Science.gov

Sample records for potential cost-effective alternative

  1. Deregulation and Nuclear Training: Cost Effective Alternatives

    SciTech Connect

    Richard P. Coe; Patricia A. Lake

    2000-11-12

    Training is crucial to the success of any organization. It is also expensive, with some estimates exceeding $50 billion annually spent on training by U.S. corporations. Nuclear training, like that of many other highly technical organizations, is both crucial and costly. It is unlikely that the amount of training can be significantly reduced. If anything, current trends indicate that training needs will probably increase as the industry and workforce ages and changes. With the advent of energy deregulation in the United States, greater pressures will surface to make the costs of energy more cost-competitive. This in turn will drive businesses to more closely examine existing costs and find ways to do things in a more cost-effective way. The commercial nuclear industry will be no exception, and nuclear training will be equally affected. It is time for nuclear training and indeed the entire nuclear industry to begin using more aggressive techniques to reduce costs. This includes the need for nuclear training to find alternatives to traditional methods for the delivery of cost-effective high-quality training that meets regulatory requirements and produces well-qualified personnel capable of working in an efficient and safe manner. Computer-based and/or Web-based training are leading emerging technologies.

  2. Thresholds for the cost-effectiveness of interventions: alternative approaches.

    PubMed

    Marseille, Elliot; Larson, Bruce; Kazi, Dhruv S; Kahn, James G; Rosen, Sydney

    2015-02-01

    Many countries use the cost-effectiveness thresholds recommended by the World Health Organization's Choosing Interventions that are Cost-Effective project (WHO-CHOICE) when evaluating health interventions. This project sets the threshold for cost-effectiveness as the cost of the intervention per disability-adjusted life-year (DALY) averted less than three times the country's annual gross domestic product (GDP) per capita. Highly cost-effective interventions are defined as meeting a threshold per DALY averted of once the annual GDP per capita. We argue that reliance on these thresholds reduces the value of cost-effectiveness analyses and makes such analyses too blunt to be useful for most decision-making in the field of public health. Use of these thresholds has little theoretical justification, skirts the difficult but necessary ranking of the relative values of locally-applicable interventions and omits any consideration of what is truly affordable. The WHO-CHOICE thresholds set such a low bar for cost-effectiveness that very few interventions with evidence of efficacy can be ruled out. The thresholds have little value in assessing the trade-offs that decision-makers must confront. We present alternative approaches for applying cost-effectiveness criteria to choices in the allocation of health-care resources.

  3. Cost-effective Alternative for Negative-pressure Wound Therapy

    PubMed Central

    Franczyk, Mieczyslawa; Gottlieb, Lawrence J.; Song, David H.

    2017-01-01

    Background: Current predominantly used equipments for negative-pressure wound therapy (NPWT) are expensive. In current healthcare climate continually emphasizing cost containment, importance in developing more cost-effective alternatives cannot be understated. Previously, therapeutically equivalent methods of providing NPWT was demonstrated using just low-cost, universally available supplies, coined Gauze-SUCtion (GSUC). Here, we examine long-term potential financial savings of utilizing GSUC over commercialized products. Methods: A retrospective cost analysis was performed at the University of Chicago Medical Center between 1999 and 2014. All NPWT was provided via either GSUC or commercialized vacuum-assisted closure (VAC, KCI) device. Sum of all material component costs were reviewed to determine theoretical average daily cost. For the VAC group, recorded institutional spend to KCI was also reviewed to determine actual daily cost. In the GSUC group, this figure was extrapolated using similar ratios. Labor costs for each method were determined using analysis from prior study. Patient demographics, etiology, wound location, and treatment length were also reviewed. Results: Total of 35,871 days of NPWT was provided during the 15-year span. Theoretical average cost of VAC was $94.01/d versus $3.61/d for GSUC, whereas actual average was $111.18/d versus $4.26/d. Average labor cost was $20.11/dressing change versus $12.32. Combined, total cost of VAC therapy was estimated at $119,224 per every 1,000 days of therapy versus $9,188 for the GSUC. Conclusions: There is clear and significant cost savings from utilization of GSUC method of NPWT. Furthermore, the added advantage of being able to provide NPWT from universally accessible materials cannot be overstated. PMID:28280658

  4. Cost-effectiveness of alternative strategies to prevent trachomatous blindness.

    PubMed

    Frick, Kevin D; Colchero, M Arantxa

    2002-06-01

    The Alliance for the Global Elimination of Blinding Trachoma was formed in the mid 1990s. The Alliance of country representatives and experts on trachoma suggested a four-pronged approach to eliminate incident trachomatous blindness: surgery for trichiasis, antibiotics to treat the disease, facial cleanliness and environmental improvements to limit disease transmission. The efficacy and effectiveness of the components of this approach have been evaluated, but the strategy as a whole has not been compared with different combinations of its components. The relevant cost-outcome and pharmacoeconomics literature is limited. This article reviews the cost-effectiveness of the approach's components. Furthermore, the article mentions ongoing research that will address the cost-effectiveness of the entire strategy for eliminating a major cause of preventable blindness in the developing world.

  5. Cost Effectiveness of Alternative Route Special Education Teacher Preparation

    ERIC Educational Resources Information Center

    Sindelar, Paul T.; Dewey, James F.; Rosenberg, Michael S.; Corbett, Nancy L.; Denslow, David; Lotfinia, Babik

    2012-01-01

    In this study, the authors estimated costs of alternative route preparation to provide states a basis for allocating training funds to maximize production. Thirty-one special education alternative route program directors were interviewed and completed cost tables. Two hundred and twenty-four program graduates were also surveyed. The authors…

  6. Cost-effectiveness of nitrogen mitigation by alternative household wastewater management technologies.

    PubMed

    Wood, Alison; Blackhurst, Michael; Hawkins, Troy; Xue, Xiaobo; Ashbolt, Nicholas; Garland, Jay

    2015-03-01

    Household wastewater, especially from conventional septic systems, is a major contributor to nitrogen pollution. Alternative household wastewater management technologies provide similar sewerage management services but their life cycle costs and nitrogen flow implications remain uncertain. This paper addresses two key questions: (1) what are the total costs, nitrogen mitigation potential, and cost-effectiveness of a range of conventional and alternative municipal wastewater treatment technologies, and (2) what uncertainties influence these outcomes and how can we improve our understanding of these technologies? We estimate a household nitrogen mass balance for various household wastewater treatment systems and combine this mass balance with life cycle cost assessment to calculate the cost-effectiveness of nitrogen mitigation, which we define as nitrogen removed from the local watershed. We apply our methods to Falmouth, MA, where failing septic systems have caused heightened eutrophication in local receiving water bodies. We find that flushing and dry (composting) urine-diversion toilets paired with conventional septic systems for greywater management demonstrate the lowest life cycle cost and highest cost-effectiveness (dollars per kilogram of nitrogen removed from the watershed). Composting toilets are also attractive options in some cases, particularly best-case nitrogen mitigation. Innovative/advanced septic systems designed for high-level nitrogen removal are cost-competitive options for newly constructed homes, except at their most expensive. A centralized wastewater treatment plant is the most expensive and least cost-effective option in all cases. Using a greywater recycling system with any treatment technology increases the cost without adding any nitrogen removal benefits. Sensitivity analysis shows that these results are robust considering a range of cases and uncertainties.

  7. Global warming and urban smog: The cost effectiveness of CAFE standards and alternative fuels

    SciTech Connect

    Krupnick, A.J.; Walls, M.A.; Collins, C.T.

    1992-01-01

    This paper evaluates alternative transportation policies for reducing greenhouse gas emissions and ozone precursors. The net cost-effectiveness -- i.e., the cost per ton of greenhouse gas reduced, adjusted for ozone reduction benefits -- of substituting methanol, compressed natural gas (CNG), and reformulated gasoline for conventional gasoline is assessed and compared with the cost-effectiveness of raising the corporate average fuel economy (CAFE) standard to 38 miles per gallon. Computing this [open quotes]net[close quotes] cost-effectiveness is one way of measuring the joint environmental benefits that these alternatives provide. Greenhouse gas emissions are assessed over the entire fuel cycle and include not only carbon dioxide emissions, but also methane, carbon monoxide, and nitrous oxide emissions. In computing cost-effectiveness, we account for the so-called [open quotes]rebound effect[close quotes] -- the impact on vehicle-miles traveled of higher or lower fuel costs. CNG is found to be the most cost-effective of these alternatives, followed by increasing the CAFE standard, substituting methanol for gasoline, and substituting reformulated for conventional gasoline. Including the ozone reduction benefits does not change the rankings of the alternatives, but does make the alternative fuels look better relative to increasing the CAFE standard. Incorporating the rebound effect greatly changes the magnitude of the estimates but does not change the rankings of the alternatives. None of the alternatives look cost-effective should a carbon tax of $35 per ton be passes (the proposal in the Stark bill, H.R. 1086), and only CNG under optimistic assumptions looks cost-effective if a tax of $100 per ton of carbon is passed.

  8. Preventing the Wernicke-Korsakoff syndrome in Australia: cost-effectiveness of thiamin-supplementation alternatives.

    PubMed

    Connelly, L; Price, J

    1996-04-01

    Alcoholic Wernicke's encephalopathy has been commonplace in Australia for many years and, as this syndrome is attributed to a deficiency in the diet, it should be preventable. This study employs conventional cost-effectiveness methodology to compare the economic efficiency of several thiamin-supplementation alternatives that have been proposed for the prevention of Wernicke's encephalopathy. A series of rankings of these measures is derived from an estimated cost per case averted for each of the alternatives studied. These rankings identify the least cost-effective thiamin-supplementation alternative as that of enriching bread-making flour with thiamin.

  9. Potential cost-effectiveness of the nonavalent human papillomavirus (HPV) vaccine.

    PubMed

    Drolet, Mélanie; Laprise, Jean-François; Boily, Marie-Claude; Franco, Eduardo L; Brisson, Marc

    2014-05-01

    Randomized clinical trials are currently examining the efficacy of a nonavalent human papillomavirus (HPV) vaccine, including HPV-types 6/11/16/18/31/33/45/52/58. Evidence on the cost-effectiveness of the nonavalent is required for timely policy-decisions. We compared the potential cost-effectiveness of the nonavalent and quadrivalent HPV vaccines. We used a multi-type individual-based transmission-dynamic model of HPV infection and diseases, 70-year time-horizon, 3% discount rate and healthcare payer perspective. We calibrated the model to Canadian sexual behavior and epidemiologic data, and estimated Quality-Adjusted Life-Years (QALYs) lost and costs ($CAN 2010) from the literature. Under base-case assumptions (vaccinating 10-year-old girls, 80% coverage, 95$/dose, vaccine-type efficacy = 95%, cross-protection for the quadrivalent vaccine, duration of vaccine-type protection (cross-protection) = 20 (10) years), using the quadrivalent and nonavalent vaccines is estimated to cost $15,528 [12,056; 19,140] and $12,203 [9,331; 17,292] per QALY-gained, respectively. At equal price, the nonavalent vaccine is more cost-effective than the quadrivalent vaccine, even when assuming both shorter duration of protection (nonavalent = 20 years vs. quadrivalent = lifelong) and lower vaccine-type efficacy (nonavalent = 85% vs. quadrivalent = 95%). However, the additional cost per dose of the nonavalent vaccine should not exceed $11 to remain more cost-effective than the quadrivalent vaccine, and $24 to represent a cost-effective alternative to the quadrivalent vaccine (using a $40,000/QALY-gained threshold). The nonavalent vaccine can be a cost-effective alternative to the quadrivalent vaccine, even in scenarios where nonavalent vaccine efficacy is 85%. However, because most cervical cancers are caused by HPV-16/18, it is unlikely that the nonavalent would be used if its efficacy against these types is lower than current HPV vaccines.

  10. Cost-effective management alternatives for Snake river chinook salmon: A biological-economic synthesis

    USGS Publications Warehouse

    Halsing, D.L.; Moore, M.R.

    2008-01-01

    The mandate to increase endangered salmon populations in the Columbia River Basin of North America has created a complex, controversial resource-management issue. We constructed an integrated assessment model as a tool for analyzing biological-economic trade-offs in recovery of Snake River spring- and summer-run chinook salmon (Oncorhynchus tshawytscha). We merged 3 frameworks: a salmon-passage model to predict migration and survival of smolts; an age-structured matrix model to predict long-term population growth rates of salmon stocks; and a cost-effectiveness analysis to determine a set of least-cost management alternatives for achieving particular population growth rates. We assessed 6 individual salmon-management measures and 76 management alternatives composed of one or more measures. To reflect uncertainty, results were derived for different assumptions of effectiveness of smolt transport around dams. Removal of an estuarine predator, the Caspian Tern (Sterna caspia), was cost-effective and generally increased long-term population growth rates regardless of transport effectiveness. Elimination of adult salmon harvest had a similar effect over a range of its cost estimates. The specific management alternatives in the cost-effective set depended on assumptions about transport effectiveness. On the basis of recent estimates of smolt transport effectiveness, alternatives that discontinued transportation or breached dams were prevalent in the cost-effective set, whereas alternatives that maximized transportation dominated if transport effectiveness was relatively high. More generally, the analysis eliminated 80-90% of management alternatives from the cost-effective set. Application of our results to salmon management is limited by data availability and model assumptions, but these limitations can help guide research that addresses critical uncertainties and information. Our results thus demonstrate that linking biology and economics through integrated models can

  11. Global warming and urban smog: Cost-effectiveness of CAFE standards and alternative fuels

    SciTech Connect

    Krupnick, A.J.; Walls, M.A.; Collins, C.T.

    1993-12-31

    In this paper we estimate the cost-effectiveness, in terms of reducing greenhouse gas emissions, of increasing the corporate average fuel economy (CAFE) standard to 38 miles per gallon and substituting methanol, compressed natural gas (CNG), and reformulated gasoline for conventional gasoline. Greenhouse gas emissions are assessed over the entire fuel cycle and include carbon dioxide, methane, carbon monoxide, and nitrous oxide emissions. To account for joint environmental benefits, the cost per ton of greenhouse gas reduced is adjusted for reductions in volatile organic compound (VOC) emissions, an ozone precursor. CNG is found to be the most cost-effective of these alternatives, followed by increasing the CAFE standard, substituting methanol for gasoline, and substituting reformulated for conventional gasoline. Including the VOC benefits does not change the ranking of the alternatives, but does make the alternative fuels look better relative to increasing the CAFE standard. None of the alternatives look cost-effective should a carbon tax of $35 per ton be passed, and only CNG under optimistic assumptions looks cost-effective with a tax of $100 per ton of carbon. 35 refs., 4 figs., 6 tabs.

  12. A PRELIMINARY METHODOLOGY FOR EVALUATING THE COST-EFFECTIVENESS OF ALTERNATIVE INDOOR AIR QUALITY APPROACHES

    EPA Science Inventory

    The report defines a simplified methodology that can be used by indoor air quality (IAQ) diagnosticians, architects/engineers, building owners/operators, and the scientific community for preliminary comparison of the cost-effectiveness of alternative IAQ control measures for any ...

  13. Cost-effective alternatives for mitigating Cryptosporidium risk in drinking water and enhancing ecosystem services

    NASA Astrophysics Data System (ADS)

    Bryan, B. A.; Kandulu, J. M.

    2009-08-01

    Under the multibarrier paradigm, water quality management barriers that mitigate risk to consumers are required at multiple points from the catchment to the tap. We present a cost-effectiveness analysis of 13 catchment- and treatment-based management alternatives for mitigating Cryptosporidium risk in the Myponga water supply catchment, South Australia. A broad range of costs and benefits are identified and valued, including setup, operation and maintenance, and opportunity costs, and benefits for ecosystem services including water quality, biodiversity, carbon sequestration, and farm production services. The results suggest that the cost-effectiveness of investment in water quality management can be substantially enhanced by considering the costs of management and the benefits for ecosystem services, in addition to Cryptosporidium removal effectiveness. Cost-effectiveness of investment in management alternatives is dependent upon the desired level of Cryptosporidium removal effectiveness by both the catchment and treatment barriers. The combination of a spatially targeted 25% restriction in water course access of nondairy cattle and treatment by enhanced coagulation provides the most (net) cost-effective Cryptosporidium risk mitigation strategy. This combination may achieve 0.614 log removal at a net cost of A0.7 million and (net) cost-effectiveness of A1.14 million per log removal. Additional risk mitigation can be achieved through the addition of ultraviolet irradiation treatment, higher levels of water course access restriction for cattle, and the adoption of dung beetles in the catchment. Economic valuation of a range of costs and benefits of management priorities can support cost-effective water quality management investment decisions and inform elements of policy design such as cost-sharing arrangements and spatial targeting.

  14. Cost-Effectiveness of Alternative Surveillance Strategies for Hepatocellular Carcinoma in Patients with Cirrhosis

    PubMed Central

    Andersson, Karin L.; Salomon, Joshua A.; Chung, Raymond T.; Goldie, Sue J.

    2015-01-01

    Background & Aims The rising incidence of hepatocellular carcinoma (HCC) in the United States has significant health and economic consequences. Ultrasound (US) surveillance is recommended for patients with cirrhosis because of their high risk of HCC and improving treatment outcomes for small tumors. We assessed the costs, clinical benefits, and cost-effectiveness of US surveillance and alternative strategies for HCC in cirrhosis using a computer-based state transition model with parameters derived from available literature. Methods Our model compared a policy of no surveillance to six surveillance strategies in cirrhotic patients ages 50 years and older in the United States: 1) annual US; 2) semiannual US; 3) semiannual US with alphafetoprotein; 4) annual computed tomography (CT); 5) semiannual CT; and 6) annual magnetic resonance imaging. The number of screening tests needed to detect one small HCC, cost per treated HCC, lifetime costs, quality-adjusted life expectancy, and incremental cost-effectiveness ratios were calculated. Results Semiannual US surveillance for HCC in cirrhosis increased quality-adjusted life expectancy by 8.6 months on average, but extended it nearly 3.5 years in patients with small treated tumors. Semiannual US surveillance had an incremental cost-effectiveness ratio of $30,700 per quality-adjusted life year (QALY) gained, and was more cost-effective than the alternative surveillance strategies using a threshold of $50,000 per QALY gained. The incremental cost-effectiveness ratios for the combined alphafetoprotein/US and annual CT strategies exceeded $50,000/QALY unless the sensitivity and specificity of US fell below 65% and 60%, respectively. Conclusion Semiannual US surveillance for HCC in cirrhotic patients improves clinical outcomes at a reasonable cost. PMID:18848905

  15. Cost-effectiveness of alternative conservation strategies with application to the Pacific leatherback turtle.

    PubMed

    Gjertsen, Heidi; Squires, Dale; Dutton, Peter H; Eguchi, Tomoharu

    2014-02-01

    Although holistic conservation addressing all sources of mortality for endangered species or stocks is the preferred conservation strategy, limited budgets require a criterion to prioritize conservation investments. We compared the cost-effectiveness of nesting site and at-sea conservation strategies for Pacific leatherback turtles (Dermochelys coriacea). We sought to determine which conservation strategy or mix of strategies would produce the largest increase in population growth rate per dollar. Alternative strategies included protection of nesters and their eggs at nesting beaches in Indonesia, gear changes, effort restrictions, and caps on turtle takes in the Hawaiian (U.S.A.) longline swordfish fishery, and temporal and area closures in the California (U.S.A.) drift gill net fishery. We used a population model with a biological metric to measure the effects of conservation alternatives. We normalized all effects by cost to prioritize those strategies with the greatest biological effect relative to its economic cost. We used Monte Carlo simulation to address uncertainty in the main variables and to calculate probability distributions for cost-effectiveness measures. Nesting beach protection was the most cost-effective means of achieving increases in leatherback populations. This result creates the possibility of noncompensatory bycatch mitigation, where high-bycatch fisheries invest in protecting nesting beaches. An example of this practice is U.S. processors of longline tuna and California drift gill net fishers that tax themselves to finance low-cost nesting site protection. Under certain conditions, fisheries interventions, such as technologies that reduce leatherback bycatch without substantially decreasing target species catch, can be cost-effective. Reducing bycatch in coastal areas where bycatch is high, particularly adjacent to nesting beaches, may be cost-effective, particularly, if fisheries in the area are small and of little commercial value.

  16. A Potential Cost Effective Liquefaction Mitigation Countermeasure: Induced Partial Saturation

    SciTech Connect

    Bian Hanbing; Jia Yun; Shahrour, Isam

    2008-07-08

    This work is devoted to illustrate the potential liquefaction mitigation countermeasure: Induced Partial Saturation. Firstly the potential liquefaction mitigation method is briefly introduced. Then the numerical model for partially saturated sandy soil is presented. At last the dynamic responses of liquefiable free filed with different water saturation is given. It shows that the induced partial saturation is efficiency for preventing the liquefaction.

  17. Potential Cost-Effective Opportunities for Methane Emission Abatement

    SciTech Connect

    Warner, Ethan; Steinberg, Daniel; Hodson, Elke; Heath, Garvin

    2015-08-01

    The energy sector was responsible for approximately 84% of carbon dioxide equivalent (CO2e) greenhouse gas (GHG) emissions in the U.S. in 2012 (EPA 2014a). Methane is the second most important GHG, contributing 9% of total U.S. CO2e emissions. A large portion of those methane emissions result from energy production and use; the natural gas, coal, and oil industries produce approximately 39% of anthropogenic methane emissions in the U.S. As a result, fossil-fuel systems have been consistently identified as high priority sectors to contribute to U.S. GHG reduction goals (White House 2015). Only two studies have recently attempted to quantify the abatement potential and cost associated with the breadth of opportunities to reduce GHG emissions within natural gas, oil, and coal supply chains in the United States, namely the U.S. Environmental Protection Agency (EPA) (2013a) and ICF (2014). EPA, in its 2013 analysis, estimated the marginal cost of abatement for non-CO2 GHG emissions from the natural gas, oil, and coal supply chains for multiple regions globally, including the United States. Building on this work, ICF International (ICF) (2014) provided an update and re-analysis of the potential opportunities in U.S. natural gas and oil systems. In this report we synthesize these previously published estimates as well as incorporate additional data provided by ICF to provide a comprehensive national analysis of methane abatement opportunities and their associated costs across the natural gas, oil, and coal supply chains. Results are presented as a suite of marginal abatement cost curves (MACCs), which depict the total potential and cost of reducing emissions through different abatement measures. We report results by sector (natural gas, oil, and coal) and by supply chain segment - production, gathering and boosting, processing, transmission and storage, or distribution - to facilitate identification of which sectors and supply chain

  18. The Cost-Effectiveness of Three Screening Alternatives for People with Diabetes with No or Early Diabetic Retinopathy

    PubMed Central

    Rein, David B; Wittenborn, John S; Zhang, Xinzhi; Allaire, Benjamin A; Song, Michael S; Klein, Ronald; Saaddine, Jinan B

    2011-01-01

    Objective To determine whether biennial eye evaluation or telemedicine screening are cost-effective alternatives to current recommendations for the estimated 10 million people aged 30–84 with diabetes but no or minimal diabetic retinopathy. Data Sources United Kingdom Prospective Diabetes Study, National Health and Nutrition Examination Survey, American Academy of Ophthalmology Preferred Practice Patterns, Medicare Payment Schedule. Study Design Cost-effectiveness Monte Carlo simulation. Data Collection/Extraction Methods Literature review, analysis of existing surveys. Principal Findings Biennial eye evaluation was the most cost-effective treatment option when the ability to detect other eye conditions was included in the model. Telemedicine was most cost-effective when other eye conditions were not considered or when telemedicine was assumed to detect refractive error. The current annual eye evaluation recommendation was costly compared with either treatment alternative. Self-referral was most cost-effective up to a willingness to pay (WTP) of U.S.$37,600, with either biennial or annual evaluation most cost-effective at higher WTP levels. Conclusions Annual eye evaluations are costly and add little benefit compared with either plausible alternative. More research on the ability of telemedicine to detect other eye conditions is needed to determine whether it is more cost-effective than biennial eye evaluation. PMID:21492158

  19. A comparison of estimates of cost-effectiveness of alternative fuels and vehicles for reducing emissions

    SciTech Connect

    Hadder, G.R.

    1995-11-01

    The cost-effectiveness ratio (CER) is a measure of the monetary value of resources expended to obtain reductions in emissions of air pollutants. The CER can lead to selection of the most effective sequence of pollution reduction options. Derived with different methodologies and technical assumptions, CER estimates for alternative fuel vehicles (AFVs) have varied widely among pervious studies. In one of several explanations of LCER differences, this report uses a consistent basis for fuel price to re-estimate CERs for AFVs in reduction of emissions of criteria pollutants, toxics, and greenhouse gases. The re-estimated CERs for a given fuel type have considerable differences due to non-fuel costs and emissions reductions, but the CERs do provide an ordinal sense of cost-effectiveness. The category with CER less than $5,000 per ton includes compressed natural gas and ed Petroleum gas vehicles; and E85 flexible-fueled vehicles (with fuel mixture of 85 percent cellulose-derived ethanol in gasoline). The E85 system would be much less attractive if corn-derived ethanol were used. The CER for E85 (corn-derived) is higher with higher values placed on the reduction of gas emissions. CER estimates are relative to conventional vehicles fueled with Phase 1 California reformulated gasoline (RFG). The California Phase 2 RFG program will be implemented before significant market penetration by AFVs. CERs could be substantially greater if they are calculated incremental to the Phase 2 RFG program. Regression analysis suggests that different assumptions across studies can sometimes have predictable effects on the CER estimate of a particular AFV type. The relative differences in cost and emissions reduction assumptions can be large, and the effect of these differences on the CER estimate is often not predictable. Decomposition of CERs suggests that methodological differences can make large contributions to CER differences among studies.

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

    PubMed Central

    Read, Simon; McGale, Paul; Darby, Sarah

    2009-01-01

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

  1. A comparison of alternative strategies for cost-effective water quality management in lakes.

    PubMed

    Kramer, Daniel Boyd; Polasky, Stephen; Starfield, Anthony; Palik, Brian; Westphal, Lynne; Snyder, Stephanie; Jakes, Pamela; Hudson, Rachel; Gustafson, Eric

    2006-09-01

    Roughly 45% of the assessed lakes in the United States are impaired for one or more reasons. Eutrophication due to excess phosphorus loading is common in many impaired lakes. Various strategies are available to lake residents for addressing declining lake water quality, including septic system upgrades and establishing riparian buffers. This study examines 25 lakes to determine whether septic upgrades or riparian buffers are a more cost-effective strategy to meet a phosphorus reduction target. We find that riparian buffers are the more cost-effective strategy in every case but one. Large transaction costs associated with the negotiation and monitoring of riparian buffers, however, may be prohibiting lake residents from implementing the most cost-effective strategy.

  2. Cost Effectiveness of Potential ART Adherence Monitoring Interventions in Sub-Saharan Africa

    PubMed Central

    Cambiano, Valentina; Nakagawa, Fumiyo; Bansi-Matharu, Loveleen; Sow, Papa Salif; Ehrenkranz, Peter; Ford, Deborah; Mugurungi, Owen; Apollo, Tsitsi; Murungu, Joseph; Bangsberg, David R.; Revill, Paul

    2016-01-01

    Background Interventions based around objective measurement of adherence to antiretroviral drugs for HIV have potential to improve adherence and to enable differentiation of care such that clinical visits are reduced in those with high adherence. It would be useful to understand the approximate upper limit of cost that could be considered for such interventions of a given effectiveness in order to be cost effective. Such information can guide whether to implement an intervention in the light of a trial showing a certain effectiveness and cost. Methods An individual-based model, calibrated to Zimbabwe, which incorporates effects of adherence and resistance to antiretroviral therapy, was used to model the potential impact of adherence monitoring-based interventions on viral suppression, death rates, disability adjusted life years and costs. Potential component effects of the intervention were: enhanced average adherence when on ART, reduced risk of ART discontinuation, and reduced risk of resistance acquisition. We considered a situation in which viral load monitoring is not available and one in which it is. In the former case, it was assumed that care would be differentiated based on the adherence level, with fewer clinic visits in those demonstrated to have high adherence. In the latter case, care was assumed to be primarily differentiated according to viral load level. The maximum intervention cost required to be cost effective was calculated based on a cost effectiveness threshold of $500 per DALY averted. Findings In the absence of viral load monitoring, an adherence monitoring-based intervention which results in a durable 6% increase in the proportion of ART experienced people with viral load < 1000 cps/mL was cost effective if it cost up to $50 per person-year on ART, mainly driven by the cost savings of differentiation of care. In the presence of viral load monitoring availability, an intervention with a similar effect on viral load suppression was cost-effective

  3. Interpreting a Museum Exhibit: The Message Effectiveness and Cost Effectiveness of Alternative Audio Messages.

    ERIC Educational Resources Information Center

    Hambleton, Susan K.

    In this Masters Thesis, the message effectiveness and cost effectiveness (in terms of costs and monetary benefits) of two interpretive audio messages were evaluated. Ninety-nine randomly selected visitors to a Central Ohio interpretive museum were exposed to one of two audio tape recorded messages. One message used interpretive technique; the…

  4. 41 CFR 301-70.802 - Must we ensure that travel on Government aircraft is the most cost-effective alternative?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... travel on Government aircraft is the most cost-effective alternative? 301-70.802 Section 301-70.802... Agencies That Authorize Travel on Government Aircraft § 301-70.802 Must we ensure that travel on Government aircraft is the most cost-effective alternative? (a) Yes, you must ensure that travel on a...

  5. 41 CFR 301-70.802 - Must we ensure that travel on Government aircraft is the most cost-effective alternative?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... travel on Government aircraft is the most cost-effective alternative? 301-70.802 Section 301-70.802... Agencies That Authorize Travel on Government Aircraft § 301-70.802 Must we ensure that travel on Government aircraft is the most cost-effective alternative? (a) Yes, you must ensure that travel on a...

  6. 41 CFR 301-70.802 - Must we ensure that travel on Government aircraft is the most cost-effective alternative?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... travel on Government aircraft is the most cost-effective alternative? 301-70.802 Section 301-70.802... Agencies That Authorize Travel on Government Aircraft § 301-70.802 Must we ensure that travel on Government aircraft is the most cost-effective alternative? (a) Yes, you must ensure that travel on a...

  7. 41 CFR 301-70.802 - Must we ensure that travel on Government aircraft is the most cost-effective alternative?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... travel on Government aircraft is the most cost-effective alternative? 301-70.802 Section 301-70.802... Agencies That Authorize Travel on Government Aircraft § 301-70.802 Must we ensure that travel on Government aircraft is the most cost-effective alternative? (a) Yes, you must ensure that travel on a...

  8. 41 CFR 301-70.802 - Must we ensure that travel on Government aircraft is the most cost-effective alternative?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... travel on Government aircraft is the most cost-effective alternative? 301-70.802 Section 301-70.802... Agencies That Authorize Travel on Government Aircraft § 301-70.802 Must we ensure that travel on Government aircraft is the most cost-effective alternative? (a) Yes, you must ensure that travel on a...

  9. Parafilm-M®, An Available Cost-Effective Alternative for Immuno-blot Pouches.

    PubMed

    Quadri, Syed M S

    2015-01-01

    Commercially available standard immuno-blot pouches do play an efficient role in antibody incubation in performing an immuno-blot, but are not readily available in the laboratory and have to be specifically ordered. We have developed an equally efficient technique to make an immune-blot more cost-effective with more conservation of antibodies by using a common and readily available laboratory product Parafilm-M(®). Parafilm-M(®) which serves as a sealant for various items of laboratory equipment can be used for antibody incubation. Manually made Parafilm-M(®) pouch has a clear advantage over standard immuno-blot pouches in terms of availability, cost-effectiveness, and consumption of antibodies that ultimately reduces the cost of an immuno-blot. We have performed a series of experiments to check the efficacy of both the techniques. Samples with equal amount of protein were analyzed on separate SDS PAGE gels. The proteins were transferred electrophoretically to the nitrocellulose membrane using Trans-Blot(®) Turbo™ Mini Nitrocellulose Transfer Pack. Antibody incubation was done using standard immuno-blot pouch, standard container and Parafilm-M(®) sealed pouch. The expression of protein was determined and the results of immuno-blots were compared. We found that antibodies are binding the membrane in Parafilm-M(®) pouches as efficiently as in container method or in standard immuno-blot pouches. By restricting the membrane, the surface area of the manually made Parafilm-M(®) pouch can be reduced, less diluent is required to cover the membrane as a result less antibodies are consumed. We also calculated that each immuno-blot pouch cost around $0.1906, whereas the cost for Parafilm-M(®) pouch is 0.0695 which is almost one-third the price of an immuno-blot pouch. Thus, Parafilm-M(®) method distinctly provides a cost-effective solution for antibody incubation.

  10. Changing environments and alternative perspectives in evaluating the cost-effectiveness of new antipsychotic drugs.

    PubMed

    Rosenheck, Robert; Doyle, Jefferson; Leslie, Douglas; Fontana, Alan

    2003-01-01

    This article examines the ways in which changes in the treatment environment and in measurement perspectives can affect the evaluation of cost-effectiveness of new medications. In three studies we reexamined data from a clinical trial of haloperidol and clozapine conducted from 1993 to 1996. The results of the studies are as follows: Study 1 found that clozapine treatment was associated with significantly reduced inpatient costs, and increased outpatient costs, suggesting that as systems use less inpatient care and more outpatient care, more effective medications may increase, rather than decrease, costs in sicker patients. Study 2 found that while provider assessments and standard measures favored clozapine over haloperidol, patient responses showed little evidence of a clinical advantage for clozapine and a less favorable side-effect profile. Study 3 found that while annual drug costs in the published trial were estimated to be dollars 4,545 for a full year of clozapine treatment, atypical antipsychotic costs in 2000 were estimated to range from dollars 1,254 to dollars 3,016 in the Department of Veterans Affairs system, and from dollars 2,221 to dollars 8,147 in the private sector. In conclusion, cost-effectiveness, as evaluated in studies like CATIE, will increasingly need to be tied to service system contingencies, environments, and evaluation perspectives.

  11. A methodological framework for assessing agreement between cost-effectiveness outcomes estimated using alternative sources of data on treatment costs and effects for trial-based economic evaluations.

    PubMed

    Achana, Felix; Petrou, Stavros; Khan, Kamran; Gaye, Amadou; Modi, Neena

    2017-02-09

    A new methodological framework for assessing agreement between cost-effectiveness endpoints generated using alternative sources of data on treatment costs and effects for trial-based economic evaluations is proposed. The framework can be used to validate cost-effectiveness endpoints generated from routine data sources when comparable data is available directly from trial case report forms or from another source. We illustrate application of the framework using data from a recent trial-based economic evaluation of the probiotic Bifidobacterium breve strain BBG administered to babies less than 31 weeks of gestation. Cost-effectiveness endpoints are compared using two sources of information; trial case report forms and data extracted from the National Neonatal Research Database (NNRD), a clinical database created through collaborative efforts of UK neonatal services. Focusing on mean incremental net benefits at £30,000 per episode of sepsis averted, the study revealed no evidence of discrepancy between the data sources (two-sided p values >0.4), low probability estimates of miscoverage (ranging from 0.039 to 0.060) and concordance correlation coefficients greater than 0.86. We conclude that the NNRD could potentially serve as a reliable source of data for future trial-based economic evaluations of neonatal interventions. We also discuss the potential implications of increasing opportunity to utilize routinely available data for the conduct of trial-based economic evaluations.

  12. Portfolio theory and the alternative decision rule of cost-effectiveness analysis: theoretical and practical considerations.

    PubMed

    Sendi, Pedram; Al, Maiwenn J; Gafni, Amiram; Birch, Stephen

    2004-05-01

    Bridges and Terris (Soc. Sci. Med. (2004)) critique our paper on the alternative decision rule of economic evaluation in the presence of uncertainty and constrained resources within the context of a portfolio of health care programs (Sendi et al. Soc. Sci. Med. 57 (2003) 2207). They argue that by not adopting a formal portfolio theory approach we overlook the optimal solution. We show that these arguments stem from a fundamental misunderstanding of the alternative decision rule of economic evaluation. In particular, the portfolio theory approach advocated by Bridges and Terris is based on the same theoretical assumptions that the alternative decision rule set out to relax. Moreover, Bridges and Terris acknowledge that the proposed portfolio theory approach may not identify the optimal solution to resource allocation problems. Hence, it provides neither theoretical nor practical improvements to the proposed alternative decision rule.

  13. Cost-Effectiveness of Nitrogen Mitigation by Alternative Household Wastewater Management Technologies

    EPA Science Inventory

    Household wastewater, especially from conventional septic systems, is a major contributor to nitrogen pollution. Alternative household wastewater management technologies provide similar sewerage management services but their life cycle costs and nitrogen flow implications remain ...

  14. Potential alternate life biochemistries

    NASA Astrophysics Data System (ADS)

    Konesky, Gregory

    2013-09-01

    While life on Earth continues to be discovered in unlikely environments, the underlying biochemistry is all very similar, based on the element carbon, and requiring liquid water. We consider alternate biochemistries based on elements other than carbon, including other group IVA elements, such as silicon and germanium, and solvents other than water. Terminal electron acceptors other than oxygen are also discussed. A fundamental issue is raised related to the detection of, and even the definition of life, whether it is carbon or non-carbon based. An extreme example of this issue would be in consideration of speculative life based on electrically charged dusty plasmas, which may have no physical body.

  15. Potential Cost-Effectiveness of Prenatal Distribution of Misoprostol for Prevention of Postpartum Hemorrhage in Uganda

    PubMed Central

    Lubinga, Solomon J.; Atukunda, Esther C.; Wasswa-Ssalongo, George; Babigumira, Joseph B.

    2015-01-01

    Background In settings where home birth rates are high, prenatal distribution of misoprostol has been advocated as a strategy to increase access to uterotonics during the third stage of labor to prevent postpartum hemorrhage (PPH). Our objective was to project the potential cost-effectiveness of this strategy in Uganda from both governmental (the relevant payer) and modified societal perspectives. Methods and Findings To compare prenatal misoprostol distribution to status quo (no misoprostol distribution), we developed a decision analytic model that tracked the delivery pathways of a cohort of pregnant women from the prenatal period, labor to delivery without complications or delivery with PPH, and successful treatment or death. Delivery pathway parameters were derived from the Uganda Demographic and Health Survey. Incidence of PPH, treatment efficacy, adverse event and case fatality rates, access to misoprostol, and health resource use and cost data were obtained from published literature and supplemented with expert opinion where necessary. We computed the expected incidence of PPH, mortality, disability adjusted life years (DALYs), costs and incremental cost effectiveness ratios (ICERs). We conducted univariate and probabilistic sensitivity analyses to examine robustness of our results. In the base-case analysis, misoprostol distribution lowered the expected incidence of PPH by 1.0% (95% credibility interval (CrI): 0.55%, 1.95%), mortality by 0.08% (95% CrI: 0.04%, 0.13%) and DALYs by 0.02 (95% CrI: 0.01, 0.03). Mean costs were higher with prenatal misoprostol distribution from governmental by US$3.3 (95% CrI: 2.1, 4.2) and modified societal (by US$1.3; 95% CrI: -1.6, 2.8) perspectives. ICERs were US$191 (95% CrI: 82, 443) per DALY averted from a governmental perspective, and US$73 (95% CI: -86, 256) per DALY averted from a modified societal perspective. Conclusions Prenatal distribution of misoprostol is potentially cost-effective in Uganda and should be

  16. A Systems Approach to Finding Cost-Effective Alternatives to European Ballistic Missile Defense

    DTIC Science & Technology

    2013-09-01

    components. Program Activity Component 1 Aegis AN/ TPY -2 6 PAC-3 Total R&D Costs $111,470,727 $710,333,127 $418,638,759 Total P& C Costs $1,322,766,392...Alternative A Program Activity Component 2 Aegis 1 AN/ TPY -2 1 THAAD Total R&D Costs $222,941,453 $710,333,127 $33,148,803 Total P& C Costs... c . Detection Systems The AN/ TPY -2, the Space Tracking and Surveillance System (STSS), the Sea-Based X-Band (SBX) Radar, and Upgraded Early Warning

  17. Cheese whey: A cost-effective alternative for hyaluronic acid production by Streptococcus zooepidemicus.

    PubMed

    Amado, Isabel R; Vázquez, José A; Pastrana, Lorenzo; Teixeira, José A

    2016-05-01

    This study focuses on the optimisation of cheese whey formulated media for the production of hyaluronic acid (HA) by Streptococcus zooepidemicus. Culture media containing whey (W; 2.1g/L) or whey hydrolysate (WH; 2.4 g/L) gave the highest HA productions. Both W and WH produced high yields on protein consumed, suggesting cheese whey is a good nitrogen source for S. zooepidemicus production of HA. Polysaccharide concentrations of 4.0 g/L and 3.2g/L were produced in W and WH in a further scale-up to 5L bioreactors, confirming the suitability of the low-cost nitrogen source. Cheese whey culture media provided high molecular weight (>3000 kDa) HA products. This study revealed replacing the commercial peptone by the low-cost alternative could reduce HA production costs by up to a 70% compared to synthetic media.

  18. Strategies for cost-effective carbon reductions: A sensitivity analysis of alternative scenarios

    SciTech Connect

    Gumerman, Etan; Koomey, Jonathan G.; Brown, Marilyn

    2001-07-11

    Analyses of alternative futures often present results for a limited set of scenarios, with little if any sensitivity analysis to identify the factors affecting the scenario results. This approach creates an artificial impression of certainty associated with the scenarios considered, and inhibits understanding of the underlying forces. This paper summarizes the economic and carbon savings sensitivity analysis completed for the Scenarios for a Clean Energy Future study (IWG, 2000). Its 19 sensitivity cases provide insight into the costs and carbon-reduction impacts of a carbon permit trading system, demand-side efficiency programs, and supply-side policies. Impacts under different natural gas and oil price trajectories are also examined. The results provide compelling evidence that policy opportunities exist to reduce carbon emissions and save society money.

  19. Bearing repair services offer a cost-effective alternative to expensive replacement

    SciTech Connect

    2009-02-15

    The article, based on a presentation during MINExpo 2008, explains how advancement is bearing design, material, maintenance and repair methods have greatly improved the potential for and popularity of bearing repair as an effective way to extend bearing life. The Trinken Co. offers a variety of service options including repair, recertification, reconditioning and remanufacturing. Benefits of a quality repair program are outlined. 2 photos.

  20. An alternative cost-effective image processing based sensor for continuous turbidity monitoring

    NASA Astrophysics Data System (ADS)

    Chai, Matthew Min Enn; Ng, Sing Muk; Chua, Hong Siang

    2017-03-01

    Turbidity is the degree to which the optical clarity of water is reduced by impurities in the water. High turbidity values in rivers and lakes promote the growth of pathogen, reduce dissolved oxygen levels and reduce light penetration. The conventional ways of on-site turbidity measurements involve the use of optical sensors similar to those used in commercial turbidimeters. However, these instruments require frequent maintenance due to biological fouling on the sensors. Thus, image processing was proposed as an alternative technique for continuous turbidity measurement to reduce frequency of maintenance. The camera was kept out of water to avoid biofouling while other parts of the system submerged in water can be coated with anti-fouling surface. The setup developed consisting of a webcam, a light source, a microprocessor and a motor used to control the depth of a reference object. The image processing algorithm quantifies the relationship between the number of circles detected on the reference object and the depth of the reference object. By relating the quantified data to turbidity, the setup was able to detect turbidity levels from 20 NTU to 380 NTU with measurement error of 15.7 percent. The repeatability and sensitivity of the turbidity measurement was found to be satisfactory.

  1. Potential cost-effectiveness and benefit-cost ratios of adult pneumococcal vaccination in Germany

    PubMed Central

    2012-01-01

    Background Invasive (IPD, defined as detection of pneumococci in sterile body fluids like meningitis or bacteremic pneumonia) and non-invasive Streptococcus pneumoniae infections (i.e. non-bacteremic pneumonia, otitis media) in adults are associated with substantial morbidity, mortality and costs. In Germany, Pneumococcal polysaccharide vaccination (PPV23) is recommended for all persons >60 years and for defined risk groups (age 5–59). The aim of this model was to estimate the potential cost-effectiveness and benefit-cost ratios of the adult vaccination program (18 years and older), considering the launch of the pneumococcal conjugate vaccine for adults (PCV13). Methods A cross-sectional steady state Markov model was developed to estimate the outcomes of PCV13, PPV23 vaccination schemes and ‘no vaccination’. Conservative assumptions were made if no data were available for PCV13 and PPV23 respectively. The effectiveness of individual pneumococcal vaccination in adults was adjusted for expected indirect effects due to the vaccination in infants. Data on incidences, effectiveness and costs were derived from scientific literature and publicly available databases. All resources used are indicated. Benefit-cost ratios and cost-effectiveness were evaluated from the perspective of the German Statutory Health Insurance as well as from social perspective. Results Under the assumption that PCV13 has a comparable effectiveness to PCV7, a vaccination program with PCV13 revealed the potential to avoid a greater number of yearly cases and deaths in IPD and pneumonia in Germany compared to PPV23. For PCV13, the costs were shown to be overcompensated by monetary savings resulting from reduction in the use of health care services. These results would render the switch from PPV23 to PCV13 as a dominant strategy compared to PPV23 and ‘no vaccination’. Given the correctness of the underlying assumptions every Euro spent on the PCV13 vaccination scheme yields savings of 2

  2. The Potential Cost-Effectiveness of HIV Vaccines: A Systematic Review

    PubMed Central

    Adamson, Blythe; Dimitrov, Dobromir; Devine, Beth; Barnabas, Ruanne

    2017-01-01

    Objective The aim of this paper was to review and compare HIV vaccine cost-effectiveness analyses and describe the effects of uncertainty in model, methodology, and parameterization. Methods We systematically searched MEDLINE (1985 through May 2016), EMBASE, the Tufts CEA Registry, and reference lists of articles following Cochrane guidelines and PRISMA reporting. Eligibility criteria included peer-reviewed manuscripts with economic models estimating cost-effectiveness of preventative HIV vaccines. Two reviewers independently assessed study quality and extracted data on model assumptions, characteristics, input parameters, and outcomes. Results The search yielded 71 studies, of which 11 met criteria for inclusion. Populations included low-income (n=7), middle-income (n=4), and high-income countries (n=2). Model structure varied including decision tree (n=1), Markov (n=5), compartmental (n=4), and microsimulation (n=1). Most measured outcomes in quality adjusted life-years (QALYs) gained (n=6) while others used unadjusted (n=3) or disability adjusted life-years (n=2). HIV vaccine cost ranged from $1.54 -$75 USD in low-income countries, $55-$100 in middle-income countries, and $500-$1,000 in the United States. Base case ICERs ranged from dominant (cost-offsetting) to $91,000 per QALY gained. Conclusion Most models predicted HIV vaccines would be cost-effective. Model assumptions about vaccine price, HIV treatment costs, epidemic context, and willingness to pay influenced results more consistently than assumptions on HIV transmission dynamics. PMID:28367539

  3. Potential Cost-Effectiveness of Schistosomiasis Treatment for Reducing HIV Transmission in Africa – The Case of Zimbabwean Women

    PubMed Central

    Ndeffo Mbah, Martial L.; Poolman, Eric M.; Atkins, Katherine E.; Orenstein, Evan W.; Meyers, Lauren Ancel; Townsend, Jeffrey P.; Galvani, Alison P.

