for an effective strategic defense. Although the method is illustrated by applying it to a space-based infrared laser system, it should be straightforward to apply it to other proposed systems. 28 references, 2 tables.« less

Advanced electric propulsion system concept for electric vehicles. Addendum 1: Voltage considerations

NASA Technical Reports Server (NTRS)

Raynard, A. E.; Forbes, F. E.

1980-01-01

The two electric vehicle propulsion systems that best met cost and performance goals were examined to assess the effect of battery pack voltage on system performance and cost. A voltage range of 54 to 540 V was considered for a typical battery pack capacity of 24 k W-hr. The highest battery specific energy (W-hr/kg) and the lowest cost ($/kW-hr) were obtained at the minimum voltage level. The flywheel system traction motor is a dc, mechanically commutated with shunt field control, and due to the flywheel the traction motor and the battery are not subject to extreme peaks of power demand. The basic system uses a permanent-magnet motor with electronic commutation supplied by an ac power control unit. In both systems battery cost were the major factor in system voltage selection, and a battery pack with the minimum voltage of 54 V produced the lowest life-cycle cost. The minimum life-cycle cost for the basic system with lead-acid batteries was $0.057/km and for the flywheel system was $0.037/km.

Claims incidence of work-related disorders of the upper extremities: Washington state, 1987 through 1995.

PubMed

Silverstein, B; Welp, E; Nelson, N; Kalat, J

1998-12-01

This study examined the claim incidence rate, cost, and industry distribution of work-related upper extremity disorders in Washington. Washington State Fund workers' compensation claims from 1987 to 1995 were abstracted and categorized into general and specific disorders of gradual or sudden onset. Accepted claims included 100,449 for hand/wrist disorders (incidence rate: 98.2/10,000 full-time equivalents; carpal tunnel syndrome rate: 27.3), 30,468 for elbow disorders (incidence rate: 29.7; epicondylitis rate: 11.7), and 55,315 for shoulder disorders (incidence rate: 54.0; rotator cuff syndrome rate: 19.9). Average direct workers' compensation claims costs (medical treatment and indemnity) were $15,790 (median: $6774) for rotator cuff syndrome, $12,794 for carpal tunnel syndrome (median: $4190), and $6593 for epicondylitis (median: $534). Construction and food processing were among the industries with the highest rate ratios for all disorders (> 4.0). Upper extremity disorders represent a large and costly problem in Washington State industry. Industries characterized by manual handling and repetitive work have high rate ratios. The contingent workforce appears to be at high risk.

Design, implementation and migration of security systems as an extreme project.

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

Scharmer, Carol; Trujillo, David

2010-08-01

Decision Trees, algorithms, software code, risk management, reports, plans, drawings, change control, presentations, and analysis - all useful tools and efforts but time consuming, resource intensive, and potentially costly for projects that have absolute schedule and budget constraints. What are necessary and prudent efforts when a customer calls with a major security problem that needs to be fixed with a proven, off-the-approval-list, multi-layered integrated system with high visibility and limited funding and expires at the end of the Fiscal Year? Whether driven by budget cycles, safety, or by management decree, many such projects begin with generic scopes and funding allocatedmore » based on a rapid management 'guestimate.' Then a Project Manager (PM) is assigned a project with a predefined and potentially limited scope, compressed schedule, and potentially insufficient funding. The PM is tasked to rapidly and cost effectively coordinate a requirements-based design, implementation, test, and turnover of a fully operational system to the customer, all while the customer is operating and maintaining an existing security system. Many project management manuals call this an impossible project that should not be attempted. However, security is serious business and the reality is that rapid deployment of proven systems via an 'Extreme Project' is sometimes necessary. Extreme Projects can be wildly successful but require a dedicated team of security professionals lead by an experienced project manager using a highly-tailored and agile project management process with management support at all levels, all combined with significant interface with the customer. This paper does not advocate such projects or condone eliminating the valuable analysis and project management techniques. Indeed, having worked on a well-planned project provides the basis for experienced team members to complete Extreme Projects. This paper does, however, provide insight into what it takes for projects to be successfully implemented and accepted when completed under extreme conditions.« less

Design implementation and migration of security systems as an extreme project.

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

Scharmer, Carol

2010-10-01

Decision Trees, algorithms, software code, risk management, reports, plans, drawings, change control, presentations, and analysis - all useful tools and efforts but time consuming, resource intensive, and potentially costly for projects that have absolute schedule and budget constraints. What are necessary and prudent efforts when a customer calls with a major security problem that needs to be fixed with a proven, off-the-approval-list, multi-layered integrated system with high visibility and limited funding and expires at the end of the Fiscal Year? Whether driven by budget cycles, safety, or by management decree, many such projects begin with generic scopes and funding allocatedmore » based on a rapid management 'guestimate.' Then a Project Manager (PM) is assigned a project with a predefined and potentially limited scope, compressed schedule, and potentially insufficient funding. The PM is tasked to rapidly and cost effectively coordinate a requirements-based design, implementation, test, and turnover of a fully operational system to the customer, all while the customer is operating and maintaining an existing security system. Many project management manuals call this an impossible project that should not be attempted. However, security is serious business and the reality is that rapid deployment of proven systems via an 'Extreme Project' is sometimes necessary. Extreme Projects can be wildly successful but require a dedicated team of security professionals lead by an experienced project manager using a highly-tailored and agile project management process with management support at all levels, all combined with significant interface with the customer. This paper does not advocate such projects or condone eliminating the valuable analysis and project management techniques. Indeed, having worked on a well-planned project provides the basis for experienced team members to complete Extreme Projects. This paper does, however, provide insight into what it takes for projects to be successfully implemented and accepted when completed under extreme conditions.« less

Rugged, Low Cost, Environmental Sensors for a Turbulent World

NASA Astrophysics Data System (ADS)

Schulz, B.; Sandell, C. T.; Wickert, A. D.

2017-12-01

Ongoing scientific research and resource management require a diverse range of high-quality and low-cost sensors to maximize the number and type of measurements that can be obtained. To accomplish this, we have developed a series of diversified sensors for common environmental applications. The TP-DownHole is an ultra-compact temperature and pressure sensor designed for use in CMT (Continuous Multi-channel Tubing) multi-level wells. Its 1 mm water depth resolution, 30 cm altitude resolution, and rugged design make it ideal for both water level measurements and monitoring barometric pressure and associated temperature changes. The TP-DownHole sensor has also been incorporated into a self-contained, fully independent data recorder for extreme and remote environments. This device (the TP-Solo) is based around the TP-DownHole design, but has self-contained power and data storage and is designed to collect data independently for up to 6 months (logging at once an hour), creating a specialized tool for extreme environment data collection. To gather spectral information, we have also developed a very low cost photodiode-based Lux sensor to measure spectral irradiance; while this does not measure the entire solar radiation spectrum, simple modeling to rescale the remainder of the solar spectrum makes this a cost-effective alternative to a thermopile pyranometer. Lastly, we have developed an instrumentation amplifier which is designed to interface a wide range of sensitive instruments to common data logging systems, such as thermopile pyranometers, thermocouples, and many other analog output sensors. These three instruments are the first in a diverse family aimed to give researchers a set of powerful and low-cost tools for environmental instrumentation.

Characterizing Injury among Battlefield Airmen

DTIC Science & Technology

2014-08-01

Lower Extremities Ankle , foot 629 11.46 595 11.37 Knee, lower leg 1,141 20.79 1,188 22.71 Pelvis, hips, thighs...proportion of shoulder injuries than the other BA career fields, but a higher proportion of ankle and foot injuries. For total cost per incident injury...Total, Upper Extremities 277 21.83 233 23.14 33 17.37 626 20.71 Lower Extremities Ankle , foot 138 10.90 104 10.30 34

Hospital markup and operation outcomes in the United States.

PubMed

Gani, Faiz; Ejaz, Aslam; Makary, Martin A; Pawlik, Timothy M

2016-07-01

Although the price hospitals charge for operations has broad financial implications, hospital pricing is not subject to regulation. We sought to characterize national variation in hospital price markup for major cardiothoracic and gastrointestinal operations and to evaluate perioperative outcomes of hospitals relative to hospital price markup. All hospitals in which a patient underwent a cardiothoracic or gastrointestinal procedure were identified using the Nationwide Inpatient Sample for 2012. Markup ratios (ratio of charges to costs) for the total cost of hospitalization were compared across hospitals. Risk-adjusted morbidity, failure-to-rescue, and mortality were calculated using multivariable, hierarchical logistic regression. Among the 3,498 hospitals identified, markup ratios ranged from 0.5-12.2, with a median markup ratio of 2.8 (interquartile range 2.7-3.9). For the 888 hospitals with extreme markup (greatest markup ratio quartile: markup ratio >3.9), the median markup ratio was 4.9 (interquartile range 4.3-6.0), with 10% of these hospitals billing more than 7 times the Medicare-allowable costs (markup ratio ≥7.25). Extreme markup hospitals were more often large (46.3% vs 33.8%, P < .001), urban, nonteaching centers (57.0% vs 37.9%, P < .001), and located in the Southern (46.4% vs 32.8%, P < .001) or Western (27.8% vs 17.6%, P < .001) regions of the United States. Of the 639 investor-owned, for-profit hospitals, 401 hospitals (62.8%) had an extreme markup ratio compared with 19.3% (n = 452) and 6.8% (n = 35) of nonprofit and government hospitals, respectively. Perioperative morbidity (32.7% vs 26.4%, P < .001) was greater at extreme markup hospitals. There is wide variation in hospital markup for cardiothoracic and gastrointestinal procedures, with approximately a quarter of hospital charges being 4 times greater than the actual cost of hospitalization. Hospitals with an extreme markup had greater perioperative morbidity. Copyright © 2016 Elsevier Inc. All rights reserved.

Promoting Healthy Outcomes Among Youth with Multiple Risks: Innovative Approaches

PubMed Central

Greenberg, Mark T.; Lippold, Melissa A.

2015-01-01

Adolescent behavior problems such as substance use, antisocial behavior problems, and mental health problems have extremely high social costs and lead to overburdened mental health and juvenile justice systems in the United States and Europe. The prevalence of these problems is substantial, and at-risk youth often present with a combination of concerns. An understanding of risk and protective factors at multiple levels, including the child, family, peer, school, and community, has influenced intervention development. At the individual and family levels, the most effective and cost-effective programs work intensively with youth and their families or use individual and group cognitive-behavioral approaches. However, there is a paucity of careful studies of effective policies and programs in the juvenile justice system. Research is needed that focuses on adoption, financing, implementation, and sustainable use of evidence-based programs in public service systems. In addition, the field needs to understand better for whom current programs are most effective to create the next generation of more effective and efficient programs. PMID:23297659

Improving the performance of extreme learning machine for hyperspectral image classification

NASA Astrophysics Data System (ADS)

Li, Jiaojiao; Du, Qian; Li, Wei; Li, Yunsong

2015-05-01

Extreme learning machine (ELM) and kernel ELM (KELM) can offer comparable performance as the standard powerful classifier―support vector machine (SVM), but with much lower computational cost due to extremely simple training step. However, their performance may be sensitive to several parameters, such as the number of hidden neurons. An empirical linear relationship between the number of training samples and the number of hidden neurons is proposed. Such a relationship can be easily estimated with two small training sets and extended to large training sets so as to greatly reduce computational cost. Other parameters, such as the steepness parameter in the sigmodal activation function and regularization parameter in the KELM, are also investigated. The experimental results show that classification performance is sensitive to these parameters; fortunately, simple selections will result in suboptimal performance.

Orchid sexual deceit provokes ejaculation.

PubMed

Gaskett, A C; Winnick, C G; Herberstein, M E

2008-06-01

Sexually deceptive orchids lure pollinators by mimicking female insects. Male insects fooled into gripping or copulating with orchids unwittingly transfer the pollinia. The effect of deception on pollinators has been considered negligible, but we show that pollinators may suffer considerable costs. Insects pollinating Australian tongue orchids (Cryptostylis species) frequently ejaculate and waste copious sperm. The costs of sperm wastage could select for pollinator avoidance of orchids, thereby driving and maintaining sexual deception via antagonistic coevolution or an arms race between pollinator learning and escalating orchid mimicry. However, we also show that orchid species provoking such extreme pollinator behavior have the highest pollination success. How can deception persist, given the costs to pollinators? Sexually-deceptive-orchid pollinators are almost exclusively solitary and haplodiploid species. Therefore, female insects deprived of matings by orchid deception could still produce male offspring, which may even enhance orchid pollination.

An improved protocol for the preparation of total genomic DNA from isolates of yeast and mould using Whatman FTA filter papers.

PubMed

Borman, Andrew M; Fraser, Mark; Linton, Christopher J; Palmer, Michael D; Johnson, Elizabeth M

2010-06-01

Here, we present a significantly improved version of our previously published method for the extraction of fungal genomic DNA from pure cultures using Whatman FTA filter paper matrix technology. This modified protocol is extremely rapid, significantly more cost effective than our original method, and importantly, substantially reduces the problem of potential cross-contamination between sequential filters when employing FTA technology.

A facile and cost-effective TEM grid approach to design gold nano-structured substrates for high throughput plasmonic sensitive detection of biomolecules.

PubMed

Jia, Kun; Bijeon, Jean Louis; Adam, Pierre Michel; Ionescu, Rodica Elena

2013-02-21

A commercial TEM grid was used as a mask for the creation of extremely well-organized gold micro-/nano-structures on a glass substrate via a high temperature annealing process at 500 °C. The structured substrate was (bio)functionalized and used for the high throughput LSPR immunosensing of different concentrations of a model protein named bovine serum albumin.

Fumigation success for California facility.

PubMed

Hacker, Robert

2010-02-01

As Robert Hacker, at the time director of facilities management at the St John's Regional Medical Center in Oxnard, California, explains, the hospital, one of the area's largest, recently successfully utilised a new technology to eliminate mould, selecting a cost and time-saving fumigation process in place of the traditional "rip and tear" method. Although hospital managers knew the technology had been used extremely effectively in other US buildings, this was reportedly among the first ever healthcare applications.

Cost Comparison of Early Intensive Behavioral Intervention and Special Education for Children with Autism

ERIC Educational Resources Information Center

Chasson, Gregory S.; Harris, Gerald E.; Neely, Wendy J.

2007-01-01

The financial implications of the increased prevalence of autism, though rarely discussed, will be extremely important to society. We compared the costs associated with 18 years of special education to the costs associated with the implementation of an average of 3 years of Discrete Trial Training as an Early Intensive Behavioral Intervention…

Vaccine stabilization: research, commercialization, and potential impact.

PubMed

Kristensen, Debra; Chen, Dexiang; Cummings, Ray

2011-09-22

All vaccines are susceptible to damage by elevated temperatures and many are also damaged by freezing. The distribution, storage, and use of vaccines therefore present challenges that could be reduced by enhanced thermostability, with resulting improvements in vaccine effectiveness. Formulation and processing technologies exist that can improve the stability of vaccines at temperature extremes, however, customization is required for individual vaccines and results are variable. Considerations affecting decisions about stabilization approaches include development cost, manufacturing cost, and the ease of use of the final product. Public sector agencies can incentivize vaccine developers to prioritize stabilization efforts through advocacy and by implementing policies that increase demand for thermostable vaccines. Copyright © 2011 Elsevier Ltd. All rights reserved.

De novo assembly of human genomes with massively parallel short read sequencing.

PubMed

Li, Ruiqiang; Zhu, Hongmei; Ruan, Jue; Qian, Wubin; Fang, Xiaodong; Shi, Zhongbin; Li, Yingrui; Li, Shengting; Shan, Gao; Kristiansen, Karsten; Li, Songgang; Yang, Huanming; Wang, Jian; Wang, Jun

2010-02-01

Next-generation massively parallel DNA sequencing technologies provide ultrahigh throughput at a substantially lower unit data cost; however, the data are very short read length sequences, making de novo assembly extremely challenging. Here, we describe a novel method for de novo assembly of large genomes from short read sequences. We successfully assembled both the Asian and African human genome sequences, achieving an N50 contig size of 7.4 and 5.9 kilobases (kb) and scaffold of 446.3 and 61.9 kb, respectively. The development of this de novo short read assembly method creates new opportunities for building reference sequences and carrying out accurate analyses of unexplored genomes in a cost-effective way.

Geology and land use

USGS Publications Warehouse

Brown, R.D.

1990-01-01

The geologic limitations for building sites of some areas can be overcome, in part, by skilled engineering and expensive construction practices. But the costs can be prohibitively high, and the solutions are not always completely effective. In "earthquake country," history has shown that costs are highest and risk factors most uncertain in a few easily recognized settings: unstable hill sloped, land at the edge of rapidly eroding sea cliffs, lowlands underlain by saturated estuarine mud of ill, and areas near faults capable of producing magnitude 7 or greater earthquakes. Safety immediately after an earthquake is also a concern in these places, for extreme damage and ground distortion may impede or prevent timely access by emergency equipment. 

The magic of 4X mask reduction

NASA Astrophysics Data System (ADS)

Lercel, Michael

2006-06-01

Although changing the mask reduction factor from 4X to a larger value offers several technical advantages, previous attempts to enact this change have not identified enough clear technical advantages to overcome the impact to productivity. Improvements in mask manufacturing, mask polarization effects, and optics cost have not been thought to be sufficient reason to accept a reduced throughput and field size. This paper summarizes the latest workshop and discussion revisiting the mask reduction factor for 32nm half-pitch lithography with hyper-numerical aperture (NA) optical or extreme ultraviolet lithography (EUVL). The workshop consensus was strongly in favor of maintaining the current magnification ratio and field size as long as mask costs can be contained.

Vial OrganicTM-Organic Chemistry Labs for High School and Junior College

NASA Astrophysics Data System (ADS)

Russo, Thomas J.; Meszaros, Mark

1999-01-01

Vial Organic is the most economical, safe, and time-effective method of performing organic chemistry experiments. Activities are carried out in low-cost, sealed vials. Vial Organic is extremely safe because only micro quantities of reactants are used, reactants are contained in tightly sealed vials, and only water baths are used for temperature control. Vial Organic laboratory activities are easily performed within one 50-minute class period. When heat is required, a simple hot-water bath is prepared from a beaker of water and an inexpensive immersion heater. The low cost, ease of use, and relatively short time requirement will allow organic chemistry to be experienced by more students with less confusion and intimidation.

Pushing precipitation to the extremes in distributed experiments: Recommendations for simulating wet and dry years

USGS Publications Warehouse

Knapp, Alan K.; Avolio, Meghan L.; Beier, Claus; Carroll, Charles J.W.; Collins, Scott L.; Dukes, Jeffrey S.; Fraser, Lauchlan H.; Griffin-Nolan, Robert J.; Hoover, David L.; Jentsch, Anke; Loik, Michael E.; Phillips, Richard P.; Post, Alison K.; Sala, Osvaldo E.; Slette, Ingrid J.; Yahdjian, Laura; Smith, Melinda D.

2017-01-01

Intensification of the global hydrological cycle, ranging from larger individual precipitation events to more extreme multiyear droughts, has the potential to cause widespread alterations in ecosystem structure and function. With evidence that the incidence of extreme precipitation years (defined statistically from historical precipitation records) is increasing, there is a clear need to identify ecosystems that are most vulnerable to these changes and understand why some ecosystems are more sensitive to extremes than others. To date, opportunistic studies of naturally occurring extreme precipitation years, combined with results from a relatively small number of experiments, have provided limited mechanistic understanding of differences in ecosystem sensitivity, suggesting that new approaches are needed. Coordinated distributed experiments (CDEs) arrayed across multiple ecosystem types and focused on water can enhance our understanding of differential ecosystem sensitivity to precipitation extremes, but there are many design challenges to overcome (e.g., cost, comparability, standardization). Here, we evaluate contemporary experimental approaches for manipulating precipitation under field conditions to inform the design of ‘Drought-Net’, a relatively low-cost CDE that simulates extreme precipitation years. A common method for imposing both dry and wet years is to alter each ambient precipitation event. We endorse this approach for imposing extreme precipitation years because it simultaneously alters other precipitation characteristics (i.e., event size) consistent with natural precipitation patterns. However, we do not advocate applying identical treatment levels at all sites – a common approach to standardization in CDEs. This is because precipitation variability varies >fivefold globally resulting in a wide range of ecosystem-specific thresholds for defining extreme precipitation years. For CDEs focused on precipitation extremes, treatments should be based on each site's past climatic characteristics. This approach, though not often used by ecologists, allows ecological responses to be directly compared across disparate ecosystems and climates, facilitating process-level understanding of ecosystem sensitivity to precipitation extremes.

Pushing precipitation to the extremes in distributed experiments: recommendations for simulating wet and dry years.

PubMed

Knapp, Alan K; Avolio, Meghan L; Beier, Claus; Carroll, Charles J W; Collins, Scott L; Dukes, Jeffrey S; Fraser, Lauchlan H; Griffin-Nolan, Robert J; Hoover, David L; Jentsch, Anke; Loik, Michael E; Phillips, Richard P; Post, Alison K; Sala, Osvaldo E; Slette, Ingrid J; Yahdjian, Laura; Smith, Melinda D

2017-05-01

Intensification of the global hydrological cycle, ranging from larger individual precipitation events to more extreme multiyear droughts, has the potential to cause widespread alterations in ecosystem structure and function. With evidence that the incidence of extreme precipitation years (defined statistically from historical precipitation records) is increasing, there is a clear need to identify ecosystems that are most vulnerable to these changes and understand why some ecosystems are more sensitive to extremes than others. To date, opportunistic studies of naturally occurring extreme precipitation years, combined with results from a relatively small number of experiments, have provided limited mechanistic understanding of differences in ecosystem sensitivity, suggesting that new approaches are needed. Coordinated distributed experiments (CDEs) arrayed across multiple ecosystem types and focused on water can enhance our understanding of differential ecosystem sensitivity to precipitation extremes, but there are many design challenges to overcome (e.g., cost, comparability, standardization). Here, we evaluate contemporary experimental approaches for manipulating precipitation under field conditions to inform the design of 'Drought-Net', a relatively low-cost CDE that simulates extreme precipitation years. A common method for imposing both dry and wet years is to alter each ambient precipitation event. We endorse this approach for imposing extreme precipitation years because it simultaneously alters other precipitation characteristics (i.e., event size) consistent with natural precipitation patterns. However, we do not advocate applying identical treatment levels at all sites - a common approach to standardization in CDEs. This is because precipitation variability varies >fivefold globally resulting in a wide range of ecosystem-specific thresholds for defining extreme precipitation years. For CDEs focused on precipitation extremes, treatments should be based on each site's past climatic characteristics. This approach, though not often used by ecologists, allows ecological responses to be directly compared across disparate ecosystems and climates, facilitating process-level understanding of ecosystem sensitivity to precipitation extremes. © 2016 John Wiley & Sons Ltd.

7 CFR 1709.3 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

..., wood and other biomass fuels, coal, wind and solar energy. Fuels used for subsistence activities in... ASSISTANCE TO HIGH ENERGY COST COMMUNITIES General Requirements § 1709.3 Definitions. Administrator means the... so identified in USDA regulations. Extremely high energy costs means community average residential...

7 CFR 1709.3 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., wood and other biomass fuels, coal, wind and solar energy. Fuels used for subsistence activities in... ASSISTANCE TO HIGH ENERGY COST COMMUNITIES General Requirements § 1709.3 Definitions. Administrator means the... so identified in USDA regulations. Extremely high energy costs means community average residential...

7 CFR 1709.3 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-01-01

..., wood and other biomass fuels, coal, wind and solar energy. Fuels used for subsistence activities in... ASSISTANCE TO HIGH ENERGY COST COMMUNITIES General Requirements § 1709.3 Definitions. Administrator means the... so identified in USDA regulations. Extremely high energy costs means community average residential...

7 CFR 1709.3 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-01-01

..., wood and other biomass fuels, coal, wind and solar energy. Fuels used for subsistence activities in... ASSISTANCE TO HIGH ENERGY COST COMMUNITIES General Requirements § 1709.3 Definitions. Administrator means the... so identified in USDA regulations. Extremely high energy costs means community average residential...

7 CFR 1709.3 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-01-01

..., wood and other biomass fuels, coal, wind and solar energy. Fuels used for subsistence activities in... ASSISTANCE TO HIGH ENERGY COST COMMUNITIES General Requirements § 1709.3 Definitions. Administrator means the... so identified in USDA regulations. Extremely high energy costs means community average residential...

Permissive weight bearing in trauma patients with fracture of the lower extremities: prospective multicenter comparative cohort study.

PubMed

Kalmet, Pishtiwan H S; Meys, Guido; V Horn, Yvette Y; Evers, Silvia M A A; Seelen, Henk A M; Hustinx, Paul; Janzing, Heinrich; Vd Veen, Alexander; Jaspars, Coen; Sintenie, Jan Bernard; Blokhuis, Taco J; Poeze, Martijn; Brink, Peter R G

2018-02-02

The standard aftercare treatment in surgically treated trauma patients with fractures around or in a joint, known as (peri)- or intra-articular fractures of the lower extremities, is either non-weight bearing or partial weight bearing. We have developed an early permissive weight bearing post-surgery rehabilitation protocol in surgically treated patients with fractures of the lower extremities. In this proposal we want to compare our early permissive weight bearing protocol to the existing current non-weight bearing guidelines in a prospective comparative cohort study. The study is a prospective multicenter comparative cohort study in which two rehabilitation aftercare treatments will be contrasted, i.e. permissive weight bearing and non-weight bearing according to the AO-guideline. The study population consists of patients with a surgically treated fracture of the pelvis/acetabulum or a surgically treated (peri)- or intra-articular fracture of the lower extremities. The inclusion period is 12 months. The duration of follow up is 6 months, with measurements taken at baseline, 2,6,12 and 26 weeks post-surgery. ADL with Lower Extremity Functional Scale. Outcome variables for compliance, as measured with an insole pressure measurement system, encompass peak load and step duration. This study will investigate the (cost-) effectiveness of a permissive weight bearing aftercare protocol. The results will provide evidence whether a permissive weight bearing protocol is more effective than the current non-weight bearing protocol. The study is registered in the Dutch Trial Register ( NTR6077 ). Date of registration: 01-09-2016.

Low Cost Carbon Fibre: Applications, Performance and Cost Models - Chapter 17

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

Warren, Charles David; Wheatley, Dr. Alan; Das, Sujit

2014-01-01

Weight saving in automotive applications has a major bearing on fuel economy. It is generally accepted that, typically, a 10% weight reduction in an automobile will lead to a 6-8% improvement in fuel economy. In this respect, carbon fibre composites are extremely attractive in their ability to provide superlative mechanical performance per unit weight. That is why they are specified for high-end uses such as Formula 1 racing cars and the latest aircraft (e.g. Boeing 787, Airbus A350 and A380), where they comprise over 50% by weight of the structure However, carbon fibres are expensive and this renders their compositesmore » similarly expensive. Research has been carried out at Oak Ridge National Laboratories (ORNL), Tennessee, USA for over a decade with the aim of reducing the cost of carbon fibre such that it becomes a cost-effective option for the automotive industry. Aspects of this research relating to the development of low cost carbon fibre have been reported in Chapter 3 of this publication. In this chapter, the practical industrial applications of low-cost carbon fibre are presented, together with considerations of the performance and cost models which underpin the work.« less

Cost-effectiveness of the introduction of the pneumococcal polysaccharide vaccine in elderly Colombian population.

PubMed

Castañeda-Orjuela, Carlos; Alvis-Guzmán, Nelson; Paternina, Angel José; De la Hoz-Restrepo, Fernando

2011-10-13

Streptococcus pneumoniae causes community-acquired pneumonia, otitis media and meningitis, with higher incidences at the extremes of life. PPV-23 vaccine is widely used in prevention of pneumonia and invasive pneumococcal disease in older adults in developed countries. We developed an evaluation of cost-effectiveness of implementing PPV-23 in Colombian population over 60 years. The number of cases of pneumonia and meningitis in patients over 60 years and the proportion by S. pneumoniae was estimated based on a review of literature. A decision tree model with a 5-year time horizon was built to evaluate the cost-effectiveness of the implementation of the PPV-23 in this population. Direct health care costs of out- and in-patients were calculated based on expenditure records from the Bogota public health system. Incremental cost-effectiveness ratios per life saved and per year of life gained were estimated based on the decision tree model. Deterministic and probabilistic sensitivity analyses were performed. Without vaccination 4460 (range 2384-8162) bacteremic pneumococcal pneumonias and 141 (range 73-183) pneumococcal meningitis would occur among people over 60 years old in Colombia. In the first year, vaccination with PPV-23 at US$8/dose would save 480 (range 100-1753) deaths due to Invasive and non-invasive pneumococcal disease. Vaccination would results in US$3400/deaths averted (range US$1028-10,862) and US$1514/life years gained (range US$408-5404). Vaccination with PPV-23 in over 60 years is a highly cost-effective public health measure in Colombia. Despite some limitations, the results are robust, and may help developing countries to perform informed decisions about the introduction of the vaccine. Copyright © 2011 Elsevier Ltd. All rights reserved.

Developing an approach to effectively use super ensemble experiments for the projection of hydrological extremes under climate change

NASA Astrophysics Data System (ADS)

Watanabe, S.; Kim, H.; Utsumi, N.

2017-12-01

This study aims to develop a new approach which projects hydrology under climate change using super ensemble experiments. The use of multiple ensemble is essential for the estimation of extreme, which is a major issue in the impact assessment of climate change. Hence, the super ensemble experiments are recently conducted by some research programs. While it is necessary to use multiple ensemble, the multiple calculations of hydrological simulation for each output of ensemble simulations needs considerable calculation costs. To effectively use the super ensemble experiments, we adopt a strategy to use runoff projected by climate models directly. The general approach of hydrological projection is to conduct hydrological model simulations which include land-surface and river routing process using atmospheric boundary conditions projected by climate models as inputs. This study, on the other hand, simulates only river routing model using runoff projected by climate models. In general, the climate model output is systematically biased so that a preprocessing which corrects such bias is necessary for impact assessments. Various bias correction methods have been proposed, but, to the best of our knowledge, no method has proposed for variables other than surface meteorology. Here, we newly propose a method for utilizing the projected future runoff directly. The developed method estimates and corrects the bias based on the pseudo-observation which is a result of retrospective offline simulation. We show an application of this approach to the super ensemble experiments conducted under the program of Half a degree Additional warming, Prognosis and Projected Impacts (HAPPI). More than 400 ensemble experiments from multiple climate models are available. The results of the validation using historical simulations by HAPPI indicates that the output of this approach can effectively reproduce retrospective runoff variability. Likewise, the bias of runoff from super ensemble climate projections is corrected, and the impact of climate change on hydrologic extremes is assessed in a cost-efficient way.

Identification of groups with poor cost-effectiveness of peginterferon plus ribavirin for naïve hepatitis C patients with a real-world cohort and database.

PubMed

Tsai, Pei-Chien; Liu, Ta-Wei; Tsai, Yi-Shan; Ko, Yu-Min; Chen, Kuan-Yu; Lin, Ching-Chih; Huang, Ching-I; Liang, Po-Cheng; Lin, Yi-Hung; Hsieh, Ming-Yen; Hou, Nai-Jen; Huang, Chung-Feng; Yeh, Ming-Lun; Lin, Zu-Yau; Chen, Shinn-Cherng; Dai, Chia-Yen; Chuang, Wan-Long; Huang, Jee-Fu; Yu, Ming-Lung

2017-06-01

For decades, peginterferon and ribavirin (PegIFN/RBV) have been the standard-of-care for chronic hepatitis C virus (CHC) infection. However, the actual cost-effectiveness of this therapy remains unclear. We purposed to explore the real-world cost effectiveness for subgroups of treatment-naïve CHC patients with PegIFN/RBV therapy in a large real-world cohort using a whole population database. A total of 1809 treatment-naïve chronic hepatitis C virus (HCV) patients (829 HCV genotype 1 [G1] and 980 HCV G2) treated with PegIFN/RBV therapies were linked to the National Health Insurance Research Database, covering the entire population of Taiwan from 1998 to 2013 to collect the total medical-care expenses of outpatient (antiviral agents, nonantiviral agents, laboratory, and consultation costs) and inpatient (medication, logistic, laboratory, and intervention costs) visits. The costs per treatment and the cost per sustained virological response (SVR) achieved were calculated. The average medical-care cost was USD $4823 (±$2984) per treatment and $6105 (±$3778) per SVR achieved. With SVR rates of 68.6% and 87.8%, the cost/SVR was significantly higher in G1 than those in G2 patients, respectively ($8285 vs $4663, P < .001). Treatment-naïve G1 patients of old ages, those with advanced fibrosis, high viral loads, or interleukin-28B unfavorable genotypes, or those without a rapid virological response (RVR: undetectable HCV RNA at week 4), or those with complete early virological response (cEVR: undetectable HCV RNA at week 12). Treatment-naïve G2 patients with high viral loads or without RVR or cEVR incurred significantly higher costs per SVR than their counterparts. The cost/SVR was extremely high among patients without RVR and in patients without cEVR. We investigated the real-world cost effectiveness data for different subgroups of treatment-naïve HCV patients with PegIFN/RBV therapies, which could provide useful, informative evidence for making decisions regarding future therapeutic strategies comprising costly direct-acting antivirals.

Evaluating the cost-effectiveness of afatinib after platinum-based therapy for the treatment of squamous non-small-cell lung cancer in France

PubMed Central

Pignata, Maud; Chouaid, Christos; Le Lay, Katell; Luciani, Laura; McConnachie, Ceilidh; Gordon, James; Roze, Stéphane

2017-01-01

Background and aims Lung cancer has the highest mortality rate of all cancers worldwide. Non-small-cell lung cancer (NSCLC) accounts for 85% of all lung cancers and has an extremely poor prognosis. Afatinib is an irreversible ErbB family blocker designed to suppress cellular signaling and inhibit cellular growth and is approved in Europe after platinum-based therapy for squamous NSCLC. The objective of the present analysis was to evaluate the cost-effectiveness of afatinib after platinum-based therapy for squamous NSCLC in France. Methods The study population was based on the LUX-Lung 8 trial that compared afatinib with erlotinib in patients with squamous NSCLC. The analysis was performed from the perspective of all health care funders and affected patients. A partitioned survival model was developed to evaluate cost-effectiveness based on progression-free survival and overall survival in the trial. Life expectancy, quality-adjusted life expectancy and direct costs were evaluated over a 10-year time horizon. Future costs and clinical benefits were discounted at 4% annually. Deterministic and probabilistic sensitivity analyses were performed. Results Model projections indicated that afatinib was associated with greater life expectancy (0.16 years) and quality-adjusted life expectancy (0.094 quality-adjusted life years [QALYs]) than that projected for erlotinib. The total cost of treatment over a 10-year time horizon was higher for afatinib than erlotinib, EUR12,364 versus EUR9,510, leading to an incremental cost-effectiveness ratio of EUR30,277 per QALY gained for afatinib versus erlotinib. Sensitivity analyses showed that the base case findings were stable under variation of a range of model inputs. Conclusion Based on data from the LUX-Lung 8 trial, afatinib was projected to improve clinical outcomes versus erlotinib, with a 97% probability of being cost-effective assuming a willingness to pay of EUR70,000 per QALY gained, after platinum-based therapy in patients with squamous NSCLC in France. PMID:29123418

Operation of SOI P-Channel Field Effect Transistors, CHT-PMOS30, under Extreme Temperatures

NASA Technical Reports Server (NTRS)

Patterson, Richard; Hammoud, Ahmad

2009-01-01

Electronic systems are required to operate under extreme temperatures in NASA planetary exploration and deep space missions. Electronics on-board spacecraft must also tolerate thermal cycling between extreme temperatures. Thermal management means are usually included in today s spacecraft systems to provide adequate temperature for proper operation of the electronics. These measures, which may include heating elements, heat pipes, radiators, etc., however add to the complexity in the design of the system, increases its cost and weight, and affects its performance and reliability. Electronic parts and circuits capable of withstanding and operating under extreme temperatures would reflect in improvement in system s efficiency, reducing cost, and improving overall reliability. Semiconductor chips based on silicon-on-insulator (SOI) technology are designed mainly for high temperature applications and find extensive use in terrestrial well-logging fields. Their inherent design offers advantages over silicon devices in terms of reduced leakage currents, less power consumption, faster switching speeds, and good radiation tolerance. Little is known, however, about their performance at cryogenic temperatures and under wide thermal swings. Experimental investigation on the operation of SOI, N-channel field effect transistors under wide temperature range was reported earlier [1]. This work examines the performance of P-channel devices of these SOI transistors. The electronic part investigated in this work comprised of a Cissoid s CHT-PMOS30, high temperature P-channel MOSFET (metal-oxide semiconductor field-effect transistor) device [2]. This high voltage, medium-power transistor is designed for geothermal well logging applications, aerospace and avionics, and automotive industry, and is specified for operation in the temperature range of -55 C to +225 C. Table I shows some specifications of this transistor [2]. The CHT-PMOS30 device was characterized at various temperatures over the range of -190 C to +225 C in terms of its voltage/current characteristic curves. The test temperatures included +22, -50, -100, -150, -175, -190, +50, +100, +150, +175, +200, and +225 C. Limited thermal cycling testing was also performed on the device. These tests consisted of subjecting the transistor to a total of twelve thermal cycles between -190 C and +225 C. A temperature rate of change of 10 C/min and a soak time at the test temperature of 10 minutes were used throughout this work. Post-cycling measurements were also performed at selected temperatures. In addition, re-start capability at extreme temperatures, i.e. power switched on while the device was soaking for a period of 20 minutes at the test temperatures of -190 C and +225 C, was investigated.

Capillarity-induced folds fuel extreme shape changes in thin wicked membranes.

PubMed

Grandgeorge, Paul; Krins, Natacha; Hourlier-Fargette, Aurélie; Laberty-Robert, Christel; Neukirch, Sébastien; Antkowiak, Arnaud

2018-04-20

Soft deformable materials are needed for applications such as stretchable electronics, smart textiles, or soft biomedical devices. However, the design of a durable, cost-effective, or biologically compatible version of such a material remains challenging. Living animal cells routinely cope with extreme deformations by unfolding preformed membrane reservoirs available in the form of microvilli or membrane folds. We synthetically mimicked this behavior by creating nanofibrous liquid-infused tissues that spontaneously form similar reservoirs through capillarity-induced folding. By understanding the physics of membrane buckling within the liquid film, we developed proof-of-concept conformable chemical surface treatments and stretchable basic electronic circuits. Copyright © 2018 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.

High-temperature Y267 EPDM elastomer: field and laboratory experiences, August 1981

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

Hirasuna, A.R.; Friese, G.J.; Stephens, C.A.

1982-03-01

Experiences which indicate the superiority of Y267 EPDM elastomer for high-temperature brines and other environments uses are summarized. Its good processing qualities, extremely good thermochemical stability, extremely good mechanical properties, its low-cost constituents, and its good performance in hydrocarbons are described in some case histories. (MCW)

Cost Scaling of a Real-World Exhaust Waste Heat Recovery Thermoelectric Generator: A Deeper Dive

NASA Technical Reports Server (NTRS)

Hendricks, Terry J.; Yee, Shannon; LeBlanc, Saniya

2015-01-01

Cost is equally important to power density or efficiency for the adoption of waste heat recovery thermoelectric generators (TEG) in many transportation and industrial energy recovery applications. In many cases the system design that minimizes cost (e.g., the $/W value) can be very different than the design that maximizes the system's efficiency or power density, and it is important to understand the relationship between those designs to optimize TEG performance-cost compromises. Expanding on recent cost analysis work and using more detailed system modeling, an enhanced cost scaling analysis of a waste heat recovery thermoelectric generator with more detailed, coupled treatment of the heat exchangers has been performed. In this analysis, the effect of the heat lost to the environment and updated relationships between the hot-side and cold-side conductances that maximize power output are considered. This coupled thermal and thermoelectric treatment of the exhaust waste heat recovery thermoelectric generator yields modified cost scaling and design optimization equations, which are now strongly dependent on the heat leakage fraction, exhaust mass flow rate, and heat exchanger effectiveness. This work shows that heat exchanger costs most often dominate the overall TE system costs, that it is extremely difficult to escape this regime, and in order to achieve TE system costs of $1/W it is necessary to achieve heat exchanger costs of $1/(W/K). Minimum TE system costs per watt generally coincide with maximum power points, but Preferred TE Design Regimes are identified where there is little cost penalty for moving into regions of higher efficiency and slightly lower power outputs. These regimes are closely tied to previously-identified low cost design regimes. This work shows that the optimum fill factor Fopt minimizing system costs decreases as heat losses increase, and increases as exhaust mass flow rate and heat exchanger effectiveness increase. These findings have profound implications on the design and operation of various thermoelectric (TE) waste heat 3 recovery systems. This work highlights the importance of heat exchanger costs on the overall TEG system costs, quantifies the possible TEG performance-cost domain space based on heat exchanger effects, and provides a focus for future system research and development efforts.

Selection on parental performance opposes selection for larger body mass in a wild population of blue tits.

PubMed

Thomson, Caroline E; Bayer, Florian; Crouch, Nicholas; Farrell, Samantha; Heap, Elizabeth; Mittell, Elizabeth; Zurita-Cassinello, Mar; Hadfield, Jarrod D

2017-03-01

There is abundant evidence in many taxa for positive directional selection on body size, and yet little evidence for microevolutionary change. In many species, variation in body size is partly determined by the actions of parents, so a proposed explanation for stasis is the presence of a negative genetic correlation between direct and parental effects. Consequently, selecting genes for increased body size would result in a correlated decline in parental effects, reducing body size in the following generation. We show that these arguments implicitly assume that parental care is cost free, and that including a cost alters the predicted genetic architectures needed to explain stasis. Using a large cross-fostered population of blue tits, we estimate direct selection on parental effects for body mass, and show it is negative. Negative selection is consistent with a cost to parental care, mainly acting through a reduction in current fecundity rather than survival. Under these conditions, evolutionary stasis is possible for moderately negative genetic correlations between direct and parental effects. This is in contrast to the implausibly extreme correlations needed when care is assumed to be cost-free. Thus, we highlight the importance of accounting correctly for complete selection acting on traits across generations. © 2017 The Author(s). Evolution © 2017 The Society for the Study of Evolution.

A dynamical systems approach to studying midlatitude weather extremes

NASA Astrophysics Data System (ADS)

Messori, Gabriele; Caballero, Rodrigo; Faranda, Davide

2017-04-01

Extreme weather occurrences carry enormous social and economic costs and routinely garner widespread scientific and media coverage. The ability to predict these events is therefore a topic of crucial importance. Here we propose a novel predictability pathway for extreme events, by building upon recent advances in dynamical systems theory. We show that simple dynamical systems metrics can be used to identify sets of large-scale atmospheric flow patterns with similar spatial structure and temporal evolution on time scales of several days to a week. In regions where these patterns favor extreme weather, they afford a particularly good predictability of the extremes. We specifically test this technique on the atmospheric circulation in the North Atlantic region, where it provides predictability of large-scale wintertime surface temperature extremes in Europe up to 1 week in advance.

Vitamin D-deficiency and post-fracture changes in lower extremity function and falls in women with hip fractures

PubMed Central

Hawkes, W. G.; Glowacki, J.; Yu-Yahiro, J.; Hurwitz, S.; Magaziner, J.

2008-01-01

Summary We determined the prevalence of vitamin D deficiency and lower extremity function in women with hip fractures. Women with extremely low vitamin D levels had reduced lower extremity muscle function and increased falls 1 year later. Ensuring vitamin D sufficiency after a hip fracture may improve function and reduce falls. Introduction Hip fractures are the most devastating of fractures, commonly leading to loss of independent ambulation and living. In this retrospective analysis we determined the prevalence of vitamin D deficiency in women with hip fractures and the association between 25-hydroxyvitamin D [25(OH)D] levels and functional impairment one year later. Methods One hundred ten community-dwelling women with hip fractures were recruited from Boston, MA (n= 30) and Baltimore, MD (n=80) before 1998 and 25(OH)D levels were measured by radioimmunoassay. In a subset of women from Baltimore, a performance measure of the lower extremities using the lower extremity gain scale (LEGS) was measured at 2, 6, and 12 months. Falls, grip strength, chair rise time, walking speed, and balance were also determined. Results Vitamin D insufficiency defined as a 25(OH)D ≤32 ng/mL was present in 96% of the women with hip fractures and 38% had extremely low levels ≤9 ng/mL. At 1 year post-fracture, compared to women with a 25(OH) D >9 ng/mL, those with 25(OH)D ≤9 ng/mL had poorer LEGS performance (p<0.0001) and higher fall rates, without group differences in grip strength or balance. Conclusion Vitamin D sufficiency may have important effects on lower extremity function following hip fractures, without excessive healthcare costs. PMID:18373057

The efficacy of electrical stimulation in lower extremity cutaneous wound healing: A systematic review.

PubMed

Ashrafi, Mohammed; Alonso-Rasgado, Teresa; Baguneid, Mohamed; Bayat, Ardeshir

2017-02-01

Current gold standard lower extremity cutaneous wound management is not always effective. Cutaneous wounds generate a "current of injury" which is directly involved in wound healing processes. Application of exogenous electrical stimulation has been hypothesised to imitate the natural electric current that occurs in cutaneous wounds. The aim of this extensive review was to provide a detailed update on the variety of electrical stimulation modalities used in the management of lower extremity wounds. Several different waveforms and delivery methods of electrical stimulation have been used. Pulsed current appears superior to other electrical modalities available. The majority of studies support the beneficial effects of pulsed current over conservative management of lower extremity cutaneous wounds. Although it appears to have no benefit over causal surgical intervention, it is a treatment option which could be utilised in those patients unsuitable for surgery. Other waveforms and modalities appear promising; however, they still lack large trial data to recommend a firm conclusion with regards to their use. Current studies also vary in quantity, quality and protocol across the different modalities. The ideal electrical stimulation device needs to be non-invasive, portable and cost-effective and provides minimal interference with patients' daily life. Further studies are necessary to establish the ideal electrical stimulation modality, parameters, method of delivery and duration of treatment. The development and implementation of newer devices in the management of acute and chronic wounds provides an exciting direction in the field of electrotherapy. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

The relation of potassium and sodium intakes to diet cost among U.S. adults.

PubMed

Drewnowski, A; Rehm, C D; Maillot, M; Monsivais, P

2015-01-01

The 2010 Dietary Guidelines recommended that Americans increase potassium and decrease sodium intakes to reduce the burden of hypertension. One reason why so few Americans meet the recommended potassium or sodium goals may be perceived or actual food costs. This study explored the monetary costs associated with potassium and sodium intakes using national food prices and a representative sample of US adults. Dietary intake data from the 2001-2002 National Health and Nutrition Examination Survey were merged with a national food prices database. In a population of 4744 adults, the association between the energy-adjusted sodium and potassium intakes, and the sodium-to-potassium ratio (Na:K) and energy-adjusted diet cost was evaluated. Diets that were more potassium-rich or had lower Na:K ratios were associated with higher diet costs, while sodium intakes were not related to cost. The difference in diet cost between extreme quintiles of potassium intakes was $1.49 (95% confidence interval: 1.29, 1.69). A food-level analysis showed that beans, potatoes, coffee, milk, bananas, citrus juices and carrots are frequently consumed and low-cost sources of potassium. Based on existing dietary data and current American eating habits, a potassium-dense diet was associated with higher diet costs, while sodium was not. Price interventions may be an effective approach to improve potassium intakes and reduce the Na:K ratio of the diet. The present methods helped identify some alternative low-cost foods that were effective in increasing potassium intakes. The identification and promotion of lower-cost foods to help individuals meet targeted dietary recommendations could accompany future dietary guidelines.

CFD Study of Full-Scale Aerobic Bioreactors: Evaluation of Dynamic O2 Distribution, Gas-Liquid Mass Transfer and Reaction

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

Humbird, David; Sitaraman, Hariswaran; Stickel, Jonathan

If advanced biofuels are to measurably displace fossil fuels in the near term, they will have to operate at levels of scale, efficiency, and margin unprecedented in the current biotech industry. For aerobically-grown products in particular, scale-up is complex and the practical size, cost, and operability of extremely large reactors is not well understood. Put simply, the problem of how to attain fuel-class production scales comes down to cost-effective delivery of oxygen at high mass transfer rates and low capital and operating costs. To that end, very large reactor vessels (>500 m3) are proposed in order to achieve favorable economiesmore » of scale. Additionally, techno-economic evaluation indicates that bubble-column reactors are more cost-effective than stirred-tank reactors in many low-viscosity cultures. In order to advance the design of extremely large aerobic bioreactors, we have performed computational fluid dynamics (CFD) simulations of bubble-column reactors. A multiphase Euler-Euler model is used to explicitly account for the spatial distribution of air (i.e., gas bubbles) in the reactor. Expanding on the existing bioreactor CFD literature (typically focused on the hydrodynamics of bubbly flows), our simulations include interphase mass transfer of oxygen and a simple phenomenological reaction representing the uptake and consumption of dissolved oxygen by submerged cells. The simulations reproduce the expected flow profiles, with net upward flow in the center of column and downward flow near the wall. At high simulated oxygen uptake rates (OUR), oxygen-depleted regions can be observed in the reactor. By increasing the gas flow to enhance mixing and eliminate depleted areas, a maximum oxygen transfer (OTR) rate is obtained as a function of superficial velocity. These insights regarding minimum superficial velocity and maximum reactor size are incorporated into NREL's larger techno-economic models to supplement standard reactor design equations.« less

Optimal allocation of conservation resources to species that may be extinct.