    2013-01-01

    Background Epidemiological data from Zimbabwe suggests that genital infection with Schistosoma haematobium may increase the risk of HIV infection in young women. Therefore, the treatment of Schistosoma haematobium with praziquantel could be a potential strategy for reducing HIV infection. Here we assess the potential cost-effectiveness of praziquantel as a novel intervention strategy against HIV infection. Methods We developed a mathematical model of female genital schistosomiasis (FGS) and HIV infections in Zimbabwe that we fitted to cross-sectional data of FGS and HIV prevalence of 1999. We validated our epidemic projections using antenatal clinic data on HIV prevalence. We simulated annual praziquantel administration to school-age children. We then used these model predictions to perform a cost-effectiveness analysis of annual administration of praziquantel as a potential measure to reduce the burden of HIV in sub-Saharan Africa. Findings We showed that for a variation of efficacy between 30–70% of mass praziquantel administration for reducing the enhanced risk of HIV transmission per sexual act due to FGS, annual administration of praziquantel to school-age children in Zimbabwe could result in net savings of US$16–101 million compared with no mass treatment of schistosomiasis over a ten-year period. For a variation in efficacy between 30–70% of mass praziquantel administration for reducing the acquisition of FGS, annual administration of praziquantel to school-age children could result in net savings of US$36−92 million over a ten-year period. Conclusions In addition to reducing schistosomiasis burden, mass praziquantel administration may be a highly cost-effective way of reducing HIV infections in sub-Saharan Africa. Program costs per case of HIV averted are similar to, and under some conditions much better than, other interventions that are currently implemented in Africa to reduce HIV transmission. As a cost-saving strategy, mass praziquantel

  4. Potential Cost-Effectiveness of RSV Vaccination of Infants and Pregnant Women in Turkey: An Illustration Based on Bursa Data

    PubMed Central

    Pouwels, Koen B.; Bozdemir, Sefika E.; Yegenoglu, Selen; Celebi, Solmaz; McIntosh, E. David; Unal, Serhat; Postma, Maarten J.; Hacimustafaoglu, Mustafa

    2016-01-01

    Background Worldwide, respiratory syncytial virus (RSV) is considered to be the most important viral cause of respiratory morbidity and mortality among infants and young children. Although no active vaccine is available on the market yet, there are several active vaccine development programs in various stages. To assess whether one of these vaccines might be a future asset for national immunization programs, modeling the costs and benefits of various vaccination strategies is needed. Objectives To evaluate the potential cost-effectiveness of RSV vaccination of infants and/or pregnant women in Turkey. Methods A multi-cohort static Markov model with cycles of one month was used to compare the cost-effectiveness of vaccinated cohorts versus non-vaccinated cohorts. The 2014 Turkish birth cohort was divided by twelve to construct twelve monthly birth cohorts of equal size (111,459 new-borns). Model input was based on clinical data from a multicenter prospective study from Bursa, Turkey, combined with figures from the (inter)national literature and publicly available data from the Turkish Statistical Institute (TÜÏK). Incremental cost-effectiveness ratios (ICERs) were expressed in Turkish Lira (TL) per quality-adjusted life year (QALY) gained. Results Vaccinating infants at 2 and 4 months of age would prevent 145,802 GP visits, 8,201 hospitalizations and 48 deaths during the first year of life, corresponding to a total gain of 1650 QALYs. The discounted ICER was estimated at 51,969 TL (26,220 US $ in 2013) per QALY gained. Vaccinating both pregnant women and infants would prevent more cases, but was less attractive from a pure economic point of view with a discounted ICER of 61,653 TL (31,106 US $ in 2013) per QALY. Vaccinating only during pregnancy would result in fewer cases prevented than infant vaccination and a less favorable ICER. Conclusion RSV vaccination of infants and/or pregnant women has the potential to be cost-effective in Turkey. Although using

  5. Cost-effectiveness analysis of the direct and indirect impact of intranasal live attenuated influenza vaccination strategies in children: alternative country profiles

    PubMed Central

    Gibson, Edward; Begum, Najida; Martinón-Torres, Federico; Safadi, Marco Aurélio; Sackeyfio, Alfred; Hackett, Judith; Rajaram, Sankarasubramanian

    2016-01-01

    Background Influenza poses a significant burden on healthcare systems and society, with under-recognition in the paediatric population. Existing vaccination policies (largely) target the elderly and other risk groups where complications may arise. Objective The goal of this study was to evaluate the cost-effectiveness of annual paediatric vaccination (in 2–17-year-olds) with live attenuated influenza vaccination (LAIV), as well as the protective effect on the wider population in England and Wales (base). The study aimed to demonstrate broad applications of the model in countries where epidemiological and transmission data is limited and that have sophisticated vaccination policies (Brazil, Spain, and Taiwan). Methods The direct and indirect impact of LAIV in the paediatric cohort was simulated using an age-stratified dynamic transmission model over a 5-year time horizon of daily cycles and applying discounting of 3.5% in the base case. Pre-existing immunity structure was based on a 1-year model run. Sensitivity analyses were conducted. Results In the base case for England and Wales, the annual paediatric strategy with LAIV was associated with improvements in influenza-related events and quality-adjusted life years (QALYs) lost, yielding an incremental cost per QALY of £6,208. The model was robust to change in the key input parameters. The probabilistic analysis demonstrated LAIV to be cost effective in more than 99% of iterations, assuming a willingness-to-pay threshold of £30,000. Incremental costs per QALY for Brazil were £2,817, and for the cases of Spain and Taiwan the proposed strategy was dominant over the current practice. Conclusion In addition to existing policies, annual paediatric vaccination using LAIV provides a cost-effective strategy that offers direct and indirect protection in the wider community. Paediatric vaccination strategies using LAIV demonstrated clinical and economic benefits over alternative (current vaccination) strategies in

  6. Potential of renewable and alternative energy sources

    NASA Astrophysics Data System (ADS)

    Konovalov, V.; Pogharnitskaya, O.; Rostovshchikova, A.; Matveenko, I.

    2015-11-01

    The article deals with application potential of clean alternative renewable energy sources. By means of system analysis the forecast for consumption of electrical energy in Tomsk Oblast as well as main energy sources of existing energy system have been studied up to 2018. Engineering potential of renewable and alternative energy sources is evaluated. Besides, ranking in the order of their efficiency descending is performed. It is concluded that Tomsk Oblast has high potential of alternative and renewable energy sources, among which the most promising development perspective is implementation of gasification stations to save fuel consumed by diesel power stations as well as building wind-power plants.

  7. Cost Effective Prototyping

    NASA Technical Reports Server (NTRS)

    Wickman, Jerry L.; Kundu, Nikhil K.

    1996-01-01

    This laboratory exercise seeks to develop a cost effective prototype development. The exercise has the potential of linking part design, CAD, mold development, quality control, metrology, mold flow, materials testing, fixture design, automation, limited parts production and other issues as related to plastics manufacturing.

  8. A simple and cost-effective method, as an appropriate alternative for visible spectrophotometry: development of a dopamine biosensor.

    PubMed

    Abbaspour, Abdolkarim; Khajehzadeh, Abdolreza; Ghaffarinejad, Ali

    2009-08-01

    In this study, a new, simple, fast and inexpensive method as an alternative to visible spectrophotometry is developed. In this method the cells containing the sample solution were scanned with a scanner, then the color of each cell was analyzed with software written in visual basic (VB 6) media to red, green and blue values. The cells were built by creating holes in the Plexiglas sheet. The dimensions of identical cells were examined by Cr (III) solution with known concentrations. The validity of this new method was studied by determination of dopamine (DA) without using any other reagent. The parameters which affect the system were optimized. The comparison between the current and traditional UV-Vis spectrophotometry methods was studied and the results revealed similar trends in both methods. The developed method was successfully applied to the determination of dopamine in serum and urine without using any pretreatment. Finally comparing the results obtained in the developed method showed that microwave irradiation of the solution can decrease the experimental time, increase sensitivity and improve the limit of detection.

  9. Home-Made Cost Effective Preservation Buffer Is a Better Alternative to Commercial Preservation Methods for Microbiome Research

    PubMed Central

    Menke, Sebastian; Gillingham, Mark A. F.; Wilhelm, Kerstin; Sommer, Simone

    2017-01-01

    The investigation of wildlife gastrointestinal microbiomes by next-generation sequencing approaches is a growing field in microbial ecology and conservation. Such studies often face difficulties in sample preservation if neither freezing facilities nor liquid nitrogen (LQN) are readily available. Thus, in order to prevent microbial community changes because of bacterial growth after sampling, preservation buffers need to be applied to samples. However, the amount of microbial community variation attributable to the different preservation treatments and potentially affecting biological interpretation is hardly known. Here, we sampled feces of 11 sheep (Ovis aries sp.) by using swabs and analyzed the effect of air-drying, an inexpensive self-made nucleic acid preservation buffer (NAP), DNA/RNA Shield™, and RNAlater®, each together with freezing (for 10 days) or storing at room temperature (for 10 days) prior to 16S rRNA gene high-throughput sequencing to determine bacterial communities. Results revealed that the proportions of operational taxonomic units (OTUs) belonging to a bacterial phylum were affected by the preservation treatments, and that alpha diversities [observed OTUs, Shannon index, and phylogenetic diversity (PD)] were lower in all preservation treatments than in samples taken by forensic swabs and immediately frozen which is considered as the favored preservation treatment in the absence of any logistic constraints. Overall, NAP had better preservation qualities than RNAlater® and DNA/RNA Shield™ making this self-made buffer a valuable solution in wildlife microbiome studies. PMID:28197142

  10. Exploring the Potential Health Impact and Cost-Effectiveness of AIDS Vaccine within a Comprehensive HIV/AIDS Response in Low- and Middle-Income Countries

    PubMed Central

    Harmon, Thomas M.; Fisher, Kevin A.; McGlynn, Margaret G.; Stover, John; Warren, Mitchell J.; Teng, Yu; Näveke, Arne

    2016-01-01

    Background The Investment Framework Enhanced (IFE) proposed in 2013 by the Joint United Nations Programme on HIV/AIDS (UNAIDS) explored how maximizing existing interventions and adding emerging prevention options, including a vaccine, could further reduce new HIV infections and AIDS-related deaths in low- and middle-income countries (LMICs). This article describes additional modeling which looks more closely at the potential health impact and cost-effectiveness of AIDS vaccination in LMICs as part of UNAIDS IFE. Methods An epidemiological model was used to explore the potential impact of AIDS vaccination in LMICs in combination with other interventions through 2070. Assumptions were based on perspectives from research, vaccination and public health experts, as well as observations from other HIV/AIDS interventions and vaccination programs. Sensitivity analyses varied vaccine efficacy, duration of protection, coverage, and cost. Results If UNAIDS IFE goals were fully achieved, new annual HIV infections in LMICs would decline from 2.0 million in 2014 to 550,000 in 2070. A 70% efficacious vaccine introduced in 2027 with three doses, strong uptake and five years of protection would reduce annual new infections by 44% over the first decade, by 65% the first 25 years and by 78% to 122,000 in 2070. Vaccine impact would be much greater if the assumptions in UNAIDS IFE were not fully achieved. An AIDS vaccine would be cost-effective within a wide range of scenarios. Interpretation Even a modestly effective vaccine could contribute strongly to a sustainable response to HIV/AIDS and be cost-effective, even with optimistic assumptions about other interventions. Higher efficacy would provide even greater impact and cost-effectiveness, and would support broader access. Vaccine efficacy and cost per regimen are critical in achieving cost-effectiveness, with cost per regimen being particularly critical in low-income countries and at lower efficacy levels. PMID:26731116

  11. Development of cost-effective media to increase the economic potential for larger-scale bioproduction of natural food additives by Lactobacillus rhamnosus , Debaryomyces hansenii , and Aspergillus niger.

    PubMed

    Salgado, José Manuel; Rodríguez, Noelia; Cortés, Sandra; Domínguez, José Manuel

    2009-11-11

    Yeast extract (YE) is the most common nitrogen source in a variety of bioprocesses in spite of the high cost. Therefore, the use of YE in culture media is one of the major technical hurdles to be overcome for the development of low-cost fermentation routes, making the search for alternative-cheaper nitrogen sources particularly desired. The aim of the current study is to develop cost-effective media based on corn steep liquor (CSL) and locally available vinasses in order to increase the economic potential for larger-scale bioproduction. Three microorganisms were evaluated: Lactobacillus rhamnosus , Debaryomyces hansenii , and Aspergillus niger . The amino acid profile and protein concentration was relevant for the xylitol and citric acid production by D. hansenii and A. niger , respectively. Metals also played an important role for citric acid production, meanwhile, D. hansenii showed a strong dependence with the initial amount of Mg(2+). Under the best conditions, 28.8 g lactic acid/L (Q(LA) = 0.800 g/L.h, Y(LA/S) = 0.95 g/g), 35.3 g xylitol/L (Q(xylitol) = 0.380 g/L.h, Y(xylitol/S) = 0.69 g/g), and 13.9 g citric acid/L (Q(CA) = 0.146 g/L.h, Y(CA/S) = 0.63 g/g) were obtained. The economic efficiency (E(p/euro)) parameter identify vinasses as a lower cost and more effective nutrient source in comparison to CSL.

  12. Recombinase Polymerase Amplification Assay—A Simple, Fast and Cost-Effective Alternative to Real Time PCR for Specific Detection of Feline Herpesvirus-1

    PubMed Central

    Wang, Jianchang; Liu, Libing; Wang, Jinfeng; Sun, Xiaoxia; Yuan, Wanzhe

    2017-01-01

    Feline herpesvirus 1 (FHV-1), an enveloped dsDNA virus, is one of the major pathogens of feline upper respiratory tract disease (URTD) and ocular disease. Currently, polymerase chain reaction (PCR) remains the gold standard diagnostic tool for FHV-1 infection but is relatively expensive, requires well-equipped laboratories and is not suitable for field tests. Recombinase polymerase amplification (RPA), an isothermal gene amplification technology, has been explored for the molecular diagnosis of infectious diseases. In this study, an exo-RPA assay for FHV-1 detection was developed and validated. Primers targeting specifically the thymidine kinase (TK) gene of FHV-1 were designed. The RPA reaction was performed successfully at 39°C and the results were obtained within 20 min. Using different copy numbers of recombinant plasmid DNA that contains the TK gene as template, we showed the detection limit of exo-RPA was 102 copies DNA/reaction, the same as that of real time PCR. The exo-RPA assay did not cross-detect feline panleukopenia virus, feline calicivirus, bovine herpesvirus-1, pseudorabies virus or chlamydia psittaci, a panel of pathogens important in feline URTD or other viruses in Alphaherpesvirinae, demonstrating high specificity. The assay was validated by testing 120 nasal and ocular conjunctival swabs of cats, and the results were compared with those obtained with real-time PCR. Both assays provided the same testing results in the clinical samples. Compared with real time PCR, the exo-RPA assay uses less-complex equipment that is portable and the reaction is completed much faster. Additionally, commercial RPA reagents in vacuum-sealed pouches can tolerate temperatures up to room temperature for days without loss of activity, suitable for shipment and storage for field tests. Taken together, the exo-RPA assay is a simple, fast and cost-effective alternative to real time PCR, suitable for use in less advanced laboratories and for field detection of FHV-1

  13. Recombinase Polymerase Amplification Assay-A Simple, Fast and Cost-Effective Alternative to Real Time PCR for Specific Detection of Feline Herpesvirus-1.

    PubMed

    Wang, Jianchang; Liu, Libing; Wang, Jinfeng; Sun, Xiaoxia; Yuan, Wanzhe

    2017-01-01

    Feline herpesvirus 1 (FHV-1), an enveloped dsDNA virus, is one of the major pathogens of feline upper respiratory tract disease (URTD) and ocular disease. Currently, polymerase chain reaction (PCR) remains the gold standard diagnostic tool for FHV-1 infection but is relatively expensive, requires well-equipped laboratories and is not suitable for field tests. Recombinase polymerase amplification (RPA), an isothermal gene amplification technology, has been explored for the molecular diagnosis of infectious diseases. In this study, an exo-RPA assay for FHV-1 detection was developed and validated. Primers targeting specifically the thymidine kinase (TK) gene of FHV-1 were designed. The RPA reaction was performed successfully at 39°C and the results were obtained within 20 min. Using different copy numbers of recombinant plasmid DNA that contains the TK gene as template, we showed the detection limit of exo-RPA was 102 copies DNA/reaction, the same as that of real time PCR. The exo-RPA assay did not cross-detect feline panleukopenia virus, feline calicivirus, bovine herpesvirus-1, pseudorabies virus or chlamydia psittaci, a panel of pathogens important in feline URTD or other viruses in Alphaherpesvirinae, demonstrating high specificity. The assay was validated by testing 120 nasal and ocular conjunctival swabs of cats, and the results were compared with those obtained with real-time PCR. Both assays provided the same testing results in the clinical samples. Compared with real time PCR, the exo-RPA assay uses less-complex equipment that is portable and the reaction is completed much faster. Additionally, commercial RPA reagents in vacuum-sealed pouches can tolerate temperatures up to room temperature for days without loss of activity, suitable for shipment and storage for field tests. Taken together, the exo-RPA assay is a simple, fast and cost-effective alternative to real time PCR, suitable for use in less advanced laboratories and for field detection of FHV-1

  14. Cellular membrane potentials induced by alternating fields

    PubMed Central

    Grosse, Constantino; Schwan, Herman P.

    1992-01-01

    Membrane potentials induced by external alternating fields are usually derived assuming that the membrane is insulating, that the cell has no surface conductance, and that the potentials are everywhere solutions of the Laplace equation. This traditional approach is reexamined taking into account membrane conductance, surface admittance, and space charge effects. We find that whenever the conductivity of the medium outside the cell is low, large corrections are needed. Thus, in most of the cases where cells are manipulated by external fields (pore formation, cell fusion, cell rotation, dielectrophoresis) the field applied to the cell membrane is significantly reduced, sometimes practically abolished. This could have a strong bearing on present theories of pore formation, and of the influence of weak electric fields on membranes. PMID:19431866

  15. Cost-effectiveness of controlling emissions for various alternative-fuel vehicle types, with vehicle and fuel price subsidies estimated on the basis of monetary values of emission reductions

    SciTech Connect

    Wang, M.Q.

    1993-12-31

    Emission-control cost-effectiveness is estimated for ten alternative-fuel vehicle (AFV) types (i.e., vehicles fueled with reformulated gasoline, M85 flexible-fuel vehicles [FFVs], M100 FFVs, dedicated M85 vehicles, dedicated M100 vehicles, E85 FFVS, dual-fuel liquefied petroleum gas vehicles, dual-fuel compressed natural gas vehicles [CNGVs], dedicated CNGVs, and electric vehicles [EVs]). Given the assumptions made, CNGVs are found to be most cost-effective in controlling emissions and E85 FFVs to be least cost-effective, with the other vehicle types falling between these two. AFV cost-effectiveness is further calculated for various cases representing changes in costs of vehicles and fuels, AFV emission reductions, and baseline gasoline vehicle emissions, among other factors. Changes in these parameters can change cost-effectiveness dramatically. However, the rank of the ten AFV types according to their cost-effectiveness remains essentially unchanged. Based on assumed dollars-per-ton emission values and estimated AFV emission reductions, the per-vehicle monetary value of emission reductions is calculated for each AFV type. Calculated emission reduction values ranged from as little as $500 to as much as $40,000 per vehicle, depending on AFV type, dollar-per-ton emission values, and baseline gasoline vehicle emissions. Among the ten vehicle types, vehicles fueled with reformulated gasoline have the lowest per-vehicle value, while EVs have the highest per-vehicle value, reflecting the magnitude of emission reductions by these vehicle types. To translate the calculated per-vehicle emission reduction values to individual AFV users, AFV fuel or vehicle price subsidies are designed to be equal to AFV emission reduction values. The subsidies designed in this way are substantial. In fact, providing the subsidies to AFVs would change most AFV types from net cost increases to net cost decreases, relative to conventional gasoline vehicles.

  16. Potential Cost-Effectiveness of an Influenza Vaccination Program Offering Microneedle Patch for Vaccine Delivery in Children

    PubMed Central

    Wong, Carlos; Jiang, Minghuan; You, Joyce H. S.

    2016-01-01

    Objective The influenza vaccine coverage rate of children is low in Hong Kong. Microneedle patches (MNPs) is a technology under development for painless delivery of vaccines. This study aimed to examine the potential clinical outcomes and direct medical costs of an influenza program offering MNP vaccine to children who have declined intramuscular (IM) vaccine in Hong Kong. Methods A decision model was designed to compare potential outcomes between IM vaccine program and a program offering MNP vaccine to those declined IM vaccine (IM/MNP program) in a hypothetical cohort of children over one-year time horizon. The model outcomes included direct medical cost, influenza infection rate, mortality rate, and quality-adjusted life-years (QALYs) loss. Model inputs were retrieved from published literature. Sensitivity analyses were performed to examine the robustness of model results. Results In base-case analysis, IM/MNP program was more costly per child (USD19.13 versus USD13.69; USD1 = HKD7.8) with lower influenza infection rate (98.9 versus 124.8 per 1,000 children), hospitalization rate (0.83 versus 1.05 per 1,000 children) and influenza-related mortality rate (0.00042 versus 0.00052 per 1,000 children) when compared to IM program. The incremental cost per QALY saved (ICER) of IM/MNP program versus IM program was 27,200 USD/QALY. Using gross domestic product (GDP) per capita of Hong Kong (USD40,594) as threshold of willingness-to-pay (WTP) per QALY, one-way sensitivity analysis found ICER of IM/MNP to exceed WTP when duration of illness in outpatient setting was <5.7 days or cost per MNP vaccine was >1.39-time of IM vaccine cost. In 10,000 Monte Carlo simulations, IM/MNP program was the preferred option in 57.28% and 91.68% of the time, using 1x and 3x GDP per capita as WTP threshold, respectively. Conclusion Acceptance of IM/MNP program as the preferred program was subject to the WTP threshold, duration of illness in outpatient settings, and cost of MNP vaccine. PMID

  17. Tapping the potential of alternative medicine.

    PubMed

    La Puma, J; Eiler, G

    1998-04-01

    Interest in alternative medicine is growing among healthcare consumers. Health plans and healthcare organizations may be able to improve clinical outcomes and benefit financially by providing patients with access to alternative services. Organizations that can assess their communities' particular needs, draw on interested professional staff to help develop alternative medicine programs and protocols, and study quality outcomes will stand a better chance of making such programs successful. Educating medical staff, designing a credible program, and forging strategic alliances with respected partners can help organizations create a sharply focused brand identity in the community.

  18. Prospective randomized controlled study using polyethylene mesh for inguinal hernia meshplasty as a safe and cost-effective alternative to polypropylene mesh.

    PubMed

    Gundre, Nitin P; Iyer, Sandhya P; Subramaniyan, Prabhakar

    2012-03-01

    Most patients who come to a general hospital in a developing country are poor. The most important prohibiting factor for use of polypropylene mesh in hernia repair is its exorbitant cost. Hence, research workers have been on the lookout for an equally effective but economically affordable mesh. Worldwide, surgical repair of inguinal hernia is the most common general surgery procedure performed at the present. Lifetime risk of groin hernia is 15% in males and 5% in females. Most of the patients who visit a general hospital are from either lower middle class or poor socioeconomic strata. The most important prohibiting factor for use of polypropylene mesh in hernia repair for the common man is its exorbitant cost. The aim of this study is to document the feasibility, safety and cost-effectiveness of the use of polyethylene mesh. A single blind, prospective, randomized controlled study, comparing 35 patients of two groups was conducted in a tertiary teaching hospital over a period of 5 years. The patients in both groups underwent inguinal hernioplasty, and were administered similar antibiotics and analgesics. The postoperative course with regard to pain, seroma formation, infection, hospital stay, recurrence and scar quality was evaluated and compared. Statistical analysis was performed with Chi square test. The properties of both meshes were the same with respect to ease of handling, pain score, seroma formation, infection rate, resumption of daily activities, scar quality and mesh rejection. Recurrence rate was zero for both groups. Polyethylene mesh was 2,808 times cheaper than the commercially available polypropylene mesh. This study proved the safety, simplicity, efficacy and cost-effectiveness of polyethylene mesh for inguinal hernia meshplasty, insuring economical, accessible health care for the financially weak section of the population.

  19. Carba NP as a simpler, rapid, cost-effective, and a more sensitive alternative to other phenotypic tests for detection of carbapenem resistance in routine diagnostic laboratories

    PubMed Central

    Shinde, Shivani; Gupta, Rajarshi; Raut, Shweta S.; Nataraj, Gita; Mehta, Preeti R.

    2017-01-01

    PURPOSE: Resistance to carbapenems due to carbapenemases has been increasingly noticed in Enterobacteriaceae. Clinical and Laboratory Standards Institute (CLSI) has recommended the latest Carba NP (CNP) test as a confirmatory test for carbapenemase production in Enterobacteriaceae. Low sensitivity of disk diffusion (DD) and modified Hodge test (MHT) may result in missing out of resistant strains which can adversely affect clinical management. The present study compares three phenotypic tests - CNP test, DD, and MHT for detection of carbapenemase production. MATERIALS AND METHODS: Four hundred consecutive, nonduplicate Enterobacteriaceae isolates were tested for carbapenem resistance using ertapenem disc (10 μg) by Kirby–Bauer DD method, MHT, and CNP. These tests were performed and interpreted as per the CLSI standards. CNP was considered to be the reference test for comparison. Sensitivity, specificity, and accuracy rates for ertapenem DD and MHT were calculated. RESULTS: One hundred and six out of 400 strains were positive by CNP test. Of the 294 CNP-negative strains, 28 were resistant by DD and 18 were resistant by MHT. Of the 106 CNP-positive strains, 82 were resistant and 16 were intermediate by DD while 76 were positive by MHT ertapenem DD had a sensitivity and specificity of 66.04% and 90.48%, respectively. Sensitivity and specificity of MHT were 54.72% and 93.88%, respectively. There was considerable discordance between all the three tests. CONCLUSION: As a rapid, simple, and cost-effective test with a greater capability greater to detect carbapenemase producers, CNP can be implemented in routine diagnostic laboratories, thereby benefiting patient care and antimicrobial stewardship. PMID:28367024

  20. Cost-effectiveness thresholds: pros and cons.

    PubMed

    Bertram, Melanie Y; Lauer, Jeremy A; De Joncheere, Kees; Edejer, Tessa; Hutubessy, Raymond; Kieny, Marie-Paule; Hill, Suzanne R

    2016-12-01

    Cost-effectiveness analysis is used to compare the costs and outcomes of alternative policy options. Each resulting cost-effectiveness ratio represents the magnitude of additional health gained per additional unit of resources spent. Cost-effectiveness thresholds allow cost-effectiveness ratios that represent good or very good value for money to be identified. In 2001, the World Health Organization's Commission on Macroeconomics in Health suggested cost-effectiveness thresholds based on multiples of a country's per-capita gross domestic product (GDP). In some contexts, in choosing which health interventions to fund and which not to fund, these thresholds have been used as decision rules. However, experience with the use of such GDP-based thresholds in decision-making processes at country level shows them to lack country specificity and this - in addition to uncertainty in the modelled cost-effectiveness ratios - can lead to the wrong decision on how to spend health-care resources. Cost-effectiveness information should be used alongside other considerations - e.g. budget impact and feasibility considerations - in a transparent decision-making process, rather than in isolation based on a single threshold value. Although cost-effectiveness ratios are undoubtedly informative in assessing value for money, countries should be encouraged to develop a context-specific process for decision-making that is supported by legislation, has stakeholder buy-in, for example the involvement of civil society organizations and patient groups, and is transparent, consistent and fair.

  1. Cost-effectiveness analysis of sandhill crane habitat management

    USGS Publications Warehouse

    Kessler, Andrew C.; Merchant, James W.; Shultz, Steven D.; Allen, Craig R.

    2013-01-01

    Invasive species often threaten native wildlife populations and strain the budgets of agencies charged with wildlife management. We demonstrate the potential of cost-effectiveness analysis to improve the efficiency and value of efforts to enhance sandhill crane (Grus canadensis) roosting habitat. We focus on the central Platte River in Nebraska (USA), a region of international ecological importance for migrating avian species including sandhill cranes. Cost-effectiveness analysis is a valuation process designed to compare alternative actions based on the cost of achieving a pre-determined objective. We estimated costs for removal of invasive vegetation using geographic information system simulations and calculated benefits as the increase in area of sandhill crane roosting habitat. We generated cost effectiveness values for removing invasive vegetation on 7 land parcels and for the entire central Platte River to compare the cost-effectiveness of management at specific sites and for the central Platte River landscape. Median cost effectiveness values for the 7 land parcels evaluated suggest that costs for creating 1 additional hectare of sandhill crane roosting habitat totaled US $1,595. By contrast, we found that creating an additional hectare of sandhill crane roosting habitat could cost as much as US $12,010 for some areas in the central Platte River, indicating substantial cost savings can be achieved by using a cost effectiveness analysis to target specific land parcels for management. Cost-effectiveness analysis, used in conjunction with geographic information systems, can provide decision-makers with a new tool for identifying the most economically efficient allocation of resources to achieve habitat management goals.

  2. Hematopoietic Progenitor Cell Mobilization with “Just-in-Time” Plerixafor Approach is a Cost Effective Alternative to Routine Plerixafor Use

    PubMed Central

    Veltri, Lauren; Cumpston, Aaron; Shillingburg, Alexandra; Wen, Sijin; Luo, Jin; Leadmon, Sonia; Watkins, Kathy; Craig, Michael; Hamadani, Mehdi; Kanate, Abraham S.

    2015-01-01

    Hematopoietic progenitor cell (HPC) mobilization with granulocyte-colony stimulating factor (G-CSF) and plerixafor results in superior CD34+ cell yield, when compared to mobilization with G-CSF alone in patients with myeloma and lymphoma. However, plerixafor-based approaches are associated with high costs. To circumvent this, several institutions use a so-called “just-in-time” plerixafor (JIT-P) approach, where plerixafor is only administered to patients likely to fail mobilization with G-CSF alone. Whether such a JIT-P approach is cost effective has not been confirmed to date. We present here, results of 136 patients with myeloma or lymphoma who underwent mobilization with two different approaches of plerixafor utilization. Between Jan 2010-Oct 2012 (n=76) patients uniformly received mobilization with G-CSF and plerixafor (routine G+P cohort). To reduce mobilization costs, between Nov 2012-Jun 2014 (n=60) patients were mobilized with JIT-P where plerixafor was only administered to patients likely to fail mobilization with G-CSF alone. Patients in routine G+P group had a higher median peak peripheral blood CD34+ cell count (62 vs. 29 cells/μL, p<0.001) and a higher median day 1 CD34+ cell yield (2.9 × 106 CD34+ cells/kg vs. 2.1 × 106 CD34+ cells/kg, p=0.001). The median total CD34+ cell collection was also higher in routine G+P group (5.8 × 106 CD34+ cells/kg vs. 4.5 × 106 CD34+ cells/kg, p=0.007). In the JIT-P group 40% (n=24) completed adequate HPC collection without plerixafor. There was no difference in mobilization failure rates. The mean number of plerixafor doses utilized in JIT-P was lower (1.3 vs. 2.1, p=0.0002). The mean estimated cost in the routine G+P group was higher than that in the JIT-P group (USD 27,513 vs. USD 23,597, p=0.01). Our analysis demonstrates that mobilization with a JIT-P approach is a safe, effective and cost efficient strategy for HPC collection. PMID:26475754

  3. Potential cost-effectiveness of a new infant tuberculosis vaccine in South Africa--implications for clinical trials: a decision analysis.

    PubMed

    Ditkowsky, Jared B; Schwartzman, Kevin

    2014-01-01

    Novel tuberculosis vaccines are in varying stages of pre-clinical and clinical development. This study seeks to estimate the potential cost-effectiveness of a BCG booster vaccine, while accounting for costs of large-scale clinical trials, using the MVA85A vaccine as a case study for estimating potential costs. We conducted a decision analysis from the societal perspective, using a 10-year time frame and a 3% discount rate. We predicted active tuberculosis cases and tuberculosis-related costs for a hypothetical cohort of 960,763 South African newborns (total born in 2009). We compared neonatal vaccination with bacille Calmette-Guérin alone to vaccination with bacille Calmette-Guérin plus a booster vaccine at 4 months. We considered booster efficacy estimates ranging from 40% to 70%, relative to bacille Calmette-Guérin alone. We accounted for the costs of Phase III clinical trials. The booster vaccine was assumed to prevent progression to active tuberculosis after childhood infection, with protection decreasing linearly over 10 years. Trial costs were prorated to South Africa's global share of bacille Calmette-Guérin vaccination. Vaccination with bacille Calmette-Guérin alone resulted in estimated tuberculosis-related costs of $89.91 million 2012 USD, and 13,610 tuberculosis cases in the birth cohort, over the 10 years. Addition of the booster resulted in estimated cost savings of $7.69-$16.68 million USD, and 2,800-4,160 cases averted, for assumed efficacy values ranging from 40%-70%. A booster tuberculosis vaccine in infancy may result in net societal cost savings as well as fewer active tuberculosis cases, even if efficacy is relatively modest and large scale Phase III studies are required.

  4. Alternating potentials assisted electrochemical deposition of mineralized collagen coatings.

    PubMed

    Zhuang, Junjun; Lin, Jun; Li, Juan; Weng, Wenjian; Cheng, Kui; Wang, Huiming

    2015-12-01

    Mineralized collagen coatings were synthesized by electrochemical deposition with alternating negative and positive potentials. The obtained coatings demonstrated a multi-layer structure alternating consisting of weakly and highly mineralized collagen layers and the proportion of each layer could be controlled by adjusting the deposition time. The coatings deposited using alternating potentials assisted electrochemical deposition (AP-ECD) showed significantly enhanced osteoblasts proliferation, and rhBMP-2 loading capability compared to those of the coatings deposited using constant potential electrochemical deposition (CP-ECD). The enhanced cytocompatibility and rhBMP-2 loading capability of the coatings might be attributed to their high proportion of weakly mineralized collagen layer. Furthermore, the deposition mechanism for alternating potentials is proposed as that positive potential induces deposition of negatively charged collagen fibrils to form a weakly mineralized collagen layer. Our results suggest that the present deposition method could be a promising approach to engineer mineralized collagen coating with better biological performances.

  5. Wireless data communication alternatives for small public safety agencies: how one community cost-effectively solved its expanding field data requirements

    NASA Astrophysics Data System (ADS)

    Canning, Ryan M.; Lefebvre, Eric

    2005-06-01

    A growing number of Public Safety agencies have begun leveraging wireless data communication technology to improve tactical response capabilities as well as overall productivity. For years police departments subscribed to CDPD (Cellular Digital Packet Data) services to provide officers with basic dispatch data and criminal database access. Now as cellular carriers have deactivated CDPD and shifted to 2.5G and 3G data services such as 1xRTT, GPRS and EDGE, police departments are scrambling to fill the void. Not surprisingly, the extraordinary investments cellular carriers made to upgrade their infrastructures have been transferred to the customer, with monthly fees running as high as $80 a month per user. It's no wonder public safety agencies have been reluctant to adopt these services. Lost in the fray are those smaller police departments which account for nearly 90% of the nation's total. This group has increasingly sought out alternative data communication solutions that are not predicated on budget-busting monthly access fees. One such example is the Marco Island Police Department (MIPD) in Southwestern Florida that received a Federal grant to augment its existing voice communications with data. After evaluating several different technologies and vendors, MIPD chose a 900 MHz ad hoc mesh network solution based on its ability to provide reliable, high-speed and secure IP-based data communications over extensive distances. This paper will discuss technical details of Marco Island's mobile mesh network implementation; including: coverage area with 900 MHz spread spectrum radios, strategic repeater tower placement, interference, throughput performance, and the necessity for application-persistence software.

  6. Alternate Assessments Based on Alternate Achievement Standards: Policy, Practice, and Potential

    ERIC Educational Resources Information Center

    Schafer, William D., Ed.; Lissitz, Robert W., Ed.

    2009-01-01

    What really works in alternate assessment based on alternate achievement standards? Every state is working to know the answer--both to comply with federal requirements for evaluating students with severe cognitive disabilities, and to ensure that all students reach their full potential. This comprehensive book is the first to gather today's best…

  7. Ion propulsion cost effectivity

    NASA Technical Reports Server (NTRS)

    Zafran, S.; Biess, J. J.

    1978-01-01

    Ion propulsion modules employing 8-cm thrusters and 30-cm thrusters were studied for Multimission Modular Spacecraft (MMS) applications. Recurring and nonrecurring cost elements were generated for these modules. As a result, ion propulsion cost drivers were identified to be Shuttle charges, solar array, power processing, and thruster costs. Cost effective design approaches included short length module configurations, array power sharing, operation at reduced thruster input power, simplified power processing units, and power processor output switching. The MMS mission model employed indicated that nonrecurring costs have to be shared with other programs unless the mission model grows. Extended performance missions exhibited the greatest benefits when compared with monopropellant hydrazine propulsion.

  8. Screening HIV-Infected Patients with Low CD4 Counts for Cryptococcal Antigenemia prior to Initiation of Antiretroviral Therapy: Cost Effectiveness of Alternative Screening Strategies in South Africa

    PubMed Central

    Rockers, Peter C.; Bonawitz, Rachael; Sriruttan, Charlotte; Glencross, Deborah K.; Cassim, Naseem; Coetzee, Lindi M.; Greene, Gregory S.; Chiller, Tom M.; Vallabhaneni, Snigdha; Long, Lawrence; van Rensburg, Craig; Govender, Nelesh P.

    2016-01-01

    countries with substantial numbers of people with untreated, advanced HIV disease such as South Africa, CrAg screening before initiation of ART has the potential to reduce cryptococcal meningitis and save lives. Reflex screening compared to provider-initiated screening saves more lives and is likely to be cost saving or have low additional costs per additional year of life saved. PMID:27390864

  9. Exactly Solvable Quantum Mechanical Potentials: An Alternative Approach.

    ERIC Educational Resources Information Center

    Pronchik, Jeremy N.; Williams, Brian W.

    2003-01-01

    Describes an alternative approach to finding exactly solvable, one-dimensional quantum mechanical potentials. Differs from the usual approach in that instead of starting with a particular potential and seeking solutions to the related Schrodinger equations, it begins with known solutions to second-order ordinary differential equations and seeks to…

  10. Cost effective alternative to low irradiance measurements

    NASA Technical Reports Server (NTRS)

    Oleary, Scott T.

    1988-01-01

    Martin Marietta's Space Simulation Laboratory (SSL) has a Thermal Environment Simulator (TES) with 56 individually controlled heater zones. The TES has a temperature range of approximately minus 129 C to plus 149 C. Because of the ability of TES to provide complex irradiance distributions, it is necessary to be able to measure a wide range of irradiance levels. SSL currently uses ambient temperature controlled radiometers with the capacity to measure sink irradiance levels of approximately 42.6 mw/sq cm, sink temperature equals 21 C and up. These radiometers could not be used to accurately measure the lower irradiance levels of the TES. Therefore, it was necessary to obtain a radiometer or develop techniques which could be used to measure lower irradiance levels.

  11. The potential cost-effectiveness of the Diamondback 360® Coronary Orbital Atherectomy System for treating de novo, severely calcified coronary lesions: an economic modeling approach

    PubMed Central

    Chambers, Jeffrey; Généreux, Philippe; Lee, Arthur; Lewin, Jack; Young, Christopher; Crittendon, Janna; Mann, Marita; Garrison, Louis P.

    2015-01-01

    Background: Patients who undergo percutaneous coronary intervention (PCI) for severely calcified coronary lesions have long been known to have worse clinical and economic outcomes than patients with no or mildly calcified lesions. We sought to assess the likely cost-effectiveness of using the Diamondback 360® Orbital Atherectomy System (OAS) in the treatment of de novo, severely calcified lesions from a health-system perspective. Methods and results: In the absence of a head-to-head trial and long-term follow up, cost-effectiveness was based on a modeled synthesis of clinical and economic data. A cost-effectiveness model was used to project the likely economic impact. To estimate the net cost impact, the cost of using the OAS technology in elderly (⩾ 65 years) Medicare patients with de novo severely calcified lesions was compared with cost offsets. Elderly OAS patients from the ORBIT II trial (Evaluate the Safety and Efficacy of OAS in Treating Severely Calcified Coronary Lesions) [ClinicalTrials.gov identifier: NCT01092426] were indirectly compared with similar patients using observational data. For the index procedure, the comparison was with Medicare data, and for both revascularization and cardiac death in the following year, the comparison was with a pooled analysis of the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI)/Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trials. After adjusting for differences in age, gender, and comorbidities, the ORBIT II mean index procedure costs were 17% (p < 0.001) lower, approximately US$2700. Estimated mean revascularization costs were lower by US$1240 in the base case. These cost offsets in the first year, on average, fully cover the cost of the device with an additional 1.2% cost savings. Even in the low-value scenario, the use of the OAS is cost-effective with a cost per life-year gained of US$11,895. Conclusions: Based on economic modeling

  12. An Efficient, Noniterative Method of Identifying the Cost-Effectiveness Frontier.

    PubMed

    Suen, Sze-chuan; Goldhaber-Fiebert, Jeremy D

    2016-01-01

    Cost-effectiveness analysis aims to identify treatments and policies that maximize benefits subject to resource constraints. However, the conventional process of identifying the efficient frontier (i.e., the set of potentially cost-effective options) can be algorithmically inefficient, especially when considering a policy problem with many alternative options or when performing an extensive suite of sensitivity analyses for which the efficient frontier must be found for each. Here, we describe an alternative one-pass algorithm that is conceptually simple, easier to implement, and potentially faster for situations that challenge the conventional approach. Our algorithm accomplishes this by exploiting the relationship between the net monetary benefit and the cost-effectiveness plane. To facilitate further evaluation and use of this approach, we also provide scripts in R and Matlab that implement our method and can be used to identify efficient frontiers for any decision problem.

  13. Estimate of Cost-Effective Potential for Minimum Efficiency Performance Standards in 13 Major World Economies Energy Savings, Environmental and Financial Impacts

    SciTech Connect

    Letschert, Virginie E.; Bojda, Nicholas; Ke, Jing; McNeil, Michael A.

    2012-07-01

    This study analyzes the financial impacts on consumers of minimum efficiency performance standards (MEPS) for appliances that could be implemented in 13 major economies around the world. We use the Bottom-Up Energy Analysis System (BUENAS), developed at Lawrence Berkeley National Laboratory (LBNL), to analyze various appliance efficiency target levels to estimate the net present value (NPV) of policies designed to provide maximum energy savings while not penalizing consumers financially. These policies constitute what we call the “cost-effective potential” (CEP) scenario. The CEP scenario is designed to answer the question: How high can we raise the efficiency bar in mandatory programs while still saving consumers money?

  14. Evaluation of the hypersensitivity potential of alternative butter flavorings.

    PubMed

    Anderson, Stacey E; Franko, Jennifer; Wells, J R; Lukomska, Ewa; Meade, B Jean

    2013-12-01

    Concern has been raised over the association of diacetyl with lung disease clinically resembling bronchiolitis obliterans in food manufacturing workers. This has resulted in the need for identification of alternative chemicals to be used in the manufacturing process. Structurally similar chemicals, 2,3-pentanedione, 2,3-hexanedione, 3,4-hexanedione and 2,3-heptanedione, used as constituents of synthetic flavoring agents have been suggested as potential alternatives for diacetyl, however, immunotoxicity data on these chemicals are limited. The present study evaluated the dermal irritation and sensitization potential of diacetyl alternatives using a murine model. None of the chemicals were identified as dermal irritants when tested at concentrations up to 50%. Similar to diacetyl (EC3=17.9%), concentration-dependent increases in lymphocyte proliferation were observed following exposure to all four chemicals, with calculated EC3 values of 15.4% (2,3-pentanedione), 18.2% (2,3-hexanedione), 15.5% (3,4-hexanedione) and 14.1% (2,3-heptanedione). No biologically significant elevations in local or total serum IgE were identified after exposure to 25-50% concentrations of these chemicals. These results demonstrate the potential for development of hypersensitivity responses to these proposed alternative butter flavorings and raise concern about the use of structurally similar replacement chemicals. Additionally, a contaminant with strong sensitization potential was found in varying concentrations in diacetyl obtained from different producers.

  15. Evaluation of the hypersensitivity potential of alternative butter flavorings

    PubMed Central

    Anderson, Stacey E.; Franko, Jennifer; Wells, J.R.; Lukomska, Ewa; Meade, B. Jean

    2015-01-01

    Concern has been raised over the association of diacetyl with lung disease clinically resembling bronchiolitis obliterans in food manufacturing workers. This has resulted in the need for identification of alternative chemicals to be used in the manufacturing process. Structurally similar chemicals, 2,3-pentanedione, 2,3-hexanedione, 3,4-hexanedione and 2,3-heptanedione, used as constituents of synthetic flavoring agents have been suggested as potential alternatives for diacetyl, however, immunotoxicity data on these chemicals are limited. The present study evaluated the dermal irritation and sensitization potential of diacetyl alternatives using a murine model. None of the chemicals were identified as dermal irritants when tested at concentrations up to 50%. Similar to diacetyl (EC3 = 17.9%), concentration-dependent increases in lymphocyte proliferation were observed following exposure to all four chemicals, with calculated EC3 values of 15.4% (2,3-pentanedione), 18.2% (2,3-hexanedione), 15.5% (3,4-hexanedione) and 14.1% (2,3-heptanedione). No biologically significant elevations in local or total serum IgE were identified after exposure to 25–50% concentrations of these chemicals. These results demonstrate the potential for development of hypersensitivity responses to these proposed alternative butter flavorings and raise concern about the use of structurally similar replacement chemicals. Additionally, a contaminant with strong sensitization potential was found in varying concentrations in diacetyl obtained from different producers. PMID:24007741

  16. Cost-Effective Fuel Treatment Planning

    NASA Astrophysics Data System (ADS)

    Kreitler, J.; Thompson, M.; Vaillant, N.

    2014-12-01

    The cost of fighting large wildland fires in the western United States has grown dramatically over the past decade. This trend will likely continue with growth of the WUI into fire prone ecosystems, dangerous fuel conditions from decades of fire suppression, and a potentially increasing effect from prolonged drought and climate change. Fuel treatments are often considered the primary pre-fire mechanism to reduce the exposure of values at risk to wildland fire, and a growing suite of fire models and tools are employed to prioritize where treatments could mitigate wildland fire damages. Assessments using the likelihood and consequence of fire are critical because funds are insufficient to reduce risk on all lands needing treatment, therefore prioritization is required to maximize the effectiveness of fuel treatment budgets. Cost-effectiveness, doing the most good per dollar, would seem to be an important fuel treatment metric, yet studies or plans that prioritize fuel treatments using costs or cost-effectiveness measures are absent from the literature. Therefore, to explore the effect of using costs in fuel treatment planning we test four prioritization algorithms designed to reduce risk in a case study examining fuel treatments on the Sisters Ranger District of central Oregon. For benefits we model sediment retention and standing biomass, and measure the effectiveness of each algorithm by comparing the differences among treatment and no treat alternative scenarios. Our objective is to maximize the averted loss of net benefits subject to a representative fuel treatment budget. We model costs across the study landscape using the My Fuel Treatment Planner software, tree list data, local mill prices, and GIS-measured site characteristics. We use fire simulations to generate burn probabilities, and estimate fire intensity as conditional flame length at each pixel. Two prioritization algorithms target treatments based on cost-effectiveness and show improvements over those

  17. The Cost-Effectiveness of NBPTS Teacher Certification

    ERIC Educational Resources Information Center

    Yeh, Stuart S.