PubMed

Rout, Tracy M; Heinze, Dean; McCarthy, Michael A

2010-08-01

Statements of extinction will always be uncertain because of imperfect detection of species in the wild. Two errors can be made when declaring a species extinct. Extinction can be declared prematurely, with a resulting loss of protection and management intervention. Alternatively, limited conservation resources can be wasted attempting to protect a species that no longer exists. Rather than setting an arbitrary level of certainty at which to declare extinction, we argue that the decision must trade off the expected costs of both errors. Optimal decisions depend on the cost of continued intervention, the probability the species is extant, and the estimated value of management (the benefit of management times the value of the species). We illustrated our approach with three examples: the Dodo (Raphus cucullatus), the Ivory-billed Woodpecker (U.S. subspecies Campephilus principalis principalis), and the mountain pygmy-possum (Burramys parvus). The dodo was extremely unlikely to be extant, so managing and monitoring for it today would not be cost-effective unless the value of management was extremely high. The probability the Ivory-billed woodpecker is extant depended on whether recent controversial sightings were accepted. Without the recent controversial sightings, it was optimal to declare extinction of the species in 1965 at the latest. Accepting the recent controversial sightings, it was optimal to continue monitoring and managing until 2032 at the latest. The mountain pygmy-possum is currently extant, with a rapidly declining sighting rate. It was optimal to conduct as many as 66 surveys without sighting before declaring the species extinct. The probability of persistence remained high even after many surveys without sighting because it was difficult to determine whether the species was extinct or undetected. If the value of management is high enough, continued intervention can be cost-effective even if the species is likely to be extinct.

Increased resource use in men with metastatic prostate cancer does not result in improved survival or quality of care at the end of life.

PubMed

Golan, Ron; Bernstein, Adrien N; Gu, Xiangmei; Dinerman, Brian F; Sedrakyan, Art; Hu, Jim C

2018-05-15

Cancer care and end-of-life (EOL) care contribute substantially to health care expenditures. Outside of clinical trials, to our knowledge there exists no standardized protocol to monitor disease progression in men with metastatic prostate cancer (mPCa). The objective of the current study was to evaluate the factors and outcomes associated with increased imaging and serum prostate-specific antigen use in men with mPCa. Using Surveillance, Epidemiology, and End Results-Medicare data from 2004 to 2012, the authors identified men diagnosed with mPCa with at least 6 months of follow-up. Extreme users were classified as those who had either received prostate-specific antigen testing greater than once per month, or who underwent cross-sectional imaging or bone scan more frequently than every 2 months over a 6-month period. Associations between extreme use and survival outcomes, costs, and quality of care at EOL, as measured by timing of hospice referral, frequency of emergency department visits, length of stay, and intensive care unit or hospital admissions, were examined. Overall, a total of 3026 men with mPCa were identified, 791 of whom (26%) were defined as extreme users. Extreme users were more commonly young, white/non-Hispanic, married, higher earning, and more educated (P<.001, respectively). Extreme use was not associated with improved quality of care at EOL. Yearly health care costs after diagnosis were 36.4% higher among extreme users (95% confidence interval, 27.4%-45.3%; P<.001). Increased monitoring among men with mPCa significantly increases health care costs, without a definitive improvement in survival nor quality of care at EOL noted. Monitoring for disease progression outside of clinical trials should be reserved for those in whom findings will change management. Cancer 2018;124:2212-9. © 2018 American Cancer Society. © 2018 American Cancer Society.

Extreme prices in electricity balancing markets from an approach of statistical physics

NASA Astrophysics Data System (ADS)

Mureddu, Mario; Meyer-Ortmanns, Hildegard

2018-01-01

An increase in energy production from renewable energy sources is viewed as a crucial achievement in most industrialized countries. The higher variability of power production via renewables leads to a rise in ancillary service costs over the power system, in particular costs within the electricity balancing markets, mainly due to an increased number of extreme price spikes. This study analyzes the impact of an increased share of renewable energy sources on the behavior of price and volumes of the Italian balancing market. Starting from configurations of load and power production, which guarantee a stable performance, we implement fluctuations in the load and in renewables; in particular we artificially increase the contribution of renewables as compared to conventional power sources to cover the total load. We then determine the amount of requested energy in the balancing market and its fluctuations, which are induced by production and consumption. Within an approach of agent-based modeling we estimate the resulting energy prices and costs. While their average values turn out to be only slightly affected by an increased contribution from renewables, the probability for extreme price events is shown to increase along with undesired peaks in the costs. Our methodology provides a tool for estimating outliers in prices obtained in the energy balancing market, once data of consumption, production and their typical fluctuations are provided.

Imaging of acoustic fields using optical feedback interferometry.

PubMed

Bertling, Karl; Perchoux, Julien; Taimre, Thomas; Malkin, Robert; Robert, Daniel; Rakić, Aleksandar D; Bosch, Thierry

2014-12-01

This study introduces optical feedback interferometry as a simple and effective technique for the two-dimensional visualisation of acoustic fields. We present imaging results for several pressure distributions including those for progressive waves, standing waves, as well as the diffraction and interference patterns of the acoustic waves. The proposed solution has the distinct advantage of extreme optical simplicity and robustness thus opening the way to a low cost acoustic field imaging system based on mass produced laser diodes.

Selection criteria for wear resistant powder coatings under extreme erosive wear conditions

NASA Astrophysics Data System (ADS)

Kulu, P.; Pihl, T.

2002-12-01

Wear-resistant thermal spray coatings for sliding wear are hard but brittle (such as carbide and oxide based coatings), which makes them useless under impact loading conditions and sensitive to fatigue. Under extreme conditions of erosive wear (impact loading, high hardness of abrasives, and high velocity of abradant particles), composite coatings ensure optimal properties of hardness and toughness. The article describes tungsten carbide-cobalt (WC-Co) systems and self-fluxing alloys, containing tungsten carbide based hardmetal particles [NiCrSiB-(WC-Co)] deposited by the detonation gun, continuous detonation spraying, and spray fusion processes. Different powder compositions and processes were studied, and the effect of the coating structure and wear parameters on the wear resistance of coatings are evaluated. The dependence of the wear resistance of sprayed and fused coatings on their hardness is discussed, and hardness criteria for coating selection are proposed. The so-called “double cemented” structure of WC-Co based hardmetal or metal matrix composite coatings, as compared with a simple cobalt matrix containing particles of WC, was found optimal. Structural criteria for coating selection are provided. To assist the end user in selecting an optimal deposition method and materials, coating selection diagrams of wear resistance versus hardness are given. This paper also discusses the cost-effectiveness of coatings in the application areas that are more sensitive to cost, and composite coatings based on recycled materials are offered.

78 FR 69366 - Information Collection Activity; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-19

..., including through the use of appropriate automated, electronic, mechanical, or other technological...: (202) 720-8435 or email [email protected] . Title: Assistance to High Energy Cost Rural... 2000 to create a new program to help rural communities with extremely high energy costs (Pub. L. 106...

Comparison of Historically Severe Droughts and the Vulnerability of Agroecosystems in Mid-Continent USA: Lessons Learned

NASA Astrophysics Data System (ADS)

Olson, C.; Rippey, B.

2016-12-01

Extreme climatic events, drought, flooding, severe storms, tropical cyclones and winter storms have cost the USA billions of dollars. Although among major natural disasters in the last 100 years, severe drought occurrences are lower in terms of discrete events than that for other extreme events, the average cost per drought event exceeds all but those of severe storms and tropical cyclones and has significantly impacted the US agroecosystems upon which much of the domestic and export food markets depend1. The impacts from the 2012, 1988, and 1950's droughts are compared with the effects on cropland in the Mid-Continent US. Drought severity in 2012 and in 1988 were similar in terms of economic agricultural loss, 40 and 31 billion in cost-adjusted dollars, respectively. The 2012 drought covered a geographic areal extent similar to that of an earlier drought in the 1950's; roughly 2/3 of the central USA was impacted. However, the 2012 drought developed relatively rapidly in less than a year whereas the drought of the 1950's was marked by multiple years of extreme heat and lack of precipitation. Each of these severe droughts has resulted in significant losses, but the 2012 drought, while costly, could have been a larger economic disaster had the same conditions occurred in the 1950's or 1988. Investment in new technology, improvements in irrigation efficiency and advanced drainage systems, targeted soil conservation practices, and flexibility to adapt to conditions have improved the resilience of agroecosystems to drought in the intervening years. Droughts continue to occur, so a better understanding of climate and available climate services along with sustained investment in new technology will improve drought tolerance. The recent establishment of USDA Regional Climate Hubs to translate and deliver science-based, region-specific information for individual natural resource managers will enable climate-smart decision-making. Implementation is now possible at scales appropriate to identify regional and potentially local vulnerabilities and rapidly assess needs and capabilities. Downscaled climate projections developed by USDA partners and tailored to regional needs will become essential tools for future drought resilience. 1. Data trends derived from www.ncdc.noaa.gov/billions/summary-stats

The cost-effectiveness of alternative therapeutic strategies for the management of chronic hepatitis B in Poland.

PubMed

Orlewska, Ewa

2002-01-01

The aim of the study was to estimate the cost-effectiveness of alternative therapeutic strategies for the management of chronic hepatitis B (CHB) in Poland. The model for the Polish health-care context was based on clinical data from the literature and local data on health-care resource utilization and unit costs. Costs and effects of a population of CHB patients were modeled using four scenarios, which attempt to reflect real-life practice in which patients may receive any of the treatment options available and in which a proportion of patients may still receive no treatment because therapy is not suitable. Strategies A and B assumed the availability of both treatment options: the first choice of treatment is in A, lamivudine, and in B, interferon alpha (IFN-alpha). In strategy C, the only approved treatment is IFN-alpha, and in strategy D, the patients receive no antiviral treatment. The outcome measures were HBeAg seroconversion and nonprogression to cirrhosis-the surrogate marker with predictive value for improved survival. Only direct medical costs were analyzed. The payer's perspective and time horizon of 1 year were adopted. One-way sensitivity analysis and extreme scenario analysis were performed. The best results in terms of seroconversion and nonprogression to cirrhosis were achieved for strategy A, costs were lowest for strategy D, and strategies B and C were dominated by strategy A. The incremental cost/effectiveness ratio (ICER) comparing strategy A with strategy D was 57,855 Polish new zloty (PLN) per extra seroconversion and 79,550 PLN per cirrhosis case avoided. Cirrhosis reduces estimated life expectancy by 37.76 years and by 20 years among 30- and 50-year-olds, respectively. The ICER for strategies A and D was 2105 PLN and 3978 PLN per life-years gained for the population at ages 30 and 50, respectively, and was below the suggested threshold for cost-effectiveness, based on treatment costs for 1 year of hemodialysis in Poland (62,400 PLN). Changing the value of key drivers for sensitivity analysis did not have a significant effect on the ICER.

Causes and costs of injuries in multiple trauma patients requiring extrication from motor vehicle crashes.

PubMed

Siegel, J H; Mason-Gonzalez, S; Dischinger, P C; Read, K M; Cushing, B M; Badellino, M C; Goodarzi, S; Smialek, J E; Heatfield, B M; Robinson, R M

1993-12-01

Prospective and contemporaneous medical and economic cost studies of 144 victims of motor vehicle crashes admitted to a regional level I trauma center with multiple injuries (ISS > or = 16) revealed 122 non-ejected patients, of whom 102 required extrication (EXTRIC) from the vehicle for physical or medical reasons and 20 who did not (N group). There were no differences in age (EXTRIC, 34 +/- 17 years; N, 41 +/- 24 years), type of crash (Frontal: 57% EXTRIC, 60% N; Lateral: 32% EXTRIC, 35% N) restraint use (35% EXTRIC, 35% N), or mortality (29% EXTRIC, 30% N). However, the estimated maximum speed before the crash was higher in EXTRIC patients (50 +/- 16 mph vs. 46 +/- 18 mph N, p < 0.04), as was the change in velocity (delta V) on impact (EXTRIC 30 +/- 15 mph; N, 24 +/- 8 mph, p < 0.01). Brain injuries (51% EXTRIC vs. 35% N) and lower extremity injuries were more numerous in EXTRIC patients (59% vs. 20% N, p < 0.003) and the number of splenic, lower extremity, and pelvic injuries associated with shock was greater in EXTRIC patients, p < 0.02; as were postinjury complications. As a result, operating room costs from orthopedic and plastic surgery increased professional charges in the EXTRIC group versus the N group ($20,000, EXTRIC; $17,000, N) and critical care costs ($13,000, EXTRIC; $4,000, N) with total costs of $72,000 and $77,000, respectively. The lower extremity injuries in EXTRIC patients were primarily a result of body part contacts with intrusions (CIs) of the car occupant compartment structures [73% with vs. 24% without (p < 0.0001)]. In lateral MVCs, brain injuries were also more commonly associated with CIs of the side window frame or A pillar (72% CI vs. 25% no CI; p < 0.035); but as a whole in MVCs in which extrication was necessary, lower extremity injuries from instrument panel or toepan CIs appeared more frequent than those resulting from contacts only (p < 0.0001). In EXTRIC patients, 69% of those in shock had CI injuries, and 80% of the deaths in the EXTRIC group were associated with CI injury. These data suggest that measures designed to prevent CIs by strengthening car passenger compartment structures may reduce the incidence of severe brain and lower extremity injuries and may reduce the need for extrication after MVCs.

Cost of nosocomial pneumonia: the example of vancomycin versus linezolid-shorter stay or fewer complications?

PubMed

Rello, Jordi; Bin, Cao

2016-10-01

Hospital and national committees often focus on drug acquisition costs when taking decisions on the use of new drugs, but antimicrobial agent costs represent a minor part of the bill compared with the indirect costs of hospitalization or loss in days of productivity in working people. Although reducing the length of stay should be a main priority in the USA due to the indirect costs associated with hospitalization, adverse events, such as renal failure, have a major impact on healthcare resource use and costs. However, where hospital reimbursement is based on closed budgets, the paradox is that treating more patients due to reductions in length of stay may not be attractive to administrators, because the cost of discharging patients earlier is not compensated by the increase in severity in replacing stays of newer patient admissions. Furthermore, neuropsychological, physical, and immune impairment caused by sepsis has an extreme impact on long-term quality of patient life and health care resource consumption. Future research is warranted to further explore the potential impact of newer therapies for infections and sepsis, taking into account the costs of complications, effects on long-term quality of life, and particularly an international perspective, which requires customization for each national payer's system. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

The importance of providing counselling and financial support to patients receiving treatment for multi-drug resistant TB: mixed method qualitative and pilot intervention studies.

PubMed

Baral, Sushil C; Aryal, Yeshoda; Bhattrai, Rekha; King, Rebecca; Newell, James N

2014-01-17

People with multi-drug resistant tuberculosis (MDR-TB) in low-income countries face many problems during treatment, and cure rates are low. The purpose of the study was (a) to identify and document the problems experienced by people receiving care for MDR-TB, and how they cope when support is not provided, to inform development of strategies; (b) to estimate the effectiveness of two resultant strategies, counselling alone, and joint counselling and financial support, of increasing DOTS-plus treatment success under routine programme conditions. A mixed-method study comprising a formative qualitative study, pilot intervention study and explanatory qualitative study to better understand barriers to completion of treatment for MDR-TB. Participants were all people starting MDR-TB treatment in seven DOTS-plus centres in the Kathmandu Valley, Nepal during January to December 2008. The primary outcome measure was cure, as internationally defined. MDR-TB treatment caused extreme social, financial and employment hardship. Most patients had to move house and leave their job, and reported major stigmatisation. They were concerned about the long-term effects of their disease, and feared infecting others. In the resultant pilot intervention study, the two strategies appeared to improve treatment outcomes: cure rates for those receiving counselling, combined support and no support were 85%, 76% and 67% respectively. Compared with no support, the (adjusted) risk ratios of cure for those receiving counselling and receiving combined support were 1.2 (95% CI 1.0 to 1.6) and 1.2 (95% CI 0.9 to 1.6) respectively. The explanatory study demonstrated that patients valued both forms of support. MDR-TB patients are extremely vulnerable to stigma and extreme financial hardship. Provision of counselling and financial support may not only reduce their vulnerability, but also increase cure rates. National Tuberculosis Programmes should consider incorporating financial support and counselling into MDR-TB care: costs are low, and benefits high, especially since costs to society of incomplete treatment and potential for incurable TB are extremely high.

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

PubMed

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

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

Travels in Extreme Social Mobility: How First-in-Family Students Find Their Way into and through Medical Education

ERIC Educational Resources Information Center

Southgate, Erica; Brosnan, Caragh; Lempp, Heidi; Kelly, Brian; Wright, Sarah; Outram, Sue; Bennett, Anna

2017-01-01

Higher education is understood as essential to enabling social mobility. Research and policy have centred on access to university, but recently attention has turned to the journey of social mobility itself--and its costs. Long-distance or "extreme" social mobility journeys particularly require analysis. This paper examines journeys of…

Manpower/Hardware Life Cycle Cost Analysis Study.

DTIC Science & Technology

1979-11-06

designer will begin to learn, on a subconscious level, about the likely outcome of tradeoffs. At the high rate of use expected for these machines, he...one requiring considerable cost analytic expertise), and the model must be redocumented and partially or completely reprogrammed . All this is extremely

Specifying the ovarian cancer risk threshold of 'premenopausal risk-reducing salpingo-oophorectomy' for ovarian cancer prevention: a cost-effectiveness analysis.

PubMed

Manchanda, Ranjit; Legood, Rosa; Antoniou, Antonis C; Gordeev, Vladimir S; Menon, Usha

2016-09-01

Risk-reducing salpingo-oophorectomy (RRSO) is the most effective intervention to prevent ovarian cancer (OC). It is only available to high-risk women with >10% lifetime OC risk. This threshold has not been formally tested for cost-effectiveness. To specify the OC risk thresholds for RRSO being cost-effective for preventing OC in premenopausal women. The costs as well as effects of surgical prevention ('RRSO') were compared over a lifetime with 'no RRSO' using a decision analysis model. RRSO was undertaken in premenopausal women >40 years. The model was evaluated at lifetime OC risk levels: 2%, 4%, 5%, 6%, 8% and 10%. Costs and outcomes are discounted at 3.5%. Uncertainty in the model was assessed using both deterministic sensitivity analysis and probabilistic sensitivity analysis (PSA). Outcomes included in the analyses were OC, breast cancer (BC) and additional deaths from coronary heart disease. Total costs and effects were estimated in terms of quality-adjusted life-years (QALYs); incidence of OC and BC; as well as incremental cost-effectiveness ratio (ICER). Published literature, Nurses Health Study, British National Formulary, Cancer Research UK, National Institute for Health and Care Excellence guidelines and National Health Service reference costs. The time horizon is lifetime and perspective: payer. Premenopausal RRSO is cost-effective at 4% OC risk (life expectancy gained=42.7 days, ICER=£19 536/QALY) with benefits largely driven by reduction in BC risk. RRSO remains cost-effective at >8.2% OC risk without hormone replacement therapy (ICER=£29 071/QALY, life expectancy gained=21.8 days) or 6%if BC risk reduction=0 (ICER=£27 212/QALY, life expectancy gained=35.3 days). Sensitivity analysis indicated results are not impacted much by costs of surgical prevention or treatment of OC/ BC or cardiovascular disease. However, results were sensitive to RRSO utility scores. Additionally, 37%, 61%, 74%, 84%, 96% and 99.5% simulations on PSA are cost-effective for RRSO at the 2%, 4%, 5%, 6%, 8% and 10% levels of OC risk, respectively. Premenopausal RRSO appears to be extremely cost-effective at ≥4% lifetime OC risk, with ≥42.7 days gain in life expectancy if compliance with hormone replacement therapy is high. Current guidelines should be re-evaluated to reduce the RRSO OC risk threshold to benefit a number of at-risk women who presently cannot access risk-reducing surgery. 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/

Nutritional support teams: the cooperation among physicians and pharmacists helps improve cost-effectiveness of home parenteral nutrition (HPN).

PubMed

Pietka, Magdalena; Watrobska-Swietlikowska, Dorota; Szczepanek, Kinga; Szybinski, Piotr; Sznitowska, Małgorzata; Kłęk, Stanisław

2014-09-12

Modern home parenteral nutrition (HPN) requires the preparation of tailored admixtures. The physicians' demands for their composition are often at the variance with pharmaceutical principles, which causes the necessity of either the preparation of ex tempore admixtures or stability testing ensuring long shelf life. Both approaches are not cost-effective. The aim of the study was to use the cooperation among physicians and pharmacists to assure both: cost-effectiveness and patient-tailored HPN admixtures. The first part of the study consisted of the thorough analysis of prescriptions for the most demanding 47 HPN patients (27 females and 20 males, mean age 53.1 year) treated at one HPN center to create few as possible long-shelf life admixtures. The second part of the study consisted of stability testing and modifications. The analysis showed over 137 variations needed to cover all macro- and micronutrients requirements. Their cost as ex-tempore solutions was extremely high (over 110 000 EURO/month) due to logistics and similarly high if stability test for variation were to be performed (68 500 EURO). Therefore prescription was prepared de novo within team of physicians and pharmacists and four base models were designed. Water and electrolytes, particularly magnesium and calcium showed to be the major issues. Stability tests failed in one admixture due to high electrolytes concentration. It was corrected, and the new formula passes the test. Five basic models were then used for creation of new bags. Cost of such an activity were 3 700 EURO (p<0.01) CONCLUSIONS: The cooperation within the members of nutritional support team could improve the cost-effectiveness and quality of HPN. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

The economic implications of a multimodal analgesic regimen for patients undergoing major orthopedic surgery: a comparative study of direct costs.

PubMed

Duncan, Christopher M; Hall Long, Kirsten; Warner, David O; Hebl, James R

2009-01-01

Total knee and total hip arthoplasty (THA) are 2 of the most common surgical procedures performed in the United States and represent the greatest single Medicare procedural expenditure. This study was designed to evaluate the economic impact of implementing a multimodal analgesic regimen (Total Joint Regional Anesthesia [TJRA] Clinical Pathway) on the estimated direct medical costs of patients undergoing lower extremity joint replacement surgery. An economic cost comparison was performed on Mayo Clinic patients (n = 100) undergoing traditional total knee or total hip arthroplasty using the TJRA Clinical Pathway. Study patients were matched 1:1 with historical controls undergoing similar procedures using traditional anesthetic (non-TJRA) techniques. Matching criteria included age, sex, surgeon, type of procedure, and American Society of Anesthesiologists (ASA) physical status (PS) classification. Hospital-based direct costs were collected for each patient and analyzed in standardized inflation-adjusted constant dollars using cost-to-charge ratios, wage indexes, and physician services valued using Medicare reimbursement rates. The estimated mean direct hospital costs were compared between groups, and a subgroup analysis was performed based on ASA PS classification. The estimated mean direct hospital costs were significantly reduced among TJRA patients when compared with controls (cost difference, 1999 dollars; 95% confidence interval, 584-3231 dollars; P = 0.0004). A significant reduction in hospital-based (Medicare Part A) costs accounted for the majority of the total cost savings. Use of a comprehensive, multimodal analgesic regimen (TJRA Clinical Pathway) in patients undergoing lower extremity joint replacement surgery provides a significant reduction in the estimated total direct medical costs. The reduction in mean cost is primarily associated with lower hospital-based (Medicare Part A) costs, with the greatest overall cost difference appearing among patients with significant comorbidities (ASA PS III-IV patients).

Lesion complexity drives the cost of superficial femoral artery endovascular interventions

PubMed Central

Walker, Karen L.; Nolan, Brian W.; Columbo, Jesse A.; Rzucidlo, Eva M.; Goodney, Philip P.; Walsh, Daniel B.; Atkinson, Benjamin J.; Powell, Richard J.

2017-01-01

Objective Patients who undergo endovascular treatment of superficial femoral artery (SFA) disease vary greatly in lesion complexity and treatment options. This study examined the association of lesion severity and cost of SFA stenting and to determine if procedure cost affects primary patency at 1 year. Methods A retrospective record review identified patients undergoing initial SFA stenting between January 1, 2010, and February 1, 2012. Medical records were reviewed to collect data on demographics, comorbidities, indication for the procedure, TransAtlantic Inter-Society Consensus (TASC) II severity, and primary patency. The interventional radiology database and hospital accounting database were queried to determine cost drivers of SFA stenting. Procedure supply cost included any item with a bar code used for the procedure. Associations between cost drivers and lesion characteristics were explored. Primary patency was determined using Kaplan-Meier survival curves and a log-rank test. Results During the study period, 95 patients underwent stenting in 98 extremities; of these, 61% of SFA stents were performed for claudication, with 80% of lesions classified as TASC II A or B. Primary patency at 1 year was 79% for the entire cohort. The mean total cost per case was $10,333. Increased procedure supply cost was associated with adjunct device use, the number of stents, and TASC II severity. Despite higher costs of treating more complex lesions, primary patency at 1 year was similar at 80% for high-cost (supply cost >$4000) vs 78% for low-cost (supply cost <$4000) interventions. Conclusions SFA lesion complexity, as defined by TASC II severity, drives the cost of endovascular interventions but does not appear to disadvantage patency at 1 year. Reimbursement agencies should consider incorporating disease severity into reimbursement algorithms for lower extremity endovascular interventions. PMID:26206581

Lesion complexity drives the cost of superficial femoral artery endovascular interventions.

PubMed

Walker, Karen L; Nolan, Brian W; Columbo, Jesse A; Rzucidlo, Eva M; Goodney, Philip P; Walsh, Daniel B; Atkinson, Benjamin J; Powell, Richard J

2015-10-01

Patients who undergo endovascular treatment of superficial femoral artery (SFA) disease vary greatly in lesion complexity and treatment options. This study examined the association of lesion severity and cost of SFA stenting and to determine if procedure cost affects primary patency at 1 year. A retrospective record review identified patients undergoing initial SFA stenting between January 1, 2010, and February 1, 2012. Medical records were reviewed to collect data on demographics, comorbidities, indication for the procedure, TransAtlantic Inter-Society Consensus (TASC) II severity, and primary patency. The interventional radiology database and hospital accounting database were queried to determine cost drivers of SFA stenting. Procedure supply cost included any item with a bar code used for the procedure. Associations between cost drivers and lesion characteristics were explored. Primary patency was determined using Kaplan-Meier survival curves and a log-rank test. During the study period, 95 patients underwent stenting in 98 extremities; of these, 61% of SFA stents were performed for claudication, with 80% of lesions classified as TASC II A or B. Primary patency at 1 year was 79% for the entire cohort. The mean total cost per case was $10,333. Increased procedure supply cost was associated with adjunct device use, the number of stents, and TASC II severity. Despite higher costs of treating more complex lesions, primary patency at 1 year was similar at 80% for high-cost (supply cost >$4000) vs 78% for low-cost (supply cost <$4000) interventions. SFA lesion complexity, as defined by TASC II severity, drives the cost of endovascular interventions but does not appear to disadvantage patency at 1 year. Reimbursement agencies should consider incorporating disease severity into reimbursement algorithms for lower extremity endovascular interventions. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

An IMS-Based Middleware Solution for Energy-Efficient and Cost-Effective Mobile Multimedia Services

NASA Astrophysics Data System (ADS)

Bellavista, Paolo; Corradi, Antonio; Foschini, Luca

Mobile multimedia services have recently become of extreme industrial relevance due to the advances in both wireless client devices and multimedia communications. That has motivated important standardization efforts, such as the IP Multimedia Subsystem (IMS) to support session control, mobility, and interoperability in all-IP next generation networks. Notwithstanding the central role of IMS in novel mobile multimedia, the potential of IMS-based service composition for the development of new classes of ready-to-use, energy-efficient, and cost-effective services is still widely unexplored. The paper proposes an original solution for the dynamic and standard-compliant redirection of incoming voice calls towards WiFi-equipped smart phones. The primary design guideline is to reduce energy consumption and service costs for the final user by automatically switching from the 3G to the WiFi infrastructure whenever possible. The proposal is fully compliant with the IMS standard and exploits the recently released IMS presence service to update device location and current communication opportunities. The reported experimental results point out that our solution, in a simple way and with full compliance with state-of-the-art industrially-accepted standards, can significantly increase battery lifetime without negative effects on call initiation delay.

Wearing a Wetsuit Alters Upper Extremity Motion during Simulated Surfboard Paddling

PubMed Central

Nessler, J. A.; Silvas, M.; Carpenter, S.; Newcomer, S. C.

2015-01-01

Surfers often wear wetsuits while paddling in the ocean. This neoprene covering may be beneficial to upper extremity movement by helping to improve proprioceptive acuity, or it may be detrimental by providing increased resistance. The purpose of this study was to evaluate the effects of wearing a wetsuit on muscle activation, upper extremity motion, heart rate, and oxygen consumption during simulated surfboard paddling in the laboratory. Twelve male, recreational surfers performed two paddling trials at a constant workload on a swim bench ergometer both with and without a wetsuit. Kinematic data and EMG were acquired from the right arm via motion capture, and oxygen consumption and heart rate were recorded with a metabolic cart and heart rate monitor. Wearing a wetsuit had no significant effect on oxygen consumption or heart rate. A significant increase in EMG activation was observed for the middle deltoid but not for any of the other shoulder muscle evaluated. Finally, approximate entropy and estimates of the maximum Lyapunov exponent increased significantly for vertical trajectory of the right wrist (i.e. stroke height) when a wetsuit was worn. These results suggest that a 2mm wetsuit has little effect on the energy cost of paddling at lower workloads but does affect arm motion. These changes may be the result of enhanced proprioceptive acuity due to mechanical compression from the wetsuit. PMID:26551321

Extreme Warming Challenges Sentinel Status of Kelp Forests as Indicators of Climate Change

NASA Astrophysics Data System (ADS)

Miller, R. J.; Reed, D.; Washburn, L.; Rassweiler, A.; Bell, T. W.; Harrer, S.

2016-12-01

The ecological effects of global warming are expected to be large, but are proving difficult and costly to measure. This has led to a growing interest in using sentinel species as early warning indicators of impending climate change effects on entire ecosystems, raising awareness of the importance of verifying that such conservation shortcuts have sound biological foundations. A recent large-scale warming event in the North Pacific Ocean of unprecedented magnitude and duration allowed us to evaluate the sentinel status of giant kelp, a coastal foundation species that thrives in cold, nutrient-rich waters and considered sensitive to warming. Here we show that giant kelp did not presage ecosystem effects of extreme warming off southern California despite its expected vulnerability. Fluctuations in the biomass of giant kelp, understory algae, invertebrates and fish remained within historical ranges despite 34 months of above average temperatures and below average nutrients. Sea stars and sea urchins were exceptions, plummeting due to disease outbreaks linked to the warming. Our results challenge the IPCC predictions about the vulnerability of kelp-dominated systems to extreme warming events and question their use as early indicators of climate change. The resilience of giant kelp to unprecedented warming not only questions our understanding of kelp ecology, but exposes the risk of relying on supposed sentinel species that are assumed to be very sensitive to climate change.

Flip the tip: an automated, high quality, cost-effective patch clamp screen.

PubMed

Lepple-Wienhues, Albrecht; Ferlinz, Klaus; Seeger, Achim; Schäfer, Arvid

2003-01-01

The race for creating an automated patch clamp has begun. Here, we present a novel technology to produce true gigaseals and whole cell preparations at a high rate. Suspended cells are flushed toward the tip of glass micropipettes. Seal, whole-cell break-in, and pipette/liquid handling are fully automated. Extremely stable seals and access resistance guarantee high recording quality. Data obtained from different cell types sealed inside pipettes show long-term stability, voltage clamp and seal quality, as well as block by compounds in the pM range. A flexible array of independent electrode positions minimizes consumables consumption at maximal throughput. Pulled micropipettes guarantee a proven gigaseal substrate with ultra clean and smooth surface at low cost.

Coordination of a supply chain with consumer return under vendor-managed consignment inventory and stochastic demand

NASA Astrophysics Data System (ADS)

Wu, Zhihui; Chen, Dongyan; Yu, Hui

2016-07-01

In this paper, the problem of the coordination policy is investigated for vendor-managed consignment inventory supply chain subject to consumer return. Here, the market demand is assumed to be affected by promotional effort and consumer return policy. The optimal consignment inventory and the optimal promotional effort level are proposed under the decentralized and centralized decisions. Based on the optimal decision conditions, the markdown allowance-promotional cost-sharing contract is investigated to coordinate the supply chain. Subsequently, the comparison between the two extreme policies shows that full-refund policy dominates the no-return policy when the returning cost and the positive effect of return policy are satisfied certain conditions. Finally, a numerical example is provided to illustrate the impacts of consumer return policy on the coordination contract and optimal profit as well as the effectiveness of the proposed supply chain decision.

Accelerating Pathology Image Data Cross-Comparison on CPU-GPU Hybrid Systems

PubMed Central

Wang, Kaibo; Huai, Yin; Lee, Rubao; Wang, Fusheng; Zhang, Xiaodong; Saltz, Joel H.

2012-01-01

As an important application of spatial databases in pathology imaging analysis, cross-comparing the spatial boundaries of a huge amount of segmented micro-anatomic objects demands extremely data- and compute-intensive operations, requiring high throughput at an affordable cost. However, the performance of spatial database systems has not been satisfactory since their implementations of spatial operations cannot fully utilize the power of modern parallel hardware. In this paper, we provide a customized software solution that exploits GPUs and multi-core CPUs to accelerate spatial cross-comparison in a cost-effective way. Our solution consists of an efficient GPU algorithm and a pipelined system framework with task migration support. Extensive experiments with real-world data sets demonstrate the effectiveness of our solution, which improves the performance of spatial cross-comparison by over 18 times compared with a parallelized spatial database approach. PMID:23355955

Hurricane Harvey Building Damage Assessment Using UAV Data

NASA Astrophysics Data System (ADS)

Yeom, J.; Jung, J.; Chang, A.; Choi, I.

2017-12-01

Hurricane Harvey which was extremely destructive major hurricane struck southern Texas, U.S.A on August 25, causing catastrophic flooding and storm damages. We visited Rockport suffered severe building destruction and conducted UAV (Unmanned Aerial Vehicle) surveying for building damage assessment. UAV provides very high resolution images compared with traditional remote sensing data. In addition, prompt and cost-effective damage assessment can be performed regardless of several limitations in other remote sensing platforms such as revisit interval of satellite platforms, complicated flight plan in aerial surveying, and cloud amounts. In this study, UAV flight and GPS surveying were conducted two weeks after hurricane damage to generate an orthomosaic image and a DEM (Digital Elevation Model). 3D region growing scheme has been proposed to quantitatively estimate building damages considering building debris' elevation change and spectral difference. The result showed that the proposed method can be used for high definition building damage assessment in a time- and cost-effective way.

Excess Cost and Healthcare Resources Associated With Delayed Diagnosis of Charcot Foot.

PubMed

Labovitz, Jonathan M; Shapiro, Jarrod M; Satterfield, V Kathleen; Smith, Nathanael T

2018-06-21

The purpose of the present study was to demonstrate the effect of a delayed diagnosis of Charcot foot on acute care cost and usage. We used International Classification of Disease, Ninth Revision, Clinical Modification codes, and the California Office for Statewide Health Planning and Development 2009 to 2012 public patient discharge files to identify patients with type 2 diabetes mellitus and Charcot foot. The costs and length of stay were compared for those with a diagnosis of Charcot foot on admission compared with those who received a delayed diagnosis of Charcot foot before discharge. Patient demographic data, diagnoses often mistaken for Charcot foot, and procedures often performed for Charcot foot were assessed to determine the potential effect on costs and length of stay in Charcot foot subjects. A delayed Charcot foot diagnosis was associated with 10.8% greater inpatient costs and 12.1% longer length of stay. These patients required greater resource usage owing to the significantly greater number of procedures performed. A significantly greater number of patients underwent lower extremity amputation when the diagnosis was delayed, resulting in a 30.4% increase in costs and 31.6% longer length of stay. A greater rate of diabetic foot ulcers, foot infections, and osteomyelitis was also observed; however, the cost was only affected by osteomyelitis, and the length of stay was not significantly affected. A delayed diagnosis of Charcot foot at admission resulted in significantly increased acute care costs and longer lengths of stay. Copyright © 2018 The American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Evaluation of solar cells for potential space satellite power applications

NASA Technical Reports Server (NTRS)

1977-01-01

The evaluation focused on the following subjects: (1) the relative merits of alternative solar cell materials, based on performance and availability, (2) the best manufacturing methods for various solar cell options and the effects of extremely large production volumes on their ultimate costs and operational characteristics, (3) the areas of uncertainty in achieving large solar cell production volumes, (4) the effects of concentration ratios on solar array mass and system performance, (5) the factors influencing solar cell life in the radiation environment during transport to and in geosynchronous orbit, and (6) the merits of conducting solar cell manufacturing operations in space.

Remote video assessment for missile launch facilities

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

Wagner, G.G.; Stewart, W.A.

1995-07-01

The widely dispersed, unmanned launch facilities (LFs) for land-based ICBMs (intercontinental ballistic missiles) currently do not have visual assessment capability for existing intrusion alarms. The security response force currently must assess each alarm on-site. Remote assessment will enhance manpower, safety, and security efforts. Sandia National Laboratories was tasked by the USAF Electronic Systems Center to research, recommend, and demonstrate a cost-effective remote video assessment capability at missile LFs. The project`s charter was to provide: system concepts; market survey analysis; technology search recommendations; and operational hardware demonstrations for remote video assessment from a missile LF to a remote security center viamore » a cost-effective transmission medium and without using visible, on-site lighting. The technical challenges of this project were to: analyze various video transmission media and emphasize using the existing missile system copper line which can be as long as 30 miles; accentuate and extremely low-cost system because of the many sites requiring system installation; integrate the video assessment system with the current LF alarm system; and provide video assessment at the remote sites with non-visible lighting.« less

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

PubMed Central

Morrison, John E.

2004-01-01

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

75 FR 25861 - Proposed Data Collections Submitted for Public Comment and Recommendations

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-10

... meeting (``pre-test''), and again after all four discussion groups have been completed (``post-test... disease, and osteoarthritis. Beyond the human costs, economic costs are extreme and are climbing. One... efforts. Two hundred fifty respondents will be recruited to participate in four on-line, small-group...

NOVEL LIGNIN-BASED MAGNETITE NANOCOMPOSITES FOR REMOVAL OF PHOSPHATE FROM CONTAMINATED WATERS - PHASE II

EPA Science Inventory

Phosphorus (P) remediation is an extremely difficult and costly environmental problem and could cost $44.5 billion for treatment using conventional water treatment plants to meet EPA requirements. Phosphorus runoffs can lead to “dead zones” due to eutrophication and also ca...

75 FR 17368 - Information Collection Activity; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-06

..., mechanical, or other technological collection techniques or other forms of information technology. Comments...., Washington, DC 20250- 1522. FAX: (202) 720-8435. Title: Assistance to High Energy Cost Rural Communities. OMB... 2000 to create a new program to help rural communities with extremely high energy costs (Pub. L. 106...

Gathering system optimization in a gas field with commingled flowlines

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

Soetedja, V.; Harun, A.F.

1995-10-01

Badak Field, located in East Kalimantan, Indonesia, is a giant onshore gas field with 181 wells and total gas deliverability of 1.3 billion standard cubic feet (BSCF) per day. In many cases, gas from more than one well is commingled in the same flowline. This study concludes that commingling flowlines has been extremely cost effective over the life of the field. However, good initial design is required to anticipate future reservoir depletion and recompletions in order to achieve the best economic efficiency.

Bill Would Expand U.S. Drought Monitoring

NASA Astrophysics Data System (ADS)

Zielinski, Sarah

2006-05-01

The collection and dissemination of drought information would be centralized within the U.S. National Oceanic and Atmospheric Administration (NOAA) under a newly proposed bill, which received support at a 4 May hearing before the U.S. House of Representatives Science Subcommittee on Environment, Technology, and Standards. The economic costs of drought average $6 to $8 billion each year in the United States, according to NOAA. The effects of prolonged drought include extreme wildfire conditions, water restrictions, and reduced crop yields.

Health effects associated with passenger vehicles: monetary values of air pollution.

PubMed

Marzouk, Mohamed; Madany, Magdy

2012-01-01

Air pollution is regarded as one of the highest priorities in environmental protection in both developed and developing countries. High levels of air pollution have adverse effects on human health that might cause premature death. This study presents the monetary value estimates for the adverse human health effects resulted from ambient air pollution. It aids decision makers to set priorities in the public health relevance of pollution abatement. The main driver of policymaker is the need to reduce the avoidable cardiopulmonary morbidity and mortality from pollutant exposures. The monetary valuation involves 2 steps: (i) relate levels of pollutants to mortality and morbidity (concentration-response relationships) and (ii) apply unit economic values. Cost of air pollution associated with passenger vehicles running over a major traffic bridge (6th of October Elevated Highway) is presented as a case study to demonstrate the use of monetary value of air pollution. The study proves that the cost of air pollution is extremely high and should not be overlooked.

Cost-effective imprinting combining macromolecular crowding and a dummy template for the fast purification of punicalagin from pomegranate husk extract.

PubMed

Sun, Guang-Ying; Wang, Chao; Luo, Yu-Qin; Zhao, Yong-Xin; Yang, Jian; Liu, Zhao-Sheng; Aisa, Haji Akber

2016-05-01

The combination of molecular crowding and virtual imprinting was employed to develop a cost-effective method to prepare molecularly imprinted polymers. By using linear polymer polystyrene as a macromolecular crowding agent, an imprinted polymer recognizable to punicalagin had been successfully synthesized with punicalin as the dummy template. The resulting punicalin-imprinted polymer presented a remarkable selectivity to punicalagin with an imprinting factor of 3.17 even at extremely low consumption of the template (template/monomer ratio of 1:782). In contrast, the imprinted polymer synthesized without crowding agent, did not show any imprinting effect at so low template amount. The imprinted polymers made by combination of molecular crowding and virtual imprinting can be utilized for the fast separation of punicalagin from pomegranate husk extract after optimizing the protocol of solid-phase extraction with the recovery of 85.3 ± 1.2%. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

PUCHEROS: a cost-effective solution for high-resolution spectroscopy with small telescopes

NASA Astrophysics Data System (ADS)

Vanzi, L.; Chacon, J.; Helminiak, K. G.; Baffico, M.; Rivinius, T.; Štefl, S.; Baade, D.; Avila, G.; Guirao, C.

2012-08-01

We present PUCHEROS, the high-resolution echelle spectrograph, developed at the Center of Astro-Engineering of Pontificia Universidad Catolica de Chile to provide an effective tool for research and teaching of astronomy. The instrument is fed by a single-channel optical fibre and it covers the visible range from 390 to 730 nm in one shot, reaching a spectral resolution of about 20 000. In the era of extremely large telescopes our instrument aims to exploit the capabilities offered by small telescopes in a cost-effective way, covering the observing needs of a community of astronomers, in Chile and elsewhere, which do not necessarily need large collecting areas for their research. In particular the instrument is well suited for long-term spectroscopic monitoring of bright variable and transient targets down to a V magnitude of about 10. We describe the instrument and present a number of text case examples of observations obtained during commissioning and early science.

Contrasting Effects of Extreme Drought and Snowmelt Patterns on Mountain Plants along an Elevation Gradient.

PubMed

Rosbakh, Sergey; Leingärtner, Annette; Hoiss, Bernhard; Krauss, Jochen; Steffan-Dewenter, Ingolf; Poschlod, Peter

2017-01-01

Despite the evidence that increased frequency and magnitude of extreme climate events (ECE) considerably affect plant performance, there is still a lack of knowledge about how these events affect mountain plant biodiversity and mountain ecosystem functioning. Here, we assessed the short-term (one vegetation period) effects of simulated ECEs [extreme drought (DR), advanced and delayed snowmelt (AD and DE), respectively] on the performance of 42 plant species occurring in the Bavarian Alps (Germany) along an elevational gradient of 600-2000 m a.s.l. in terms of vegetative growth and reproduction performance. We demonstrate that plant vegetative and generative traits respond differently to the simulated ECEs, but the nature and magnitude treatment effects strongly depend on study site location along the elevational gradient, species' altitudinal origin and plant functional type (PFT) of the target species. For example, the negative effect of DR treatment on growth (e.g., lower growth rates and lower leaf nitrogen content) and reproduction (e.g., lower seed mass) was much stronger in upland sites, as compared to lowlands. Species' response to the treatments also differed according to their altitudinal origin. Specifically, upland species responded negatively to extreme DR (e.g., lower growth rates and lower leaf carbon concentrations, smaller seed set), whereas performance of lowland species remained unaffected (e.g., stable seed set and seed size) or even positively responded (e.g., higher growth rates) to that treatment. Furthermore, we were able to detect some consistent differences in responses to the ECEs among three PFTs (forbs, graminoids, and legumes). For instance, vegetative growth and sexual reproduction of highly adaptable opportunistic graminoids positively responded to nearly all ECEs, likely on the costs of other, more conservative, forbs and legumes. Our results suggest that ECEs can significantly modify the performance of specific plant groups and therefore lead to changes in plant community structure and composition under ongoing climate change. Our study therefore underlines the need for more experimental studies on the effects of extreme climate events to understand the potential consequences of climate change for the alpine ecosystem.

Quantitative methods for stochastic high frequency spatio-temporal and non-linear analysis: Assessing health effects of exposure to extreme ambient temperature

NASA Astrophysics Data System (ADS)

Liss, Alexander

Extreme weather events, such as heat waves and cold spells, cause substantial excess mortality and morbidity in the vulnerable elderly population, and cost billions of dollars. The accurate and reliable assessment of adverse effects of extreme weather events on human health is crucial for environmental scientists, economists, and public health officials to ensure proper protection of vulnerable populations and efficient allocation of scarce resources. However, the methodology for the analysis of large national databases is yet to be developed. The overarching objective of this dissertation is to examine the effect of extreme weather on the elderly population of the Conterminous US (ConUS) with respect to seasonality in temperature in different climatic regions by utilizing heterogeneous high frequency and spatio-temporal resolution data. To achieve these goals the author: 1) incorporated dissimilar stochastic high frequency big data streams and distinct data types into the integrated data base for use in analytical and decision support frameworks; 2) created an automated climate regionalization system based on remote sensing and machine learning to define climate regions for the Conterminous US; 3) systematically surveyed the current state of the art and identified existing gaps in the scientific knowledge; 4) assessed the dose-response relationship of exposure to temperature extremes on human health in relatively homogeneous climate regions using different statistical models, such as parametric and non-parametric, contemporaneous and asynchronous, applied to the same data; 5) assessed seasonal peak timing and synchronization delay of the exposure and the disease within the framework of contemporaneous high frequency harmonic time series analysis and modification of the effect by the regional climate; 6) modeled using hyperbolic functional form non-linear properties of the effect of exposure to extreme temperature on human health. The proposed climate regionalization method algorithmically forms eight climatically homogeneous regions for Conterminous US from satellite Remote Sensing inputs. The relative risk of hospitalizations due to extreme ambient temperature varied across climatic regions. Difference in regional hospitalization rates suggests presence of an adaptation effect to a prevailing climate. In various climatic regions the hospitalizations peaked earlier than the peak of exposure. This suggests disproportionally high impact of extreme weather events, such as cold spells or heat waves when they occur early in the season. These findings provide an insight into the use of high frequency disjoint data sets for the assessment of the magnitude, timing, synchronization and non-linear properties of adverse health consequences due to exposure to extreme weather events to the elderly in defined climatic regions. These findings assist in the creation of decision support frameworks targeting preventions and adaptation strategies such as improving infrastructure, providing energy assistance, education and early warning notifications for the vulnerable population. This dissertation offers a number of methodological innovations for the assessment of the high frequency spatio-temporal and non-linear impacts of extreme weather events on human health. These innovations help to ensure an improved protection of the elderly population, aid policy makers in the development of efficient disaster prevention strategies, and facilitate more efficient allocation of scarce resources.

Regression and Data Mining Methods for Analyses of Multiple Rare Variants in the Genetic Analysis Workshop 17 Mini-Exome Data

PubMed Central

Bailey-Wilson, Joan E.; Brennan, Jennifer S.; Bull, Shelley B; Culverhouse, Robert; Kim, Yoonhee; Jiang, Yuan; Jung, Jeesun; Li, Qing; Lamina, Claudia; Liu, Ying; Mägi, Reedik; Niu, Yue S.; Simpson, Claire L.; Wang, Libo; Yilmaz, Yildiz E.; Zhang, Heping; Zhang, Zhaogong

2012-01-01

Group 14 of Genetic Analysis Workshop 17 examined several issues related to analysis of complex traits using DNA sequence data. These issues included novel methods for analyzing rare genetic variants in an aggregated manner (often termed collapsing rare variants), evaluation of various study designs to increase power to detect effects of rare variants, and the use of machine learning approaches to model highly complex heterogeneous traits. Various published and novel methods for analyzing traits with extreme locus and allelic heterogeneity were applied to the simulated quantitative and disease phenotypes. Overall, we conclude that power is (as expected) dependent on locus-specific heritability or contribution to disease risk, large samples will be required to detect rare causal variants with small effect sizes, extreme phenotype sampling designs may increase power for smaller laboratory costs, methods that allow joint analysis of multiple variants per gene or pathway are more powerful in general than analyses of individual rare variants, population-specific analyses can be optimal when different subpopulations harbor private causal mutations, and machine learning methods may be useful for selecting subsets of predictors for follow-up in the presence of extreme locus heterogeneity and large numbers of potential predictors. PMID:22128066

Fast but not intuitive, slow but not reflective: Decision conflict drives reaction times in social dilemmas.

PubMed

Evans, Anthony M; Dillon, Kyle D; Rand, David G

2015-10-01

When people have the chance to help others at a cost to themselves, are cooperative decisions driven by intuition or reflection? To answer this question, recent studies have tested the relationship between reaction times (RTs) and cooperation, reporting both positive and negative correlations. To reconcile this apparent contradiction, we argue that decision conflict (rather than the use of intuition vs. reflection) drives response times, leading to an inverted-U shaped relationship between RT and cooperation. Studies 1 through 3 show that intermediate decisions take longer than both extremely selfish and extremely cooperative decisions. Studies 4 and 5 find that the conflict between self-interested and cooperative motives explains individual differences in RTs. Manipulating conflictedness causes longer RTs and more intermediate decisions, and RTs mediate the relationship between conflict and intermediate decisions. Finally, Studies 6 and 7 demonstrate that conflict is distinct from reflection by manipulating the use of intuition (vs. reflection). Experimentally promoting reliance on intuition increases cooperation, but has no effects on decision extremity or feelings of conflictedness. In sum, we provide evidence that RTs should not be interpreted as a direct proxy for the use of intuitive or reflective processes, and dissociate the effects of conflict and reflection in social decision making. (c) 2015 APA, all rights reserved).

Catastrophe Finance: An Emerging Discipline

NASA Astrophysics Data System (ADS)

Elsner, James B.; Burch, R. King; Jagger, Thomas H.

2009-08-01

While the recent disasters in the world's financial markets demonstrate that finance theory remains far from perfected, science also faces steep challenges in the quest to predict and manage the effects of natural disasters. Worldwide, as many as half a million people have died in disasters such as earthquakes, tsunamis, and tropical cyclones since the turn of the 21st century [Wirtz, 2008]. Further, natural disasters can lead to extreme financial losses, and independent financial collapses can be exacerbated by natural disasters. In financial cost, 2008 was the second most expensive year on record for such catastrophes and for financial market declines. These extreme events in the natural and financial realms push the issue of risk management to the fore, expose the deficiencies of existing knowledge and practice, and suggest that progress requires further research and training at the graduate level.

Optimal control theory (OWEM) applied to a helicopter in the hover and approach phase

NASA Technical Reports Server (NTRS)

Born, G. J.; Kai, T.

1975-01-01

A major difficulty in the practical application of linear-quadratic regulator theory is how to choose the weighting matrices in quadratic cost functions. The control system design with optimal weighting matrices was applied to a helicopter in the hover and approach phase. The weighting matrices were calculated to extremize the closed loop total system damping subject to constraints on the determinants. The extremization is really a minimization of the effects of disturbances, and interpreted as a compromise between the generalized system accuracy and the generalized system response speed. The trade-off between the accuracy and the response speed is adjusted by a single parameter, the ratio of determinants. By this approach an objective measure can be obtained for the design of a control system. The measure is to be determined by the system requirements.

An overview of LED applications for general illumination

NASA Astrophysics Data System (ADS)

Pelka, David G.; Patel, Kavita

2003-11-01

This paper begins by reviewing the current state of development of LEDs, their existing markets as well as their potential for energy conservation and their potential for gaining market share in the general illumination market. It discusses LED metrics such as chip size, lumens per watt, thermal resistance, and the recommended maximum current rating. The paper then goes on to consider the importance of non-imaging optics for both optically efficient and extremely compact LED lighting systems. Finally, microstructures useful for controlling the fields-of-view of LED lighting systems are considered and described in some detail. An extremely efficient and cost effective microstructure, called kinoform diffusers, is shown to have very unique properties that make this technology almost ideal for shaping the output beams of LED lighting systems. It concludes by illustrating some general illumination LED lighting systems

Gold Medal Forum Winner. Unfractionated heparin three times a day versus enoxaparin in the prevention of deep vein thrombosis in trauma patients.

PubMed

Arnold, Joshua D; Dart, Benjamin W; Barker, Donald E; Maxwell, Robert A; Burkholder, Hans C; Mejia, Vicente A; Smith, Philip W; Longley, Joy M

2010-06-01

Venous thromboembolic disease is a significant source of morbidity and mortality in hospitalized trauma patients. Multiple drugs and dosing regimens have been suggested for pharmacoprophylaxis. In this study, we compared efficacy, complications, and cost of unfractionated heparin administered subcutaneously three times a day with standard-dosed enoxaparin for prophylaxis of deep venous thrombosis (DVT) in adult trauma patients over 1 year. Patients admitted for greater than 72 hours who received pharmacoprophylaxis as part of a comprehensive DVT protocol were included. A change was made in the protocol from enoxaparin (30 mg twice a day or 40 mg per day) to heparin (5000 U three times a day) at midyear. Surveillance lower extremity venous ultrasound was performed according to established institutional guidelines. Data, including demographics, associated injuries, complications, and cost, were collected and analyzed. Four hundred seventy-six patients met inclusion criteria. Two hundred thirty-seven (49.8%) patients received enoxaparin and 239 (50.2%) received heparin. Proximal lower extremity DVTs were detected in 16 (6.75%) patients in the enoxaparin group and 17 (7.11%) in the heparin group (P = 0.999). Risk factors for DVT in these patients included spinal cord injury (P = 0.001) and closed head injury (P = 0.031). There was no difference between the incidence of pulmonary emboli and bleeding. There was an estimated yearly pharmacy cost savings of $135,606. In trauma patients, subcutaneous heparin dosed three times a day may be as effective as standard-dosed enoxaparin for prophylaxis of venous thromboembolism without increased complications. Heparin three times a day for venous thromboembolism prophylaxis was associated with significant pharmaceutical cost savings.

A one-step strategy for ultra-fast and low-cost mass production of plastic membrane microfluidic chips.

PubMed

Hu, Chong; Lin, Sheng; Li, Wanbo; Sun, Han; Chen, Yangfan; Chan, Chiu-Wing; Leung, Chung-Hang; Ma, Dik-Lung; Wu, Hongkai; Ren, Kangning

2016-10-05

An ultra-fast, extremely cost-effective, and environmentally friendly method was developed for fabricating flexible microfluidic chips with plastic membranes. With this method, we could fabricate plastic microfluidic chips rapidly (within 12 seconds per piece) at an extremely low cost (less than $0.02 per piece). We used a heated perfluoropolymer perfluoroalkoxy (often called Teflon PFA) solid stamp to press a pile of two pieces of plastic membranes, low density polyethylene (LDPE) and polyethylene terephthalate (PET) coated with an ethylene-vinyl acetate copolymer (EVA). During the short period of contact with the heated PFA stamp, the pressed area of the membranes permanently bonded, while the LDPE membrane spontaneously rose up at the area not pressed, forming microchannels automatically. These two regions were clearly distinguishable even at the micrometer scale so we were able to fabricate microchannels with widths down to 50 microns. This method combines the two steps in the conventional strategy for microchannel fabrication, generating microchannels and sealing channels, into a single step. The production is a green process without using any solvent or generating any waste. Also, the chips showed good resistance against the absorption of Rhodamine 6G, oligonucleotides, and green fluorescent protein (GFP). We demonstrated some typical microfluidic manipulations with the flexible plastic membrane chips, including droplet formation, on-chip capillary electrophoresis, and peristaltic pumping for quantitative injection of samples and reagents. In addition, we demonstrated convenient on-chip detection of lead ions in water samples by a peristaltic-pumping design, as an example of the application of the plastic membrane chips in a resource-limited environment. Due to the high speed and low cost of the fabrication process, this single-step method will facilitate the mass production of microfluidic chips and commercialization of microfluidic technologies.

A New Generation of Building Insulation by Foaming Polymer Blend Materials with CO 2

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

Yang, Arthur; Domszy, Roman; Yang, Jeff

Advanced thermal insulation is among the most effective technologies in transforming our nation’s energy system and contributing to DOE’s stated goal of 50% less building energy consumption by 2030. The installation of an advanced thermal insulation would prevent energy waste without the need for any maintenance, and ISTN conservatively estimates that the commercialization of such a new technology would contribute to annual U.S. energy savings of 0.361 Quads and $8 billion in annual economic savings. The key challenge to improving building insulation is to maintain and surpass the industry standard of R-5 per inch insulation value in a cost-competitive manner.more » Improvements in R-value without cost-efficiency are not likely to impact the market given the cost-sensitive nature of the construction industry (insulation is already the lowest-cost component of the building envelope). However, significantly higher insulating value at competitive costs is extremely appealing to the market given the greater potential to save on energy consumption and costs over the long-term. Thus, our goal is to develop a super-thermal insulation with 50% greater insulation value (R-9 to R-10 per inch) and manufacturing costs that are equal on a per-R-value basis (< $0.70/ft 2).« less

Site restoration: Estimation of attributable costs from plutonium-dispersal accidents

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

Chanin, D.I.; Murfin, W.B.

1996-05-01

A nuclear weapons accident is an extremely unlikely event due to the extensive care taken in operations. However, under some hypothetical accident conditions, plutonium might be dispersed to the environment. This would result in costs being incurred by the government to remediate the site and compensate for losses. This study is a multi-disciplinary evaluation of the potential scope of the post-accident response that includes technical factors, current and proposed legal requirements and constraints, as well as social/political factors that could influence decision making. The study provides parameters that can be used to assess economic costs for accidents postulated to occurmore » in urban areas, Midwest farmland, Western rangeland, and forest. Per-area remediation costs have been estimated, using industry-standard methods, for both expedited and extended remediation. Expedited remediation costs have been evaluated for highways, airports, and urban areas. Extended remediation costs have been evaluated for all land uses except highways and airports. The inclusion of cost estimates in risk assessments, together with the conventional estimation of doses and health effects, allows a fuller understanding of the post-accident environment. The insights obtained can be used to minimize economic risks by evaluation of operational and design alternatives, and through development of improved capabilities for accident response.« less

The clinical impact and cost-effectiveness of essential oils and aromatherapy for the treatment of acne vulgaris: a protocol for a randomized controlled trial.

PubMed

Agnew, Tamara; Leach, Matthew; Segal, Leonie

2014-05-01

Acne is a prevalent, chronic, and sometimes severe skin disorder affecting an estimated 85% of adolescents and 50% of adults older than age 20 years. The psychosocial implications of acne can be considerable, often continuing long after physical symptoms resolve. Although effective acne medications are available, most exhibit adverse-effect profiles that can leave the patient with few effective treatment options. Emerging evidence indicates that plant-derived essential oils may be a biologically plausible treatment for acne, although high-quality evidence of effectiveness and safety is lacking. To examine the clinical effectiveness and cost-effectiveness of essential oils and aromatherapy for the treatment of acne. This randomized, wait-list controlled trial will have three parallel groups; 192 participants with acne vulgaris, aged 16-45 years, will be recruited primarily through eight Technical and Further Education campuses across Adelaide, South Australia. Participants will be randomly assigned to standard essential oil blend, customized aromatherapy treatment, or wait-list control. Changes in the physical and psychosocial symptoms of acne will be assessed at baseline and 6 and 12 weeks by using the Leeds Acne Grading System, Assessment of Quality of Life-8 Dimension instrument, and Acne-Specific Quality of Life instrument. Costs of treatment will be measured on the basis of resource inputs and unit costs and will be limited to acne treatment. The clinical effectiveness and cost-effectiveness will be compared between each intervention and against usual care, using standard health economic techniques. The provision of high-quality evidence of the effectiveness of essential oils and aromatherapy in the treatment of acne may help consumers make better-informed choices about acne management. Insights gained from this research will also contribute to the academic field of complementary medicine, specifically aromatherapy, for which the evidence base is extremely limited.

Modeling Compound Flood Hazards in Coastal Embayments

NASA Astrophysics Data System (ADS)

Moftakhari, H.; Schubert, J. E.; AghaKouchak, A.; Luke, A.; Matthew, R.; Sanders, B. F.

2017-12-01

Coastal cities around the world are built on lowland topography adjacent to coastal embayments and river estuaries, where multiple factors threaten increasing flood hazards (e.g. sea level rise and river flooding). Quantitative risk assessment is required for administration of flood insurance programs and the design of cost-effective flood risk reduction measures. This demands a characterization of extreme water levels such as 100 and 500 year return period events. Furthermore, hydrodynamic flood models are routinely used to characterize localized flood level intensities (i.e., local depth and velocity) based on boundary forcing sampled from extreme value distributions. For example, extreme flood discharges in the U.S. are estimated from measured flood peaks using the Log-Pearson Type III distribution. However, configuring hydrodynamic models for coastal embayments is challenging because of compound extreme flood events: events caused by a combination of extreme sea levels, extreme river discharges, and possibly other factors such as extreme waves and precipitation causing pluvial flooding in urban developments. Here, we present an approach for flood risk assessment that coordinates multivariate extreme analysis with hydrodynamic modeling of coastal embayments. First, we evaluate the significance of correlation structure between terrestrial freshwater inflow and oceanic variables; second, this correlation structure is described using copula functions in unit joint probability domain; and third, we choose a series of compound design scenarios for hydrodynamic modeling based on their occurrence likelihood. The design scenarios include the most likely compound event (with the highest joint probability density), preferred marginal scenario and reproduced time series of ensembles based on Monte Carlo sampling of bivariate hazard domain. The comparison between resulting extreme water dynamics under the compound hazard scenarios explained above provides an insight to the strengths/weaknesses of each approach and helps modelers choose the appropriate scenario that best fit to the needs of their project. The proposed risk assessment approach can help flood hazard modeling practitioners achieve a more reliable estimate of risk, by cautiously reducing the dimensionality of the hazard analysis.

Identifying Patterns in Extreme Precipitation Risk and the Related Impacts

NASA Astrophysics Data System (ADS)

Schroeer, K.; Tye, M. R.

2017-12-01

Extreme precipitation can harm human life and assets through flooding, hail, landslides, or debris flows. Flood risk assessments typically concentrate on river or mountain torrent channels, using water depth, flow velocity, and/or sediment deposition to quantify the risk. In addition, extreme events with high recurrence intervals are often the main focus. However, damages from short-term and localized convective showers often occur away from watercourses. Also, damages from more frequent small scale extremes, although usually less disastrous, can accumulate to considerable financial burdens. Extreme convective precipitation is expected to intensify in a warmer climate, and vulnerability patterns might change in tandem with changes in the character of precipitation and flood types. This has consequences for adaptation planners who want to establish effective protection measures and reduce the cost from natural hazards. Here we merge hydrological and exposure data to identify patterns of risk under varying synoptic conditions. Exposure is calculated from a database of 76k damage claims reported to the national disaster fund in 480 municipalities in south eastern Austria from 1990-2015. Hydrological data comprise sub-daily precipitation (59 gauges) and streamflow (62 gauges) observations. We use synoptic circulation types to identify typical precipitation patterns. They indicate the character of precipitation even if a gauge is not in close proximity, facilitating potential future research with regional climate model data. Results show that more claims are reported under synoptic conditions favouring convective precipitation (on average 1.5-3 times more than on other days). For agrarian municipalities, convective precipitation damages are among the costliest after long low-intensity precipitation events. In contrast, Alpine communities are particularly vulnerable to convective high-intensity rainfall. In addition to possible observational error, uncertainty is present in damage reporting errors, claims from private insurers and adaptation effects after damaging events. As for the latter, preliminary results indicate that investments regularly occur after big events, which may skew subsequent damage claims. Their effectiveness, though, needs to be analyzed in future research.

Further Evidence on the "Costs of Privilege": Perfectionism in High-Achieving Youth at Socioeconomic Extremes

ERIC Educational Resources Information Center

Lyman, Emily L.; Luthar, Suniya S.

2014-01-01

This study involved two academically-gifted samples of 11th and 12th grade youth at the socioeconomic status (SES) extremes; one from an exclusive private, affluent school, and the other from a magnet school with low-income students. Negative and positive adjustment outcomes were examined in relation to multiple dimensions of perfectionism…

Simulating US Agriculture in a Modern Dust Bowl Drought

NASA Technical Reports Server (NTRS)

Glotter, Michael; Elliott, Joshua

2016-01-01

Drought-induced agricultural loss is one of the most costly impacts of extreme weather, and without mitigation, climate change is likely to increase the severity and frequency of future droughts. The Dust Bowl of the 1930s was the driest and hottest for agriculture in modern US history. Improvements in farming practices have increased productivity, but yields today are still tightly linked to climate variation and the impacts of a 1930s-type drought on current and future agricultural systems remain unclear. Simulations of biophysical process and empirical models suggest that Dust-Bowl-type droughts today would have unprecedented consequences, with yield losses approx.50% larger than the severe drought of 2012. Damages at these extremes are highly sensitive to temperature, worsening by approx.25% with each degree centigrade of warming. We find that high temperatures can be more damaging than rainfall deficit, and, without adaptation, warmer mid-century temperatures with even average precipitation could lead to maize losses equivalent to the Dust Bowl drought. Warmer temperatures alongside consecutive droughts could make up to 85% of rain-fed maize at risk of changes that may persist for decades. Understanding the interactions of weather extremes and a changing agricultural system is therefore critical to effectively respond to, and minimize, the impacts of the next extreme drought event.

Simulating US agriculture in a modern Dust Bowl drought.

PubMed

Glotter, Michael; Elliott, Joshua

2016-12-12

Drought-induced agricultural loss is one of the most costly impacts of extreme weather 1-3 , and without mitigation, climate change is likely to increase the severity and frequency of future droughts 4,5 . The Dust Bowl of the 1930s was the driest and hottest for agriculture in modern US history. Improvements in farming practices have increased productivity, but yields today are still tightly linked to climate variation 6 and the impacts of a 1930s-type drought on current and future agricultural systems remain unclear. Simulations of biophysical process and empirical models suggest that Dust-Bowl-type droughts today would have unprecedented consequences, with yield losses ∼50% larger than the severe drought of 2012. Damages at these extremes are highly sensitive to temperature, worsening by ∼25% with each degree centigrade of warming. We find that high temperatures can be more damaging than rainfall deficit, and, without adaptation, warmer mid-century temperatures with even average precipitation could lead to maize losses equivalent to the Dust Bowl drought. Warmer temperatures alongside consecutive droughts could make up to 85% of rain-fed maize at risk of changes that may persist for decades. Understanding the interactions of weather extremes and a changing agricultural system is therefore critical to effectively respond to, and minimize, the impacts of the next extreme drought event.

Lack of access to chemotherapy for colon cancer: multiplicative disadvantage of being extremely poor, inadequately insured and African American.

PubMed

Gorey, Kevin M; Haji-Jama, Sundus; Bartfay, Emma; Luginaah, Isaac N; Wright, Frances C; Kanjeekal, Sindu M

2014-03-22

Despite evidence of chemotherapy's ability to cure or comfort those with colon cancer, nearly half of such Americans do not receive it. African Americans (AA) seem particularly disadvantaged. An ethnicity by poverty by health insurance interaction was hypothesized such that the multiplicative disadvantage of being extremely poor and inadequately insured is worse for AAs than for non-Hispanic white Americans (NHWA). California registry data were analyzed for 459 AAs and 3,001 NHWAs diagnosed with stage II to IV colon cancer between 1996 and 2000 and followed until 2011. Socioeconomic data from the 2000 census categorized neighborhoods: extremely poor (≥ 30% of households poor), middle (5-29% poor) and low poverty (< 5% poor). Participants were randomly selected from these poverty strata. Primary health insurers were Medicaid, Medicare, private or none. Chemotherapy rates were age and stage-adjusted and comparisons used standardized rate ratios (RR). Logistic and Cox regressions, respectively, modeled chemotherapy receipt and long term survival. A significant 3-way ethnicity by poverty by health insurance interaction effect on chemotherapy receipt was observed. Among those who did not live in extremely poor neighborhoods and were adequately insured privately or by Medicare, chemotherapy rates did not differ significantly between AAs (37.7%) and NHWAs (39.5%). Among those who lived in extremely poor neighborhoods and were inadequately insured by Medicaid or uninsured, AAs (14.6%) were nearly 60% less likely to receive chemotherapy than were NHWAs (25.5%, RR = 0.41). When the 3-way interaction effect as well as the main effects of poverty, health insurance and chemotherapy was accounted for, survival rates of AAs and NHWAs were the same. The multiplicative barrier to colon cancer care that results from being extremely poor and inadequately insured is worse for AAs than it is for NHWAs. AAs are more prevalently poor, inadequately insured, and have fewer assets so they are probably less able to absorb the indirect and direct, but uncovered, costs of colon cancer care. Policy makers ought to be cognizant of these factors as they implement the Affordable Care Act and consider future health care reforms.

An efficient Bayesian data-worth analysis using a multilevel Monte Carlo method

NASA Astrophysics Data System (ADS)

Lu, Dan; Ricciuto, Daniel; Evans, Katherine

2018-03-01

Improving the understanding of subsurface systems and thus reducing prediction uncertainty requires collection of data. As the collection of subsurface data is costly, it is important that the data collection scheme is cost-effective. Design of a cost-effective data collection scheme, i.e., data-worth analysis, requires quantifying model parameter, prediction, and both current and potential data uncertainties. Assessment of these uncertainties in large-scale stochastic subsurface hydrological model simulations using standard Monte Carlo (MC) sampling or surrogate modeling is extremely computationally intensive, sometimes even infeasible. In this work, we propose an efficient Bayesian data-worth analysis using a multilevel Monte Carlo (MLMC) method. Compared to the standard MC that requires a significantly large number of high-fidelity model executions to achieve a prescribed accuracy in estimating expectations, the MLMC can substantially reduce computational costs using multifidelity approximations. Since the Bayesian data-worth analysis involves a great deal of expectation estimation, the cost saving of the MLMC in the assessment can be outstanding. While the proposed MLMC-based data-worth analysis is broadly applicable, we use it for a highly heterogeneous two-phase subsurface flow simulation to select an optimal candidate data set that gives the largest uncertainty reduction in predicting mass flow rates at four production wells. The choices made by the MLMC estimation are validated by the actual measurements of the potential data, and consistent with the standard MC estimation. But compared to the standard MC, the MLMC greatly reduces the computational costs.

Assessment of the sunk-cost effect in clinical decision-making.

PubMed

Braverman, Jennifer A; Blumenthal-Barby, J S

2012-07-01

Despite the current push toward the practice of evidence-based medicine and comparative effectiveness research, clinicians' decisions may be influenced not only by evidence, but also by cognitive biases. A cognitive bias describes a tendency to make systematic errors in certain circumstances based on cognitive factors rather than evidence. Though health care providers have been shown in several studies to be susceptible to a variety of types of cognitive biases, research on the role of the sunk-cost bias in clinical decision-making is extremely limited. The sunk-cost bias is the tendency to pursue a course of action, even after it has proved to be suboptimal, because resources have been invested in that course of action. This study explores whether health care providers' medical treatment recommendations are affected by prior investments in a course of treatment. Specifically, we surveyed 389 health care providers in a large urban medical center in the United States during August 2009. We asked participants to make a treatment recommendation based on one of four hypothetical clinical scenarios that varied in the source and type of prior investment described. By comparing recommendations across scenarios, we found that providers did not demonstrate a sunk-cost effect; rather, they demonstrated a significant tendency to over-compensate for the effect. In addition, we found that more than one in ten health care providers recommended continuation of an ineffective treatment. Copyright © 2012 Elsevier Ltd. All rights reserved.

Wound healing with honey--a randomised controlled trial.

PubMed

Ingle, Ronald; Levin, Jonathan; Polinder, Krijn

2006-09-01

To compare honey and IntraSite Gel as woundhealing agents, to record side-effects, gauge patient satisfaction and calculate the cost-effectiveness of the honey used. A prospective, randomised, double-blind controlled trial was carried out among goldmine workers. Outcome measures were healing times of shallow wounds and abrasions; side-effects; patient satisfaction with treatment; and amount of honey and IntraSite Gel used. The mean healing times of shallow wounds treated with honey or with IntraSite Gel did not differ significantly (p = 0.75, 95% confidence interval (CI): -5.41; 7.49 days). When adjusted for wound size, the 2.8-day difference in favour of honey was not significant (p = 0.21, 95% CI: -2.41; 8.09). In the case of abrasions there was also no significant difference (p = 0.83, 95% CI: -4.98; 6.19 days). When adjusted for wound size, the difference of 0.22 days in favour of IntraSite Gel was not significant (p = 0.94, 95% CI: -5.72; 6.15.4). Of patients treated with honey, 27% and 10% respectively experienced itching and pain, and 2 experienced burning for a short time after application. Of patients treated with IntraSite Gel, 31% experienced itching. All patients in both treatment groups were either satisfied or extremely satisfied with treatment. The average cost of treatment per patient was R0.49 with honey and R12.03 with with IntraSite Gel. A distinction should be made between shallow wounds and abrasions when wound healing is being measured. There was no evidence of a real difference between honey and IntraSite Gel as healing agents. Honey is a safe, satisfying and effective healing agent. Natural honey is extremely costeffective.

The disproportionate growth of office-based atherectomy.

PubMed

Mukherjee, Dipankar; Hashemi, Homayoun; Contos, Brian

2017-02-01

The purpose of this study was to evaluate the trends in procedure volume, clinical sites of care, and Medicare expenditure for peripheral vascular interventions (PVIs) for lower extremity occlusive disease since the Centers for Medicare and Medicaid Services instituted reimbursement policy changes that broadened payment for procedures performed in physician-owned office-based laboratories (OBLs). We analyzed fee-for-service Medicare claims data from 2011 to 2014 to obtain the frequency of use of PVI by type, care setting, and physician specialty. We also assessed changes in the total Medicare cost for PVI by setting. There was a 60% increase in atherectomy cases among Medicare beneficiaries between 2011 and 2014. During the same period, OBLs experienced a 298% increase in atherectomy volume vs a 27% increase in hospital outpatient settings and an 11% decrease for inpatient hospital settings. In 2014, OBLs were the most common setting for atherectomy. Nonatherectomy PVIs grew more modestly at just 3% but also experienced site of care shifts. Vascular surgeons and cardiologists accounted for the majority of office-based PVIs in 2014. Total Medicare costs for PVIs increased 18% from 2011 to 2014. Hospital inpatient costs declined 1%, whereas costs for hospital outpatient PVIs increased by 41% and physician office costs increased by 258%. The migration of revascularization procedures for lower extremity peripheral arterial occlusive disease continues from the inpatient to the outpatient setting and especially to OBLs. Increased use of atherectomy in all segments of the lower extremity arterial system has been observed, particularly in OBLs, without substantial evidence in the literature of increased efficacy compared with standard angioplasty with or without stenting. Generous Medicare reimbursement for in-office atherectomy procedures is likely contributing to the volume shifts observed. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

The potential impact of pre-exposure prophylaxis for HIV prevention among men who have sex with men and transwomen in Lima, Peru: a mathematical modelling study.

PubMed

Gomez, Gabriela B; Borquez, Annick; Caceres, Carlos F; Segura, Eddy R; Grant, Robert M; Garnett, Geoff P; Hallett, Timothy B

2012-01-01

HIV pre-exposure prophylaxis (PrEP), the use of antiretroviral drugs by uninfected individuals to prevent HIV infection, has demonstrated effectiveness in preventing acquisition in a high-risk population of men who have sex with men (MSM). Consequently, there is a need to understand if and how PrEP can be used cost-effectively to prevent HIV infection in such populations. We developed a mathematical model representing the HIV epidemic among MSM and transwomen (male-to-female transgender individuals) in Lima, Peru, as a test case. PrEP effectiveness in the model is assumed to result from the combination of a "conditional efficacy" parameter and an adherence parameter. Annual operating costs from a health provider perspective were based on the US Centers for Disease Control and Prevention interim guidelines for PrEP use. The model was used to investigate the population-level impact, cost, and cost-effectiveness of PrEP under a range of implementation scenarios. The epidemiological impact of PrEP is largely driven by programme characteristics. For a modest PrEP coverage of 5%, over 8% of infections could be averted in a programme prioritising those at higher risk and attaining the adherence levels of the Pre-Exposure Prophylaxis Initiative study. Across all scenarios, the highest estimated cost per disability-adjusted life year averted (uniform strategy for a coverage level of 20%, US$1,036-US$4,254) is below the World Health Organization recommended threshold for cost-effective interventions, while only certain optimistic scenarios (low coverage of 5% and some or high prioritisation) are likely to be cost-effective using the World Bank threshold. The impact of PrEP is reduced if those on PrEP decrease condom use, but only extreme behaviour changes among non-adherers (over 80% reduction in condom use) and a low PrEP conditional efficacy (40%) would adversely impact the epidemic. However, PrEP will not arrest HIV transmission in isolation because of its incomplete effectiveness and dependence on adherence, and because the high cost of programmes limits the coverage levels that could potentially be attained. A strategic PrEP intervention could be a cost-effective addition to existing HIV prevention strategies for MSM populations. However, despite being cost-effective, a substantial expenditure would be required to generate significant reductions in incidence. Please see later in the article for the Editors' Summary.

The Potential Impact of Pre-Exposure Prophylaxis for HIV Prevention among Men Who Have Sex with Men and Transwomen in Lima, Peru: A Mathematical Modelling Study

PubMed Central

Caceres, Carlos F.; Segura, Eddy R.; Grant, Robert M.; Garnett, Geoff P.; Hallett, Timothy B.

2012-01-01

Background HIV pre-exposure prophylaxis (PrEP), the use of antiretroviral drugs by uninfected individuals to prevent HIV infection, has demonstrated effectiveness in preventing acquisition in a high-risk population of men who have sex with men (MSM). Consequently, there is a need to understand if and how PrEP can be used cost-effectively to prevent HIV infection in such populations. Methods and Findings We developed a mathematical model representing the HIV epidemic among MSM and transwomen (male-to-female transgender individuals) in Lima, Peru, as a test case. PrEP effectiveness in the model is assumed to result from the combination of a “conditional efficacy” parameter and an adherence parameter. Annual operating costs from a health provider perspective were based on the US Centers for Disease Control and Prevention interim guidelines for PrEP use. The model was used to investigate the population-level impact, cost, and cost-effectiveness of PrEP under a range of implementation scenarios. The epidemiological impact of PrEP is largely driven by programme characteristics. For a modest PrEP coverage of 5%, over 8% of infections could be averted in a programme prioritising those at higher risk and attaining the adherence levels of the Pre-Exposure Prophylaxis Initiative study. Across all scenarios, the highest estimated cost per disability-adjusted life year averted (uniform strategy for a coverage level of 20%, US$1,036–US$4,254) is below the World Health Organization recommended threshold for cost-effective interventions, while only certain optimistic scenarios (low coverage of 5% and some or high prioritisation) are likely to be cost-effective using the World Bank threshold. The impact of PrEP is reduced if those on PrEP decrease condom use, but only extreme behaviour changes among non-adherers (over 80% reduction in condom use) and a low PrEP conditional efficacy (40%) would adversely impact the epidemic. However, PrEP will not arrest HIV transmission in isolation because of its incomplete effectiveness and dependence on adherence, and because the high cost of programmes limits the coverage levels that could potentially be attained. Conclusions A strategic PrEP intervention could be a cost-effective addition to existing HIV prevention strategies for MSM populations. However, despite being cost-effective, a substantial expenditure would be required to generate significant reductions in incidence. Please see later in the article for the Editors' Summary PMID:23055836

A Time-Trend Economic Analysis of Cancer Drug Trials

PubMed Central

Browman, George P.; Hoch, Jeffrey S.; Kovacic, Laurel; Peacock, Stuart J.

2015-01-01

Background. Scientific advances have led to the discovery of novel treatments with high prices. The cost to publicly fund high-cost drugs may threaten the sustainability of drug budgets in different health care systems. In oncology, there are concerns that health-benefit gains are diminishing over time and that the economic evidence to support funding decisions is too limited. Methods. To assess the additional costs and benefits gained from oncology drugs over time, we used treatment protocols and efficacy results from U.S. Food and Drug Administration records to calculate cost-effectiveness ratios for drugs approved to treat first- and second-line metastatic or advanced breast, colorectal, and non-small cell lung cancer during the years 1994–2013. We assessed reimbursement recommendations reached by health technology assessment agencies in the U.K., Australia, and Canada. Results. Cost-effectiveness ratios were calculated for 50 drugs approved by the U.S. regulator. The more recent approvals were often based on surrogate efficacy outcomes and had extremely high costs, often triple the costs of drugs approved in previous years. Over time, the effectiveness gains have increased for some cancer indications; however, for other indications (non-small cell lung and second-line colorectal cancer), the magnitude of gains in effectiveness decreased. Reimbursement recommendations for drugs with the highest cost-effectiveness ratios were the most inconsistent. Conclusion. Evaluation of the clinical benefits that oncology drugs offer as a function of their cost has become highly complex, and for some clinical indications, health benefits are diminishing over time. There is an urgent need for better economic evidence from oncology drug trials and systematic processes to inform funding decisions. Implications for Practice: High-cost oncology drugs may threaten the ability of health care systems to provide access to promising new drugs for patients. In order to make better drug-funding decisions and enable equitable access to breakthrough treatments, discussions in the oncology community should include economic evidence. This study summarizes the extra benefits and costs of newly approved drugs from pivotal trials during the postgenomic era of drug discovery. The reader will gain an appreciation of the need for economic evidence to make better drug-reimbursement decisions and the dynamics at play in today’s oncology drug market. PMID:26032135

Survival in an extreme habitat: the roles of behaviour and energy limitation

NASA Astrophysics Data System (ADS)

Plath, Martin; Tobler, Michael; Riesch, Rüdiger; García de León, Francisco J.; Giere, Olav; Schlupp, Ingo

2007-12-01

Extreme habitats challenge animals with highly adverse conditions, like extreme temperatures or toxic substances. In this paper, we report of a fish ( Poecilia mexicana) inhabiting a limestone cave in Mexico. Several springs inside the cave are rich in toxic H2S. We demonstrate that a behavioural adaptation, aquatic surface respiration (ASR), allows for the survival of P. mexicana in this extreme, sulphidic habitat. Without the possibility to perform ASR, the survival rate of P. mexicana was low even at comparatively low H2S concentrations. Furthermore, we show that food limitation affects the survival of P. mexicana pointing to energetically costly physiological adaptations to detoxify H2S.

Weathering a Perfect Storm from Space

USGS Publications Warehouse

Love, Jeffrey J.

2016-01-01

Extreme space-weather events — intense solar and geomagnetic storms — have occurred in the past: most recently in 1859, 1921 and 1989. So scientists expect that, sooner or later, another extremely intense spaceweather event will strike Earth again. Such storms have the potential to cause widespread interference with and damage to technological systems. A National Academy of Sciences study projects that an extreme space-weather event could end up costing the American economy more than $1 trillion. The question now is whether or not we will take the actions needed to avoid such expensive consequences. Let’s assume that we do. Below is an imagined scenario of how, sometime in the future, an extreme space-weather event might play out.

Comparative effectiveness of the SNaP™ Wound Care System.

PubMed

Hutton, David W; Sheehan, Peter

2011-04-01

Diabetic lower extremity wounds cause substantial burden to healthcare systems, costing tens of thousands of dollars per episode. Negative pressure wound therapy (NPWT) devices have been shown to be cost-effective at treating these wounds, but the traditional devices use bulky electrical pumps that require a durable medical equipment rental-based procurement process. The Spiracur SNaP™ Wound Care System is an ultraportable NPWT system that does not use an electric pump and is fully disposable. It has superior healing compared to standard of care with modern dressings and comparable healing to traditional NPWT devices while giving patients greater mobility and giving clinicians a simpler procurement process. We used a mathematical model to analyse the costs of the SNaP™ system and compare them to standard of care and electrically powered NPWT devices. When compared to standard of care, the SNaP™ system saves over $9000 per wound treated and more than doubles the number of patients healed. The SNaP system has similar healing time to powered NPWT devices, but saves $2300 in Medicare payments or $2800 for private payers per wound treated. Our analysis shows that the SNaP™ system could save substantial treatment costs in addition to allowing patients greater freedom and mobility. © 2011 The Authors. © 2011 Blackwell Publishing Ltd and Medicalhelplines.com Inc.

Dynamical systems proxies of atmospheric predictability and mid-latitude extremes

NASA Astrophysics Data System (ADS)

Messori, Gabriele; Faranda, Davide; Caballero, Rodrigo; Yiou, Pascal

2017-04-01

Extreme weather ocurrences carry enormous social and economic costs and routinely garner widespread scientific and media coverage. Many extremes (for e.g. storms, heatwaves, cold spells, heavy precipitation) are tied to specific patterns of midlatitude atmospheric circulation. The ability to identify these patterns and use them to enhance the predictability of the extremes is therefore a topic of crucial societal and economic value. We propose a novel predictability pathway for extreme events, by building upon recent advances in dynamical systems theory. We use two simple dynamical systems metrics - local dimension and persistence - to identify sets of similar large-scale atmospheric flow patterns which present a coherent temporal evolution. When these patterns correspond to weather extremes, they therefore afford a particularly good forward predictability. We specifically test this technique on European winter temperatures, whose variability largely depends on the atmospheric circulation in the North Atlantic region. We find that our dynamical systems approach provides predictability of large-scale temperature extremes up to one week in advance.

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

Adaptive Nulling for Interferometric Detection of Planets

NASA Technical Reports Server (NTRS)

Lay, Oliver P.; Peters, Robert D.

2010-01-01

An adaptive-nulling method has been proposed to augment the nulling-optical- interferometry method of detection of Earth-like planets around distant stars. The method is intended to reduce the cost of building and aligning the highly precise optical components and assemblies needed for nulling. Typically, at the mid-infrared wavelengths used for detecting planets orbiting distant stars, a star is millions of times brighter than an Earth-sized planet. In order to directly detect the light from the planet, it is necessary to remove most of the light coming from the star. Nulling interferometry is one way to suppress the light from the star without appreciably suppressing the light from the planet. In nulling interferometry in its simplest form, one uses two nominally identical telescopes aimed in the same direction and separated laterally by a suitable distance. The light collected by the two telescopes is processed through optical trains and combined on a detector. The optical trains are designed such that the electric fields produced by an on-axis source (the star) are in anti-phase at the detector while the electric fields from the planet, which is slightly off-axis, combine in phase, so that the contrast ratio between the star and the planet is greatly decreased. If the electric fields from the star are exactly equal in amplitude and opposite in phase, then the star is effectively nulled out. Nulling is effective only if it is complete in the sense that it occurs simultaneously in both polarization states and at all wavelengths of interest. The need to ensure complete nulling translates to extremely tight demands upon the design and fabrication of the complex optical trains: The two telescopes must be highly symmetric, the reflectivities of the many mirrors in the telescopes and other optics must be carefully tailored, the optical coatings must be extremely uniform, sources of contamination must be minimized, optical surfaces must be nearly ideal, and alignments must be extremely precise. Satisfaction of all of these requirements entails substantial cost.

The Influence of Power Limitations on Closed Environment Life Support System Applications

NASA Technical Reports Server (NTRS)

Flynn, Michael; Kliss, Mark (Technical Monitor)

1997-01-01

The future of manned space exploration will be determined through a process which balances the innate need of humanity to explore its surroundings and the costs associated with accomplishing these goals. For NASA, this balance is derived from economics and budgetary constraints that hold it accountable for the expenditure of public funds. These budgetary realities demand a reduction in cost and expenditures of exploration and research activities. For missions venturing out to the edge of habitability, the development of cost effective life support approaches will have a significant influence on mission viability. Over the past several years, a variety of mission scenarios for potential Lunar and Mars missions have been developed. The most promising of these scenarios attempt to provide basic mission requirements at a minimum cost. As a result, these scenarios are extremely power limited. For Closed Environment Life Support System (CELSS) applications, these realities impose both limitations and direction to future research. This paper presents a summary of these mission scenarios and an evaluation of the impact which these power limitations will have on CELSS system design.

Impacts of extreme weather events on transport infrastructure in Norway

NASA Astrophysics Data System (ADS)

Frauenfelder, Regula; Solheim, Anders; Isaksen, Ketil; Romstad, Bård; Dyrrdal, Anita V.; Ekseth, Kristine H. H.; Gangstø Skaland, Reidun; Harbitz, Alf; Harbitz, Carl B.; Haugen, Jan E.; Hygen, Hans O.; Haakenstad, Hilde; Jaedicke, Christian; Jónsson, Árni; Klæboe, Ronny; Ludvigsen, Johanna; Meyer, Nele K.; Rauken, Trude; Sverdrup-Thygeson, Kjetil

2016-04-01

With the latest results on expected future increase in air temperature and precipitation changes reported by the Intergovernmental Panel on Climate Change (IPCC), the climate robustness of important infrastructure is of raising concern in Norway, as well as in the rest of Europe. Economic consequences of natural disasters have increased considerably since 1950. In addition to the effect of demographic changes such as population growth, urbanization and more and more concentration of valuable assets, this increase is also related to an augmenting frequency of extreme events, such as storms, flooding, drought, and landslides. This change is also observable in Norway, where the increased frequency of strong precipitation has led to frequent flooding and landslide events during the last 20 years. A number of studies show that climate change causes an increase in both frequency and intensity of several types of extreme weather, especially when it comes to precipitation. Such extreme weather events greatly affect the transport infrastructure, with numerous and long closures of roads and railroads, in addition to damage and repair costs. Frequent closures of railroad and roads lead to delay or failure in delivery of goods, which again may lead to a loss of customers and/or - eventually - markets. Much of the Norwegian transport infrastructure is more than 50 years old and therefore not adequately dimensioned, even for present climatic conditions. In order to assess these problems and challenges posed to the Norwegian transport infrastructure from present-day and future extreme weather events, the project "Impacts of extreme weather events on infrastructure in Norway (InfraRisk)" was performed under the research Council of Norway program 'NORKLIMA', between 2009 and 2013. The main results of the project are: - Moderate to strong precipitation events have become more frequent and more intense in Norway over the last 50 years, and this trend continues throughout the 21st century. The increase, both in total precipitation, and in the frequency and intensity of extreme events, is greatest in the west and southwest, and in parts of northern Norway, areas with the highest present precipitation. - Snowfall will increase due to increased precipitation in cold areas inland and at high elevations. In lower lying parts of the country, and along the coast, more precipitation as rain will replace snowfall. - The frequency of near-zero events, with freeze-thaw cycles, which can trigger rock falls, will decrease due to the generally increased temperatures. - The greatest uncertainties in the weather trends are linked to uncertainties in climate and emission scenarios, and to the downscaling. - More than 30% of the total length of road and railroads in Norway is exposed to snow avalanche and rock fall/slide hazard. As an example, one of the most exposed railroads, Raumabanen, has an annual probability of 1/3 to be hit by snow avalanches. - Total costs of geohazard impact on the road infrastructure (major roads only) were estimated to be roughly 100 mill. NOK per year, of which the costs of road closures comprise 70%. The numbers are unevenly distributed throughout the country, reflecting the topographic and climatic variability in Norway.

Extreme Temperature Operation of a 10 MHz Silicon Oscillator Type STCL1100

NASA Technical Reports Server (NTRS)

Patterson, Richard L.; Hammoud, Ahmad

2008-01-01

The performance of STMicroelectronics 10 MHz silicon oscillator was evaluated under exposure to extreme temperatures. The oscillator was characterized in terms of its output frequency stability, output signal rise and fall times, duty cycle, and supply current. The effects of thermal cycling and re-start capability at extreme low and high temperatures were also investigated. The silicon oscillator chip operated well with good stability in its output frequency over the temperature region of -50 C to +130 C, a range that by far exceeded its recommended specified boundaries of -20 C to +85 C. In addition, this chip, which is a low-cost oscillator designed for use in applications where great accuracy is not required, continued to function at cryogenic temperatures as low as - 195 C but at the expense of drop in its output frequency. The STCL1100 silicon oscillator was also able to re-start at both -195 C and +130 C, and it exhibited no change in performance due to the thermal cycling. In addition, no physical damage was observed in the packaging material due to extreme temperature exposure and thermal cycling. Therefore, it can be concluded that this device could potentially be used in space exploration missions under extreme temperature conditions in microprocessor and other applications where tight clock accuracy is not critical. In addition to the aforementioned screening evaluation, additional testing, however, is required to fully establish the reliability of these devices and to determine their suitability for long-term use.

The cost of large numbers of hypothesis tests on power, effect size and sample size.

PubMed

Lazzeroni, L C; Ray, A

2012-01-01

Advances in high-throughput biology and computer science are driving an exponential increase in the number of hypothesis tests in genomics and other scientific disciplines. Studies using current genotyping platforms frequently include a million or more tests. In addition to the monetary cost, this increase imposes a statistical cost owing to the multiple testing corrections needed to avoid large numbers of false-positive results. To safeguard against the resulting loss of power, some have suggested sample sizes on the order of tens of thousands that can be impractical for many diseases or may lower the quality of phenotypic measurements. This study examines the relationship between the number of tests on the one hand and power, detectable effect size or required sample size on the other. We show that once the number of tests is large, power can be maintained at a constant level, with comparatively small increases in the effect size or sample size. For example at the 0.05 significance level, a 13% increase in sample size is needed to maintain 80% power for ten million tests compared with one million tests, whereas a 70% increase in sample size is needed for 10 tests compared with a single test. Relative costs are less when measured by increases in the detectable effect size. We provide an interactive Excel calculator to compute power, effect size or sample size when comparing study designs or genome platforms involving different numbers of hypothesis tests. The results are reassuring in an era of extreme multiple testing.

Effects of extreme natural events on the provision of ecosystem services in a mountain environment: The importance of trail design in delivering system resilience and ecosystem service co-benefits.

PubMed

Tomczyk, Aleksandra M; White, Piran C L; Ewertowski, Marek W

2016-01-15

A continued supply of ecosystem services (ES) from a system depends on the resilience of that system to withstand shocks and perturbations. In many parts of the world, climate change is leading to an increased frequency of extreme weather events, potentially influencing ES provision. Our study of the effects of an intense rainfall event in Gorce National Park, Poland, shows: (1) the intense rainfall event impacted heavily on the supply of ES by limiting potential recreation opportunities and reducing erosion prevention; (2) these negative impacts were not only restricted to the period of the extreme event but persisted for up to several years, depending on the pre-event trail conditions and post-event management activities; (3) to restore the pre-event supply of ES, economic investments were required in the form of active repairs to trails, which, in Gorce National Park, were an order of magnitude higher than the costs of normal trail maintenance; and (4) when recreational trails were left to natural restoration, loss of biodiversity was observed, and recovery rates of ES (recreation opportunities and soil erosion prevention) were reduced in comparison to their pre-event state. We conclude that proper trail design and construction provides a good solution to avoid some of the negative impacts of extreme events on recreation, as well as offering co-benefits in terms of protecting biodiversity and enhancing the supply of regulating services such as erosion prevention. Copyright © 2015 Elsevier Ltd. All rights reserved.

Systematic review of economic evaluations of the 23-valent pneumococcal polysaccharide vaccine (PPV23) in individuals 60 years of age or older.

PubMed

Nishikawa, Alvaro Mitsunori; Sartori, Ana Marli Christovam; Mainardi, Giulia Marcelino; Freitas, Angela Carvalho; Itria, Alexander; Novaes, Hillegonda Maria Dutilh; de Soárez, Patrícia Coelho

2018-05-03

To systematically review the economic evaluations of 23-valent pneumococcal polysaccharide vaccine (PPV23) in adults aged ≥60 years to inform the development of local studies through the discussion of parameters and assumptions that influence the results of the analyses. We searched the MEDLINE, Excerpta Medica, Cochrane Library, Latin-American and Caribbean Health Sciences Literature (LILACS), Brazilian Regional Library of Medicine, National Health Service Economic Evaluation, and Centre for Reviews and Dissemination-as well as the Scopus citation index and the Web of Science for full economic evaluations of PPV23 published up to March 2016. Two independent reviewers screened the articles for relevance and extracted the data. Main study characteristics and methods (clinical and epidemiological data, cost and incremental cost-effectiveness ratios (ICERs) were extracted and compared. Costs were updated to 2016 international dollars. Twenty-seven studies published from 1980 to 2016 were reviewed. Most studies were conducted in Europe and the USA; three studies were conducted in Latin America (Brazil, 2; Colombia, 1). In addition to the scenario comparing the vaccination with the PPV23 to non-vaccination, three studies also compared PPV23 to pneumococcal conjugate 13-valent vaccine (PCV13). All studies used static models. Most used a lifetime (44.4%) or 5-6 year's time horizon (33.3%). Only three studies considered herd protection from children immunization with PCV13 in the model. Most studies considered PPV23 cost-effective (less than US$50,000 per LYG or QALY) and sometimes cost-saving (results ranging from cost-saving to US$84,636/QALY). The estimates of disease burden, the efficacy/effectiveness of PPV23, and the effects of herd protection from childhood immunization had most influence on the results. Well-designed cost-effectiveness studies of PPV23 that represent the current epidemiological scenario and reduce uncertainty related to efficacy/effectiveness are extremely relevant to informing the decision-making process. Copyright © 2018 Elsevier Ltd. All rights reserved.

What is the Best Strategy to Minimize After-Care Costs for Total Joint Arthroplasty in a Bundled Payment Environment?

PubMed

Slover, James D; Mullaly, Kathleen A; Payne, Ashley; Iorio, Richard; Bosco, Joseph

2016-12-01

The post-acute care strategies after lower extremity total joint arthroplasty including the use of post-acute rehabilitation centers and home therapy services are associated with different costs. Providers in bundled payment programs are incentivized to use the most cost-effective strategies. We used decision analysis to examine the impact of extending the inpatient hospital stay to avoid discharge of patients to a post-acute rehabilitation facility. The results of this decision analysis show that extended acute hospital care for up to 5.2 extra days to allow for home discharge, rather than discharge to a post-acute inpatient facility can be financially preferable, provided quality is not negatively impacted. The data demonstrate that because the cost of additional acute care hospital days is relatively small and because the cost of an extended post-acute inpatient rehabilitation facility is high, keeping patients in the acute facility for a few extra days and then discharging them directly to home may result in an overall lower cost than discharge after a shorter hospital stay to an expensive post-acute facility. However, this approach will have challenges, and future studies are needed to evaluate this change in strategy. Copyright © 2016 Elsevier Inc. All rights reserved.

Developing a global health diplomacy supply chain--a viable option for the United States to curb extremism.