    2010-01-01

    A cost-effectiveness analysis of the National Board for Professional Teaching Standards (NBPTS) program suggests that Board certification is less cost-effective than a range of alternative approaches for raising student achievement, including comprehensive school reform, class size reduction, a 10% increase in per pupil expenditure, the use of…

  18. Potential Alternatives Report for Validation of Alternatives to Aliphatic Isocyanate Polyurethanes

    NASA Technical Reports Server (NTRS)

    Lewis, pattie

    2011-01-01

    Identifying and selecting alternative materials and technologies that have the potential to reduce the identified HazMats and hazardous air pollutants (HAPs), while incorporating sound corrosion prevention and control technologies, is a complicated task due to the fast pace at which new technologies emerge and rules change. The alternatives are identified through literature searches, electronic database and Internet searches, surveys, and/or personal and professional contacts. Available test data was then compiled on the proposed alternatives to determine if the materials meet the test objectives or if further)laboratory or field-testing will be required. After reviewing technical information documented in the PAR, government representatives, technical representatives from the affected facilities, and other stakeholders involved in the process will select the list of viable alternative coatings for consideration and testing under the project's Joint Test Protocol entitled Joint Test Protocol for Validation of Alternatives to Aliphatic Isocyanate Polyurethanes and Field Test Plan entitled Field Evaluations Test Plan for Validation of Alternatives to Aliphatic Isocyanate Polyurethanes, both prepared by ITB. Test results will be reported in a Joint Test Report upon completion oftesting. The selection rationale and conclusions are documented in this PAR. A cost benefit analysis will be prepared to quantify the estimated capital and process costs of coating alternatives and cost savings relative to the current coating processes, however, some initial cost data has been included in this PAR. For this coatings project, isocyanates, as found in aliphatic isocyanate polyurethanes, were identified as the target HazMat to be eliminated. Table 1-1 lists the target HazMats, the related process and application, current specifications, and affected programs.

  19. The cost-effectiveness of NBPTS teacher certification.

    PubMed

    Yeh, Stuart S

    2010-06-01

    A cost-effectiveness analysis of the National Board for Professional Teaching Standards (NBPTS) program suggests that Board certification is less cost-effective than a range of alternative approaches for raising student achievement, including comprehensive school reform, class size reduction, a 10% increase in per pupil expenditure, the use of value-added statistical methods to identify effective teachers, and the implementation of systems where student performance in math and reading is rapidly assessed 2-5 times per week. The most cost-effective approach, rapid assessment, is three magnitudes as cost-effective as Board certification.

  20. Effects of disputes and easement violations on the cost-effectiveness of land conservation.

    PubMed

    Schuster, Richard; Arcese, Peter

    2015-01-01

    Conservation initiatives to protect and restore valued species communities in human-dominated landscapes face challenges linked to their potential costs. Conservation easements on private land may represent a cost-effective alternative to land purchase, but long-term costs to monitor and enforce easements, or defend legal challenges, remain uncertain. We explored the cost-effectiveness of conservation easements, defined here as the fraction of the high-biodiversity landscape potentially protected via investment in easements versus land purchase. We show that easement violation and dispute rates substantially affect the estimated long-term cost-effectiveness of an easement versus land purchase strategy. Our results suggest that conservation easements can outperform land purchase as a strategy to protect biodiversity as long as the rate of disputes and legal challenges is low, pointing to a critical need for monitoring data to reduce costs and maximize the value of conservation investments.

  1. Effects of disputes and easement violations on the cost-effectiveness of land conservation

    PubMed Central

    Arcese, Peter

    2015-01-01

    Conservation initiatives to protect and restore valued species communities in human-dominated landscapes face challenges linked to their potential costs. Conservation easements on private land may represent a cost-effective alternative to land purchase, but long-term costs to monitor and enforce easements, or defend legal challenges, remain uncertain. We explored the cost-effectiveness of conservation easements, defined here as the fraction of the high-biodiversity landscape potentially protected via investment in easements versus land purchase. We show that easement violation and dispute rates substantially affect the estimated long-term cost-effectiveness of an easement versus land purchase strategy. Our results suggest that conservation easements can outperform land purchase as a strategy to protect biodiversity as long as the rate of disputes and legal challenges is low, pointing to a critical need for monitoring data to reduce costs and maximize the value of conservation investments. PMID:26413430

  2. Potential alternative energy technologies on the Outer Continental Shelf.

    SciTech Connect

    Elcock, D.; Environmental Assessment

    2007-04-20

    This technical memorandum (TM) describes the technology requirements for three alternative energy technologies for which pilot and/or commercial projects on the U.S. Outer Continental Shelf (OCS) are likely to be proposed within the next five to seven years. For each of the alternative technologies--wind, wave, and ocean current--the TM first presents an overview. After each technology-specific overview, it describes the technology requirements for four development phases: site monitoring and testing, construction, operation, and decommissioning. For each phase, the report covers the following topics (where data are available): facility description, electricity generated, ocean area (surface and bottom) occupied, resource requirements, emissions and noise sources, hazardous materials stored or used, transportation requirements, and accident potential. Where appropriate, the TM distinguishes between pilot-scale (or demonstration-scale) facilities and commercial-scale facilities.

  3. Heat-flow properties of systems with alternate masses or alternate on-site potentials.

    PubMed

    Pereira, Emmanuel; Santana, Leonardo M; Ávila, Ricardo

    2011-07-01

    We address a central issue of phononics: the search of properties or mechanisms to manage the heat flow in reliable materials. We analytically study standard and simple systems modeling the heat flow in solids, namely, the harmonic, self-consistent harmonic and also anharmonic chains of oscillators, and we show an interesting insulating effect: While in the homogeneous models the heat flow decays as the inverse of the particle mass, in the chain with alternate masses it decays as the inverse of the square of the mass difference, that is, it decays essentially as the mass ratio (between the smaller and the larger one) for a large mass difference. A similar effect holds if we alternate on-site potentials instead of particle masses. The existence of such behavior in these different systems, including anharmonic models, indicates that it is a ubiquitous phenomenon with applications in the heat flow control.

  4. Investigating polymorphisms by bioinformatics is a potential cost-effective method to screen for germline mutations in Chinese familial adenomatous polyposis patients

    PubMed Central

    YANG, JUN; LIU, WEI QING; LI, WEN LIANG; CHEN, CHENG; ZHU, ZHU; HONG, MIN; WANG, ZHI QIANG; DONG, JIAN

    2016-01-01

    The aim of this study was to investigate germline mutations of the APC, MUTYH and AXIN2 genes in Chinese patients with familial adenomatous polyposis (FAP), and further assess the value of bioinformatics in screening the pathogenic changes predisposing to FAP. APC genes from 11 unrelated FAP patients in Yunnan province in China were firstly examined by exon-specific DNA sequencing. For samples without already known pathogenic changes predisposing to FAP in the APC gene, whole-gene sequencing of MUTYH and AXIN2 was performed. Mutational analysis of each gene was performed by bioinformatics. Eleven different types of APC polymorphisms were observed in the cohort of families analyzed. Of these polymorphisms, four were missense substitutions (V1822D, V1173G, P1760H and K2057), one was a nonsense substitution (S1196X), and six were silent substitutions (Y486Y, T449T, T1493T, G1678G, S1756S and P1960P). One missense mutation (Q335H) and two intronic substitutions (c.264+11G>A and c.420+35A>G) were detected in the MUTYH gene, and four synonymous mutations (I144I, P455P, P462P and L688L) and three intonic mutations (c.1060–77G>T, c.1060–287A>G and c.1060–282 A>G) of the AXIN2 gene were observed. In addition to the already reported pathogenic mutations, by using function assessment tools and databases, the synonymous substitutions observed in the APC gene of our samples were predicted to affect splicing regulation in the translation of mRNA, while the missense mutations observed in the APC gene and MUTYH gene were predicted to be disease-related polymorphisms; however, no functional effect of the mutations was observed in the AXIN2 gene. Comprehensive screening for germline mutations in APC, MUTYH and AXIN2 genes followed by prediction of pathogenicity using bioinformatic tools contributes to a cost-effective way of screening germline mutations in Chinese familial adenomatous polyposis patients. PMID:27347161

  5. Cost-effectiveness of zinc as adjunct therapy for acute childhood diarrhoea in developing countries.

    PubMed Central

    Robberstad, Bjarne; Strand, Tor; Black, Robert E.; Sommerfelt, Halvor

    2004-01-01

    OBJECTIVE: To analyse the incremental costs, effects and cost-effectiveness of zinc used as adjunct therapy to standard treatment of acute childhood diarrhoea, including dysentery, and to reassess the cost-effectiveness of standard case management with oral rehydration salt (ORS). METHODS: A decision tree was used to model expected clinical outcomes and expected costs under four alternative treatment strategies. The best available epidemiological, clinical and economic evidence was used in the calculations, and the United Republic of Tanzania was the reference setting. Probabilistic cost-effectiveness analysis was performed using a Monte-Carlo simulation technique and the potential impacts of uncertainty in single parameters were explored in one-way sensitivity analyses. FINDINGS: ORS was found to be less cost-effective than previously thought. The use of zinc as adjunct therapy significantly improved the cost-effectiveness of standard management of diarrhoea for dysenteric as well as non-dysenteric illness. The results were particularly sensitive to mortality rates in non-dysenteric diarrhoea, but the alternative interventions can be defined as highly cost-effective even in pessimistic scenarios. CONCLUSION: There is sufficient evidence to recommend the inclusion of zinc into standard case management of both dysenteric and non-dysenteric acute diarrhoea.A direct transfer of our findings from the United Republic of Tanzania to other settings is not justified, but there are no indications of large geographical differences in the efficacy of zinc. It is therefore plausible that our findings are also applicable to other developing countries. PMID:15500284

  6. Alternative Fuels and Their Potential Impact on Aviation

    NASA Technical Reports Server (NTRS)

    Daggett, D.; Hendricks, R.; Walther, R.

    2006-01-01

    With a growing gap between the growth rate of petroleum production and demand, and with mounting environmental needs, the aircraft industry is investigating issues related to fuel availability, candidates for alternative fuels, and improved aircraft fuel efficiency. Bio-derived fuels, methanol, ethanol, liquid natural gas, liquid hydrogen, and synthetic fuels are considered in this study for their potential to replace or supplement conventional jet fuels. Most of these fuels present the airplane designers with safety, logistical, and performance challenges. Synthetic fuel made from coal, natural gas, or other hydrocarbon feedstock shows significant promise as a fuel that could be easily integrated into present and future aircraft with little or no modification to current aircraft designs. Alternatives, such as biofuel, and in the longer term hydrogen, have good potential but presently appear to be better suited for use in ground transportation. With the increased use of these fuels, a greater portion of a barrel of crude oil can be used for producing jet fuel because aircraft are not as fuel-flexible as ground vehicles.

  7. Alternative sugars as potential carriers for dry powder inhalations.

    PubMed

    Steckel, Hartwig; Bolzen, Nina

    2004-02-11

    Most dry powder inhaler (DPI) formulations rely on lactose monohydrate as a carrier in the drug powder blends. However, lactose cannot be used for compounds that interact with the reducing sugar function of the lactose, such as formoterol, budesonide or peptides and proteins. In this study, alternative carriers like mannitol, glucose, sorbitol, maltitol and xylitol have therefore been evaluated for their potential use in DPI formulations. Raw materials were characterised physico-chemically and blends with the model drug substance budesonide were tested with respect to the aerosolization behaviour of the powders. It was found out that similarly to the problems known for lactose monohydrate, such as supplier variability, variability between different qualities of one supplier, the same difficulties apply to the alternative carriers investigated. Different sources and qualities of mannitol led to significant differences in the fine particle fraction (FPF), varying from 15 to 50% for two different qualities of mannitol. Similar observations were made for the other carrier materials studied. Also, the influence of conditioning the raw material at different relative humidity was found to have substantial influence on the performance of drug/carrier blends which is characterised by a strong decrease in the FPF. In summary, mannitol showed potential as a drug carrier to be used in DPIs whereas the more hygroscopic sugars only showed poor dispersibility.

  8. Fuels for urban transit buses: a cost-effectiveness analysis.

    PubMed

    Cohen, Joshua T; Hammitt, James K; Levy, Jonathan I

    2003-04-15

    Public transit agencies have begun to adopt alternative propulsion technologies to reduce urban transit bus emissions associated with conventional diesel (CD) engines. Among the most popular alternatives are emission controlled diesel buses (ECD), defined here to be buses with continuously regenerating diesel particle filters burning low-sulfur diesel fuel, and buses burning compressed natural gas (CNG). This study uses a series of simplifying assumptions to arrive at first-order estimates for the incremental cost-effectiveness (CE) of ECD and CNG relative to CD. The CE ratio numerator reflects acquisition and operating costs. The denominator reflects health losses (mortality and morbidity) due to primary particulate matter (PM), secondary PM, and ozone exposure, measured as quality adjusted life years (QALYs). We find that CNG provides larger health benefits than does ECD (nine vs six QALYs annually per 1000 buses) but that ECD is more cost-effective than CNG (dollar 270 000 per QALY for ECD vs dollar 1.7 million to dollar 2.4 million for CNG). These estimates are subject to much uncertainty. We identify assumptions that contribute most to this uncertainty and propose potential research directions to refine our estimates.

  9. Cost-effective nursing practice: cost-awareness and empowerment.

    PubMed

    Fisher, P

    1993-12-01

    Cost-effective nursing practice is essential to succeed today as resources allocated to health care are declining. Realizing that any change poses a threat to our security, it is imperative that stakeholders be permitted to participate in decision-making processes affecting their work. An honest, open exchange of ideas towards cost-effective practices should be encouraged. Cost-effective behaviours are influenced significantly by negative attitudes with regard to loss of human resources, increased workload, and potential pay cuts. This article describes innovative strategies which could promote successful cost-effective nursing practice, including working smarter, not working harder. Topics addressed are attitude, awareness and empowerment.

  10. Therapeutic potential and outlook of alternative medicine for osteoporosis.

    PubMed

    Wang, Tao; Liu, Qian; Tjhioe, William; Zhao, Jinmin; Lu, Aiping; Zhang, Ge; Tan, Renxiang; Zhou, Mengyu; Xu, Jiake; Feng, Haotian

    2017-03-21

    Osteoporosis, a bone disease resulting in loss of bone density and microstructure quality, is often associated with fragility fractures, and the latter imposes a great burden on the patient and society. Although there are several different treatments available for osteoporosis such as hormone replacement therapy, bisphosphonates, Denosumab, and parathyroid hormone some concern has been raised regarding the inherent side effects of their long term use. It would be of great relevance to search for alternative natural compounds, which could complementarily overcome the limitations of the currently available therapy. Herein, we review current literature on natural compounds that might have therapeutic values for osteoporosis. Search terms included bone resorption, bone density, osteoporosis, postmenopausal, osteoporosis or bone density conservation agents, and any of the terms related to traditional, herbal, natural therapy, natural health, diet, or phytoestrogens. All the compounds and herbs included in the review are naturally bioactive or are used in folk herbal medicine and have been reported to be capable of attenuating osteopenia or osteoporosis in vivo or in vitro, through various mechanisms - estrogen-like activity, antioxidant and anti-inflammatory properties, or by modulating the key signaling pathways in the pathogenesis of osteoporosis. Through our assessment of the therapeutic potential and outlook of alternative medicine, we aim to provide an appealing perspective for the consideration of the application of a complementary anti-osteoporotic treatment option and prevention strategy for osteoporosis or osteolytic bone disorders.

  11. The Sunk Cost Effect in Pigeons and Humans

    ERIC Educational Resources Information Center

    Navarro, Anton D.; Fantino, Edmund

    2005-01-01

    The sunk cost effect is the increased tendency to persist in an endeavor once an investment of money, effort, or time has been made. To date, humans are the only animal in which this effect has been observed unambiguously. We developed a behavior-analytic model of the sunk cost effect to explore the potential for this behavior in pigeons as well…

  12. Costs in Perspective: Understanding Cost-Effectiveness Analysis.

    PubMed

    Detsky

    1996-01-01

    This paper covers five questions: (1) What is cost-effectiveness analysis;quest; (2) How can cost-effectiveness analysis help policymakers allocate scarce resources;quest; (3) What are misconceptions about the cost effectiveness of health care interventions;quest; (4) What is an attractive cost-effectiveness ratio;quest; (5) What is the relevance of cost effectiveness to clinicians? The cost side of the equation includes more than simply the cost of the intervention, but rather the cost of all of the downstream clinical events that occur with either therapeutic alternative. Cost-effectiveness analyses are used to help decisionmakers rank programs competing for scarce resources in order to achieve the following objective: to maximize the net health benefits derived from a fixed budget for a target population. A simple example is shown. Measured cost-effectiveness ratios for selected cardiovascular interventions are displayed. The systematic use of information on effectiveness and cost effectiveness should help those involved in setting policies to have a more rational basis for funding of new programs and discontinuation of funding for old programs. In Canadian health care it is important that we use this information to make room for innovations that are effective and efficient, and to remove funding from programs that are either known to be ineffective and costly or inefficient use of resources. More energy should be put toward generating the information necessary to make these kinds of decisions.

  13. Alternate corrections for estimating actual wetland evapotranspiration from potential evapotranspiration

    USGS Publications Warehouse

    Barclay, Shoemaker W.; Sumner, D.M.

    2006-01-01

    Corrections can be used to estimate actual wetland evapotranspiration (AET) from potential evapotranspiration (PET) as a means to define the hydrology of wetland areas. Many alternate parameterizations for correction coefficients for three PET equations are presented, covering a wide range of possible data-availability scenarios. At nine sites in the wetland Everglades of south Florida, USA, the relatively complex PET Penman equation was corrected to daily total AET with smaller standard errors than the PET simple and Priestley-Taylor equations. The simpler equations, however, required less data (and thus less funding for instrumentation), with the possibility of being corrected to AET with slightly larger, comparable, or even smaller standard errors. Air temperature generally corrected PET simple most effectively to wetland AET, while wetland stage and humidity generally corrected PET Priestley-Taylor and Penman most effectively to wetland AET. Stage was identified for PET Priestley-Taylor and Penman as the data type with the most correction ability at sites that are dry part of each year or dry part of some years. Finally, although surface water generally was readily available at each monitoring site, AET was not occurring at potential rates, as conceptually expected under well-watered conditions. Apparently, factors other than water availability, such as atmospheric and stomata resistances to vapor transport, also were limiting the PET rate. ?? 2006, The Society of Wetland Scientists.

  14. Sublingual Delivery of Frovatriptan: An Indication of Potential Alternative Route

    PubMed Central

    Verma, Surajpal; Prasad, Shyam Baboo

    2014-01-01

    Frovatriptan, a 5-HT1B and 5-HT1D receptor agonist, is used for the treatment of acute migraine attack. This molecule is classified into second line therapy because of its slow onset of action (peak response obtained after 4 hours of administration) and low bioavailability (25%). Moreover, its therapy is the most costly among all triptans. Attempt has been made in present work to suggest a way out to fasten its onset of action and to enhance its bioavailability. Prepared tablets were evaluated by physicochemical tests, in vitro permeation studies, ex vivo permeation studies, and histopathological studies. Suitable mathematical calculations were performed to calculate the minimum amount of bioavailability that could be enhanced. Tablets containing chitosan (5% w/w) were found to give optimum results. Prepared tablets can double the bioavailability of frovatriptan and can initiate its response within 10 minutes of its administration. Suggestive alternative has the potential to increase the efficacy of frovatriptan for treating acute migraine attack. PMID:27433492

  15. Potential Alternatives Report for Validation of Alternative Low-Emission Surface PreparationlDepainting Technologies for Structural Steel

    NASA Technical Reports Server (NTRS)

    Lewis, Pattie

    2006-01-01

    For this project, particulates and solvents used during the depainting process of steel structures were the identified hazardous material (HazMat) targeted for elimination or reduction. This Potential Alternatives Report (PAR) provides technical analyses of identified alternatives to the current coating removal processes, criteria used to select alternatives for further analysis, and a list of those alternatives recommended for testing. The initial coating removal alternatives list was compiled using literature searches and center participant recommendations. The involved project participants initially considered fifteen (15) alternatives. In late 2004, stakeholders down-selected the list and identified specific processes as potential alternatives to the current depainting methods. The selected alternatives were: 1. Plastic Blast Media 2. Hard Abrasive Media 3. Sponge Blast Media 4. Mechanical Removal with Vacuum Attachment 5. Liquid Nitrogen 6. Laser Coating Removal Available information about these processes was used to analyze the technical merits and the potential environmental, safety, and occupational health (ESOH) impacts of these methods. A preliminary cost benefit analysis will be performed to determine if implementation of alternative technologies is economically justified. NASA AP2

  16. Cost-effectiveness and total costs of three alternative strategies for the prevention and management of severe skin reactions attributable to thiacetazone in the treatment of Human Immunodeficiency Virus positive patients with tuberculosis in Kenya.

    PubMed

    van Gorkom, J; Kibuga, D K

    1996-02-01

    In Kenya, the National Leprosy Tuberculosis Programme (NLTP) used previously reported data from Nairobi to compare the cost-effectiveness and total costs of a hypothetical strategy with three intervention strategies for the prevention and management of severe skin reactions caused by thiacetazone in treating HIV-positive patients with tuberculosis (TB). The hypothetical strategy was continued use of thiacetazone despite adverse skin reactions. The intervention strategies included patient education about possible side effects of anti-TB drugs (discontinue use if skin rash develops, report situation to clinic, replace thiacetazone with ethambutol when other skin diseases have been excluded), abandonment of thiacetazone and replacement with ethambutol, and HIV testing and pre- and post-test counseling. NLTP currently used the education strategy. It assumed a mortality rate of 5%. When the HIV prevalence rate is 1-90%, the education strategy is the most cost-effective strategy. In terms of total costs, the education strategy was also the most inexpensive strategy regardless of the HIV prevalence. At an HIV prevalence rate greater than 65%, the abandonment of thiacetazone strategy was the cheapest strategy. When the assumed mortality rate was 3%, the cost per averted death for the education strategy was reduced from about US$120 to about US$80 and the education strategy became the most cost-effective strategy over the entire range of HIV prevalence. In addition, the cost of HIV testing significantly increased the cost per averted death. Thus, the findings of this study are truly sensitive to different program conditions. Based on these findings, the authors recommended that the education strategy be applied with a range of HIV prevalence of 1-45%, that HIV testing be applied with a range of 46-72%, and that total abandonment be applied with an HIV prevalence greater than 72%.

  17. Cost-effective design of economic instruments in nutrition policy

    PubMed Central

    Jensen, Jørgen D; Smed, Sinne

    2007-01-01

    This paper addresses the potential for using economic regulation, e.g. taxes or subsidies, as instruments to combat the increasing problems of inappropriate diets, leading to health problems such as obesity, diabetes 2, cardiovascular diseases etc. in most countries. Such policy measures may be considered as alternatives or supplements to other regulation instruments, including information campaigns, bans or enhancement of technological solutions to the problems of obesity or related diseases. 7 different food tax and subsidy instruments or combinations of instruments are analysed quantitatively. The analyses demonstrate that the average cost-effectiveness with regard to changing the intake of selected nutritional variables can be improved by 10–30 per cent if taxes/subsidies are targeted against these nutrients, compared with targeting selected food categories. Finally, the paper raises a range of issues, which need to be investigated further, before firm conclusions about the suitability of economic instruments in nutrition policy can be drawn. PMID:17408494

  18. Cost-effective design of economic instruments in nutrition policy.

    PubMed

    Jensen, Jørgen D; Smed, Sinne

    2007-04-04

    This paper addresses the potential for using economic regulation, e.g. taxes or subsidies, as instruments to combat the increasing problems of inappropriate diets, leading to health problems such as obesity, diabetes 2, cardiovascular diseases etc. in most countries. Such policy measures may be considered as alternatives or supplements to other regulation instruments, including information campaigns, bans or enhancement of technological solutions to the problems of obesity or related diseases. 7 different food tax and subsidy instruments or combinations of instruments are analysed quantitatively. The analyses demonstrate that the average cost-effectiveness with regard to changing the intake of selected nutritional variables can be improved by 10-30 per cent if taxes/subsidies are targeted against these nutrients, compared with targeting selected food categories. Finally, the paper raises a range of issues, which need to be investigated further, before firm conclusions about the suitability of economic instruments in nutrition policy can be drawn.

  19. Are Certified Breast Centers Cost-Effective?

    PubMed Central

    Beckmann, Matthias W.; Bani, Mayada R.; Loehberg, Christian R.; Hildebrandt, Thomas; Schrauder, Michael G.; Wagner, Stefanie; Fasching, Peter A.; Lux, Michael Patrick

    2009-01-01

    Summary The German health care system has entered an era of specialist centers and certification. Hospitals are required to introduce quality management with external monitoring, refining and improving their quality of treatment. These statutory requirements can only be met through specialization, centralization, and establishing centers and networks with internal and external interdisciplinary collaboration. The breast centers certified according to the criteria of the German Cancer Society (DKG) and German Society for Mastology (DGS) are pioneers here. Simultaneously, there are increasing demands for more cost-effective medical services despite limited resources – making economic analysis of health care provision necessary. Few economic studies of the centers and certification system have been conducted, however. General long-term quality data, particularly for results, are not yet available from certified breast centers. At present, a certified breast center is not itself a proven independent prognostic parameter for treatment results. However, the individual criteria required for breast center certification show a significant positive influence on clinical efficacy. Certified breast centers involve substantial extra costs that are not reimbursed by funding bodies, so the slightest potential benefit for patients from certified centers already appears cost-effective. When the actual costs, currently usually subsidized by other departments, are considered, it is unclear whether certified breast centers remain cost-effective. PMID:20877662

  20. Phytogenic Compounds as Alternatives to In-Feed Antibiotics: Potentials and Challenges in Application

    PubMed Central

    Yang, Chengbo; Chowdhury, M .A. Kabir; Hou, Yongqing; Gong, Joshua

    2015-01-01

    This article summarizes current experimental knowledge on the efficacy, possible mechanisms and feasibility in the application of phytogenic products as feed additives for food-producing animals. Phytogenic compounds comprise a wide range of plant-derived natural bioactive compounds and essential oils are a major group. Numerous studies have demonstrated that phytogenic compounds have a variety of functions, including antimicrobial/antiviral, antioxidative and anti-inflammation effects and improvement in the palatability of feed and gut development/health. However, the mechanisms underlying their functions are still largely unclear. In the past, there has been a lack of consistency in the results from both laboratory and field studies, largely due to the varied composition of products, dosages, purities and growing conditions of animals used. The minimal inhibitory concentration (MIC) of phytogenic compounds required for controlling enteric pathogens may not guarantee the best feed intake, balanced immunity of animals and cost-effectiveness in animal production. The lipophilic nature of photogenic compounds also presents a challenge in effective delivery to the animal gut and this can partially be resolved by microencapsulation and combination with other compounds (synergistic effect). Interestingly, the effects of photogenic compounds on anti-inflammation, gut chemosensing and possible disruption of bacterial quorum sensing could explain a certain number of studies with different animal species for the better production performance of animals that have received phytogenic feed additives. It is obvious that phytogenic compounds have good potential as an alternative to antibiotics in feed for food animal production and the combination of different phytogenic compounds appears to be an approach to improve the efficacy and safety of phytogenic compounds in the application. It is our expectation that the recent development of high-throughput and

  1. Airports Offer Unrealized Potential for Alternative Energy Production

    NASA Astrophysics Data System (ADS)

    Devault, Travis L.; Belant, Jerrold L.; Blackwell, Bradley F.; Martin, James A.; Schmidt, Jason A.; Wes Burger, L.; Patterson, James W.

    2012-03-01

    Scaling up for alternative energy such as solar, wind, and biofuel raises a number of environmental issues, notably changes in land use and adverse effects on wildlife. Airports offer one of the few land uses where reductions in wildlife abundance and habitat quality are necessary and socially acceptable, due to risk of wildlife collisions with aircraft. There are several uncertainties and limitations to establishing alternative energy production at airports, such as ensuring these facilities do not create wildlife attractants or other hazards. However, with careful planning, locating alternative energy projects at airports could help mitigate many of the challenges currently facing policy makers, developers, and conservationists.

  2. Airports offer unrealized potential for alternative energy production.

    PubMed

    DeVault, Travis L; Belant, Jerrold L; Blackwell, Bradley F; Martin, James A; Schmidt, Jason A; Wes Burger, L; Patterson, James W

    2012-03-01

    Scaling up for alternative energy such as solar, wind, and biofuel raises a number of environmental issues, notably changes in land use and adverse effects on wildlife. Airports offer one of the few land uses where reductions in wildlife abundance and habitat quality are necessary and socially acceptable, due to risk of wildlife collisions with aircraft. There are several uncertainties and limitations to establishing alternative energy production at airports, such as ensuring these facilities do not create wildlife attractants or other hazards. However, with careful planning, locating alternative energy projects at airports could help mitigate many of the challenges currently facing policy makers, developers, and conservationists.

  3. Notes and correspondence: An alternative form for potential vorticity

    NASA Technical Reports Server (NTRS)

    Lait, Leslie R.

    1994-01-01

    A form of potential vorticity is described that has conversation properties similar to those of Ertel's potential vorticity (EPV) but removes the exponential variation with height displayed by EPV. This form is thus more suitable for inspecting vertical cross sections of potential vorticity and for use (with potential temperature) as a quasi-conserved coordinate in the analysis of chemical constituent data.

  4. The Costs and Potential Benefits of Alternative Scholarly Publishing Models

    ERIC Educational Resources Information Center

    Houghton, John W.

    2011-01-01

    Introduction: This paper reports on a study undertaken for the UK Joint Information Systems Committee (JISC), which explored the economic implications of alternative scholarly publishing models. Rather than simply summarising the study's findings, this paper focuses on the approach and presents a step-by-step account of the research process,…

  5. Winter safflower, a potential alternative crop for the Pacific Northwest

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The dryland cropping system in the Pacific Northwest is dominated by a winter wheat-summer fallow cropping system that occupies more than 90% of the dryland hectares. Success in finding a viable alternative crop has been limited because the annual precipitation in this region varies from less than 1...

  6. The Pursuit of Romantic Alternatives Online: Social Media Friends as Potential Romantic Alternatives.

    PubMed

    Abbasi, Irum Saeed; Alghamdi, Nawal G

    2017-03-20

    What causes some marriages to stand the test of time while others fail? Marital commitment is the key force underlying the stability, quality, and longevity of the romantic relationship. Commitment is strengthened in the presence of marital satisfaction, the absence of alternative attractions, and steady investments made in the relationship. Commitment is also a consequence of increasing dependence such that when partners are emotionally engaged with their virtual connections, their dependence on their significant other weakens resulting in low commitment. Dependence on the partner increases when people feel satisfied in their relationship, think unfavorably about the quality of available alternatives and feel that they have made great investments in their relationship. Technological advancements and the ever-evolving communication mediums contribute to relationship troubles by providing access to alternatives that substantially reduce shared family time. The boastfully curated profiles of virtual connections and their overly glossed pictures may lead partners to feel deficient in their life. Previous research showed that Facebook can reduce relationship satisfaction by providing alternatives and deflecting time and emotional investments away from the committed relationship. This article examines the commitment literature and discusses how commitment is undermined in the contemporary era. Finally, marital therapy is addressed with suggestions for future areas of exploration.

  7. Heterologously expressed Aspergillus aculeatus β-glucosidase in Saccharomyces cerevisiae is a cost-effective alternative to commercial supplementation of β-glucosidase in industrial ethanol production using Trichoderma reesei cellulases.

    PubMed

    Treebupachatsakul, Treesukon; Nakazawa, Hikaru; Shinbo, Hideaki; Fujikawa, Hiroki; Nagaiwa, Asami; Ochiai, Nobuhiro; Kawaguchi, Takashi; Nikaido, Mitsuru; Totani, Kazuhide; Shioya, Koki; Shida, Yosuke; Morikawa, Yasushi; Ogasawara, Wataru; Okada, Hirofumi

    2016-01-01

    Trichoderma reesei is a filamentous organism that secretes enzymes capable of degrading cellulose to cellobiose. The culture supernatant of T. reesei, however, lacks sufficient activity to convert cellobiose to glucose using β-glucosidase (BGL1). In this study, we identified a BGL (Cel3B) from T. reesei (TrCel3B) and compared it with the active β-glucosidases from Aspergillus aculeatus (AaBGL1). AaBGL1 showed higher stability and conversion of sugars to ethanol compared to TrCel3B, and therefore we chose to express this recombinant protein for use in fermentation processes. We expressed the recombinant protein in the yeast Saccharomyces cerevisiae, combined it with the superb T. reesei cellulase machinery and used the combination in a simultaneous saccharification and fermentation (SSF) process, with the hope that the recombinant would supplement the BGL activity. As the sugars were processed, the yeast immediately converted them to ethanol, thereby eliminating the problem posed by end product inhibition. Recombinant AaBGL1 activity was compared with Novozyme 188, a commercially available supplement for BGL activity. Our results show that the recombinant protein is as effective as the commercial supplement and can process sugars with equal efficiency. Expression of AaBGL1 in S. cerevisiae increased ethanol production effectively. Thus, heterologous expression of AaBGL1 in S. cerevisiae is a cost-effective and efficient process for the bioconversion of ethanol from lignocellulosic biomass.

  8. Cost-Effectiveness Analysis of School Desegregation Plans.

    ERIC Educational Resources Information Center

    Rossell, Christine H.

    Cost-effectiveness analysis provides a useful tool for choosing between alternative desegregation plans or justifying one particular plan. Previous analyses of school desegregation effects on white enrollment, which focus only upon costs, have had limited use for policy. Traditional cost-benefit analysis poses problems because of the difficulty of…

  9. Assessing the Cost-Effectiveness of Family Connections

    ERIC Educational Resources Information Center

    DePanfilis, Diane; Dubowitz, Howard; Kunz, James

    2008-01-01

    Objective: To assess the cost-effectiveness of two alternate forms of Family Connections (FC), a child neglect prevention program, in relation to changes in risk and protective factors and improvements in child safety and behavioral outcomes. Methods: In the original FC study, a sample of 154 families (473 children) in a poor, urban neighborhood,…

  10. Electronic cigarettes: a safer alternative or potential poison?

    PubMed

    Smith, Janet E

    2014-10-01

    Electronic cigarettes have been marketed as a safer alternative to cigarettes, and their use is expanding exponentially. However, there is a severe lack of scientific data about the ingredients in the liquid used in the device and the health consequences of using electronic cigarettes. As technology has outpaced regulations, the production and sale of electronic cigarettes are, as yet, unregulated and do not fall under the purview of the Food and Drug Administration. This article will review the mechanism of action and what is currently known about the safety of electronic cigarettes. The risk of poisoning for children will also be identified, as well as the implications for home healthcare clinicians.

  11. Costs and Cost-Effectiveness of Plasmodium vivax Control

    PubMed Central

    White, Michael T.; Yeung, Shunmay; Patouillard, Edith; Cibulskis, Richard

    2016-01-01

    The continued success of efforts to reduce the global malaria burden will require sustained funding for interventions specifically targeting Plasmodium vivax. The optimal use of limited financial resources necessitates cost and cost-effectiveness analyses of strategies for diagnosing and treating P. vivax and vector control tools. Herein, we review the existing published evidence on the costs and cost-effectiveness of interventions for controlling P. vivax, identifying nine studies focused on diagnosis and treatment and seven studies focused on vector control. Although many of the results from the much more extensive P. falciparum literature can be applied to P. vivax, it is not always possible to extrapolate results from P. falciparum–specific cost-effectiveness analyses. Notably, there is a need for additional studies to evaluate the potential cost-effectiveness of radical cure with primaquine for the prevention of P. vivax relapses with glucose-6-phosphate dehydrogenase testing. PMID:28025283

  12. Cost-effectiveness of payments for ecosystem services with dual goals of environment and poverty alleviation.

    PubMed

    Gauvin, Crystal; Uchida, Emi; Rozelle, Scott; Xu, Jintao; Zhan, Jinyan

    2010-03-01

    The goal of this article is to understand strategies by which both the environmental and poverty alleviation objectives of PES programs can be achieved cost effectively. To meet this goal, we first create a conceptual framework to understand the implications of alternative targeting when policy makers have both environmental and poverty alleviation goals. We then use the Grain for Green program in China, the largest PES program in the developing world, as a case study. We also use a data set from a survey that we designed and implemented to evaluate the program. Using the data set we first evaluate what factors determined selection of program areas for the Grain for Green program. We then demonstrate the heterogeneity of parcels and households and examine the correlations across households and their parcels in terms of their potential environmental benefits, opportunity costs of participating, and the asset levels of households as an indicator of poverty. Finally, we compare five alternative targeting criteria and simulate their performance in terms of cost effectiveness in meeting both the environmental and poverty alleviation goals when given a fixed budget. Based on our simulations, we find that there is a substantial gain in the cost effectiveness of the program by targeting parcels based on the "gold standard," i.e., targeting parcels with low opportunity cost and high environmental benefit managed by poorer households.

  13. Cost-Effectiveness of Payments for Ecosystem Services with Dual Goals of Environment and Poverty Alleviation

    NASA Astrophysics Data System (ADS)

    Gauvin, Crystal; Uchida, Emi; Rozelle, Scott; Xu, Jintao; Zhan, Jinyan

    2010-03-01

    The goal of this article is to understand strategies by which both the environmental and poverty alleviation objectives of PES programs can be achieved cost effectively. To meet this goal, we first create a conceptual framework to understand the implications of alternative targeting when policy makers have both environmental and poverty alleviation goals. We then use the Grain for Green program in China, the largest PES program in the developing world, as a case study. We also use a data set from a survey that we designed and implemented to evaluate the program. Using the data set we first evaluate what factors determined selection of program areas for the Grain for Green program. We then demonstrate the heterogeneity of parcels and households and examine the correlations across households and their parcels in terms of their potential environmental benefits, opportunity costs of participating, and the asset levels of households as an indicator of poverty. Finally, we compare five alternative targeting criteria and simulate their performance in terms of cost effectiveness in meeting both the environmental and poverty alleviation goals when given a fixed budget. Based on our simulations, we find that there is a substantial gain in the cost effectiveness of the program by targeting parcels based on the “gold standard,” i.e., targeting parcels with low opportunity cost and high environmental benefit managed by poorer households.

  14. Cost-effectiveness of nurse practitioners in primary and specialised ambulatory care: systematic review

    PubMed Central

    Martin-Misener, Ruth; Harbman, Patricia; Donald, Faith; Reid, Kim; Kilpatrick, Kelley; Carter, Nancy; Bryant-Lukosius, Denise; Kaasalainen, Sharon; Marshall, Deborah A; Charbonneau-Smith, Renee; DiCenso, Alba

    2015-01-01

    Objective To determine the cost-effectiveness of nurse practitioners delivering primary and specialised ambulatory care. Design A systematic review of randomised controlled trials reported since 1980. Data sources 10 electronic bibliographic databases, handsearches, contact with authors, bibliographies and websites. Included studies Randomised controlled trials that evaluated nurse practitioners in alternative and complementary ambulatory care roles and reported health system outcomes. Results 11 trials were included. In four trials of alternative provider ambulatory primary care roles, nurse practitioners were equivalent to physicians in all but seven patient outcomes favouring nurse practitioner care and in all but four health system outcomes, one favouring nurse practitioner care and three favouring physician care. In a meta-analysis of two studies (2689 patients) with minimal heterogeneity and high-quality evidence, nurse practitioner care resulted in lower mean health services costs per consultation (mean difference: −€6.41; 95% CI −€9.28 to −€3.55; p<0.0001) (2006 euros). In two trials of alternative provider specialised ambulatory care roles, nurse practitioners were equivalent to physicians in all but three patient outcomes and one health system outcome favouring nurse practitioner care. In five trials of complementary provider specialised ambulatory care roles, 16 patient/provider outcomes favouring nurse practitioner plus usual care, and 16 were equivalent. Two health system outcomes favoured nurse practitioner plus usual care, four favoured usual care and 14 were equivalent. Four studies of complementary specialised ambulatory care compared costs, but only one assessed costs and outcomes jointly. Conclusions Nurse practitioners in alternative provider ambulatory primary care roles have equivalent or better patient outcomes than comparators and are potentially cost-saving. Evidence for their cost-effectiveness in alternative provider

  15. Applying risk adjusted cost-effectiveness (RAC-E) analysis to hospitals: estimating the costs and consequences of variation in clinical practice.

    PubMed

    Karnon, Jonathan; Caffrey, Orla; Pham, Clarabelle; Grieve, Richard; Ben-Tovim, David; Hakendorf, Paul; Crotty, Maria

    2013-06-01

    Cost-effectiveness analysis is well established for pharmaceuticals and medical technologies but not for evaluating variations in clinical practice. This paper describes a novel methodology--risk adjusted cost-effectiveness (RAC-E)--that facilitates the comparative evaluation of applied clinical practice processes. In this application, risk adjustment is undertaken with a multivariate matching algorithm that balances the baseline characteristics of patients attending different settings (e.g., hospitals). Linked, routinely collected data are used to analyse patient-level costs and outcomes over a 2-year period, as well as to extrapolate costs and survival over patient lifetimes. The study reports the relative cost-effectiveness of alternative forms of clinical practice, including a full representation of the statistical uncertainty around the mean estimates. The methodology is illustrated by a case study that evaluates the relative cost-effectiveness of services for patients presenting with acute chest pain across the four main public hospitals in South Australia. The evaluation finds that services provided at two hospitals were dominated, and of the remaining services, the more effective hospital gained life years at a low mean additional cost and had an 80% probability of being the most cost-effective hospital at realistic cost-effectiveness thresholds. Potential determinants of the estimated variation in costs and effects were identified, although more detailed analyses to identify specific areas of variation in clinical practice are required to inform improvements at the less cost-effective institutions.

  16. A critical evaluation of the cost-effectiveness of radon protection methods in new homes in a radon affected area of England.

    PubMed

    Coskeran, Thomas; Denman, Antony; Phillips, Paul; Tornberg, Roger

    2009-08-01

    In the UK, building new homes in areas prone to radon gas is currently subject to regulations that require installation of radon-proof membranes. These membranes are not, however, the only way to protect residents of new homes against radon's potential to cause lung cancer. Alternative regulatory regimes can be constructed that would achieve the same end. The purpose of this paper is to examine the cost-effectiveness of four alternative regimes and so determine if building regulations for new homes could be altered to protect residents from the effects of radon more cost-effectively than at present. In addressing this question, the paper also contributes to the wider debate on how best to reduce the effect on public health of exposure to radon. The measure of cost-effectiveness used, cost per quality-adjusted life-year gained, is determined from radon test results obtained in properties in Brixworth, England, UK, a radon Affected Area. Confidence intervals for the cost-effectiveness estimates are also derived using bootstrap techniques. The central estimates of cost-effectiveness range from 2870 pounds per quality-adjusted life-year gained for the most cost-effective of the alternative regimes to 6182 pounds for the current regime. These results suggest that alternative regimes may be more cost-effective in tackling the radon problem. A definitive assessment of the most suitable to adopt will require extensive negotiation between government departments, the construction industry, and other interested parties to ensure acceptance of any new regime. The paper offers suggestions for future research that should help in the process of identifying the key features of a new regulatory approach.

  17. Bioeconomic analysis of child-targeted subsidies for artemisinin combination therapies: a cost-effectiveness analysis

    PubMed Central

    Klein, Eili Y.; Smith, David L.; Cohen, Justin M.; Laxminarayan, Ramanan

    2015-01-01

    The Affordable Medicines Facility for malaria (AMFm) was conceived as a global market-based mechanism to increase access to effective malaria treatment and prolong effectiveness of artemisinin. Although results from a pilot implementation suggested that the subsidy was effective in increasing access to high-quality artemisinin combination therapies (ACTs), the Global Fund has converted AMFm into a country-driven mechanism whereby individual countries could choose to fund the subsidy from within their country envelopes. Because the initial costs of the subsidy in the pilot countries was higher than expected, countries are also exploring alternatives to a universal subsidy, such as subsidizing only child doses. We examined the incremental cost-effectiveness of a child-targeted policy using an age-structured bioeconomic model of malaria from the provider perspective. Because the vast majority of malaria deaths occur in children, targeting children could potentially improve the cost-effectiveness of the subsidy, though it would avert significantly fewer deaths. However, the benefits of a child-targeted subsidy (i.e. deaths averted) are eroded as leakage (i.e. older individuals taking young child-targeted doses) increases, with few of the benefits of a universal subsidy gained (i.e. reductions in overall prevalence). Although potentially more cost-effective, a child-targeted subsidy must contain measures to reduce the possibility of leakage. PMID:25994293

  18. A compatibility-based procedure designed to generate potential sanitation system alternatives.

    PubMed

    Maurer, Max; Bufardi, Ahmed; Tilley, Elizabeth; Zurbrügg, Christian; Truffer, Bernhard

    2012-08-15

    Regarding multi-criteria decision analysis (MCDA), the problem of generating alternatives has not received the attention it deserves. Most research is currently devoted to the problem of alternative selection, where it is assumed that a set of appropriate alternatives is already given. This paper addresses the generation of potential alternatives in the domain of sanitation systems planning and decision-making. A compatibility assessment procedure is proposed to determine the set of technically feasible or potential sanitation system alternatives. This is based on a clear definition of such an alternative containing sub-processes that include a user interface, storage, conveyance treatment and reuse/disposal. A newly developed compatibility matrix is applied to identify incompatibilities between the options of the sub-processes. A potential sanitation system alternative is therefore defined by the absence of two-by-two incompatibility between all its options. The compatibility assessment acts as a first filter on the set of sanitation system alternatives to eliminate those that are inoperable before the feasibility assessment. The objective of both steps is to obtain a set of alternatives that are of reasonable and manageable size from which the final solution may be selected.

  19. Cost-Effectiveness Analysis. Instructor Guide. Working for Clean Water: An Information Program for Advisory Groups.

    ERIC Educational Resources Information Center

    Buskirk, E. Drannon, Jr.

    Presented is the instructor's manual for a one-hour presentation on cost-effectiveness analysis. Topics covered are the scope of cost-effectiveness analysis, basic assessment procedures, and the role of citizens in the analysis of alternatives. A supplementary audiovisual program is available. These materials are part of the Working for Clean…

  20. The Sunk Cost Effect with Pigeons: Some Determinants of Decisions about Persistence

    ERIC Educational Resources Information Center

    Macaskill, Anne C.; Hackenberg, Timothy D.