PubMed

Kumar, Sameer; Honkanen, Erik J; Karl, Chad C

2009-01-01

This study examines the idea of developing a global health diplomacy supply chain as an important foreign policy approach with the aim of improving the lives of vulnerable populations and serving the best interests of the United States. The study was based on the review of academic literature, news events, and military communiques, and historical writings were studied to determine the feasibility of the idea and the extent of costs and benefits of such an endeavor. An integrated strategic business model, supported by a medical care delivery process, was developed to create a framework for a feasible global health diplomacy supply chain. The findings indicate that extremism can be contained by creating and efficiently executing an effective supply chain to get medical care units to those that need them. The limitations are the potential exit strategies required, the tactical abilities, and diplomatic techniques needed in order to create positive diplomatic change in aid distribution. Managers must consider how supply chains will affect other organizations giving aid and the potential public response. Moreover, determining the level of care necessary to achieve the greatest positive health diplomacy continues to require vigilant scrutiny over the potential cost/benefit analysis. The analysis is valuable to policymakers considering the impacts of health diplomacy by utilizing supply chain management.

Omnidirectional, broadband light absorption using large-area, ultrathin lossy metallic film coatings

NASA Astrophysics Data System (ADS)

Li, Zhongyang; Palacios, Edgar; Butun, Serkan; Kocer, Hasan; Aydin, Koray

2015-10-01

Resonant absorbers based on nanostructured materials are promising for variety of applications including optical filters, thermophotovoltaics, thermal emitters, and hot-electron collection. One of the significant challenges for such micro/nanoscale featured medium or surface, however, is costly lithographic processes for structural patterning which restricted from industrial production of complex designs. Here, we demonstrate lithography-free, broadband, polarization-independent optical absorbers based on a three-layer ultrathin film composed of subwavelength chromium (Cr) and oxide film coatings. We have measured almost perfect absorption as high as 99.5% across the entire visible regime and beyond (400-800 nm). In addition to near-ideal absorption, our absorbers exhibit omnidirectional independence for incidence angle over ±60 degrees. Broadband absorbers introduced in this study perform better than nanostructured plasmonic absorber counterparts in terms of bandwidth, polarization and angle independence. Improvements of such “blackbody” samples based on uniform thin-film coatings is attributed to extremely low quality factor of asymmetric highly-lossy Fabry-Perot cavities. Such broadband absorber designs are ultrathin compared to carbon nanotube based black materials, and does not require lithographic processes. This demonstration redirects the broadband super absorber design to extreme simplicity, higher performance and cost effective manufacturing convenience for practical industrial production.

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

PubMed

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

2013-04-01

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

Extremely large telescopes as a motor of socio-economic development and implications of their construction and installation

NASA Astrophysics Data System (ADS)

Burgos-Martin, J.; Sanchez-Padron, M.; Sanchez, F.; Martinez-Roger, Carlos

2004-07-01

Large-Scale observing facilities are scarce and costly. Even so, the perspective to enlarge or to increase the number of these facilities are quite real and several projects are undertaking their first steps in this direction. These costly facilities require the cooperation of highly qualified institutions, able to undertake the project from the scientific and technological point of view, as well as the vital collaboration and effective support of several countries, at the highest level, able to provide the necessary investment for their construction. Because of these technological implications and the financial magnitude of these projects, their impact goes well beyond the international astrophysical community. We propose to carry out a study on the socio-economic impact from the construction and operation of an Extremely Large Telescope of class 30 - 100 m. We plan to approach several aspects such as its impact in the promotion of the employment; social, educational and cultural integration of the population; the impulse of industries; its impact on the national and international policies on research; environmental issues; etc. We will also analyze the financial instruments available, and those special aids only accessible for some countries and regions to encourage their participation in projects of this magnitude.

Optical and Physical Methods for Mapping Flooding with Satellite Imagery

NASA Technical Reports Server (NTRS)

Fayne, Jessica Fayne; Bolten, John; Lakshmi, Venkat; Ahamed, Aakash

2016-01-01

Flood and surface water mapping is becoming increasingly necessary, as extreme flooding events worldwide can damage crop yields and contribute to billions of dollars economic damages as well as social effects including fatalities and destroyed communities (Xaio et al. 2004; Kwak et al. 2015; Mueller et al. 2016).Utilizing earth observing satellite data to map standing water from space is indispensable to flood mapping for disaster response, mitigation, prevention, and warning (McFeeters 1996; Brakenridge and Anderson 2006). Since the early 1970s(Landsat, USGS 2013), researchers have been able to remotely sense surface processes such as extreme flood events to help offset some of these problems. Researchers have demonstrated countless methods and modifications of those methods to help increase knowledge of areas at risk and areas that are flooded using remote sensing data from optical and radar systems, as well as free publically available and costly commercial datasets.

Test Generation Algorithm for Fault Detection of Analog Circuits Based on Extreme Learning Machine

PubMed Central

Zhou, Jingyu; Tian, Shulin; Yang, Chenglin; Ren, Xuelong

2014-01-01

This paper proposes a novel test generation algorithm based on extreme learning machine (ELM), and such algorithm is cost-effective and low-risk for analog device under test (DUT). This method uses test patterns derived from the test generation algorithm to stimulate DUT, and then samples output responses of the DUT for fault classification and detection. The novel ELM-based test generation algorithm proposed in this paper contains mainly three aspects of innovation. Firstly, this algorithm saves time efficiently by classifying response space with ELM. Secondly, this algorithm can avoid reduced test precision efficiently in case of reduction of the number of impulse-response samples. Thirdly, a new process of test signal generator and a test structure in test generation algorithm are presented, and both of them are very simple. Finally, the abovementioned improvement and functioning are confirmed in experiments. PMID:25610458

Impact of an absorbent silver-eluting dressing system on lower extremity revascularization wound complications.

PubMed

Childress, Beverly B; Berceli, Scott A; Nelson, Peter R; Lee, W Anthony; Ozaki, C Keith

2007-09-01

Surgical wounds for lower extremity revascularization are prone to infection and dehiscence. Acticoat Absorbent, an antimicrobial dressing, offers sustained release of ionic silver. We hypothesized that immediate application of Acticoat as a postoperative dressing would reduce wound complications in patients undergoing leg revascularization. All infrainguinal revascularization cases involving leg incisions at a single Veterans Administration Medical Center were identified from July 1, 2002, to September 30, 2005. The control group received conventional dressings, while the treatment group received an Acticoat dressing. Wound complication rates were captured via National Surgical Quality Improvement Program data. Patient characteristics and procedure distributions were similar between groups. The wound complication rate fell 64% with utilization of the Acticoat-based dressing (control 14% [17/118], treatment 5% [7/130]; P = 0.016). An Acticoat-based dressing system offers a potentially useful, cost-effective adjunct to reduce open surgical leg revascularization wound complications.

Staged reconstruction brachytherapy has lower overall cost in recurrent soft-tissue sarcoma.

PubMed

Naghavi, Arash O; Gonzalez, Ricardo J; Scott, Jacob G; Kim, Youngchul; Abuodeh, Yazan A; Strom, Tobin J; Echevarria, Michelle; Mullinax, John E; Ahmed, Kamran A; Harrison, Louis B; Fernandez, Daniel C

2017-02-01

Adjuvant brachytherapy (AB) with immediate (IR) and staged reconstruction (SR) are distinct treatment modalities available for patients with recurrent soft tissue sarcoma (STS). Although SR may offer local control and toxicity benefit, it requires additional upfront procedures, and there is no evidence that it improves overall survival. With the importance of value-based care, our goal is to identify which technique is more cost effective. A retrospective review of 22 patients with recurrent extremity STS treated with resection followed by AB alone. Hospital charges were used to compare the cost between SR and IR at the time of initial treatment, at 6-month intervals following surgery, and cumulative cost comparisons at 18 months. Median follow-up was 31 months. Staged reconstruction ( n = 12) was associated with an 18-month local control benefit (85% vs. 42%, p = 0.034), compared to IR ( n = 10). Staged reconstruction had a longer hospital stay during initial treatment (10 vs. 3 days, p = 0.002), but at 18 months, the total hospital stay was no longer different (11 vs. 11 days). Initially, there was no difference in the cost of SR and IR. With longer follow-up, cost eventually favored SR, which was attributed primarily to the costs associated with local failure (LF). On multivariate analysis, cost of initial treatment was associated with length of hospital stay (~$4.5K per hospital day, p < 0.001), and at 18 months, the cumulative cost was ~175K lower with SR ( p = 0.005) and $58K higher with LF ( p = 0.02). In recurrent STS, SR has a longer initial hospital stay when compared to IR. At 18 months, SR had lower rates of LF, translating to lower total costs for the patient. SR is the more cost-effective brachytherapy approach in the treatment of STS, and should be considered as healthcare transitions into value-based medicine.

Staged reconstruction brachytherapy has lower overall cost in recurrent soft-tissue sarcoma

PubMed Central

Naghavi, Arash O.; Gonzalez, Ricardo J.; Scott, Jacob G.; Kim, Youngchul; Abuodeh, Yazan A.; Strom, Tobin J.; Echevarria, Michelle; Mullinax, John E.; Ahmed, Kamran A.; Harrison, Louis B.

2017-01-01

Purpose Adjuvant brachytherapy (AB) with immediate (IR) and staged reconstruction (SR) are distinct treatment modalities available for patients with recurrent soft tissue sarcoma (STS). Although SR may offer local control and toxicity benefit, it requires additional upfront procedures, and there is no evidence that it improves overall survival. With the importance of value-based care, our goal is to identify which technique is more cost effective. Material and methods A retrospective review of 22 patients with recurrent extremity STS treated with resection followed by AB alone. Hospital charges were used to compare the cost between SR and IR at the time of initial treatment, at 6-month intervals following surgery, and cumulative cost comparisons at 18 months. Results Median follow-up was 31 months. Staged reconstruction (n = 12) was associated with an 18-month local control benefit (85% vs. 42%, p = 0.034), compared to IR (n = 10). Staged reconstruction had a longer hospital stay during initial treatment (10 vs. 3 days, p = 0.002), but at 18 months, the total hospital stay was no longer different (11 vs. 11 days). Initially, there was no difference in the cost of SR and IR. With longer follow-up, cost eventually favored SR, which was attributed primarily to the costs associated with local failure (LF). On multivariate analysis, cost of initial treatment was associated with length of hospital stay (~$4.5K per hospital day, p < 0.001), and at 18 months, the cumulative cost was ~175K lower with SR (p = 0.005) and $58K higher with LF (p = 0.02). Conclusions In recurrent STS, SR has a longer initial hospital stay when compared to IR. At 18 months, SR had lower rates of LF, translating to lower total costs for the patient. SR is the more cost-effective brachytherapy approach in the treatment of STS, and should be considered as healthcare transitions into value-based medicine. PMID:28344600

Assessing the Costs and Benefits of Resilience Investments: Tennessee Valley Authority Case Study

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

Allen, Melissa R.; Wilbanks, Thomas J.; Preston, Benjamin L.

This report describes a general approach for assessing climate change vulnerabilities of an electricity system and evaluating the costs and benefits of certain investments that would increase system resilience. It uses Tennessee Valley Authority (TVA) as a case study, concentrating on the Cumberland River basin area on the northern side of the TVA region. The study focuses in particular on evaluating risks associated with extreme heat wave and drought conditions that could be expected to affect the region by mid-century. Extreme climate event scenarios were developed using a combination of dynamically downscaled output from the Community Earth System Model andmore » historical heat wave and drought conditions in 1993 and 2007, respectively.« less

Economic Geology of the Moon: Some Considerations

NASA Technical Reports Server (NTRS)

Gillett, Stephen L.

1992-01-01

Supporting any but the smallest lunar facility will require indigenous resources due to the extremely high cost of bringing material from Earth. The Moon has also attracted interest as a resource base to help support near-Earth space activities, because of the potential lower cost once the necessary infrastructure has been amortized. Obviously, initial lunar products will be high-volume, bulk commodities, as they are the only ones for which the economics of lunar production are conceivably attractive. Certain rarer elements, such as the halogens, C, and H, would also be extremely useful (for propellant, life support, and/or reagents), and indeed local sources of such elements would vastly improve the economics of lunar resource extraction. The economic geology of the Moon is discussed.

Trend, Risk Factors, and Costs of Clostridium difficile Infections in Vascular Surgery.

PubMed

Egorova, Natalia N; Siracuse, Jeffrey J; McKinsey, James F; Nowygrod, Roman

2015-01-01

Starting in December 2013, the Hospital Inpatient Quality Reporting Program included Clostridium difficile infection (CDI) rates as a new publically reported quality measure. Our goal was to review the trend, hospital variability in CDI rates, and associated risk factors and costs in vascular surgery. The rates of CDI after major vascular procedures including aortic abdominal aneurysm (AAA) repair, carotid endarterectomy or stenting, lower extremity revascularization (LER), and LE amputation were identified using Nationwide Inpatient Sample database for 2000-2011. Risk factors associated with CDI were analyzed with hierarchical multivariate logistic regression. Extra costs, length of stay (LOS), and mortality were assessed for propensity-matched hospitalizations with and without CDI. During the study period, the rates of CDI after vascular procedures had increased by 74% from 0.6 in 2000 to 1.05% in 2011, whereas the case fatality rate was stable at 9-11%. In 2011, the highest rates were after ruptured aortic abdominal aneurysm (rAAA) repair (3.3%), followed by lower extremity amputations (2.3%) and elective open AAA (1.3%). The rates of CDI increased after all vascular procedures during the 12 years. The highest increase was after endovascular LER (151.8%) and open rAAA repair (135.7%). In 2011, patients who had experienced CDI had median LOS of 15 days (interquartile range, 9-25 days) compared with 8.3 days for matched patients without CDI, in-hospital mortality 9.1% (compared with 5.0%), and $13,471 extra cost per hospitalization. The estimated cost associated with CDI in vascular surgery in the United States was ∼$98 million in 2011. Hospital rates of CDI varied from 0 to 50% with 3.5% of hospitals having infection rates ≥5%. Factors associated with CDI included multiple chronic conditions, female gender, surgery type, emergent and weekend hospitalizations, hospital transfers, and urban locations. Despite potential reduction of infection rates as evidenced by the experience of hospitals with effective interventions, CDI is increasing among vascular surgery patients. It is associated with prolonged LOS, increased mortality, and higher costs. Copyright © 2015 Elsevier Inc. All rights reserved.

A Cost-Benefit Analysis for Per-Student Expenditures and Academic Achievement

ERIC Educational Resources Information Center

Womack, Sid T.; Roberts, Kerry; Bell, C. David; Womack, Karen

2015-01-01

Cost-benefit correlations have been subject to "selective sampling" in the media. Usually extremes of data from a very few high-funding and low-funding states are cited in the media to construct the case that there is no relationship between economic inputs and academic outputs. This study, using average per-pupil expenditures and ACT…

Development of a solar-powered residential air conditioner: Screening analysis

NASA Technical Reports Server (NTRS)

1975-01-01

Screening analysis aimed at the definition of an optimum configuration of a Rankine cycle solar-powered air conditioner designed for residential application were conducted. Initial studies revealed that system performance and cost were extremely sensitive to condensing temperature and to the type of condenser used in the system. Consequently, the screening analyses were concerned with the generation of parametric design data for different condenser approaches; i. e., (1) an ambient air condenser, (2) a humidified ambient air condenser (3) an evaporative condenser, and (4) a water condenser (with a cooling tower). All systems feature a high performance turbocompressor and a single refrigerant (R-11) for the power and refrigeration loops. Data were obtained by computerized methods developed to permit system characterization over a broad range of operating and design conditions. The criteria used for comparison of the candidate system approaches were (1) overall system COP (refrigeration effect/solar heat input), (2) auxiliary electric power for fans and pumps, and (3) system installed cost or cost to the user.

Using Publicly Available Data to Construct a Transparent Measure of Health Care Value: A Method and Initial Results.

PubMed

Weeks, William B; Kotzbauer, Gregory R; Weinstein, James N

2016-06-01

Using publicly available Hospital Compare and Medicare data, we found a substantial range of hospital-level performance on quality, expenditure, and value measures for 4 common reasons for admission. Hospitals' ability to consistently deliver high-quality, low-cost care varied across the different reasons for admission. With the exception of coronary artery bypass grafting, hospitals that provided the highest-value care had more beds and a larger average daily census than those providing the lowest-value care. Transparent data like those we present can empower patients to compare hospital performance, make better-informed treatment decisions, and decide where to obtain care for particular health care problems. In the United States, the transition from volume to value dominates discussions of health care reform. While shared decision making might help patients determine whether to get care, transparency in procedure- and hospital-specific value measures would help them determine where to get care. Using Hospital Compare and Medicare expenditure data, we constructed a hospital-level measure of value from a numerator composed of quality-of-care measures (satisfaction, use of timely and effective care, and avoidance of harms) and a denominator composed of risk-adjusted 30-day episode-of-care expenditures for acute myocardial infarction (1,900 hospitals), coronary artery bypass grafting (884 hospitals), colectomy (1,252 hospitals), and hip replacement surgery (1,243 hospitals). We found substantial variation in aggregate measures of quality, cost, and value at the hospital level. Value calculation provided additional richness when compared to assessment based on quality or cost alone: about 50% of hospitals in an extreme quality- (and about 65% more in an extreme cost-) quintile were in the same extreme value quintile. With the exception of coronary artery bypass grafting, higher-value hospitals were larger and had a higher average daily census than lower-value hospitals, but were no more likely to be accredited by the Joint Commission or to have a residency program accredited by the American Council of Graduate Medical Education. While future efforts to compose value measures will certainly be modified and expanded to examine other reasons for admission, the construct that we present could allow patients to transparently compare procedure- and hospital-specific quality, spending, and value and empower them to decide where to obtain care. © 2016 Milbank Memorial Fund.

Telescience - Concepts and contributions to the Extreme Ultraviolet Explorer mission

NASA Technical Reports Server (NTRS)

Marchant, Will; Dobson, Carl; Chakrabarti, Supriya; Malina, Roger F.

1987-01-01

It is shown how the contradictory goals of low-cost and fast data turnaround characterizing the Extreme Ultraviolet Explorer (EUVE) mission can be achieved via the early use of telescience style transparent tools and simulations. The use of transparent tools reduces the parallel development of capability while ensuring that valuable prelaunch experience is not lost in the operations phase. Efforts made to upgrade the 'EUVE electronics' simulator are described.

[A cost-benefit analysis of occupational disease reporting in China].

PubMed

Tang, X Z; Zeng, Q; Liu, D S

2017-03-20

Objective: To perform a cost-benefit analysis of the occupational disease reporting system in China, and to provide a basis for effective resource allocation. Methods: The data on the cost of occupational diseases were collected from China Health Statistics Yearbook 2013, the estimated benefit data were collected from published articles in China and foreign countries, and the probability data were collected from the occupational diseasereports published by health and family planning administrative departments. Adecision-making tree was used for the cost-benefit analysis. Results: The estimated cost of occupational disease reporting was about 102.47 million yuan/year, consisting of a cost of reporting in national medical institutions of 1.25 million yuan/year, a management cost of 30.35 million yuan/year, a management cost in local public health institutions of 69.80 million yuan/year, a management cost in national public health institutions of 370 thousand yuan/year, and a cost of construction and maintenance of reporting system of 700 thousand yuan/year. The results of the decision tree analysis showed that when an occupational disease monitoring system was established, the incremental input for occupational disease monitoring and prevention/control was 2.1 billion yuan/year, the output was 6.5 billion yuan/year, and the benefit of occupational disease reporting system was 4.4 billion yuan/year. Conclusion: The benefit of occupational disease reporting system depends on the cost-benefit of occupational disease prevention and control measures, and proper prevention and control measures are extremely important for improving the benefit of occupational disease reporting system.

The magnitude and colour of noise in genetic negative feedback systems.

PubMed

Voliotis, Margaritis; Bowsher, Clive G

2012-08-01

The comparative ability of transcriptional and small RNA-mediated negative feedback to control fluctuations or 'noise' in gene expression remains unexplored. Both autoregulatory mechanisms usually suppress the average (mean) of the protein level and its variability across cells. The variance of the number of proteins per molecule of mean expression is also typically reduced compared with the unregulated system, but is almost never below the value of one. This relative variance often substantially exceeds a recently obtained, theoretical lower limit for biochemical feedback systems. Adding the transcriptional or small RNA-mediated control has different effects. Transcriptional autorepression robustly reduces both the relative variance and persistence (lifetime) of fluctuations. Both benefits combine to reduce noise in downstream gene expression. Autorepression via small RNA can achieve more extreme noise reduction and typically has less effect on the mean expression level. However, it is often more costly to implement and is more sensitive to rate parameters. Theoretical lower limits on the relative variance are known to decrease slowly as a measure of the cost per molecule of mean expression increases. However, the proportional increase in cost to achieve substantial noise suppression can be different away from the optimal frontier-for transcriptional autorepression, it is frequently negligible.

Some like it hot, some like it cold: Temperature dependent biotechnological applications and improvements in extremophilic enzymes.

PubMed

Siddiqui, Khawar Sohail

2015-12-01

The full biotechnological exploitation of enzymes is still hampered by their low activity, low stability and high cost. Temperature-dependent catalytic properties of enzymes are a key to efficient and cost-effective translation to commercial applications. Organisms adapted to temperature extremes are a rich source of enzymes with broad ranging thermal properties which, if isolated, characterized and their structure-function-stability relationship elucidated, could underpin a variety of technologies. Enzymes from thermally-adapted organisms such as psychrophiles (low-temperature) and thermophiles (high-temperature) are a vast natural resource that is already under scrutiny for their biotechnological potential. However, psychrophilic and thermophilic enzymes show an activity-stability trade-off that necessitates the use of various genetic and chemical modifications to further improve their properties to suit various industrial applications. This review describes in detail the properties and biotechnological applications of both cold-adapted and thermophilic enzymes. Furthermore, the review critically examines ways to improve their value for biotechnology, concluding by proposing an integrated approach involving thermally-adapted, genetically and magnetically modified enzymes to make biocatalysis more efficient and cost-effective. Copyright © 2015 Elsevier Inc. All rights reserved.

Generation of Stable Knockout Mammalian Cells by TALEN-Mediated Locus-Specific Gene Editing.

PubMed

Mahata, Barun; Biswas, Kaushik

2017-01-01

Precise and targeted genome editing using Transcription Activator-Like Effector Endonucleases (TALENs) has been widely used and proven to be an extremely effective and specific knockout strategy in both cultured cells and animal models. The current chapter describes a protocol for the construction and generation of TALENs using serial and hierarchical digestion and ligation steps, and using the synthesized TALEN pairs to achieve locus-specific targeted gene editing in mammalian cell lines using a modified clonal selection strategy in an easy and cost-efficient manner.

Microwave Atmospheric Sounder on CubeSat

NASA Astrophysics Data System (ADS)

Padmanabhan, S.; Brown, S. E.; Kangaslahti, P.; Cofield, R.; Russell, D.; Stachnik, R. A.; Su, H.; Wu, L.; Tanelli, S.; Niamsuwan, N.

2014-12-01

To accurately predict how the distribution of extreme events may change in the future we need to understand the mechanisms that influence such events in our current climate. Our current observing system is not well-suited for observing extreme events globally due to the sparse sampling and in-homogeneity of ground-based in-situ observations and the infrequent revisit time of satellite observations. Observations of weather extremes, such as extreme precipitation events, temperature extremes, tropical and extra-tropical cyclones among others, with temporal resolution on the order of minutes and spatial resolution on the order of few kms (<10 kms), are required for improved forecasting of extreme weather events. We envision a suite of low-cost passive microwave sounding and imaging sensors on CubeSats that would work in concert with traditional flagship observational systems, such as those manifested on large environmental satellites (i.e. JPSS,WSF,GCOM-W), to monitor weather extremes. A 118/183 GHz sensor would enable observations of temperature and precipitation extremes over land and ocean as well as tropical and extra-tropical cyclones. This proposed project would enable low cost, compact radiometer instrumentation at 118 and 183 GHz that would fit in a 6U Cubesat with the objective of mass-producing this design to enable a suite of small satellites to image the key geophysical parameters needed to improve prediction of extreme weather events. We take advantage of past and current technology developments at JPL viz. HAMSR (High Altitude Microwave Scanning Radiometer), Advanced Component Technology (ACT'08) to enable low-mass, low-power high frequency airborne radiometers. In this paper, we will describe the design and implementation of the 118 GHz temperature sounder and 183 GHz humidity sounder on the 6U CubeSat. In addition, a summary of radiometer calibration and retrieval techniques of temperature and humidity will be discussed. The successful demonstration of this instrument on the 6U CubeSat would pave the way for the development of a constellation which could sample tropospheric temperature and humidity with fine temporal and spatial resolution.

Airborne Deployment and Calibration of Microwave Atmospheric Sounder on 6U CubeSat

NASA Astrophysics Data System (ADS)

Padmanabhan, S.; Brown, S. T.; Lim, B.; Kangaslahti, P.; Russell, D.; Stachnik, R. A.

2015-12-01

To accurately predict how the distribution of extreme events may change in the future we need to understand the mechanisms that influence such events in our current climate. Our current observing system is not well-suited for observing extreme events globally due to the sparse sampling and in-homogeneity of ground-based in-situ observations and the infrequent revisit time of satellite observations. Observations of weather extremes, such as extreme precipitation events, temperature extremes, tropical and extra-tropical cyclones among others, with temporal resolution on the order of minutes and spatial resolution on the order of few kms (<10 kms), are required for improved forecasting of extreme weather events. We envision a suite of low-cost passive microwave sounding and imaging sensors on CubeSats that would work in concert with traditional flagship observational systems, such as those manifested on large environmental satellites (i.e. JPSS,WSF,GCOM-W), to monitor weather extremes. A 118/183 GHz sensor would enable observations of temperature and precipitation extremes over land and ocean as well as tropical and extra-tropical cyclones. This proposed project would enable low cost, compact radiometer instrumentation at 118 and 183 GHz that would fit in a 6U Cubesat with the objective of mass-producing this design to enable a suite of small satellites to image the key geophysical parameters needed to improve prediction of extreme weather events. We take advantage of past and current technology developments at JPL viz. HAMSR (High Altitude Microwave Scanning Radiometer), Advanced Component Technology (ACT'08) to enable low-mass, low-power high frequency airborne radiometers. In this paper, we will describe the design and implementation of the 118 GHz temperature sounder and 183 GHz humidity sounder on the 6U CubeSat. In addition, we will discuss the maiden airborne deployment of the instrument during the Plain Elevated Convection at Night (PECAN) experiment. The successful demonstration of this instrument on the 6U CubeSat would pave the way for the development of a constellation which could sample tropospheric temperature and humidity with fine temporal and spatial resolution.

Decoupling of microbial carbon, nitrogen, and phosphorus cycling in response to extreme temperature events

PubMed Central

Mooshammer, Maria; Hofhansl, Florian; Frank, Alexander H.; Wanek, Wolfgang; Hämmerle, Ieda; Leitner, Sonja; Schnecker, Jörg; Wild, Birgit; Watzka, Margarete; Keiblinger, Katharina M.; Zechmeister-Boltenstern, Sophie; Richter, Andreas

2017-01-01

Predicted changes in the intensity and frequency of climate extremes urge a better mechanistic understanding of the stress response of microbially mediated carbon (C) and nutrient cycling processes. We analyzed the resistance and resilience of microbial C, nitrogen (N), and phosphorus (P) cycling processes and microbial community composition in decomposing plant litter to transient, but severe, temperature disturbances, namely, freeze-thaw and heat. Disturbances led temporarily to a more rapid cycling of C and N but caused a down-regulation of P cycling. In contrast to the fast recovery of the initially stimulated C and N processes, we found a slow recovery of P mineralization rates, which was not accompanied by significant changes in community composition. The functional and structural responses to the two distinct temperature disturbances were markedly similar, suggesting that direct negative physical effects and costs associated with the stress response were comparable. Moreover, the stress response of extracellular enzyme activities, but not that of intracellular microbial processes (for example, respiration or N mineralization), was dependent on the nutrient content of the resource through its effect on microbial physiology and community composition. Our laboratory study provides novel insights into the mechanisms of microbial functional stress responses that can serve as a basis for field studies and, in particular, illustrates the need for a closer integration of microbial C-N-P interactions into climate extremes research. PMID:28508070

Economic analysis of the costs associated with prematurity from a literature review.

PubMed

Soilly, A L; Lejeune, C; Quantin, C; Bejean, S; Gouyon, J B

2014-01-01

To analyse published cost-of-illness studies that had assessed the cost of prematurity according to gestational age at birth. A review of the literature was carried out in March 2011 using the following databases: Medline, ScienceDirect, The Cochrane Library, Econlit and Business Source Premier, and a French Public-Health database. Key-word sequences related to 'prematurity' and 'costs' were considered. Studies that assessed costs according to the gestational age (GA) at the premature birth (<37 weeks of gestation) in industrialized countries and during the last two decades were included. Variations in the reported costs were analysed using a check-list, which allowed the studies to be described according to several methodological and contextual criteria. A total of 18 studies published since 1990 were included. According to these studies, costs were assessed for different follow-up periods (short, medium or long-term), and for different degrees of prematurity (extreme, early, moderate and late). Results showed that whatever the follow-up period, costs correlated inversely with GA. They also showed considerable variability in costs within the same GA group. Differences between studies could be explained by the choices made, concerning i/the study populations, ii/contextual information, iii/and various economic criteria. Despite these variations, a global trend of costs was estimated in the short-term period using mean costs from four American studies that presented similar methodologies. Costs stand at over US$ 100,000 for extreme prematurity, between US$ 40,000 and US$ 100,000 for early prematurity, between US$ 10,000 and US$ 30,000 for moderate prematurity and below US$ 4500 for late prematurity. This review underlined not only the clear inverse relationship between costs and GA at birth, but also the difficulty to transfer the results to the French context. It suggests that studies specific to the French health system need to be carried out. Copyright © 2013 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Effect of Footwear on Joint Pain and Function in Older Adults With Lower Extremity Osteoarthritis.

PubMed

Wagner, Amy; Luna, Sarah

Lower extremity osteoarthritis (OA) is a common condition among older adults; given the risks of surgical and pharmaceutical interventions, conservative, lower-cost management options such as footwear warrant further investigation. This systematic review investigated the effects of footwear, including shoe inserts, in reducing lower extremity joint pain and improving gait, mobility, and quality of life in older adults with OA. The CINAHL, SPORTDiscus, PubMed, RECAL, and Web of Knowledge databases were searched for publications from January 1990 to September 2014, using the terms "footwear," "shoes," "gait," "pain," and "older adult." Participants who were 50 years or older and those who had OA in at least one lower extremity joint narrowed the results. Outcomes of interest included measures of pain, comfort, function, gait, or quality of life. Exclusion criteria applied to participants with rheumatoid arthritis, amputation, diabetes, multiple sclerosis, use of modified footwear or custom orthotics, purely biomechanical studies, and outcomes of balance or falls only. Single-case studies, qualitative narrative descriptions, and expert opinions were also excluded. The initial search resulted in a total of 417 citations. Eleven articles met inclusion criteria. Two randomized controlled trials and 3 quasiexperimental studies reported lateral wedge insoles may have at least some pain-relieving effects and improved functional mobility in older adults at 4 weeks to 2 years' follow-up, particularly when used with subtalar and ankle strapping. Three randomized controlled trials with large sample sizes reported that lateral wedges provided no knee pain relief compared with flat insoles. Hardness of shoe soles did not significantly affect joint comfort in the foot in a quasiexperimental study. A quasiexperimental designed study investigating shock-absorbing insoles showed reduction in knee joint pain with 1 month of wear. Finally, a cross-sectional prognostic study indicated poor footwear at early ages exhibits an association with hindfoot pain later in life. Because of the limited number of randomized control trials, it is not possible to make a definitive conclusion about the long-term effects of footwear on lower extremity joint pain caused by OA. There is mounting evidence that shock-absorbing insoles, subtalar strapping, and avoidance of high heels and sandals early in life may prevent lower extremity joint pain in older adults, but no conclusive evidence exists to show that lateral wedge insoles will provide long-term relief from knee joint pain and improved mobility in older adults with OA. More high-quality randomized control trials are needed to study the effectiveness of footwear and shoe inserts on joint pain and function in older adults with OA.

Modeling and Simulating Multiple Failure Masking enabled by Local Recovery for Stencil-based Applications at Extreme Scales

DOE PAGES

Gamell, Marc; Teranishi, Keita; Mayo, Jackson; ...

2017-04-24

By obtaining multi-process hard failure resilience at the application level is a key challenge that must be overcome before the promise of exascale can be fully realized. Some previous work has shown that online global recovery can dramatically reduce the overhead of failures when compared to the more traditional approach of terminating the job and restarting it from the last stored checkpoint. If online recovery is performed in a local manner further scalability is enabled, not only due to the intrinsic lower costs of recovering locally, but also due to derived effects when using some application types. In this papermore » we model one such effect, namely multiple failure masking, that manifests when running Stencil parallel computations on an environment when failures are recovered locally. First, the delay propagation shape of one or multiple failures recovered locally is modeled to enable several analyses of the probability of different levels of failure masking under certain Stencil application behaviors. These results indicate that failure masking is an extremely desirable effect at scale which manifestation is more evident and beneficial as the machine size or the failure rate increase.« less

Climate Changes and Human Health: A Review of the Effect of Environmental Stressors on Cardiovascular Diseases Across Epidemiology and Biological Mechanisms.

PubMed

Giorgini, Paolo; Di Giosia, Paolo; Petrarca, Marco; Lattanzio, Francesco; Stamerra, Cosimo Andrea; Ferri, Claudio

2017-01-01

Climate change is rapidly affecting all the regions of our planet. The most relevant example is global warming, which impacts on the earth's ecosystems, threatening human health. Other effects include extreme variations in temperature and increases in air pollution. These events may negatively impact mortality and morbidity for cardiovascular diseases. In this review, we discuss the main effects of climate changes on cardiovascular diseases, reporting the epidemiological evidences and the biological mechanisms linking climate change consequences to hypertension, diabetes, ischemic heart diseases, heart failure and stroke. Up to now, findings suggest that humans acclimate under different weather conditions, even though extreme temperatures and higher levels of air pollution can influence health-related outcomes. In these cases, climate change adversely affects cardiovascular system and the high-risk subjects for cardiovascular diseases are those more exposed. Finally, we examine climate change implications on publich health and suggest adaptation strategies to monitor the high-risk population, and reduce the amount of hospital admissions associated to these events. Such interventions may minimize the costs of public health and reduce the mortality for cardiovascular diseases. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Modeling and Simulating Multiple Failure Masking enabled by Local Recovery for Stencil-based Applications at Extreme Scales

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

Gamell, Marc; Teranishi, Keita; Mayo, Jackson

By obtaining multi-process hard failure resilience at the application level is a key challenge that must be overcome before the promise of exascale can be fully realized. Some previous work has shown that online global recovery can dramatically reduce the overhead of failures when compared to the more traditional approach of terminating the job and restarting it from the last stored checkpoint. If online recovery is performed in a local manner further scalability is enabled, not only due to the intrinsic lower costs of recovering locally, but also due to derived effects when using some application types. In this papermore » we model one such effect, namely multiple failure masking, that manifests when running Stencil parallel computations on an environment when failures are recovered locally. First, the delay propagation shape of one or multiple failures recovered locally is modeled to enable several analyses of the probability of different levels of failure masking under certain Stencil application behaviors. These results indicate that failure masking is an extremely desirable effect at scale which manifestation is more evident and beneficial as the machine size or the failure rate increase.« less

A new function of graphene oxide emerges: inactivating phytopathogenic bacterium Xanthomonas oryzae pv. Oryzae

NASA Astrophysics Data System (ADS)

Chen, Juanni; Wang, Xiuping; Han, Heyou

2013-05-01

Xanthomonas oryzae pv. oryzae ( Xoo) is one representative phytopathogenic bacterium causing bacteria infections in rice. The antibacterial activity of graphene suspended in different dispersants against Xoo was first investigated. Bacteriological test data, fluorescence microscope and transmission electron microscopy images are provided, which yield insight into the antibacterial action of the nanoscale materials. Surprisingly, the results showed graphene oxide (GO) exhibits superior bactericidal effect even at extremely low dose in water (250 μg/mL), almost killing 94.48 % cells, in comparison to common bactericide bismerthiazol with only 13.3 % mortality. The high efficiency in inactivating the bacteria on account of considerable changes in the cell membranes caused by the extremely sharp edges of graphene oxide and generation of reactive oxygen species, which may be the fatal factor for bacterial inactivation. Given the superior antibacterial effect of GO and the fact that GO can be mass-produced with low cost, we expect a new application could be developed as bactericide for controlling plant disease, which may be a matter of great importance for agricultural development.

Managing healthcare costs within an integrated framework.

PubMed

Fernandes, Rudy

2002-01-01

Laupacis, Anderson and O'Brien's comprehensive diagnosis of the illness affecting the Canadian healthcare system is very insightful. In addition, their call for improving the quality of drug evidence and outcomes is a laudable goal. However, their prognosis of the negative impact on healthcare due to escalating drug costs appears to be rather pessimistic, as they fail to view drugs within an integrated framework. In part, their prescription for the perceived malady is rather impractical. Their recommendation for mandatory head-to-head randomized studies, as a prerequisite for achieving new drug listing in benefit formularies, suffers from many drawbacks. Such studies would be highly time-consuming, extremely costly, and given the fact that the choice of a drug comparator is a "moving target," the end result may not achieve the original intent. Growing anxieties about the rising healthcare costs in Canada, now forecast to reach C$100 billion in 2002, have led to implementation ofa variety of reforms aimed at cost-cutting. Shifts in drug utilization, demographics and prescribing have contributed to the authors' understandable concern about the rapid rise in drug plan expenditure, which has undeniably outpaced the increases of other healthcare components. However, drug plan costs represent only 7.7% of total provincial/territorial healthcare expenditures. Innovative medicines have played a significant role in reducing the burden of illness and overall healthcare costs. Drugs prevent, treat and cure disease, improve quality of life, control pain/suffering and save lives. Despite their great value, spending on drugs has received particular scrutiny from policy-makers, and pharmaceuticals have become the primary cost-containment target. The authors' goal-oriented concept of creating a clinical milieu that encourages cost-effective prescribing via "optimum" drug use is very attractive. One such approach is Disease Management, which relies on evidence-based, outcome-oriented performance indicators. It is highly regarded for promoting effective treatment options, improving patient care and optimizing healthcare resource utilization--hence deserving serious consideration for reducing overall costs while achieving improved outcomes.

Development of disease-resistant rice using regulatory components of induced disease resistance

PubMed Central

Takatsuji, Hiroshi

2014-01-01

Infectious diseases cause huge crop losses annually. In response to pathogen attacks, plants activate defense systems that are mediated through various signaling pathways. The salicylic acid (SA) signaling pathway is the most powerful of these pathways. Several regulatory components of the SA signaling pathway have been identified, and are potential targets for genetic manipulation of plants’ disease resistance. However, the resistance associated with these regulatory components is often accompanied by fitness costs; that is, negative effects on plant growth and crop yield. Chemical defense inducers, such as benzothiadiazole and probenazole, act on the SA pathway and induce strong resistance to various pathogens without major fitness costs, owing to their ‘priming effect.’ Studies on how benzothiadiazole induces disease resistance in rice have identified WRKY45, a key transcription factor in the branched SA pathway, and OsNPR1/NH1. Rice plants overexpressing WRKY45 were extremely resistant to rice blast disease caused by the fungus Magnaporthe oryzae and bacterial leaf blight disease caused by Xanthomonas oryzae pv. oryzae (Xoo), the two major rice diseases. Disease resistance is often accompanied by fitness costs; however, WRKY45 overexpression imposed relatively small fitness costs on rice because of its priming effect. This priming effect was similar to that of chemical defense inducers, although the fitness costs were amplified by some environmental factors. WRKY45 is degraded by the ubiquitin–proteasome system, and the dual role of this degradation partly explains the priming effect. The synergistic interaction between SA and cytokinin signaling that activates WRKY45 also likely contributes to the priming effect. With a main focus on these studies, I review the current knowledge of SA-pathway-dependent defense in rice by comparing it with that in Arabidopsis, and discuss potential strategies to develop disease-resistant rice using signaling components. PMID:25431577

Tuberculosis active case finding in Cambodia: a pragmatic, cost-effectiveness comparison of three implementation models.

PubMed

James, Richard; Khim, Keovathanak; Boudarene, Lydia; Yoong, Joanne; Phalla, Chea; Saint, Saly; Koeut, Pichenda; Mao, Tan Eang; Coker, Richard; Khan, Mishal Sameer

2017-08-22

Globally, almost 40% of tuberculosis (TB) patients remain undiagnosed, and those that are diagnosed often experience prolonged delays before initiating correct treatment, leading to ongoing transmission. While there is a push for active case finding (ACF) to improve early detection and treatment of TB, there is extremely limited evidence about the relative cost-effectiveness of different ACF implementation models. Cambodia presents a unique opportunity for addressing this gap in evidence as ACF has been implemented using different models, but no comparisons have been conducted. The objective of our study is to contribute to knowledge and methodology on comparing cost-effectiveness of alternative ACF implementation models from the health service perspective, using programmatic data, in order to inform national policy and practice. We retrospectively compared three distinct ACF implementation models - door to door symptom screening in urban slums, checking contacts of TB patients, and door to door symptom screening focusing on rural populations aged above 55 - in terms of the number of new bacteriologically-positive pulmonary TB cases diagnosed and the cost of implementation assuming activities are conducted by the national TB program of Cambodia. We calculated the cost per additional case detected using the alternative ACF models. Our analysis, which is the first of its kind for TB, revealed that the ACF model based on door to door screening in poor urban areas of Phnom Penh was the most cost-effective (249 USD per case detected, 737 cases diagnosed), followed by the model based on testing contacts of TB patients (308 USD per case detected, 807 cases diagnosed), and symptomatic screening of older rural populations (316 USD per case detected, 397 cases diagnosed). Our study provides new evidence on the relative effectiveness and economics of three implementation models for enhanced TB case finding, in line with calls for data from 'routine conditions' to be included in disease control program strategic planning. Such cost-effectiveness comparisons are essential to inform resource allocation decisions of national policy makers in resource constraint settings. We applied a novel, pragmatic methodological approach, which was designed to provide results that are directly relevant to policy makers, costing the interventions from Cambodia's national TB program's perspective and using case finding data from implementation activities, rather than experimental settings.

Inexpensive and fast pathogenic bacteria screening using field-effect transistors.

PubMed

Formisano, Nello; Bhalla, Nikhil; Heeran, Mel; Reyes Martinez, Juana; Sarkar, Amrita; Laabei, Maisem; Jolly, Pawan; Bowen, Chris R; Taylor, John T; Flitsch, Sabine; Estrela, Pedro

2016-11-15

While pathogenic bacteria contribute to a large number of globally important diseases and infections, current clinical diagnosis is based on processes that often involve culturing which can be time-consuming. Therefore, innovative, simple, rapid and low-cost solutions to effectively reduce the burden of bacterial infections are urgently needed. Here we demonstrate a label-free sensor for fast bacterial detection based on metal-oxide-semiconductor field-effect transistors (MOSFETs). The electric charge of bacteria binding to the glycosylated gates of a MOSFET enables quantification in a straightforward manner. We show that the limit of quantitation is 1.9×10(5) CFU/mL with this simple device, which is more than 10,000-times lower than is achieved with electrochemical impedance spectroscopy (EIS) and matrix-assisted laser desorption ionisation time-of-flight mass spectrometry (MALDI-ToF) on the same modified surfaces. Moreover, the measurements are extremely fast and the sensor can be mass produced at trivial cost as a tool for initial screening of pathogens. Copyright © 2016 Elsevier B.V. All rights reserved.

Conducting Slug Tests in Mini-Piezometers: B.G. Fritz Ground Water xx, no. x: x-xx

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

Fritz, Bradley G.; Mackley, Rob D.; Arntzen, Evan V.

Slug tests performed using mini-piezometers with diameters as small as 0.43 cm can provide a cost effective tool for hydraulic characterization. We evaluated the hydraulic properties of the apparatus in an infinite hydraulic conductivity environment and compared those results with field tests of mini-piezometers installed into locations with varying hydraulic properties. Based on our evaluation, slug tests conducted in mini-piezometers using the fabrication and installation approach described here are effective within formations where the hydraulic conductivity is less than 1 x 10-3 cm/s. While these constraints limit the potential application of this method, the benefits to this approach are thatmore » the installation, measurement and analysis is extremely cost effective, and the installation can be completed in areas where other (larger diameter) methods might not be possible. Additionally, this methodology could be applied to existing mini-piezometers previously installed for other purposes. Such analysis of existing installations could be beneficial in interpreting previously collected data (e.g. water quality data or hydraulic head data).« less

Cognitive trade-offs and the costs of resilience.

PubMed

Crespi, Bernard J

2015-01-01

Genetic, endocrinological, and psychological evidence demonstrates that resilience commonly trades off with sensitivity. The existence of such trade-offs indicates that resilience bears costs as well as benefits, and that some disorders can best be conceptualized in terms of extremes of trade-offs rather than expression of deficits. Testing for cognitive trade-offs should be a priority for psychiatry, psychology, neuroscience, and genetics.

The cost of acquiring public hunting access on family forests lands

Treesearch

Michael A. Kilgore; Stephanie A. Snyder; Joesph M. Schertz; Steven J. Taff

2008-01-01

To address the issue of declining access to private forest land in the United States for hunting, over 1,000 Minnesota family forest owners were surveyed to estimate the cost of acquiring non-exclusive public hunting access rights. The results indicate landowner interest in selling access rights is extremely modest. Using binary logistic regression, the mean annual...

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

NASA Astrophysics Data System (ADS)

Skipper, Richard S.; Spencer, Ian D.

2005-09-01

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

The effects of weld-repair and hot isostatic pressing on the fracture properties of Ti-5Al-2.5Sn ELI castings

NASA Technical Reports Server (NTRS)

Misra, M. S.; Lemeshewsky, S.; Bolstad, D.

1982-01-01

The Ti-5Al-2.5Sn extremely low interstitial alloy employed in the large castings which form the critical attachment fittings of the Space Shuttle External Tank was selected because of its high fracture resistance at cryogenic temperatures. Casting was selected over alternative fabrication methods because of its lower cost and adaptability to design changes, although it was found necessary to weld-repair surface and subsurface casting defects in order to reduce the scrap rate and maintain the inherent cost advantage of the castings. Hot Isostatic Pressing was experimentally found to heal the surface and internal defects of the castings, but did not improve tensile or fracture properties and was therefore rejected as a production technique. Production castings are instead weld-repaired, without any mechanical property degradation.

Development and Validation of Various Phenotyping Algorithms for Diabetes Mellitus Using Data from Electronic Health Records.

PubMed

Esteban, Santiago; Rodríguez Tablado, Manuel; Peper, Francisco; Mahumud, Yamila S; Ricci, Ricardo I; Kopitowski, Karin; Terrasa, Sergio

2017-01-01

Precision medicine requires extremely large samples. Electronic health records (EHR) are thought to be a cost-effective source of data for that purpose. Phenotyping algorithms help reduce classification errors, making EHR a more reliable source of information for research. Four algorithm development strategies for classifying patients according to their diabetes status (diabetics; non-diabetics; inconclusive) were tested (one codes-only algorithm; one boolean algorithm, four statistical learning algorithms and six stacked generalization meta-learners). The best performing algorithms within each strategy were tested on the validation set. The stacked generalization algorithm yielded the highest Kappa coefficient value in the validation set (0.95 95% CI 0.91, 0.98). The implementation of these algorithms allows for the exploitation of data from thousands of patients accurately, greatly reducing the costs of constructing retrospective cohorts for research.

A lower bound to the social cost of CO2 emissions

NASA Astrophysics Data System (ADS)

van den Bergh, J. C. J. M.; Botzen, W. J. W.

2014-04-01

Many studies have estimated the social cost of carbon (SCC). We critically evaluate SCC estimates, focusing on omitted cost categories, discounting, uncertainties about damage costs and risk aversion. This allows for the calculation of a lower bound to the SCC. Dominant SCC values turn out to be gross underestimates, notably, but not only, for a low discount rate. The validity of this lower bound is supported by a precautionary approach to reflect risk aversion against extreme climate change. The results justify a more stringent climate policy than is suggested by most influential past studies.

Jig For Stereoscopic Photography

NASA Technical Reports Server (NTRS)

Nielsen, David J.

1990-01-01

Separations between views adjusted precisely for best results. Simple jig adjusted to set precisely, distance between right and left positions of camera used to make stereoscopic photographs. Camera slides in slot between extreme positions, where it takes stereoscopic pictures. Distance between extreme positions set reproducibly with micrometer. In view of trend toward very-large-scale integration of electronic circuits, training method and jig used to make training photographs useful to many companies to reduce cost of training manufacturing personnel.

Structures and Materials Technologies for Extreme Environments Applied to Reusable Launch Vehicles

NASA Technical Reports Server (NTRS)

Scotti, Stephen J.; Clay, Christopher; Rezin, Marc

2003-01-01

This paper provides an overview of the evolution of structures and materials technology approaches to survive the challenging extreme environments encountered by earth-to-orbit space transportation systems, with emphasis on more recent developments in the USA. The evolution of technology requirements and experience in the various approaches to meeting these requirements has significantly influenced the technology approaches. While previous goals were primarily performance driven, more recently dramatic improvements in costs/operations and in safety have been paramount goals. Technologies that focus on the cost/operations and safety goals in the area of hot structures and thermal protection systems for reusable launch vehicles are presented. Assessments of the potential ability of the various technologies to satisfy the technology requirements, and their current technology readiness status are also presented.

Cost analysis of surgically treated pressure sores stage III and IV.