    2012-01-01

    The sunk cost effect occurs when an individual persists following an initial investment, even when persisting is costly in the long run. The current study used a laboratory model of the sunk cost effect. Two response alternatives were available: Pigeons could persist by responding on a schedule key with mixed ratio requirements, or escape by…

  1. Class Size Reduction or Rapid Formative Assessment?: A Comparison of Cost-Effectiveness

    ERIC Educational Resources Information Center

    Yeh, Stuart S.

    2009-01-01

    The cost-effectiveness of class size reduction (CSR) was compared with the cost-effectiveness of rapid formative assessment, a promising alternative for raising student achievement. Drawing upon existing meta-analyses of the effects of student-teacher ratio, evaluations of CSR in Tennessee, California, and Wisconsin, and RAND cost estimates, CSR…

  2. A Proposed Alternative Measure for Climate Change Potential

    NASA Astrophysics Data System (ADS)

    DeGroff, F. A.

    2015-12-01

    Background/Issue There currently exists no comprehensive metric to measure and value anthropogenic changes in carbon flux between geospheric carbon sinks. We propose that changes in carbon residence time within geospheres be used as a metric to assess anthropogenic changes in carbon flux, and the term 'carbon quality' (cq) be used to describe such changes. Carbon residence time represents the inverse of carbon flux; as carbon flux increases, the corresponding cq will decrease, and vice versa. Focusing on atmospheric carbon emissions as a measure of anthropogenic activity on the environment ignores the fungible characteristics of carbon that are crucial in both the biosphere and the worldwide economy. The ubiquitous carbon molecule enables the enormous diversity in the biosphere, as well as the widespread, strategic economic presence of carbon in the world economy. Focusing on a single form of inorganic carbon as a proxy metric for the plethora of anthropogenic activity and carbon compounds will prove inadequate, convoluted, and unmanageable. A broader, more basic metric is needed to capture the breath and scope of carbon activity. Results/Conclusions We propose a logarithmic vector scale for cq to measure anthropogenic carbon flux. The distance between vector points, e.g. the starting and ending residence times, would represent the change in cq. A base-10 logarithmic scale would allow the addition and subtraction of exponents to calculate changes in cq. As carbon moves between carbon reservoirs, the change in cq is measured as: cq = b ( log10 [mean carbon residence time] ) where b represents the carbon price coefficient for a particular country. For any country, cq measures the climate change potential for any organic carbon when converted to inorganic CO2, or to any lower residence time carbon state. The greater the carbon fees for a country, the larger the b coefficient would be, and the greater the import fees would be to achieve carbon parity on imports from

  3. Cost Effectiveness Analysis for Nursing Research

    PubMed Central

    Bensink, Mark E.; Eaton, Linda H.; Morrison, Megan L.; Cook, Wendy A.; Curtis, R. Randall; Kundu, Anjana; Gordon, Deborah B.; Doorenbos, Ardith Z.

    2013-01-01

    Background With ever increasing pressure to reduce costs and increase quality, nurses are faced with the challenge of producing evidence that their interventions and care provide value. Cost effectiveness analysis (CEA) is a tool that can be used to provide this evidence by comparative evaluation of the costs and consequences of two or more alternatives. Objectives The aim of this article is to introduce the essential components of CEA to nurses and nurse researchers with the protocol of a recently funded cluster randomized controlled trial as an example. Methods This article provides: (a) a description of the main concepts and key steps in CEA, and (b) a summary of the background and objectives of a CEA designed to evaluate a nursing led pain and symptom management intervention in rural communities compared to current usual care. Discussion As the example highlights, incorporating CEA into nursing research studies is feasible. The burden of the additional data collection required is off-set by quantitative evidence of the given intervention's cost and impact using humanistic and economic outcomes. At a time when US health care is moving toward accountable care, the information provided by CEA will be an important additional component of the evidence produced by nursing research. PMID:23817285

  4. In Search of Cost-Effective Schools.

    ERIC Educational Resources Information Center

    Raywid, Mary Anne; Shaheen, Thomas A.

    1994-01-01

    Examines major cost-effectiveness proposals, describing developments that highlight concerns over making schools cost effective. The article discusses ways to blend the concerns of educational quality, equity, and costs (district consolidations, shared service and facilities arrangements, new accountability strategies, new information systems,…

  5. Dengue dynamics and vaccine cost-effectiveness in Brazil.

    PubMed

    Durham, David P; Ndeffo Mbah, Martial L; Medlock, Jan; Luz, Paula M; Meyers, Lauren A; Paltiel, A David; Galvani, Alison P

    2013-08-20

    Recent Phase 2b dengue vaccine trials have demonstrated the safety of the vaccine and estimated the vaccine efficacy with further trials underway. In anticipation of vaccine roll-out, cost-effectiveness analysis of potential vaccination policies that quantify the dynamics of disease transmission are fundamental to the optimal allocation of available doses. We developed a dengue transmission and vaccination model and calculated, for a range of vaccination costs and willingness-to-pay thresholds, the level of vaccination coverage necessary to sustain herd-immunity, the price at which vaccination is cost-effective and is cost-saving, and the sensitivity of our results to parameter uncertainty. We compared two vaccine efficacy scenarios, one a more optimistic scenario and another based on the recent lower-than-expected efficacy from the latest clinical trials. We found that herd-immunity may be achieved by vaccinating 82% (95% CI 58-100%) of the population at a vaccine efficacy of 70%. At this efficacy, vaccination may be cost-effective for vaccination costs up to US$ 534 (95% CI $369-1008) per vaccinated individual and cost-saving up to $204 (95% CI $39-678). At the latest clinical trial estimates of an average of 30% vaccine efficacy, vaccination may be cost-effective and cost-saving at costs of up to $237 (95% CI $159-512) and $93 (95% CI $15-368), respectively. Our model provides an assessment of the cost-effectiveness of dengue vaccination in Brazil and incorporates the effect of herd immunity into dengue vaccination cost-effectiveness. Our results demonstrate that at the relatively low vaccine efficacy from the recent Phase 2b dengue vaccine trials, age-targeted vaccination may still be cost-effective provided the total vaccination cost is sufficiently low.

  6. Cost-effectiveness of lenalidomide in multiple myeloma.

    PubMed

    Schey, Steve; Higginson, Irene

    2010-06-01

    Lenalidomide represents the first drug in a novel class of agents known as IMiDs. It has both direct antimyeloma activity and an indirect effect acting through the microenvironment. In the relapsed/refractory setting, lenalidomide has been demonstrated to be highly active, producing partial and complete responses that translate into improved survival. Generally, the drug is well tolerated and more recently this agent has been used in combination with steroids, chemotherapy agents and other novel agents that have further enhanced its efficacy in clinical trials. However, the cost of this and other novel agents is significantly greater than previously used chemotherapy protocols, which in turn means that they have fallen under the scrutiny of regulatory bodies such as NICE. It is important that researchers understand the instruments used by these bodies to come to decisions regarding cost-effectiveness if patients are not to be disadvantaged by not being given access to these active new agents. This article outlines the models used by health economists and assesses their potential shortcomings. It also suggests alternative methods and identifies areas of research where improvements might be achieved.

  7. Analysis of U.S. School Bus Populations and Alternative Fuel Potential

    SciTech Connect

    Laughlin, M.

    2004-04-01

    This Clean Cities final report provides information concerning different school bus types, school bus populations, school bus miles and fuel use, school bus emissions, alternative fuel school buses, and potential for alternative fuel school bus use through 2010. It is intended to provide general information concerning the size of the school bus market in the U.S., as well as to provide some quantification of the potential for alternative fuel use in school buses in the U.S., and what that might mean for petroleum displacement and emissions reductions.

  8. Potential of MALDI-TOF MS as an alternative approach for capsular typing Streptococcus pneumoniae isolates

    PubMed Central

    Pinto, Tatiana C. A.; Costa, Natalia S.; Castro, Luciana F. S.; Ribeiro, Rachel L.; Botelho, Ana Caroline N.; Neves, Felipe P. G.; Peralta, Jose Mauro; Teixeira, Lucia M.

    2017-01-01

    Streptococcus pneumoniae can be classified in more than 90 capsular types, as traditionally determined by serological methods and more recently by PCR-based techniques. Such methods, however, can be expensive, laborious or unable to accurately discriminate among certain serotypes. Therefore, determination of capsular types, although extremely important for epidemiological purposes and for estimating the impact of pneumococcal conjugate vaccines, is mainly restricted to research laboratories, being rarely performed in the clinical setting. In the present study, MALDI-TOF MS was evaluated as an alternative tool to characterize 416 pneumococcal isolates belonging to serotypes 6A, 6B, 6C, 9N, 9V or 14. For MALDI-TOF MS analysis, each isolate was submitted to an extraction protocol using formic acid and acetonitrile. Measurements were performed with a Bruker Microflex LT mass spectrometer using default parameters and generating spectra in the range of 2,000–20,000 m/z. Spectra were analyzed with the BioNumerics software v7.6. Isolates were mainly distributed according to the capsular type in a Neighbor Joining tree and serotypes investigated were successfully discriminated by the presence/absence of 14 selected biomarkers. The results suggest that MALDI-TOF MS is a promising alternative for typing pneumococcal strains, highlighting its usefulness for rapid and cost-effective routine application in clinical laboratories. PMID:28349999

  9. Media and Cost-Effectiveness.

    ERIC Educational Resources Information Center

    Molnar, Andrew R.

    1970-01-01

    Instructional media systems might be of help in meeting the educational crisis of today, but it is difficult to find systems which reached the potential demonstrated in pilot efforts. Some of the more obvious reasons for the failures in educational technology are these: there is research but not development, equipment but no materials, a market…

  10. Cost effectiveness of type 2 diabetes screening: A systematic review

    PubMed Central

    Najafi, Behzad; Farzadfar, Farshad; Ghaderi, Hossein; Hadian, Mohammad

    2016-01-01

    Background: Although studies reported diabetes mellitus screening cost effective, the mass screening for type2 diabetes remains controversial. In this study we reviewed the recently evidence about the cost effectiveness of mass screening systematically. Methods: We reviewed the MEDLINE, Scopus, Web of Science (WOS), and Cochrane library databases by MeSH terms to identify relevant studies from 2000 to 2013. We had 4 inclusion and 6 exclusion criteria and used the Drummond’s checklist for appraising the quality of studies. Results: The initial search yielded 358 potentially related studies from selected databases. 6 studies met our inclusion and exclusion criteria and included in final review. 3 and 2 of them were conducted in Europe and America and only one of them in Asia. Quality-adjusted life year (QALY) was the main outcome to appraise the effectiveness in the studies. Incremental cost effectiveness ratio (ICER) was computed in range from $516.33 to $126,238 per QALY in the studies. Conclusion: A review of previous diabetes screening cost effectiveness analysis showed that the studies varied in some aspects but reached similar conclusions. They concluded that the screening may be cost effective, however further studies is required to support the diabetes mass screening. PMID:27390696

  11. Cost Effective Repair Techniques for Turbine Airfoils. Volume I

    DTIC Science & Technology

    1978-11-01

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

  12. Geography of Existing and Potential Alternative Fuel Markets in the United States

    SciTech Connect

    Johnson, C.; Hettinger, D.

    2014-11-01

    When deploying alternative fuels, it is paramount to match the right fuel with the right location, in accordance with local market conditions. We used six market indicators to evaluate the existing and potential regional market health for each of the five most commonly deployed alternative fuels: electricity (used by plug-in electric vehicles), biodiesel (blends of B20 and higher), E85 ethanol, compressed natural gas (CNG), and propane. Each market indicator was mapped, combined, and evaluated by industry experts. This process revealed the weight the market indicators should be given, with the proximity of fueling stations being the most important indicator, followed by alternative fuel vehicle density, gasoline prices, state incentives, nearby resources, and finally, environmental benefit. Though markets vary among states, no state received 'weak' potential for all five fuels, indicating that all states have an opportunity to use at least one alternative fuel. California, Illinois, Indiana, Pennsylvania, and Washington appear to have the best potential markets for alternative fuels in general, with each sporting strong markets for four of the fuels. Wyoming showed the least potential, with weak markets for all alternative fuels except for CNG, for which it has a patchy market. Of all the fuels, CNG is promising in the greatest number of states--largely because freight traffic provides potential demand for many far-reaching corridor markets and because the sources of CNG are so widespread geographically.

  13. Cost effectiveness and efficiency in assistive technology service delivery.

    PubMed

    Warren, C G

    1993-01-01

    In order to develop and maintain a viable service delivery program, the realities of cost effectiveness and cost efficiency in providing assistive technology must be addressed. Cost effectiveness relates to value of the outcome compared to the expenditures. Cost efficiency analyzes how a provider uses available resources to supply goods and services. This paper describes how basic business principles of benefit/cost analysis can be used to determine cost effectiveness. In addition, basic accounting principles are used to illustrate methods of evaluating a program's cost efficiency. Service providers are encouraged to measure their own program's effectiveness and efficiency (and potential viability) in light of current trends. This paper is meant to serve as a catalyst for continued dialogue on this topic.

  14. Direct estimation of the cost effectiveness of tornado shelters.

    PubMed

    Simmons, Kevin M; Sutter, Daniel

    2006-08-01

    This article estimates the cost effectiveness of tornado shelters using the annual probability of a tornado and new data on fatalities per building struck by a tornado. This approach differs from recent estimates of the cost effectiveness of tornado shelters in Reference 1 that use historical casualties. Historical casualties combine both tornado risk and resident action. If residents of tornado-prone states take greater precautions, observed fatalities might not be much higher than in states with lower risk. Estimation using the tornado probability avoids this potential bias. Despite the very different method used, the estimates are 68 million US dollars in permanent homes and 6.0 million US dollars in mobile homes in Oklahoma using a 3% real discount rate, within about 10% of estimates based on historical fatalities. The findings suggest that shelters provide cost-effective protection for mobile homes in the most tornado-prone states but not for permanent homes.

  15. Thiopurine S- methyltransferase [corrected] testing in idiopathic pulmonary fibrosis: a pharmacogenetic cost-effectiveness analysis.

    PubMed

    Hagaman, Jared T; Kinder, Brent W; Eckman, Mark H

    2010-04-01

    Azathioprine in combination with N-acetylcysteine (NAC) and steroids is a standard therapy for idiopathic pulmonary fibrosis (IPF). Its use, however, is limited by its side effects, principally leukopenia. A genotypic assay, thiopurine S-methyltransferase (TPMT), has been developed that can potentially identify those at risk for developing leukopenia with azathioprine, and thereby limit its toxicity. In those with abnormal TPMT activity, azathioprine can be started at lower dose or an alternate regimen selected. Determine the cost-effectiveness of a treatment strategy using TPMT testing before initiation of azathioprine, NAC, and steroids in IPF by performing a computer-based simulation. We developed a decision analytic model comparing three strategies: azathioprine, NAC and steroids with and without prior TPMT testing, and conservative therapy, consisting of only supportive measures. Prevalence of abnormal TPMT alleles and complication rates of therapy were taken from the literature. We assumed a 12.5% incidence of abnormal TPMT alleles, 4% overall incidence of leukopenia while taking azathioprine, and that azathioprine, NAC, and steroids in combination reduced IPF disease progression by 14% during 12 months. TPMT testing before azathioprine, NAC, and steroids was the most effective and most costly strategy. The marginal cost-effectiveness of the TPMT testing strategy was $49,156 per quality adjusted life year (QALY) gained versus conservative treatment. Compared with azathioprine, NAC and steroids without prior testing, the TPMT testing strategy cost only $29,662 per QALY gained. In sensitivity analyses, when the prevalence of abnormal TPMT alleles was higher than our base case, TPMT was "cost-effective." At prevalence rates lower than our base case, it was not. TPMT testing before initiating therapy with azathioprine, NAC, and steroids is a cost-effective treatment strategy for IPF.

  16. Solar central receiver hybrid - A cost effective future power alternative

    NASA Astrophysics Data System (ADS)

    Beshore, D. G.; Bolton, C. N.; Montague, J. E.

    1980-05-01

    System analyses and conceptual designs of solar central receiver hybrid concepts using molten salt (60% NaNO3, 40% KNO3 by weight) and fossil fired nonsolar energy sources (coal, oil, or gas) have been performed. Analyses have developed plant configurations with various solar energy storage capacities and fossil fuels. Economic analyses support the final configuration selection based on minimization of the cost of energy produced from the plant. A 500 MWe commercial plant size installed for a 1990 initial year of operation is competitive with new coal, oil, and nuclear power generation sources. This hybrid plant will save an estimated 5 million barrels of oil per year.

  17. Cost-Effective Stress Management Training.

    ERIC Educational Resources Information Center

    Shea, Gordon F.

    1980-01-01

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

  18. Cost effectiveness of robotic mitral valve surgery

    PubMed Central

    2017-01-01

    Significant technological advances have led to an impressive evolution in mitral valve surgery over the last two decades, allowing surgeons to safely perform less invasive operations through the right chest. Most new technology comes with an increased upfront cost that must be measured against postoperative savings and other advantages such as decreased perioperative complications, faster recovery, and earlier return to preoperative level of functioning. The Da Vinci robot is an example of such a technology, combining the significant benefits of minimally invasive surgery with a “gold standard” valve repair. Although some have reported that robotic surgery is associated with increased overall costs, there is literature suggesting that efficient perioperative care and shorter lengths of stay can offset the increased capital and intraoperative expenses. While data on current cost is important to consider, one must also take into account future potential value resulting from technological advancement when evaluating cost-effectiveness. Future refinements that will facilitate more effective surgery, coupled with declining cost of technology will further increase the value of robotic surgery compared to traditional approaches. PMID:28203539

  19. [Cost-effectiveness of colorectal cancer screening].

    PubMed

    Heresbach, Denis; Manfrédi, Sylvain; Branger, Bernard; Bretagne, Jean-François

    2006-01-01

    Colorectal cancer (CRC) screening in France is based on a faecal occult blood test every two years in average risk subjects 50-74 years of age while other endoscopic or non-endoscopic screening methods are used in Europe and in the USA. Beside the reduced incidence of and mortality from CRC found in available studies, cost-effectiveness data need to be taken into account. Because of the delay between randomized controlled trials and clinical results, transitional probabilistic models of screening programs are useful for public health policy makers. The aim of the present review was to promote the implementation of cost-effectiveness studies, to provide a guide to analyze cost-effectiveness studies on CRC screening and, to propose a French cost effectiveness study comparing CRC screening strategies. Most of these trials were performed by US or UK authors and demonstrate that the incremental cost-effectiveness ratio varies between 5 000 and 15 000 US dollars/one year life gained, with wide variations: these results were highly dependent on the unit costs of the different devices as well as the predictive values of the screening tests. Although CRC screening programs have been implemented in several administrative districts of France since 2002, and the results of these randomized controlled trials using fecal occult blood have been updated, cost-effectiveness criteria need to be integrated; especially since the results of screening campaigns based on other tools such as flexible sigmoidoscopy should be available in 2007.

  20. Cost effectiveness of the implantable cardioverter defibrillator: a preliminary analysis

    PubMed Central

    O'Brien, Bernie J; Buxton, Martin J; Rushby, Julia A

    1992-01-01

    Background—An implantable cardioverter defibrillator (ICD) may be effective in reducing the risk of sudden cardiac death. The high cost of ICD treatment, however, compared with alternatives raises the question of whether this new technology is an efficient use of scarce health care resources. Objective—To estimate the incremental cost effectiveness of the implantable cardioverter defibrillator compared with drug treatment with amiodarone in the management of patients at high risk of sudden cardiac death. Design—A cost effectiveness model was constructed from data already published and other secondary sources. Differences in patient survival were calculated from life tables for comparable ICD and amiodarone patient series. Costs were based on typical patient management protocols derived from current United Kingdom practice and interviews with physicians. Main outcome measures—Cost effectiveness of ICD treatment was computed over 20 years; all future costs and effects were discounted at 6% per year. Results—Estimated life expectancy was 11·1 and 6·7 years with ICD and amiodarone respectively; the discounted 20 year difference lies in the range 1·7 to 3·7 years. Discounted 20 year treatment costs were £28 400 for the ICD and £2300 for amiodarone. Cost effectiveness of ICD treatment lies in the range of £15 400 to £8200 per life-year gained. Conclusions—Cost effectiveness of ICD treatment is similar to some existing cardiac programmes funded under the NHS but uncertainty exists due to limitations of the data. Costs of ICD treatment may fall in the future as the life of the device increases and less invasive implantation methods are needed. The effectivess of ICD compared with amiodarone is currently being studied by a randomised controlled trial. PMID:1389748

  1. Are current cost-effectiveness thresholds for low- and middle-income countries useful? Examples from the world of vaccines.

    PubMed

    Newall, A T; Jit, M; Hutubessy, R

    2014-06-01

    The World Health Organization's CHOosing Interventions that are Cost Effective (WHO-CHOICE) thresholds for averting a disability-adjusted life-year of one to three times per capita income have been widely cited and used as a measure of cost effectiveness in evaluations of vaccination for low- and middle-income countries (LMICs). These thresholds were based upon criteria set out by the WHO Commission on Macroeconomics and Health, which reflected the potential economic returns of interventions. The CHOICE project sought to evaluate a variety of health interventions at a subregional level and classify them into broad categories to help assist decision makers, but the utility of the thresholds for within-country decision making for individual interventions (given budgetary constraints) has not been adequately explored. To examine whether the 'WHO-CHOICE thresholds' reflect funding decisions, we examined the results of two recent reviews of cost-effectiveness analyses of human papillomavirus and rotavirus vaccination in LMICs, and we assessed whether the results of these studies were reflected in funding decisions for these vaccination programmes. We found that in many cases, programmes that were deemed cost effective were not subsequently implemented in the country. We consider the implications of this finding, the advantages and disadvantages of alternative methods to estimate thresholds, and how cost perspectives and the funders of healthcare may impact on these choices.

  2. Climate-change impact potentials as an alternative to global warming potentials

    NASA Astrophysics Data System (ADS)

    Kirschbaum, Miko U. F.

    2014-03-01

    For policy applications, such as for the Kyoto Protocol, the climate-change contributions of different greenhouse gases are usually quantified through their global warming potentials. They are calculated based on the cumulative radiative forcing resulting from a pulse emission of a gas over a specified time period. However, these calculations are not explicitly linked to an assessment of ultimate climate-change impacts. A new metric, the climate-change impact potential (CCIP), is presented here that is based on explicitly defining the climate-change perturbations that lead to three different kinds of climate-change impacts. These kinds of impacts are: (1) those related directly to temperature increases; (2) those related to the rate of warming; and (3) those related to cumulative warming. From those definitions, a quantitative assessment of the importance of pulse emissions of each gas is developed, with each kind of impact assigned equal weight for an overall impact assessment. Total impacts are calculated under the RCP6 concentration pathway as a base case. The relevant climate-change impact potentials are then calculated as the marginal increase of those impacts over 100 years through the emission of an additional unit of each gas in 2010. These calculations are demonstrated for CO2, methane and nitrous oxide. Compared with global warming potentials, climate-change impact potentials would increase the importance of pulse emissions of long-lived nitrous oxide and reduce the importance of short-lived methane.

  3. Theoretical study of OCCHCN as a potential alternative insulation gas for SF6

    NASA Astrophysics Data System (ADS)

    Chen, Zhiguo; Zhang, Hui; Shang, Yan; Chen, Qingguo; Han, Baozhong; Li, Zesheng

    2017-01-01

    Cyanoketene (OCCHCN) has been reported as a potential alternative insulation gas for SF6 in Patent US0135817. Stationary point equilibrium geometries on the ground state have been optimized at the B3LYP/6-311+G(d,p) level, and the harmonic vibration frequencies are calculated at the same level. The HOMO-LUMO energy gaps (Eg), ionization potentials (IP), and electron affinities (EA) of the studied molecules are obtained. The minimum energy path (MEP) is obtained by the intrinsic reaction coordinate (IRC) theory, and the energetic information is further refined by QCISD(T) (single-point) method. The results show that OCCHCN can be used as SF6 alternative insulation gas in high voltage equipment according to potential energy surface analysis. As the isomerization and the cleavage reactions potential barriers are lower than the Eg and IP values, resulting in OCCHCN is not easy to be ionized and excited.

  4. Brain Games as a Potential Nonpharmaceutical Alternative for the Treatment of ADHD

    ERIC Educational Resources Information Center

    Wegrzyn, Stacy C.; Hearrington, Doug; Martin, Tim; Randolph, Adriane B.

    2013-01-01

    Attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed childhood neurobehavioral disorder, affecting approximately 5.5 million children, of which approximately 66% take ADHD medication daily. This study investigated a potential nonpharmaceutical alternative to address the academic engagement of 5th through 11th grade…

  5. An Examination of the Transformative Learning Potential of Alternative Spring Breaks

    ERIC Educational Resources Information Center

    Mann, Jessica; DeAngelo, Linda

    2016-01-01

    As institutions seek to offer students an educational experience equipped with opportunities to develop as not only active learners but also engaged citizens, service-learning initiatives in the form of alternative spring breaks (ASB) have become prevalent. This study examines the potential of ASBs, as service-learning initiatives, to deliver a…

  6. 76 FR 24925 - Solicitation for Public Comment on Potential Alternatives To Resolve Generic Safety Issue 191...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-03

    ... informing the path forward to resolve Generic Safety Issue (GSI) 191, Pressurized Water Reactor (PWR) Sump... COMMISSION Solicitation for Public Comment on Potential Alternatives To Resolve Generic Safety Issue 191, Pressurized Water Reactor Sump Performance AGENCY: Nuclear Regulatory Commission (NRC). ACTION:...

  7. Selecting cost-effective areas for restoration of ecosystem services.

    PubMed

    Adame, M F; Hermoso, V; Perhans, K; Lovelock, C E; Herrera-Silveira, J A

    2015-04-01

    Selection of areas for restoration should be based on cost-effectiveness analysis to attain the maximum benefit with a limited budget and overcome the traditional ad hoc allocation of funds for restoration projects. Restoration projects need to be planned on the basis of ecological knowledge and economic and social constraints. We devised a novel approach for selecting cost-effective areas for restoration on the basis of biodiversity and potential provision of 3 ecosystem services: carbon storage, water depuration, and coastal protection. We used Marxan, a spatial prioritization tool, to balance the provision of ecosystem services against the cost of restoration. We tested this approach in a mangrove ecosystem in the Caribbean. Our approach efficiently selected restoration areas that at low cost were compatible with biodiversity targets and that maximized the provision of one or more ecosystem services. Choosing areas for restoration of mangroves on the basis carbon storage potential, largely guaranteed the restoration of biodiversity and other ecosystem services.

  8. Supported employment: cost-effectiveness across six European sites

    PubMed Central

    Knapp, Martin; Patel, Anita; Curran, Claire; Latimer, Eric; Catty, Jocelyn; Becker, Thomas; Drake, Robert E; Fioritti, Angelo; Kilian, Reinhold; Lauber, Christoph; Rössler, Wulf; Tomov, Toma; van Busschbach, Jooske; Comas-Herrera, Adelina; White, Sarah; Wiersma, Durk; Burns, Tom

    2013-01-01

    A high proportion of people with severe mental health problems are unemployed but would like to work. Individual Placement and Support (IPS) offers a promising approach to establishing people in paid employment. In a randomized controlled trial across six European countries, we investigated the economic case for IPS for people with severe mental health problems compared to standard vocational rehabilitation. Individuals (n=312) were randomized to receive either IPS or standard vocational services and followed for 18 months. Service use and outcome data were collected. Cost-effectiveness analysis was conducted with two primary outcomes: additional days worked in competitive settings and additional percentage of individuals who worked at least 1 day. Analyses distinguished country effects. A partial cost-benefit analysis was also conducted. IPS produced better outcomes than alternative vocational services at lower cost overall to the health and social care systems. This pattern also held in disaggregated analyses for five of the six European sites. The inclusion of imputed values for missing cost data supported these findings. IPS would be viewed as more cost-effective than standard vocational services. Further analysis demonstrated cost-benefit arguments for IPS. Compared to standard vocational rehabilitation services, IPS is, therefore, probably cost-saving and almost certainly more cost-effective as a way to help people with severe mental health problems into competitive employment. PMID:23471803

  9. Cost-effectiveness of lowering the aflatoxin tolerance level.

    PubMed

    Dichter, C R; Weinstein, M C

    1984-06-01

    The cost-effectiveness of adopting aflatoxin tolerance levels of 15, 10 and 5 ppb for peanuts and peanut products was assessed. Estimates of the annual cost to manufacturers of monitoring and controlling peanut aflatoxin levels at the current 20-ppb action level, and estimates of the projected increase in costs of establishing lower tolerances were elicited from producers by questionnaire. Exposures to peanut products were derived from the HANES I survey and from peanut production statistics. The risk of liver cancer at each tolerance level was estimated using both epidemiological and extrapolated experimental data assuming that exposure would be reduced in direct proportion to the decrease in the tolerance. It was found that the 15-ppb tolerance would cost $60,000 per cancer death averted (range $20,000-$1,700,000) and is therefore relatively cost-effective. The marginal costs per life saved for both the 10-ppb and 5-ppb levels were found to be $1.7 million (range $0.6 million-$11.4 million) and $1.6 million (range +0.6 million-$31.1 million), respectively. Conclusions on the optimal regulatory approach should be guided by comparisons of these figures with corresponding cost-effectiveness ratios for alternative regulatory uses of national resources in the interests of public health.

  10. A cost effective data management subsystem for the LST

    NASA Technical Reports Server (NTRS)

    Dougherty, J. A.; Patterson, T. D.; Cole, A. E.

    1975-01-01

    The paper outlines the approach used in developing DMS (Data Management Subsystem) alternatives for the LST (Large Space Telescope) and in selecting the concept considered to be the most cost effective means of implementing the LST DMS requirements. Two candidate DMS concepts are discussed: a functionally integrated and a functionally separated one. For the single vehicle LST program, separation of the DMS functions best provides high reliability, operations flexibility, minimal interface complexity, and the least complex software development and verification task. The use of available hardware and NASA standard components is stressed.

  11. Key aspects of cost effective collector and solar field design

    NASA Astrophysics Data System (ADS)

    von Reeken, Finn; Nicodemo, Dario; Keck, Thomas; Weinrebe, Gerhard; Balz, Markus

    2016-05-01

    A study has been performed where different key parameters influencing solar field cost are varied. By using levelised cost of energy as figure of merit it is shown that parameters like GoToStow wind speed, heliostat stiffness or tower height should be adapted to respective site conditions from an economical point of view. The benchmark site Redstone (Northern Cape Province, South Africa) has been compared to an alternate site close to Phoenix (AZ, USA) regarding site conditions and their effect on cost-effective collector and solar field design.

  12. Cost-Effective Helicopter Options for Partner Nations

    DTIC Science & Technology

    2015-01-01

    elevation feature MGTOW maximum gross takeoff weight MOB main operating base MoD Ministry of Defense MoI Ministry of Interior nm nautical miles NSRW...we provided a main operat- ing base ( MOB ) or forward operating base (FOB) from which operations would be conducted. In these instances, the...RAND RR141z1-2.2 MOB /FOB MOB /FOB X Y Z LZs Alternate LZs 23 nmPrimary LZ Bor der Bor der 120º 120º 10 Cost-Effective Helicopter Options for Partner

  13. A Cost-Effective Model for Digital Forensic Investigations

    NASA Astrophysics Data System (ADS)

    Overill, Richard; Kwan, Michael; Chow, Kam-Pui; Lai, Pierre; Law, Frank

    Because of the way computers operate, every discrete event potentially leaves a digital trace. These digital traces must be retrieved during a digital forensic investigation to prove or refute an alleged crime. Given resource constraints, it is not always feasible (or necessary) for law enforcement to retrieve all the related digital traces and to conduct comprehensive investigations. This paper attempts to address the issue by proposing a model for conducting swift, practical and cost-effective digital forensic investigations.

  14. The potential of tissue engineering for developing alternatives to animal experiments: a systematic review.

    PubMed

    de Vries, Rob B M; Leenaars, Marlies; Tra, Joppe; Huijbregtse, Robbertjan; Bongers, Erik; Jansen, John A; Gordijn, Bert; Ritskes-Hoitinga, Merel

    2015-07-01

    An underexposed ethical issue raised by tissue engineering is the use of laboratory animals in tissue engineering research. Even though this research results in suffering and loss of life in animals, tissue engineering also has great potential for the development of alternatives to animal experiments. With the objective of promoting a joint effort of tissue engineers and alternative experts to fully realise this potential, this study provides the first comprehensive overview of the possibilities of using tissue-engineered constructs as a replacement of laboratory animals. Through searches in two large biomedical databases (PubMed, Embase) and several specialised 3R databases, 244 relevant primary scientific articles, published between 1991 and 2011, were identified. By far most articles reviewed related to the use of tissue-engineered skin/epidermis for toxicological applications such as testing for skin irritation. This review article demonstrates, however, that the potential for the development of alternatives also extends to other tissues such as other epithelia and the liver, as well as to other fields of application such as drug screening and basic physiology. This review discusses which impediments need to be overcome to maximise the contributions that the field of tissue engineering can make, through the development of alternative methods, to the reduction of the use and suffering of laboratory animals.

  15. The cost-effectiveness of health communication programs: what do we know?

    PubMed

    Hutchinson, Paul; Wheeler, Jennifer

    2006-01-01

    While a considerable body of evidence has emerged supporting the effectiveness of communication programs in augmenting health, only a very small subset of studies has examined also whether these programs are cost-effective, that is, whether they achieve greater health gains for available financial resources than alternative interventions. In this article, we examine the available literature on the cost-effectiveness of health behavior change communication programs, focusing on communication interventions involving mass media, and, to a lesser extent, community mobilization and interpersonal communication or counseling. Our objective is to identify the state of past and current research efforts of the cost-effectiveness of behavior change communication programs. This review makes three principal conclusions. First, the analysis of the cost-effectiveness of health communication programs commonly has not been performed. Second, the studies reviewed here have utilized a considerable diversity of methods and have reflected varying levels of quality and adherence to standard cost-effectiveness methodologies. This leads to problems of transparency, comparability, and generalizability. Third, while the available studies generally are indicative of the cost-effectiveness of communication interventions relative to alternatives, the evidence base clearly needs to be expanded by additional rigorous cost-effectiveness analyses.

  16. Cost-effectiveness analysis and innovation.

    PubMed

    Jena, Anupam B; Philipson, Tomas J

    2008-09-01

    While cost-effectiveness (CE) analysis has provided a guide to allocating often scarce resources spent on medical technologies, less emphasis has been placed on the effect of such criteria on the behavior of innovators who make health care technologies available in the first place. A better understanding of the link between innovation and cost-effectiveness analysis is particularly important given the large role of technological change in the growth in health care spending and the growing interest of explicit use of CE thresholds in leading technology adoption in several Westernized countries. We analyze CE analysis in a standard market context, and stress that a technology's cost-effectiveness is closely related to the consumer surplus it generates. Improved CE therefore often clashes with interventions to stimulate producer surplus, such as patents. We derive the inconsistency between technology adoption based on CE analysis and economic efficiency. Indeed, static efficiency, dynamic efficiency, and improved patient health may all be induced by the cost-effectiveness of the technology being at its worst level. As producer appropriation of the social surplus of an innovation is central to the dynamic efficiency that should guide CE adoption criteria, we exemplify how appropriation can be inferred from existing CE estimates. For an illustrative sample of technologies considered, we find that the median technology has an appropriation of about 15%. To the extent that such incentives are deemed either too low or too high compared to dynamically efficient levels, CE thresholds may be appropriately raised or lowered to improve dynamic efficiency.

  17. Cost Effectiveness of On-Orbit Servicing

    DTIC Science & Technology

    2009-06-30

    distribution unlimited 1 AAS 09- XXX COST EFFECTIVENESS OF ON-ORBIT SERVICING Tiffany Rexius* This study was performed to model on...4,6 of total spacecraft failures and the pink line represents the model prediction of all failures. The pink “all failures” line is slightly higher

  18. Notes on Cost-Effectiveness Evaluation of Schooling in Developing Countries.

    ERIC Educational Resources Information Center

    Jamison, Dean T.

    Within the parameter of a given level of expenditure on the educational system as a function of time, this cost-effectiveness analysis examines all feasible ways of providing schooling in developing nations to see what levels of output each alternative method entails. Both technological and conventional alternatives are considered: degree of…

  19. 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

  20. French Brittany macroalgae screening: composition and methane potential for potential alternative sources of energy and products.

    PubMed

    Jard, G; Marfaing, H; Carrère, H; Delgenes, J P; Steyer, J P; Dumas, C

    2013-09-01

    Macroalgae are biomass resources that represent a valuable feedstock to be used entirely for human consumption or for food additives after some extractions (mainly colloids) and/or for energy production. In order to better develop the algal sector, it is important to determine the capacity of macroalgae to produce these added-values molecules for food and/or for energy industries on the basis of their biochemical characteristics. In this study, ten macroalgae obtained from French Brittany coasts (France) were selected. The global biochemical composition (proteins, lipids, carbohydrates, fibers), the presence and characteristics of added-values molecules (alginates, polyphenols) and the biochemical methane potential of these algae were determined. Regarding its biochemical composition, Palmaria palmata is interesting for food (rich in nutrients) and for anaerobic digestion (0.279 LCH4/gVS). Saccharina latissima could be used for alginate extraction (242 g/kgTS, ratio between mannuronic and guluronic acid M/G=1.4) and Sargassum muticum for polyphenol extraction (19.8 g/kgTS).

  1. Cost-effectiveness of Different Diabetic Retinopathy Screening Modalities.

    PubMed

    Pasquel, Francisco J; Hendrick, Andrew M; Ryan, Martha; Cason, Emily; Ali, Mohammed K; Narayan, K M Venkat

    2015-12-29

    Current screening strategies aimed at detection of diabetic retinopathy (DR) historically have poor compliance, but advancements in technology can enable improved access to care. Nearly 80% of all persons with diabetes live in low- and middle-income countries (LMICs), highlighting the importance of a cost effective screening program. Establishing mechanisms to reach populations with geographic and financial barriers to access is essential to prevent visual disability. Teleretinal programs leverage technology to improve access and reduce cost. The quality of currently employed screening modalities depends on many variables including the instrument used, use of pupillary mydriasis, number of photographic fields, and the qualifications of the photographer and image interpreter. Recent telemedicine and newer technological approaches have been introduced, but data for these technologies is yet limited. We present results of a systematic review of studies evaluating cost-effectiveness of DR screening, and discuss potential relevance for LMICs.

  2. A review of potential alternatives for air cleaning at the Hanford Waste Vitrification Plant

    SciTech Connect

    Sehmel, G.A.

    1990-07-01

    Pacific Northwest Laboratory conducted this review in support of the Hanford Waste Vitrification Plant (HWVP) being designed by Fluor Daniel Inc. for the US Department of Energy (DOE). The literature on air cleaning systems is reviewed to identify potential air cleaning alternatives that might be included in the design of HWVP. An overview of advantages/disadvantages of the various air cleaning technologies follows. Information and references are presented for the following potential air cleaning alternatives: deep-bed glass-fiber filters (DBGF), high-efficiency particulate air filters (HEPA), remote modular filter systems, high-efficiency mist eliminators (HEME), electrostatic precipitators, and the sand filter. Selected information is summarized for systems in the United States, Belgium, Japan, and West Germany. This review addresses high-capacity air cleaning systems currently used in the nuclear industry and emphasizes recent developments. 10 refs., 9 figs., 3 tabs.

  3. Cost-effectiveness analysis of a continuing care intervention for cocaine-dependent adults

    PubMed Central

    McCollister, Kathryn; Yang, Xuan; McKay, James R.

    2015-01-01

    Introduction The study conducts a cost-effectiveness analysis (CEA) of a continuing care Telephone Monitoring and Counseling (TMC) intervention for adults diagnosed with cocaine dependence. Participants were randomly assigned to a control condition of intensive outpatient treatment only (treatment-as-usual, or TAU; N = 108), or to one of two treatment conditions featuring TMC (N = 106) and TMC plus incentives (TMC-plus; N = 107). Follow-up assessments were conducted over a 2-year period. Methods Intervention and client costs were collected with the program and client versions of the Drug Abuse Treatment Cost Analysis Program (DATCAP). Effectiveness was measured as the number of days abstinent during follow-up. Secondary analyses consider alternative measures of effectiveness and the reduced societal costs of physical and mental health problems and criminal justice involvement. Results From the societal perspective, TMC dominates both TAU and TMC-plus as a cost-effective and cost-saving intervention. Results varied by substance-using status, however, with the subgroup of participants in TMC-plus that were using drugs at intake and early in treatment having the greatest number of days of abstinence and generating similar savings during follow-up than the TMC subgroup using drugs at intake. Conclusions Telephone monitoring and counseling appears to be a cost-effective and potentially cost-saving strategy for reducing substance use among chronic substance users. Providing client incentives added to total intervention costs but did not improve overall effectiveness. Clinical trial registration Clinical Trials.gov Number: NCT00685659. PMID:26621551

  4. Maximizing cost-effectiveness by adjusting treatment strategy according to glaucoma severity

    PubMed Central

    Guedes, Ricardo Augusto Paletta; Guedes, Vanessa Maria Paletta; Gomes, Carlos Eduardo de Mello; Chaoubah, Alfredo

    2016-01-01

    Abstract Background: The aim of this study is to determine the most cost-effective strategy for the treatment of primary open-angle glaucoma (POAG) in Brazil, from the payer's perspective (Brazilian Public Health System) in the setting of the Glaucoma Referral Centers. Methods: Study design was a cost-effectiveness analysis of different treatment strategies for POAG. We developed 3 Markov models (one for each glaucoma stage: early, moderate and advanced), using a hypothetical cohort of POAG patients, from the perspective of the Brazilian Public Health System (SUS) and a horizon of the average life expectancy of the Brazilian population. Different strategies were tested according to disease severity. For early glaucoma, we compared observation, laser and medications. For moderate glaucoma, medications, laser and surgery. For advanced glaucoma, medications and surgery. Main outcome measures were ICER (incremental cost-effectiveness ratio), medical direct costs and QALY (quality-adjusted life year). Results: In early glaucoma, both laser and medical treatment were cost-effective (ICERs of initial laser and initial medical treatment over observation only, were R$ 2,811.39/QALY and R$ 3,450.47/QALY). Compared to observation strategy, the two alternatives have provided significant gains in quality of life. In moderate glaucoma population, medical treatment presented the highest costs among treatment strategies. Both laser and surgery were highly cost-effective in this group. For advanced glaucoma, both tested strategies were cost-effective. Starting age had a great impact on results in all studied groups. Initiating glaucoma therapy using laser or surgery were more cost-effective, the younger the patient. Conclusion: All tested treatment strategies for glaucoma provided real gains in quality of life and were cost-effective. However, according to the disease severity, not all strategies provided the same cost-effectiveness profile. Based on our findings, there should be a

  5. High-throughput and Cost-effective Chicken Genotyping Using Next-Generation Sequencing

    PubMed Central

    Pértille, Fábio; Guerrero-Bosagna, Carlos; Silva, Vinicius Henrique da; Boschiero, Clarissa; Nunes, José de Ribamar da Silva; Ledur, Mônica Corrêa; Jensen, Per; Coutinho, Luiz Lehmann

    2016-01-01

    Chicken genotyping is becoming common practice in conventional animal breeding improvement. Despite the power of high-throughput methods for genotyping, their high cost limits large scale use in animal breeding and selection. In the present paper we optimized the CornellGBS, an efficient and cost-effective genotyping by sequence approach developed in plants, for its application in chickens. Here we describe the successful genotyping of a large number of chickens (462) using CornellGBS approach. Genomic DNA was cleaved with the PstI enzyme, ligated to adapters with barcodes identifying individual animals, and then sequenced on Illumina platform. After filtering parameters were applied, 134,528 SNPs were identified in our experimental population of chickens. Of these SNPs, 67,096 had a minimum taxon call rate of 90% and were considered ‘unique tags’. Interestingly, 20.7% of these unique tags have not been previously reported in the dbSNP. Moreover, 92.6% of these SNPs were concordant with a previous Whole Chicken-genome re-sequencing dataset used for validation purposes. The application of CornellGBS in chickens showed high performance to infer SNPs, particularly in exonic regions and microchromosomes. This approach represents a cost-effective (~US$50/sample) and powerful alternative to current genotyping methods, which has the potential to improve whole-genome selection (WGS), and genome-wide association studies (GWAS) in chicken production. PMID:27220827

  6. Increased cost-effectiveness of low-grade fossil fuels using ammonia FGD

    SciTech Connect

    Ellison, W.

    1998-07-01

    Current worldwide advancements in site-specific application and commercial operation of ammonia-base flue gas desulfurization (FGD), in high-capacity, high-sulfur, electric utility service, economically justified by significant revenues from ammonium sulfate generation and worldwide sale, are detailed. This major new direction in cost-effectiveness in FGD selection/application and in the process design of such flue gas cleaning systems overcomes the problem of FGD waste/byproduct management/utilization and encompasses numerous major performance advancements reviewed herein: (1) Conversion of anions of all captured acid-gas, i.e., SO{sub 2}, HCI, etc., and of all collected residual particulate matter into agriculturally-usable ammonium compounds combined in the single byproduct yield; (2) No discard or long-term, outdoor storage of sulfurous waste byproducts; and (3) No liquid effluent. In the face of a capital-cost penalty in any application of ammonia FGD, an attractive cost effectiveness is nonetheless realized. This favorable process economics, superior to all other available alternatives in high-capacity, high-sulfur electric utility service, is made possible through substantial value added in conversion of ammonia reagent supply to agglomerated sulfur blending stock, i.e., comprised principally of ammonium sulfate, much in demand for increased use in worldwide, large-scale agriculture. The growing, potentially vast size of the international market for ammonium sulfate is quantified herein.

  7. 42 CFR 457.1015 - Cost-effectiveness.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... of the cost-effectiveness of family coverage in the aggregate reveals that it is not cost-effective... 42 Public Health 4 2010-10-01 2010-10-01 false Cost-effectiveness. 457.1015 Section 457.1015... Waivers: General Provisions § 457.1015 Cost-effectiveness. (a) Definition. For purposes of this...

  8. Cost effective management of space venture risks

    NASA Technical Reports Server (NTRS)

    Giuntini, Ronald E.; Storm, Richard E.

    1986-01-01

    The development of a model for the cost-effective management of space venture risks is discussed. The risk assessment and control program of insurance companies is examined. A simplified system development cycle which consists of a conceptual design phase, a preliminary design phase, a final design phase, a construction phase, and a system operations and maintenance phase is described. The model incorporates insurance safety risk methods and reliability engineering, and testing practices used in the development of large aerospace and defense systems.

  9. Theater SBI cost-effectiveness ratios

    SciTech Connect

    Canavan, G.H.

    1993-11-01

    To address M missiles spaced at intervals longer than the constillation reconstitution time t, the defense needs at the absentee ratio N{sub a} of SBIs to fill the belt plus the M SBIs needed for the intercepts; the resulting cost effectiveness scales as M/(M + N{sub a}). N{sub a} is large and CER small for small ranges and numbers of missiles. For several-hundred missile threats, CERs are greater than unity for ranges of interest.

  10. Alternating block polyurethanes based on PCL and PEG as potential nerve regeneration materials.

    PubMed

    Li, Guangyao; Li, Dandan; Niu, Yuqing; He, Tao; Chen, Kevin C; Xu, Kaitian

    2014-03-01

    Polyurethanes with regular and controlled block arrangement, i.e., alternating block polyurethanes (abbreviated as PUCL-alt-PEG) based on poly(ε-caprolactone) (PCL-diol) and poly(ethylene glycol) (PEG) was prepared via selectively coupling reaction between PCL-diol and diisocyanate end-capped PEG. Chemical structure, molecular weight, distribution, and thermal properties were systematically characterized by FTIR, (1)H NMR, GPC, DSC, and TGA. Hydrophilicity was studied by static contact angle of H2O and CH2I2. Film surface was observed by scanning electron microscope (SEM) and atomic force microscopy, and mechanical properties were assessed by universal test machine. Results show that alternating block polyurethanes give higher crystal degree, higher mechanical properties, and more hydrophilic and rougher (deep ravine) surface than their random counterpart, due to regular and controlled structure. Platelet adhesion illustrated that PUCL-alt-PEG has better hemocompatibility and the hemacompatibility was affected significantly by PEG content. Excellent hemocompatibility was obtained with high PEG content. CCK-8 assay and SEM observation revealed much better cell compatibility of fibroblast L929 and rat glial cells on the alternating block polyurethanes than that on random counterpart. Alternating block polyurethane PUC20-a-E4 with optimized composition, mechanical, surface properties, hemacompatibility, and highest cell growth and proliferation was achieved for potential use in nerve regeneration.

  11. Cost effectiveness of stream-gaging program in Michigan

    USGS Publications Warehouse

    Holtschlag, D.J.

    1985-01-01

    This report documents the results of a study of the cost effectiveness of the stream-gaging program in Michigan. Data uses and funding sources were identified for the 129 continuous gaging stations being operated in Michigan as of 1984. One gaging station was identified as having insufficient reason to continue its operation. Several stations were identified for reactivation, should funds become available, because of insufficiencies in the data network. Alternative methods of developing streamflow information based on routing and regression analyses were investigated for 10 stations. However, no station records were reproduced with sufficient accuracy to replace conventional gaging practices. A cost-effectiveness analysis of the data-collection procedure for the ice-free season was conducted using a Kalman-filter analysis. To define missing-record characteristics, cross-correlation coefficients and coefficients of variation were computed at stations on the basis of daily mean discharge. Discharge-measurement data were used to describe the gage/discharge rating stability at each station. The results of the cost-effectiveness analysis for a 9-month ice-free season show that the current policy of visiting most stations on a fixed servicing schedule once every 6 weeks results in an average standard error of 12.1 percent for the current $718,100 budget. By adopting a flexible servicing schedule, the average standard error could be reduced to 11.1 percent. Alternatively, the budget could be reduced to $700,200 while maintaining the current level of accuracy. A minimum budget of $680,200 is needed to operate the 129-gaging-station program; a budget less than this would not permit proper service and maintenance of stations. At the minimum budget, the average standard error would be 14.4 percent. A budget of $789,900 (the maximum analyzed) would result in a decrease in the average standard error to 9.07 percent. Owing to continual changes in the composition of the network

  12. Cost effectiveness of detritiating water with resin columns

    SciTech Connect

    Drake, R.H.; Williams, D.S.

    1997-10-01

    There are technologies in use for cleaning up concentrated tritiated process water. These are not cost effective for tritiated water with low concentrations of tritium. There are currently no cost-effective technologies for cleaning up low-tritium-concentration tritiated water, such as most tritiated groundwater, spent fuel storage basin water, or underground storage tank water. Resin removal of tritium from tritiated water at low concentrations (near the order of magnitude of drinking water standard maximums) is being tested on TA-SO (Los Alamos National Laboratory`s Liquid Radioactive Waste Treatment Facility) waste streams. There are good theoretical and test indications that this may be a technologically effective means of removing tritium from tritiated water. Because of likely engineering design similarity, it is reasonable to anticipate that a resin column system`s costs will be similar to some common commercial water treatment systems. Thus, the potential cost effectiveness of a resin treatment system offers hope for treating tritiated water at affordable costs. The TA-50 resin treatment cost projection of $18 per 1,000 gallons is within the same order of magnitude as cost data for typical commercial groundwater cleanup projects. The prospective Los Alamos National Laboratory (LANL) resin treatment system at $18 per 1,000 gallons appears to have a likely cost advantage of at least an order of magnitude over the competing, developmental, water detritiation technologies.

  13. Cost-Effectiveness of Fiscal Policies to Prevent Obesity.

    PubMed

    Moodie, Marj; Sheppard, Lauren; Sacks, Gary; Keating, Catherine; Flego, Anna

    2013-01-01

    Cost-effective, sustainable strategies are urgently required to curb the global obesity epidemic. To date, fiscal policies such as taxes and subsidies have been driven largely by imperatives to raise revenue or increase supply, rather than to change population behaviours. This paper reviews the economic evaluation literature around the use of fiscal policies to prevent obesity. The cost-effectiveness literature is limited, and more robust economic evaluation studies are required. However, uncertainty and gaps in the effectiveness evidence base need to be addressed first: more studies are needed that collect 'real-world' empirical data, and larger studies with more robust designs and longer follow-up timeframes are required. Reliability of cross-price elasticity data needs to be investigated, and greater consideration given to moderators of intervention effects and the sustainability of outcomes. Economic evaluations should adopt a societal perspective, incorporate a broader spectrum of economic costs and consider other factors likely to affect the implementation of fiscal measures. The paucity of recent cost-effectiveness studies means that definitive conclusions about the value for money of fiscal policies for obesity prevention cannot yet be drawn. However, as in other public health areas such as alcohol and tobacco, early indications are that population-level fiscal policies are likely to be potentially effective and cost-saving.

  14. Using propensity scores to estimate the cost-effectiveness of medical therapies.

    PubMed

    Indurkhya, Alka; Mitra, Nandita; Schrag, Deborah

    2006-05-15

    The cost-effectiveness ratio is a popular statistic that is used by policy makers to decide which programs are cost-effective in the public health sector. Recently, the net monetary benefit has been proposed as an alternative statistical summary measure to overcome the limitations associated with the cost-effectiveness ratio. Research on using the net monetary benefit to assess the cost-effectiveness of therapies in non-randomized studies has yet to be done. Propensity scores are useful in estimating adjusted effectiveness of programs that have non-randomized or quasi-experimental designs. This article introduces the use of propensity score adjustment in cost-effectiveness analyses to estimate net monetary benefits for non-randomized studies. The uncertainty associated with the net monetary benefit estimate is evaluated using cost-effectiveness acceptability curves. Our method is illustrated by applying it to SEER-Medicare data for muscle invasive bladder cancer to determine the most cost-effective treatment protocol.

  15. Antimicrobial Peptides as Potential Alternatives to Antibiotics in Food Animal Industry.

    PubMed

    Wang, Shuai; Zeng, Xiangfang; Yang, Qing; Qiao, Shiyan

    2016-05-03

    Over the last decade, the rapid emergence of multidrug-resistant pathogens has become a global concern, which has prompted the search for alternative antibacterial agents for use in food animals. Antimicrobial peptides (AMPs), produced by bacteria, insects, amphibians and mammals, as well as by chemical synthesis, are possible candidates for the design of new antimicrobial agents because of their natural antimicrobial properties and a low propensity for development of resistance by microorganisms. This manuscript reviews the current knowledge of the basic biology of AMPs and their applications in non-ruminant nutrition. Antimicrobial peptides not only have broad-spectrum activity against bacteria, fungi, and viruses but also have the ability to bypass the common resistance mechanisms that are placing standard antibiotics in jeopardy. In addition, AMPs have beneficial effects on growth performance, nutrient digestibility, intestinal morphology and gut microbiota in pigs and broilers. Therefore, AMPs have good potential as suitable alternatives to conventional antibiotics used in swine and poultry industries.

  16. Emergence of large-scale vorticity during diffusion in a random potential under an alternating bias.

    PubMed

    Makeev, Maxim A; Derényi, Imre; Barabási, Albert-László

    2005-02-01

    Conventional wisdom indicates that the presence of an alternating driving force will not change the long-term behavior of a Brownian particle moving in a random potential. Although this is true in one dimension, here we offer direct evidence that the inevitable local symmetry breaking present in a two-dimensional random potential leads to the emergence of a local ratchet effect that generates large-scale vorticity patterns consisting of steady-state net diffusive currents. For small fields the spatial correlation function of the current follows a logarithmic distance dependence, while for large external fields both the vorticity and the correlations gradually disappear. We uncover the scaling laws characterizing this unique pattern formation process, and discuss their potential relevance to real systems.

  17. The "e" in cost-effectiveness analyses. A case study of omalizumab efficacy and effectiveness for cost-effectiveness analysis evidence.

    PubMed

    Campbell, Jonathan D; McQueen, R Brett; Briggs, Andrew

    2014-02-01

    This article is a call for increased use of real-world evidence in health technology assessment and related policy and decision making. There is currently a disconnect between evidence used to guide regulatory approval of therapies and evidence used to inform therapeutic coverage and reimbursement decisions. Public and private payers need to understand not only whether an intervention works but also whether it offers good value compared with licensed alternatives (not placebo) as they are used in the real-world practice and population (not in a controlled trial environment). Addressing such concerns requires evidence to be drawn from a wide range of study designs, but with consideration and weighting given to their relative strengths and weaknesses, as well as their position on the pragmatic-explanatory (i.e., effectiveness-efficacy) continuum. The potential impact of using different types of evidence to inform cost-effectiveness analysis (CEA) is discussed for omalizumab, comparing and contrasting a CEA model informed by an omalizumab efficacy trial to a CEA model drawing primarily on evidence from effectiveness observational studies of omalizumab. There was reasonable agreement between the two omalizumab CEA models, although the incremental cost-effectiveness ratio generated by the effectiveness observational study-driven model was more favorable for omalizumab. Health technology assessment bodies and payers must use their judgment to determine which components of efficacy-based and effectiveness-based CEA evidence are most closely aligned with their goals. For each CEA evidence component, perhaps the two E's form bounds of the truth as well as a fuller picture of the uncertainty surrounding the truth.

  18. Alternative derivation of an exchange-only density-functional optimized effective potential

    SciTech Connect

    Joubert, D. P.

    2007-10-15

    An alternative derivation of the exchange-only density-functional optimized effective potential equation is given. It is shown that the localized Hartree-Fock-common energy denominator Green's function approximation (LHF-CEDA) for the density-functional exchange potential proposed independently by Della Sala and Goerling [J. Chem. Phys. 115, 5718 (2001)] and Gritsenko and Baerends [Phys. Rev. A 64, 42506 (2001)] can be derived as an approximation to the OEP exchange potential in a similar way that the KLI approximation [Phys. Rev. A 45, 5453 (1992)] was derived. An exact expression for the correction term to the LHF-CEDA approximation can thus be found. The correction term can be expressed in terms of the first-order perturbation-theory many-electron wave function shift when the Kohn-Sham Hamiltonian is subjected to a perturbation equal to the difference between the density-functional exchange potential and the Hartree-Fock nonlocal potential, expressed in terms of the Kohn-Sham orbitals. An explicit calculation shows that the density weighted mean of the correction term is zero, confirming that the LHF-CEDA approximation can be interpreted as a mean-field approximation. The corrected LHF-CEDA equation and the optimized effective potential equation are shown to be identical, with information distributed differently between terms in the equations. For a finite system the correction term falls off at least as fast as 1/r{sup 4} for large r.

  19. Development of Alternating Current Potential Drop (ACPD) procedures for crack detection in aluminum aircraft panels

    NASA Astrophysics Data System (ADS)

    Jablonski, D. A.

    1993-12-01

    The Alternating Current Potential Drop (ACPD) method is investigated as a means of making measurements in laboratory experiments on the initiation and growth of multiple site damage (MSD) cracks in a common aluminum alloy used for aircraft construction. Procedures for instrumenting MSD test specimens are recommended. The ACPD method is found to be capable of the following: (1) detecting crack initiation at a crack length of the order of 1 mm; (2) monitoring crack propagation at a resolution of the order of 5 micrometers; and (3) providing an indirect measurement of crack extension in R-curve type tests of fastener hole details.

  20. Potential use of California lignite and other alternate fuel for enhanced oil recovery. Phase I and II. Final report. [As alternative fuels for steam generation in thermal EOR

    SciTech Connect

    Shelton, R.; Shimizu, A.; Briggs, A.

    1980-02-01

    The Nation's continued reliance on liquid fossil fuels and decreasing reserves of light oils gives increased impetus to improving the recovery of heavy oil. Thermal enhanced oil recovery EOR techniques, such as steam injection, have generally been the most effective for increasing heavy oil production. However, conventional steam generation consumes a large fraction of the produced oil. The substitution of alternate (solid) fuels would release much of this consumed oil to market. This two-part report focuses on two solid fuels available in California, the site of most thermal EOR - petroleum coke and lignite. Phase I, entitled Economic Analysis, shows detailed cost comparisons between the two candidate fuels and also with Western coal. The analysis includes fuels characterizations, process designs for several combustion systems, and a thorough evaluation of the technical and economic uncertainties. In Phase II, many technical parameters of petroleum coke combustion were measured in a pilot-plant fluidized bed. The results of the study showed that petroleum coke combustion for EOR is feasible and cost effective in a fluidized bed combustor.

  1. The Real Problem (Humans) and Some Potentially Effective Alternatives and New Tools

    SciTech Connect

    Hanlon, Edward; Capece, John

    2011-01-07

    The presentation offers a wider perspective, where on the example of Everglades’ restoration efforts, the real problem – humans – is exposed. Some potentially effective alternatives and new tools are offered and discussed. Everglades’s problems are primarily caused to human activity, whether these are related to poor water quality, land use changes or cheap short-sighted fixes. Ground rules need to be set in order to have a real discussion and seek real solutions to such problems. The difference between facts and opinions is explained, so is the difference between interests and positions. These terms are often partly coinciding in human minds, thus causing further misunderstandings in pursuing real solutions. Some confounding factors in the Everglades restoration efforts are listed, with one of the main examples being the assignment of a monetary value to all factors. Some of these factors are priceless, but not being valued easily and properly (such as water). The proposed alternative to monetary value is assigning energy as the unit of measurement. The two main methods for such alternate approach are (1) Embodied energy (Emergy) and (2) Life Cycle Analysis. Agriculturally-based ecosystems services are different from natural ecosystems services. Pursuing agriculturally-based ecosystems services (such as e.g. water storage on farms, reducing nutrients in water, using flood-tolerant crops cultivars, etc.) can develop eco-services into agricultural operations and systems, addressing everyone’s interest and benefiting the society.

  2. Potential Alternative Lower Global Warming Refrigerants for Air Conditioning in Hot Climates

    SciTech Connect

    Abdelaziz, Omar; Shrestha, Som S; Shen, Bo

    2017-01-01

    The earth continues to see record increase in temperatures and extreme weather conditions that is largely driven by anthropogenic emissions of warming gases such as carbon dioxide and other more potent greenhouse gases such as refrigerants. The cooperation of 188 countries in the Conference of the Parties in Paris 2015 (COP21) resulted in an agreement aimed to achieve a legally binding and universal agreement on climate, with the aim of keeping global warming below 2 C. A global phasedown of hydrofluorocarbons (HFCs) can prevent 0.5 C of warming by 2100. However, most of the countries in hot climates are considered as developing countries and as such are still using R-22 (a Hydrochlorofluorocarbon (HCFC)) as the baseline refrigerant and are currently undergoing a phase-out of R-22 which is controlled by current Montreal Protocol to R-410A and other HFC based refrigerants. These HFCs have significantly high Global Warming Potential (GWP) and might not perform as well as R-22 at high ambient temperature conditions. In this paper we present recent results on evaluating the performance of alternative lower GWP refrigerants for R-22 and R-410A for small residential mini-split air conditioners and large commercial packaged units. Results showed that several of the alternatives would provide adequate replacement for R-22 with minor system modification. For the R-410A system, results showed that some of the alternatives were almost drop-in ready with benefit in efficiency and/or capacity. One of the most promising alternatives for R-22 mini-split unit is propane (R-290) as it offers higher efficiency; however it requires compressor and some other minor system modification to maintain capacity and minimize flammability risk. Between the R-410A alternatives, R-32 appears to have a competitive advantage; however at the cost of higher compressor discharge temperature. With respect to the hydrofluoroolefin (HFO) blends, there existed a tradeoff in performance and system design

  3. Knee Joint Distraction Compared to Total Knee Arthroplasty for Treatment of End Stage Osteoarthritis: Simulating Long-Term Outcomes and Cost-Effectiveness

    PubMed Central

    van der Woude, J. A. D.; Nair, S. C.; Custers, R. J. H.; van Laar, J. M.; Kuchuck, N. O.; Lafeber, F. P. J. G.; Welsing, P. M. J.

    2016-01-01

    Objective In end-stage knee osteoarthritis the treatment of choice is total knee arthroplasty (TKA). An alternative treatment is knee joint distraction (KJD), suggested to postpone TKA. Several studies reported significant and prolonged clinical improvement of KJD. To make an appropriate decision regarding the position of this treatment, a cost-effectiveness and cost-utility analysis from healthcare perspective for different age and gender categories was performed. Methods A treatment strategy starting with TKA and a strategy starting with KJD for patients of different age and gender was simulated. To extrapolate outcomes to long-term health and economic outcomes a Markov (Health state) model was used. The number of surgeries, QALYs, and treatment costs per strategy were calculated. Costs-effectiveness is expressed using the cost-effectiveness plane and cost-effectiveness acceptability curves. Results Starting with KJD the number of knee replacing procedures could be reduced, most clearly in the younger age categories; especially revision surgery. This resulted in the KJD strategy being dominant (more effective with cost-savings) in about 80% of simulations (with only inferiority in about 1%) in these age categories when compared to TKA. At a willingness to pay of 20.000 Euro per QALY gained, the probability of starting with KJD to be cost-effective compared to starting with a TKA was already found to be over 75% for all age categories and over 90–95% for the younger age categories. Conclusion A treatment strategy starting with knee joint distraction for knee osteoarthritis has a large potential for being a cost-effective intervention, especially for the relatively young patient. PMID:27171268

  4. Laboratory animal science in China: current status and potential for adoption of Three R alternatives.

    PubMed

    Kong, Qi; Qin, Chuan

    2010-03-01

    R alternatives, and animal welfare, and shows that there is currently great potential for the adoption of alternatives. The information will help scientists and organisations around the world to gain better insight into the current state of laboratory animal science in China, and hopefully, will enable them to give advice on how we can improve the adoption of Three R alternatives in our country.

  5. Cost Effective Polymer Solar Cells Research and Education

    SciTech Connect

    Sun, Sam-Shajing

    2015-10-13

    The technical or research objective of this project is to investigate and develop new polymers and polymer based optoelectronic devices for potentially cost effective (or cost competitive), durable, lightweight, flexible, and high efficiency solar energy conversion applications. The educational objective of this project includes training of future generation scientists, particularly young, under-represented minority scientists, working in the areas related to the emerging organic/polymer based solar energy technologies and related optoelectronic devices. Graduate and undergraduate students will be directly involved in scientific research addressing issues related to the development of polymer based solar cell technology.

  6. Estimating 'costs' for cost-effectiveness analysis.

    PubMed

    Miners, Alec

    2008-01-01

    Since 1999, the National Institute for Health and Clinical Excellence (NICE) Technology Appraisal Programme has been charged with producing guidance for the NHS in England and Wales on the appropriate use of new and existing healthcare programmes. Guidance is based on an assessment of a number of factors, including cost effectiveness. The identification, measurement and valuation of costs are important components of any cost-effectiveness analysis. However, working through these steps raises a number of important methodological questions. For example, how should 'future' resource use be estimated, and is there a need to consider all 'future' costs? Given that NICE produces national guidance, should national unit cost data be used to value resources or should local variations in negotiated prices be taken into account? This paper was initially prepared as a briefing paper as part of the process of updating NICE's 2004 Guide to the Methods of Technology Appraisal for a workshop on 'costs'. It outlines the issues that were raised in the original briefing paper and the subsequent questions that were discussed at the workshop.

  7. Effectiveness and Cost-Effectiveness of Expanded Antiviral Prophylaxis and Adjuvanted Vaccination Strategies for the Next Influenza Pandemic

    PubMed Central

    Khazeni, Nayer; Hutton, David W; Garber, Alan M; Owens, Douglas K

    2011-01-01

    Background The pandemic potential of the influenza A (H5N1) virus is among the greatest public health concerns of the 21st century. Objective To determine the effectiveness and cost-effectiveness of alternative pandemic mitigation and response strategies. Design Compartmental epidemic model in conjunction with a Markov model of disease progression. Data Sources Literature and expert opinion. Target Population Residents of a U.S. metropolitan city. Time Horizon Lifetime. Perspective Societal. Interventions One mitigation strategy used non-pharmaceutical interventions, vaccination, and antiviral pharmacotherapy in quantities similar to those available currently in the U.S. stockpile. The second and third strategies used expanded supplies of either antivirals (expanded antiviral prophylaxis strategy) or adjuvanted vaccine (expanded vaccination strategy) in addition to non-pharmaceutical interventions. Outcome Measures Infections and deaths averted, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness. Results of Base Case Analysis The stockpiled strategy averted 44% of infections and deaths, gaining 258,342 QALYs at $8,907 per QALY gained relative to no intervention. Expanded antiviral prophylaxis delayed the pandemic, averting 48% of infections and deaths, and gaining 282,329 QALYs, with a less favorable cost-effectiveness ratio than adjuvanted vaccination. Adjuvanted vaccination was the most effective strategy and was cost-effective, averting 68% of infections and deaths, and gaining 404,030 QALYs at $10,844 per QALY gained relative to stockpiled strategy. Results of Sensitivity Analysis Over a wide range of assumptions, the incremental cost-effectiveness ratio of the expanded adjuvanted vaccination strategy was less than $50,000 per QALY gained. Limitations Large groups and frequent contacts may spread the virus more rapidly. The model is not designed to target interventions to specific groups. Conclusions Expanded adjuvanted vaccination

  8. 41 CFR 301-70.903 - What are our responsibilities for ensuring that Government aircraft are the most cost-effective...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... responsibilities for ensuring that Government aircraft are the most cost-effective alternative for travel? 301-70... Policies and Procedures for Agencies That Own or Hire Government Aircraft for Travel § 301-70.903 What are our responsibilities for ensuring that Government aircraft are the most cost-effective alternative...

  9. 41 CFR 301-70.903 - What are our responsibilities for ensuring that Government aircraft are the most cost-effective...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... responsibilities for ensuring that Government aircraft are the most cost-effective alternative for travel? 301-70... Policies and Procedures for Agencies That Own or Hire Government Aircraft for Travel § 301-70.903 What are our responsibilities for ensuring that Government aircraft are the most cost-effective alternative...

  10. 41 CFR 301-70.903 - What are our responsibilities for ensuring that Government aircraft are the most cost-effective...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... responsibilities for ensuring that Government aircraft are the most cost-effective alternative for travel? 301-70... Policies and Procedures for Agencies That Own or Hire Government Aircraft for Travel § 301-70.903 What are our responsibilities for ensuring that Government aircraft are the most cost-effective alternative...

  11. 41 CFR 301-70.903 - What are our responsibilities for ensuring that Government aircraft are the most cost-effective...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... responsibilities for ensuring that Government aircraft are the most cost-effective alternative for travel? 301-70... Policies and Procedures for Agencies That Own or Hire Government Aircraft for Travel § 301-70.903 What are our responsibilities for ensuring that Government aircraft are the most cost-effective alternative...

  12. 41 CFR 301-70.903 - What are our responsibilities for ensuring that Government aircraft are the most cost-effective...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... responsibilities for ensuring that Government aircraft are the most cost-effective alternative for travel? 301-70... Policies and Procedures for Agencies That Own or Hire Government Aircraft for Travel § 301-70.903 What are our responsibilities for ensuring that Government aircraft are the most cost-effective alternative...

  13. SOCIAL NETWORK BRIDGING POTENTIAL AND THE USE OF COMPLEMENTARY AND ALTERNATIVE MEDICINE IN LATER LIFE *

    PubMed Central

    Goldman, Alyssa; Cornwell, Benjamin

    2015-01-01

    The use of complementary/alternative medicine (CAM) is typically modeled as a function of individual health beliefs, including changes in perceptions of conventional medicine, an orientation toward more holistic care, and increasing patient involvement in health care decision-making. Expanding on research that shows that health-related behavior is shaped by social networks, this paper examines the possibility that CAM usage is partly a function of individuals’ social network structure. We argue that people are more likely to adopt CAM when they function as bridges between network members who are otherwise not (or poorly) connected to each other. This circumstance not only provides individuals with access to a wider range of information about treatment options, it also reduces the risk of sanctioning by network members if one deviates from conventional forms of treatment. We test this idea using data from the National Social Life, Health, and Aging Project (NSHAP), a nationally representative study of older Americans. Analyses of egocentric social network data show that older adults with bridging potential in their networks are significantly more likely to engage in a greater number of types of CAM. We close by discussing alternative explanations of these findings and their potential implications for research on CAM usage. PMID:26207353

  14. Pharmacoinformatics approach for investigation of alternative potential hepatitis C virus nonstructural protein 5B inhibitors

    PubMed Central

    Mirza, Muhammad Usman; Ghori, Noor-Ul-Huda; Ikram, Nazia; Adil, Abdur Rehman; Manzoor, Sadia

    2015-01-01

    Hepatitis C virus (HCV) is one of the major viruses affecting the world today. It is a highly variable virus, having a rapid reproduction and evolution rate. The variability of genomes is due to hasty replication catalyzed by nonstructural protein 5B (NS5B) which is also a potential target site for the development of anti-HCV agents. Recently, the US Food and Drug Administration approved sofosbuvir as a novel oral NS5B inhibitor for the treatment of HCV. Unfortunately, it is much highlighted for its pricing issues. Hence, there is an urgent need to scrutinize alternate therapies against HCV that are available at affordable price and do not have associated side effects. Such a need is crucial especially in underdeveloped countries. The search for various new bioactive compounds from plants is a key part of pharmaceutical research. In the current study, we applied a pharmacoinformatics-based approach for the identification of active plant-derived compounds against NS5B. The results were compared to docking results of sofosbuvir. The lead compounds with high-binding ligands were further analyzed for pharmacokinetic and pharmacodynamic parameters based on in silico absorption, distribution, metabolism, excretion, and toxicity (ADMET) profile. The results showed the potential alternative lead compounds that can be developed into commercial drugs having high binding energy and promising ADMET properties. PMID:25848219

  15. Social network bridging potential and the use of complementary and alternative medicine in later life.

    PubMed

    Goldman, Alyssa W; Cornwell, Benjamin

    2015-09-01

    The use of complementary/alternative medicine (CAM) is typically modeled as a function of individual health beliefs, including changes in perceptions of conventional medicine, an orientation toward more holistic care, and increasing patient involvement in health care decision-making. Expanding on research that shows that health-related behavior is shaped by social networks, this paper examines the possibility that CAM usage is partly a function of individuals' social network structure. We argue that people are more likely to adopt CAM when they function as bridges between network members who are otherwise not (or poorly) connected to each other. This circumstance not only provides individuals with access to a wider range of information about treatment options, it also reduces the risk of sanctioning by network members if one deviates from conventional forms of treatment. We test this idea using data from the National Social Life, Health, and Aging Project (NSHAP), a nationally representative study of older Americans. Analyses of egocentric social network data show that older adults with bridging potential in their networks are significantly more likely to engage in a greater number of types of CAM. We close by discussing alternative explanations of these findings and their potential implications for research on CAM usage.

  16. The role of zinc(II) in the absorption-desorption of CO2 by aqueous NH3, a potentially cost-effective method for CO2 capture and recycling.

    PubMed

    Mani, Fabrizio; Peruzzini, Maurizio; Barzagli, Francesco

    2008-01-01

    The absorption of CO2 by aqueous NH3 solutions has been investigated at atmospheric pressure and 0 degrees C. The CO2 absorption is fast and occurs with high efficiency (88-99%). The maximum CO2-removal efficiency increases slightly with the NH3 concentration. Addition of zinc(II) salts (as chloride, nitrate or sulfate) to the NH3 absorbent solution increases the overall CO2-absorption capacity without appreciably affecting the removal efficiency. Stripping of pure CO2 from HCO3(-) solutions is achieved by adding the calculated amount of ZnII salts, which under ambient conditions lead to rapid release of about 30-35% of the initially captured CO2. At the same time, about 65-70% of the captured CO2 is transformed into solid basic zinc carbonates. The recovery of these valuable solid products and the release of only 1/3 of free CO2 at room temperature and pressure reduces the cost of the overall process of CO2 capture, making it a potentially attractive method for CO2 capture on a larger scale.

  17. Potentiality of embryonic stem cells: an ethical problem even with alternative stem cell sources.

    PubMed

    Denker, H-W

    2006-11-01

    The recent discussions about alternative sources of human embryonic stem cells (White Paper of the US President's Council on Bioethics, 2005), while stirring new interest in the developmental potential of the various abnormal embryos or constructs proposed as such sources, also raise questions about the potential of the derived embryonic stem cells. The data on the developmental potential of embryonic stem cells that seem relevant for ethical considerations and aspects of patentability are discussed. Particular attention is paid to the meaning of "totipotency, omnipotency and pluripotency" as illustrated by a comparison of the developmental potential of three-dimensional clusters of blastomeres (morula), embryonic stem cells, somatic or (adult) stem cells or other somatic (non-stem) cells. This paper focuses on embryoid bodies and on direct cloning by tetraploid complementation. Usage and patenting of these cells cannot be considered to be ethically sound as long as totipotency and tetraploid complementability of embryonic stem cells are not excluded for the specific cell line in question. Testing this poses an ethical problem in itself and needs to be discussed in the future.

  18. Understanding Cost-Effectiveness of Energy Efficiency Programs

    EPA Pesticide Factsheets

    This paper discusses the five standard tests used to assess the cost-effectiveness of energy efficiency, how states are using these tests, and how the tests can be used to determine the cost-effectiveness of energy efficiency measures.

  19. Big Bang, inflation, standard Physics… and the potentialities of new Physics and alternative cosmologies. Present statuts of observational and experimental Cosmology. Open questions and potentialities of alternative cosmologies

    NASA Astrophysics Data System (ADS)

    Gonzalez-Mestres, Luis

    2016-11-01

    A year ago, we wrote [1] that the field of Cosmology was undergoing a positive and constructive crisis. The possible development of more direct links between the Mathematical Physics aspects of cosmological patterns and the interpretation of experimental and observational results was particularly emphasized. Controversies on inflation are not really new, but in any case inflation is not required in pre-Big Bang models and the validity of the standard Big Bang + inflation + ΛCDM pattern has not by now been demonstrated by data. Planck has even explicitly reported the existence of "anomalies". Remembering the far-reaching work of Yoichiro Nambu published in 1959-61, it seems legitimate to underline the need for a cross-disciplinary approach in the presence of deep, unsolved theoretical problems concerning new domains of matter properties and of the physical world. The physics of a possible preonic vacuum and the associated cosmology constitute one of these domains. If the vacuum is made of superluminal preons (superbradyons), and if standard particles are vacuum excitations, how to build a suitable theory to describe the internal structure of such a vacuum at both local and cosmic level? Experimental programs (South Pole, Atacama, AUGER, Telescope Array…) and observational ones (Planck, JEM-EUSO…) devoted to the study of cosmic microwave background radiation (CMB) and of ultra-high energy cosmic rays (UHECR) are crucial to elucidate such theoretical interrogations and guide new phenomenological developments. Together with a brief review of the observational and experimental situation, we also examine the main present theoretical and phenomenological problems and point out the role new physics and alternative cosmologies can potentially play. The need for data analyses less focused a priori on the standard models of Particle Physics and Cosmology is emphasized in this discussion. An example of a new approach to both fields is provided by the pre-Big Bang pattern

  20. A Guide to the Selection of Cost-Effective Wastewater Treatment Systems. Technical Report.

    ERIC Educational Resources Information Center

    Van Note, Robert H.; And Others

    The data within this publication provide guidelines for planners, engineers and decision-makers at all governmental levels to evaluate cost-effectiveness of alternative wastewater treatment proposals. The processes described include conventional and advanced treatment units as well as most sludge handling and processing units. Flow sheets, cost…

  1. Assembly of a Cost-Effective Anode Using Palladium Nanoparticles for Alkaline Fuel Cell Applications

    ERIC Educational Resources Information Center

    Feliciano-Ramos, Ileana; Casan~as-Montes, Barbara; García-Maldonado, María M.; Menendez, Christian L.; Mayol, Ana R.; Díaz-Vazquez, Liz M.; Cabrera, Carlos R.

    2015-01-01

    Nanotechnology allows the synthesis of nanoscale catalysts, which offer an efficient alternative for fuel cell applications. In this laboratory experiment, the student selects a cost-effective anode for fuel cells by comparing three different working electrodes. These are commercially available palladium (Pd) and glassy carbon (GC) electrodes, and…

  2. [Intensified insulin treatment is cost-effective].

    PubMed

    Reichard, P; Alm, C; Andersson, E; Wärn, I; Rosenqvist, U

    1999-01-20

    Both the Diabetes Control and Complications Trial (DCCT) in USA/Canada, and Stockholm Diabetes Intervention Study (SDIS) showed intensified insulin treatment and reduced glycaemia to prevent complications in patients with insulin-dependent (type I) diabetes mellitus. In the DCCT, the intensified treatment was considered cost-effective. In the SDIS, investigation of the direct increase in costs due to the intensified insulin treatment showed the saving in direct costs due to the reduction in photocoagulation requirements, and in the prevalence of renal insufficiency and of amputation, to correspond to 10 years' intensive insulin treatment. Thus, as intensified insulin treatment in type I diabetes reduces direct suffering at a low cost, it may be regarded as 'evidence-based' and mandatory.

  3. Is nuclear medicine cost-effective?

    PubMed

    Ripley, S

    1991-03-01

    Clearly, there is currently no consensus on the cost-effectiveness of nuclear medicine--or in fact any other aspect of medicine. It is hoped that common sense prevails in clinical medicine today. An appropriate case history and physical examination may negate the need for any additional investigation. From the perspective of the capital cost of equipment and supply costs, ultrasound is clearly the most cost-effective diagnostic imaging modality. But while it is useful, it does not always provide definitive answers, and other modalities must be used to arrive at a diagnosis. In comparison, the capital cost of general radiology equipment and nuclear medicine equipment is relatively equal. Radiology has more operating costs per case than nuclear medicine and requires a lower staffing component per given volume of examinations. In any given diagnostic imaging procedure, the practitioner and imagist must maintain a dialogue to ascertain the appropriateness of the study and to use the available resources in the most effective manner. This is even more imperative when CT scanning and MRI are included in the equation. The development of an investigative protocol that makes the most efficient use of the various imaging modalities without compromising the quality of care makes sense for the patient, the physician and the insurance provider. It is unreasonable to expect the physician to be aware of the optimal protocol for the diagnostic workup of every patient. The guidance of the imaging department is required to maximize the efficient use of the available facilities. A critical and exhaustive appraisal of the medical literature may be required to determine the optimal diagnostic protocol.(ABSTRACT TRUNCATED AT 250 WORDS)

  4. Cost-effective ultrasound PACS solution

    NASA Astrophysics Data System (ADS)

    Honeyman-Buck, Janice C.; Frost, Meryll M.; Staab, Edward V.

    1995-05-01

    Picture archiving and communication systems (PACS) have been quite successful at the University of Florida in the areas of CT, MR, and nuclear medicine. In each case, although we have not always been able to provide the optimal level of performance, we have been able to solve a problem and the systems are used extensively. Ultrasound images are required in a number of locations and the multiformat camera print capability was no longer adequate for the growing volume in the ultrasound section. Although we were certain we could successfully implement PACS for ultrasound, new forces in health care dictate that we justify our system in terms of cost. We analyzed the feasibility of a PACS solution for ultrasound and designed a system that meets our needs and is cost effective. We evaluated the ultrasound operation in terms of image acquisition patterns and throughput requirements. An inventory of existing and PACS equipment was made to determine the feasibility of interfacing the two systems. Commercial systems were evaluated for functionality and cost and a system was designed to meet our needs. The only way to achieve our goal of installing a cost effective ultrasound PACS was to eliminate film and use the cost savings to offset the cost of new equipment and development. We designed a system that could be produced using inexpensive components and existing hardware and software to meet our needs. A commercial vendor was chosen to provide the ultrasound acquisition. The Radiology Information System interface used at the University provides the necessary data to build a DICOM header, and an existing DICOM server routes the images to the appropriate workstations, archives, and printers. Additional storage is added to an existing archive to accommodate the ultrasound images and two existing workstations are evaluated for use in ultrasound.

  5. 23 CFR 635.205 - Finding of cost effectiveness.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 23 Highways 1 2010-04-01 2010-04-01 false Finding of cost effectiveness. 635.205 Section 635.205... CONSTRUCTION AND MAINTENANCE Force Account Construction § 635.205 Finding of cost effectiveness. (a) It may be found cost effective for a State transportation department or county to undertake a federally...

  6. 49 CFR 639.21 - Determination of cost-effectiveness.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 7 2010-10-01 2010-10-01 false Determination of cost-effectiveness. 639.21... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION CAPITAL LEASES Cost-Effectiveness § 639.21 Determination of cost-effectiveness. (a) To qualify a lease for capital assistance, a recipient must— (1) Make a written comparison...

  7. An assessment of potential impact of alternative fluorocarbons on tropospheric ozone

    NASA Technical Reports Server (NTRS)

    Niki, Hiromi

    1990-01-01

    While the chlorofuorocarbons (CFCs) such as CFC-11 (CFCl3) and CFC-12 (CF2Cl2) are chemically inert in the troposphere, the hydrogen-containing halocarbons being considered as their replacements can, to a large extent, be removed in the troposphere by the HO radical. These alternative halocarbons include the hydrochlorofluorocarbons (HCFCs) 123 (CF3CHCl2), 141b (CFCl2CH3), 142b (CF2ClCH3), 22 (CHF2Cl), and 124 (CF3CHFCl) and the hydrofluorocarbons (HCFs) 134a (CF3CH2F), 152a (CHF2CH3) and 125 (CF3CHF2). Listed are the rate constants (k) for the HO radical reaction of these compounds and their estimated chemical lifetimes in the troposphere. In this table, values of the lifetimes of these selected HCFCs and HCFs are seen to vary by more than a factor of more than ten ranging from 1.6 years for HFC 152a and HCFC 125 to as long as 28 years for HFC 125. Clearly, from the standpoint of avoiding or minimizing impact on stratospheric O3, those halocarbons with short tropospheric lifetimes are the desirable alternates. However, potential environmental consequences of their degradation in the troposphere should be assessed and taken into account in the selection process.

  8. Antimicrobial Peptides as Potential Alternatives to Antibiotics in Food Animal Industry

    PubMed Central

    Wang, Shuai; Zeng, Xiangfang; Yang, Qing; Qiao, Shiyan

    2016-01-01

    Over the last decade, the rapid emergence of multidrug-resistant pathogens has become a global concern, which has prompted the search for alternative antibacterial agents for use in food animals. Antimicrobial peptides (AMPs), produced by bacteria, insects, amphibians and mammals, as well as by chemical synthesis, are possible candidates for the design of new antimicrobial agents because of their natural antimicrobial properties and a low propensity for development of resistance by microorganisms. This manuscript reviews the current knowledge of the basic biology of AMPs and their applications in non-ruminant nutrition. Antimicrobial peptides not only have broad-spectrum activity against bacteria, fungi, and viruses but also have the ability to bypass the common resistance mechanisms that are placing standard antibiotics in jeopardy. In addition, AMPs have beneficial effects on growth performance, nutrient digestibility, intestinal morphology and gut microbiota in pigs and broilers. Therefore, AMPs have good potential as suitable alternatives to conventional antibiotics used in swine and poultry industries. PMID:27153059

  9. Potential impacts on air quality of the use of ethanol as an alternative fuel. Final report

    SciTech Connect

    Gaffney, J.S.; Marley, N.A.

    1994-09-01

    The use of ethanol/gasoline mixtures in motor vehicles has been proposed as an alternative fuel strategy that might improve air quality while minimizing US dependence on foreign oil. New enzymatic production methodologies are being explored to develop ethanol as a viable, economic fuel. In an attempt to reduce urban carbon monoxide (CO) and ozone levels, a number of cities are currently mandating the use of ethanol/gasoline blends. However, it is not at all clear that these blended fuels will help to abate urban pollution. In fact, the use of these fuels may lead to increased levels of other air pollutants, specifically aldehydes and peroxyacyl nitrates. Although these pollutants are not currently regulated, their potential health and environmental impacts must be considered when assessing the impacts of alternative fuels on air quality. Indeed, formaldehyde has been identified as an important air pollutant that is currently being considered for control strategies by the State of California. This report focuses on measurements taken in Albuquerque, New Mexico during the summer of 1993 and the winter of 1994 as an initial attempt to evaluate the air quality effects of ethanol/gasoline mixtures. The results of this study have direct implications for the use of such fuel mixtures as a means to reduce CO emissions and ozone in a number of major cities and to bring these urban centers into compliance with the Clean Air Act.

  10. Cost-effectiveness of minimally invasive sacroiliac joint fusion

    PubMed Central

    Cher, Daniel J; Frasco, Melissa A; Arnold, Renée JG; Polly, David W

    2016-01-01

    Background Sacroiliac joint (SIJ) disorders are common in patients with chronic lower back pain. Minimally invasive surgical options have been shown to be effective for the treatment of chronic SIJ dysfunction. Objective To determine the cost-effectiveness of minimally invasive SIJ fusion. Methods Data from two prospective, multicenter, clinical trials were used to inform a Markov process cost-utility model to evaluate cumulative 5-year health quality and costs after minimally invasive SIJ fusion using triangular titanium implants or non-surgical treatment. The analysis was performed from a third-party perspective. The model specifically incorporated variation in resource utilization observed in the randomized trial. Multiple one-way and probabilistic sensitivity analyses were performed. Results SIJ fusion was associated with a gain of approximately 0.74 quality-adjusted life years (QALYs) at a cost of US$13,313 per QALY gained. In multiple one-way sensitivity analyses all scenarios resulted in an incremental cost-effectiveness ratio (ICER) <$26,000/QALY. Probabilistic analyses showed a high degree of certainty that the maximum ICER for SIJ fusion was less than commonly selected thresholds for acceptability (mean ICER =$13,687, 95% confidence interval $5,162–$28,085). SIJ fusion provided potential cost savings per QALY gained compared to non-surgical treatment after a treatment horizon of greater than 13 years. Conclusion Compared to traditional non-surgical treatments, SIJ fusion is a cost-effective, and, in the long term, cost-saving strategy for the treatment of SIJ dysfunction due to degenerative sacroiliitis or SIJ disruption. PMID:26719717

  11. Analysis of Burnup and Economic Potential of Alternative Fuel Materials in Thermal Reactors

    SciTech Connect

    Oggianu, Stella Maris; No, Hee Cheon; Kazimi, Mujid S.

    2003-09-15

    A strategy is proposed for the assessment of nuclear fuel material economic potential use in future light water reactors (LWRs). In this methodology, both the required enrichment and the fuel performance limits are considered. In order to select the best fuel candidate, the optimal burnup that produces the lowest annual fuel cost within the burnup potential for a given fuel material and smear density ratio is determined.Several nuclear materials are presented as examples of the application of the methodology proposed in this paper. The alternative fuels considered include uranium dioxide (UO{sub 2}), uranium carbide (UC), uranium nitride (UN), metallic uranium (U-Zr alloy), combined thorium and uranium oxides (ThO{sub 2}/UO{sub 2}), and combined thorium and uranium metals (U/Th). For these examples, a typical LWR lattice geometry in a zirconium-based cladding was assumed. The uncertainties in the results presented are large due to the scarcity of experimental data regarding the behavior of the considered materials at high burnups. Also, chemical compatibility issues are to be considered separately.The same methodology can be applied in the future to evaluate the economic potential of other nuclear fuel materials including different cladding designs, dispersions of ceramics into ceramics, dispersions of ceramics into metals, and also for geometries other than the traditional circular fuel pin.

  12. Nanostructured systems containing babassu (Orbignya speciosa) oil as a potential alternative therapy for benign prostatic hyperplasia

    PubMed Central

    de Sousa, Valeria Pereira; Crean, Joanne; de Almeida Borges, Vinícius Raphael; Rodrigues, Carlos Rangel; Tajber, Lidia; Boylan, Fabio; Cabral, Lucio Mendes

    2013-01-01

    The oil of babassu tree nuts (Orbignya speciosa) is a potential alternative for treatment and prophylaxis of benign prostatic hyperplasia. Improved results can be obtained by drug vectorization to the hyperplastic tissue. The main objective of this work was the preparation and characterization of poly(lactic-co-glycolic acid) (PLGA) nanoparticle and clay nanosystems containing babassu oil (BBS). BBS was extracted from the kernels of babassu tree nuts and characterized by gas chromatography-mass spectrometry as well as 1H and 13C nuclear magnetic resonance. BBS-clay nanosystems were obtained by adding polyvinylpyrrolidone, Viscogel B8®, and BBS at a 2:1:1 mass ratio and characterized by X-ray diffraction, thermogravimetric analysis, infrared spectroscopy, and laser diffraction. The PLGA-BBS nanoparticles were prepared by the precipitation-solvent evaporation method. Mean diameter, polydispersity, zeta potential, and scanning electron microscopic images of the nanosystems were analyzed. Thermogravimetric analysis showed successful formation of the nanocomposite. PLGA nanoparticles containing BBS were obtained, with a suitable size that was confirmed by scanning electron microscopy. Both nanostructured systems showed active incorporation yields exceeding 90%. The two systems obtained represent a new and potentially efficient therapy for benign prostatic hyperplasia. PMID:23990721

  13. Osthole: A Review on Its Bioactivities, Pharmacological Properties, and Potential as Alternative Medicine

    PubMed Central

    Zhang, Zhong-Rong; Leung, Wing Nang; Cheung, Ho Yee; Chan, Chun Wai

    2015-01-01

    This paper reviews the latest understanding of biological and pharmacological properties of osthole (7-methoxy-8-(3-methyl-2-butenyl)-2H-1-benzopyran-2-one), a natural product found in several medicinal plants such as Cnidium monnieri and Angelica pubescens. In vitro and in vivo experimental results have revealed that osthole demonstrates multiple pharmacological actions including neuroprotective, osteogenic, immunomodulatory, anticancer, hepatoprotective, cardiovascular protective, and antimicrobial activities. In addition, pharmacokinetic studies showed osthole uptake and utilization are fast and efficient in body. Moreover, the mechanisms of multiple pharmacological activities of osthole are very likely related to the modulatory effect on cyclic adenosine monophosphate (cAMP) and cyclic adenosine monophosphate (cGMP) level, though some mechanisms remain unclear. This review aims to summarize the pharmacological properties of osthole and give an overview of the underlying mechanisms, which showcase its potential as a multitarget alternative medicine. PMID:26246843

  14. Use of alternative assays to identify and prioritize organophosphorus flame retardants for potential developmental and neurotoxicity.