PubMed

Filius, A; Damen, T H C; Schuijer-Maaskant, K P; Polinder, S; Hovius, S E R; Walbeehm, E T

2013-11-01

Health-care costs associated with pressure sores are significant and their financial burden is likely to increase even further. The aim of this study was to analyse the direct medical costs of hospital care for surgical treatment of pressure sores stage III and IV. We performed a retrospective chart study of patients who were surgically treated for stage III and IV pressure sores between 2007 and 2010. Volumes of health-care use were obtained for all patients and direct medical costs were subsequently calculated. In addition, we evaluated the effect of location and number of pressure sores on total costs. A total of 52 cases were identified. Average direct medical costs in hospital were €20,957 for the surgical treatment of pressure sores stage III or IV; average direct medical costs for patients with one pressure sore on an extremity (group 1, n = 5) were €30,286, €10,113 for patients with one pressure sore on the trunk (group 2, n = 32) and €40,882 for patients with multiple pressure sores (group 3, n = 15). The additional costs for patients in group 1 and group 3 compared to group 2 were primarily due to longer hospitalisation. The average direct medical costs for surgical treatment of pressure sores stage III and IV were high. Large differences in costs were related to the location and number of pressure sores. Insight into the distribution of these costs allows identification of high-risk patients and enables the development of specific cost-reducing measures. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Past and future weather-induced risk in crop production

NASA Astrophysics Data System (ADS)

Elliott, J. W.; Glotter, M.; Russo, T. A.; Sahoo, S.; Foster, I.; Benton, T.; Mueller, C.

2016-12-01

Drought-induced agricultural loss is one of the most costly impacts of extreme weather and may harm more people than any other consequence of climate change. Improvements in farming practices have dramatically increased crop productivity, but yields today are still tightly linked to climate variation. We report here on a number of recent studies evaluating extreme event risk and impacts under historical and near future conditions, including studies conducted as part of the Agricultural Modeling Intercomparison and Improvement Project (AgMIP), the Inter-Sectoral Impacts Model Intercomparison Project (ISI-MIP) and the UK-US Taskforce on Extreme Weather and Global Food System Resilience.

The effect of segmental weight of prosthesis on hemodynamic responses and energy expenditure of lower extremity amputees

PubMed Central

Mutlu, Akmer; Kharooty, Mohammad Dawood; Yakut, Yavuz

2017-01-01

[Purpose] The aim of this study was to investigate the effect of segmental weight of the prosthesis on hemodynamic responses and energy expenditure in lower extremity amputees. [Subjects and Methods] Thirteen patients with a mean age of 44 ± 15.84 years and with unilateral transtibial, transfemoral and Syme’s amputation were included to the study. The difference between the lightest and the heaviest prosthesis, 250 g used as the weight. All the patients completed the measurements first without weight and then with 250 g weight on the ankle joint. The blood pressure and heart rate of the patients were recorded before and after Six Minute Walk Test (6MWT) and 10 stairs up & down stairs test. Physiological Cost Index was used to calculate the energy expenditure. [Results] Heart rate and energy expenditure increased significantly when without weight and with weight results compared. [Conclusion] We conclude that the segmental weight of the prosthetic limb has a significant effect on the heart rate and energy expenditure but has no effect on the systolic and diastolic blood pressure of lower limb amputees. In order to generalize our results to lower limb amputees, more patients need to be included in future studies. PMID:28533599

Infection dynamics on spatial small-world network models

NASA Astrophysics Data System (ADS)

Iotti, Bryan; Antonioni, Alberto; Bullock, Seth; Darabos, Christian; Tomassini, Marco; Giacobini, Mario

2017-11-01

The study of complex networks, and in particular of social networks, has mostly concentrated on relational networks, abstracting the distance between nodes. Spatial networks are, however, extremely relevant in our daily lives, and a large body of research exists to show that the distances between nodes greatly influence the cost and probability of establishing and maintaining a link. A random geometric graph (RGG) is the main type of synthetic network model used to mimic the statistical properties and behavior of many social networks. We propose a model, called REDS, that extends energy-constrained RGGs to account for the synergic effect of sharing the cost of a link with our neighbors, as is observed in real relational networks. We apply both the standard Watts-Strogatz rewiring procedure and another method that conserves the degree distribution of the network. The second technique was developed to eliminate unwanted forms of spatial correlation between the degree of nodes that are affected by rewiring, limiting the effect on other properties such as clustering and assortativity. We analyze both the statistical properties of these two network types and their epidemiological behavior when used as a substrate for a standard susceptible-infected-susceptible compartmental model. We consider and discuss the differences in properties and behavior between RGGs and REDS as rewiring increases and as infection parameters are changed. We report considerable differences both between the network types and, in the case of REDS, between the two rewiring schemes. We conclude that REDS represent, with the application of these rewiring mechanisms, extremely useful and interesting tools in the study of social and epidemiological phenomena in synthetic complex networks.

Are wetland regulations cost effective for species protection? A case study of amphibian metapopulations.

PubMed

Bauer, Dana Marie; Paton, Peter W C; Swallow, Stephen K

2010-04-01

Recent declines in amphibian populations have raised concern among conservation biologists, with habitat loss and degradation due to human activities among the leading causes. The most common policies used to protect the habitat of pond-breeding amphibians are wetland regulations that safeguard the wetland itself. However, many amphibians spend much of their adult lives foraging and over-wintering in upland habitats and exist as metapopulations with dispersal among ponds. With no consideration of lands in the dispersal matrix, wetland policies may be ineffective at protecting amphibians or other wetland species that disperse across the landscape. This paper examined the adequacy and cost effectiveness of alternative conservation policies and their corresponding land use patterns on the long-term persistence of pond-breeding amphibians in exurban landscapes. We used computer simulations to compare outcomes of wetland buffer policies and broader landscape-wide conservation policies across a variety of landscape scenarios, and we conducted sensitivity analyses on the model's species parameters in order to generalize our results to other wetland species. Results showed that, in the majority of human-dominated landscapes, some amount of dispersal matrix protection is necessary for long-term species persistence. However, in landscapes with extremely low-intensity land use (e.g., low-density residential housing) and high pond density, wetland buffer policies may be all that is required. It is not always more cost effective to protect core habitat over the dispersal matrix, a common conservation practice. Conservation costs that result from forgone residential, commercial, or agricultural activities can vary substantially but increase in a nonlinear manner regardless of land use zoning. There appears to be a threshold around an average habitat patch occupancy level of 80%, after which opportunity costs rise dramatically.

A review of typhoid fever transmission dynamic models and economic evaluations of vaccination.

PubMed

Watson, Conall H; Edmunds, W John

2015-06-19

Despite a recommendation by the World Health Organization (WHO) that typhoid vaccines be considered for the control of endemic disease and outbreaks, programmatic use remains limited. Transmission models and economic evaluation may be informative in decision making about vaccine programme introductions and their role alongside other control measures. A literature search found few typhoid transmission models or economic evaluations relative to analyses of other infectious diseases of similar or lower health burden. Modelling suggests vaccines alone are unlikely to eliminate endemic disease in the short to medium term without measures to reduce transmission from asymptomatic carriage. The single identified data-fitted transmission model of typhoid vaccination suggests vaccines can reduce disease burden substantially when introduced programmatically but that indirect protection depends on the relative contribution of carriage to transmission in a given setting. This is an important source of epidemiological uncertainty, alongside the extent and nature of natural immunity. Economic evaluations suggest that typhoid vaccination can be cost-saving to health services if incidence is extremely high and cost-effective in other high-incidence situations, when compared to WHO norms. Targeting vaccination to the highest incidence age-groups is likely to improve cost-effectiveness substantially. Economic perspective and vaccine costs substantially affect estimates, with disease incidence, case-fatality rates, and vaccine efficacy over time also important determinants of cost-effectiveness and sources of uncertainty. Static economic models may under-estimate benefits of typhoid vaccination by omitting indirect protection. Typhoid fever transmission models currently require per-setting epidemiological parameterisation to inform their use in economic evaluation, which may limit their generalisability. We found no economic evaluation based on transmission dynamic modelling, and no economic evaluation of typhoid vaccination against interventions such as improvements in sanitation or hygiene. Copyright © 2015. Published by Elsevier Ltd.

Alternatives to lifting concrete masonry blocks onto rebar: biomechanical and perceptual evaluations.

PubMed

Hess, J A; Mizner, R L; Kincl, L; Anton, D

2012-01-01

This study examined the use of and barriers to H-block and high lift grouting, two alternatives to lifting concrete masonry blocks onto vertical rebar. Peak and cumulative shoulder motions were evaluated, as well as adoption barriers: H-block cost and stakeholder perceptions. Results indicated that using the alternatives significantly decreased peak shoulder flexion (p < 0.001). A case study indicated that building cost was higher with H-block, but the difference was less than 2% of the total cost. Contractors and specifiers reported important differences in perceptions, work norms, and material use and practices. For example, 48% of specifiers reported that use of high lift grouting was the contractor's choice, while 28% of contractors thought it must be specified. Use of H-block or high-lift grouting should be considered as methods to reduce awkward upper extremity postures. Cost and stakeholders' other perceptions present barriers that are important considerations when developing diffusion strategies for these alternatives. This study provides information from several perspectives about ergonomic controls for a high risk bricklaying task, which will benefit occupational safety experts, health professionals and ergonomists. It adds to the understanding of shoulder stresses, material cost and stakeholder perceptions that will contribute to developing effective diffusion strategies.

Magnetic resonance imaging in evaluating workers' compensation patients.

PubMed

Babbel, Daniel; Rayan, Ghazi

2012-04-01

We studied the utility of magnetic resonance imaging (MRI) studies for workers' compensation patients with hand conditions in which the referring doctor obtained the images. We compared the MRI findings with the eventual clinical findings. We also investigated the approximate cost of these MRI studies. We retrospectively reviewed the charts of all workers' compensation patients seen in a hand and upper extremity practice over the course of 3 years. We selected patients who had MRI studies of the affected upper extremities before referral to the senior author (G.R.). We reviewed the charts for information regarding demographics, referral diagnoses, MRI diagnoses made by the radiologist, the area of the upper extremity studied, and eventual clinical diagnoses by the senior author. We made a determination as to whether a hand surgeon could have adequately diagnosed and treated the patients' conditions without the imaging studies. We also investigated the cost associated with these MRIs. We included 62 patients with a total of 67 MRI scans in this study. The MRI studies did not contribute to clinically diagnosing the patients' conditions in any of the cases we reviewed. The hand surgeon's clinical diagnosis disagreed with the radiologist's MRI diagnosis in 63% of patients. The MRI was unnecessary to arrive at the clinical diagnosis and did not influence the treatment offered for any of the 62 patients. The total cost for the 67 non-contrast MRI studies was approximately $53,000. Costly imaging studies are frequently done to determine the validity of a patient's reported problems; unfortunately, these tests are frequently unnecessary and waste resources. Magnetic resonance imaging scans may not be the standard for accurate diagnosis and can misdirect care. Therapeutic III. Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Analysis of usage and associated cost of external fixators at an urban level 1 trauma centre.

PubMed

Chaus, George W; Dukes, Chase; Hak, David J; Mauffrey, Cyril; Mark Hammerberg, E

2014-10-01

To determine the usage, indication, duration, and cost associated with external fixation usage. Additionally, to show the significant cost associated with external fixator use and reinvigorate discussions on external fixator reuse. A retrospective review of a prospectively gathered trauma database was undertaken to identify all patients treated with external fixation frames for pelvic and lower extremity injuries between September 2007 and July 2010. We noted the indications for frame use, and we determined the average duration of external fixation for each indication. The cost of each frame was calculated from implant records. 341 lower extremity and pelvic fractures were treated with external fixation frames during the study period. Of these, 92% were used as temporary external fixation. The average duration of temporary external fixation was 10.5 days. The cost of external fixation frame components was $670,805 per year. The average cost per external fixation frame was $5900. The majority of external fixators are intended as temporary frames, in place for a limited period of time prior to definitive fixation of skeletal injuries. As such, most frames are not intended to withstand physiologic loads, nor are they expected provide a precise maintenance of reduction. Given the considerable expense associated with external fixation frame components, the practice of purchasing external fixation frame components as disposable "single-use" items appears to be somewhat wasteful. Level II. Copyright © 2014 Elsevier Ltd. All rights reserved.

Influence of the world's most challenging mountain ultra-marathon on energy cost and running mechanics.

PubMed

Vernillo, Gianluca; Savoldelli, Aldo; Zignoli, Andrea; Trabucchi, Pietro; Pellegrini, Barbara; Millet, Grégoire P; Schena, Federico

2014-05-01

To examine the effects of the world's most challenging mountain ultra-marathon (Tor des Géants(®) 2012) on the energy cost of three types of locomotion (cycling, level and uphill running) and running kinematics. Before (pre-) and immediately after (post-) the competition, a group of ten male experienced ultra-marathon runners performed in random order three submaximal 4-min exercise trials: cycling at a power of 1.5 W kg(-1) body mass; level running at 9 km h(-1) and uphill running at 6 km h(-1) at an inclination of +15 % on a motorized treadmill. Two video cameras recorded running mechanics at different sampling rates. Between pre- and post-, the uphill-running energy cost decreased by 13.8 % (P = 0.004); no change was noted in the energy cost of level running or cycling (NS). There was an increase in contact time (+10.3 %, P = 0.019) and duty factor (+8.1 %, P = 0.001) and a decrease in swing time (-6.4 %, P = 0.008) in the uphill-running condition. After this extreme mountain ultra-marathon, the subjects modified only their uphill-running patterns for a more economical step mechanics.

Quality of life and costs of spasticity treatment in German stroke patients.

PubMed

Rychlik, Reinhard; Kreimendahl, Fabian; Schnur, Nicole; Lambert-Baumann, Judith; Dressler, Dirk

2016-12-01

To gather data about the medical and non-medical health service in patients suffering from post-stroke spasticity of the upper limb and evaluate treatment effectiveness and tolerability as well as costs over the treatment period of one year. Prospective, non-interventional, multicenter, parallel-group study comparing effectivenessand costs of incobotulinumtoxinA (INCO) treatment (n = 118) to conventional (CON) antispastic therapy (n = 110) for upper limb spasticity after stroke in 47 clinical practices across Germany over a 1-year treatment period. IncobotulinumtoxinA was applied according to the individual treatment algorithms of each participating site and additional antispastic treatments were allowed. Primary efficacy objective was the reduction of the muscle tone measured by Ashworth scale. Responder analyses and logistic regressions were performed. Quality of life, measured by SF-12 questionnaire and functional disability were assessed. Besides calculating treatment costs, a cost-utility analysis was performed. Responder rates of all muscle groups of the upper extremities were significantly higher in the treatment group (62.9-86.2 % vs. 15.5-26.9 %, p < 0.01). Total health service costs were twice as high in the INCO group, however cost-utility ratios were consistently superior compared to the control group. Lowest incremental costs were documented to improve the "physical health" dimension in quality of life. Higher responder rates, higher increases in quality of life and superior cost-utility ratios in the BoNT/A-treatment group underline guideline recommendations for botulinum toxin A treatment in focal or segmental spasticity. Results may partially be influenced by different patient demographics or disease severity at study entry.

A Sensitivity-Based Approach to Quantifying the Costs of Weather and Climate Impacts: A Case Study of the Southern Pennsylvania Transportation Authority Adaptation Pilot Project

NASA Astrophysics Data System (ADS)

Casola, J.; Johanson, E.; Groth, P.; Snow, C.; Choate, A.

2012-12-01

Southeastern Pennsylvania Transportation Authority (SEPTA), with support from the Federal Transit Administration, has been investigating its agency's vulnerability to weather-related disruption and damages as a way to inform an overall adaptation strategy for climate variability and change. Exploiting daily rail service records maintained by SEPTA and observations from nearby weather stations, we have developed a methodology for quantifying the sensitivity of SEPTA's Manayunk/Norristown rail line to various weather events (e.g., snow storms, heat waves, heavy rainfall and flooding, tropical storms). For each type of event, sensitivity is equated to the frequency and extent of service disruptions associated with the event, and includes the identification of thresholds beyond which impacts are observed. In addition, we have estimated the monetary costs associated with repair and replacement of infrastructure following these events. Our results have facilitated discussions with SEPTA operational staff, who have outlined the institutional aspects of their preparation and response processes for these weather events. We envision the methodology as being useful for resource and infrastructure managers across the public and private sector, and potentially scalable to smaller or larger operations. There are several advantageous aspects of the method: 1) the quantification of sensitivity, and the coupling of that sensitivity to cost information, provides credible input to SEPTA decision-makers as they establish the priorities and level of investment associated with their adaptation actions for addressing extreme weather; 2) the method provides a conceptual foundation for estimating the magnitude, frequency, and costs of potential future impacts at a local scale, especially with regard to heat waves; 3) the sensitivity information serves as an excellent discussion tool, enabling further research and information gathering about institutional relationships and procedures. These relationships and procedures are critical to the effectiveness of preparation for and responses to extreme weather events, but are often not explicitly documented.

Development of a Micro-Fabricated Total-Field Magnetometer

DTIC Science & Technology

2011-03-01

are made with fluxgate technologies. Fluxgates have lower sensitivity than Cs magnetometers , yet they continue to be used in small wands simply...extraction process by providing the sensitivity of a Cs magnetometer with the convenience and low cost of a fluxgate wand. Extremely small and low cost...FINAL REPORT Development of a Micro-Fabricated Total-Field Magnetometer SERDP Project MR-1512 MARCH 2011 Mark Prouty Geometrics, Inc

Cost of Cardiac Surgery in Frail Compared With Nonfrail Older Adults.

PubMed

Goldfarb, Michael; Bendayan, Melissa; Rudski, Lawrence G; Morin, Jean-Francois; Langlois, Yves; Ma, Felix; Lachapelle, Kevin; Cecere, Renzo; DeVarennes, Benoit; Tchervenkov, Christo I; Brophy, James M; Afilalo, Jonathan

2017-08-01

Frailty is a risk factor for mortality, morbidity, and prolonged length of stay after cardiac surgery, all of which are major drivers of hospitalization costs. The incremental hospitalization costs incurred in frail patients have yet to be elucidated. Patients aged ≥ 60 years were evaluated for frailty before coronary artery bypass grafting or heart valve surgery at 2 academic centres between 2013 and 2015 as part of the McGill Frailty Registry. Total costs were summed from the date of the index surgery to the date of hospital discharge. Mutivariable linear regression was used to determine the association between preoperative frailty status and total costs after adjusting for conventional surgical risk factors. Among 235 patients included in the analysis, the median age was 73.0 years (interquartile range [IQR], 70.0-78.0 years) and 68 (29%) were women. The median cost was $32,742 (IQR, $23,221-$49,627) in 91 frail patients compared with $23,370 (IQR, $19,977-$29,705) in 144 nonfrail patients. Seven extreme-cost cases > $100,000 were identified, and all of the patients in these cases exhibited baseline frailty. In the multivariable model, total costs were independently associated with frailty (adjusted additional cost, $21,245; 95% confidence interval [CI], $12,418-$30,073; P < 0.001) and valve surgery (adjusted additional cost, $20,600; 95% CI, $9,661-$31,539; P < 0.001). Frailty is associated with a marked increase in hospitalization costs after cardiac surgery, an effect that persists after adjusting for age, sex, surgery type, and surgical risk score. Further efforts are needed to optimize care and resource use in this vulnerable population. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

The economic value of specialized lower-extremity medical care by podiatric physicians in the treatment of diabetic foot ulcers.

PubMed

Carls, Ginger S; Gibson, Teresa B; Driver, Vickie R; Wrobel, James S; Garoufalis, Matthew G; Defrancis, Roy R; Wang, Shaohung; Bagalman, J Erin; Christina, James R

2011-01-01

We sought to examine the economic value of specialized lower-extremity medical care by podiatric physicians in the treatment of diabetic foot ulcers by evaluating cost outcomes for patients with diabetic foot ulcer who did and did not receive care from a podiatric physician in the year before the onset of a foot ulcer. We analyzed the economic value among commercially insured patients and Medicare-eligible patients with employer-sponsored supplemental medical benefits using the MarketScan Databases. The analysis consisted of two parts. In part I, we examined cost or savings per patient associated with care by podiatric physicians using propensity score matching and regression techniques; in part II, we extrapolated cost or savings to populations. Matched and regression-adjusted results indicated that patients who visited a podiatric physician had $13,474 lower costs in commercial plans and $3,624 lower costs in Medicare plans during 2-year follow-up (P < .01 for both). A positive net present value of increasing the share of patients at risk for diabetic foot ulcer by 1% was found, with a range of $1.2 to $17.7 million for employer-sponsored plans and $1.0 to $12.7 million for Medicare plans. These findings suggest that podiatric medical care can reduce the disease and economic burdens of diabetes.

An analysis of the effect of lower extremity strength on impact severity during a backward fall.

PubMed

Sandler, R; Robinovitch, S

2001-12-01

At least 280 000 hip fractures occur annually in the U.S. at an estimated cost of $9 billion. While over 90 percent of these are caused by falls, only about 2 percent of all falls result in hip fracture. Evidence suggests that the most important determinants of hip fracture risk during a fall are the body's impact velocity and configuration. Accordingly, protective responses for reducing impact velocity and the likelihood for direct impact to the hip, strongly influence fracture risk. One method for reducing the body's impact velocity and kinetic energy during a fall is to absorb energy in the lower extremity muscles during descent, as occurs during sitting and squatting. In the present study, we employed a series of in verted pendulum models to determine: (a) the theoretical effect of this mechanism on impact severity during a backward fall, and (b) the effect on impact severity of age-related declines (or exercise-induced enhancements) in lower extremity strength. Compared to the case of a fall with zero energy absorption in the lower extremity joints, best-case falls (which involved 81 percent activation of ankle and hip muscles, but only 23 percent activation of knees muscles) involved 79 percent attenuation (from 352 J to 74 J) in the body's vertical kinetic energy at impact (KEv), and 48 percent attenuation (from 3.22 to 1.68 m/s) in the downward velocity of the pelvis at impact (v(v)). Among the mechanisms responsible for this were: (1) eccentric contraction of lower extremity muscles during descent, which resulted in up to 150 J of energy absorption; (2) impact with the trunk in an upright configuration, which reduced the change in potential energy associated with the fall by 100 J; and (3) knee extension during the final stage of descent, which "transferred" up to 90 J of impact energy into horizontal (as opposed to vertical) kinetic energy. Declines in joint strength reduced the effectiveness of mechanisms (1) and (3), and thereby increased impact severity However, even with reductions of 80 percent in available torques, KEv was attenuated by 50 percent. This indicates the importance of both technique and strength in reducing impact severity. These results provide motivation for attempts to reduce elderly individuals' risk for fall-related injury through the combination of instruction in safe falling techniques and exercises that enhance lower extremity strength.

Compressed gas combined single- and two-stage light-gas gun

NASA Astrophysics Data System (ADS)

Lamberson, L. E.; Boettcher, P. A.

2018-02-01

With more than 1 trillion artificial objects smaller than 1 μm in low and geostationary Earth orbit, space assets are subject to the constant threat of space debris impact. These collisions occur at hypervelocity or speeds greater than 3 km/s. In order to characterize material behavior under this extreme event as well as study next-generation materials for space exploration, this paper presents a unique two-stage light-gas gun capable of replicating hypervelocity impacts. While a limited number of these types of facilities exist, they typically are extremely large and can be costly and dangerous to operate. The design presented in this paper is novel in two distinct ways. First, it does not use a form of combustion in the first stage. The projectile is accelerated from a pressure differential using air and inert gases (or purely inert gases), firing a projectile in a nominal range of 1-4 km/s. Second, the design is modular in that the first stage sits on a track sled and can be pulled back and used in itself to study lower speed impacts without any further modifications, with the first stage piston as the impactor. The modularity of the instrument allows the ability to investigate three orders of magnitude of impact velocities or between 101 and 103 m/s in a single, relatively small, cost effective instrument.

Coastal Hazards and Integration of Impacts in Local Adaptation Planning

NASA Astrophysics Data System (ADS)

Knudsen, P.; Sorensen, C.; Molgaard, M. R.; Broge, N. H.; Andersen, O. B.

2016-12-01

Data on sea and groundwater levels, precipitation, land subsidence, geology, and geotechnical soil properties are combined with information on flood and erosion protection measures to analyze water-related impacts from climate change at an exposed coastal location. Future sea extremes will have a large impact but several coupled effects in the hydrological system need to be considered as well to provide for optimal protection and mitigation efforts. For instance, the investment and maintenance costs of securing functional water and wastewater pipes are significantly reduced by incorporating knowledge about climate change. The translation of regional sea level rise evidence and projections to concrete impact measures should take into account the potentially affected stakeholders who must collaborate on common and shared adaptation solutions. Here, knowledge integration across levels of governance and between research, private and public institutions, and the local communities provides: understanding of the immediate and potential future challenges; appreciation of different stakeholder motives, business agendas, legislative constraints etc., and a common focus on how to cost-efficiently adapt to and manage impacts of climate change. By construction of a common working platform that is updated with additional data and knowledge, e.g. from future regional models or extreme events, advances in sea level research can more readily be translated into concrete and local impact measures in a way that handles uncertainties in the future climate and urban development as well as suiting the varying stakeholder needs.

Mechanically assisted liquid lens zoom system for mobile phone cameras

NASA Astrophysics Data System (ADS)

Wippermann, F. C.; Schreiber, P.; Bräuer, A.; Berge, B.

2006-08-01

Camera systems with small form factor are an integral part of today's mobile phones which recently feature auto focus functionality. Ready to market solutions without moving parts have been developed by using the electrowetting technology. Besides virtually no deterioration, easy control electronics and simple and therefore cost-effective fabrication, this type of liquid lenses enables extremely fast settling times compared to mechanical approaches. As a next evolutionary step mobile phone cameras will be equipped with zoom functionality. We present first order considerations for the optical design of a miniaturized zoom system based on liquid-lenses and compare it to its mechanical counterpart. We propose a design of a zoom lens with a zoom factor of 2.5 considering state-of-the-art commercially available liquid lens products. The lens possesses auto focus capability and is based on liquid lenses and one additional mechanical actuator. The combination of liquid lenses and a single mechanical actuator enables extremely short settling times of about 20ms for the auto focus and a simplified mechanical system design leading to lower production cost and longer life time. The camera system has a mechanical outline of 24mm in length and 8mm in diameter. The lens with f/# 3.5 provides market relevant optical performance and is designed for an image circle of 6.25mm (1/2.8" format sensor).

Compressed gas combined single- and two-stage light-gas gun.

PubMed

Lamberson, L E; Boettcher, P A

2018-02-01

With more than 1 trillion artificial objects smaller than 1 μm in low and geostationary Earth orbit, space assets are subject to the constant threat of space debris impact. These collisions occur at hypervelocity or speeds greater than 3 km/s. In order to characterize material behavior under this extreme event as well as study next-generation materials for space exploration, this paper presents a unique two-stage light-gas gun capable of replicating hypervelocity impacts. While a limited number of these types of facilities exist, they typically are extremely large and can be costly and dangerous to operate. The design presented in this paper is novel in two distinct ways. First, it does not use a form of combustion in the first stage. The projectile is accelerated from a pressure differential using air and inert gases (or purely inert gases), firing a projectile in a nominal range of 1-4 km/s. Second, the design is modular in that the first stage sits on a track sled and can be pulled back and used in itself to study lower speed impacts without any further modifications, with the first stage piston as the impactor. The modularity of the instrument allows the ability to investigate three orders of magnitude of impact velocities or between 10 1 and 10 3 m/s in a single, relatively small, cost effective instrument.

TRI-SERVICE ELF COMMUNICATIONS - VOL. II, BIBLIOGRAPHY.

DTIC Science & Technology

BIBLIOGRAPHIES, UNDERGROUND ANTENNAS , ELECTRICAL RESISTANCE, UNDERGROUND , COSTS, VERY LOW FREQUENCY, LOW FREQUENCY, PROPAGATION, NOISE(RADIO)....EXTREMELY LOW FREQUENCY), (*COMMAND AND CONTROL SYSTEMS, COMMUNICATION AND RADIO SYSTEMS), (* COMMUNICATION AND RADIO SYSTEMS, MILITARY RESEARCH

Incorporating Conservation Zone Effectiveness for Protecting Biodiversity in Marine Planning

PubMed Central

Makino, Azusa; Klein, Carissa J.; Beger, Maria; Jupiter, Stacy D.; Possingham, Hugh P.

2013-01-01

Establishing different types of conservation zones is becoming commonplace. However, spatial prioritization methods that can accommodate multiple zones are poorly understood in theory and application. It is typically assumed that management regulations across zones have differential levels of effectiveness (“zone effectiveness”) for biodiversity protection, but the influence of zone effectiveness on achieving conservation targets has not yet been explored. Here, we consider the zone effectiveness of three zones: permanent closure, partial protection, and open, for planning for the protection of five different marine habitats in the Vatu-i-Ra Seascape, Fiji. We explore the impact of differential zone effectiveness on the location and costs of conservation priorities. We assume that permanent closure zones are fully effective at protecting all habitats, open zones do not contribute towards the conservation targets and partial protection zones lie between these two extremes. We use four different estimates for zone effectiveness and three different estimates for zone cost of the partial protection zone. To enhance the practical utility of the approach, we also explore how much of each traditional fishing ground can remain open for fishing while still achieving conservation targets. Our results show that all of the high priority areas for permanent closure zones would not be a high priority when the zone effectiveness of the partial protection zone is equal to that of permanent closure zones. When differential zone effectiveness and costs are considered, the resulting marine protected area network consequently increases in size, with more area allocated to permanent closure zones to meet conservation targets. By distributing the loss of fishing opportunity equitably among local communities, we find that 84–88% of each traditional fishing ground can be left open while still meeting conservation targets. Finally, we summarize the steps for developing marine zoning that accounts for zone effectiveness. PMID:24223870

Cost-effective data storage/archival subsystem for functional PACS

NASA Astrophysics Data System (ADS)

Chen, Y. P.; Kim, Yongmin

1993-09-01

Not the least of the requirements of a workable PACS is the ability to store and archive vast amounts of information. A medium-size hospital will generate between 1 and 2 TBytes of data annually on a fully functional PACS. A high-speed image transmission network coupled with a comparably high-speed central data storage unit can make local memory and magnetic disks in the PACS workstations less critical and, in an extreme case, unnecessary. Under these circumstances, the capacity and performance of the central data storage subsystem and database is critical in determining the response time at the workstations, thus significantly affecting clinical acceptability. The central data storage subsystem not only needs to provide sufficient capacity to store about ten days worth of images (five days worth of new studies, and on the average, about one comparison study for each new study), but also supplies images to the requesting workstation in a timely fashion. The database must provide fast retrieval responses upon users' requests for images. This paper analyzes both advantages and disadvantages of multiple parallel transfer disks versus RAID disks for short-term central data storage subsystem, as well as optical disk jukebox versus digital recorder tape subsystem for long-term archive. Furthermore, an example high-performance cost-effective storage subsystem which integrates both the RAID disks and high-speed digital tape subsystem as a cost-effective PACS data storage/archival unit are presented.

Trauma transitional care coordination: A mature system at work.

PubMed

Hall, Erin C; Tyrrell, Rebecca L; Doyle, Karen E; Scalea, Thomas M; Stein, Deborah M

2018-05-01

We have previously demonstrated effectiveness of a Trauma Transitional Care Coordination (TTCC) Program in reducing 30-day readmission rates for trauma patients most at risk. With program maturation, we achieved improved readmission rates for specific patient populations. TTCC is a nursing driven program that supports patients at high risk for 30-day readmission. The TTCC interventions include calls to patients within 72 hours of discharge, complete medication reconciliation, coordination of medical appointments, and individualized problem solving. Account IDs were used to link TTCC patients with the Health Services Cost Review Commission database to collect data on statewide unplanned 30-day readmissions. Four hundred seventy-five patients were enrolled in the TTCC program from January 2014 to September 2016. Only 10.5% (n = 50) of TTCC enrollees were privately insured, 54.5% had Medicaid (n = 259), and 13.5% had Medicare (n = 64). Seventy-three percent had Health Services Cost Review Commission severity of injury ratings of 3 or 4 (maximum severity of injury = 4). The most common All Patient Refined Diagnosis Related Groups for participants were: lower-extremity procedures (n = 67, 14%); extensive abdominal/thoracic procedures (n = 40, 8.4%); musculoskeletal procedures (n = 37, 7.8%); complicated tracheostomy and upper extremity procedures (n = 29 each, 6.1%); infectious disease complications (n = 14, 2.9%); major chest/respiratory trauma, major small and large bowel procedures and vascular procedures (n = 13 each, 2.7%). The TTCC participants with lower-extremity injury, complicated tracheostomy, and bowel procedures had 6-point reduction (10% vs. 16%, p = 0.05), 11-point reduction (13% vs. 24%, p = 0.05), and 16-point reduction (11% vs. 27%, p = 0.05) in 30-day readmission rates, respectively, compared to those without TTCC. Targeted outpatient support for high-risk patients can decrease 30-day readmission rates. As our TTCC program matured, we reduced 30-day readmission in patients with lower-extremity injury, complicated tracheostomy and bowel procedures. This represents over one million-dollar savings for the hospital per year through quality-based reimbursement. Therapeutic/care management, level III.

2006 Defense Economics Conference: The Defense Department’s Future in a Changing Macroeconomic Environment. Held in Alexandria, Virginia on September 21, 2006

DTIC Science & Technology

2007-01-01

cost of defense and the value of insurance against threats purchased by those costs. But a large fraction of the public debate at this time was...happen. One extreme we could ask of people is basically to self- insure . Let them bear the cost of things to happen. Th at’s a pretty powerful incentive...instruments KEYNOTE ADDRESS 11 2006 DEFENSE ECONOMICS CONFERENCE that can be used to shift risk burdens, and the use of insurance and pricing of

B-2 Extremely High Frequency SATCOM and Computer Increment 1 (B-2 EHF Inc 1)

DTIC Science & Technology

2015-12-01

Confidence Level Confidence Level of cost estimate for current APB: 55% This APB reflects cost and funding data based on the B-2 EHF Increment I SCP...This cost estimate was quantified at the Mean (~55%) confidence level . Total Quantity Quantity SAR Baseline Production Estimate Current APB...Production Estimate Econ Qty Sch Eng Est Oth Spt Total 33.624 -0.350 1.381 0.375 0.000 -6.075 0.000 -0.620 -5.289 28.335 Current SAR Baseline to Current

Gear materials for high-production light-deputy service

NASA Technical Reports Server (NTRS)

Townsend, D. P.

1973-01-01

The selection of a material for high volume, low cost gears requires careful consideration of all the requirements and the processes used to manufacture the gears. The wrong choice in material selection could very well mean the difference between success and failure. A summary of the cost that might be expected for different materials and processes is presented; it can be seen that the cost can span nearly three order of magnitudes from the molded plastic gear to the machined gear with stamped and powder metal gears falling in between these extremes.

Application of probabilistic event attribution in the summer heat extremes in the western US to emissions traced to major industrial carbon producers

NASA Astrophysics Data System (ADS)

Mera, R. J.; Allen, M. R.; Mote, P.; Ekwurzel, B.; Frumhoff, P. C.; Rupp, D. E.

2015-12-01

Heat waves in the western US have become progressively more severe due to increasing relative humidity and nighttime temperatures, increasing the health risks of vulnerable portions of the population, including Latino farmworkers in California's Central Valley and other socioeconomically disadvantaged communities. Recent research has shown greenhouse gas emissions doubled the risk of the hottest summer days during the 2000's in the Central Valley, increasing public health risks and costs, and raising the question of which parties are responsible for paying these costs. It has been argued that these costs should not be taken up solely by the general public through taxation, but that additional parties can be considered, including multinational corporations who have extracted and marketed a large proportion of carbon-based fuels. Here, we apply probabilistic event attribution (PEA) to assess the contribution of emissions traced to the world's 90 largest major industrial carbon producers to the severity and frequency of these extreme heat events. Our research uses very large ensembles of regional climate model simulations to calculate fractional attribution of policy-relevant extreme heat variables. We compare a full forcings world with observed greenhouse gases, sea surface temperatures and sea ice extent to a counter-factual world devoid of carbon pollution from major industrial carbon producers. The results show a discernable fraction of record-setting summer temperatures in the western US during the 2000's can be attributed to emissions sourced from major carbon producers.

Frequency Domain Modeling of SAW Devices

NASA Technical Reports Server (NTRS)

Wilson, W. C.; Atkinson, G. M.

2007-01-01

New SAW sensors for integrated vehicle health monitoring of aerospace vehicles are being investigated. SAW technology is low cost, rugged, lightweight, and extremely low power. However, the lack of design tools for MEMS devices in general, and for Surface Acoustic Wave (SAW) devices specifically, has led to the development of tools that will enable integrated design, modeling, simulation, analysis and automatic layout generation of SAW devices. A frequency domain model has been created. The model is mainly first order, but it includes second order effects from triple transit echoes. This paper presents the model and results from the model for a SAW delay line device.

Radiofrequency ablation for benign thyroid nodules.

PubMed

Bernardi, S; Stacul, F; Zecchin, M; Dobrinja, C; Zanconati, F; Fabris, B

2016-09-01

Benign thyroid nodules are an extremely common occurrence. Radiofrequency ablation (RFA) is gaining ground as an effective technique for their treatment, in case they become symptomatic. Here we review what are the current indications to RFA, its outcomes in terms of efficacy, tolerability, and cost, and also how it compares to the other conventional and experimental treatment modalities for benign thyroid nodules. Moreover, we will also address the issue of treating with this technique patients with cardiac pacemakers (PM) or implantable cardioverter-defibrillators (ICD), as it is a rather frequent occurrence that has never been addressed in detail in the literature.

Vehicle fault diagnostics and management system

NASA Astrophysics Data System (ADS)

Gopal, Jagadeesh; Gowthamsachin

2017-11-01

This project is a kind of advanced automatic identification technology, and is more and more widely used in the fields of transportation and logistics. It looks over the main functions with like Vehicle management, Vehicle Speed limit and Control. This system starts with authentication process to keep itself secure. Here we connect sensors to the STM32 board which in turn is connected to the car through Ethernet cable, as Ethernet in capable of sending large amounts of data at high speeds. This technology involved clearly shows how a careful combination of software and hardware can produce an extremely cost-effective solution to a problem.

Single-wavelength functional photoacoustic microscopy in biological tissue.

PubMed

Danielli, Amos; Favazza, Christopher P; Maslov, Konstantin; Wang, Lihong V

2011-03-01

Recently, we developed a reflection-mode relaxation photoacoustic microscope, based on saturation intensity, to measure picosecond relaxation times using a nanosecond laser. Here, using the different relaxation times of oxygenated and deoxygenated hemoglobin molecules, both possessing extremely low fluorescence quantum yields, the oxygen saturation was quantified in vivo with single-wavelength photoacoustic microscopy. All previous functional photoacoustic microscopy measurements required imaging with multiple-laser-wavelength measurements to quantify oxygen saturation. Eliminating the need for multiwavelength measurements removes the influence of spectral properties on oxygenation calculations and improves the portability and cost-effectiveness of functional or molecular photoacoustic microscopy.

Single-wavelength functional photoacoustic microscopy in biological tissue

PubMed Central

Danielli, Amos; Favazza, Christopher P.; Maslov, Konstantin; Wang, Lihong V.

2011-01-01

Recently, we developed a reflection-mode relaxation photoacoustic microscope, based on saturation intensity, to measure picosecond relaxation times using a nanosecond laser. Here, using the different relaxation times of oxygenated and deoxygenated hemoglobin molecules, both possessing extremely low fluorescence quantum yields, the oxygen saturation was quantified in vivo with single-wavelength photoacoustic microscopy. All previous functional photoacoustic microscopy measurements required imaging with multiple laser-wavelength measurements to quantify oxygen saturation. Eliminating the need for multi-wavelength measurements removes the influence of spectral properties on oxygenation calculations and improves the portability and cost-effectiveness of functional or molecular photoacoustic microscopy. PMID:21368977

Geologic results of the TMS survey over Mt. Emmons, Colorado. [Thematic Mapper Simulator

NASA Technical Reports Server (NTRS)

Rickman, D. L.; Sadowski, R. M.

1985-01-01

In 1981, NASA conducted with an American company a cooperative study, involving the use of Thematic Mapper Simulator (TMS) data. The study was concerned with an area near Crested Butte, Colorado, which contains a known, but unmined, major molybdenum deposit. Detailed ground observations in the Mt. Emmons area demonstrated that the imagery was extremely effective for detection of geologically significant features. The imagery specifically delineated areas of ferric iron staining, seritization, and hornfelized rock. Attention is given to data acquisition and data processing, field work in 1982 and in 1983, the integration of gravity data, and costs.

After the revolution: DRGs at age 30.

PubMed

Quinn, Kevin

2014-03-18

1 October 2013 marked 30 years since Medicare began paying hospitals by diagnosis-related group (DRG), arguably the most influential innovation in the history of health care financing. Initially developed as a tool for hospital management, DRGs became the basis of the inpatient prospective payment system that Medicare implemented in 1983. The strong incentives were revolutionary in their impact. Medicare spending growth slowed sharply, and, more remarkable, hospitals posted record profits. After the link between cost and payment was broken, hospitals moved quickly to cut costs. Nevertheless, a literature survey concluded that none of the worst fears about adverse effects on patients were realized. Diagnosis-related groups have also come to define "the product of a hospital" for purposes of benchmarking and risk adjustment. The acceptance of DRG algorithms owes much to their categorical approach, clinical focus, and transparency. The 2 most commonly used algorithms, Medicare DRGs and All Patient Refined (APR) DRGs, typically explain more than 40% of cost variance in inpatient stays, although with considerable range by care category. Because Medicare DRGs are unsuitable for obstetrics, pediatrics, and neonatology, some payers prefer APR DRGs. Diagnosis-related groups have proven to be a suitable basis for payment, as evidenced by widespread use. Common issues include mitigation of adverse incentives, appropriate payment for extremely costly stays, applicability to certain hospitals and care categories, and growing complexity. The DRG experience offers lessons about the effectiveness of financial incentives, the likelihood of adverse effects, the usefulness of case-mix measures, the risks of growing complexity, and the example that sensible policy need not be the domain of any one political party or other entity.

Effects of salinity and hypoxia-induced hyperventilation on oxygen consumption and cost of osmoregulation in the estuarine red drum (Sciaenops ocellatus).

PubMed

Ern, Rasmus; Esbaugh, Andrew J

2018-04-23

Understanding the physiological responses of fishes to salinity changes and aquatic hypoxia is essential for the conservation of marine species. Salinity changes affect the osmotic gradient across the gill epithelium, while hypoxia increases gill ventilation and the flow of water over the gills. Both processes affect the diffusive movement of ions and water across the gill epithelium, and the rate of active ion transport required for maintaining osmotic homeostasis. Consequently, salinity and hypoxia may affect the energetic cost of osmoregulation, and consequently the energy available for other physiological functions such as migration, growth, and reproduction. Historically, studies have assessed the costs of osmoregulation and ventilation in fishes via standard metabolic rate (SMR); however, few studies have used a multi-stressor approach that fully accounts for the osmorespiratory compromise. Here, we determined the combined effects of salinity and hypoxia on SMR, routine metabolic rate (RMR), and plasma ion concentrations in red drum (Sciaenops ocellatus) acclimated to salinities ranging from freshwater to hypersalinity. Surprisingly, there was no significant change in any parameter as a consequence of salinity or hypoxia, including the relatively extreme scenario of combined hypersalinity and hypoxia exposure. We conclude that changes in the osmotic gradient across the gill epithelium and the flow of water over the gills have a negligible effect on the whole animal energy budget of S. ocellatus, suggesting that the cost of osmoregulation is a minor component of basal metabolism regardless of oxygenation status. Copyright © 2018 Elsevier Inc. All rights reserved.

Environmental cost and pollution risk caused by the industrial transfer in Qinghai Province

NASA Astrophysics Data System (ADS)

Jiang, Qun'ou; Tang, Chengcai; Zhan, Jinyan; Zhang, Wei; Wu, Feng

2014-09-01

With the rising pressure due to energy consumption and costs of environmental protection and recovery, industrial transfer from the eastern to central and western areas has surged in China. However, extremely fragile ecological conditions and severe water shortage are significant hurdles for industry development in Western China. Whether the vulnerable environment can bear the pollution caused by the transferred industry from Eastern China becomes a significant issue. This study firstly estimates energy and environmental costs in different areas of China, and assesses the necessity to upgrade the industrial structure of Qinghai Province. Then the emissions of waste water, waste gas, and smoke caused by transferred industries are calculated by Input-Output Model. On the basis of the effect analysis of waste emission on environment, pollution risks of Qinghai province are assessed. The results illustrate that the costs of environmental protection and recovery in China have a gradient distribution, of which the energy efficiency is lower while environmental costs are higher in Western China. Industrial structure adjustment has different impacts on the pollution of different sectors. Although the development of machinery and equipment, hotels and catering services, and real estate, leasing, and business services has increased the emission of pollutants, it is offset by the decreasing emissions caused by other industries such as construction and metal products. Therefore, although economic development will increase environmental pollution, industrial adjustments can effectively decrease waste water and waste gas emissions to reduce the pollution risk. It should be noted that there are still tremendous challenges for industrial transfer in Qinghai Province to coordinate the environment and industry development.

Cost effectiveness of enoxaparin as prophylaxis against venous thromboembolic complications in acutely ill medical inpatients: modelling study from the hospital perspective in Germany.

PubMed

Schädlich, Peter K; Kentsch, Michael; Weber, Manfred; Kämmerer, Wolfgang; Brecht, Josef Georg; Nadipelli, Vijay; Huppertz, Eduard

2006-01-01

To estimate, from the hospital perspective in Germany, the cost effectiveness of the low-molecular-weight heparin (LMWH) subcutaneous enoxaparin sodium 40 mg once daily (ENOX) relative to no pharmacological prophylaxis (NPP) and relative to subcutaneous unfractionated heparin (UFH) 5,000 IU three times daily (low-dose UFH [LDUFH]). Each is used in addition to elastic bandages/compression stockings and physiotherapy in the prevention of venous thromboembolic events (VTE) in immobilised acutely ill medical inpatients without impaired renal function or extremes of body weight. The incremental cost-effectiveness ratios (ICERs) of the 'additional cost for ENOX per clinical VTE avoided versus NPP' and 'additional cost for ENOX per episode of major bleeding avoided versus LDUFH' were chosen as target variables. The target variables were quantified using a modelling approach based on the decision-tree technique. Resource use during thromboprophylaxis, diagnosis and treatment of VTEs, episode of major bleeding and secondary pneumonia after pulmonary embolism (PE) was collected from a hospital survey. Costs were exclusively those to hospitals incurred by staff expenses, drugs, devices, disposables, laboratory tests and equipment for diagnostic procedures. These costs were determined by multiplying utilised resource items by the price or tariff of each item as of the first quarter of 2003. Safety and efficacy values of the comparators were taken from the MEDENOX (prophylaxis in MEDical patients with ENOXaparin) and the THE-PRINCE (THromboEmbolism-PRevention IN Cardiac or respiratory disease with Enoxaparin) trials and from a meta-analysis. The evaluation encompassed 8 (6-14) days of thromboprophylaxis plus time to treat VTE and episode of major bleeding in hospital. Point estimates of all model parameters were applied exclusively in the base-case analysis. There were incremental costs of euro 1,106 for ENOX per clinical VTE avoided versus NPP (1 euro approximately equals 1.07 US dollars; average of the first quarter of 2003). ENOX dominated LDUFH: cost savings of euro 55,825 were obtained and 7.7 episodes of major bleeding were avoided by ENOX compared with LDUFH, each per 1000 patients. In comprehensive sensitivity analyses, the robustness of the model and its results was shown. Results of this evaluation suggest that, in immobilised acutely ill medical inpatients, ENOX may offer hospitals in Germany a very cost-effective option for thromboprophylaxis compared with NPP and a cost-saving alternative compared with LDUFH.

[Qualified and emergency specialized surgical care for those with wounds to the extremities].

PubMed

Iurkevich, V V; Fidarov, E Z; Bauér, V A

1997-06-01

Experience of organization of the surgical care in the military hospital to 438 wounded in extremities during armed conflict in Republic of Chechnya is generalized. Maximum reduction of stages of medical evacuation of the wounded in extremities, approaching of the qualified and urgent specialized surgical care directly to the region of battle actions, use of opportunities for it one-moment rendering corresponded to principles of the modern military-medical doctrine. Due to realization of the requirements of the doctrine life of many wounded ++ was saved, terms of treatment, medical and social rehabilitation are reduced. Besides lethality, treatment cost and numbers of transferring to the reserve from the Armed Forces were reduced.

Extreme-scale Algorithms and Solver Resilience

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

Dongarra, Jack

A widening gap exists between the peak performance of high-performance computers and the performance achieved by complex applications running on these platforms. Over the next decade, extreme-scale systems will present major new challenges to algorithm development that could amplify this mismatch in such a way that it prevents the productive use of future DOE Leadership computers due to the following; Extreme levels of parallelism due to multicore processors; An increase in system fault rates requiring algorithms to be resilient beyond just checkpoint/restart; Complex memory hierarchies and costly data movement in both energy and performance; Heterogeneous system architectures (mixing CPUs, GPUs,more » etc.); and Conflicting goals of performance, resilience, and power requirements.« less

The Perioperative Surgical Home: Improving the Value and Quality of Care in Total Joint Replacement.

PubMed

Chimento, George F; Thomas, Leslie C

2017-09-01

The perioperative surgical home (PSH) is a patient-centered, physician-led, multidisciplinary care pathway developed to deliver value-based care based on shared decision-making. Physician and hospital reimbursement will be tied to providing quality care at lower cost, and the PSH model has been used in providing care to patients undergoing lower extremity arthroplasty. The purpose of this review is to discuss the rationale, definition, development, current state, and future direction of the PSH. The PSH model guides the patient throughout the pre and perioperative process and into the postoperative phase. It has been shown in multiple studies to decrease length of stay, improve functional outcomes, allow more home discharges, and lower costs. There is no increase in complications or readmission rates. The PSH pathway is a safe and effective method of providing value-based care to patients undergoing hip and knee arthroplasty.

High-power direct-diode laser successes

NASA Astrophysics Data System (ADS)

Haake, John M.; Zediker, Mark S.

2004-06-01

Direct diode laser will become much more prevalent in the solar system of manufacturing due to their high efficiency, small portable size, unique beam profiles, and low ownership costs. There has been many novel applications described for high power direct diode laser [HPDDL] systems but few have been implemented in extreme production environments due to diode and diode system reliability. We discuss several novel applications in which the HPDDL have been implemented and proven reliable and cost-effective in production environments. These applications are laser hardening/surface modification, laser wire feed welding and laser paint stripping. Each of these applications uniquely tests the direct diode laser systems capabilities and confirms their reliability in production environments. A comparison of the advantages direct diode laser versus traditional industrial lasers such as CO2 and Nd:YAG and non-laser technologies such a RF induction, and MIG welders for each of these production applications is presented.

New Directions in Chronic Disease Management.

PubMed

Kim, Hun Sung; Cho, Jae Hyoung; Yoon, Kun Ho

2015-06-01

A worldwide epidemic of chronic disease, and complications thereof, is underway, with no sign of abatement. Healthcare costs have increased tremendously, principally because of the need to treat chronic complications of non-communicable diseases including cardiovascular disease, blindness, end-stage renal disease, and amputation of extremities. Current healthcare systems fail to provide an appropriate quality of care to prevent the development of chronic complications without additional healthcare costs. A new paradigm for prevention and treatment of chronic disease and the complications thereof is urgently required. Several clinical studies have clearly shown that frequent communication between physicians and patients, based on electronic data transmission from medical devices, greatly assists in the management of chronic disease. However, for various reasons, these advantages have not translated effectively into real clinical practice. In the present review, we describe current relevant studies, and trends in the use of information technology for chronic disease management. We also discuss limitations and future directions.

The impact of climate change on transportation in the gulf coast

USGS Publications Warehouse

Savonis, M.J.; Burkett, V.R.; Potter, J.R.; Kafalenos, R.; Hyman, R.; Leonard, K.

2009-01-01

Climate affects the design, construction, safety, operations, and maintenance of transportation infrastructure and systems. The prospect of a changing climate raises critical questions regarding how alterations in temperature, precipitation, storm events, and other aspects of the climate could affect the nation's transportation system. This regional assessment of climate change and its potential impacts on transportation systems addresses these questions for the central Gulf Coast between Houston and Mobile. Warming temperatures are likely to increase the costs of transportation construction, maintenance, and operations. More frequent extreme precipitation events will likely disrupt transportation networks with flooding and visibility problems. Relative sea level rise will make much of the existing infrastructure more prone to frequent or permanent inundation. Increased storm intensity may lead to increased service disruption and damage. Consideration of these factors in today's transportation decisions should lead to a more robust, resilient, and cost-effective transportation network in the coming decades. ?? 2009 ASCE.

Report focuses on improving resilience to disasters

NASA Astrophysics Data System (ADS)

Showstack, Randy

2012-08-01

“Disaster resilience is everyone's business,” states a new report that calls for a series of local and national measures to increase resilience in the face of an increasingly costly toll from natural disasters to human lives and the economy. In 2011 natural disasters were responsible for damages in the United States exceeding $55 billion, and costs could increase with more people and structures located in harm's way and with the effects of extreme events, according to the report, Disaster Resilience: A National Imperative, issued by a committee of the U.S. National Academies on 1 August. Among the recommendations is for federal government agencies to incorporate national resilience as an organizing principle to guide federal government actions and programs. The report defines resilience as “the ability to prepare and plan for, absorb, recover from, and more successfully adapt to adverse events.”

The costs and benefits of bone marrow transplantation.

PubMed

Beard, M E; Inder, A B; Allen, J R; Hart, D N; Heaton, D C; Spearing, R L

1991-07-24

The average direct costs of performing a bone marrow transplant (BMT), including the subsequent year, was found to be NZ$27,074 for 43 consecutive transplants. In 29 BMTs a full two year period of follow up was available and a quality of life analysis was carried out on these patients. It was calculated that 59 quality adjusted life years (QALYs) had been gained by the BMT procedure at the time of analysis. By combining these two analyses the cost of each QALY gained by BMT is NZ$13,272. The relatively low cost of BMT is partly due to the extremely low annual costs in second and subsequent years post BMT. In our patients this cost amounted to $195 per year. The costs and benefits of BMT compare very favourably with other complex medical procedures.

The magnitude and colour of noise in genetic negative feedback systems

PubMed Central

Voliotis, Margaritis; Bowsher, Clive G.

2012-01-01

The comparative ability of transcriptional and small RNA-mediated negative feedback to control fluctuations or ‘noise’ in gene expression remains unexplored. Both autoregulatory mechanisms usually suppress the average (mean) of the protein level and its variability across cells. The variance of the number of proteins per molecule of mean expression is also typically reduced compared with the unregulated system, but is almost never below the value of one. This relative variance often substantially exceeds a recently obtained, theoretical lower limit for biochemical feedback systems. Adding the transcriptional or small RNA-mediated control has different effects. Transcriptional autorepression robustly reduces both the relative variance and persistence (lifetime) of fluctuations. Both benefits combine to reduce noise in downstream gene expression. Autorepression via small RNA can achieve more extreme noise reduction and typically has less effect on the mean expression level. However, it is often more costly to implement and is more sensitive to rate parameters. Theoretical lower limits on the relative variance are known to decrease slowly as a measure of the cost per molecule of mean expression increases. However, the proportional increase in cost to achieve substantial noise suppression can be different away from the optimal frontier—for transcriptional autorepression, it is frequently negligible. PMID:22581772

High-Performance Flexible Transparent Electrode with an Embedded Metal Mesh Fabricated by Cost-Effective Solution Process.

PubMed

Khan, Arshad; Lee, Sangeon; Jang, Taehee; Xiong, Ze; Zhang, Cuiping; Tang, Jinyao; Guo, L Jay; Li, Wen-Di

2016-06-01

A new structure of flexible transparent electrodes is reported, featuring a metal mesh fully embedded and mechanically anchored in a flexible substrate, and a cost-effective solution-based fabrication strategy for this new transparent electrode. The embedded nature of the metal-mesh electrodes provides a series of advantages, including surface smoothness that is crucial for device fabrication, mechanical stability under high bending stress, strong adhesion to the substrate with excellent flexibility, and favorable resistance against moisture, oxygen, and chemicals. The novel fabrication process replaces vacuum-based metal deposition with an electrodeposition process and is potentially suitable for high-throughput, large-volume, and low-cost production. In particular, this strategy enables fabrication of a high-aspect-ratio (thickness to linewidth) metal mesh, substantially improving conductivity without considerably sacrificing transparency. Various prototype flexible transparent electrodes are demonstrated with transmittance higher than 90% and sheet resistance below 1 ohm sq(-1) , as well as extremely high figures of merit up to 1.5 × 10(4) , which are among the highest reported values in recent studies. Finally using our embedded metal-mesh electrode, a flexible transparent thin-film heater is demonstrated with a low power density requirement, rapid response time, and a low operating voltage. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Modelling of sequential groundwater treatment with zero valent iron and granular activated carbon.

PubMed

Bayer, Peter; Finkel, Michael

2005-06-01

Multiple contaminant mixtures in groundwater may not efficiently be treated by a single technology if contaminants possess rather different properties with respect to sorptivity, solubility, and degradation potential. An obvious choice is to use sequenced units of the generally accepted treatment materials zero valent iron (ZVI) and granular activated carbon (GAC). However, as the results of this modelling study suggest, the required dimensions of both reactor units may strongly differ from those expected on the grounds of a contaminant-specific design. This is revealed by performing an analysis for a broad spectrum of design alternatives through numerical experiments for selected patterns of contaminant mixtures consisting of monochlorobenzene, tetrachloroethylene, trichloroethylene (TCE), cis-1,2-dichloroethylene (cis-DCE), and vinyl chloride (VC). It is shown that efficient treatment can be achieved only if competitive sorption effects in the GAC unit as well as the formation of intermediate products in the ZVI unit are carefully taken into account. Cost-optimal designs turned out to vary extremely depending on the prevailing conditions concerning contaminant concentrations, branching ratios, and unit costs of both reactor materials. Where VC is the critical contaminant, due to high initial concentration or extensive production as an intermediate, two options are cost-effective: an oversized ZVI unit with an oversized GAC unit or a pure GAC reactor.

Rapid Experimental Evolution of Pesticide Resistance in C. elegans Entails No Costs and Affects the Mating System

PubMed Central

Lopes, Patricia C.; Sucena, Élio; Santos, M. Emília; Magalhães, Sara

2008-01-01

Pesticide resistance is a major concern in natural populations and a model trait to study adaptation. Despite the importance of this trait, the dynamics of its evolution and of its ecological consequences remain largely unstudied. To fill this gap, we performed experimental evolution with replicated populations of Caenorhabditis elegans exposed to the pesticide Levamisole during 20 generations. Exposure to Levamisole resulted in decreased survival, fecundity and male frequency, which declined from 30% to zero. This was not due to differential susceptibility of males. Rather, the drug affected mobility, resulting in fewer encounters, probably leading to reduced outcrossing rates. Adaptation, i.e., increased survival and fecundity, occurred within 10 and 20 generations, respectively. Male frequency also increased by generation 20. Adaptation costs were undetected in the ancestral environment and in presence of Ivermectin, another widely-used pesticide with an opposite physiological effect. Our results demonstrate that pesticide resistance can evolve at an extremely rapid pace. Furthermore, we unravel the effects of behaviour on life-history traits and test the environmental dependence of adaptation costs. This study establishes experimental evolution as a powerful tool to tackle pesticide resistance, and paves the way to further investigations manipulating environmental and/or genetic factors underlying adaptation to pesticides. PMID:19011681

Extreme Environment Technologies for Space and Terrestrial Applications

NASA Technical Reports Server (NTRS)

Balint, Tibor S.; Cutts, James A.; Kolawa, Elizabeth A.; Peterson, Craig E.

2008-01-01

Over the next decades, NASA's planned solar system exploration missions are targeting planets, moons and small bodies, where spacecraft would be expected to encounter diverse extreme environmental (EE) conditions throughout their mission phases. These EE conditions are often coupled. For instance, near the surface of Venus and in the deep atmospheres of giant planets, probes would experience high temperatures and pressures. In the Jovian system low temperatures are coupled with high radiation. Other environments include thermal cycling, and corrosion. Mission operations could also introduce extreme conditions, due to atmospheric entry heat flux and deceleration. Some of these EE conditions are not unique to space missions; they can be encountered by terrestrial assets from the fields of defense,oil and gas, aerospace, and automotive industries. In this paper we outline the findings of NASA's Extreme Environments Study Team, including discussions on state of the art and emerging capabilities related to environmental protection, tolerance and operations in EEs. We will also highlight cross cutting EE mitigation technologies, for example, between high g-load tolerant impactors for Europa and instrumented projectiles on Earth; high temperature electronics sensors on Jupiter deep probes and sensors inside jet engines; and pressure vessel technologies for Venus probes and sea bottom monitors. We will argue that synergistic development programs between these fields could be highly beneficial and cost effective for the various agencies and industries. Some of these environments, however, are specific to space and thus the related technology developments should be spear headed by NASA with collaboration from industry and academia.

Comparative Physiology of Fatigue.

PubMed

Jones, James H

2016-11-01

This review attempts to provide insights into factors associated with fatigue in human and nonhuman animals by using the two fundamental approaches of comparative physiology: determining common principles that govern structure and function in animals that are relatively invariant between animals and evaluating animals that have been highly adapted by natural selection to demonstrate extreme performance. In this review, I approach the topic of fatigue by considering factors that are associated with its reciprocal or inverse or duration of sustained performance before fatigue sets in to end the performance. The two general factors that I consider that affect endurance time more than any other are body temperature and body mass. The former affects endurance time because of thermodynamic effects on chemical reaction rates and metabolism; the latter acts through the mechanism of allometry or scaling. The examples of extreme animal performance that I discuss are two examples of bird migration, the diving performance of marine mammals, and the unique relationship that governs energy cost of locomotion in hopping kangaroos.

Strategic Studies Quarterly. Volume 2, Number 2, Summer 2008

DTIC Science & Technology

2008-06-01

terrorists seek financing , recruit followers, and continue to plot against the United States and our partners and allies. The phenomenon of suicide...moderate cost in terms of lives, finances , and opportunity costs to other missions and global commitments). Once physical sustainment is possible...private Saudi financing of al-Qaeda and other terrorist groups and the Saudi monarchy’s official promotion, throughout the Muslim world, of its own extreme

Impact of Foot Type on Cost of Lower Extremity Injury

DTIC Science & Technology

2013-01-25

were at higher risk for injury. Additionally, researchers have found relationships between chronic heel pain and osteoarthritis of the knee and hip...Cost of Injury, in Physical Training and Sports Injury Prevention Guidelines . 2010, U.S. Army Public Health Command (Provisional). 11. Injury...study. BMC Musculoskelet Disord, 2007. 8: p. 41. 48. Reilly, K., et al., The role of foot and ankle assessment of patients with lower limb osteoarthritis

Analysis and Cost Optimization of a USCG Remote Hybrid Power System

DTIC Science & Technology

2002-06-01

finding a system that can withstand the extreme weather conditions at these two sites is limited. It is recommended that as technology advances the...sites be conducted. 2. Battery Technology There have been significant advances in battery technology during the recent past. As these advancements ...costs associated with advanced technology decrease to more affordable levels to help 98 identify replacement batteries for the VRLA batteries when

Phase 2 of the array automated assembly task for the low cost silicon solar array project

NASA Technical Reports Server (NTRS)

Petersen, R. C.

1980-01-01

Studies were conducted on several fundamental aspects of electroless nickel/solder metallization for silicon solar cells. A process, which precedes the electroless nickel plating with several steps of palladium plating and heat treatment, was compared directly with single step electroless nickel plating. Work was directed toward answering specific questions concerning the effect of silicon surface oxide on nickel plating, effects of thermal stresses on the metallization, sintering of nickel plated on silicon, and effects of exposure to the plating solution on solar cell characteristics. The process was found to be extremely lengthy and cumbersome, and was also found to produce a product virtually identical to that produced by single step electroless nickel plating, as shown by adhesion tests and electrical characteristics of cells under illumination.

A low cost, adaptive mixed reality system for home-based stroke rehabilitation.

PubMed

Chen, Yinpeng; Baran, Michael; Sundaram, Hari; Rikakis, Thanassis

2011-01-01

This paper presents a novel, low-cost, real-time adaptive multimedia environment for home-based upper extremity rehabilitation of stroke survivors. The primary goal of this system is to provide an interactive tool with which the stroke survivor can sustain gains achieved within the clinical phase of therapy and increase the opportunity for functional recovery. This home-based mediated system has low cost sensing, off the shelf components for the auditory and visual feedback, and remote monitoring capability. The system is designed to continue active learning by reducing dependency on real-time feedback and focusing on summary feedback after a single task and sequences of tasks. To increase system effectiveness through customization, we use data from the training strategy developed by the therapist at the clinic for each stroke survivor to drive automated system adaptation at the home. The adaptation includes changing training focus, selecting proper feedback coupling both in real-time and in summary, and constructing appropriate dialogues with the stroke survivor to promote more efficient use of the system. This system also allows the therapist to review participant's progress and adjust the training strategy weekly.

Users' reaction to the drought of 2014 in Lebanon; quantifying the effects

NASA Astrophysics Data System (ADS)

Farajalla, Nadim; Haydamous, Patricia; El Hajj, Rana

2016-04-01

A drought that Lebanon witnessed during the water cycle of 2013-2014 seemed to mimic the expected decrease in precipitation projected in one of the 2020 scenarios reported in Lebanon's second national communication to the United Nations Framework Convention on Climate Change. Nationally, data and assessment studies on drought impacts are generally lacking, and thus, this drought presented an opportunity to quantify drought effects. In the aim of understanding the effect drought has on the Lebanese economy, and its different sectors, a survey was conducted to set a baseline of the changes in the direct cost of water as well as other impacts that might have resulted on the water users. The survey reached out to different sectors to include the touristic establishments, industries, agriculture holders, and households. The sample selection and the data collection underwent several controls in order to ensure unbiased data. Moreover, a descriptive analysis was produced from the survey results, using STATA and Microsoft Excel. The main results have shown a shift of dependency towards water tankers during the drought season as opposed to the normal higher dependency on the public networks and private wells. Moreover, the cost incurred in general showed an average of 32% increase to the previous water bills across the different sectors, this in return is expected to have ripple effects on the national economy accounting for around 13.5% of GDP. However, the survey showed that little was done in terms of long term adaptation on the consumers' side, where most of the adaptation done included awareness campaigns for an economized water usage on the short term. The survey brought forward the un-preparedness of the country to react to such extreme events due to the absence of drought preparedness and management plan. . The results highlight the projected losses the country will have if no proper adaptation measures were taken. These impacts were caused by a one-year drought, however as this is expected to be the normal scenario in the future, it is of great importance to work on an adaptation policy in Lebanon, and on a drought management plan in particular. The high costs and unsustainable solutions that were applied during the drought season have shown how unprepared and unaware the Lebanese citizens are of such extreme weather events.

TOTAL KNEE REPLACEMENT IN PATIENTS WITH BELOW-KNEE AMPUTATION

PubMed Central

Karam, Matthew D; Willey, Michael; Shurr, Donald G

2010-01-01

Total knee replacement (TKR) is reserved for patients with severe and disabling arthritis that is non-responsive to conservative measures. Based on existing data, total knee replacement is a safe and cost-effective treatment for alleviating pain and improving physical function in patients who do not respond to conservative therapy. Despite the large variation in health status of patients and types of prosthesis implanted, total knee replacement has proven to be a relatively low risk and successful operation. Each year in the United States surgeons perform approximately 300,000 TKR.1 Likewise, lower extremity amputation is commonly performed in the United States with an annual incidence of 110,000 per year.2 Nearly 70% of all lower extremity amputations are performed as the result of chronic vascular disease, followed by trauma (22%), congenital etiology and tumor (4% each).3 Approximately 50% of all lower extremity amputations are performed secondary to complications from Diabetes Mellitus. Norvell et al. demonstrated that patients who have previously undergone transtibial amputation and ambulate with a prosthesis are more likely to develop degenerative joint disease in the con-tralateral extremity than the ipsilateral extremity.4 Further, radiographic changes consistent with osteoporosis have been demonstrated in up to 88% of limbs that have undergone transtibial amputation.8 To our knowledge, there have been only three reported cases of total knee replacement in patients with ipsilateral transtibial amputation.5,7 The purpose of the present study is to review the existing data on total knee replacement in patients who have undergone transtibial amputation. Further we present a patient with a transtibial amputation who underwent contralateral total knee replacement. PMID:21045987

Handling Emergency Management in [an] Object Oriented Modeling Environment

NASA Technical Reports Server (NTRS)

Tokgoz, Berna Eren; Cakir, Volkan; Gheorghe, Adrian V.

2010-01-01

It has been understood that protection of a nation from extreme disasters is a challenging task. Impacts of extreme disasters on a nation's critical infrastructures, economy and society could be devastating. A protection plan itself would not be sufficient when a disaster strikes. Hence, there is a need for a holistic approach to establish more resilient infrastructures to withstand extreme disasters. A resilient infrastructure can be defined as a system or facility that is able to withstand damage, but if affected, can be readily and cost-effectively restored. The key issue to establish resilient infrastructures is to incorporate existing protection plans with comprehensive preparedness actions to respond, recover and restore as quickly as possible, and to minimize extreme disaster impacts. Although national organizations will respond to a disaster, extreme disasters need to be handled mostly by local emergency management departments. Since emergency management departments have to deal with complex systems, they have to have a manageable plan and efficient organizational structures to coordinate all these systems. A strong organizational structure is the key in responding fast before and during disasters, and recovering quickly after disasters. In this study, the entire emergency management is viewed as an enterprise and modelled through enterprise management approach. Managing an enterprise or a large complex system is a very challenging task. It is critical for an enterprise to respond to challenges in a timely manner with quick decision making. This study addresses the problem of handling emergency management at regional level in an object oriented modelling environment developed by use of TopEase software. Emergency Operation Plan of the City of Hampton, Virginia, has been incorporated into TopEase for analysis. The methodology used in this study has been supported by a case study on critical infrastructure resiliency in Hampton Roads.

Extreme Mississippi River Floods in the Late Holocene: Reconstructions and Simulations

NASA Astrophysics Data System (ADS)

Munoz, S. E.; Giosan, L.; Donnelly, J. P.; Dee, S.

2016-12-01

Extreme flooding of the Mississippi River is costly in both economic and social terms. Despite ambitious engineering projects conceived in the early 20th century to mitigate damage from extreme floods, economic losses due to flooding have increased over recent years. Forecasting extreme flood occurrence over seasonal or longer time-scales remains a major challenge - especially in light of shifts in hydroclimatic conditions expected in response to continued greenhouse forcing. Here, we present findings from a series of paleoflood records that span the late Holocene derived from laminated sediments deposited in abandoned channels of the Mississippi River. These sedimentary archives record individual overbank floods as unique events beds with upward fining that we identify using grain-size analysis, bulk geochemistry, and radiography. We use sedimentological characteristics to reconstruct flood magnitude by calibrating our records against instrumental streamflow data from nearby gauging stations. We also use the Last Millennium Experiments of the Community Earth System Model (CESM-LME) and historical reanalysis data to examine the state of climate system around river discharge extremes. Our paleo-flood records exhibit strong non-stationarities in flood frequency and magnitude that are associated with fluctuations in the frequency of the El Niño-Southern Oscillation (ENSO), because the warm ENSO phase is associated with increased surface water storage of the lower Mississippi basin that leads to enhanced runoff delivery to the main channel. We also show that the early 20th century was a period of anomalously high flood frequency and magnitude due to the combined effects of river engineering and natural climate variability. Our findings imply that flood risk along the lower Mississippi River is tightly coupled to the frequency of ENSO, highlighting the need for robust projections of ENSO variability under greenhouse warming.

The Challenges from Extreme Climate Events for Sustainable Development in Amazonia: the Acre State Experience

NASA Astrophysics Data System (ADS)

Araújo, M. D. N. M.

2015-12-01

In the past ten years Acre State, located in Brazil´s southwestern Amazonia, has confronted sequential and severe extreme events in the form of droughts and floods. In particular, the droughts and forest fires of 2005 and 2010, the 2012 flood within Acre, the 2014 flood of the Madeira River which isolated Acre for two months from southern Brazil, and the most severe flooding throughout the state in 2015 shook the resilience of Acrean society. The accumulated costs of these events since 2005 have exceeded 300 million dollars. For the last 17 years, successive state administrations have been implementing a socio-environmental model of development that strives to link sustainable economic production with environmental conservation, particularly for small communities. In this context, extreme climate events have interfered significantly with this model, increasing the risks of failure. The impacts caused by these events on development in the state have been exacerbated by: a) limitations in monitoring; b) extreme events outside of Acre territory (Madeira River Flood) affecting transportation systems; c) absence of reliable information for decision-making; and d) bureaucratic and judicial impediments. Our experience in these events have led to the following needs for scientific input to reduce the risk of disasters: 1) better monitoring and forecasting of deforestation, fires, and hydro-meteorological variables; 2) ways to increase risk perception in communities; 3) approaches to involve more effectively local and regional populations in the response to disasters; 4) more accurate measurements of the economic and social damages caused by these disasters. We must improve adaptation to and mitigation of current and future extreme climate events and implement a robust civil defense, adequate to these new challenges.

Management of stormwater facility maintenance residuals

DOT National Transportation Integrated Search

1998-06-01

Current research on stormwater maintenance residuals has revealed that the source and nature of these materials is extremely variable, that regulation can be ambiguous, and handling can be costly and difficult. From a regulatory perspective, data ind...

Integrated assessment of water-power grid systems under changing climate

NASA Astrophysics Data System (ADS)

Yan, E.; Zhou, Z.; Betrie, G.

2017-12-01

Energy and water systems are intrinsically interconnected. Due to an increase in climate variability and extreme weather events, interdependency between these two systems has been recently intensified resulting significant impacts on both systems and energy output. To address this challenge, an Integrated Water-Energy Systems Assessment Framework (IWESAF) is being developed to integrate multiple existing or developed models from various sectors. In this presentation, we are focusing on recent improvement in model development of thermoelectric power plant water use simulator, power grid operation and cost optimization model, and model integration that facilitate interaction among water and electricity generation under extreme climate events. A process based thermoelectric power water use simulator includes heat-balance, climate, and cooling system modules that account for power plant characteristics, fuel types, and cooling technology. The model is validated with more than 800 power plants of fossil-fired, nuclear and gas-turbine power plants with different cooling systems. The power grid operation and cost optimization model was implemented for a selected regional in the Midwest. The case study will be demonstrated to evaluate the sensitivity and resilience of thermoelectricity generation and power grid under various climate and hydrologic extremes and potential economic consequences.

Impact of Optimized Breastfeeding on the Costs of Necrotizing Enterocolitis in Extremely Low Birthweight Infants.

PubMed

Colaizy, Tarah T; Bartick, Melissa C; Jegier, Briana J; Green, Brittany D; Reinhold, Arnold G; Schaefer, Andrew J; Bogen, Debra L; Schwarz, Eleanor Bimla; Stuebe, Alison M

2016-08-01

To estimate risk of necrotizing enterocolitis (NEC) for extremely low birth weight (ELBW) infants as a function of preterm formula (PF) and maternal milk intake and calculate the impact of suboptimal feeding on the incidence and costs of NEC. We used aORs derived from the Glutamine Trial to perform Monte Carlo simulation of a cohort of ELBW infants under current suboptimal feeding practices, compared with a theoretical cohort in which 90% of infants received at least 98% human milk. NEC incidence among infants receiving ≥98% human milk was 1.3%; 11.1% among infants fed only PF; and 8.2% among infants fed a mixed diet (P = .002). In adjusted models, compared with infants fed predominantly human milk, we found an increased risk of NEC associated with exclusive PF (aOR = 12.1, 95% CI 1.5, 94.2), or a mixed diet (aOR 8.7, 95% CI 1.2-65.2). In Monte Carlo simulation, current feeding of ELBW infants was associated with 928 excess NEC cases and 121 excess deaths annually, compared with a model in which 90% of infants received ≥98% human milk. These models estimated an annual cost of suboptimal feeding of ELBW infants of $27.1 million (CI $24 million, $30.4 million) in direct medical costs, $563 655 (CI $476 191, $599 069) in indirect nonmedical costs, and $1.5 billion (CI $1.3 billion, $1.6 billion) in cost attributable to premature death. Among ELBW infants, not being fed predominantly human milk is associated with an increased risk of NEC. Efforts to support milk production by mothers of ELBW infants may prevent infant deaths and reduce costs. Copyright © 2016 Elsevier Inc. All rights reserved.

Beryllium and titanium cost-adjustment report

NASA Astrophysics Data System (ADS)

Owen, John; Ulph, Eric, Sr.

1991-09-01

This report summarizes cost adjustment factors for beryllium (Be, S200) and titanium (Ti, 6Al-4V) that were derived relative to aluminum (Al, 7075-T6). Aluminum is traditionally the material upon which many of the Cost Analysis Office, Missile Division cost estimating relationships (CERs) are based. The adjustment factors address both research and development and production (Q > 100) quantities. In addition, the factors derived include optical elements, normal structure, and structure with special requirements for minimal microcreep, such as sensor assembly parts and supporting components. Since booster cost per payload pound is an even larger factor in total missile launch costs than was initially presumed, the primary cost driver for all materials compared was the missiles' booster cost per payload pound for both R&D and production quantities. Al and Ti are 1.5 and 2.4 times more dense, respectively, than Be, and the cost to lift the heavier materials results in greater booster expense. In addition, Al and Ti must be 2.1 and 2.8, respectively, times the weight of a Be component to provide equivalent stiffness, based on the example component addressed in the report. These factors also increase booster costs. After review of the relative factors cited above, especially the lower costs for Be when stiffness and booster costs are taken into consideration, affordability becomes an important issue. When this study was initiated, both government and contractor engineers said that Be was the material to be used as a last resort because of its prohibitive cost and extreme toxicity. Although the initial price of Be may lead one to believe that any Be product would be extremely expensive, the total cost of Be used for space applications is actually competitive with or less costly than either Al or Ti. Also, the Be toxicity problem has turned out to be a non-issue for purchasers of finished Be components since no machining or grinding operations are required on the finished components. Several new costing techniques are developed which provide quantitative measures of the cost of material stiffness, costs related to payload weight, and costs associated with the relative temperature stability of different materials. In addition, use is made of the Design/Cost Trade Model developed by Applied Research, Inc., to determine the booster cost differential relative to changes in payload weight, and a mirror fabrication cost model, developed by OCA Applied Optics, was used for mirror costing. This report is a summary of an extensive study done by the U.S. Army Strategic Defense Command, Huntsville, Alabama.

A highly sensitive biological detection substrate based on TiO2 nanowires supporting gold nanoparticles

NASA Astrophysics Data System (ADS)

Zeng, Yuan; Tan, Hai-jun; Cheng, Xiu-Lan; Chen, Rui; Wang, Ying

2011-12-01

Surface enhanced Raman scattering (SERS) has attracted widespread concern in the field of bioassay because it can enhance normally weak Raman signal by several orders of magnitude and facilitate the highly sensitive detection of molecules. Conventional SERS substrates are prepared by placing metal nanoparticles on a planar surface. Here we show a unique SERS substrate stacked by disordered TiO2 nanowires (TiO2-NWs) supportig gold nanocrystals. The structure can be easily fabricated by chemical synthesis at low cost. The COMSOL model simulation shows the designed SERS substrate is capable of output high Local Field Enhancement (LFE) in the Near Infrared region (NIR) that is the optimal wavelength in bio-detection because of both the unique coupling enhancement effect amony nearby Au nanocrystals on TiO2-NWs and the Suface Plasmon Resonance (SPR) effect of TiO2 -NWs. The as-prepared transparent and freestanding SERS substrate is capable of detecting extremely low concentration R6G molecular, showing much higher Raman signal because of the extremely large surface area and the uniqueTiO2-NWs self-assemblied by Au nanocrystals. These results provide a new approach to ultrasensitive bioassay device.

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

Quon, Eliot; Platt, Andrew; Yu, Yi-Hsiang

Extreme loads are often a key cost driver for wave energy converters (WECs). As an alternative to exhaustive Monte Carlo or long-term simulations, the most likely extreme response (MLER) method allows mid- and high-fidelity simulations to be used more efficiently in evaluating WEC response to events at the edges of the design envelope, and is therefore applicable to system design analysis. The study discussed in this paper applies the MLER method to investigate the maximum heave, pitch, and surge force of a point absorber WEC. Most likely extreme waves were obtained from a set of wave statistics data based onmore » spectral analysis and the response amplitude operators (RAOs) of the floating body; the RAOs were computed from a simple radiation-and-diffraction-theory-based numerical model. A weakly nonlinear numerical method and a computational fluid dynamics (CFD) method were then applied to compute the short-term response to the MLER wave. Effects of nonlinear wave and floating body interaction on the WEC under the anticipated 100-year waves were examined by comparing the results from the linearly superimposed RAOs, the weakly nonlinear model, and CFD simulations. Overall, the MLER method was successfully applied. In particular, when coupled to a high-fidelity CFD analysis, the nonlinear fluid dynamics can be readily captured.« less

Not everything is black and white: color and behavioral variation reveal a continuum between cryptic and aposematic strategies in a polymorphic poison frog.

PubMed

Willink, Beatriz; Brenes-Mora, Esteban; Bolaños, Federico; Pröhl, Heike

2013-10-01

Aposematism and crypsis are often viewed as two extremes of a continuum of visual conspicuousness to predators. Theory predicts that behavioral and coloration conspicuousness should vary in tandem along the conspicuousness spectrum for antipredator strategies to be effective. Here we used visual modeling of contrast and behavioral observations to examine the conspicuousness of four populations of the granular poison frog, Oophaga granulifera, which exhibits almost continuous variation in dorsal color. The patterns of geographic variation in color, visual contrast, and behavior support a gradient of overall conspicuousness along the distribution of O. granulifera. Red and green populations, at the extremes of the color distribution, differ in all elements of color, contrast, and behavior, strongly reflecting aposematic and cryptic strategies. However, there is no smooth cline in any elements of behavior or coloration between the two extremes. Instead populations of intermediate colors attain intermediate conspicuousness by displaying different combinations of aposematic and cryptic traits. We argue that coloration divergence among populations may be linked to the evolution of a gradient of strategies to balance the costs of detection by predators and the benefits of learned aversion. © 2013 The Author(s). Evolution © 2013 The Society for the Study of Evolution.

Genome editing of BmFib-H gene provides an empty Bombyx mori silk gland for a highly efficient bioreactor

PubMed Central

Ma, Sanyuan; Shi, Run; Wang, Xiaogang; Liu, Yuanyuan; Chang, Jiasong; Gao, Jie; Lu, Wei; Zhang, Jianduo; Zhao, Ping; Xia, Qingyou

2014-01-01

Evolution has produced some remarkable creatures, of which silk gland is a fascinating organ that exists in a variety of insects and almost half of the 34,000 spider species. The impressive ability to secrete huge amount of pure silk protein, and to store proteins at an extremely high concentration (up to 25%) make the silk gland of Bombyx mori hold great promise to be a cost-effective platform for production of recombinant proteins. However, the extremely low production yields of the numerous reported expression systems greatly hindered the exploration and application of silk gland bioreactors. Using customized zinc finger nucleases (ZFN), we successfully performed genome editing of Bmfib-H gene, which encodes the largest and most abundant silk protein, in B. mori with efficiency higher than any previously reported. The resulted Bmfib-H knocked-out B. mori showed a smaller and empty silk gland, abnormally developed posterior silk gland cells, an extremely thin cocoon that contain only sericin proteins, and a slightly heavier pupae. We also showed that removal of endogenous Bmfib-H protein could significantly increase the expression level of exogenous protein. Furthermore, we demonstrated that the bioreactor is suitable for large scale production of protein-based materials. PMID:25359576

Methane Leaks from Natural Gas Systems Follow Extreme Distributions.

PubMed

Brandt, Adam R; Heath, Garvin A; Cooley, Daniel

2016-11-15

Future energy systems may rely on natural gas as a low-cost fuel to support variable renewable power. However, leaking natural gas causes climate damage because methane (CH 4 ) has a high global warming potential. In this study, we use extreme-value theory to explore the distribution of natural gas leak sizes. By analyzing ∼15 000 measurements from 18 prior studies, we show that all available natural gas leakage data sets are statistically heavy-tailed, and that gas leaks are more extremely distributed than other natural and social phenomena. A unifying result is that the largest 5% of leaks typically contribute over 50% of the total leakage volume. While prior studies used log-normal model distributions, we show that log-normal functions poorly represent tail behavior. Our results suggest that published uncertainty ranges of CH 4 emissions are too narrow, and that larger sample sizes are required in future studies to achieve targeted confidence intervals. Additionally, we find that cross-study aggregation of data sets to increase sample size is not recommended due to apparent deviation between sampled populations. Understanding the nature of leak distributions can improve emission estimates, better illustrate their uncertainty, allow prioritization of source categories, and improve sampling design. Also, these data can be used for more effective design of leak detection technologies.

Methane Leaks from Natural Gas Systems Follow Extreme Distributions

DOE PAGES

Brandt, Adam R.; Heath, Garvin A.; Cooley, Daniel

2016-10-14

Future energy systems may rely on natural gas as a low-cost fuel to support variable renewable power. However, leaking natural gas causes climate damage because methane (CH 4) has a high global warming potential. In this study, we use extreme-value theory to explore the distribution of natural gas leak sizes. By analyzing ~15,000 measurements from 18 prior studies, we show that all available natural gas leakage datasets are statistically heavy-tailed, and that gas leaks are more extremely distributed than other natural and social phenomena. A unifying result is that the largest 5% of leaks typically contribute over 50% of themore » total leakage volume. While prior studies used lognormal model distributions, we show that lognormal functions poorly represent tail behavior. Our results suggest that published uncertainty ranges of CH 4 emissions are too narrow, and that larger sample sizes are required in future studies to achieve targeted confidence intervals. Additionally, we find that cross-study aggregation of datasets to increase sample size is not recommended due to apparent deviation between sampled populations. Finally, understanding the nature of leak distributions can improve emission estimates, better illustrate their uncertainty, allow prioritization of source categories, and improve sampling design. Also, these data can be used for more effective design of leak detection technologies.« less

Methane Leaks from Natural Gas Systems Follow Extreme Distributions

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

Brandt, Adam R.; Heath, Garvin A.; Cooley, Daniel

Future energy systems may rely on natural gas as a low-cost fuel to support variable renewable power. However, leaking natural gas causes climate damage because methane (CH 4) has a high global warming potential. In this study, we use extreme-value theory to explore the distribution of natural gas leak sizes. By analyzing ~15,000 measurements from 18 prior studies, we show that all available natural gas leakage datasets are statistically heavy-tailed, and that gas leaks are more extremely distributed than other natural and social phenomena. A unifying result is that the largest 5% of leaks typically contribute over 50% of themore » total leakage volume. While prior studies used lognormal model distributions, we show that lognormal functions poorly represent tail behavior. Our results suggest that published uncertainty ranges of CH 4 emissions are too narrow, and that larger sample sizes are required in future studies to achieve targeted confidence intervals. Additionally, we find that cross-study aggregation of datasets to increase sample size is not recommended due to apparent deviation between sampled populations. Finally, understanding the nature of leak distributions can improve emission estimates, better illustrate their uncertainty, allow prioritization of source categories, and improve sampling design. Also, these data can be used for more effective design of leak detection technologies.« less

Cost Utility Analysis of Percutaneous Adhesiolysis in Managing Pain of Post-lumbar Surgery Syndrome and Lumbar Central Spinal Stenosis.

PubMed

Manchikanti, Laxmaiah; Helm, Standiford; Pampati, Vidyasagar; Racz, Gabor B

2015-06-01

The increase in the number of interventions for the management of chronic pain and associated escalation of healthcare costs has captured the attention of health policymakers, in no small part due to the lack of documentation of efficacy, cost-effectiveness, or cost utility analysis. A recent cost utility analysis of caudal epidural injections in managing chronic low back pain of various pathologies showed a high cost utility with improvement in quality of life years, competitive with various other modalities of treatments. However, there are no analyses derived from high-quality controlled studies related to the cost utility of percutaneous adhesiolysis in the treatment of post-lumbar surgery syndrome or lumbar central spinal stenosis. This analysis is based on 2 previously published controlled studies. To assess the cost utility of percutaneous adhesiolysis procedures in managing chronic low back and lower extremity pain secondary to post-lumbar surgery syndrome and lumbar central spinal stenosis. A private, specialty referral interventional pain management center in the United States. Two controlled studies were conducted assessing the clinical effectiveness of percutaneous adhesiolysis for post-lumbar surgery syndrome and lumbar central spinal stenosis in an interventional pain management setting utilizing contemporary interventional pain management practices. A cost utility analysis was performed with direct payment data for a total of 130 patients in treatment groups over a 2-year period. Various outcome measures were included with significant improvement, defined as at least 50% improvement with reduction in pain and disability status. The results of 2 controlled studies of low back pain with 60 and 70 patients and a 2-year follow-up with the actual reimbursement data showed cost utility for 1 year of quality-adjusted life year (QALY) of USD $2,652 for post-lumbar surgery syndrome and USD $2,649 for lumbar central spinal stenosis. The results of this assessment show that the cost utility of managing chronic, intractable low back pain with percutaneous adhesiolysis at a QALY that is similar or lower in price than medical therapy only, physical therapy, manipulation, spinal cord stimulation, and surgery. The limitations of this cost utility analysis are that it is a single-center evaluation, with the inclusion of costs of adhesiolysis procedures in an ambulatory surgery center and physician visits, rather than all related costs including drug therapy and costs of disability in multiple settings. This cost utility analysis of percutaneous adhesiolysis in the treatment of post-lumbar surgery syndrome and lumbar central spinal stenosis shows the clinical effectiveness and cost utility of these procedures at USD $2,650 per one year of QALY when performed in an ambulatory surgery center. © 2014 World Institute of Pain.

Combination therapy in combating cancer

PubMed Central

Mokhtari, Reza Bayat; Homayouni, Tina S.; Baluch, Narges; Morgatskaya, Evgeniya; Kumar, Sushil; Das, Bikul; Yeger, Herman

2017-01-01

Combination therapy, a treatment modality that combines two or more therapeutic agents, is a cornerstone of cancer therapy. The amalgamation of anti-cancer drugs enhances efficacy compared to the mono-therapy approach because it targets key pathways in a characteristically synergistic or an additive manner. This approach potentially reduces drug resistance, while simultaneously providing therapeutic anti-cancer benefits, such as reducing tumour growth and metastatic potential, arresting mitotically active cells, reducing cancer stem cell populations, and inducing apoptosis. The 5-year survival rates for most metastatic cancers are still quite low, and the process of developing a new anti-cancer drug is costly and extremely time-consuming. Therefore, new strategies that target the survival pathways that provide efficient and effective results at an affordable cost are being considered. One such approach incorporates repurposing therapeutic agents initially used for the treatment of different diseases other than cancer. This approach is effective primarily when the FDA-approved agent targets similar pathways found in cancer. Because one of the drugs used in combination therapy is already FDA-approved, overall costs of combination therapy research are reduced. This increases cost efficiency of therapy, thereby benefiting the “medically underserved”. In addition, an approach that combines repurposed pharmaceutical agents with other therapeutics has shown promising results in mitigating tumour burden. In this systematic review, we discuss important pathways commonly targeted in cancer therapy. Furthermore, we also review important repurposed or primary anti-cancer agents that have gained popularity in clinical trials and research since 2012. PMID:28410237

Development of a Two-Stage Microalgae Dewatering Process – A Life Cycle Assessment Approach

PubMed Central

Soomro, Rizwan R.; Zeng, Xianhai; Lu, Yinghua; Lin, Lu; Danquah, Michael K.

2016-01-01

Even though microalgal biomass is leading the third generation biofuel research, significant effort is required to establish an economically viable commercial-scale microalgal biofuel production system. Whilst a significant amount of work has been reported on large-scale cultivation of microalgae using photo-bioreactors and pond systems, research focus on establishing high performance downstream dewatering operations for large-scale processing under optimal economy is limited. The enormous amount of energy and associated cost required for dewatering large-volume microalgal cultures has been the primary hindrance to the development of the needed biomass quantity for industrial-scale microalgal biofuels production. The extremely dilute nature of large-volume microalgal suspension and the small size of microalgae cells in suspension create a significant processing cost during dewatering and this has raised major concerns towards the economic success of commercial-scale microalgal biofuel production as an alternative to conventional petroleum fuels. This article reports an effective framework to assess the performance of different dewatering technologies as the basis to establish an effective two-stage dewatering system. Bioflocculation coupled with tangential flow filtration (TFF) emerged a promising technique with total energy input of 0.041 kWh, 0.05 kg CO2 emissions and a cost of $ 0.0043 for producing 1 kg of microalgae biomass. A streamlined process for operational analysis of two-stage microalgae dewatering technique, encompassing energy input, carbon dioxide emission, and process cost, is presented. PMID:26904075

Economic evaluation of drug-eluting stents in coronary angioplasty.

PubMed

Santos, Ricardo; Pereira, Hélder

2005-11-01

Coronary angioplasty has revolutionized the treatment of coronary artery disease, from the first balloon angioplasty to the current era of drug-eluting stents (DES), which were developed to eliminate the bare metal stent's (BMS) Achilles' heel, restenosis. DES have an extremely low restenosis rate but are significantly more expensive and need more prolonged dual antiplatelet therapy. Restenosis has a generally benign prognosis and is not associated with higher mortality or major adverse cardiovascular events, which has limited the penetration of DES, whose only advantage is the reduction of restenosis. Economic evaluation of DES is therefore of paramount importance for assessing their appropriate use. In randomized trials in which they are compared with BMS, economic evaluation is advantageous for DES, with good cost-effectiveness ratios for both cost per quality-adjusted life year (QALY) and cost per revascularization avoided. However, these trials have two major limitations--the angiographic follow-up protocol and selection of patients with lower risk--and so their results do not accurately reflect reality. Other studies with unselected populations and cost-effectiveness models show that there is an economic advantage in the use of DES in groups with higher risk of restenosis, but not for the whole population undergoing angioplasty. Use of DES will be more appropriate if we can identify populations with a higher likelihood of restenosis, because these are the patients that will benefit most from their use and in whom they will be economically advantageous.

Effects of extreme-duration heavy load carriage on neuromuscular function and locomotion: a military-based study.

PubMed

Grenier, Jordane G; Millet, Guillaume Y; Peyrot, Nicolas; Samozino, Pierre; Oullion, Roger; Messonnier, Laurent; Morin, Jean-Benoît

2012-01-01

Trekking and military missions generally consist of carrying heavy loads for extreme durations. These factors have been separately shown to be sources of neuromuscular (NM) fatigue and locomotor alterations. However, the question of their combined effects remains unresolved, and addressing this issue required a representative context. The aim was to investigate the effects of extreme-duration heavy load carriage on NM function and walking characteristics. Ten experienced infantrymen performed a 21-h simulated military mission (SMM) in a middle-mountain environment with equipment weighing ∼27 kg during battles and ∼43 kg during marches. NM function was evaluated for knee extensors (KE) and plantar flexors (PF) pre- and immediately post-SMM using isometric maximal voluntary contraction (MVC) measurement, neural electrical stimulation and surface EMG. The twitch-interpolation method was used to assess central fatigue. Peripheral changes were examined by stimulating the muscle in the relaxed state. The energy cost, mechanical work and spatio-temporal pattern of walking were also evaluated pre-/post-SMM on an instrumented treadmill in three equipment conditions: Sportswear, Battle and March. After the SMM, MVC declined by -10.2±3.6% for KE (P<0.01) and -10.7±16.1% for PF (P = 0.06). The origin of fatigue was essentially peripheral for both muscle groups. A trend toward low-frequency fatigue was detected for KE (5.5%, P = 0.08). These moderate NM alterations were concomitant with a large increase in perceived fatigue from pre- (rating of 8.3±2.2) to post-SMM (15.9±2.1, P<0.01). The SMM-related fatigue did not alter walking energetics or mechanics, and the different equipment carried on the treadmill did not interact with this fatigue either. this study reports the first data on physiological and biomechanical consequences of extreme-duration heavy load carriage. Unexpectedly, NM function alterations due to the 21-h SMM were moderate and did not alter walking characteristics. Name: Effect of prolonged military exercises with high load carriage on neuromuscular fatigue and physiological/biomechanical responses. Number: NCT01127191.

Effects of Extreme-Duration Heavy Load Carriage on Neuromuscular Function and Locomotion: A Military-Based Study

PubMed Central

Grenier, Jordane G.; Millet, Guillaume Y.; Peyrot, Nicolas; Samozino, Pierre; Oullion, Roger; Messonnier, Laurent; Morin, Jean-Benoît

2012-01-01

Trekking and military missions generally consist of carrying heavy loads for extreme durations. These factors have been separately shown to be sources of neuromuscular (NM) fatigue and locomotor alterations. However, the question of their combined effects remains unresolved, and addressing this issue required a representative context. Purpose The aim was to investigate the effects of extreme-duration heavy load carriage on NM function and walking characteristics. Methods Ten experienced infantrymen performed a 21-h simulated military mission (SMM) in a middle-mountain environment with equipment weighing ∼27 kg during battles and ∼43 kg during marches. NM function was evaluated for knee extensors (KE) and plantar flexors (PF) pre- and immediately post-SMM using isometric maximal voluntary contraction (MVC) measurement, neural electrical stimulation and surface EMG. The twitch-interpolation method was used to assess central fatigue. Peripheral changes were examined by stimulating the muscle in the relaxed state. The energy cost, mechanical work and spatio-temporal pattern of walking were also evaluated pre−/post-SMM on an instrumented treadmill in three equipment conditions: Sportswear, Battle and March. Results After the SMM, MVC declined by −10.2±3.6% for KE (P<0.01) and −10.7±16.1% for PF (P = 0.06). The origin of fatigue was essentially peripheral for both muscle groups. A trend toward low-frequency fatigue was detected for KE (5.5%, P = 0.08). These moderate NM alterations were concomitant with a large increase in perceived fatigue from pre- (rating of 8.3±2.2) to post-SMM (15.9±2.1, P<0.01). The SMM-related fatigue did not alter walking energetics or mechanics, and the different equipment carried on the treadmill did not interact with this fatigue either. Conclusion this study reports the first data on physiological and biomechanical consequences of extreme-duration heavy load carriage. Unexpectedly, NM function alterations due to the 21-h SMM were moderate and did not alter walking characteristics. Clinical Trial Registration Name: Effect of prolonged military exercises with high load carriage on neuromuscular fatigue and physiological/biomechanical responses. Number: NCT01127191. PMID:22927995

Comparative cost analysis of insecticide-treated net delivery strategies: sales supported by social marketing and free distribution through antenatal care.