    PubMed

    Behl, Mamta; Hsieh, Jui-Hua; Shafer, Timothy J; Mundy, William R; Rice, Julie R; Boyd, Windy A; Freedman, Jonathan H; Hunter, E Sidney; Jarema, Kimberly A; Padilla, Stephanie; Tice, Raymond R

    2015-01-01

    Due to their toxicity and persistence in the environment, brominated flame retardants (BFRs) are being phased out of commercial use, leading to the increased use of alternative chemicals such as the organophosphorus flame retardants (OPFRs). There is, however, limited information on the potential health effects of OPFRs. Due to the structural similarity of the OPFRs to organophosphorus insecticides, there is concern regarding developmental toxicity and neurotoxicity. In response, we evaluated a set of OPFRs (triphenyl phosphate [TPHP]), isopropylated phenyl phosphate [IPP], 2-ethylhexyl diphenyl phosphate [EHDP], tert-butylated phenyl diphenyl phosphate [BPDP], trimethyl phenyl phosphate [TMPP], isodecyl diphenyl phosphate [IDDP], (tris(1,3-dichloroisopropyl) phosphate [TDCIPP], and tris(2-chloroethyl)phosphate [TCEP]) in a battery of cell-based in vitro assays and alternative model organisms and compared the results to those obtained for two classical BFRs (3,3',5,5'-tetrabromobisphenol A [TBBPA] and 2,2'4,4'-brominated diphenyl ether [BDE-47]). The assays used evaluated the effects of chemicals on the differentiation of mouse embryonic stem cells, the proliferation and growth of human neural stem cells, rat neuronal growth and network activity, and development of nematode (Caenorhabditis elegans) and zebrafish (Danio rerio). All assays were performed in a concentration-response format, allowing for the determination of the point of departure (POD: the lowest concentration where a chemically-induced response exceeds background noise). The majority of OPFRs (8/9) were active in multiple assays in the range of 1-10 μM, most of which had comparable activity to the BFRs TBBPA and BDE-47. TCEP was negative in all assays. The results indicate that the replacement OPFRs, with the exception of TCEP, showed comparable activity to the two BFRs in the assays tested. Based on these results, more comprehensive studies are warranted to further characterize the potential hazard

  15. Model-based cost-effectiveness analysis of B-type natriuretic peptide-guided care in patients with heart failure

    PubMed Central

    Mohiuddin, Syed; Reeves, Barnaby; Pufulete, Maria; Maishman, Rachel; Dayer, Mark; Macleod, John; McDonagh, Theresa; Purdy, Sarah; Rogers, Chris; Hollingworth, William

    2016-01-01

    Objective Monitoring B-type natriuretic peptide (BNP) to guide pharmacotherapy might improve survival in patients with heart failure with reduced ejection fraction (HFrEF) or preserved ejection fraction (HFpEF). However, the cost-effectiveness of BNP-guided care is uncertain and guidelines do not uniformly recommend it. We assessed the cost-effectiveness of BNP-guided care in patient subgroups defined by age and ejection fraction. Methods We used a Markov model with a 3-month cycle length to estimate the lifetime health service costs, quality-adjusted life years (QALYs) and incremental net monetary benefits (iNMBs) of BNP-guided versus clinically guided care in 3 patient subgroups: (1) HFrEF patients <75 years; (2) HFpEF patients <75 years; and (3) HFrEF patients ≥75 years. There is no evidence of benefit in patients with HFpEF aged ≥75 years. We used individual patient data meta-analyses and linked primary care, hospital and mortality data to inform the key model parameters. We performed probabilistic analysis to assess the uncertainty in model results. Results In younger patients (<75 years) with HFrEF, the mean QALYs (5.57 vs 5.02) and costs (£63 527 vs £58 139) were higher with BNP-guided care. At the willingness-to-pay threshold of £20 000 per QALY, the positive iNMB (£5424 (95% CI £987 to £9469)) indicates that BNP-guided care is cost-effective in this subgroup. The evidence of cost-effectiveness of BNP-guided care is less strong for younger patients with HFpEF (£3155 (−£10 307 to £11 613)) and older patients (≥75 years) with HFrEF (£2267 (−£1524 to £6074)). BNP-guided care remained cost-effective in the sensitivity analyses, albeit the results were sensitive to assumptions on its sustained effect. Conclusions We found strong evidence that BNP-guided care is a cost-effective alternative to clinically guided care in younger patients with HFrEF. It is potentially cost-effective in younger patients with HFpEF and older

  16. Using Cost-Effectiveness Tests to Design CHP Incentive Programs

    SciTech Connect

    Tidball, Rick

    2014-11-01

    This paper examines the structure of cost-effectiveness tests to illustrate how they can accurately reflect the costs and benefits of CHP systems. This paper begins with a general background discussion on cost-effectiveness analysis of DER and then describes how cost-effectiveness tests can be applied to CHP. Cost-effectiveness results are then calculated and analyzed for CHP projects in five states: Arkansas, Colorado, Iowa, Maryland, and North Carolina. Based on the results obtained for these five states, this paper offers four considerations to inform regulators in the application of cost-effectiveness tests in developing CHP programs.

  17. Cost-Effectiveness of Hypertension Therapy According to 2014 Guidelines

    PubMed Central

    Moran, Andrew E.; Odden, Michelle C.; Thanataveerat, Anusorn; Tzong, Keane Y.; Rasmussen, Petra W.; Guzman, David; Williams, Lawrence; Bibbins-Domingo, Kirsten; Coxson, Pamela G.; Goldman, Lee

    2015-01-01

    BACKGROUND On the basis of the 2014 guidelines for hypertension therapy in the United States, many eligible adults remain untreated. We projected the cost-effectiveness of treating hypertension in U.S. adults according to the 2014 guidelines. METHODS We used the Cardiovascular Disease Policy Model to simulate drug-treatment and monitoring costs, costs averted for the treatment of cardiovascular disease, and quality-adjusted life-years (QALYs) gained by treating previously untreated adults between the ages of 35 and 74 years from 2014 through 2024. We assessed cost-effectiveness according to age, hypertension level, and the presence or absence of chronic kidney disease or diabetes. RESULTS The full implementation of the new hypertension guidelines would result in approximately 56,000 fewer cardiovascular events and 13,000 fewer deaths from cardiovascular causes annually, which would result in overall cost savings. The projections showed that the treatment of patients with existing cardiovascular disease or stage 2 hypertension would save lives and costs for men between the ages of 35 and 74 years and for women between the ages of 45 and 74 years. The treatment of men or women with existing cardiovascular disease or men with stage 2 hypertension but without cardiovascular disease would remain cost-saving even if strategies to increase medication adherence doubled treatment costs. The treatment of stage 1 hypertension was cost-effective (defined as <$50,000 per QALY) for all men and for women between the ages of 45 and 74 years, whereas treating women between the ages of 35 and 44 years with stage 1 hypertension but without cardiovascular disease had intermediate or low cost-effectiveness. CONCLUSIONS The implementation of the 2014 hypertension guidelines for U.S. adults between the ages of 35 and 74 years could potentially prevent about 56,000 cardiovascular events and 13,000 deaths annually, while saving costs. Controlling hypertension in all patients with

  18. Cost-effective energy efficiency in the Czech Republic

    SciTech Connect

    Shankle, S.A.; Secrest, T.J.; Zemen, Z.; Popelka, A.

    1994-08-01

    Energy efficiency is a particularly important issue in the emerging economies of Eastern Europe. Much of the energy used in the Czech Republic is supplied by lignite, a soft brown form of coal. Its combustion is largely responsible for an extreme acid rain problem and other forms of air pollution and land use complications. Additionally, inefficient energy use is prevalent, placing additional stresses on an already fragile economy. This paper reports on a project in the mid-sized (250,000 residents) and industrial city of Plzen, in the Czech Republic. The Facility Energy Decision Screening (FEDS) process, developed by PNL for the U.S. Department of Energy`s (DOE`s) Federal Energy Management Program (FEMP), was applied to the city to determine the level of cost-effective energy efficiency potential in the city. Significant potential was found to exist, primarily in large, cooperatively owned apartment buildings heated by district systems.

  19. Cost-effectiveness of reducing sulfur emissions from ships.

    PubMed

    Wang, Chengfeng; Corbett, James J; Winebrake, James J

    2007-12-15

    We model cost-effectiveness of control strategies for reducing SO2 emissions from U.S. foreign commerce ships traveling in existing European or hypothetical U.S. West Coast SO(x) Emission Control Areas (SECAs) under international maritime regulations. Variation among marginal costs of control for individual ships choosing between fuel-switching and aftertreatment reveals cost-saving potential of economic incentive instruments. Compared to regulations prescribing low sulfur fuels, a performance-based policy can save up to $260 million for these ships with 80% more emission reductions than required because least-cost options on some individual ships outperform standards. Optimal simulation of a market-based SO2 control policy for approximately 4,700 U.S. foreign commerce ships traveling in the SECAs in 2002 shows that SECA emissions control targets can be achieved by scrubbing exhaust gas of one out of ten ships with annual savings up to $480 million over performance-based policy. A market-based policy could save the fleet approximately $63 million annually under our best-estimate scenario. Spatial evaluation of ship emissions reductions shows that market-based instruments can reduce more SO2 closer to land while being more cost-effective for the fleet. Results suggest that combining performance requirements with market-based instruments can most effectively control SO2 emissions from ships.

  20. The Value of Heterogeneity for Cost-Effectiveness Subgroup Analysis

    PubMed Central

    Manca, Andrea; Claxton, Karl; Sculpher, Mark J.

    2014-01-01

    This article develops a general framework to guide the use of subgroup cost-effectiveness analysis for decision making in a collectively funded health system. In doing so, it addresses 2 key policy questions, namely, the identification and selection of subgroups, while distinguishing 2 sources of potential value associated with heterogeneity. These are 1) the value of revealing the factors associated with heterogeneity in costs and outcomes using existing evidence (static value) and 2) the value of acquiring further subgroup-related evidence to resolve the uncertainty given the current understanding of heterogeneity (dynamic value). Consideration of these 2 sources of value can guide subgroup-specific treatment decisions and inform whether further research should be conducted to resolve uncertainty to explain variability in costs and outcomes. We apply the proposed methods to a cost-effectiveness analysis for the management of patients with acute coronary syndrome. This study presents the expected net benefits under current and perfect information when subgroups are defined based on the use and combination of 6 binary covariates. The results of the case study confirm the theoretical expectations. As more subgroups are considered, the marginal net benefit gains obtained under the current information show diminishing marginal returns, and the expected value of perfect information shows a decreasing trend. We present a suggested algorithm that synthesizes the results to guide policy. PMID:24944196

  1. Parameter solicitation for planning cost effectiveness studies with dichotomous outcomes.

    PubMed

    McIntosh, M; Ramsey, S; Berry, K; Urban, N

    2001-01-01

    When economic endpoints are included alongside clinical effectiveness measures in randomized clinical trials (RCT), they are summarized together by the incremental cost effectiveness ratio (ICER). Adding economic endpoints to an RCT complicates the planning of experiments because investigators must now solicit their beliefs about costs, but even more challenging, they must also specify their association with effectiveness. Solicitation of correlations between costs and effects can be unintuitive, and so potentially highly inaccurate. This is unfortunate because power is highly sensitive to the association between costs and effects. Mis-specification in this association may lead to substantially underpowered or overpowered studies. We show that when clinical effectiveness measures are dichotomous, specification of the correlation between costs and effects can be avoided by instead describing their association with a mixture model. This representation leads to simple and highly intuitive parameter specifications. It may also be used to generate realistic raw data that can be used to evaluate experiment power with simulation. We give particular attention to evaluating and interpreting power when Fieller's theorem method (FTM) is used to calculate confidence for, and test hypotheses about, the ICER. Data from a previously published clinical trial are used to demonstrate the use of this new method to calculate sample size for a cost effectiveness study.

  2. Chlorella zofingiensis as an Alternative Microalgal Producer of Astaxanthin: Biology and Industrial Potential

    PubMed Central

    Liu, Jin; Sun, Zheng; Gerken, Henri; Liu, Zheng; Jiang, Yue; Chen, Feng

    2014-01-01

    Astaxanthin (3,3′-dihydroxy-β,β-carotene-4,4′-dione), a high-value ketocarotenoid with a broad range of applications in food, feed, nutraceutical, and pharmaceutical industries, has been gaining great attention from science and the public in recent years. The green microalgae Haematococcus pluvialis and Chlorella zofingiensis represent the most promising producers of natural astaxanthin. Although H. pluvialis possesses the highest intracellular astaxanthin content and is now believed to be a good producer of astaxanthin, it has intrinsic shortcomings such as slow growth rate, low biomass yield, and a high light requirement. In contrast, C. zofingiensis grows fast phototrophically, heterotrophically and mixtrophically, is easy to be cultured and scaled up both indoors and outdoors, and can achieve ultrahigh cell densities. These robust biotechnological traits provide C. zofingiensis with high potential to be a better organism than H. pluvialis for mass astaxanthin production. This review aims to provide an overview of the biology and industrial potential of C. zofingiensis as an alternative astaxanthin producer. The path forward for further expansion of the astaxanthin production from C. zofingiensis with respect to both challenges and opportunities is also discussed. PMID:24918452

  3. Microbial Peptidyl-Prolyl cis/trans Isomerases (PPIases): Virulence Factors and Potential Alternative Drug Targets

    PubMed Central

    2014-01-01

    SUMMARY Initially discovered in the context of immunomodulation, peptidyl-prolyl cis/trans isomerases (PPIases) were soon identified as enzymes catalyzing the rate-limiting protein folding step at peptidyl bonds preceding proline residues. Intense searches revealed that PPIases are a superfamily of proteins consisting of three structurally distinguishable families with representatives in every described species of prokaryote and eukaryote and, recently, even in some giant viruses. Despite the clear-cut enzymatic activity and ubiquitous distribution of PPIases, reports on solely PPIase-dependent biological roles remain scarce. Nevertheless, they have been found to be involved in a plethora of biological processes, such as gene expression, signal transduction, protein secretion, development, and tissue regeneration, underscoring their general importance. Hence, it is not surprising that PPIases have also been identified as virulence-associated proteins. The extent of contribution to virulence is highly variable and dependent on the pleiotropic roles of a single PPIase in the respective pathogen. The main objective of this review is to discuss this variety in virulence-related bacterial and protozoan PPIases as well as the involvement of host PPIases in infectious processes. Moreover, a special focus is given to Legionella pneumophila macrophage infectivity potentiator (Mip) and Mip-like PPIases of other pathogens, as the best-characterized virulence-related representatives of this family. Finally, the potential of PPIases as alternative drug targets and first tangible results are highlighted. PMID:25184565

  4. Cost-effectiveness of Antivenoms for Snakebite Envenoming in Nigeria

    PubMed Central

    Habib, Abdulrazaq G.; Lamorde, Mohammed; Dalhat, Mahmood M.; Habib, Zaiyad G.; Kuznik, Andreas

    2015-01-01

    Background Snakebite envenoming is a major public health problem throughout the rural tropics. Antivenom is effective in reducing mortality and remains the mainstay of therapy. This study aimed to determine the cost-effectiveness of using effective antivenoms for Snakebite envenoming in Nigeria. Methodology Economic analysis was conducted from a public healthcare system perspective. Estimates of model inputs were obtained from the literature. Incremental Cost Effectiveness Ratios (ICERs) were quantified as deaths and Disability-Adjusted-Life-Years (DALY) averted from antivenom therapy. A decision analytic model was developed and analyzed with the following model base-case parameter estimates: type of snakes causing bites, antivenom effectiveness to prevent death, untreated mortality, risk of Early Adverse Reactions (EAR), mortality risk from EAR, mean age at bite and remaining life expectancy, and disability risk (amputation). End-user costs applied included: costs of diagnosing and monitoring envenoming, antivenom drug cost, supportive care, shipping/freezing antivenom, transportation to-and-from hospital and feeding costs while on admission, management of antivenom EAR and free alternative snakebite care for ineffective antivenom. Principal Findings We calculated a cost/death averted of ($2330.16) and cost/DALY averted of $99.61 discounted and $56.88 undiscounted. Varying antivenom effectiveness through the 95% confidence interval from 55% to 86% yield a cost/DALY averted of $137.02 to $86.61 respectively. Similarly, varying the prevalence of envenoming caused by carpet viper from 0% to 96% yield a cost/DALY averted of $254.18 to $78.25 respectively. More effective antivenoms and carpet viper envenoming rather than non-carpet viper envenoming were associated with lower cost/DALY averted. Conclusions/Significance Treatment of snakebite envenoming in Nigeria is cost-effective with a cost/death averted of $2330.16 and cost/DALY averted of $99.61 discounted, lower

  5. Cost effectiveness of recycling: a systems model.

    PubMed

    Tonjes, David J; Mallikarjun, Sreekanth

    2013-11-01

    Financial analytical models of waste management systems have often found that recycling costs exceed direct benefits, and in order to economically justify recycling activities, externalities such as household expenses or environmental impacts must be invoked. Certain more empirically based studies have also found that recycling is more expensive than disposal. Other work, both through models and surveys, have found differently. Here we present an empirical systems model, largely drawn from a suburban Long Island municipality. The model accounts for changes in distribution of effort as recycling tonnages displace disposal tonnages, and the seven different cases examined all show that curbside collection programs that manage up to between 31% and 37% of the waste stream should result in overall system savings. These savings accrue partially because of assumed cost differences in tip fees for recyclables and disposed wastes, and also because recycling can result in a more efficient, cost-effective collection program. These results imply that increases in recycling are justifiable due to cost-savings alone, not on more difficult to measure factors that may not impact program budgets.

  6. Cost effectiveness of recycling: A systems model

    SciTech Connect

    Tonjes, David J.; Mallikarjun, Sreekanth

    2013-11-15

    Highlights: • Curbside collection of recyclables reduces overall system costs over a range of conditions. • When avoided costs for recyclables are large, even high collection costs are supported. • When avoided costs for recyclables are not great, there are reduced opportunities for savings. • For common waste compositions, maximizing curbside recyclables collection always saves money. - Abstract: Financial analytical models of waste management systems have often found that recycling costs exceed direct benefits, and in order to economically justify recycling activities, externalities such as household expenses or environmental impacts must be invoked. Certain more empirically based studies have also found that recycling is more expensive than disposal. Other work, both through models and surveys, have found differently. Here we present an empirical systems model, largely drawn from a suburban Long Island municipality. The model accounts for changes in distribution of effort as recycling tonnages displace disposal tonnages, and the seven different cases examined all show that curbside collection programs that manage up to between 31% and 37% of the waste stream should result in overall system savings. These savings accrue partially because of assumed cost differences in tip fees for recyclables and disposed wastes, and also because recycling can result in a more efficient, cost-effective collection program. These results imply that increases in recycling are justifiable due to cost-savings alone, not on more difficult to measure factors that may not impact program budgets.

  7. Plant oils as feedstock alternatives to petroleum - A short survey of potential oil crop platforms.

    PubMed

    Carlsson, Anders S

    2009-06-01

    Our society is highly depending on petroleum for its activities. About 90% is used as an energy source for transportation and for generation of heat and electricity and the remaining as feedstocks in the chemical industry. However, petroleum is a finite source as well as causing several environmental problems such as rising carbon dioxide levels in the atmosphere. Petroleum therefore needs to be replaced by alternative and sustainable sources. Plant oils and oleochemicals derived from them represent such alternative sources, which can deliver a substantial part of what is needed to replace the petroleum used as feedstocks. Plant derived feedstock oils can be provided by two types of oil qualities, multi-purpose and technical oils. Multi-purpose oils represent oil qualities that contain common fatty acids and that can be used for both food and feedstock applications. Technical oil qualities contain unusual fatty acids with special properties gained from their unique molecular structure and these types of oils should only be used for feedstock applications. As a risk mitigation strategy in the selection of crops, technical oil qualities should therefore preferably be produced by oil crop platforms dedicated for industrial usage. This review presents a short survey of oil crop platforms to be considered for either multi-purpose or technical oils production. Included among the former platforms are some of the major oil crops in cultivation such as oil palm, soybean and rapeseed. Among the later are those that could be developed into dedicated industrial platforms such as crambe, flax, cotton and Brassica carinata. The survey finishes off by highlighting the potential of substantial increase in plant oil production by developing metabolic flux platforms, which are starch crops converted into oil crops.

  8. Over-Reporting in Handwashing Self-Reports: Potential Explanatory Factors and Alternative Measurements

    PubMed Central

    Contzen, Nadja; De Pasquale, Sandra; Mosler, Hans-Joachim

    2015-01-01

    Handwashing interventions are a priority in development and emergency aid programs. Evaluation of these interventions is essential to assess the effectiveness of programs; however, measuring handwashing is quite difficult. Although observations are considered valid, they are time-consuming and cost-ineffective; self-reports are highly efficient but considered invalid because desirable behaviour tends to be over-reported. Socially desirable responding has been claimed to be the main cause of inflated self-reports, but its underlying factors and mechanisms are understudied. The present study investigated socially desirable responding and additional potential explanatory factors for over-reported handwashing to identify indications for measures which mitigate over-reporting. Additionally, a script-based covert recall, an alternative interview question intended to mitigate recall errors and socially desirable responding, was developed and tested. Cross-sectional data collection was conducted in the Borena Zone, Ethiopia, through 2.5-hour observations and 1-hour interviews with the primary caregivers in households. A total sample of N = 554 was surveyed. Data were analysed with correlation and multiple regression analyses and dependent t-tests. Over-reporting of handwashing was associated with factors assumed to be involved in (1) socially desirable responding, (2) encoding and recall of information, and (3) dissonance processes. The latter two factor groups explained over-reported handwashing beyond socially desirable responding. The alternative interview question—script-based covert recall—reduced over-reporting compared to conventional self-reports. Although the difficulties involved in measuring handwashing by self-reports and observations are widely known, the present study is the first to investigate the factors which explain over-reporting of handwashing. This research contributes to the limited evidence base on a highly important subject: how to evaluate

  9. Development and Characterization of Nisin Nanoparticles as Potential Alternative for the Recurrent Vaginal Candidiasis Treatment.

    PubMed

    de Abreu, Letícia Coli Louvisse; Todaro, Valerio; Sathler, Plinio Cunha; da Silva, Luiz Cláudio Rodrigues Pereira; do Carmo, Flávia Almada; Costa, Cleonice Marques; Toma, Helena Keiko; Castro, Helena Carla; Rodrigues, Carlos Rangel; de Sousa, Valeria Pereira; Cabral, Lucio Mendes

    2016-12-01

    The aim of this work was the development and characterization of nisin-loaded nanoparticles and the evaluation of its potential antifungal activity. Candidiasis is a fungal infection caused by Candida sp. considered as one of the major public health problem currently. The discovery of antifungal agents that present a reduced or null resistance of Candida sp. and the development of more efficient drug release mechanisms are necessary for the improvement of candidiasis treatment. Nisin, a bacteriocin commercially available for more than 50 years, exhibits antibacterial action in food products with potential antifungal activity. Among several alternatives used to modulate antifungal activity of bacteriocins, polymeric nanoparticles have received great attention due to an effective drug release control and reduction of therapeutic dose, besides the minimization of adverse effects by the preferential accumulation in specific tissues. The nisin nanoparticles were prepared by double emulsification and solvent evaporation methods. Nanoparticles were characterized by dynamic light scattering, zeta potential, Fourier transform infrared, X-ray diffraction, differential scanning calorimetry, and scanning electron microscopy. Antifungal activity was accessed by pour plate method and cell counting using Candida albicans strains. The in vitro release profile and in vitro permeation studies were performed using dialysis bag method and pig vaginal mucosa in Franz diffusion cell, respectively. The results revealed nisin nanoparticles (300 nm) with spherical shape and high loading efficiency (93.88 ± 3.26%). In vitro test results suggest a promising application of these nanosystems as a prophylactic agent in recurrent vulvovaginal candidiasis and other gynecological diseases.

  10. Cost Effectiveness of Home Energy Retrofits in Pre-Code Vintage Homes in the United States

    SciTech Connect

    Fairey, Philip

    2012-11-01

    This analytical study examines the opportunities for cost-effective energy efficiency and renewable energy retrofits in residential archetypes constructed prior to 1980 (Pre-Code) in fourteen U.S. cities. These fourteen cities are representative of each of the International Energy Conservation Code (IECC) climate zones in the contiguous United States. The analysis is conducted using an in-house version of EnergyGauge USA v.2.8.05 named CostOpt that has been programmed to perform iterative, incremental economic optimization on a large list of residential energy efficiency and renewable energy retrofit measures. The principle objectives of the study are to determine the opportunities for cost effective source energy reductions in this large cohort of existing residential building stock as a function of local climate and energy costs; and to examine how retrofit financing alternatives impact the source energy reductions that are cost effectively achievable.

  11. Cost-effectiveness of Denosumab for the treatment of postmenopausal osteoporosis

    PubMed Central

    Ström, O.; Eisman, J. A.; Papaioannou, A.; Siris, E. S.; Tosteson, A.; Kanis, J. A.

    2016-01-01

    Summary Denosumab is an injectable drug that reduces the risk of fractures. The objective was to estimate the cost-effectiveness of denosumab in a Swedish setting, also accounting for poor adherence to treatment. Denosumab is cost-effective, particularly for patients at high risk of fracture and low adherence to oral treatments. Introduction Denosumab is a novel biologic agent developed for the treatment of osteoporosis and osteoporotic fractures that has been shown to reduce the risk of fractures in a phase III trial. The objective of this study was to estimate the cost-effectiveness of denosumab from a societal perspective compared with generic alendronate, branded risedronate, strontium ranelate, and no treatment in a Swedish setting. Methods A Markov cohort model was used to estimate the cost-effectiveness of denosumab given for up to 5 years to a typical Swedish patient population (women aged 71 years, T-score=−2.5 SD and a prevalence of morphometric vertebral fractures of 34%). The model included treatment persistence and residual effect after discontinuation assumed to be equal to the time on treatment. Persistence with the comparator treatments and with denosumab was derived from prescription data and a persistence study, respectively. Results The base-case incremental cost-effectiveness ratios were estimated at €27,000, €12,000, €5,000, and €14,000, for denosumab compared with generic alendronate, risedronate, strontium ranelate, and no treatment, respectively. Suboptimal persistence had the greatest impact in the comparison with generic alendronate, where the difference in drug cost was large. Conclusion Improving persistence with osteoporosis treatment impacts positively on cost-effectiveness with a larger number of fractures avoided in the population targeted for treatment. Denosumab is a cost-effective alternative to oral osteoporosis treatments, particularly for patients at high risk of fracture and low expected adherence to oral treatments

  12. Cost-effectiveness of bazedoxifene compared with raloxifene in the treatment of postmenopausal osteoporotic women.

    PubMed

    Hiligsmann, Mickael; Ben Sedrine, Wafa; Reginster, Jean-Yves

    2013-04-01

    Bazedoxifene is a novel selective estrogen receptor modulator (SERM) for the prevention and treatment of osteoporosis. In addition to the therapeutic value of a new agent, evaluation of the cost-effectiveness compared with relevant alternative treatment(s) is an important consideration to facilitate healthcare decision making. This study evaluated the cost-effectiveness of bazedoxifene compared with raloxifene for the treatment of postmenopausal women with osteoporosis. The cost-effectiveness of treatment for 3 years with bazedoxifene was compared with raloxifene using an updated version of a previously validated Markov microsimulation model. Analyses were conducted from a Belgian healthcare payer perspective and, the base-case population was women (aged 70 years) with bone mineral density T-score ≤ -2.5. The effects of bazedoxifene and raloxifene on fracture risk were derived from the 3-year results of a randomized, double-blind, placebo-controlled and active-controlled study, including postmenopausal women with osteoporosis. The cost-effectiveness analysis based on efficacy data from the overall clinical trial indicated that bazedoxifene and raloxifene were equally cost-effective. When the results were examined based on the subgroup analysis of women at higher risk of fractures, bazedoxifene was dominant (lower cost for higher effectiveness) compared with raloxifene in most of the simulations. Sensitivity analyses confirmed the robustness of the results, which were largely independent of starting age of treatment, fracture risk, cost, and disutility. In addition, when the cost of raloxifene was reduced by one-half or when incorporating the raloxifene effects on reducing breast cancer, bazedoxifene remained cost-effective, at a threshold of €35,000 per quality-adjusted life-years gained, in 85% and 68% of the simulations, respectively. Under the assumption of improved antifracture efficacy of bazedoxifene over raloxifene in women with high risk of fractures

  13. Assessing Zambia's industrial fortification options: getting beyond changes in prevalence and cost-effectiveness.

    PubMed

    Fiedler, John L; Lividini, Keith; Kabaghe, Gladys; Zulu, Rodah; Tehinse, John; Bermudez, Odilia I; Jallier, Vincent; Guyondet, Christophe

    2013-12-01

    Background. Since fortification of sugar with vitamin A was mandated in 1998, Zambia's fortification program has not changed, while the country remains plagued by high rates ofmicronutrient deficiencies. Objective. To provide evidence-based fortification options with the hope of reinvigorating the Zambian fortification program. Methods. Zambia's 2006 Living Conditions Monitoring Survey is used to estimate the apparent intakes of vitamin A, iron, and zinc, as well as the apparent consumption levels and coverage of four fortification vehicles. Fourteen alternativefoodfortification portfolios are modeled, and their costs, impacts, average cost-effectiveness, and incremental cost-effectiveness are calculated using three alternative impact measures. Results. Alternative impact measures result in different rank orderings of the portfolios. The most cost-effective portfolio is vegetable oil, which has a cost per disability-adjusted life-year (DALY) saved ranging from 12% to 25% of that of sugar, depending on the impact measure used. The public health impact of fortified vegetable oil, however, is relatively modest. Additional criteria beyond cost-effectiveness are introduced and used to rank order the portfolios. The size of the public health impact, the total cost, and the incremental cost-effectiveness of phasing in multiple vehicle portfolios over time are analyzed. Conclusions. Assessing fortification portfolios by measuring changes in the prevalence of inadequate intakes underestimates impact. A more sensitive measure, which also takes into account change in the Estimated Average Requirement (EAR) gap, is provided by a dose-response-based approach to estimating the number ofDALYs saved. There exist highly cost-effective fortification intervention portfolios with substantial public health impacts and variable price tags that could help improve Zambians' nutrition status.

  14. Cost-Effectiveness in Higher Education.

    ERIC Educational Resources Information Center

    Bottomley, J. A.

    This study was undertaken to investigate new techniques of costing and resource allocation in higher education. A preliminary study was made of current costs of producing graduates in different disciplines broken down by major items of expenditure (capital and maintenance costs, salaries, administrative costs, etc.). Then, alternative models were…

  15. One Health approach to cost-effective rabies control in India

    PubMed Central

    Shah, Hiral A.; Pandey, Abhishek; Bilinski, Alyssa M.; Kakkar, Manish; Clark, Andrew D.; Galvani, Alison P.

    2016-01-01

    Over 20,000 rabies deaths occur annually in India, representing one-third of global human rabies. The Indian state of Tamil Nadu has pioneered a “One Health” committee to address the challenge of rabies in dogs and humans. Currently, rabies control in Tamil Nadu involves postexposure vaccination of humans after dog bites, whereas potential supplemental approaches include canine vaccination and sterilization. We developed a data-driven rabies transmission model fit to human rabies autopsy data and human rabies surveillance data from Tamil Nadu. Integrating local estimates for canine demography and costs, we predicted the impact of canine vaccination and sterilization on human health outcomes and evaluated cost-effectiveness according to the WHO criteria for India, which correspond to thresholds of $1,582 and $4,746 per disability-adjusted life-years (DALYs) for very cost-effective and cost-effective strategies, respectively. We found that highly feasible strategies focused on stray dogs, vaccinating as few as 7% of dogs annually, could very cost-effectively reduce human rabies deaths by 70% within 5 y, and a modest expansion to vaccinating 13% of stray dogs could cost-effectively reduce human rabies by almost 90%. Through integration over parameter uncertainty, we find that, for a cost-effectiveness threshold above $1,400 per DALY, canine interventions are at least 95% likely to be optimal. If owners are willing to bring dogs to central point campaigns at double the rate that campaign teams can capture strays, expanded annual targets become cost-effective. This case study of cost-effective canine interventions in Tamil Nadu may have applicability to other settings in India and beyond. PMID:27994161

  16. Methods of cost-effectiveness analysis in the evaluation of new antipsychotics: implications for schizophrenia treatment.

    PubMed

    Neumann, P J

    1999-01-01

    Because health care payers are increasingly interested in learning whether new treatments offer value for money, there has been an abundance of research into the cost-effectiveness of pharmacologic therapies in the United States. In the past few years, a number of studies comparing the cost-effectiveness of the conventional neuroleptics with that of the atypical antipsychotics have been published. Cost-effectiveness analyses show the relationship between the resources used (costs) and the health benefits achieved (effects) for a health or medical intervention compared with an alternative strategy. Ideally, the analyses can help decision makers improve the health of the population by better allocating society's limited health care resources. However, the extent to which cost-effectiveness data are actually used in decision making is unclear. The analyses are sometimes viewed with skepticism, in part because studies differ in their methodological approaches. Recently, the U.S. Panel on Cost-Effectiveness in Health and Medicine offered recommendations for standard methodological practices, which may help improve the quality of studies and the acceptability of the approach in the future. The issue is particularly important in light of new legislation governing how the Food and Drug Administration will regulate promotional claims made by drug companies regarding health economic information.

  17. Modifying the gastrointestinal ecology in alternatively raised poultry and the potential for molecular and metabolomic assessment.

    PubMed

    Park, S H; Hanning, I; Perrota, A; Bench, B J; Alm, E; Ricke, S C

    2013-02-01

    Consumer demand for nonconventional poultry products continues to increase in the United States. In pasture flock and organic poultry production, probiotics and prebiotic feed additives have potential advantages because they are thought to promote intestinal health and may offer a replacement for current intervention strategies that are not considered acceptable for these production systems. Prebiotics have been demonstrated to produce effects on the gastrointestinal tract including modulation of microflora by promoting selective increases in beneficial bacteria concomitant with decreases in undesirable bacteria. In-depth assessment of microbial community changes during host growth and development as well as the establishment of beneficial microbial species by adding biologicals such as probiotics and prebiotics is important to achieve predictable and consistent improvements in chicken health and productivity. To analyze microflora shifts and metabolites produced by bacteria in the gut as well as host responses to biological additives, sophisticated molecular techniques are now available and are becoming more widely used. Polymerase chain reaction assays, denaturing gradient gel electrophoresis, and temperature gradient gel electrophoresis offer approaches for detecting microbial shifts in the gut. Likewise, the employment of microarrays and molecular analysis of gut tissues can reveal insight into gut physiological and responses to dietary and other changes. Recent application of 16S rDNA sequencing and analysis utilizing basic local alignment search tool (BLAST) and FASTA databases on poultry gut samples have the potential to provide a much more in-depth assessment of the gut microbiome. Utilizing ultra pressure liquid chromatography-mass spectroscopy profiling, metabolomic assessment of gut contents will also allow for parallel comparisons of changes in the gut contents with microbiome and physiological responses. Combining all these technologies will provide a

  18. Infrared Drying as a Potential Alternative to Convective Drying for Biltong Production

    PubMed Central

    Cherono, Kipchumba; Mwithiga, Gikuru; Schmidt, Stefan

    2016-01-01

    Two infrared systems set at an intensity of 4777 W/m2 with peak emission wavelengths of 2.5 and 3.5 µm were used to produce biltong by drying differently pre-treated meat. In addition to meat texture and colour, the microbial quality of the biltong produced was assessed by quantifying viable heterotrophic microorganisms using a most probable number (MPN) method and by verifying the presence of presumptive Escherichia coli in samples produced using infrared and conventional convective drying. The two infrared drying systems reduced the heterotrophic microbial burden from 5.11 log10 MPN/g to 2.89 log10 MPN/g (2.5 µm) and 3.42 log10 MPN/g (3.5 µm), respectively. The infrared systems achieved an up to one log higher MPN/g reduction than the convective system. In biltong samples produced by short wavelength (2.5 µm) infrared drying, E. coli was not detectable. This study demonstrates that the use of short wavelength infrared drying is a potential alternative to conventional convective drying by improving the microbiological quality of biltong products while at the same time delivering products of satisfactory quality. PMID:27853706

  19. Evaluation of the odour reduction potential of alternative cover materials at a commercial landfill.

    PubMed

    Solan, P J; Dodd, V A; Curran, T P

    2010-02-01

    The availability of virgin soils and traditional landfill covers are not only costly and increasingly becoming scarce, but they also reduce the storage capacity of landfill. The problem can be overcome by the utilisation of certain suitable waste streams as alternative landfill covers. The objective of this study was to assess the suitability of Construction & Demolition fines (C&D), Commercial & Industrial fines (C&I) and woodchip (WC) as potential landfill cover materials in terms of odour control. Background odour analysis was conducted to determine if any residual odour was emitted from the cover types. It was deemed negligible for the three materials. The odour reduction performance of each of the materials was also examined on an area of an active landfill site. A range of intermediate cover compositions were also studied to assess their performance. Odour emissions were sampled using a Jiang hood and analysed. Results indicate that the 200 mm deep combination layer of C&D and wood chip used on-site is adequate for odour abatement. The application of daily cover was found to result in effective reduction allowing for the background odour of woodchip.

  20. Infrared Drying as a Potential Alternative to Convective Drying for Biltong Production.

    PubMed

    Cherono, Kipchumba; Mwithiga, Gikuru; Schmidt, Stefan

    2016-06-03

    Two infrared systems set at an intensity of 4777 W/m(2) with peak emission wavelengths of 2.5 and 3.5 µm were used to produce biltong by drying differently pre-treated meat. In addition to meat texture and colour, the microbial quality of the biltong produced was assessed by quantifying viable heterotrophic microorganisms using a most probable number (MPN) method and by verifying the presence of presumptive Escherichia coli in samples produced using infrared and conventional convective drying. The two infrared drying systems reduced the heterotrophic microbial burden from 5.11 log10 MPN/g to 2.89 log10 MPN/g (2.5 µm) and 3.42 log10 MPN/g (3.5 µm), respectively. The infrared systems achieved an up to one log higher MPN/g reduction than the convective system. In biltong samples produced by short wavelength (2.5 µm) infrared drying, E. coli was not detectable. This study demonstrates that the use of short wavelength infrared drying is a potential alternative to conventional convective drying by improving the microbiological quality of biltong products while at the same time delivering products of satisfactory quality.

  1. Ametantrone-based compounds as potential regulators of Tau pre-mRNA alternative splicing.

    PubMed

    Artigas, Gerard; López-Senín, Paula; González, Carlos; Escaja, Núria; Marchán, Vicente

    2015-01-14

    Tau pre-mRNA contains a stem-loop structure involved in the regulation of the alternative splicing of tau protein. We describe here a new family of Tau RNA ligands selected by dynamic combinatorial chemistry based on the combination of ametantrone with small RNA-binding molecules. The most promising compound results from derivatization of one of the side chains of the anthraquinone ring with the small aminoglycoside neamine through a short spacer. This compound binds the RNA target with a high affinity in a preferred binding site, in which the heteroaromatic moiety intercalates in the bulged region of the stem-loop and its side chains and neamine interact with the major groove of the RNA. Importantly, binding of this compound to mutated RNA sequences involved in the onset of some tauopathies such as FTDP-17 restores their thermodynamic stability to a similar or even higher levels than that of the wild-type sequence, thereby revealing its potential as a modulator of Tau pre-mRNA splicing.

  2. Oleoylethanolamide: a novel potential pharmacological alternative to cannabinoid antagonists for the control of appetite.

    PubMed

    Romano, Adele; Coccurello, Roberto; Giacovazzo, Giacomo; Bedse, Gaurav; Moles, Anna; Gaetani, Silvana

    2014-01-01

    The initial pharmaceutical interest for the endocannabinoid system as a target for antiobesity therapies has been restricted by the severe adverse effects of the CB1 antagonist rimonabant. This study points at oleoylethanolamide (OEA), a monounsaturated analogue, and functional antagonist of anandamide, as a potential and safer antiobesity alternative to CB1 antagonism. Mice treated with equal doses (5 or 10 mg/kg, i.p.) of OEA or rimonabant were analyzed for the progressive expression of spontaneous behaviors (eating, grooming, rearing, locomotion, and resting) occurring during the development of satiety, according to the paradigm called behavioral satiety sequence (BSS). Both drugs reduced food (wet mash) intake to a similar extent. OEA treatment decreased eating activity within the first 30 min and caused a temporary increase of resting time that was not accompanied by any decline of horizontal, vertical and total motor activity. Besides decreasing eating activity, rimonabant caused a marked increase of the time spent grooming and decreased horizontal motor activity, alterations that might be indicative of aversive nonmotivational effects on feeding. These results support the idea that OEA suppresses appetite by stimulating satiety and that its profile of action might be predictive of safer effects in humans as a novel antiobesity treatment.

  3. Assessment of reducing ozone forming potential for vehicles using liquefied petroleum gas as an alternative fuel

    NASA Astrophysics Data System (ADS)

    Chang, Chih-Chung; Lo, Jiunn-Guang; Wang, Jia-Lin

    Liquefied petroleum gas (LPG) is currently used in a small fleet of taxis as an alternative fuel to gasoline in Taipei, Taiwan as part of an incentive program promoted by Taiwan EPA to improve urban air quality. Under the test procedure in accordance with the US FTP-75 protocol to simulate an average urban driving pattern, the exhaust from four LPG and four gasoline-powered vehicles was analyzed for the percent composition of NMHCs. Emission factors for individual NMHCs were apportioned from the emission factors of total hydrocarbon based on chemical composition of the exhaust from both types of vehicles. After adjusting for ozone formation potential (OFP) by maximum incremental reactivity, the average OFP for LPG vehicles was estimated to be only 52.8% (g-O 3/veh-km) of the gasoline vehicles, or 3.3% of ozone reduction in Taipei metropolitan area, should all taxis be converted to LPG fuel. Composition analysis of the local LPG revealed that propane, butane and isobutane were the three major components and negligible amounts of alkenes were also found. In addition, the leakage from a LPG service station was substantially smaller than from a gasoline service station because of the closed design with the LPG pumping systems.

  4. How to Develop Renewable Power in China? A Cost-Effective Perspective

    PubMed Central

    2014-01-01

    To address the problems of climate change and energy security, Chinese government strived to develop renewable power as an important alternative of conventional electricity. In this paper, the learning curve model is employed to describe the decreasing unit investment cost due to accumulated installed capacity; the technology diffusion model is used to analyze the potential of renewable power. Combined with the investment cost, the technology potential, and scenario analysis of China social development in the future, we develop the Renewable Power Optimization Model (RPOM) to analyze the optimal development paths of three sources of renewable power from 2009 to 2020 in a cost-effective way. Results show that (1) the optimal accumulated installed capacities of wind power, solar power, and biomass power will reach 169000, 20000, and 30000 MW in 2020; (2) the developments of renewable power show the intermittent feature; (3) the unit investment costs of wind power, solar power, and biomass power will be 4500, 11500, and 5700 Yuan/KW in 2020; (4) the discounting effect dominates the learning curve effect for solar and biomass powers; (5) the rise of on-grid ratio of renewable power will first promote the development of wind power and then solar power and biomass power. PMID:24578672

  5. How to develop renewable power in China? A cost-effective perspective.

    PubMed

    Cong, Rong-Gang; Shen, Shaochuan

    2014-01-01

    To address the problems of climate change and energy security, Chinese government strived to develop renewable power as an important alternative of conventional electricity. In this paper, the learning curve model is employed to describe the decreasing unit investment cost due to accumulated installed capacity; the technology diffusion model is used to analyze the potential of renewable power. Combined with the investment cost, the technology potential, and scenario analysis of China social development in the future, we develop the Renewable Power Optimization Model (RPOM) to analyze the optimal development paths of three sources of renewable power from 2009 to 2020 in a cost-effective way. Results show that (1) the optimal accumulated installed capacities of wind power, solar power, and biomass power will reach 169000, 20000, and 30000 MW in 2020; (2) the developments of renewable power show the intermittent feature; (3) the unit investment costs of wind power, solar power, and biomass power will be 4500, 11500, and 5700 Yuan/KW in 2020; (4) the discounting effect dominates the learning curve effect for solar and biomass powers; (5) the rise of on-grid ratio of renewable power will first promote the development of wind power and then solar power and biomass power.

  6. Quality of Life and Cost Effectiveness of Prostate Cancer Treatment

    DTIC Science & Technology

    2005-03-01

    AD Award Number: W81XWH-04-1-0257 TITLE: Quality of Life and Cost Effectiveness of Prostate Cancer Treatment PRINCIPAL INVESTIGATOR: Ravishankar...patients across two ethnic groups, (2) analyze and compare short and long term cost-effectiveness of prostate cancer treatment across ethnic groups; and...cost-effectiveness of prostate cancer treatment across ethnic groups; and (3) analyze and compare resource utilization patterns, treatment modalities

  7. Release of Lungworm Larvae from Snails in the Environment: Potential for Alternative Transmission Pathways

    PubMed Central

    Giannelli, Alessio; Colella, Vito; Abramo, Francesca; do Nascimento Ramos, Rafael Antonio; Falsone, Luigi; Brianti, Emanuele; Varcasia, Antonio; Dantas-Torres, Filipe; Knaus, Martin; Fox, Mark T.; Otranto, Domenico

    2015-01-01

    Background Gastropod-borne parasites may cause debilitating clinical conditions in animals and humans following the consumption of infected intermediate or paratenic hosts. However, the ingestion of fresh vegetables contaminated by snail mucus and/or water has also been proposed as a source of the infection for some zoonotic metastrongyloids (e.g., Angiostrongylus cantonensis). In the meantime, the feline lungworms Aelurostrongylus abstrusus and Troglostrongylus brevior are increasingly spreading among cat populations, along with their gastropod intermediate hosts. The aim of this study was to assess the potential of alternative transmission pathways for A. abstrusus and T. brevior L3 via the mucus of infected Helix aspersa snails and the water where gastropods died. In addition, the histological examination of snail specimens provided information on the larval localization and inflammatory reactions in the intermediate host. Methodology/Principal Findings Twenty-four specimens of H. aspersa received ~500 L1 of A. abstrusus and T. brevior, and were assigned to six study groups. Snails were subjected to different mechanical and chemical stimuli throughout 20 days in order to elicit the production of mucus. At the end of the study, gastropods were submerged in tap water and the sediment was observed for lungworm larvae for three consecutive days. Finally, snails were artificially digested and recovered larvae were counted and morphologically and molecularly identified. The anatomical localization of A. abstrusus and T. brevior larvae within snail tissues was investigated by histology. L3 were detected in the snail mucus (i.e., 37 A. abstrusus and 19 T. brevior) and in the sediment of submerged specimens (172 A. abstrusus and 39 T. brevior). Following the artificial digestion of H. aspersa snails, a mean number of 127.8 A. abstrusus and 60.3 T. brevior larvae were recovered. The number of snail sections positive for A. abstrusus was higher than those for T. brevior

  8. Accounting for future costs in medical cost-effectiveness analysis.

    PubMed

    Meltzer, D

    1997-02-01

    Most medical cost-effectiveness analyses include future costs only for related illnesses, but this approach is controversial. This paper demonstrates that cost-effectiveness analysis is consistent with lifetime utility maximization only if it includes all future medical and non-medical expenditures. Estimates of the magnitude of these future costs suggest that they may substantially alter both the absolute and relative cost-effectiveness of medical interventions, particularly when an intervention increases length of life more than quality of life. In older populations, current methods overstate the cost-effectiveness of interventions which extend life compared to interventions which improve the quality of life.