PubMed

De Allegri, Manuela; Marschall, Paul; Flessa, Steffen; Tiendrebéogo, Justin; Kouyaté, Bocar; Jahn, Albrecht; Müller, Olaf

2010-01-01

Insecticide-treated nets (ITNs) are effective in substantially reducing malaria transmission. Still, ITN coverage in sub-Saharan Africa (SSA) remains extremely low. Policy makers are concerned with identifying the most suitable delivery mechanism to achieve rapid yet sustainable increases in ITN coverage. Little is known, however, on the comparative costs of alternative ITN distribution strategies. This paper aimed to fill this gap in knowledge by developing such a comparative cost analysis, looking at the cost per ITN distributed for two alternative interventions: subsidized sales supported by social marketing and free distribution to pregnant women through antenatal care (ANC). The study was conducted in rural Burkina Faso, where the two interventions were carried out alongside one another in 2006/07. Cost information was collected prospectively to derive both a financial analysis adopting a provider's perspective and an economic analysis adopting a societal perspective. The average financial cost per ITN distributed was US$8.08 and US$7.21 for sales supported by social marketing and free distribution through ANC, respectively. The average economic cost per ITN distributed was US$4.81 for both interventions. Contrary to common belief, costs did not differ substantially between the two interventions. Due to the district's ability to rely fully on the use of existing resources, financial costs associated with free ITN distribution through ANC were in fact even lower than those associated with the social marketing campaign. This represents an encouraging finding for SSA governments and points to the possibility to invest in programmes to favour free ITN distribution through existing health facilities. Given restricted budgets, however, free distribution programmes are unlikely to be feasible.

Generalisability and Cost-Impact of Antibiotic-Impregnated Central Venous Catheters for Reducing Risk of Bloodstream Infection in Paediatric Intensive Care Units in England.

PubMed

Harron, Katie; Mok, Quen; Hughes, Dyfrig; Muller-Pebody, Berit; Parslow, Roger; Ramnarayan, Padmanabhan; Gilbert, Ruth

2016-01-01

We determined the generalisability and cost-impact of adopting antibiotic-impregnated CVCs in all paediatric intensive care units (PICUs) in England, based on results from a large randomised controlled trial (the CATCH trial; ISRCTN34884569). BSI rates using standard CVCs were estimated through linkage of national PICU audit data (PICANet) with laboratory surveillance data. We estimated the number of BSI averted if PICUs switched from standard to antibiotic-impregnated CVCs by applying the CATCH trial rate-ratio (0.40; 95% CI 0.17,0.97) to the BSI rate using standard CVCs. The value of healthcare resources made available by averting one BSI as estimated from the trial economic analysis was £10,975; 95% CI -£2,801,£24,751. The BSI rate using standard CVCs was 4.58 (95% CI 4.42,4.74) per 1000 CVC-days in 2012. Applying the rate-ratio gave 232 BSI averted using antibiotic CVCs. The additional cost of purchasing antibiotic-impregnated compared with standard CVCs was £36 for each child, corresponding to additional costs of £317,916 for an estimated 8831 CVCs required in PICUs in 2012. Based on 2012 BSI rates, management of BSI in PICUs cost £2.5 million annually (95% uncertainty interval: -£160,986, £5,603,005). The additional cost of antibiotic CVCs would be less than the value of resources associated with managing BSI in PICUs with standard BSI rates >1.2 per 1000 CVC-days. The cost of introducing antibiotic-impregnated CVCs is less than the cost associated with managing BSIs occurring with standard CVCs. The long-term benefits of preventing BSI could mean that antibiotic CVCs are cost-effective even in PICUs with extremely low BSI rates.

Parity and Time-Reversal Violation in Atomic Systems

NASA Astrophysics Data System (ADS)

Roberts, B. M.; Dzuba, V. A.; Flambaum, V. V.

2015-10-01

Studying the violation of parity and time-reversal invariance in atomic systems has proven to be a very effective means of testing the electroweak theory at low energy and searching for physics beyond it. Recent developments in both atomic theory and experimental methods have led to the ability to make extremely precise theoretical calculations and experimental measurements of these effects. Such studies are complementary to direct high-energy searches, and can be performed for only a fraction of the cost. We review the recent progress in the field of parity and time-reversal violation in atoms, molecules, and nuclei, and examine the implications for physics beyond the Standard Model, with an emphasis on possible areas for development in the near future.

Impedance matched thin metamaterials make metals absorbing.

PubMed

Mattiucci, N; Bloemer, M J; Aközbek, N; D'Aguanno, G

2013-11-13

Metals are generally considered good reflectors over the entire electromagnetic spectrum up to their plasma frequency. Here we demonstrate an approach to tailor their absorbing characteristics based on the effective metamaterial properties of thin, periodic metallo-dielectric multilayers by exploiting a broadband, inherently non-resonant, surface impedance matching mechanism. Based on this mechanism, we design, fabricate and test omnidirectional, thin (<1 micron), polarization independent, extremely efficient absorbers (in principle being capable to reach A > 99%) over a frequency range spanning from the UV to the IR. Our approach opens new venues to design cost effective materials for many applications such as thermo-photovoltaic energy conversion devices, light harvesting for solar cells, flat panel display, infrared detectors, stray light reduction, stealth and others.

Introduction: Geomorphic studies of the storm and flood of November 3-5, 1985, in the upper Potomac and Cheat River basins: Chapter A in Geomorphic studies of the storm and flood of November 3-5, 1985, in the upper Potomac and Cheat River basins in West Virginia and Virginia

USGS Publications Warehouse

Jacobson, Robert B.

1993-01-01

The heavy rains of November 3-5, 1985, produced record floods and extensive landsliding in the Potomac and Cheat River basins in West Virginia and Virginia (pl. 1). Although rainfall intensity was moderate, the storm covered a very large area and produced record floods for basins in the size range of 1000-10,000 km2. In addition, thousands of landslides were triggered on slopes underlain by shale bedrock. The total social cost of the storm amounted to 70 lives lost and an estimated $1.3 billion in damage to homes, businesses, roads, and productive land in West Virginia and Virginia (Federal Emergency Management Agency (FEMA) 1985a, b). These extreme costs were incurred despite the fact that the affected area is sparsely populated. To understand the origins and geomorphic effects of the 1985 storm, studies were undertaken by the U.S. Geological Survey, University of Maryland, West Virginia University, Cornell University, University of Virginia, The Johns Hopkins University, and Carleton College. Personnel were also consulted from the National Weather Service, Nuclear Regulatory Commission, U.S. Army Corps of Engineers, Soil Conservation Service, and Interstate Commission on the Potomac River basin. This cooperative effort serves to document the effects of the storm as an example of an extreme geomorphic event in the central Appalachian Mountains. The following chapters comprise observations and preliminary analyses for some of the observed phenomena. Subsequent publications by the contributors to this volume will expand the scope of this research.

Effects of behavioral response and vaccination policy on epidemic spreading--an approach based on evolutionary-game dynamics.

PubMed

Zhang, Hai-Feng; Wu, Zhi-Xi; Tang, Ming; Lai, Ying-Cheng

2014-07-11

How effective are governmental incentives to achieve widespread vaccination coverage so as to prevent epidemic outbreak? The answer largely depends on the complex interplay among the type of incentive, individual behavioral responses, and the intrinsic epidemic dynamics. By incorporating evolutionary games into epidemic dynamics, we investigate the effects of two types of incentives strategies: partial-subsidy policy in which certain fraction of the cost of vaccination is offset, and free-subsidy policy in which donees are randomly selected and vaccinated at no cost. Through mean-field analysis and computations, we find that, under the partial-subsidy policy, the vaccination coverage depends monotonically on the sensitivity of individuals to payoff difference, but the dependence is non-monotonous for the free-subsidy policy. Due to the role models of the donees for relatively irrational individuals and the unchanged strategies of the donees for rational individuals, the free-subsidy policy can in general lead to higher vaccination coverage. Our findings indicate that any disease-control policy should be exercised with extreme care: its success depends on the complex interplay among the intrinsic mathematical rules of epidemic spreading, governmental policies, and behavioral responses of individuals.

Quadrupedal locomotor simulation: producing more realistic gaits using dual-objective optimization

PubMed Central

Hirasaki, Eishi

2018-01-01

In evolutionary biomechanics it is often considered that gaits should evolve to minimize the energetic cost of travelling a given distance. In gait simulation this goal often leads to convincing gait generation. However, as the musculoskeletal models used get increasingly sophisticated, it becomes apparent that such a single goal can lead to extremely unrealistic gait patterns. In this paper, we explore the effects of requiring adequate lateral stability and show how this increases both energetic cost and the realism of the generated walking gait in a high biofidelity chimpanzee musculoskeletal model. We also explore the effects of changing the footfall sequences in the simulation so it mimics both the diagonal sequence walking gaits that primates typically use and also the lateral sequence walking gaits that are much more widespread among mammals. It is apparent that adding a lateral stability criterion has an important effect on the footfall phase relationship, suggesting that lateral stability may be one of the key drivers behind the observed footfall sequences in quadrupedal gaits. The observation that single optimization goals are no longer adequate for generating gait in current models has important implications for the use of biomimetic virtual robots to predict the locomotor patterns in fossil animals. PMID:29657790

Effects of behavioral response and vaccination policy on epidemic spreading - an approach based on evolutionary-game dynamics

NASA Astrophysics Data System (ADS)

Zhang, Hai-Feng; Wu, Zhi-Xi; Tang, Ming; Lai, Ying-Cheng

2014-07-01

How effective are governmental incentives to achieve widespread vaccination coverage so as to prevent epidemic outbreak? The answer largely depends on the complex interplay among the type of incentive, individual behavioral responses, and the intrinsic epidemic dynamics. By incorporating evolutionary games into epidemic dynamics, we investigate the effects of two types of incentives strategies: partial-subsidy policy in which certain fraction of the cost of vaccination is offset, and free-subsidy policy in which donees are randomly selected and vaccinated at no cost. Through mean-field analysis and computations, we find that, under the partial-subsidy policy, the vaccination coverage depends monotonically on the sensitivity of individuals to payoff difference, but the dependence is non-monotonous for the free-subsidy policy. Due to the role models of the donees for relatively irrational individuals and the unchanged strategies of the donees for rational individuals, the free-subsidy policy can in general lead to higher vaccination coverage. Our findings indicate that any disease-control policy should be exercised with extreme care: its success depends on the complex interplay among the intrinsic mathematical rules of epidemic spreading, governmental policies, and behavioral responses of individuals.

Stringent Mitigation Policy Implied By Temperature Impacts on Economic Growth

NASA Astrophysics Data System (ADS)

Moore, F.; Turner, D.

2014-12-01

Integrated assessment models (IAMs) compare the costs of greenhouse gas mitigation with damages from climate change in order to evaluate the social welfare implications of climate policy proposals and inform optimal emissions reduction trajectories. However, these models have been criticized for lacking a strong empirical basis for their damage functions, which do little to alter assumptions of sustained GDP growth, even under extreme temperature scenarios. We implement empirical estimates of temperature effects on GDP growth-rates in the Dynamic Integrated Climate and Economy (DICE) model via two pathways, total factor productivity (TFP) growth and capital depreciation. Even under optimistic adaptation assumptions, this damage specification implies that optimal climate policy involves the elimination of emissions in the near future, the stabilization of global temperature change below 2°C, and a social cost of carbon (SCC) an order of magnitude larger than previous estimates. A sensitivity analysis shows that the magnitude of growth effects, the rate of adaptation, and the dynamic interaction between damages from warming and GDP are three critical uncertainties and an important focus for future research.

Newborn Screening for Biliary Atresia.

PubMed

Wang, Kasper S

2015-12-01

Biliary atresia is the most common cause of pediatric end-stage liver disease and the leading indication for pediatric liver transplantation. Affected infants exhibit evidence of biliary obstruction within the first few weeks after birth. Early diagnosis and successful surgical drainage of bile are associated with greater survival with the child's native liver. Unfortunately, because noncholestatic jaundice is extremely common in early infancy, it is difficult to identify the rare infant with cholestatic jaundice who has biliary atresia. Hence, the need for timely diagnosis of this disease warrants a discussion of the feasibility of screening for biliary atresia to improve outcomes. Herein, newborn screening for biliary atresia in the United States is assessed by using criteria established by the Discretionary Advisory Committee on Heritable Disorders in Newborns and Children. Published analyses indicate that newborn screening for biliary atresia by using serum bilirubin concentrations or stool color cards is potentially life-saving and cost-effective. Further studies are necessary to evaluate the feasibility, effectiveness, and costs of potential screening strategies for early identification of biliary atresia in the United States. Copyright © 2015 by the American Academy of Pediatrics.

Intertidal pool fish Girella laevifrons (Kyphosidae) shown strong physiological homeostasis but shy personality: The cost of living in hypercapnic habitats.

PubMed

Benítez, S; Duarte, C; Opitz, T; Lagos, N A; Pulgar, J M; Vargas, C A; Lardies, M A

2017-05-15

Tide pools habitats are naturally exposed to a high degree of environmental variability. The consequences of living in these extreme habitats are not well established. In particular, little it is known about of the effects of hypercanic seawater (i.e. high pCO 2 levels) on marine vertebrates such as intertidal pool fish. The aim of this study was to evaluate the effects of increased pCO 2 on the physiology and behavior in juveniles of the intertidal pool fish Girella laevifrons. Two nominal pCO 2 concentrations (400 and 1600μatm) were used. We found that exposure to hypercapnic conditions did not affect oxygen consumption and absorption efficiency. However, the lateralization and boldness behavior was significantly disrupted in high pCO 2 conditions. In general, a predator-risk cost of boldness is assumed, thus the increased occurrence of shy personality in juvenile fishes may result in a change in the balance of this biological interaction, with significant ecological consequences. Copyright © 2017 Elsevier Ltd. All rights reserved.

Impact of Exercise to Improve Gait Efficiency on Activity and Participation in Older Adults With Mobility Limitations: A Randomized Controlled Trial

PubMed Central

Perera, Subashan; Brach, Jennifer S.; Wert, David; Studenski, Stephanie A.

2011-01-01

Background Definitive evidence that exercise interventions that improve gait also reduce disability is lacking. A task-oriented, motor sequence learning exercise intervention has been shown to reduce the energy cost of walking and improve gait speed, but whether the intervention also improves activity and participation has not been demonstrated. Objective The objective of this study was to compare the impact of a task-oriented, motor sequence learning exercise (TO) intervention and the impact of an impairment-oriented, multicomponent exercise (IO) intervention on activity and participation outcomes in older adults with mobility limitations. The mediating effects of a change in the energy cost of walking on changes in activity and participation also were determined. Design This study was a single-blind, randomized controlled trial. Setting The study was conducted in an ambulatory clinical research training center. Participants The study participants were 47 older adults (mean age=77.2 years, SD=5.5) with slow and variable gait. Intervention The intervention was a 12-week, physical therapist–guided program of TO or IO. Measurements Measures of activity (gait speed over an instrumented walkway; daily physical activity measured with an accelerometer; confidence in walking determined with the Gait Efficacy Scale; and physical function determined with the total, basic lower-extremity, and advanced lower-extremity components of the Late-Life Function and Disability Instrument [Late-Life FDI]) and participation (disability limitation dimension and instrumental role [home and community task performance] domain components of the Late-Life FDI) were recorded before and after the intervention. The energy cost of walking was determined from the rate of oxygen consumption during self-paced treadmill walking at the physiological steady state standardized by walking speed. An adjusted comparison of activity and participation outcomes in the treatment arms was made by use of an analysis of covariance model, with baseline and change in energy cost of walking added to the model to test for mediation. Tests were used to determine the significance of the mediating effects. Results Activity improved in TO but not in IO for confidence in walking (Gait Efficacy Scale; mean adjusted difference=9.8 [SD=3.5]) and physical function (Late-Life FDI basic lower-extremity component; mean adjusted difference=3.5 [SD=1.7]). Improvements in TO were marginally greater than those in IO for gait speed, physical activity, and total physical function. Participation improved marginally more in TO than in IO for disability limitations and instrumental role. Limitations The older adults were randomized to the intervention group, but differences in baseline measures had to be accounted for in the analyses. Conclusions A TO intervention that improved gait also led to improvements in some activity and participation outcomes in older adults with mobility limitations. PMID:22003158

Summary of Natural Hazard Statistics for 2017 in the United States

MedlinePlus

... Damage Costs Weather Event Convection Lightning Tornado Thunderstorm Wind Hail Extreme Temperatures Cold Heat Flood Flash Flood ... Drought Dust Storm Dust Devil Rain Fog High Wind Waterspout Fire Weather Mud Slide Volcanic Ash Miscellaneous ...

Mathematical physics: Glitches in time [Glitches in time: Capturing the underlying dynamics of data with flawed timing

DOE PAGES

Haley, Charlotte A. L.

2016-04-27

Here, a mathematical technique has now been developed that reveals the underlying dynamics of time-dependent data collected with extreme temporal uncertainty, without using additional, costly instrumentation.

Summary of Natural Hazard Statistics for 2015 in the United States

MedlinePlus

... Damage Costs Weather Event Convection Lightning Tornado Thunderstorm Wind Hail Extreme Temperatures Cold Heat Flood Flash Flood ... Drought Dust Storm Dust Devil Rain Fog High Wind Waterspout Fire Weather Mud Slide Volcanic Ash Miscellaneous ...

Progress on high-performance rapid prototype aluminum mirrors

NASA Astrophysics Data System (ADS)

Woodard, Kenneth S.; Myrick, Bruce H.

2017-05-01

Near net shape parts can be produced using some very old processes (investment casting) and the relatively new direct metal laser sintering (DMLS) process. These processes have significant advantages for complex blank lightweighting and costs but are not inherently suited for producing high performance mirrors. The DMLS process can provide extremely complex lightweight structures but the high residual stresses left in the material results in unstable mirror figure retention. Although not to the extreme intricacy of DMLS, investment casting can also provide complex lightweight structures at considerably lower costs than DMLS and even conventional wrought mirror blanks but the less than 100% density for casting (and also DMLS) limits finishing quality. This paper will cover the progress that has been made to make both the DMLS and investment casting processes into viable near net shape blank options for high performance aluminum mirrors. Finish and figure results will be presented to show performance commensurate with existing conventional processes.

Medicare: Better Controls Needed for Peer Review Organizations’ Evaluations.

DTIC Science & Technology

1987-10-01

reflected significant uncertainties (percent of cases reviewed and cost per case). The national funding model utilized to develop the Goverrnent estimates...differences. As GAO stated, HCFA’s funding model was based on data from HCFA’s actuary, the Departnent of Labor, professional medical associations and... funding model extremely valuable in negotiating PRO contracts. The conclusion reached by GAO that the overall average cost contracted per review was less

Feasibility Study of Solar Dome Encapsulation of Photovoltaic Arrays

NASA Technical Reports Server (NTRS)

1978-01-01

The technical and economic advantages of using air-supported plastic enclosures to protect flat plate photovoltaic arrays are described. Conceptual designs for a fixed, latitude-tilt array and a fully tracking array were defined. Detailed wind loads and strength analyses were performed for the fixed array. Detailed thermal and power output analyses provided array performance for typical seasonal and extreme temperature conditions. Costs of each design as used in a 200 MWe central power station were defined from manufacturing and material cost estimates. The capital cost and cost of energy for the enclosed fixed-tilt array were lower than for the enclosed tracking array. The enclosed fixed-tilt array capital investment was 38% less, and the levelized bus bar energy cost was 26% less than costs for a conventional, glass-encapsulated array design. The predicted energy cost for the enclosed fixed array was 79 mills/kW-h for direct current delivered to the power conditioning units.

Costs of Physician-Hospital Integration

PubMed Central

Cho, Na-Eun

2015-01-01

Abstract Given that the enactment of the Patient Protection and Affordable Care Act of 2010 is expected to generate forces toward physician-hospital integration, this study examined an understudied, albeit important, area of costs incurred in physician-hospital integration. Such costs were analyzed through 24 semi-structured interviews with physicians and hospital administrators in a multiple-case, inductive study. Two extreme types of physician-hospital arrangements were examined: an employed model (ie, integrated salary model, a group of physicians integrated by a hospital system) and a private practice (ie, a physician or group of physicians who are independent of economic or policy control). Interviews noted that integration leads to 3 evident costs, namely, monitoring, coordination, and cooperation costs. Improving our understanding of the kinds of costs that are incurred after physician-hospital integration will help hospitals and physicians to avoid common failures after integration. PMID:26496300

Electrocatalyst advances for hydrogen oxidation in phosphoric acid fuel cells

NASA Technical Reports Server (NTRS)

Stonehart, P.

1984-01-01

The important considerations that presently exist for achieving commercial acceptance of fuel cells are centered on cost (which translates to efficiency) and lifetime. This paper addresses the questions of electrocatalyst utilization within porous electrode structures and the preparation of low-cost noble metal electrocatalyst combinations with extreme dispersions of the metal. Now that electrocatalyst particles can be prepared with dimensions of 10 A, either singly or in alloy combinations, a very large percentage of the noble metal atoms in a crystallite are available for reaction. The cost savings for such electrocatalysts in the present commercially driven environment are considerable.

Assessing the comparative effectiveness of Tai Chi versus physical therapy for knee osteoarthritis: design and rationale for a randomized trial.

PubMed

Wang, Chenchen; Iversen, Maura D; McAlindon, Timothy; Harvey, William F; Wong, John B; Fielding, Roger A; Driban, Jeffrey B; Price, Lori Lyn; Rones, Ramel; Gamache, Tressa; Schmid, Christopher H

2014-09-08

Knee osteoarthritis (OA) causes pain and long-term disability with annual healthcare costs exceeding $185 billion in the United States. Few medical remedies effectively influence the course of the disease. Finding effective treatments to maintain function and quality of life in patients with knee OA is one of the national priorities identified by the Institute of Medicine. We are currently conducting the first comparative effectiveness and cost-effectiveness randomized trial of Tai Chi versus a physical-therapy regimen in a sample of patients with symptomatic and radiographically confirmed knee OA. This article describes the design and conduct of this trial. A single-center, 52-week, comparative effectiveness randomized controlled trial of Tai Chi versus a standardized physical-therapy regimen is being conducted at an urban tertiary medical center in Boston, Massachusetts. The study population consists of adults ≥ 40 years of age with symptomatic and radiographic knee OA (American College of Rheumatology criteria). Participants are randomly allocated to either 12 weeks of Tai Chi (2x/week) or Physical Therapy (2x/week for 6 weeks, followed by 6 weeks of rigorously monitored home exercise). The primary outcome measure is pain (Western Ontario and McMaster Universities WOMAC) subscale at 12 weeks. Secondary outcomes include WOMAC stkiffness and function domain scores, lower extremity strength and power, functional balance, physical performance tests, psychological and psychosocial functioning, durability effects, health related quality of life, and healthcare utilization at 12, 24 and 52 weeks. This study will be the first randomized comparative-effectiveness and cost-effectiveness trial of Tai Chi versus Physical Therapy in a large symptomatic knee OA population with long-term follow up. We present here a robust and well-designed randomized comparative-effectiveness trial that also explores multiple outcomes to elucidate the potential mechanisms of mind-body effect for a major disabling disease with substantial health burdens and economic costs. Results of this study are expected to have important public health implications for the large and growing population with knee OA. ClinicalTrials.gov identifier: NCT01258985.

Construction Cost Growth for New Department of Energy Nuclear Facilities

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

Kubic, Jr., William L.

Cost growth and construction delays are problems that plague many large construction projects including the construction of new Department of Energy (DOE) nuclear facilities. A study was conducted to evaluate cost growth of large DOE construction projects. The purpose of the study was to compile relevant data, consider the possible causes of cost growth, and recommend measures that could be used to avoid extreme cost growth in the future. Both large DOE and non-DOE construction projects were considered in this study. With the exception of Chemical and Metallurgical Research Building Replacement Project (CMRR) and the Mixed Oxide Fuel Fabrication Facilitymore » (MFFF), cost growth for DOE Nuclear facilities is comparable to the growth experienced in other mega construction projects. The largest increase in estimated cost was found to occur between early cost estimates and establishing the project baseline during detailed design. Once the project baseline was established, cost growth for DOE nuclear facilities was modest compared to non-DOE mega projects.« less

Hood River Passive House, Hood River, Oregon (Fact Sheet)

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

None, None

2014-02-01

The Hood River Passive Project was developed by Root Design Build of Hood River Oregon using the Passive House Planning Package (PHPP) to meet all of the requirements for certification under the European Passive House standards. The Passive House design approach has been gaining momentum among residential designers for custom homes and BEopt modeling indicates that these designs may actually exceed the goal of the U.S. Department of Energy's (DOE) Building America program to "reduce home energy use by 30%-50%" (compared to 2009 energy codes for new homes). This report documents the short term test results of the Shift Housemore » and compares the results of PHPP and BEopt modeling of the project. The design includes high R-Value assemblies, extremely tight construction, high performance doors and windows, solar thermal DHW, heat recovery ventilation, moveable external shutters and a high performance ductless mini-split heat pump. Cost analysis indicates that many of the measures implemented in this project did not meet the BA standard for cost neutrality. The ductless mini-split heat pump, lighting and advanced air leakage control were the most cost effective measures. The future challenge will be to value engineer the performance levels indicated here in modeling using production based practices at a significantly lower cost.« less

New Whole-House Solutions Case Study: Hood River Passive House

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

None

2014-02-01

The Hood River Passive Project was developed by Root Design Build of Hood River Oregon using the Passive House Planning Package (PHPP) to meet all of the requirements for certification under the European Passive House standards. The Passive House design approach has been gaining momentum among residential designers for custom homes and BEopt modeling indicates that these designs may actually exceed the goal of the U.S. Department of Energy's (DOE) Building America program to "reduce home energy use by 30%-50%" (compared to 2009 energy codes for new homes). This report documents the short term test results of the Shift Housemore » and compares the results of PHPP and BEopt modeling of the project. The design includes high R-Value assemblies, extremely tight construction, high performance doors and windows, solar thermal DHW, heat recovery ventilation, moveable external shutters and a high performance ductless mini-split heat pump. Cost analysis indicates that many of the measures implemented in this project did not meet the BA standard for cost neutrality. The ductless mini-split heat pump, lighting and advanced air leakage control were the most cost effective measures. The future challenge will be to value engineer the performance levels indicated here in modeling using production based practices at a significantly lower cost.« less

Which interventions offer best value for money in primary prevention of cardiovascular disease?

PubMed

Cobiac, Linda J; Magnus, Anne; Lim, Stephen; Barendregt, Jan J; Carter, Rob; Vos, Theo

2012-01-01

Despite many decades of declining mortality rates in the Western world, cardiovascular disease remains the leading cause of death worldwide. In this research we evaluate the optimal mix of lifestyle, pharmaceutical and population-wide interventions for primary prevention of cardiovascular disease. In a discrete time Markov model we simulate the ischaemic heart disease and stroke outcomes and cost impacts of intervention over the lifetime of all Australian men and women, aged 35 to 84 years, who have never experienced a heart disease or stroke event. Best value for money is achieved by mandating moderate limits on salt in the manufacture of bread, margarine and cereal. A combination of diuretic, calcium channel blocker, ACE inhibitor and low-cost statin, for everyone with at least 5% five-year risk of cardiovascular disease, is also cost-effective, but lifestyle interventions aiming to change risky dietary and exercise behaviours are extremely poor value for money and have little population health benefit. There is huge potential for improving efficiency in cardiovascular disease prevention in Australia. A tougher approach from Government to mandating limits on salt in processed foods and reducing excessive statin prices, and a shift away from lifestyle counselling to more efficient absolute risk-based prescription of preventive drugs, could cut health care costs while improving population health.

Extreme rainfall, vulnerability and risk: a continental-scale assessment for South America.

PubMed

Vörösmarty, Charles J; Bravo de Guenni, Lelys; Wollheim, Wilfred M; Pellerin, Brian; Bjerklie, David; Cardoso, Manoel; D'Almeida, Cassiano; Green, Pamela; Colon, Lilybeth

2013-11-13

Extreme weather continues to preoccupy society as a formidable public safety concern bearing huge economic costs. While attention has focused on global climate change and how it could intensify key elements of the water cycle such as precipitation and river discharge, it is the conjunction of geophysical and socioeconomic forces that shapes human sensitivity and risks to weather extremes. We demonstrate here the use of high-resolution geophysical and population datasets together with documentary reports of rainfall-induced damage across South America over a multi-decadal, retrospective time domain (1960-2000). We define and map extreme precipitation hazard, exposure, affectedpopulations, vulnerability and risk, and use these variables to analyse the impact of floods as a water security issue. Geospatial experiments uncover major sources of risk from natural climate variability and population growth, with change in climate extremes bearing a minor role. While rural populations display greatest relative sensitivity to extreme rainfall, urban settings show the highest rates of increasing risk. In the coming decades, rapid urbanization will make South American cities the focal point of future climate threats but also an opportunity for reducing vulnerability, protecting lives and sustaining economic development through both traditional and ecosystem-based disaster risk management systems.

Economic summary of woody biomass direct combustion and gasification alternatives

NASA Astrophysics Data System (ADS)

1981-08-01

A base case analysis indicates that acceptable rates of return on investment are possible when utilizing wood as a commercial scale boiler fuel. Principal variables include the availability of cost competitive wood fuel over the term of the loan and overall installed cost for the system. In some cases the cost of coal at the point of end use will be comparable with wood. Hardware costs will determine system economics and applicable air quality standards, or lack thereof, will play an important role. The overall economics of using wood for fuel are extremely site specific. The additional 10 percent energy tax credit greatly enhances the economics of a wood fired system, although system economics are very attractive without this tax incentive. Cost of money does not seem to drastically affect overall system economics.

Application of travel time information for traffic management : technical summary.

DOT National Transportation Integrated Search

2012-01-01

Using conventional methods, it is extremely costly to measure detailed traffic characteristics in high quality spatial or temporal resolution. For analyzing travel characteristics on roadways, the floating car method, developed in the 1920s, has hist...

Beef customer satisfaction: USDA quality grade and marination effects on consumer evaluations of top round steaks.

PubMed

Behrends, J M; Goodson, K J; Koohmaraie, M; Shackelford, S D; Wheeler, T L; Morgan, W W; Reagan, J O; Gwartney, B L; Wise, J W; Savell, J W

2005-03-01

An in-home beef study evaluated consumer ratings of top round steaks (semimembranosus) as influenced by USDA quality grade (top Choice or high Select), city (Chicago or Philadelphia), consumer segment (beef loyalists = heavy consumers of beef; budget rotators = cost-driven and split meat consumption between beef and chicken; and variety rotators = higher incomes and education and split meat consumption among beef, poultry, and other foods), degree of doneness, cooking method, and marination. Consumers evaluated each steak for overall like, tenderness, juiciness, flavor like, and flavor amount using 10-point scales (1 = dislike extremely, not at all tender, not at all juicy, dislike extremely, and none at all to 10 = like extremely, extremely tender, extremely juicy, like extremely, and an extreme amount of flavor, respectively). Quality grade affected several consumer sensory traits, with top Choice receiving higher (P < or = 0.004) tenderness, juiciness, and flavor like scores than high Select. Consumers in Chicago rated steaks cooked "medium and less" higher for overall like, tenderness, juiciness, flavor like, and flavor amount than those in Philadelphia (city x degree of doneness; P < or = 0.020). Steaks braised by customers in Philadelphia received among the highest scores for overall like, tenderness, juiciness, flavor like, and flavor amount compared with any cooking method used by customers in Chicago (cooking method x city; P < or = 0.026). Overall like and flavor amount ratings were least (P < 0.05) for steaks that were marinated and cooked to "medium and less" degree of doneness (marination x degree of doneness; P < or = 0.014). Braised steaks received among the highest values for overall like, tenderness, juiciness, flavor like, and flavor amount when cooked to "medium and less" or "medium well and more" (cooking method x degree of doneness; P < or = 0.008). Correlation and stepwise regression analysis indicated that flavor like was pivotal in customers' satisfaction with top round steaks, and was the sensory trait most highly correlated to overall like, followed by tenderness, flavor amount, and juiciness. Preparation of top round steaks was crucial in consumers' likes and dislikes, and by improving flavor, higher consumer satisfaction may be achieved.

Natural Flood Management Plus: Scaling Up Nature Based Solutions to Larger Catchments

NASA Astrophysics Data System (ADS)

Quinn, Paul; Nicholson, Alex; Adams, Russ

2017-04-01

It has been established that networks NFM features, such as ponds and wetlands, can have a significant effect on flood flow and pollution at local scales (less than 10km2). However, it is much less certain that NFM and NBS can impact at larger scales and protect larger cities. This is especially true for recent storms in the UK such as storm Desmond that caused devastation across the north of England. It is possible using observed rainfall and runoff data to estimate the amounts of storage that would be required to impact on extreme flood events. Here we will how a toolkit that will estimate the amount of storage that can be accrued through a dense networks of NFM features. The analysis suggest that the use of many hundreds of small NFM features can have a significant impact on peak flow, however we still require more storage in order to address extreme events and to satisfy flood engineers who may propose more traditional flood defences. We will also show case studies of larger NFM feature positioned on flood plains that can store significantly more flood flow. Examples designs of NFM plus feature will be shown. The storage aggregation tool will then show the degree to which storing large amounts of flood flow in NFM plus features can contribute to flood management and estimate the likely costs. Together smaller and larger NFM features if used together can produce significant flood storage and at a much lower cost than traditional schemes.

Fabrication of wafer-scale nanopatterned sapphire substrate through phase separation lithography

NASA Astrophysics Data System (ADS)

Guo, Xu; Ni, Mengyang; Zhuang, Zhe; Dai, Jiangping; Wu, Feixiang; Cui, Yushuang; Yuan, Changsheng; Ge, Haixiong; Chen, Yanfeng

2016-04-01

A phase separation lithography (PSL) based on polymer blend provides an extremely simple, low-cost, and high-throughput way to fabricate wafer-scale disordered nanopatterns. This method was introduced to fabricate nanopatterned sapphire substrates (NPSSs) for GaN-based light-emitting diodes (LEDs). The PSL process only involved in spin-coating of polystyrene (PS)/polyethylene glycol (PEG) polymer blend on sapphire substrate and followed by a development with deionized water to remove PEG moiety. The PS nanoporous network was facilely obtained, and the structural parameters could be effectively tuned by controlling the PS/PEG weight ratio of the spin-coating solution. 2-in. wafer-scale NPSSs were conveniently achieved through the PS nanoporous network in combination with traditional nanofabrication methods, such as O2 reactive ion etching (RIE), e-beam evaporation deposition, liftoff, and chlorine-based RIE. In order to investigate the performance of such NPSSs, typical blue LEDs with emission wavelengths of ~450 nm were grown on the NPSS and a flat sapphire substrate (FSS) by metal-organic chemical vapor deposition, respectively. The integral photoluminescence (PL) intensity of the NPSS LED was enhanced by 32.3 % compared to that of the FSS-LED. The low relative standard deviation of 4.7 % for PL mappings of NPSS LED indicated the high uniformity of PL data across the whole 2-in. wafer. Extremely simple, low cost, and high throughput of the process and the ability to fabricate at the wafer scale make PSL a potential method for production of nanopatterned sapphire substrates.

Decision-making competence and attempted suicide

PubMed Central

Szanto, Katalin; Bruine de Bruin, Wändi; Parker, Andrew M; Hallquist, Michael N; Vanyukov, Polina M; Dombrovski, Alexandre Y

2015-01-01

Objective The propensity of people vulnerable to suicide to make poor life decisions is increasingly well documented. Do they display an extreme degree of decision biases? The present study used a behavioral decision approach to examine the susceptibility of low-lethality and high-lethality suicide attempters to common decision biases, which may ultimately obscure alternative solutions and deterrents to suicide in a crisis. Method We assessed older and middle-aged individuals who made high-lethality (medically serious; N=31) and low-lethality suicide attempts (N=29). Comparison groups included suicide ideators (N=30), non-suicidal depressed (N=53), and psychiatrically healthy participants (N=28). Attempters, ideators, and non-suicidal depressed participants had unipolar non-psychotic major depression. Decision biases included sunk cost (inability to abort an action for which costs are irrecoverable), framing (responding to superficial features of how a problem is presented), under/overconfidence (appropriateness of confidence in knowledge), and inconsistent risk perception. Data were collected between June of 2010 and February of 2014. Results Both high- and low-lethality attempters were more susceptible to framing effects, as compared to the other groups included in this study (p≤ 0.05, ηp2 =.06). In contrast, low-lethality attempters were more susceptible to sunk costs than both the comparison groups and high-lethality attempters (p≤ 0.01, ηp2 =.09). These group differences remained after accounting for age, global cognitive performance, and impulsive traits. Premorbid IQ partially explained group differences in framing effects. Conclusion Suicide attempters’ failure to resist framing may reflect their inability to consider a decision from an objective standpoint in a crisis. Low-lethality attempters’ failure to resist sunk-cost may reflect their tendency to confuse past and future costs of their behavior, lowering their threshold for acting on suicidal thoughts. PMID:26717535

Decision-making competence and attempted suicide.

PubMed

Szanto, Katalin; Bruine de Bruin, Wändi; Parker, Andrew M; Hallquist, Michael N; Vanyukov, Polina M; Dombrovski, Alexandre Y

2015-12-01

The propensity of people vulnerable to suicide to make poor life decisions is increasingly well documented. Do they display an extreme degree of decision biases? The present study used a behavioral-decision approach to examine the susceptibility of low-lethality and high-lethality suicide attempters to common decision biases that may ultimately obscure alternative solutions and deterrents to suicide in a crisis. We assessed older and middle-aged (42-97 years) individuals who made high-lethality (medically serious) (n = 31) and low-lethality suicide attempts (n = 29). Comparison groups included suicide ideators (n = 30), nonsuicidal depressed participants (n = 53), and psychiatrically healthy participants (n = 28). Attempters, ideators, and nonsuicidal depressed participants had nonpsychotic major depression (DSM-IV criteria). Decision biases included sunk cost (inability to abort an action for which costs are irrecoverable), framing (responding to superficial features of how a problem is presented), underconfidence/overconfidence (appropriateness of confidence in knowledge), and inconsistent risk perception. Data were collected between June 2010 and February 2014. Both high- and low-lethality attempters were more susceptible to framing effects as compared to the other groups included in this study (P ≤ .05, ηp2 = 0.06). In contrast, low-lethality attempters were more susceptible to sunk costs than both the comparison groups and high-lethality attempters (P ≤ .01, ηp2 = 0.09). These group differences remained after accounting for age, global cognitive performance, and impulsive traits. Premorbid IQ partially explained group differences in framing effects. Suicide attempters' failure to resist framing may reflect their inability to consider a decision from an objective standpoint in a crisis. Failure of low-lethality attempters to resist sunk cost may reflect their tendency to confuse past and future costs of their behavior, lowering their threshold for acting on suicidal thoughts. © Copyright 2015 Physicians Postgraduate Press, Inc.

Case study of a floor-cleaning robot

NASA Astrophysics Data System (ADS)

Branch, Allan C.

1998-01-01

Developing the technologies suitable of ra high level robotic application such as cleaning a floor has proved extremely difficult. Developing the robot mobility technology has been a stumbling block and developing and integrating the applications technology to the machine and the mobility technology has also been a difficult stage in this quest, but doing so in a cost effective and realistic manner suitable for the market place and to compete with humans and manually operated machines has been the most difficult of all. This paper describes one of these quests spanning a 14 year period and resulting in what is hoped will be the world's first commercially manufactured household robot vacuum cleaner.

Donor human milk banking and the emergence of milk sharing.

PubMed

Landers, Susan; Hartmann, Ben T

2013-02-01

Donor human milk has emerged as the preferred substrate to feed extremely preterm infants, when mother's own milk is unavailable. This article summarizes the clinical data demonstrating the safety, efficacy, and cost-effectiveness of feeding donor human milk to premature babies. It describes the current state of milk banking in North America, as well as other parts of the world, and the differing criteria for donor selection, current pasteurization techniques, and quality control measures. A risk assessment methodology is proposed, which would allow milk banks globally to assess the safety of their process and respond appropriately to differing risk environments. Copyright © 2013. Published by Elsevier Inc.

Functionally Graded Bismuth Oxide/Zirconia Bilayer Electrolytes for High-Performance Intermediate-Temperature Solid Oxide Fuel Cells (IT-SOFCs).

PubMed

Joh, Dong Woo; Park, Jeong Hwa; Kim, Doyeub; Wachsman, Eric D; Lee, Kang Taek

2017-03-15

A functionally graded Bi 1.6 Er 0.4 O 3 (ESB)/Y 0.16 Zr 0.84 O 1.92 (YSZ) bilayer electrolyte is successfully developed via a cost-effective screen printing process using nanoscale ESB powders on the tape-cast NiO-YSZ anode support. Because of the highly enhanced oxygen incorporation process at the cathode/electrolyte interface, a novel bilayer solid oxide fuel cell (SOFC) yields extremely high power density of ∼2.1 W cm -2 at 700 °C, which is a 2.4 times increase compared to that of the YSZ single electrolyte SOFC.

Bioremediation of Turbid Surface Water Using Seed Extract from the Moringa oleifera Lam. (Drumstick) Tree.

PubMed

Lea, Michael

2014-05-01

An indigenous water treatment method uses Moringa oleifera seeds in the form of a crude water-soluble extract in suspension, resulting in an effective natural clarification agent for highly turbid and untreated pathogenic surface water. Efficient reduction (80.0% to 99.5%) of high turbidity produces an aesthetically clear supernatant, concurrently accompanied by 90.00% to 99.99% (1 to 4 log) bacterial reduction. Application of this low-cost Moringa oleifera protocol is recommended for water treatment where rural and peri-urban people living in extreme poverty are presently drinking highly turbid and microbiologically contaminated water. Copyright © 2014 John Wiley & Sons, Inc.

Design and fabrication of Si-HDPE hybrid Fresnel lenses for infrared imaging systems.

PubMed

Manaf, Ahmad Rosli Abdul; Sugiyama, Tsunetoshi; Yan, Jiwang

2017-01-23

In this work, novel hybrid Fresnel lenses for infrared (IR) optical applications were designed and fabricated. The Fresnel structures were replicated from an ultraprecision diamond-turned aluminum mold to an extremely thin layer (tens of microns) of high-density polyethylene polymer, which was directly bonded onto a flat single-crystal silicon wafer by press molding without using adhesives. Night mode imaging results showed that the fabricated lenses were able to visualize objects in dark fields with acceptable image quality. The capability of the lenses for thermography imaging was also demonstrated. This research provides a cost-effective method for fabricating ultrathin IR optical components.

The Rational Hybrid Monte Carlo algorithm

NASA Astrophysics Data System (ADS)

Clark, Michael

2006-12-01

The past few years have seen considerable progress in algorithmic development for the generation of gauge fields including the effects of dynamical fermions. The Rational Hybrid Monte Carlo (RHMC) algorithm, where Hybrid Monte Carlo is performed using a rational approximation in place the usual inverse quark matrix kernel is one of these developments. This algorithm has been found to be extremely beneficial in many areas of lattice QCD (chiral fermions, finite temperature, Wilson fermions etc.). We review the algorithm and some of these benefits, and we compare against other recent algorithm developements. We conclude with an update of the Berlin wall plot comparing costs of all popular fermion formulations.

Sediment dynamics of muddy coasts and estuaries in China: An introduction

NASA Astrophysics Data System (ADS)

Wang, Xiao Hua; Gan, Jianping; Lowe, Ryan

2018-06-01

Sustainable livelihoods and economic development is supported by effective management of coastal and estuarine assets, which represents a huge and, in many instances, extremely costly challenge, in particular given the multiple stakeholders with mixed interests in ports and harbours and the adjacent coastal and marine environments. Given the importance of the well-being of coastal environments, the rapid expansion of major ports has caused concerns within both the scientific community and the general public about the possible environmental consequences. The implications of these rapid coastal changes, including urbanization and industrialization, are often highly degraded natural systems, ecosystems with compromised functions, and intense conflict and competition between users.

Evaluating industrial drying of cellulosic feedstock for bioenergy: A systems approach

DOE PAGES

Sokhansanj, Shahab; Webb, Erin

2016-01-21

Here, a large portion of herbaceous and woody biomass must be dried following harvest. Natural field drying is possible if the weather cooperates. Mechanical drying is a certain way of reducing the moisture content of biomass. This paper presents an engineering analysis applied to drying of 10 Mg h –1 (exit mass flow) of biomass with an initial moisture content ranging from 25% to 70% (wet mass basis) down to 10% exit moisture content. The requirement for hog fuel to supply heat to the dryer increases from 0.5 dry Mg to 3.8 dry Mg h –1 with the increased initialmore » moisture of biomass. The capital cost for the entire drying system including equipment for biomass size reduction, pollution control, dryer, and biomass combustor sums up to more than 4.7 million dollars. The operating cost (electricity, labor, repair, and maintenance) minus fuel cost for the dryer alone amount to 4.05 Mg –1 of dried biomass. For 50% moisture content biomass, the cost of fuel to heat the drying air is 7.41 dollars/ dry ton of biomass for a total 11.46 dollars per dry ton at 10% moisture content. The fuel cost ranges from a low of 2.21 dollars to a high of 18.54 dollars for a biomass at an initial moisture content of 25% to 75%, respectively. This wide range in fuel cost indicates the extreme sensitivity of the drying cost to initial moisture content of biomass and to ambient air humidity and temperature and highlights the significance of field drying for a cost effective drying operation.« less

Rapid Deployment of Optimal Control for Building HVAC Systems using Innovative Software Tools and a Hybrid Heuristic/Model Based Control Approach

DTIC Science & Technology

2017-03-21

Energy and Water Projects March 21, 2017 REPORT DOCUMENTATION PAGE Form Approved OMB No. 0704-0188 Public reporting burden for this collection of...included reduced system energy use and cost as well as improved performance driven by autonomous commissioning and optimized system control. In the end...improve system performance and reduce energy use and cost. However, implementing these solutions into the extremely heterogeneous and often

Cut your losses: self-amputation of injured limbs increases survival.

PubMed

Emberts, Zachary; Miller, Christine W; Kiehl, Daniel; St Mary, Colette M

2017-01-01

Autotomy, self-induced limb loss, is an extreme trait observed throughout the animal kingdom; lizards drop their tails, crickets release their legs, and crabs drop their claws. These repeated evolutionary origins suggest that autotomy is adaptive. Yet, we do not have a firm understanding of the selective pressures that promote and maintain this extreme trait. Although multiple adaptive hypotheses exist, research has generally focused on autotomy's adaptive value as a form of predator escape. However, autotomy could also be selected to reduce the cost of an injured limb, which we investigate here. Previously, this alternative hypothesis has been challenging to directly test because when an injury occurs on an autotomizable limb, that limb is almost always dropped (i.e., autotomy is behaviorally fixed within populations). Recently, however, we have identified a species, Narnia femorata (Insecta: Hemiptera: Coreidae), where some individuals autotomize limbs in response to injury, but some do not. This natural variation allowed us to investigate both the survival costs of retaining an injured limb and the benefits of autotomizing it. In this study, we find a positive association between autotomizing injured limbs and survival, thereby quantifying a new and likely widespread benefit of autotomy-reducing the cost of injury.

Cut your losses: self-amputation of injured limbs increases survival

PubMed Central

Miller, Christine W; Kiehl, Daniel; St. Mary, Colette M

2017-01-01

Abstract Autotomy, self-induced limb loss, is an extreme trait observed throughout the animal kingdom; lizards drop their tails, crickets release their legs, and crabs drop their claws. These repeated evolutionary origins suggest that autotomy is adaptive. Yet, we do not have a firm understanding of the selective pressures that promote and maintain this extreme trait. Although multiple adaptive hypotheses exist, research has generally focused on autotomy’s adaptive value as a form of predator escape. However, autotomy could also be selected to reduce the cost of an injured limb, which we investigate here. Previously, this alternative hypothesis has been challenging to directly test because when an injury occurs on an autotomizable limb, that limb is almost always dropped (i.e., autotomy is behaviorally fixed within populations). Recently, however, we have identified a species, Narnia femorata (Insecta: Hemiptera: Coreidae), where some individuals autotomize limbs in response to injury, but some do not. This natural variation allowed us to investigate both the survival costs of retaining an injured limb and the benefits of autotomizing it. In this study, we find a positive association between autotomizing injured limbs and survival, thereby quantifying a new and likely widespread benefit of autotomy—reducing the cost of injury. PMID:29622925

Silent Aircraft Initiative Concept Risk Assessment

NASA Technical Reports Server (NTRS)

Nickol, Craig L.

2008-01-01

A risk assessment of the Silent Aircraft Initiative's SAX-40 concept design for extremely low noise has been performed. A NASA team developed a list of 27 risk items, and evaluated the level of risk for each item in terms of the likelihood that the risk would occur and the consequences of the occurrence. The following risk items were identified as high risk, meaning that the combination of likelihood and consequence put them into the top one-fourth of the risk matrix: structures and weight prediction; boundary-layer ingestion (BLI) and inlet design; variable-area exhaust and thrust vectoring; displaced-threshold and continuous descent approach (CDA) operational concepts; cost; human factors; and overall noise performance. Several advanced-technology baseline concepts were created to serve as a basis for comparison to the SAX-40 concept. These comparisons indicate that the SAX-40 would have significantly greater research, development, test, and engineering (RDT&E) and production costs than a conventional aircraft with similar technology levels. Therefore, the cost of obtaining the extremely low noise capability that has been estimated for the SAX-40 is significant. The SAX-40 concept design proved successful in focusing attention toward low noise technologies and in raising public awareness of the issue.