  9. Alternative energy sources

    NASA Astrophysics Data System (ADS)

    Todd, R. W.

    1982-04-01

    Renewable energy sources and their potential contribution for solving energy needs are presented. Centralized supply technologies include those alternative fuels derived from biomass using solar energy, (supplying 57% of the energy supply in some countries), and those using directly collected solar energy to manufacture a fuel. Fuel utilization effects can be doubled by using combined heat and power stations, and other major sources include wind, wave, tidal, and solar. In terms of local supply technology, wood burning appliances are becoming more popular, and methane is being used for heating and to fuel spark ignition engines. Geothermal low temperature heating exists worldwide at a capacity of 7.2 GW, supplying heat, particularly in Hungary, parts of the U.S.S.R., and Iceland, and a geothermal research program has been established in the United States. Sweden has a potential hydroelectric capacity of 600 MW, and the United States has a 100 GW capacity. Many of these technologies are already cost effective.

  10. On the potential for alternative greenhouse gas equivalence metrics to influence sectoral mitigation patterns

    NASA Astrophysics Data System (ADS)

    Brennan, Mark E.; Zaitchik, Benjamin F.

    2013-03-01

    Equivalence metrics used to quantify the relative climate impacts of different atmospheric forcers serve an essential function in policy and economic discussions about global climate change. The 100-year global warming potential (GWP-100), the most established greenhouse gas (GHG) equivalence metric, is used within the Kyoto Protocol, and in most emissions inventory, trading and offset mechanisms, to assign the mitigation value of non-carbon dioxide greenhouse gases relative to carbon dioxide. In recent literature the GWP-100 and alternative metrics have been used to compare various anthropogenic climate forcers with respect to a wide range of environmental and economic goals. Building on this work, we examine how 16 different static and time-varying CO2-equivalence schemes might influence GHG mitigation across sectors and gases in a perfect and fluid global mitigation regime. This mitigation regime is guided by achieving a global mean radiative forcing (RF) of 5.7 Wm-2 in 2100 from 1765 levels through a mitigation policy of prescribed emissions reductions in each decade. It was found that static metrics defined on 20- instead of 100-year time horizons favor mitigation strategies that maximize the abatement of short-lived gases (e.g. methane), on average resulting in an RF from methane in 2100 of 0.5 Wm-2 instead of 1.1 Wm-2 from 100-year metrics. Similarly, metrics that consider integrated rather than end-point climate impacts imply mitigation strategies that maximize mitigation of shorter-lived GHGs, resulting in higher abatement of agriculture and waste emissions. Comparing extreme scenarios, these mitigation shifts across gases and sectors result in a nearly 30% difference in the representation of methane in global cumulative emissions reductions. This shift across gases and sectors to mitigate shorter-lived GHGs, in lieu of longer-lived GHGs like carbon dioxide, has implications for the long-term warming commitment due to 21st century emissions.

  11. Weak Polygyny in California Sea Lions and the Potential for Alternative Mating Tactics

    PubMed Central

    Flatz, Ramona; González-Suárez, Manuela; Young, Julie K.; Hernández-Camacho, Claudia J.; Immel, Aaron J.; Gerber, Leah R.

    2012-01-01

    Female aggregation and male territoriality are considered to be hallmarks of polygynous mating systems. The development of genetic parentage assignment has called into question the accuracy of behavioral traits in predicting true mating systems. In this study we use 14 microsatellite markers to explore the mating system of one of the most behaviorally polygynous species, the California sea lion (Zalophus californianus). We sampled a total of 158 female-pup pairs and 99 territorial males across two breeding rookeries (San Jorge and Los Islotes) in the Gulf of California, Mexico. Fathers could be identified for 30% of pups sampled at San Jorge across three breeding seasons and 15% of sampled pups at Los Islotes across two breeding seasons. Analysis of paternal relatedness between the pups for which no fathers were identified (sampled over four breeding seasons at San Jorge and two at Los Islotes) revealed that few pups were likely to share a father. Thirty-one percent of the sampled males on San Jorge and 15% of the sampled males on Los Islotes were assigned at least one paternity. With one exception, no male was identified as the father of more than two pups. Furthermore, at Los Islotes rookery there were significantly fewer pups assigned paternity than expected given the pool of sampled males (p<0.0001). Overall, we found considerably lower variation in male reproductive success than expected in a species that exhibits behavior associated with strongly polygynous mating. Low variation in male reproductive success may result from heightened mobility among receptive females in the Gulf of California, which reduces the ability of males to monopolize groups of females. Our results raise important questions regarding the adaptive role of territoriality and the potential for alternative mating tactics in this species. PMID:22432039

  12. Geostatistics and cost-effective environmental remediation

    SciTech Connect

    Rautman, C.A.

    1996-04-12

    Numerous sites within the U.S. Department of Energy (DOE) complex have been contaminated with various radioactive and hazardous materials by defense-related activities during the post-World War II era. The perception is that characterization and remediation of these contaminated sites will be too costly using currently available technology. Consequently, the DOE Office of Technology Development has funded development of a number of alternative processes for characterizing and remediating these sites. The former Feed-Materials Processing Center near Fernald, Ohio (USA), was selected for demonstrating several innovative technologies. Contamination at the Fernald site consists principally of particulate uranium and derivative compounds in surficial soil. A field-characterization demonstration program was conducted during the summer of 1994 specifically to demonstrate the relative economic performance of seven proposed advanced-characterization tools for measuring uranium activity of in-situ soils. These innovative measurement technologies are principally radiation detectors of varied designs. Four industry-standard measurement technologies, including conventional, regulatory-agency-accepted soil sampling followed by laboratory geochemical analysis, were also demonstrated during the program for comparative purposes. A risk-based economic-decision model has been used to evaluate the performance of these alternative characterization tools. The decision model computes the dollar value of an objective function for each of the different characterization approaches. The methodology not only can assist site operators to choose among engineering alternatives for site characterization and/or remediation, but also can provide an objective and quantitative basis for decisions with respect to the completeness of site characterization.

  13. Soybean protein as a cost-effective lignin-blocking additive for the saccharification of sugarcane bagasse.

    PubMed

    Florencio, Camila; Badino, Alberto C; Farinas, Cristiane S

    2016-12-01

    Addition of surfactants, polymers, and non-catalytic proteins can improve the enzymatic hydrolysis of lignocellulosic materials by blocking the exposed lignin surfaces, but involves extra expense. Here, soybean protein, one of the cheapest proteins available, was evaluated as an alternative additive for the enzymatic hydrolysis of pretreated sugarcane bagasse. The effect of the enzyme source was investigated using enzymatic cocktails from A. niger and T. reesei cultivated under solid-state, submerged, and sequential fermentation. The use of soybean protein led to approximately 2-fold increases in hydrolysis, relative to the control, for both A. niger and T. reesei enzymatic cocktails from solid-state fermentation. The effect was comparable to that of BSA. Moreover, the use of soybean protein and a 1:1 combination of A. niger and T. reesei enzymatic cocktails resulted in 54% higher glucose release, compared to the control. Soybean protein is a potential cost-effective additive for use in the biomass conversion process.

  14. Cell dualism: presence of cells with alternative membrane potentials in growing populations of bacteria and yeasts.

    PubMed

    Ivanov, Volodymyr; Rezaeinejad, Saeid; Chu, Jian

    2013-10-01

    It is considered that all growing cells, for exception of acidophilic bacteria, have negatively charged inside cytoplasmic membrane (Δψ⁻-cells). Here we show that growing populations of microbial cells contain a small portion of cells with positively charged inside cytoplasmic membrane (Δψ⁺-cells). These cells were detected after simultaneous application of the fluorescent probes for positive membrane potential (anionic dye DIBAC⁻) and membrane integrity (propidium iodide, PI). We found in exponentially growing cell populations of Escherichia coli and Saccharomyces cerevisiae that the content of live Δψ⁻-cells was 93.6 ± 1.8 % for bacteria and 90.4 ± 4.0 % for yeasts and the content of live Δψ⁺-cells was 0.9 ± 0.3 % for bacteria and 2.4 ± 0.7 % for yeasts. Hypothetically, existence of Δψ⁺-cells could be due to short-term, about 1 min for bacteria and 5 min for yeasts, change of membrane potential from negative to positive value during the cell cycle. This change has been shown by the reversions of K⁺, Na⁺, and Ca²⁺ ions fluxes across the cell membrane during synchronous yeast culture. The transformation of Δψ(⁻-cells to Δψ⁺-cells can be explained by slow influx of K⁺ ions into Δψ⁻-cell to the trigger level of K⁺ concentration ("compression of potassium spring"), which is forming "alternative" Δψ⁺-cell for a short period, following with fast efflux of K⁺ ions out of Δψ⁺-cell ("release of potassium spring") returning cell to normal Δψ⁻ state. We anticipate our results to be a starting point to reveal the biological role of cell dualism in form of Δψ⁻- and Δψ⁺- cells.

  15. A study protocol testing the implementation, efficacy, and cost effectiveness of the ezParent program in pediatric primary care

    PubMed Central

    Schoeny, Michael; Risser, Heather; Johnson, Tricia

    2016-01-01

    Introduction Up to 20% of children demonstrate behavior problems that interfere with relationship development and academic achievement. Parent participation in behavioral parent training programs has been shown to decrease child problem behaviors and promote positive parent-child relationships. However, attendance and parent involvement in face-to-face parent training remain low. Testing the implementation, efficacy, and cost of alternative delivery models is needed to (a) increase the reach and sustainability of parent training interventions and (b) address the barriers to parent participation and implementation of such programs, specifically in primary health care settings. The purpose of this paper is to describe the study protocol evaluating the implementation, efficacy, and cost-effectiveness of delivering the tablet-based ezParent program in pediatric primary care sites. Methods The implementation of the ezParent in four pediatric primary care sites will be evaluated using a descriptive design and cost-effectiveness analysis. The efficacy of the ezParent will be tested using a randomized controlled trial design with 312 parents of 2 to 5 year old children from pediatric primary care settings. Data on parenting and child behavior outcomes will be obtained from all participants at baseline, and 3, 6, and 12 months post baseline. Discussion Integrating and evaluating the implementation of the ezParent in pediatric primary care is an innovative opportunity to promote positive parenting with potential for universal access to the preschool population and for low cost by building on existing infrastructure in pediatric primary care. PMID:27592122

  16. The Sunk Cost Effect In Pigeons And Humans

    PubMed Central

    Navarro, Anton D; Fantino, Edmund

    2005-01-01

    The sunk cost effect is the increased tendency to persist in an endeavor once an investment of money, effort, or time has been made. To date, humans are the only animal in which this effect has been observed unambiguously. We developed a behavior-analytic model of the sunk cost effect to explore the potential for this behavior in pigeons as well as in humans. Each trial started out with a short expected ratio, but on some trials assumed a longer expected ratio part way through the trial. Subjects had the (usually preferable) option of “escaping” the trial if the longer expected ratio had come into effect in order to bring on a new trial that again had a short expected ratio. In Experiments 1 through 3, we manipulated two independent variables that we hypothesized would affect the pigeons' ability to discriminate the increase in the expected ratio within a trial: (a) the presence or absence of stimuli that signal an increase in the expected ratio, and (b) the severity of the increase in the expected ratio. We found that the pigeons were most likely to persist nonoptimally through the longer expected ratios when stimulus changes were absent and when the increase in the expected ratio was less severe. Experiment 4 employed a similar procedure with human subjects that manipulated only the severity of the increase in the expected ratio and found a result similar to that of the pigeon experiment. In Experiment 5, we tested the hypothesis that a particular history of reinforcement would induce pigeons to persist through the longer expected ratios; the results suggested instead that the history of reinforcement caused the pigeons to persist less compared to pigeons that did not have that history. PMID:15762377

  17. Reducing Wildlife Damage with Cost-Effective Management Programmes.

    PubMed

    Krull, Cheryl R; Stanley, Margaret C; Burns, Bruce R; Choquenot, David; Etherington, Thomas R

    2016-01-01

    Limiting the impact of wildlife damage in a cost effective manner requires an understanding of how control inputs change the occurrence of damage through their effect on animal density. Despite this, there are few studies linking wildlife management (control), with changes in animal abundance and prevailing levels of wildlife damage. We use the impact and management of wild pigs as a case study to demonstrate this linkage. Ground disturbance by wild pigs has become a conservation issue of global concern because of its potential effects on successional changes in vegetation structure and composition, habitat for other species, and functional soil properties. In this study, we used a 3-year pig control programme (ground hunting) undertaken in a temperate rainforest area of northern New Zealand to evaluate effects on pig abundance, and patterns and rates of ground disturbance and ground disturbance recovery and the cost effectiveness of differing control strategies. Control reduced pig densities by over a third of the estimated carrying capacity, but more than halved average prevailing ground disturbance. Rates of new ground disturbance accelerated with increasing pig density, while rates of ground disturbance recovery were not related to prevailing pig density. Stochastic simulation models based on the measured relationships between control, pig density and rate of ground disturbance and recovery indicated that control could reduce ground disturbance substantially. However, the rate at which prevailing ground disturbance was reduced diminished rapidly as more intense, and hence expensive, pig control regimes were simulated. The model produced in this study provides a framework that links conservation of indigenous ecological communities to control inputs through the reduction of wildlife damage and suggests that managers should consider carefully the marginal cost of higher investment in wildlife damage control, relative to its marginal conservation return.

  18. Reducing Wildlife Damage with Cost-Effective Management Programmes

    PubMed Central

    Krull, Cheryl R.; Stanley, Margaret C.; Burns, Bruce R.; Choquenot, David; Etherington, Thomas R.

    2016-01-01

    Limiting the impact of wildlife damage in a cost effective manner requires an understanding of how control inputs change the occurrence of damage through their effect on animal density. Despite this, there are few studies linking wildlife management (control), with changes in animal abundance and prevailing levels of wildlife damage. We use the impact and management of wild pigs as a case study to demonstrate this linkage. Ground disturbance by wild pigs has become a conservation issue of global concern because of its potential effects on successional changes in vegetation structure and composition, habitat for other species, and functional soil properties. In this study, we used a 3-year pig control programme (ground hunting) undertaken in a temperate rainforest area of northern New Zealand to evaluate effects on pig abundance, and patterns and rates of ground disturbance and ground disturbance recovery and the cost effectiveness of differing control strategies. Control reduced pig densities by over a third of the estimated carrying capacity, but more than halved average prevailing ground disturbance. Rates of new ground disturbance accelerated with increasing pig density, while rates of ground disturbance recovery were not related to prevailing pig density. Stochastic simulation models based on the measured relationships between control, pig density and rate of ground disturbance and recovery indicated that control could reduce ground disturbance substantially. However, the rate at which prevailing ground disturbance was reduced diminished rapidly as more intense, and hence expensive, pig control regimes were simulated. The model produced in this study provides a framework that links conservation of indigenous ecological communities to control inputs through the reduction of wildlife damage and suggests that managers should consider carefully the marginal cost of higher investment in wildlife damage control, relative to its marginal conservation return. PMID

  19. Cost effectiveness of the stream-gaging program in Louisiana

    USGS Publications Warehouse

    Herbert, R.A.; Carlson, D.D.

    1985-01-01

    This report documents the results of a study of the cost effectiveness of the stream-gaging program in Louisiana. Data uses and funding sources were identified for the 68 continuous-record stream gages currently (1984) in operation with a budget of $408,700. Three stream gages have uses specific to a short-term study with no need for continued data collection beyond the study. The remaining 65 stations should be maintained in the program for the foreseeable future. In addition to the current operation of continuous-record stations, a number of wells, flood-profile gages, crest-stage gages, and stage stations, are serviced on the continuous-record station routes; thus, increasing the current budget to $423,000. The average standard error of estimate for data collected at the stations is 34.6%. Standard errors computed in this study are one measure of streamflow errors, and can be used as guidelines in comparing the effectiveness of alternative networks. By using the routes and number of measurements prescribed by the ' Traveling Hydrographer Program, ' the standard error could be reduced to 31.5% with the current budget of $423,000. If the gaging resources are redistributed, the 34.6% overall level of accuracy at the 68 continuous-record sites and the servicing of the additional wells or gages could be maintained with a budget of approximately $410,000. (USGS)

  20. Cost effective ER data acquisition using a dynamic characterization strategy

    SciTech Connect

    Skinner, Kenneth M.; Salpas, Peter A.

    2007-07-01

    The important first step in remediating contaminated sites is completing characterization. The process for characterization of natural environmental media (i.e., soil, sediment, surface water, groundwater) involves three basic steps: (1) develop a plan, (2) implement the plan by collecting information necessary to define the nature and extent of contaminants in the natural media, and (3) integrate, interpret and report the results. Because of budgetary constraints, these three steps are typically applied linearly with the expectation that by the end of one application of the process the site will be characterized with sufficient resolution to make decisions about remedial actions. Our experience over the past 13 years at a complex site in Tennessee has shown that this linear approach to characterization does not produce the desired resolution. Because characterization is typically a process of defining unknowns the inflexible nature of the linear approach makes it impractical to react as the conceptual understanding of site contaminants changes in response to the acquisition of new data. An alternative, flexible approach to characterization has been developed based on lessons learned. Over the past 3 years the flexible approach has cost-effectively produced the information needed for decision making. (authors)

  1. Potential radiological impacts of upper-bound operational accidents during proposed waste disposal alternatives for Hanford defense waste

    SciTech Connect

    Mishima, J.; Sutter, S.L.; Hawley, K.A.; Jenkins, C.E.; Napier, B.A.

    1986-02-01

    The Geologic Disposal Alternative, the In-Place Stabilization and Disposal Alternative, and the Reference Disposal Alternative are being evaluated for disposal of Hanford defense high-level, transuranic, and tank wastes. Environmental impacts associated with disposal of these wastes according to the alternatives listed above include potential doses to the downwind population from operation during the application of the handling and processing techniques comprising each disposal alternative. Scenarios for operational accident and abnormal operational events are postulated, on the basis of the currently available information, for the application of the techniques employed for each waste class for each disposal alternative. From these scenarios, an upper-bound airborne release of radioactive material was postulated for each waste class and disposal alternative. Potential downwind radiologic impacts were calculated from these upper-bound events. In all three alternatives, the single postulated event with the largest calculated radiologic impact for any waste class is an explosion of a mixture of ferri/ferro cyanide precipitates during the mechanical retrieval or microwave drying of the salt cake in single shell waste tanks. The anticipated downwind dose (70-year dose commitment) to the maximally exposed individual is 3 rem with a total population dose of 7000 man-rem. The same individual would receive 7 rem from natural background radiation during the same time period, and the same population would receive 3,000,000 man-rem. Radiological impacts to the public from all other postulated accidents would be less than that from this accident; furthermore, the radiological impacts resulting from this accident would be less than one-half that from the natural background radiation dose.

  2. Cost-Effectiveness of “Golden Mustard” for Treating Vitamin A Deficiency in India

    PubMed Central

    Chow, Jeffrey; Klein, Eili Y.; Laxminarayan, Ramanan

    2010-01-01

    Background Vitamin A deficiency (VAD) is an important nutritional problem in India, resulting in an increased risk of severe morbidity and mortality. Periodic, high-dose vitamin A supplementation is the WHO-recommended method to prevent VAD, since a single dose can compensate for reduced dietary intake or increased need over a period of several months. However, in India only 34 percent of targeted children currently receive the two doses per year, and new strategies are urgently needed. Methodology Recent advancements in biotechnology permit alternative strategies for increasing the vitamin A content of common foods. Mustard (Brassica juncea), which is consumed widely in the form of oil by VAD populations, can be genetically modified to express high levels of beta-carotene, a precursor to vitamin A. Using estimates for consumption, we compare predicted costs and benefits of genetically modified (GM) fortification of mustard seed with high-dose vitamin A supplementation and industrial fortification of mustard oil during processing to alleviate VAD by calculating the avertable health burden in terms of disability-adjusted life years (DALY). Principal Findings We found that all three interventions potentially avert significant numbers of DALYs and deaths. Expanding vitamin A supplementation to all areas was the least costly intervention, at $23–$50 per DALY averted and $1,000–$6,100 per death averted, though cost-effectiveness varied with prevailing health subcenter coverage. GM fortification could avert 5 million–6 million more DALYs and 8,000–46,000 more deaths, mainly because it would benefit the entire population and not just children. However, the costs associated with GM fortification were nearly five times those of supplementation. Industrial fortification was dominated by both GM fortification and supplementation. The cost-effectiveness ratio of each intervention decreased with the prevalence of VAD and was sensitive to the efficacy rate of averted

  3. Cost-effectiveness of pharmacotherapy for autoimmune hepatitis.

    PubMed

    Heneghan, Michael A; Al-Chalabi, Thawab; McFarlane, Ian G

    2006-02-01

    In > 80% of patients with autoimmune hepatitis, steroid therapy alone or in combination with azathioprine results in disease remission. Treatment response results in reversal of fibrosis and excellent long-term survival in many patients, whereas untreated patients may expect a 10-year survival of < 30%. The use of azathioprine monotherapy (2 mg/kg/day) has gained widespread acceptance in maintaining remission in clinical practice. Although all patients with autoimmune hepatitis may not need treatment, particularly those with mild disease, alternative strategies are required in patients who have failed to achieve remission on standard therapy of steroids with or without azathioprine, or patients with azathioprine-induced drug toxicity. In such circumstances, the use of salvage therapy in the form of ciclosporin, tacrolimus or mycophenolate mofetil may be warranted. Liver transplantation is the treatment of choice for patients who present with subacute liver failure or decompensated cirrhosis. Salvage therapy results in an exponential rise in cost with each increment in therapeutic escalation. As an alternative to standard therapy, it has also been suggested that novel therapies such as ciclosporin, tacrolimus or mycophenolate mofetil be initiated to achieve remission. However, a > 10-fold cost differential exists between the charges associated with more potent immunosuppression and standard therapy. Therefore, in evaluating novel immunosuppression in autoimmune hepatitis, it behoves clinicians not only to consider end points pertaining to efficacy, but also end points pertaining to cost-effectiveness. Moreover, the exact role of pharmacogenomics and genotyping of thiopurine methyltransferase in patients with autoimmune hepatitis needs to be fully defined.

  4. 42 CFR 457.1015 - Cost-effectiveness.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Cost-effectiveness. 457.1015 Section 457.1015... Waivers: General Provisions § 457.1015 Cost-effectiveness. (a) Definition. For purposes of this subpart, “cost-effective” means that the State's cost of purchasing family coverage that includes coverage...

  5. 23 CFR 635.205 - Finding of cost effectiveness.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... CONSTRUCTION AND MAINTENANCE Force Account Construction § 635.205 Finding of cost effectiveness. (a) It may be... highway construction project by force account when a situation exists in which the rights or... involved, it is cost effective to perform by force account the adjustment of railroad or utility...

  6. 23 CFR 635.205 - Finding of cost effectiveness.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... CONSTRUCTION AND MAINTENANCE Force Account Construction § 635.205 Finding of cost effectiveness. (a) It may be... highway construction project by force account when a situation exists in which the rights or... involved, it is cost effective to perform by force account the adjustment of railroad or utility...

  7. 23 CFR 635.205 - Finding of cost effectiveness.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... CONSTRUCTION AND MAINTENANCE Force Account Construction § 635.205 Finding of cost effectiveness. (a) It may be... highway construction project by force account when a situation exists in which the rights or... involved, it is cost effective to perform by force account the adjustment of railroad or utility...

  8. 23 CFR 635.205 - Finding of cost effectiveness.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... CONSTRUCTION AND MAINTENANCE Force Account Construction § 635.205 Finding of cost effectiveness. (a) It may be... highway construction project by force account when a situation exists in which the rights or... involved, it is cost effective to perform by force account the adjustment of railroad or utility...

  9. Cost Effective Repair Techniques for Turbine Airfoils. Volume 2

    DTIC Science & Technology

    1979-04-01

    BLADES , *GUIDE VANES , *REPAIR, TURBOFAN ENGINES , DIFFUSION BONDING, COST EFFECTIVENESS Identifiers: (U) * Turbine vanes , TF-39 engines , Activated...REPAIR TECHNIQUES FOR TURBINE AIRFOILS J. A. WEIN W. R. YOUNG GENERAL ELECTRIC COMPANY AIRCRAFT ENGINE GROUP CINCINNATI, OHIO 45215 APRIL 1979...Author: GENERAL ELECTRIC CO CINCINNATI OH AIRCRAFT ENGINE BUSINESS GROUP Unclassified Title: (U) Cost Effective Repair Techniques for

  10. Cost-effectiveness of vaccination against herpes zoster.

    PubMed

    de Boer, Pieter T; Wilschut, Jan C; Postma, Maarten J

    2014-01-01

    Herpes zoster (HZ) is a common disease among elderly, which may develop into a severe pain syndrome labeled postherpetic neuralgia (PHN). A live-attenuated varicella zoster virus vaccine has been shown to be effective in reducing the incidence and burden of illness of HZ and PHN, providing the opportunity to prevent significant health-related and financial consequences of HZ. In this review, we summarize the available literature on cost-effectiveness of HZ vaccination and discuss critical parameters for cost-effectiveness results. A search in PubMed and EMBASE was performed to identify full cost-effectiveness studies published before April 2013. Fourteen cost-effectiveness studies were included, all performed in western countries. All studies evaluated cost-effectiveness among elderly above 50 years and used costs per quality-adjusted life year (QALY) gained as primary outcome. The vast majority of studies showed vaccination of 60- to 75-year-old individuals to be cost-effective, when duration of vaccine efficacy was longer than 10 years. Duration of vaccine efficacy, vaccine price, HZ incidence, HZ incidence and discount rates were influential to the incremental cost-effectiveness ratio (ICER). HZ vaccination may be a worthwhile intervention from a cost-effectiveness point of view. More extensive reporting on methodology and more detailed results of sensitivity analyses would be desirable to address uncertainty and to guarantee optimal comparability between studies, for example regarding model structure, discounting, vaccine characteristics and loss of quality of life due to HZ and PHN.

  11. Cost Effectiveness for Gifted and Talented Educational Programs.

    ERIC Educational Resources Information Center

    Storms, Walt W.

    Presented is a systematic approach for analyzing cost effectiveness of gifted and talented educational programs in terms of categorizing funds, prorating expenditures, designing a data collection form, determining cost effectiveness, and considering multiple variable implications. All costs are reported to be subsumed under six major categories:…

  12. The Cost Effectiveness of 22 Approaches for Raising Student Achievement

    ERIC Educational Resources Information Center

    Yeh, Stuart S.

    2010-01-01

    Review of cost-effectiveness studies suggests that rapid assessment is more cost effective with regard to student achievement than comprehensive school reform (CSR), cross-age tutoring, computer-assisted instruction, a longer school day, increases in teacher education, teacher experience or teacher salaries, summer school, more rigorous math…

  13. Teaching and Technology Transfer as Alternative Revenue Streams: A Primer on the Potential Legal Implications for UK Universities

    ERIC Educational Resources Information Center

    Van Hoorebeek, Mark; Marson, James

    2005-01-01

    Purpose: The purpose of this paper is to assess the financial and intellectual issues facing the university sector as many institutions in the UK pursue alternative revenue streams. As a consequence to the increasing financial pressures, university departments are increasingly exposed to new forms of potential litigation and also face the risk to…

  14. Cost and cost-effectiveness of nationwide school-based helminth control in Uganda

    PubMed Central

    BROOKER, SIMON; KABATEREINE, NARCIS B; FLEMING, FIONA; DEVLIN, NANCY

    2009-01-01

    Estimates of cost and cost-effectiveness are typically based on a limited number of small-scale studies with no investigation of the existence of economies to scale or intra-country variation in cost and cost-effectiveness. This information gap hinders the efficient allocation of health care resources and the ability to generalize estimates to other settings. The current study investigates the intra-country variation in the cost and cost-effectiveness of nationwide school-based treatment of helminth (worm) infection in Uganda. Programme cost data were collected through semi-structured interviews with districts officials and from accounting records in six of the 23 intervention districts. Both financial and economic costs were assessed. Costs were estimated on the basis of cost in US$ per schoolchild treated and an incremental cost effectiveness ratio (cost in US$ per case of anaemia averted) was used to evaluate programme cost-effectiveness. Sensitivity analysis was performed to assess the effect of discount rate and drug price. The overall economic cost per child treated in the six districts was US$ 0.54 and the cost-effectiveness was US$ 3.19 per case of anaemia averted. Analysis indicated that estimates of both cost and cost-effectiveness differ markedly with the total number of children which received treatment, indicating economies of scale. There was also substantial variation between districts in the cost per individual treated (US$ 0.41-0.91) and cost per anaemia case averted (US$ 1.70-9.51). Independent variables were shown to be statistically associated with both sets of estimates. This study highlights the potential bias in transferring data across settings without understanding the nature of observed variations. PMID:18024966

  15. Cost-effectiveness of conservation payment schemes for species with different range sizes.

    PubMed

    Drechsler, Martin; Smith, Henrik G; Sturm, Astrid; Wätzold, Frank

    2016-08-01

    Payments to compensate landowners for carrying out costly land-use measures that benefit endangered biodiversity have become an important policy instrument. When designing such payments, it is important to take into account that spatially connected habitats are more valuable for many species than isolated ones. One way to incentivize provision of connected habitats is to offer landowners an agglomeration bonus, that is, a bonus on top of payments they are receiving to conserve land if the land is spatially connected. Researchers have compared the cost-effectiveness of the agglomeration bonus with 2 alternatives: an all-or-nothing, agglomeration payment, where landowners receive a payment only if the conserved land parcels have a certain level of spatial connectivity, and a spatially homogeneous payment, where landowners receive a payment for conserved land parcels irrespective of their location. Their results show the agglomeration bonus is rarely the most cost-effective option, and when it is, it is only slightly better than one of the alternatives. This suggests that the agglomeration bonus should not be given priority as a policy design option. However, this finding is based on consideration of only 1 species. We examined whether the same applied to 2 species, one for which the homogeneous payment is best and the other for which the agglomeration payment is most cost-effective. We modified a published conceptual model so that we were able to assess the cost-effectiveness of payment schemes for 2 species and applied it to a grassland bird and a grassland butterfly in Germany that require the same habitat but have different spatial-connectivity needs. When conserving both species, the agglomeration bonus was more cost-effective than the agglomeration and the homogeneous payment; thus, we showed that as a policy the agglomeration bonus is a useful conservation-payment option.

  16. Cost-effectiveness of the stream-gaging program in Missouri

    USGS Publications Warehouse

    Waite, L.A.

    1987-01-01

    This report documents the results of an evaluation of the cost effectiveness of the 1986 stream-gaging program in Missouri. Alternative methods of developing streamflow information and cost-effective resource allocation were used to evaluate the Missouri program. Alternative methods were considered statewide, but the cost effective resource allocation study was restricted to the area covered by the Rolla field headquarters. The average standard error of estimate for records of instantaneous discharge was 17 percent; assuming the 1986 budget and operating schedule, it was shown that this overall degree of accuracy could be improved to 16 percent by altering the 1986 schedule of station visitations. A minimum budget of $203,870, with a corresponding average standard error of estimate 17 percent, is required to operate the 1986 program for the Rolla field headquarters; a budget of less than this would not permit proper service and maintenance of the stations or adequate definition of stage-discharge relations. The maximum budget analyzed was $418,870, which resulted in an average standard error of estimate of 14 percent. Improved instrumentation can have a positive effect on streamflow uncertainties by decreasing lost records. An earlier study of data uses found that data uses were sufficient to justify continued operation of all stations. One of the stations investigated, Current River at Doniphan (07068000) was suitable for the application of alternative methods for simulating discharge records. However, the station was continued because of data use requirements. (Author 's abstract)

  17. The impact of ignoring population heterogeneity when Markov models are used in cost-effectiveness analysis.

    PubMed

    Zaric, Gregory S

    2003-01-01

    Many factors related to the spread and progression of diseases vary throughout a population. This heterogeneity is frequently ignored in cost-effectiveness analyses by using average or representative values or by considering multiple risk groups. The author explores the impact that such simplifying assumptions may have on the results and interpretation of cost-effectiveness analyses when Markov models are used to calculate the costs and health impact of interventions. A discrete-time Markov model for a disease is defined, and 5 potential interventions are considered. Health benefits, costs, and incremental cost-effectiveness ratios are calculated for each intervention. It is assumed that the population is heterogeneous with respect to the probability of becoming sick. Ignoring this heterogeneity may lead to optimistic or pessimistic estimates of cost-effectiveness ratios, depending on the intervention and, in some cases, the parameter values. Implications are discussed of this finding on the use of league tables and on comparisons of cost-effectiveness ratios versus commonly accepted threshold values.

  18. Cost-Effectiveness Analysis of the Diagnosis and Treatment of Primary Aldosteronism in Japan.

    PubMed

    Sato, M; Morimoto, R; Seiji, K; Iwakura, Y; Ono, Y; Kudo, M; Satoh, F; Ito, S; Ishibashi, T; Takase, K

    2015-10-01

    Approximately 10% of cases of hypertension in Japan are caused by primary aldosteronism (PA), amounting to about 4 million patients in total. Primary aldosteronism due to unilateral aldosterone hypersecretion is potentially curable by adrenalectomy. The clinical benefits of identifying and treating PA have been reported internationally, but its cost-effectiveness is unclear. We examined whether diagnosing and treating hidden PA in hypertensive population was cost-effective compared with suboptimal treatment. Our hypothetical patient was a 50-year-old man diagnosed with stage I-III hypertension. We established a Markov decision model based on plausible clinical pathways and prognoses of PA. We applied cost-effectiveness analysis comparing a comprehensive diagnostic strategy for PA (measurement of plasma aldosterone/renin ratio, 2 loading tests, imaging, and selective adrenal venous sampling) with a suboptimal strategy to manage hypertension by medication unless the typical signs of PA or other complication were manifest. Outcome measures were expected costs, expected effectiveness, and incremental cost-effectiveness ratio. The robustness of the findings was established by one-way and scenario sensitivity analyses. The comprehensive PA diagnostic strategy increased the expected costs by 64 004 JPY and expected life-years by 0.013 compared with standard treatment. The incremental cost-effectiveness ratio for the diagnosis of PA was 4 923 385 JPY per year. Our findings were sensitive to the outcomes of screening and treatment, and the costs of continuous or periodic medication for hypertension and the treatment of stroke and its complications.

  19. Cost-effectiveness of interventions to control Campylobacter in the New Zealand poultry meat food supply.

    PubMed

    Lake, Robin J; Horn, Beverley J; Dunn, Alex H; Parris, Ruth; Green, F Terri; McNickle, Don C

    2013-07-01

    An analysis of the cost-effectiveness of interventions to control Campylobacter in the New Zealand poultry supply examined a series of interventions. Effectiveness was evaluated in terms of reduced health burden measured by disability-adjusted life years (DALYs). Costs of implementation were estimated from the value of cost elements, determined by discussions with industry. Benefits were estimated by changing the inputs to a poultry food chain quantitative risk model. Proportional reductions in the number of predicted Campylobacter infections were converted into reductions in the burden of disease measured in DALYs. Cost-effectiveness ratios were calculated for each intervention, as cost per DALY reduction and the ratios compared. The results suggest that the most cost-effective interventions (lowest ratios) are at the primary processing stage. Potential phage-based controls in broiler houses were also highly cost-effective. This study is limited by the ability to quantify costs of implementation and assumptions required to estimate health benefits, but it supports the implementation of interventions at the primary processing stage as providing the greatest quantum of benefit and lowest cost-effectiveness ratios.

  20. Potential of alternative sorbents for desulphurization: from laboratory tests to the full-scale combustion unit

    SciTech Connect

    Zbyszek Szeliga; Dagmar Juchelkova; Bohumir Cech; Pavel Kolat; Franz Winter; Adam J. Campen; Tomasz S. Wiltowski

    2008-09-15

    At present, natural limestone is used for the desulphurization of waste gases from the combustion of fossil fuels. However, it is important to save all primary resources, such as limestone, for the future. The researchers focused on finding alternative sorbents for the purpose of desulphurization in a dry additive method, which would become the alternative for natural limestone. This paper is primarily focused on desulphurization tests of selected substances. Tests were initially conducted on the laboratory scale, followed by pilot and full-scale combustion units. 15 refs., 9 figs., 5 tabs.

  1. Cost-effectiveness of a Primary Care Depression Intervention

    PubMed Central

    Pyne, Jeffrey M; Rost, Kathryn M; Zhang, Mingliang; Williams, D Keith; Smith, Jeffrey; Fortney, John

    2003-01-01

    OBJECTIVE To determine the incremental cost-effectiveness of a quality improvement depression intervention (enhanced care) in primary care settings relative to usual care. DESIGN Following stratification, we randomized 12 primary care practices to enhanced or usual care conditions and followed patients for 12 months. SETTING Primary care practices located in 10 states across the United States. PATIENTS/PARTICIPANTS Two hundred eleven patients beginning a new treatment episode for major depression. INTERVENTIONS Training the primary care team to assess, educate, and monitor depressed patients during the acute and continuation stages of their depression treatment episode over 1 year. MEASUREMENTS AND MAIN RESULTS Cost-effectiveness was measured by calculating incremental (enhanced minus usual care) costs and quality-adjusted life years (QALYs) derived from SF-36 data. The mean incremental cost-effectiveness ratio in the main analysis was $15,463 per QALY. The mean incremental cost-effectiveness ratios for the sensitivity analyses ranged from $11,341 (using geographic block variables to control for pre-intervention service utilization) to $19,976 (increasing the cost estimates by 50%) per QALY. CONCLUSIONS This quality improvement depression intervention was cost-effective relative to usual care compared to cost-effectiveness ratios for common primary care interventions and commonly cited cost-effectiveness ratio thresholds for intervention implementation. PMID:12823650

  2. Photovoltaics for municipal planners. Cost-effective municipal applications of photovoltaics for electric power

    SciTech Connect

    Not Available

    1993-04-01

    This booklet is intended for city and county government personnel, as well as community organizations, who deal with supplying, regulating, or recommending electric power resources. Specifically, this document deals with photovoltaic (PV) power, or power from solar cells, which is currently the most cost-effective energy source for electricity requirements that are relatively small, located in isolated areas, or difficult to serve with conventional technology. Recently, PV has been documented to be more cost-effective than conventional alternatives (such as line extensions or engine generators) in dozens of applications within the service territories of electric, gas, and communications utilities. Here, we document numerous cost-effective urban applications, chosen by planners and utilities because they were the most cost-effective option or because they were appropriate for environmental or logistical reasons. These applications occur within various municipal departments, including utility, parks and recreation, traffic engineering, transportation, and planning, and they include lighting applications, communications equipment, corrosion protection, irrigation control equipment, remote monitoring, and even portable power supplies for emergency situations.

  3. Cost effectiveness of collagen crosslinking for progressive keratoconus in the UK NHS

    PubMed Central

    Salmon, H A; Chalk, D; Stein, K; Frost, N A

    2015-01-01

    Background Keratoconus is a progressive degenerative corneal disorder of children and young adults that is traditionally managed by refractive error correction, with corneal transplantation reserved for the most severe cases. UVA collagen crosslinking is a novel procedure that aims to prevent disease progression, currently being considered for use in the UK NHS. We assess whether it might be a cost-effective alternative to standard management for patients with progressive keratoconus. Methods We constructed a Markov model in which we estimated disease progression from prospective follow-up studies, derived costs derived from the NHS National Tariff, and calculated utilities from linear regression models of visual acuity in the better-seeing eye. We performed deterministic and probabilistic sensitivity analyses to assess the impact of possible variations in the model parameters. Results Collagen crosslinking is cost effective compared with standard management at an incremental cost of £3174 per QALY in the base case. Deterministic sensitivity analysis shows that this could rise above £33 263 per QALY if the duration of treatment efficacy is limited to 5 years. Other model parameters are not decision significant. Collagen crosslinking is cost effective in 85% of simulations at a willingness-to-pay threshold of £30 000 per QALY. Conclusion UVA collagen crosslinking is very likely to be cost effective, compared with standard management, for the treatment of progressive keratoconus. However, further research to explore its efficacy beyond 5 years is desirable. PMID:26315704

  4. Cost-Effectiveness of Radiofrequency Ablation for Supraventricular Tachycardia in Guatemala

    PubMed Central

    Rodriguez, Benjamin Cruz; Leal, Sergio; Calvimontes, Gonzalo; Hutton, David

    2015-01-01

    Background Radiofrequency ablation (RFA) is an established but expensive treatment alternative for many forms supraventricular tachycardia (SVT). Currently no studies exist on the cost-effectiveness of RFA compared to medical treatment (MT) in adult Latin American population. Methods Between 2007 and 2012, we identified 103 adults who underwent RFA for SVT in the National Unit of Cardiovascular Surgery (UNICAR) in Guatemala. A decision tree was developed with all clinical outcome parameter estimates obtained from the Adult Electrophysiology Clinic. Costs were obtained from UNICAR's administration. A cost-effectiveness analysis was conducted which evaluated costs and quality adjusted life years (QALYs) to compare interventions in terms of their incremental cost-effectiveness ratios (ICERs). Results The first RFA had 83% success and cumulative 94% success was achieved with a second one. The cost of the RFA procedure itself was $5,411. RFA gains 1.46 QALYs and saves $ 7,993 compared to of MT for patients with SVT. This demonstrates that in Guatemala, RFA dominates MT in the management of SVT. Using assumptions based largely on the outcomes in UNICAR, we found that the RFA is highly cost-effective. This is a consistent finding, even after varying assumptions about efficacy, complication rates and quality of life. Conclusions RFA dominates MT by improving quality of life and reducing expenditures when used to treat severely symptomatic patients with SVT in Guatemala. The robustness of these finding to variations in parameter assumptions, suggests these findings may hold in other similar settings. PMID:26543802

  5. Cost-effectiveness of different strategies to manage patients with sciatica.

    PubMed

    Fitzsimmons, Deborah; Phillips, Ceri J; Bennett, Hayley; Jones, Mari; Williams, Nefyn; Lewis, Ruth; Sutton, Alex; Matar, Hosam E; Din, Nafees; Burton, Kim; Nafees, Sadia; Hendry, Maggie; Rickard, Ian; Wilkinson, Claire

    2014-07-01

    The aim of this paper is to estimate the relative cost-effectiveness of treatment regimens for managing patients with sciatica. A deterministic model structure was constructed based on information from the findings from a systematic review of clinical effectiveness and cost-effectiveness, published sources of unit costs, and expert opinion. The assumption was that patients presenting with sciatica would be managed through one of 3 pathways (primary care, stepped approach, immediate referral to surgery). Results were expressed as incremental cost per patient with symptoms successfully resolved. Analysis also included incremental cost per utility gained over a 12-month period. One-way sensitivity analyses were used to address uncertainty. The model demonstrated that none of the strategies resulted in 100% success. For initial treatments, the most successful regime in the first pathway was nonopioids, with a probability of success of 0.613. In the second pathway, the most successful strategy was nonopioids, followed by biological agents, followed by epidural/nerve block and disk surgery, with a probability of success of 0.996. Pathway 3 (immediate surgery) was not cost-effective. Sensitivity analyses identified that the use of the highest cost estimates results in a similar overall picture. While the estimates of cost per quality-adjusted life year are higher, the economic model demonstrated that stepped approaches based on initial treatment with nonopioids are likely to represent the most cost-effective regimens for the treatment of sciatica. However, development of alternative economic modelling approaches is required.

  6. Simulation modeling of outcomes and cost effectiveness.

    PubMed

    Ramsey, S D; McIntosh, M; Etzioni, R; Urban, N

    2000-08-01

    Modeling will continue to be used to address important issues in clinical practice and health policy issues that have not been adequately studied with high-quality clinical trials. The apparent ad hoc nature of models belies the methodologic rigor that is applied to create the best models in cancer prevention and care. Models have progressed from simple decision trees to extremely complex microsimulation analyses, yet all are built using a logical process based on objective evaluation of the path between intervention and outcome. The best modelers take great care to justify both the structure and content of the model and then test their assumptions using a comprehensive process of sensitivity analysis and model validation. Like clinical trials, models sometimes produce results that are later found to be invalid as other data become available. When weighing the value of models in health care decision making, it is reasonable to consider the alternatives. In the absence of data, clinical policy decisions are often based on the recommendations of expert opinion panels or on poorly defined notions of the standard of care or medical necessity. Because such decision making rarely entails the rigorous process of data collection, synthesis, and testing that is the core of well-conducted modeling, it is usually not possible for external audiences to examine the assumptions and data that were used to derive the decisions. One of the modeler's most challenging tasks is to make the structure and content of the model transparent to the intended audience. The purpose of this article is to clarify the process of modeling, so that readers of models are more knowledgeable about their uses, strengths, and limitations.

  7. A Cost-Effectiveness Analysis of First Trimester Non-Invasive Prenatal Screening for Fetal Trisomies in the United States

    PubMed Central

    Walker, Brandon S.; Nelson, Richard E.; Jackson, Brian R.; Grenache, David G.; Ashwood, Edward R.; Schmidt, Robert L.

    2015-01-01

    Background Non-invasive prenatal testing (NIPT) is a relatively new technology for diagnosis of fetal aneuploidies. NIPT is more accurate than conventional maternal serum screening (MSS) but is also more costly. Contingent NIPT may provide a cost-effective alternative to universal NIPT screening. Contingent screening used a two-stage process in which risk is assessed by MSS in the first stage and, based on a risk cutoff, high-risk pregnancies are referred for NIPT. The objective of this study was to (1) determine the optimum MSS risk cutoff for contingent NIPT and (2) compare the cost effectiveness of optimized contingent NIPT to universal NIPT and conventional MSS. Study Design Decision-analytic model using micro-simulation and probabilistic sensitivity analysis. We evaluated cost effectiveness from three perspectives: societal, governmental, and payer. Results From a societal perspective, universal NIPT dominated both contingent NIPT and MSS. From a government and payer perspective, contingent NIPT dominated MSS. Compared to contingent NIPT, adopting a universal NIPT would cost $203,088 for each additional case detected from a government perspective and $263,922 for each additional case detected from a payer perspective. Conclusions From a societal perspective, universal NIPT is a cost-effective alternative to MSS and contingent NIPT. When viewed from narrower perspectives, contingent NIPT is less costly than universal NIPT and provides a cost-effective alternative to MSS. PMID:26133556

  8. Guide for Identifying and Converting High-Potential Petroleum Brownfield Sites to Alternative Fuel Stations

    SciTech Connect

    Johnson, C.; Hettinger, D.; Mosey, G.

    2011-05-01

    Former gasoline stations that are now classified as brownfields can be good sites to sell alternative fuels because they are in locations that are convenient to vehicles and they may be seeking a new source of income. However, their success as alternative fueling stations is highly dependent on location-specific criteria. First, this report outlines what these criteria are, how to prioritize them, and then applies that assessment framework to five of the most popular alternative fuels--electricity, natural gas, hydrogen, ethanol, and biodiesel. The second part of this report delves into the criteria and tools used to assess an alternative fuel retail site at the local level. It does this through two case studies of converting former gasoline stations in the Seattle-Eugene area into electric charge stations. The third part of this report addresses steps to be taken after the specific site has been selected. This includes choosing and installing the recharging equipment, which includes steps to take in the permitting process and key players to include.