Mechanical characterization of alloys in extreme conditions of high strain rates and high temperature

NASA Astrophysics Data System (ADS)

Cadoni, Ezio

2018-03-01

The aim of this paper is the description of the mechanical characterization of alloys under extreme conditions of temperature and loading. In fact, in the frame of the Cost Action CA15102 “Solutions for Critical Raw Materials Under Extreme Conditions (CRM-EXTREME)” this aspect is crucial and many industrial applications have to consider the dynamic response of materials. Indeed, for a reduction and substitution of CRMs in alloys is necessary to design the materials and understand if the new materials behave better or if the substitution or reduction badly affect their performance. For this reason, a deep knowledge of the mechanical behaviour at high strain-rates of considered materials is required. In general, machinery manufacturing industry or transport industry as well as energy industry have important dynamic phenomena that are simultaneously affected by extended strain, high strain-rate, damage and pressure, as well as conspicuous temperature gradients. The experimental results in extreme conditions of high strain rate and high temperature of an austenitic stainless steel as well as a high-chromium tempered martensitic reduced activation steel Eurofer97 are presented.

Economic study on the impact of side effects in patients taking oxycodone controlled-release for noncancer pain.

PubMed

Anastassopoulos, Kathryn P; Chow, Wing; Tapia, Crisanta I; Baik, Rebecca; Ackerman, Stacey J; Biondi, David; Kim, Myoung S

2012-10-01

Chronic pain is a prevalent condition in the United States. Musculoskeletal pain, including joint and back pain, is the most common type of chronic pain, and many patients with back pain have a neuropathic component. Pain has direct economic consequences. While oxycodone controlled-release (CR) is one of the most widely used oral long-acting opioids for pain, including pain with a neuropathic component, it is often associated with bothersome side effects, resulting in additional medical resource use (MRU) and costs. To examine the impact on MRU and costs to payers of side effects in patients taking oxycodone CR alone or in combination with other pain medications for noncancer pain (including those with neuropathic pain symptoms). A nationwide convenience sample of adults in the United States, who participated in a survey research panel and reported current use of oxycodone CR for noncancer pain, completed an online survey between November 2, 2010, and December 13, 2010. Respondents were excluded if they reported current use of other extended-release or long-acting opioid prescription medications. The survey consisted of questions on demographics, clinical characteristics, pain characteristics, experience with pain medication, and MRU associated with side effects. Payer costs were calculated based on the MRU reported by the respondents multiplied by Medicare reimbursement rates for hospitalizations and outpatient visits and average wholesale price (AWP) minus 20% for medications. A subgroup of patients who reported neuropathic pain symptoms also was examined. After applying the exclusion criteria, 432 respondents completed the survey. Approximately half of the respondents (n = 219; 50.7%) reported neuropathic pain symptoms. The majority of respondents were Caucasian (88.4%) and female (63.7%) with an average age of 41.8 years (14.89). Respondents most frequently reported low back pain (41.2%), followed by osteoarthritis/rheumatoid arthritis (20.4%), neuropathic pain (10.6%), and fibromyalgia (9.0%). Respondents reported having their pain condition for an average of 5.4 (7.42) years. On days when taken, respondents reported a mean oxycodone CR daily dose of 83.3 mg (126.93) taken in an average of 2 doses. Most respondents (82.4%) reported experiencing at least 1 side effect with 77.5% being bothered by at least 1 side effect. The most frequently reported side effects ( greater than 25%) were drowsiness (41.4%), constipation (37.0%), fatigue or daytime sleepiness (36.6%), and dizziness (27.1%). Among respondents who reported being bothered by one or more side effects in the previous month, MRU associated with side effects was reported by 39.1% of respondents and significantly increased as the level of side-effect bother increased from 19.8% among those "A little bit bothered" to 38.4% among those "Bothered" to 61.0% among those "Extremely bothered" (P less than 0.001). Additionally, total average payer costs (in 2010 dollars) per respondent in the previous month associated with side effects were $238 ($1,159) and also significantly increased as the level of side-effect bother increased from $61 ($512) among those "A little bit bothered" to $238 ($1,160) among those "Bothered" to $425 ($1,561) among those "Extremely bothered" (P less than 0.001). Results reported in the neuropathic pain subgroup were similar to results reported in the total study sample. Among adults taking oxycodone CR for chronic noncancer pain (with or without a neuropathic pain component), over three-fourths reported being bothered by side effects. Respondents who reported higher levels of side-effect bother also reported greater MRU, resulting in increased payer costs. The results of this study provide further support of the econo-mic burden to payers associated with opioid-related side effects in patients with chronic noncancer pain, with and without neuropathic pain.

The influences of obesity and age on functional performance during intermittent upper extremity tasks.

PubMed

Cavuoto, Lora A; Nussbaum, Maury A

2014-01-01

In this study, the main and interactive effects of obesity and age on functional performance were assessed during intermittent exertions involving the upper extremity. The prevalence of obesity has doubled over the past 30 years and this increase is associated with higher health care costs, rates of workplace injury, and lost workdays. Obesity and aging can modify job demands and affect worker capacity in terms of muscular and psychomotor function. However, there is a lack of empirical studies quantifying the work-relevant (or ergonomic) impacts related to task demands, capacities, and their potential imbalance. Eight obese and eight non-obese participants from each of two age groups (18-25 and 50-65 years) completed three endurance tasks involving fixed levels of task demands: hand grip, shoulder flexion, and a simulated assembly task using the upper extremity. Measures of functional performance including endurance, discomfort, motor control, and task performance were recorded for each of the task conditions. Endurance times were ∼60% longer for the non-obese group, and older participants had longer endurance times; however there was no evidence of interactive effects of obesity and age. Obesity also impaired functional performance, as indicated by higher rates of strength loss, increases in discomfort, and declines in task performance. These observed impairments may reflect underlying physiological differences among individuals who are obese, but that are independent of age. Obesity-related impairments may have implications for the design of work duration and demand level to prevent fatigue development for workers who are obese.

Cost-effectiveness of lower extremity compression ultrasound in emergency department patients with a high risk of hemodynamically stable pulmonary embolism.

PubMed

Ward, Michael J; Sodickson, Aaron; Diercks, Deborah B; Raja, Ali S

2011-01-01

Computed tomography angiograms (CTAs) for patients with suspected pulmonary embolism (PE) are being ordered with increasing frequency from the emergency department (ED). Strategies are needed to safely decrease the utilization of CTs to control rising health care costs and minimize the associated risks of anaphylaxis, contrast-induced nephropathy, and radiation-induced carcinogenesis. The use of compression ultrasonography (US) to identify deep vein thromboses (DVTs) in hemodynamically stable patients with signs and symptoms suggestive of PE is highly specific for the diagnosis of PE and may represent a cost-effective alternative to CT imaging.   The objective was to analyze the cost-effectiveness of a selective CT strategy incorporating the use of compression US to diagnose and treat DVT in patients with a high pretest probability of PE. The authors constructed a decision analytic model to evaluate the scenario of an otherwise healthy 59-year-old female in whom PE was being considered as a diagnosis. Two strategies were used. The selective CT strategy began with a screening compression US. Negative studies were followed up with a CTA, while patients with positive studies identifying a DVT were treated as though they had a PE and were anticoagulated. The universal CT strategy used CTA as the initial test, and anticoagulation was based on the CT result. Costs were estimated from the 2009 Medicare data for hospital reimbursement, and professional fees were obtained from the 2009 National Physician Fee Schedule. Clinical probabilities were obtained from existing published data, and sensitivity analyses were performed across plausible ranges for all clinical variables. In the base case, the selective CT strategy cost $1,457.70 less than the universal CT strategy and resulted in a gain of 0.0213 quality-adjusted life-years (QALYs). Sensitivity analyses confirm that the selective CT strategy is dominant above both a pretest probability for PE of 8.3% and a compression US specificity of 87.4%. A selective CT strategy using compression US is cost-effective for patients provided they have a high pretest probability of PE. This may reduce the need for, and decrease the adverse events associated with, CTAs. © 2010 by the Society for Academic Emergency Medicine.

The effectiveness and cost-effectiveness of cinacalcet for secondary hyperparathyroidism in end-stage renal disease patients on dialysis: a systematic review and economic evaluation.

PubMed

Garside, R; Pitt, M; Anderson, R; Mealing, S; Roome, C; Snaith, A; D'Souza, R; Welch, K; Stein, K

2007-05-01

To establish the effectiveness and cost-effectiveness of cinacalcet for the treatment of secondary hyperparathyroidism (SHPT) for people on dialysis due to end-stage renal disease (ESRD). Electronic databases were searched up to February 2006. Included randomised controlled trials (RCTs) on the clinical effectiveness of cinacalcet for SHPT in ESRD were critically appraised, had relevant data extracted and were summarised narratively. A Markov (state transition) model was developed that compared cinacalcet in addition to current standard treatment with phosphate binders and vitamin D to standard treatment alone. A simulated cohort of 1000 people aged 55 with SHPT was modelled until the whole cohort was dead. Incremental costs and quality-adjusted life-years (QALYs) were calculated. Extensive one-way sensitivity analysis was undertaken as well as probabilistic sensitivity analysis. Seven trials comparing cinacalcet plus standard treatment with placebo plus standard treatment were included in the systematic review. A total of 846 people were randomised to receive cinacalcet. Cinacalcet was more effective at meeting parathyroid hormone (PTH) target levels (40% vs 5% in placebo, p < 0.001). In those patients meeting PTH targets, 90% also experienced a reduction in calcium-phosphate product levels, compared with 1% in placebo. Significantly fewer people treated with cinacalcet were hospitalised for cardiovascular events, although no difference was seen in all-cause hospitalisation or mortality. Significantly fewer fractures and parathyroidectomies were also seen with cinacalcet. Findings on all patient-based clinical outcomes were based on small numbers. The authors' economic model estimated that, compared to standard treatment alone, cinacalcet in addition to standard care costs an additional 21,167 pounds and confers 0.34 QALYs (or 18 quality-adjusted weeks) per person. The incremental cost-effectiveness ratio (ICER) was 61,890 pounds/QALY. In most cases, even extreme adjustments to individual parameters did not result in an ICER below a willingness-to-pay threshold of 30,000 pounds/QALY with probabilistic analysis showing only 0.5% of simulations to be cost-effective at this threshold. Altering the assumptions in the model through using different data sources for the inputs produced a range of ICERs from 39,000 pounds to 92,000 pounds/QALY. Cinacalcet in addition to standard care is more effective than placebo plus standard care at reducing PTH levels without compromising calcium levels. However, there is limited information about the impact of this reduction on patient-relevant clinical outcomes. Given the short follow-up in the trials, it is unclear how data should be extrapolated to the long term. Together with the high drug cost, this leads to cinacalcet being unlikely to be considered cost-effective. Recommendations for future research include obtaining accurate estimates of the multivariate relationship between biochemical disruption in SHPT and long-term clinical outcomes.

Using the adaptive cycle in climate-risk insurance to design resilient futures

NASA Astrophysics Data System (ADS)

Cremades, R.; Surminski, S.; Máñez Costa, M.; Hudson, P.; Shrivastava, P.; Gascoigne, J.

2018-01-01

Assessing the dynamics of resilience could help insurers and governments reduce the costs of climate-risk insurance schemes and secure future insurability in the face of an increase in extreme hydro-meteorological events related to climate change.

Safety in tunnels : transport of dangerous goods through road tunnels : highlights

DOT National Transportation Integrated Search

2001-10-01

A serious incident involving dangerous goods in a tunnel can be extremely costly in terms of loss of human lives, environmental degradation, tunnel damage and transport disruption. On the other hand, needlessly banning dangerous goods from tunnels ma...

7 CFR 1709.117 - Application requirements.

Code of Federal Regulations, 2011 CFR

2011-01-01

... and the eligible extremely high energy cost communities to be served. (6) Project management. The... perform project management functions. If the applicant proposes to use the equipment or design.... Each application must include a narrative proposal describing the proposed project and addressing...

7 CFR 1709.117 - Application requirements.

Code of Federal Regulations, 2013 CFR

2013-01-01

... and the eligible extremely high energy cost communities to be served. (6) Project management. The... perform project management functions. If the applicant proposes to use the equipment or design.... Each application must include a narrative proposal describing the proposed project and addressing...

Deep-Learning Technique To Convert a Crude Piezoresistive Carbon Nanotube-Ecoflex Composite Sheet into a Smart, Portable, Disposable, and Extremely Flexible Keypad.

PubMed

Lee, Jin-Woong; Chung, Jiyong; Cho, Min-Young; Timilsina, Suman; Sohn, Keemin; Kim, Ji Sik; Sohn, Kee-Sun

2018-06-20

An extremely simple bulk sheet made of a piezoresistive carbon nanotube (CNT)-Ecoflex composite can act as a smart keypad that is portable, disposable, and flexible enough to be carried crushed inside the pocket of a pair of trousers. Both a rigid-button-imbedded, rollable (or foldable) pad and a patterned flexible pad have been introduced for use as portable keyboards. Herein, we suggest a bare, bulk, macroscale piezoresistive sheet as a replacement for these complex devices that are achievable only through high-cost fabrication processes such as patterning-based coating, printing, deposition, and mounting. A deep-learning technique based on deep neural networks (DNN) enables this extremely simple bulk sheet to play the role of a smart keypad without the use of complicated fabrication processes. To develop this keypad, instantaneous electrical resistance change was recorded at several locations on the edge of the sheet along with the exact information on the touch position and pressure for a huge number of random touches. The recorded data were used for training a DNN model that could eventually act as a brain for a simple sheet-type keypad. This simple sheet-type keypad worked perfectly and outperformed all of the existing portable keypads in terms of functionality, flexibility, disposability, and cost.

Effectiveness and cost-effectiveness of outpatient physiotherapy after knee replacement for osteoarthritis: study protocol for a randomised controlled trial.

PubMed

Wylde, Vikki; Artz, Neil; Marques, Elsa; Lenguerrand, Erik; Dixon, Samantha; Beswick, Andrew D; Burston, Amanda; Murray, James; Parwez, Tarique; Blom, Ashley W; Gooberman-Hill, Rachael

2016-06-13

Primary total knee replacement is a common operation that is performed to provide pain relief and restore functional ability. Inpatient physiotherapy is routinely provided after surgery to enhance recovery prior to hospital discharge. However, international variation exists in the provision of outpatient physiotherapy after hospital discharge. While evidence indicates that outpatient physiotherapy can improve short-term function, the longer term benefits are unknown. The aim of this randomised controlled trial is to evaluate the long-term clinical effectiveness and cost-effectiveness of a 6-week group-based outpatient physiotherapy intervention following knee replacement. Two hundred and fifty-six patients waiting for knee replacement because of osteoarthritis will be recruited from two orthopaedic centres. Participants randomised to the usual-care group (n = 128) will be given a booklet about exercise and referred for physiotherapy if deemed appropriate by the clinical care team. The intervention group (n = 128) will receive the same usual care and additionally be invited to attend a group-based outpatient physiotherapy class starting 6 weeks after surgery. The 1-hour class will be run on a weekly basis over 6 weeks and will involve task-orientated and individualised exercises. The primary outcome will be the Lower Extremity Functional Scale at 12 months post-operative. Secondary outcomes include: quality of life, knee pain and function, depression, anxiety and satisfaction. Data collection will be by questionnaire prior to surgery and 3, 6 and 12 months after surgery and will include a resource-use questionnaire to enable a trial-based economic evaluation. Trial participation and satisfaction with the classes will be evaluated through structured telephone interviews. The primary statistical and economic analyses will be conducted on an intention-to-treat basis with and without imputation of missing data. The primary economic result will estimate the incremental cost per quality-adjusted life year gained from this intervention from a National Health Services (NHS) and personal social services perspective. This research aims to benefit patients and the NHS by providing evidence on the long-term effectiveness and cost-effectiveness of outpatient physiotherapy after knee replacement. If the intervention is found to be effective and cost-effective, implementation into clinical practice could lead to improvement in patients' outcomes and improved health care resource efficiency. ISRCTN32087234 , registered on 11 February 2015.

Advanced Tissue Sciences Inc.: learning from the past, a case study for regenerative medicine.

PubMed

Pangarkar, Nitin; Pharoah, Marc; Nigam, Avinav; Hutmacher, Dietmar W; Champ, Simon

2010-09-01

On 31st March 2003 Advanced Tissue Sciences (ATS) was liquidated, with the effect that in excess of US$300 million of stakeholder financing was destroyed. Although successful in the development of breakthrough technologies in the regenerative medicine arena and the building of a substantial portfolio of patents, the company never made a profit. In this case study, ATS’ business strategy, market and competitive environment will be discussed in the context of the company’s historical development. A number of important lessons from this case are discussed. From a management perspective the most critical lesson is the importance of effective financial planning and management of costs, and in particular R&D costs, including the significant costs associated with clinical trials. In addition, a clear strategic focus is extremely important due to the significant resources required in the development of a new therapy. From an investor’s perspective the lessons to be gathered from the ATS case are related to the risk involved in investing in the field of regenerative medicine. This case indicates that both professional and private investors did not fully question the validity of ATS’ business strategy and financial forecasts. A clear and focused strategy based on long-term investor commitment is essential for the successful commercialization of regenerative medicine.

Pulsed CO2 Laser Ablation of Superficial Basal Cell of Limbs and Trunk: A Comparative Randomized Clinical Trial With Cryotherapy and Surgical Ablation.

PubMed

Zane, Cristina; Facchinetti, Elena; Arisi, Mariachiara; Ortel, Bernhard; Calzavara-Pinton, Piergiacomo

2017-07-01

Pulsed CO2 laser is a treatment of superficial basal cell carcinoma (sBCC) although robust clinical evidence has not been reported so far. The authors investigated efficacy, safety, time to wound healing, cosmetic outcome, patient satisfaction, and cost-effectiveness ratio of pulsed CO2 laser in comparison to cryotherapy and surgery. BCCs of the trunk and extremities were randomized to one of the treatments. After 90 days, efficacy and cosmetic outcome were assessed. Patients recorded the time to complete healing of the wound and scored their overall satisfaction. Two hundred forty patients were randomized. After 3 months, complete remission (CR) rate with pulsed CO2 laser was 78.8%. This was significantly lower than surgery, whereas the CR rate with cryotherapy was not significantly different. Cosmetic result was better with surgery. High satisfaction was reported by 65.0% of patients treated with CO2 ablation. Time of wound healing was significantly shorter with CO2 laser. In comparison to cryotherapy, pulsed CO2 laser showed no statistically significant difference in efficacy, cosmetic outcome, and patient satisfaction. Time to healing was shorter; the cost and cost-effectiveness ratio were similar. Surgery had the greatest efficacy rate. The main limitation of this study was the short duration of follow-up (3 months).

Review of the Need for a Large-scale Test Facility for Research on the Effects of Extreme Winds on Structures

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

R. G. Little

1999-03-01

The Idaho National Engineering and Environmental Laboratory (INEEL), through the US Department of Energy (DOE), has proposed that a large-scale wind test facility (LSWTF) be constructed to study, in full-scale, the behavior of low-rise structures under simulated extreme wind conditions. To determine the need for, and potential benefits of, such a facility, the Idaho Operations Office of the DOE requested that the National Research Council (NRC) perform an independent assessment of the role and potential value of an LSWTF in the overall context of wind engineering research. The NRC established the Committee to Review the Need for a Large-scale Testmore » Facility for Research on the Effects of Extreme Winds on Structures, under the auspices of the Board on Infrastructure and the Constructed Environment, to perform this assessment. This report conveys the results of the committee's deliberations as well as its findings and recommendations. Data developed at large-scale would enhanced the understanding of how structures, particularly light-frame structures, are affected by extreme winds (e.g., hurricanes, tornadoes, sever thunderstorms, and other events). With a large-scale wind test facility, full-sized structures, such as site-built or manufactured housing and small commercial or industrial buildings, could be tested under a range of wind conditions in a controlled, repeatable environment. At this time, the US has no facility specifically constructed for this purpose. During the course of this study, the committee was confronted by three difficult questions: (1) does the lack of a facility equate to a need for the facility? (2) is need alone sufficient justification for the construction of a facility? and (3) would the benefits derived from information produced in an LSWTF justify the costs of producing that information? The committee's evaluation of the need and justification for an LSWTF was shaped by these realities.« less

Monitoring and control requirement definition study for Dispersed Storage and Generation (DSG). Volume 5, appendix D: Cost-benefit considerations for providing dispersed storage and generation for electric utilities

NASA Technical Reports Server (NTRS)

1980-01-01

Cost benefit considerations are extremely important in obtaining the acceptance of dispersed storage and generation (DSG) by the electric utilities. These considerations involved somewhat different economic analyses depending on whether the generation is utility, customer, or combined ownership. It is necessary to get acceptance of more easily understood methods for evaluating the economics of DSG because much of the benefits of DSG may accrue in the generation and transmission portions of the utility system while the costs tend to be centered in the distribution portion of that system. The influence of factors, such as reliability, capital costs, and other economic measures were also investigated.

Optimal habits can develop spontaneously through sensitivity to local cost

PubMed Central

Desrochers, Theresa M.; Jin, Dezhe Z.; Goodman, Noah D.; Graybiel, Ann M.

2010-01-01

Habits and rituals are expressed universally across animal species. These behaviors are advantageous in allowing sequential behaviors to be performed without cognitive overload, and appear to rely on neural circuits that are relatively benign but vulnerable to takeover by extreme contexts, neuropsychiatric sequelae, and processes leading to addiction. Reinforcement learning (RL) is thought to underlie the formation of optimal habits. However, this theoretic formulation has principally been tested experimentally in simple stimulus-response tasks with relatively few available responses. We asked whether RL could also account for the emergence of habitual action sequences in realistically complex situations in which no repetitive stimulus-response links were present and in which many response options were present. We exposed naïve macaque monkeys to such experimental conditions by introducing a unique free saccade scan task. Despite the highly uncertain conditions and no instruction, the monkeys developed a succession of stereotypical, self-chosen saccade sequence patterns. Remarkably, these continued to morph for months, long after session-averaged reward and cost (eye movement distance) reached asymptote. Prima facie, these continued behavioral changes appeared to challenge RL. However, trial-by-trial analysis showed that pattern changes on adjacent trials were predicted by lowered cost, and RL simulations that reduced the cost reproduced the monkeys’ behavior. Ultimately, the patterns settled into stereotypical saccade sequences that minimized the cost of obtaining the reward on average. These findings suggest that brain mechanisms underlying the emergence of habits, and perhaps unwanted repetitive behaviors in clinical disorders, could follow RL algorithms capturing extremely local explore/exploit tradeoffs. PMID:20974967

Extreme flood estimation by the SCHADEX method in a snow-driven catchment: application to Atnasjø (Norway)

NASA Astrophysics Data System (ADS)

Paquet, Emmanuel; Lawrence, Deborah

2013-04-01

The SCHADEX method for extreme flood estimation was developed by Paquet et al. (2006, 2013), and since 2008, it is the reference method used by Electricité de France (EDF) for dam spillway design. SCHADEX is a so-called "semi-continuous" stochastic simulation method in that flood events are simulated on an event basis and are superimposed on a continuous simulation of the catchment saturation hazard usingrainfall-runoff modelling. The MORDOR hydrological model (Garçon, 1999) has thus far been used for the rainfall-runoff modelling. MORDOR is a conceptual, lumped, reservoir model with daily areal rainfall and air temperature as the driving input data. The principal hydrological processes represented are evapotranspiration, direct and indirect runoff, ground water, snow accumulation and melt, and routing. The model has been intensively used at EDF for more than 15 years, in particular for inflow forecasts for French mountainous catchments. SCHADEX has now also been applied to the Atnasjø catchment (463 km²), a well-documented inland catchment in south-central Norway, dominated by snowmelt flooding during spring/early summer. To support this application, a weather pattern classification based on extreme rainfall was first established for Norway (Fleig, 2012). This classification scheme was then used to build a Multi-Exponential Weather Pattern distribution (MEWP), as introduced by Garavaglia et al. (2010) for extreme rainfall estimation. The MORDOR model was then calibrated relative to daily discharge data for Atnasjø. Finally, a SCHADEX simulation was run to build a daily discharge distribution with a sufficient number of simulations for assessing the extreme quantiles. Detailed results are used to illustrate how SCHADEX handles the complex and interacting hydrological processes driving flood generation in this snow driven catchment. Seasonal and monthly distributions, as well as statistics for several thousand simulated events reaching a 1000 years return level value and assessment of snowmelt role in extreme floods are presented. This study illustrates the complexity of the extreme flood estimation in snow driven catchments, and the need for a good representation of snow accumulation and melting processes in simulations for design flood estimations. In particular, the SCHADEX method is able to represent a range of possible catchment conditions (representing both soil moisture and snowmelt) in which extreme flood events can occur. This study is part of a collaboration between NVE and EDF, initiated within the FloodFreq COST Action (http://www.cost-floodfreq.eu/). References: Fleig, A., Scientific Report of the Short Term Scientific Mission Anne Fleig visiting Électricité de France, FloodFreq COST action - STSM report, 2012 Garavaglia, F., Gailhard, J., Paquet, E., Lang, M., Garçon, R., and Bernardara, P., Introducing a rainfall compound distribution model based on weather patterns sub-sampling, Hydrol. Earth Syst. Sci., 14, 951-964, doi:10.5194/hess-14-951-2010, 2010 Garçon, R. Modèle global pluie-débit pour la prévision et la prédétermination des crues, La Houille Blanche, 7-8, 88-95. doi: 10.1051/lhb/1999088 Paquet, E., Gailhard, J. and Garçon, R. (2006), Evolution of the GRADEX method: improvement by atmospheric circulation classification and hydrological modeling, La Houille Blanche, 5, 80-90. doi: 10.1051/lhb/2006091 Paquet, E., Garavaglia, F., Garçon, R. and Gailhard, J. (2012), The SCHADEX method: a semi-continuous rainfall-runoff simulation for extreme food estimation, Journal of Hydrology, under revision

Cryosurgery as an effective alternative for treatment of oral lesions in children.

PubMed

Rezende, Karla Mayra; Moraes, Paulo de Camargo; Oliveira, Luciana Butini; Thomaz, Luiz Alexandre; Junqueira, José Luiz Cintra; Bönecker, Marcelo

2014-01-01

Children can exhibit a wide variety of oral pathologies, such as oral lesions, bone lesions, tumors, cysts and cutaneous lesions. Different techniques have been described for the treatment of these lesions, but all of them are invasive. This paper presents a series of cases that demonstrate the clinical efficacy of cryosurgery as an alternative to invasive surgical treatments of the most common oral lesions in children. This technique has been well tolerated by patients due to the absence of anesthesia, rapid healing and minimal bleeding. Cryotherapy has many applications in oral medicine and is an extremely useful alternative in patients to whom surgery is contraindicated due to age or medical history. It is a simple procedure to perform, minimally invasive, low-cost and very effective in pediatric dentistry clinic.

Home-based tele-assisted robotic rehabilitation of joint impairments in children with cerebral palsy.

PubMed

Chen, Kai; Ren, Yupeng; Gaebler-Spira, Deborah; Zhang, Li-Qun

2014-01-01

A portable rehabilitation robot incorporating intelligent stretching, robot-guided voluntary movement training with motivating games and tele-rehabilitation was developed to provide convenient and cost-effective rehabilitation to children with cerebral palsy (CP) and extend rehabilitation care beyond hospital. Clinicians interact with the patients remotely for periodic evaluations and updated guidance. The tele-assisted stretching and active movement training was done over 6-week 18 sessions on the impaired ankle of 23 children with CP in their home setting. Treatment effectiveness was evaluated using biomechanical measures and clinical outcome measures. After the tele-assisted home robotic rehabilitation intervention, there were significant increases in the ankle passive and active range of motion, muscle strength, a decrease in spasticity, and increases in balance and selective control assessment of lower-extremity.

Design of the Revascularization With Open Bypass vs Angioplasty and Stenting of the Lower Extremity Trial (ROBUST): a randomized clinical trial.

PubMed

Malas, Mahmoud B; Qazi, Umair; Glebova, Natalia; Arhuidese, Isibor; Reifsnyder, Thomas; Black, James; Perler, Bruce A; Freischlag, Julie A

2014-12-01

To our knowledge, there is no level 1 evidence comparing open bypass with angioplasty and stenting in TransAtlantic Inter-Society Consensus (TASC II) B and C superficial femoral artery lesions. The Revascularization With Open Bypass vs Angioplasty and Stenting of the Lower Extremity Trial (ROBUST) is the first prospective randomized clinical trial comparing both treatments. To report the design of the ROBUST trial. The primary aim of the trial is to compare (1) the patency rate (primary, primary assisted, and secondary patency at 6 and 12 months), (2) improvement of quality of life, (3) clinical improvement (at least 1 Rutherford category), and (4) wound healing and limb salvage in patients presenting with critical limb ischemia; secondary aims include (1) cost-effectiveness by factoring procedure and hospital admission costs including rehabilitation, readmission, and reintervention costs, (2) amputation-free survival, (3) reintervention rate, and (4) 30-day operative mortality, morbidity, and wound and access complications. ROBUST is a prospective randomized clinical trial with the aim to enroll 320 patients with intermittent claudication that does not respond to medical management and patients with critical limb ischemia. The maximum level of medical therapy will be administered using antiplatelet agents and statins, as well as measures to control hypertension and diabetes mellitus. Patients with TASC II B or C lesions are prospectively randomized to receive either femoropopliteal bypass or percutaneous transluminal angioplasty and stenting; patients with TASC II A and D lesions are not randomized and receive percutaneous transluminal angioplasty and stenting or femoropopliteal bypass, respectively. All patients will be evaluated at 1, 6, and 12 months postoperatively with physical examination, ankle brachial index, duplex, and a quality-of-life questionnaire. The trial is actively enrolling participants. At the time of writing, 29 patients have been enrolled; most are male (60%) and white (65%). Providing level 1 evidence, ROBUST may help to establish guidelines for the treatment of superficial femoral artery lesions, eliminate unnecessary procedures, and reduce health care costs. clinicaltrials.gov Identifier: NCT01602159.

Pediatric sports-related lower extremity fractures: hospital length of stay and charges: what is the role of the primary payer?

PubMed

Gao, Yubo; Johnston, Richard C; Karam, Matthew

2010-01-01

The purposes of this study were (a) to evaluate the distribution by primary payer (public vs. private) of U.S. pediatric patients aged 5-18 years who were hospitalized with a sports-related lower extremity fracture and (b) to discern the adjusted mean hospital length of stay and mean charge per day by payer type. Children who were aged 5 to 18 years and had diagnoses of lower extremity fracture and sports-related injury in the 2006 Healthcare Cost and Utilization Project Kids' Inpatient Database were included. Lower extremity fractures are defined as International Classification of Diseases, 9th Revision, Clinical Modification codes 820-829 under Section "Injury and Poisoning (800-999)," while sports-related external cause of injury codes (E-codes) are E886.0, E917.0, and E917.5. Differences in hospital length of stay and cost per day by payer type were assessed via adjusted least square mean analysis. The adjusted mean hospital length of stay was 20% higher for patients with a public payer (2.50 days) versus a private payer (2.08 days). The adjusted mean charge per day differed about 10% by payer type (public, US$7,900; private, US$8,794). Further research is required to identify factors that are associated with different length of stay and mean charge per day by payer type, and explore whether observed differences in hospital length of stay are the result of private payers enhancing patient care, thereby discharging patients in a more efficient manner.

Assessing the indirect effects due to natural hazards on a mesoscale

NASA Astrophysics Data System (ADS)

Pfurtscheller, C.; Schwarze, R.

2009-04-01

Measuring indirect economic costs and other effects from natural hazards, especially floods in alpine and other mountainous regions, are a necessary part of a comprehensive economic assessment. Their omission seriously affects the relative economic benefits of structural or non structural measures of flood defence. Surpassing controversial, IO-model-based economic estimates, analysing indirect economic effects lead to the key question of identifying and evaluating the drivers of indirect economic effects and resilience to system effects in the regional economy, i.e. at the meso-level. This investigation takes place for the catastrophic floods in summer 2005 in the provinces of Tyrol and Vorarlberg, Austria, which caused an estimated € 670 Mio direct loss on private and public assets and severe interruptions in lifeline services. The paper starts out with differentiating the concept of indirect economic costs from direct costs, examing different temporal (short vs. long-term) and spatial (macro-, meso- vs. microeconomic) system boundaries. It surveys common theories of economic resilience and vulnerability at the regional economy level. Indirect effects at the regional economy level can be defined as interferences of the economic exchange of goods and services triggered by breakdowns of transport lines and critical production inputs. The extent and persistence of indirect effects of natural hazards is not only by parameters of the extreme event, such as duration and amplitude of the flood, but much more by resilience parameters of the regional economy such as size of enterprises, the network structure (linkages) of the regional economy, availability of insurance and relief funds, and the stock of inventory. These effects can only be dissected by means of expert judgement and event studies. This paper presents the results of a survey conducted among business practioneers, members of chamber of commerce, civil protection agencies to identify and scale the drivers of indirect costs triggered by floods on a local and regional scale. We develop a risk point scale and explain how it can be nested into IO-model-based economic tools such as the HAZUS indirect economic loss calculator

The case for implementing activity based costing.

PubMed

Monge, Paul H; Bolinger-Perez, Nicole; Boysen, Kent

2012-01-01

ABC identifies profitable volumes to give managers information to better manage volumes. Managers must balance the demand for service while maintaining a reasonable profit margin. Disparate systems work extremely well for their intended purposes, but they do not communicate with one another. The strength of the data they hold individually may be leveraged when implementing ABC methodology. Mayo Clinic in Rochester, Minnesota implemented a pilot of ABC to evaluate CT services where there is a high volume, multiple service location for cost comparison, variety of patient acuity and service mix, and large capital investments.The goal was to reveal the actual cost of CT services at the procedural level.

Lysosomal storage diseases: natural history and ethical and economic aspects.

PubMed

Beutler, Ernest

2006-07-01

Potential treatment for lysosomal diseases now includes enzyme replacement therapy, substrate reduction therapy, and chaperone therapy. The first two of these have been implemented commercially, and the spectrum of diseases that are now treatable has expanded from Gaucher disease to include several other disorders. Treatment of these diseases is extremely costly. We explore some of the reasons for the high cost and discuss how, by proper selection of patients and appropriate dosing, the economic burden on society of treating these disease may be ameliorated, at least in part. However, the cost of treating rare diseases is a growing problem that society needs to address.

Effects of packet retransmission with finite packet lifetime on traffic capacity in scale-free networks

NASA Astrophysics Data System (ADS)

Jiang, Zhong-Yuan; Ma, Jian-Feng

Existing routing strategies such as the global dynamic routing [X. Ling, M. B. Hu, R. Jiang and Q. S. Wu, Phys. Rev. E 81, 016113 (2010)] can achieve very high traffic capacity at the cost of extremely long packet traveling delay. In many real complex networks, especially for real-time applications such as the instant communication software, extremely long packet traveling time is unacceptable. In this work, we propose to assign a finite Time-to-Live (TTL) parameter for each packet. To guarantee every packet to arrive at its destination within its TTL, we assume that a packet is retransmitted by its source once its TTL expires. We employ source routing mechanisms in the traffic model to avoid the routing-flaps induced by the global dynamic routing. We compose extensive simulations to verify our proposed mechanisms. With small TTL, the effects of packet retransmission on network traffic capacity are obvious, and the phase transition from flow free state to congested state occurs. For the purpose of reducing the computation frequency of the routing table, we employ a computing cycle Tc within which the routing table is recomputed once. The simulation results show that the traffic capacity decreases with increasing Tc. Our work provides a good insight into the understanding of effects of packet retransmission with finite packet lifetime on traffic capacity in scale-free networks.

Contracting by managed care systems for pharmaceutical products and services.

PubMed

Sharp, W T; Strandberg, L R

1990-11-01

The health care delivery system has received criticism because of its rapidly increasing costs. In an attempt to control costs, the administrators of managed care organizations are searching for cost control mechanisms. Thus, the administrators of managed care organizations appear to be searching carefully for any alternative method to lower the cost of delivering medical care to plan members. In this environment pharmacists must be extremely careful to study the cost of providing prescription services to managed care organizations, because they will be constrained by the obligations indicated in the contractual relationship. Any decisions to provide pharmaceutical services should be studied in detail after careful discussion with administrators of a managed care organization. Only after a careful analysis should a pharmacist make a decision to offer or not offer pharmaceutical services to a managed care organization.

High-performance wire-grid polarizers using jet and Flash™ imprint lithography

NASA Astrophysics Data System (ADS)

Ahn, Se Hyun; Yang, Shuqiang; Miller, Mike; Ganapathisubramanian, Maha; Menezes, Marlon; Choi, Jin; Xu, Frank; Resnick, Douglas J.; Sreenivasan, S. V.

2013-07-01

Extremely large-area roll-to-roll (R2R) manufacturing on flexible substrates is ubiquitous for applications such as paper and plastic processing. It combines the benefits of high speed and inexpensive substrates to deliver a commodity product at low cost. The challenge is to extend this approach to the realm of nanopatterning and realize similar benefits. In order to achieve low-cost nanopatterning, it is imperative to move toward high-speed imprinting, less complex tools, near zero waste of consumables, and low-cost substrates. We have developed a roll-based J-FIL process and applied it to a technology demonstrator tool, the LithoFlex 100, to fabricate large-area flexible bilayer wire-grid polarizers (WGPs) and high-performance WGPs on rigid glass substrates. Extinction ratios of better than 10,000 are obtained for the glass-based WGPs. Two simulation packages are also employed to understand the effects of pitch, aluminum thickness, and pattern defectivity on the optical performance of the WGP devices. It is determined that the WGPs can be influenced by both clear and opaque defects in the gratings; however, the defect densities are relaxed relative to the requirements of a high-density semiconductor device.

High volume nanoscale roll-based imprinting using jet and flash imprint lithography

NASA Astrophysics Data System (ADS)

Ahn, Se Hyun; Miller, Mike; Yang, Shuqiang; Ganapathisubramanian, Maha; Menezes, Marlon; Singh, Vik; Choi, Jin; Xu, Frank; LaBrake, Dwayne; Resnick, Douglas J.; Sreenivasan, S. V.

2013-09-01

Extremely large-area roll-to-roll (R2R) manufacturing on flexible substrates is ubiquitous for applications such as paper and plastic processing. It combines the benefits of high speed and inexpensive substrates to deliver a commodity product at low cost. The challenge is to extend this approach to the realm of nanopatterning and realize similar benefits. In order to achieve low-cost nanopatterning, it is imperative to move toward high-speed imprinting, less complex tools, near zero waste of consumables, and low-cost substrates. We have developed a roll-based J-FIL process and applied it to a technology demonstrator tool, the LithoFlex 100, to fabricate large-area flexible bilayer wire-grid polarizers (WGPs) and high-performance WGPs on rigid glass substrates. Extinction ratios of better than 10,000 are obtained for the glass-based WGPs. Two simulation packages are also employed to understand the effects of pitch, aluminum thickness, and pattern defectivity on the optical performance of the WGP devices. It is determined that the WGPs can be influenced by both clear and opaque defects in the gratings; however, the defect densities are relaxed relative to the requirements of a high-density semiconductor device.

Health economics and the European Heart Rhythm Association.

PubMed

Vardas, Panos; Boriani, Giuseppe

2011-05-01

The management of healthcare is becoming extremely complex in developed countries, as a result of increasing age of the population and increasing costs of care, coupled with diminishing resources due to global financial crisis. This situation threatens access to appropriate care, and a more or less explicit rationing of some types of treatment may occur in 'real world' clinical practice. This is particularly true for those treatments or interventions with a relatively high up-front cost, such as cardioverter defibrillators, devices for cardiac resynchronization therapy or ablation procedures for atrial fibrillation. The European Heart Rhythm Association (EHRA) is strongly convinced that the skills of electrophysiologists and cardiologists responsible for the management of rhythm disorders have to evolve, also embracing the knowledge of health economics, clinical epidemiology, health-care management and outcome research. These disciplines do not belong to what is considered as the conventional cultural background of physicians, but knowledge of comparative cost effectiveness and of other economic approaches nowadays appears fundamental for a dialogue with a series of stakeholders, such as policy makers, politicians, and administrators, involved in budgeting the activity of hospitals and health-care services, as well as in approaching health technology assessment.

Development of FB-MultiPier dynamic vessel-collision analysis models, phase 2 : [summary].

DOT National Transportation Integrated Search

2014-07-01

When collisions between large vessels and bridge : supports occur, they can result in significant : damage to bridge and vessel. These collisions : are extremely hazardous, often taking lives on : the vessel and the bridge. Direct costs of repair : a...

Table manners.

PubMed

Jahn, D

2001-01-01

Although hospitals today exist in a competitive environment, the recent Survivor television program is not the best model. It has pushed competition to the extreme: the winner takes all at any cost. It is whether or not you win the game, and no holds barred on how you play.

Impressive Performance: New Disposable Digital Ureteroscope Allows for Extreme Lower Pole Access and Use of 365 μm Holmium Laser Fiber.

PubMed

Leveillee, Raymond J; Kelly, Emily Fell

2016-01-01

Since the development of the first flexible ureteroscope, in 1964, technological advances in image quality, flexibility, and deflection have led to the development of the first single-use digital flexible ureteroscope, LithoVue™ (Boston Scientific, Marlborough, MA). With respect to reusable fiber-optic and now digital ureteroscopes, there is an initial capital cost of several thousand dollars (USD) as well as, controversy regarding durability, the cost of repairs and the burdensome reprocessing steps of ureteroscopy. The single-use LithoVue eliminates the need for costly repairs, the occurrence of unpredictable performance, and procedural delays. Renal stones located in the lower pole of the kidney can be extremely challenging as extreme deflections of greater than 160° are difficult to maintain and are often further compromised when using stone treatment tools, such as laser fibers and baskets. This case describes an initial use of the LithoVue digital disposable ureteroscope in the effective treatment of lower pole calculi using a 365 μm holmium laser fiber. A 35-year-old female, with a medical history significant for chronic bacteriuria, and recurrent symptomatic culture proven urinary tract infections, underwent localization studies. Retrograde ureteropyelography demonstrated two calcifications adjoining, measuring a total of 1.4 cm, overlying the left renal shadow. Urine aspirated yielded clinically significant, >100,000, Escherichia coli and Streptococcus anginosus bacteriuria, which was felt to be originating from the left lower calix. This case used the newly FDA-approved LithoVue flexible disposable ureteroscope. The two stones were seen using the ureteroscope passed through an ureteral access sheath in the lower pole calix. A 365 μm holmium laser fiber was inserted into the ureteroscope and advanced toward the stones. There was no loss of deflection as the ureteroscope performed reproducibly. The laser was used for more than 4000 pulses at 15 W, producing mucoid debris and fragments. A 1.9F nitinol basket was, then, used to extract the fragments, and the patient was rendered stone free. Treatment success was confirmed by plain abdominal film obtained 1 week after stent removal. The LithoVue system single-use digital flexible ureteroscope provides an economical advantage over both reusable digital and fiber-optic ureteroscopes. The LithoVue system uses the enhanced image resolution of the digital complementary metal oxide semiconductor imager, similar to other reusable digital ureteroscopes, while maintaining the small ureteroscope size of a flexible fiber-optic ureteroscope, allowing for consistent and effective lower pole access. Deflection characteristics are maintained even when thicker laser fibers are passed through the working channel.

Towing Tank and Flume Testing of Passively Adaptive Composite Tidal Turbine Blades: Preprint

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

Murray, Robynne; Ordonez-Sanchez, Stephanie; Porter, Kate E.

Composite tidal turbine blades with bend-twist (BT) coupled layups allow the blade to self-adapt to local site conditions by passively twisting. Passive feathering has the potential to increase annual energy production and shed thrust loads and power under extreme tidal flows. Decreased hydrodynamic thrust and power during extreme conditions meann that the turbine support structure, generator, and other components can be sized more appropriately, resulting in a higher utilization factor and increased cost effectiveness. This paper presents new experimental data for a small-scale turbine with BT composite blades. The research team tested the turbine in the Kelvin Hydrodynamics Laboratory towingmore » tank at the University of Strathclyde in Glasgow, United Kingdom, and in the recirculating current flume at the l Institut Francais de Recherche pour l Exploitation de la Mer Centre in Boulogne-sur-Mer, France. Tests were also performed on rigid aluminum blades with identical geometry, which yielded baseline test sets for comparison. The results from both facilities agreed closely, supporting the hypothesis that increased blade flexibility can induce load reductions. Under the most extreme conditions tested the turbine with BT blades had up to 11 percent lower peak thrust loads and a 15 percent reduction in peak power compared to the turbine with rigid blades. The load reductions varied as a function of turbine rotational velocity and ambient flow velocity.« less

[Treating vaginismus in Turkish women].

PubMed

Gül, V; Ruf, G D

2009-03-01

Vaginismus is a sexual dysfunction involving various branches of medicine, including psychiatry and gynaecology. Psychiatric help is sought in only a small proportion of cases, although it is probable that the psychopathological aetiology is more frequent than generally recognized. This article deals with the causes and psychological circumstances in four Turkish couples who presented with unconsummated marriage for 3 to 7 years. Vaginismus F52.5 to the ICD-10 is a sexual dysfunction characterised as: deep anxiety about coitus leading to extreme spasm of musculature making coitus impossible or extremely unpleasant and painful. Four Turkish couples with unconsummated marriage due to the female partners' penetration phobia were included to this study. A patient-oriented multidimensional individual treatment (combination therapy) is a cost effective, short-term (typically 10- to 12-week) treatment model for both partners. It includes some elements of cognitive behavioural therapy and systemic partner therapy which were considered not radically different from previous therapeutic strategies. Results were successful in all cases; the couples were extremely satisfied with having a normal sex life for the first time. This led to desired pregnancies and avoiding of possible breakdown of their families. The couples did well with combination behavioural therapy. This methodology is discussed in its various aspects and with a cultural background. We also emphasise the need for physicians to be mindful of cases of vaginismus requiring psychiatric intervention rather than gynaecological treatment.

Advanced space optics development in freeform optics design, ceramic polishing, rapid and extreme freeform polishing

NASA Astrophysics Data System (ADS)

Geyl, R.; Leplan, H.; Ruch, E.

2017-09-01

In this paper Safran-Reosc wants to share with the space community its recent work performed in the domain of space optics. Our main topic is a study about the advantages that freeform optical surfaces can offer to advanced space optics in term of compactness or performances. We have separated smart and extreme freeform in our design exploration work. Our second topic is to answer about the immediate question following: can we manufacture and test these freeform optics? We will therefore present our freeform optics capability, report recent achievement in extreme aspheric optics polishing and introduce to the industrialisation process of large off axis optics polishing for the ESO Extremely Large Telescope primary mirror segments. Thirdly we present our R-SiC polishing layer technology for SiC material. This technique has been developed to reduce costs, risks and schedule in the manufacturing of advanced SiC optics for Vis and IR applications.

Integrated modeling for assessment of energy-water system resilience under changing climate

NASA Astrophysics Data System (ADS)

Yan, E.; Veselka, T.; Zhou, Z.; Koritarov, V.; Mahalik, M.; Qiu, F.; Mahat, V.; Betrie, G.; Clark, C.

2016-12-01

Energy and water systems are intrinsically interconnected. Due to an increase in climate variability and extreme weather events, interdependency between these two systems has been recently intensified resulting significant impacts on both systems and energy output. To address this challenge, an Integrated Water-Energy Systems Assessment Framework (IWESAF) is being developed to integrate multiple existing or developed models from various sectors. The IWESAF currently includes an extreme climate event generator to predict future extreme weather events, hydrologic and reservoir models, riverine temperature model, power plant water use simulator, and power grid operation and cost optimization model. The IWESAF can facilitate the interaction among the modeling systems and provide insights of the sustainability and resilience of the energy-water system under extreme climate events and economic consequence. The regional case demonstration in the Midwest region will be presented. The detailed information on some of individual modeling components will also be presented in several other abstracts submitted to AGU this year.

xSDK Foundations: Toward an Extreme-scale Scientific Software Development Kit

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

Heroux, Michael A.; Bartlett, Roscoe; Demeshko, Irina

Here, extreme-scale computational science increasingly demands multiscale and multiphysics formulations. Combining software developed by independent groups is imperative: no single team has resources for all predictive science and decision support capabilities. Scientific libraries provide high-quality, reusable software components for constructing applications with improved robustness and portability. However, without coordination, many libraries cannot be easily composed. Namespace collisions, inconsistent arguments, lack of third-party software versioning, and additional difficulties make composition costly. The Extreme-scale Scientific Software Development Kit (xSDK) defines community policies to improve code quality and compatibility across independently developed packages (hypre, PETSc, SuperLU, Trilinos, and Alquimia) and provides a foundationmore » for addressing broader issues in software interoperability, performance portability, and sustainability. The xSDK provides turnkey installation of member software and seamless combination of aggregate capabilities, and it marks first steps toward extreme-scale scientific software ecosystems from which future applications can be composed rapidly with assured quality and scalability.« less

xSDK Foundations: Toward an Extreme-scale Scientific Software Development Kit

DOE PAGES

Heroux, Michael A.; Bartlett, Roscoe; Demeshko, Irina; ...

2017-03-01

Here, extreme-scale computational science increasingly demands multiscale and multiphysics formulations. Combining software developed by independent groups is imperative: no single team has resources for all predictive science and decision support capabilities. Scientific libraries provide high-quality, reusable software components for constructing applications with improved robustness and portability. However, without coordination, many libraries cannot be easily composed. Namespace collisions, inconsistent arguments, lack of third-party software versioning, and additional difficulties make composition costly. The Extreme-scale Scientific Software Development Kit (xSDK) defines community policies to improve code quality and compatibility across independently developed packages (hypre, PETSc, SuperLU, Trilinos, and Alquimia) and provides a foundationmore » for addressing broader issues in software interoperability, performance portability, and sustainability. The xSDK provides turnkey installation of member software and seamless combination of aggregate capabilities, and it marks first steps toward extreme-scale scientific software ecosystems from which future applications can be composed rapidly with assured quality and scalability.« less