  9. Cost-Effective Cloud Computing: A Case Study Using the Comparative Genomics Tool, Roundup

    PubMed Central

    Kudtarkar, Parul; DeLuca, Todd F.; Fusaro, Vincent A.; Tonellato, Peter J.; Wall, Dennis P.

    2010-01-01

    Background Comparative genomics resources, such as ortholog detection tools and repositories are rapidly increasing in scale and complexity. Cloud computing is an emerging technological paradigm that enables researchers to dynamically build a dedicated virtual cluster and may represent a valuable alternative for large computational tools in bioinformatics. In the present manuscript, we optimize the computation of a large-scale comparative genomics resource—Roundup—using cloud computing, describe the proper operating principles required to achieve computational efficiency on the cloud, and detail important procedures for improving cost-effectiveness to ensure maximal computation at minimal costs. Methods Utilizing the comparative genomics tool, Roundup, as a case study, we computed orthologs among 902 fully sequenced genomes on Amazon’s Elastic Compute Cloud. For managing the ortholog processes, we designed a strategy to deploy the web service, Elastic MapReduce, and maximize the use of the cloud while simultaneously minimizing costs. Specifically, we created a model to estimate cloud runtime based on the size and complexity of the genomes being compared that determines in advance the optimal order of the jobs to be submitted. Results We computed orthologous relationships for 245,323 genome-to-genome comparisons on Amazon’s computing cloud, a computation that required just over 200 hours and cost $8,000 USD, at least 40% less than expected under a strategy in which genome comparisons were submitted to the cloud randomly with respect to runtime. Our cost savings projections were based on a model that not only demonstrates the optimal strategy for deploying RSD to the cloud, but also finds the optimal cluster size to minimize waste and maximize usage. Our cost-reduction model is readily adaptable for other comparative genomics tools and potentially of significant benefit to labs seeking to take advantage of the cloud as an alternative to local computing

  10. The potential of standards-based agriculture biology as an alternative to traditional biology in California

    NASA Astrophysics Data System (ADS)

    Sellu, George Sahr

    schools. Thoron & Meyer (2011) suggested that research into the contribution of integrated science courses toward higher test scores yielded mixed results. This finding may have been due in part to the fact that integrated science courses only incorporate select topics into agriculture education courses. In California, however, agriculture educators have developed standards-based courses such as Agriculture Biology (AgBio) that cover the same content standards as core traditional courses such as traditional biology. Students in both AgBio and traditional biology take the same standardized biology test. This is the first time there has been an opportunity for a fair comparison and a uniform metric for an agriscience course such as AgBio to be directly compared to traditional biology. This study will examine whether there are differences between AgBio and traditional biology with regard to standardized test scores in biology. Furthermore, the study examines differences in perception between teachers and students regarding teaching and learning activities associated with higher achievement in science. The findings of the study could provide a basis for presenting AgBio as a potential alternative to traditional biology. The findings of this study suggest that there are no differences between AgBio and traditional biology students with regard to standardized biology test scores. Additionally, the findings indicate that co-curricular activities in AgBio could contribute higher student achievement in biology. However, further research is required to identify specific activities in AgBio that contribute to higher achievement in science.

  11. Alternative Splicing of hTERT Pre-mRNA: A Potential Strategy for the Regulation of Telomerase Activity

    PubMed Central

    Liu, Xuewen; Wang, Yuchuan; Chang, Guangming; Wang, Feng; Wang, Fei; Geng, Xin

    2017-01-01

    The activation of telomerase is one of the key events in the malignant transition of cells, and the expression of human telomerase reverse transcriptase (hTERT) is indispensable in the process of activating telomerase. The pre-mRNA alternative splicing of hTERT at the post-transcriptional level is one of the mechanisms for the regulation of telomerase activity. Shifts in splicing patterns occur in the development, tumorigenesis, and response to diverse stimuli in a tissue-specific and cell type–specific manner. Despite the regulation of telomerase activity, the alternative splicing of hTERT pre-mRNA may play a role in other cellular functions. Modulating the mode of hTERT pre-mRNA splicing is providing a new precept of therapy for cancer and aging-related diseases. This review focuses on the patterns of hTERT pre-mRNA alternative splicing and their biological functions, describes the potential association between the alternative splicing of hTERT pre-mRNA and telomerase activity, and discusses the possible significance of the alternative splicing of the hTERT pre-mRNA in the diagnosis, therapy, and prognosis of cancer and aging-related diseases. PMID:28272339

  12. Cost effective seasonal storage of wind energy

    SciTech Connect

    Cavallo, A.J.; Keck, M.B.

    1995-09-01

    Seasonal variation of the wind electric potential on the Great Plains could be a significant obstacle to the large scale utilization of wind generated electricity. Wind power densities usually are greatest during the spring, and decrease by at least 30 percent relative to the annual average in many areas during the summer months, when demand is highest. This problem can be overcome by using an oversized wind farm and a compressed air energy storage system (a baseload wind energy system). A minimum volume storage reservoir is needed to transform intermittent wind energy to baseload power, while a larger reservoir can be used to store excess power produced during the spring for either peak power or baseload output during the summer. The yearly average cost of energy increases by about 3 percent for the largest storage reservoir, indicating the seasonal storage of wind energy is economically as well as technically feasible.

  13. Cost-effective electric vehicle charging infrastructure siting for Delhi

    NASA Astrophysics Data System (ADS)

    Sheppard, Colin J. R.; Gopal, Anand R.; Harris, Andrew; Jacobson, Arne

    2016-06-01

    Plug-in electric vehicles (PEVs) represent a substantial opportunity for governments to reduce emissions of both air pollutants and greenhouse gases. The Government of India has set a goal of deploying 6-7 million hybrid and PEVs on Indian roads by the year 2020. The uptake of PEVs will depend on, among other factors like high cost, how effectively range anxiety is mitigated through the deployment of adequate electric vehicle charging stations (EVCS) throughout a region. The Indian Government therefore views EVCS deployment as a central part of their electric mobility mission. The plug-in electric vehicle infrastructure (PEVI) model—an agent-based simulation modeling platform—was used to explore the cost-effective siting of EVCS throughout the National Capital Territory (NCT) of Delhi, India. At 1% penetration in the passenger car fleet, or ˜10 000 battery electric vehicles (BEVs), charging services can be provided to drivers for an investment of 4.4 M (or 440/BEV) by siting 2764 chargers throughout the NCT of Delhi with an emphasis on the more densely populated and frequented regions of the city. The majority of chargers sited by this analysis were low power, Level 1 chargers, which have the added benefit of being simpler to deploy than higher power alternatives. The amount of public infrastructure needed depends on the access that drivers have to EVCS at home, with 83% more charging capacity required to provide the same level of service to a population of drivers without home chargers compared to a scenario with home chargers. Results also depend on the battery capacity of the BEVs adopted, with approximately 60% more charging capacity needed to achieve the same level of service when vehicles are assumed to have 57 km versus 96 km of range.

  14. Cost effective propulsion systems for small satellites using butane propellant

    NASA Astrophysics Data System (ADS)

    Gibbon, D.; Underwood, C.; Sweeting, M.; Amri, R.

    2002-07-01

    This paper will describe the work performed at the Surrey Space Centre to produce cost effective propulsion systems for small spacecraft with relatively low deltaV (ΔV) requirements. Traditionally, cold gas nitrogen systems have been used for this type of application, however they have high storage volume requirements. This can be a problem on small spacecraft, which are typically volume limited. An alternative solution is to use liquefied gases, which store as liquids, hence have reasonable density levels, and can be used in a cold gas thruster. At the Surrey Space Centre, butane has been selected as the propellant of choice. Although it has slightly lower specific impulse performance than nitrogen, it has a significantly higher storage density and it stores at a very low pressure, hence no regulation system is required. On 28 th June 2000 Surrey Satellite Technology Ltd (SSTL) launched it first nanosatellite SNAP-1. This 6.5kg spacecraft was equipped with a small cold gas propulsion system utilising 32.6 grams of butane propellant. During the propulsion system operation phase the spacecraft's semi major axis was raised by nearly 4 kilometers using the propulsion system. The design of the propulsion system will be described and the low cost features highlighted. Telemetry data will be used to describe the propulsion operations and an overall mission specific impulse will be derived. SSTL are currently under contract to build three Earth observation spacecraft for a Disaster Monitoring Constellation (DMC). Each spacecraft will weigh approx 100 kg and have a ΔV requirement of 10 m/sec. A butane system has been designed and manufactured to meet the requirements of these spacecraft. The system is based very much on the flight heritage of the SNAP-1 system, with the addition of greater propellant storage capacity. The lessons learnt from the SNAP-1 operation will be reviewed and the resulting design improvements on the DMC propulsion systems will be detailed.

  15. Guidelines for Cost-Effective Training Product Development.

    ERIC Educational Resources Information Center

    Awotua-Efebo, Ebi Bio

    1984-01-01

    Presents guidelines for cost effective product development for training managers charged with quality control of products and training specialists who design materials. Discusses phases of educational product development--diagnosis, design, development, and evaluation. (MBR)

  16. Cost-effective forensic image enhancement

    NASA Astrophysics Data System (ADS)

    Dalrymple, Brian E.

    1998-12-01

    In 1977, a paper was presented at the SPIE conference in Reston, Virginia, detailing the computer enhancement of the Zapruder film. The forensic value of this examination in a major homicide investigation was apparent to the viewer. Equally clear was the potential for extracting evidence which is beyond the reach of conventional detection techniques. The cost of this technology in 1976, however, was prohibitive, and well beyond the means of most police agencies. Twenty-two years later, a highly efficient means of image enhancement is easily within the grasp of most police agencies, not only for homicides but for any case application. A PC workstation combined with an enhancement software package allows a forensic investigator to fully exploit digital technology. The goal of this approach is the optimization of the signal to noise ratio in images. Obstructive backgrounds may be diminished or eliminated while weak signals are optimized by the use of algorithms including Fast Fourier Transform, Histogram Equalization and Image Subtraction. An added benefit is the speed with which these processes are completed and the results known. The efficacy of forensic image enhancement is illustrated through case applications.

  17. Cost-effectiveness of vaccination against herpes zoster

    PubMed Central

    de Boer, Pieter T; Wilschut, Jan C; Postma, Maarten J

    2014-01-01

    Herpes zoster (HZ) is a common disease among elderly, which may develop into a severe pain syndrome labeled postherpetic neuralgia (PHN). A live-attenuated varicella zoster virus vaccine has been shown to be effective in reducing the incidence and burden of illness of HZ and PHN, providing the opportunity to prevent significant health-related and financial consequences of HZ. In this review, we summarize the available literature on cost-effectiveness of HZ vaccination and discuss critical parameters for cost-effectiveness results. A search in PubMed and EMBASE was performed to identify full cost-effectiveness studies published before April 2013. Fourteen cost-effectiveness studies were included, all performed in western countries. All studies evaluated cost-effectiveness among elderly above 50 years and used costs per quality-adjusted life year (QALY) gained as primary outcome. The vast majority of studies showed vaccination of 60- to 75-year-old individuals to be cost-effective, when duration of vaccine efficacy was longer than 10 years. Duration of vaccine efficacy, vaccine price, HZ incidence, HZ incidence and discount rates were influential to the incremental cost-effectiveness ratio (ICER). HZ vaccination may be a worthwhile intervention from a cost-effectiveness point of view. More extensive reporting on methodology and more detailed results of sensitivity analyses would be desirable to address uncertainty and to guarantee optimal comparability between studies, for example regarding model structure, discounting, vaccine characteristics and loss of quality of life due to HZ and PHN. PMID:25424815

  18. System Analysis, Program Development, and Cost-Effectiveness Modeling of Indian Education for the Bureau of Indian Affairs. Volume III, Planning and Cost-Effectiveness Modeling for BIA Schools.

    ERIC Educational Resources Information Center

    Abt Associates, Inc., Cambridge, MA.

    Nine models developed principally for use at the central level of the Bureau of Indian Affairs in evaluating the costs and cost-effectiveness of alternative policies and programs are described in this document. The 9 models are: (1) Population Projection Model, (2) Enrollment Projection Model, (3) Facilities Planning Model, (4) Economic Projection…

  19. Climate targets and cost-effective climate stabilization pathways

    NASA Astrophysics Data System (ADS)

    Held, H.

    2015-08-01

    Climate economics has developed two main tools to derive an economically adequate response to the climate problem. Cost benefit analysis weighs in any available information on mitigation costs and benefits and thereby derives an "optimal" global mean temperature. Quite the contrary, cost effectiveness analysis allows deriving costs of potential policy targets and the corresponding cost- minimizing investment paths. The article highlights pros and cons of both approaches and then focusses on the implications of a policy that strives at limiting global warming to 2 °C compared to pre-industrial values. The related mitigation costs and changes in the energy sector are summarized according to the IPCC report of 2014. The article then points to conceptual difficulties when internalizing uncertainty in these types of analyses and suggests pragmatic solutions. Key statements on mitigation economics remain valid under uncertainty when being given the adequate interpretation. Furthermore, the expected economic value of perfect climate information is found to be on the order of hundreds of billions of Euro per year if a 2°-policy were requested. Finally, the prospects of climate policy are sketched.

  20. [From the therapeutic utility to the added therapeutic value and the incremental cost-effectiveness ratio].

    PubMed

    Puig-Junoy, Jaume; Peiró, Salvador

    2009-01-01

    From the social perspective, the concepts of therapeutic utility and degree of innovation of new drugs should be referred to their social added value in relation to the available treatment alternatives and the added costs that they imply; that is, to their incremental cost-effectiveness ratio. The analytic elements highlighting this approach are: 1) the dimensions of the social value of the medication that should go beyond the conventional outcomes measures to also incorporate measures of health related quality of life, patient and family comfort and convenience, healthcare consumption avoided and productive losses avoided; 2) the relative or incremental character of this value that should be quantified in front of previous alternatives -not versus placebo- and under conditions of real use; and 3) the incremental costs that bears the administration of the new medication. The incremental cost-effectiveness ratio is the appropriate approach for decisions about coverage of a treatment by the public insurer, the price that he is willing to pay for the drug, and the clinical situations and patient groups in which it is recommended. The incremental cost-effectiveness analysis and the use of an indicative threshold of the maximum cost that the society is willing to pay for one additional "quality adjusted life year" are the essential elements of this approach, which doesn't require to fix the price of the new medications at the threshold of the willingness to pay.

  1. Rheostat re-wired: alternative hypotheses for the control of thioredoxin reduction potentials.

    PubMed

    Bewley, Kathryn D; Dey, Mishtu; Bjork, Rebekah E; Mitra, Sangha; Chobot, Sarah E; Drennan, Catherine L; Elliott, Sean J

    2015-01-01

    Thioredoxins are small soluble proteins that contain a redox-active disulfide (CXXC). These disulfides are tuned to oxidizing or reducing potentials depending on the function of the thioredoxin within the cell. The mechanism by which the potential is tuned has been controversial, with two main hypotheses: first, that redox potential (Em) is specifically governed by a molecular 'rheostat'-the XX amino acids, which influence the Cys pKa values, and thereby, Em; and second, the overall thermodynamics of protein folding stability regulates the potential. Here, we use protein film voltammetry (PFV) to measure the pH dependence of the redox potentials of a series of wild-type and mutant archaeal Trxs, PFV and glutathionine-equilibrium to corroborate the measured potentials, the fluorescence probe BADAN to measure pKa values, guanidinium-based denaturation to measure protein unfolding, and X-ray crystallography to provide a structural basis for our functional analyses. We find that when these archaeal thioredoxins are probed directly using PFV, both the high and low potential thioredoxins display consistent 2H+:2e- coupling over a physiological pH range, in conflict with the conventional 'rheostat' model. Instead, folding measurements reveals an excellent correlation to reduction potentials, supporting the second hypothesis and revealing the molecular mechanism of reduction potential control in the ubiquitous Trx family.

  2. Gas permeability of biochar-amended clay: potential alternative landfill final cover material.

    PubMed

    Wong, James Tsz Fung; Chen, Zhongkui; Ng, Charles Wang Wai; Wong, Ming Hung

    2016-04-01

    Compacted biochar-amended clay (BAC) has been proposed as an alternative landfill final cover material in this study. Biochar has long been proposed to promote crop growth, mitigate odor emission, and promote methane oxidation in field soils. However, previous studies showed that soil-gas permeability was increased upon biochar application, which will promote landfill gas emission. The objective of the present study is to investigate the possibility of using compacted BAC as an alternative material in landfill final cover by evaluating its gas permeability. BAC samples were prepared by mixing 425-μm-sieved peanut shell biochar with kaolin clay in different ratios (0, 5, 10, and 15 %, w/w) and compacting at different degrees of compactions (DOC) (80, 85, and 90 %) with an optimum water content of 35 %. The gas permeability of the BACs was measured by flexible wall gas permeameter and the microstructure of the BACs was analyzed by SEM with energy-dispersive x-ray spectroscopy (EDX). The results show that the effects of biochar content on BAC gas permeability is highly dependent on the DOC. At high DOC (90 %), the gas permeability of BAC decreases with increasing biochar content due to the combined effect of the clay aggregation and the inhibition of biochar in the gas flow. However, at low DOC (80 %), biochar incorporation has no effects on gas permeability because it no longer acts as a filling material to the retard gas flow. The results from the present study imply that compacted BAC can be used as an alternative final cover material with decreased gas permeability when compared with clay.

  3. Potential Use of Lime as Nitric Acid Source for Alternative Electrolyte Fuel-Cell Method

    NASA Astrophysics Data System (ADS)

    Christianto, V.; Smarandache, Florentin

    2011-04-01

    Despite growing popularity for the use of biofuel and other similar methods to generate renewable energy sources from natural plantation in recent years, there is also growing concern over its disadvantage, i.e. that the energy use of edible plants may cause unwanted effects, because the plantation price tends to increase following the oil price. Therefore an alternative solution to this problem is to find `natural plantation' which have no direct link to `food chain' (for basic foods, such as palm oil etc.).

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

    PubMed

    Babo Martins, S; Rushton, J

    2014-12-01

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

  5. Cost-effective usage of membrane oxygenators in extracorporeal membrane oxygenation in infants.

    PubMed

    Özyüksel, A; Ersoy, C; Akçevin, A; Türkoğlu, H; Çiçek, A E; Kahraman, A; Kayhan, B; Cantürk, E

    2015-04-01

    Although the poly-methylpentene (PMP) oxygenators have significant advantages in ECMO implementation, their usage may be limited in some situations, which may be related to economic constraints. In this report, we aimed to emphasize our cost-effective usage of a membrane oxygenator at the ECMO setup. We implemented ECMO with eight Capiox® FX05 or Baby RX05 hollow-fiber membrane oxygenators in five neonatal patients. The average ECMO duration was 121 hours (ranging from 41 to 272 hours). Following the termination of the ECMO, the system was broken down into its components for macroscopic analysis. Neither gross blood clots nor plasma leakage were observed in any of the components. The integration of a centrifugal pump and a separate hollow-fiber oxygenator may provide a cost-effective ECMO implementation setup with no adverse effects which may be an encouraging alternative for the low cost usage of ECMO in neonates.

  6. Cost-effectiveness of the US Geological Survey stream-gaging program in Arkansas

    USGS Publications Warehouse

    Darling, M.E.; Lamb, T.E.

    1984-01-01

    This report documents the results of the cost-effectiveness of the stream-gaging program in Arkansas. Data uses and funding sources were identified for the daily-discharge stations. All daily-discharge stations were found to be in one or more data use categories, and none were candidates for alternate methods which would result in discontinuation or conversion to a partial record station. The cost for operation of daily-discharge stations and routing costs to partial record stations, crest gages, pollution control stations as well as seven recording ground-water stations was evaluated in the Kalman-Filtering Cost-Effective Resource allocation (K-CERA) analysis. This operation under current practices requires a budget of $292,150. The average standard error of estimate of streamflow record for the Arkansas District was analyzed at 33 percent.

  7. A clinically effective breast cancer screening program can be cost-effective, too.

    PubMed

    Carter, A P; Thompson, R S; Bourdeau, R V; Andenes, J; Mustin, H; Straley, H

    1987-01-01

    The logistics of complying with current American Cancer Society breast cancer screening recommendations in a large health maintenance organization, serving more than 50,000 women age 40 or older, are described. An alternative screening approach estimated to be at least as health-effective as the American Cancer Society recommendations has been developed and appears to solve the problem and is financially feasible. Cost-effectiveness depends on optimal use of mammography and health-care personnel resources. The authors show how the start-up and maintenance costs of an organized program can be offset by future cost savings resulting from reduced long-term disability in patients diagnosed at Stages 0-1 as opposed to Stages 2 and later. Careful selection of the delivery model before implementation can make a breast cancer screening program cost-effective as well as health-effective.

  8. Trypanosome alternative oxidase, a potential therapeutic target for sleeping sickness, is conserved among Trypanosoma brucei subspecies.

    PubMed

    Nakamura, Kosuke; Fujioka, Sunao; Fukumoto, Shinya; Inoue, Noboru; Sakamoto, Kimitoshi; Hirata, Haruyuki; Kido, Yasutoshi; Yabu, Yoshisada; Suzuki, Takashi; Watanabe, Yoh-ichi; Saimoto, Hiroyuki; Akiyama, Hiroshi; Kita, Kiyoshi

    2010-12-01

    Trypanosoma brucei rhodesiense and T. b. gambiense are known causes of human African trypanosomiasis (HAT), or "sleeping sickness," which is deadly if untreated. We previously reported that a specific inhibitor of trypanosome alternative oxidase (TAO), ascofuranone, quickly kills African trypanosomes in vitro and cures mice infected with another subspecies, non-human infective T. b. brucei, in in vivo trials. As an essential factor for trypanosome survival, TAO is a promising drug target due to the absence of alternative oxidases in the mammalian host. This study found TAO expression in HAT-causing trypanosomes; its amino acid sequence was identical to that in non-human infective T. b. brucei. The biochemical understanding of the TAO including its 3 dimensional structure and inhibitory compounds against TAO could therefore be applied to all three T. brucei subspecies in search of a cure for HAT. Our in vitro study using T. b. rhodesiense confirmed the effectiveness of ascofuranone (IC(50) value: 1 nM) to eliminate trypanosomes in human infective strain cultures.

  9. Use of Insecticide-Treated School Uniforms for Prevention of Dengue in Schoolchildren: A Cost-Effectiveness Analysis

    PubMed Central

    Tozan, Yesim; Ratanawong, Pitcha; Louis, Valérie R.; Kittayapong, Pattamaporn; Wilder-Smith, Annelies

    2014-01-01

    Background Dengue-related illness is a leading cause of hospitalization and death, particularly among children. Practical, acceptable and affordable measures are urgently needed to protect this age group. Schools where children spend most of their day is proposed as an ideal setting to implement preventive strategies against day-biting Aedes mosquitoes. The use of insecticide-treated school uniforms is a promising strategy currently under investigation. Methods Using a decision-analytic model, we evaluated the cost-effectiveness of the use of insecticide-treated school uniforms for prevention of dengue, compared with a “do-nothing” alternative, in schoolchildren from the societal perspective. We explored how the potential economic value of the intervention varied under various scenarios of intervention effectiveness and cost, as well as dengue infection risk in school-aged children, using data specific to Thailand. Results At an average dengue incidence rate of 5.8% per year in school-aged children, the intervention was cost-effective (ICER≤$16,440) in a variety of scenarios when the intervention cost per child was $5.3 or less and the intervention effectiveness was 50% or higher. In fact, the intervention was cost saving (ICER<0) in all scenarios in which the intervention cost per child was $2.9 or less per year and the intervention effectiveness was 50% or higher. The results suggested that this intervention would be of no interest to Thai policy makers when the intervention cost per child was $10.6 or higher per year regardless of intervention effectiveness (ICER>$16,440). Conclusions Our results present the potential economic value of the use of insecticide-treated uniforms for prevention of dengue in schoolchildren in a typical dengue endemic setting and highlight the urgent need for additional research on this intervention. PMID:25247556

  10. A cost-effectiveness analysis of self-debriefing versus instructor debriefing for simulated crises in perioperative medicine in Canada

    PubMed Central

    2016-01-01

    Purpose High-fidelity simulation training is effective for learning crisis resource management (CRM) skills, but cost is a major barrier to implementing high-fidelity simulation training into the curriculum. The aim of this study was to examine the cost-effectiveness of self-debriefing and traditional instructor debriefing in CRM training programs and to calculate the minimum willingness-to-pay (WTP) value when one debriefing type becomes more cost-effective than the other. Methods This study used previous data from a randomized controlled trial involving 50 anesthesiology residents in Canada. Each participant managed a pretest crisis scenario. Participants who were randomized to self-debrief used the video of their pretest scenario with no instructor present during their debriefing. Participants from the control group were debriefed by a trained instructor using the video of their pretest scenario. Participants individually managed a post-test simulated crisis scenario. We compared the cost and effectiveness of self-debriefing versus instructor debriefing using net benefit regression. The cost-effectiveness estimate was reported as the incremental net benefit and the uncertainty was presented using a cost-effectiveness acceptability curve. Results Self-debriefing costs less than instructor debriefing. As the WTP increased, the probability that self-debriefing would be cost-effective decreased. With a WTP ≤Can$200, the self-debriefing program was cost-effective. However, when effectiveness was priced higher than cost-savings and with a WTP >Can$300, instructor debriefing was the preferred alternative. Conclusion With a lower WTP (≤Can$200), self-debriefing was cost-effective in CRM simulation training when compared to instructor debriefing. This study provides evidence regarding cost-effectiveness that will inform decision-makers and clinical educators in their decision-making process, and may help to optimize resource allocation in education. PMID:28028288

  11. Analyzing cost-effectiveness of ulnar and median nerve transfers to regain forearm flexion.

    PubMed

    Wali, Arvin R; Park, Charlie C; Brown, Justin M; Mandeville, Ross

    2017-03-01

    increased probability of returning to work. One-way sensitivity analysis demonstrated that the model was most sensitive to assumptions about cost of surgery, probability of good surgical outcome, and spontaneous recovery of neurological function with conservative treatment. Two-way sensitivity analysis demonstrated that surgical intervention was cost-effective with an ICER of $18,828.06/QALY even with the authors' most conservative parameters with surgical costs at $50,000 and probability of success of 50% when considering the potential income recovered through returning to work. Probabilistic sampling demonstrated that surgical intervention was cost-effective in 76% of cases at a willingness-to-pay threshold of $50,000/QALY gained. CONCLUSIONS The authors' model demonstrates that ulnar and median nerve transfers for upper brachial plexus injury improves QALY in a cost-effective manner.

  12. Pulsed Excimer Laser Processing for Cost-Effective Solar Cells

    NASA Technical Reports Server (NTRS)

    Wong, D.

    1985-01-01

    Residual lattice damage by 5 keV ion implantation and surface flaws induced by wafer cleaning are proven to affect the V sub oc more adversely for laser annealed cells than conventional thermal diffusion. However, an alternative, molecular implantation of molecular species holds potential. The first experimental results are encouraging. The lack of a commercially available mass analyzed implantation with low energy, high fluence ions is constraining.

  13. Analyses of Blood Bank Efficiency, Cost-Effectiveness and Quality

    NASA Astrophysics Data System (ADS)

    Lam, Hwai-Tai Chen

    In view of the increasing costs of hospital care, it is essential to investigate methods to improve the labor efficiency and the cost-effectiveness of the hospital technical core in order to control costs while maintaining the quality of care. This study was conducted to develop indices to measure efficiency, cost-effectiveness, and the quality of blood banks; to identify factors associated with efficiency, cost-effectiveness, and quality; and to generate strategies to improve blood bank labor efficiency and cost-effectiveness. Indices developed in this study for labor efficiency and cost-effectiveness were not affected by patient case mix and illness severity. Factors that were associated with labor efficiency were identified as managerial styles, and organizational designs that balance workload and labor resources. Medical directors' managerial involvement was not associated with labor efficiency, but their continuing education and specialty in blood bank were found to reduce the performance of unnecessary tests. Surprisingly, performing unnecessary tests had no association with labor efficiency. This suggested the existence of labor slack in blood banks. Cost -effectiveness was associated with workers' benefits, wages, and the production of high-end transfusion products by hospital-based donor rooms. Quality indices used in this study included autologous transfusion rates, platelet transfusion rates, and the check points available in an error-control system. Because the autologous transfusion rate was related to patient case mix, severity of illness, and possible inappropriate transfusion, it was not recommended to be used for quality index. Platelet-pheresis transfusion rates were associated with the transfusion preferences of the blood bank medical directors. The total number of check points in an error -control system was negatively associated with government ownership and workers' experience. Recommendations for improving labor efficiency and cost-effectiveness

  14. Screening strategies for active tuberculosis: focus on cost-effectiveness

    PubMed Central

    Dobler, Claudia Caroline

    2016-01-01

    In recent years, there has been renewed interest in screening for active tuberculosis (TB), also called active case-finding (ACF), as a possible means to achieve control of the global TB epidemic. ACF aims to increase the detection of TB, in order to diagnose and treat patients with TB earlier than if they had been diagnosed and treated only at the time when they sought health care because of symptoms. This will reduce or avoid secondary transmission of TB to other people, with the long-term goal of reducing the incidence of TB. Here, the history of screening for active TB, current screening practices, and the role of TB-diagnostic tools are summarized and the literature on cost-effectiveness of screening for active TB reviewed. Cost-effectiveness analyses indicate that community-wide ACF can be cost-effective in settings with a high incidence of TB. ACF among close TB contacts is cost-effective in settings with a low as well as a high incidence of TB. The evidence for cost-effectiveness of screening among HIV-infected persons is not as strong as for TB contacts, but the reviewed studies suggest that the intervention can be cost-effective depending on the background prevalence of TB and test volume. None of the cost-effectiveness analyses were informed by data from randomized controlled trials. As the results of randomized controlled trials evaluating different ACF strategies will become available in future, we will hopefully gain a better understanding of the role that ACF can play in achieving global TB control. PMID:27418848

  15. Identifying Cost-Effective Residential Energy Efficiency Opportunities for the Kauai Island Utility Cooperative

    SciTech Connect

    Busche, S.; Hockett, S.

    2010-06-01

    This analysis is an update to the 2005 Energy Efficiency Potential Study completed by KEMA for the Kauai Island Utility Cooperative (KIUC) and identifies potential energy efficiency opportunities in the residential sector on Kauai (KEMA 2005). The Total Resource Cost (TRC) test is used to determine which of the energy efficiency measures analyzed in the KEMA report are cost effective for KIUC to include in a residential energy efficiency program. This report finds that there remains potential energy efficiency savings that could be cost-effectively incentivized through a utility residential demand-side management program on Kauai if implemented in such a way that the program costs per measure are consistent with the current residential program costs.

  16. Volatile organic compounds (VOCs) in surface coating materials: Their compositions and potential as an alternative fuel.

    PubMed

    Dinh, Trieu-Vuong; Choi, In-Young; Son, Youn-Suk; Song, Kyu-Yong; Sunwoo, Young; Kim, Jo-Chun

    2016-03-01

    A sampling system was designed to determine the composition ratios of VOCs emitted from 31 surface coating materials (SCMs). Representative architectural, automotive, and marine SCMs in Korea were investigated. Toluene, ethylbenzene, and xylene were the predominant VOCs. The VOC levels (wt%) from automotive SCMs were significantly higher than those from architectural and marine paints. It was found that target SCMs comprised mainly VOCs with 6-10 carbon atoms in molecules, which could be adsorbed by activated carbon. The saturated activated carbon which had already adsorbed toluene, ethylbenzene, and m-xylene was combusted. The saturated activated carbon was more combustible than new activated carbon because it comprised inflammable VOCs. Therefore, it could be an alternative fuel when using in a "fuelization system". To use the activated carbon as a fuel, a control technology of VOCs from a coating process was also designed and introduced.

  17. An alternative model for postdoctoral education of nurses engaged in research with potentially vulnerable populations.

    PubMed

    Gennaro, Susan; Deatrick, Janet A; Dobal, May T; Jemmott, Loretta Sweet; Ball, Katherine R

    2007-01-01

    Post-doctoral education has become a necessity for new nursing doctoral graduates. However, post-doctoral positions are limited and nurse scientists may face barriers that make non-traditional programs necessary. This study describes the outcomes of the Summer Nursing Research Institute (SNRI), an alternative post-doctoral educational program, reports formative perceptions of SNRI participants, and illustrates the efficacy and limitations of the model with selected summative research related outcomes. Participants between 1997 and 2006 were asked to evaluate the experience while attending the Institute (formative evaluation) and an overall summative evaluation was also conducted. Evaluations indicate that participants gained knowledge, skills, and networking abilities in terms of conducting research with vulnerable populations. A program like the SNRI can be successful in widening the research pipeline, in imparting knowledge, and in fostering positive attitudes as well as in improving research skills.

  18. EPA RE-Powering Mapper: Alternative Energy Potential at Cleanup Sites

    EPA Pesticide Factsheets

    The U.S. Environmental Protection Agency (EPA) Office of Land and Emergency Management??s (OLEM) Office of Communications, Partnerships and Analysis (OCPA) initiated the RE-Powering America's Land Initiative to demonstrate the enormous potential that contaminated lands, landfills, and mine sites provide for developing renewable energy in the United States. EPA developed national level site screening criteria in partnership with the U.S. Department of Energy (DOE) National Renewable Energy Laboratory (NREL) for wind, solar, biomass, and geothermal facilities. While the screening criteria demonstrate the potential to reuse contaminated land for renewable energy facilities, the criteria and data are neither designed to identify the best sites for developing renewable energy nor all-inclusive. Therefore, more detailed, site-specific analysis is necessary to identify or prioritize the best sites for developing renewable energy facilities based on the technical and economic potential. Please note that these sites were only pre-screened for renewable energy potential. The sites were not evaluated for land use constraints or current on the ground conditions. Additional research and site-specific analysis are needed to verify viability for renewable energy potential at a given site.

  19. Cost-effectiveness of Occupational Therapy in Older People: Systematic Review of Randomized Controlled Trials.

    PubMed

    Nagayama, Hirofumi; Tomori, Kounosuke; Ohno, Kanta; Takahashi, Kayoko; Yamauchi, Keita

    2016-06-01

    A systematic review of the cost-effectiveness of occupational therapy for older people was conducted. MEDLINE, CINAHL, Web of Science, PsycINFO, Cochrane Library, OT seeker and unpublished trials registers were searched. Reference lists of all potentially eligible studies were searched with no language restrictions. We included trial-based full economic evaluations that considered both costs and outcomes in occupational therapy for older people compared with standard care (i.e. other therapy) or no intervention. We reviewed each trial for methodological quality using the Cochrane risk of bias tool and assessed the quality of economic evaluations using a Drummond checklist. In the results of this review, we included five eligible studies (1-5) that were randomized controlled trials with high-quality economic evaluation. Two studies were full economic evaluations of interventions for fall prevention (1 and 2); two studies were full economic evaluations of preventive occupational therapy interventions (3 and 4; one was a comparison of an occupational therapy group with a social work group); one study was a full economic evaluation of occupational therapy for individuals with dementia (5). Two of the studies (one was preventive occupational therapy [3] and the other was occupational therapy for dementia [5]) found a significant effect and confirmed the cost-effectiveness of occupational therapy for older people compared with the control group. These studies found that occupational therapy for older people was clinically effective and cost-effective in comparison with standard care or other therapies. With reference to their clinical implication, these intervention studies (using a client-centred approach) suggested potentially cost-effective means to motivate clients to maintain their own health. However, this review has limitations because of the high heterogeneity of the reviewed studies on full economic evaluations of occupational therapy for older people. Future

  20. Economic Impact of Dengue Illness and the Cost-Effectiveness of Future Vaccination Programs in Singapore

    PubMed Central

    Carrasco, Luis R.; Lee, Linda K.; Lee, Vernon J.; Ooi, Eng Eong; Shepard, Donald S.; Thein, Tun L.; Gan, Victor; Cook, Alex R.; Lye, David; Ng, Lee Ching; Leo, Yee Sin

    2011-01-01

    Background Dengue illness causes 50–100 million infections worldwide and threatens 2.5 billion people in the tropical and subtropical regions. Little is known about the disease burden and economic impact of dengue in higher resourced countries or the cost-effectiveness of potential dengue vaccines in such settings. Methods and Findings We estimate the direct and indirect costs of dengue from hospitalized and ambulatory cases in Singapore. We consider inter alia the impacts of dengue on the economy using the human-capital and the friction cost methods. Disease burden was estimated using disability-adjusted life years (DALYs) and the cost-effectiveness of a potential vaccine program was evaluated. The average economic impact of dengue illness in Singapore from 2000 to 2009 in constant 2010 US$ ranged between $0.85 billion and $1.15 billion, of which control costs constitute 42%–59%. Using empirically derived disability weights, we estimated an annual average disease burden of 9–14 DALYs per 100 000 habitants, making it comparable to diseases such as hepatitis B or syphilis. The proportion of symptomatic dengue cases detected by the national surveillance system was estimated to be low, and to decrease with age. Under population projections by the United Nations, the price per dose threshold for which vaccines stop being more cost-effective than the current vector control program ranged from $50 for mass vaccination requiring 3 doses and only conferring 10 years of immunity to $300 for vaccination requiring 2 doses and conferring lifetime immunity. The thresholds for these vaccine programs to not be cost-effective for Singapore were $100 and $500 per dose respectively. Conclusions Dengue illness presents a serious economic and disease burden in Singapore. Dengue vaccines are expected to be cost-effective if reasonably low prices are adopted and will help to reduce the economic and disease burden of dengue in Singapore substantially. PMID:22206028

  1. Cost-effectiveness league tables: think of the fans.

    PubMed

    Drummond, M; Mason, J; Torrance, G

    1995-03-01

    In a recent issue of Health Policy, Birch and Gafni argued against the use of cost-effectiveness league tables in health care decision making. They argued that league tables should be returned to where they are best used and understood--the sports pages. Recently the debate about the presentation and interpretation of cost-effectiveness data has been given an additional impetus in the UK through the publication, by the Department of Health, of the Register of Cost-Effectiveness Studies (RCES). During the production of the RCES, it became apparent that there were similarities between the decision makers' thirst for economic data and the sports fans' thirst for information about their team. In this paper we review the pros and cons of using published cost-effectiveness data in decision making, compared with the local team approach suggested by Birch and Gafni. We conclude that there are advantages from using published data, providing these are produced according to standardized methods and interpreted intelligently. Most importantly, cost-effectiveness data, whether published or generated locally, are unlikely to give decision makers a technical solution to the resource allocation problem. Rather, they should be viewed as a stimulus for local discussion and debate.

  2. Groundwater remediation and the cost effectiveness of phytoremediation.

    PubMed

    Compernolle, T; Van Passel, S; Weyens, N; Vangronsveld, J; Lebbe, L; Thewys, T

    2012-10-01

    In 1999, phytoremediation was applied at the site of a Belgian car factory to contain two BTEX plumes. This case study evaluates the cost effectiveness of phytoremediation compared to other remediation options, applying a tailored approach for economic evaluation. Generally, when phytoremediation is addressed as being cost effective, the cost effectiveness is only determined on an average basis. This study however, demonstrates that an incremental analysis may provide a more nuanced conclusion. When the cost effectiveness is calculated on an average basis, in this particular case, the no containment strategy (natural attenuation) has the lowest cost per unit mass removed and hence, should be preferred. However, when the cost effectiveness is determined incrementally, no containment should only be preferred if the value of removing an extra gram of contaminant mass is lower than 320 euros. Otherwise, a permeable reactive barrier should be adopted. A similar analysis is provided for the effect determined on the basis of remediation time. Phytoremediation is preferred compared to 'no containment' if reaching the objective one year earlier is worth 7 000 euros.

  3. Comparative Cost-Effectiveness of Interventions to Improve Medication Adherence after Myocardial Infarction

    PubMed Central

    Ito, Kouta; Shrank, William H; Avorn, Jerry; Patrick, Amanda R; Brennan, Troyen A; Antman, Elliot M; Choudhry, Niteesh K

    2012-01-01

    Objective To evaluate the comparative cost-effectiveness of interventions to improve adherence to evidence-based medications among postmyocardial infarction (MI) patients. Data Sources/Study Setting Cost-effectiveness analysis. Study Design We developed a Markov model simulating a hypothetical cohort of 65-year-old post-MI patients who were prescribed secondary prevention medications. We evaluated mailed education, disease management, polypill use, and combinations of these interventions. The analysis was performed from a societal perspective over a lifetime horizon. The main outcome was an incremental cost-effectiveness ratio (ICER) as measured by cost per quality-adjusted life year (QALY) gained. Data Collection/Extraction Methods Model inputs were extracted from published literature. Principal Findings Compared with usual care, only mailed education had both improved health outcomes and reduced spending. Mailed education plus disease management, disease management, polypill use, polypill use plus mailed education, and polypill use plus disease management cost were $74,600, $69,200, $133,000, $113,000, and $142,900 per QALY gained, respectively. In an incremental analysis, only mailed education had an ICER of less than $100,000 per QALY and was therefore the optimal strategy. Polypill use, particularly when combined with mailed education, could be cost effective, and potentially cost saving if its price decreased to less than $100 per month. Conclusions Mailed education and a polypill, once available, may be the cost-saving strategies for improving post-MI medication adherence. PMID:22998129

  4. The cost-effectiveness of a school-based smoking prevention program in India

    PubMed Central

    Brown, H. Shelton; Stigler, Melissa; Perry, Cheryl; Dhavan, Poonam; Arora, Monika; Reddy, K. Srinath

    2013-01-01

    Intervention programs aimed at preventing tobacco use among youth have been shown to be effective in curbing tobacco use onset and progression. However, the effects of even very successful tobacco prevention programs may not always impress policy-makers and lay audiences. Economic analysis potentially strengthens the case. In this paper, we evaluate the cost-effectiveness of a youth tobacco use prevention program which has been translated and implemented in India, a developing country. Although programs like these are inexpensive to implement in the USA, they are even less expensive in India due to low labor costs. Our results show that the costs per quality-adjusted life-year added, due to averted smoking, was $2057, even without including averted medical costs. If we ignore student time, cost-effectiveness improves by roughly 10%. To put the cost-effectiveness of this smoking prevention program into context, it is over 24 times more cost-effective than dialysis in the USA, which costs $50 000 for a life-year. PMID:22271928

  5. Novel Method for Sizing Metallic Bottom Crack Depth Using Multi-frequency Alternating Current Potential Drop Technique

    NASA Astrophysics Data System (ADS)

    Li, Yuting; Gan, Fangji; Wan, Zhengjun; Liao, Junbi; Li, Wenqiang

    2015-10-01

    Potential drop techniques are of two types: the direct current potential drop (DCPD) technique and alternating current potential drop (ACPD) technique, and both of them are used in nondestructive testing. ACPD, as a kind of valid method in sizing metal cracks, has been applied to evaluate metal structures. However, our review of most available approaches revealed that some improvements can be done in measuring depth of metal bottom crack by means of ACPD, such as accuracy and sensitivity of shallow crack. This paper studied a novel method which utilized the slope of voltage ratio-frequency curve to solve bottom crack depth by using a simple mathematic equation based on finite element analysis. It is found that voltage ratio varies linearly with frequency in the range of 5-15 Hz; this range is slightly higher than the equivalent frequency and lower than semi-permeable frequency. Simulation and experiment show that the novel method can measure the bottom crack depth accurately.

  6. The cost effectiveness of NHS physiotherapy support for occupational health (OH) services

    PubMed Central

    2012-01-01

    contributed to a cost/QALY of £1386-£7760, which would represent value for money according to current UK thresholds. Sensitivity analyses demonstrated that the service would remain cost effective until the service costs were increased to 160% per user. Conclusions This pragmatic evaluation of the OHPPP indicated that it was likely to be feasible in terms of service usage and could potentially be cost effective in terms of QALYs. Further, the study confirmed that improving physical health status for musculoskeletal pain patients is important in reducing problems with work capacity and related costs. This study suggests that this type of service could be potentially be useful in reducing the burden of pain and should be further investigated, ideally via randomised controlled trials assessing effectiveness and cost-effectiveness. PMID:22361319

  7. Air Quality and Population Exposure in Urban Areas: Potential Co-Benefits of Alternative Strategies

    NASA Astrophysics Data System (ADS)

    Mikolajczyk, U.; Suppan, P.; Forkel, R.; Williams, M.

    2014-12-01

    Even though much progress has been achieved through dedicated approaches to improving air quality in many European cities, there are various threats which still remain unchanged. According to the World Health Organization, outdoor air pollution was linked to 3.7 million deaths in year 2012. As climate changes, the frequency of days with harmful levels of air pollutants may significantly increase causing exacerbation of cardiovascular and respiratory diseases. The aim of this study is to conduct health impact assessment by utilizing regionally and spatially specific data in order to assess the influence of alternative emission strategies on human health. In the first stage of this investigation, a modeling study was carried out using the Weather Research and Forecasting (WRF) model coupled with Chemistry (WRF/Chem; Grell et al., 2005) to estimate ambient concentrations of air pollutants. The model set-up included a nesting approach, where three domains with horizontal resolution of 18 km, 6 km and 2 km were defined. The investigation area included the city of Munich (1.5 million inhabitants). The model performance has been evaluated against available air quality observations from the monitoring database "AirBase". The chemical species including O3, NO, NO2 and PM10 simulated by WRF/Chem compare favorably with the observations. The model performs especially well in resolving the observed O3 concentrations. In the ongoing study, different emission reduction scenarios are compared to a baseline 2009 scenario based on Germany's National Emissions Inventory. To investigate health effects associated with air pollution concentrations a local-scale health impact assessment (HIA) will be conducted. Concentration-response functions (CRFs) link the change in mortality rates to the change in concentrations of air pollutants. CRFs are applied to population-weighted mean concentrations to estimate relative risks and hence estimate numbers of attributable deaths and associated

  8. An Alternative View of the Climate Warming Mitigation Potential of U.S. Temperate Forests

    EPA Science Inventory

    Many U.S. federal and non-governmental agencies promote forestation as a means to mitigate climate warming because of the carbon sequestration potential of forests. This biogeochemical-oriented carbon sequestration policy is somewhat inconsistent with a decade or more of researc...

  9. A conceptual framework for the evaluation of cost-effectiveness of projects to reduce GHG emissions and sequester carbon

    SciTech Connect

    Sathaye, J.; Norgaard, R.; Makundi, W.

    1993-07-01

    This paper proposes a conceptual framework for evaluating the cost of projects to reduce atmospheric greenhouse gases (GHGs). The evaluation of cost-effectiveness should account for both the timing of carbon emissions and the damage caused by the atmospheric stock of carbon. We develop a conceptual basis to estimate the cost-effectiveness of projects in terms of the cost of reducing atmospheric carbon (CRAC) and other GHGs. CRAC accounts for the economic discount rate, alternative functional forms of the shadow price, the residence period of carbon in the atmosphere, and the multiple monetary benefits of projects. The last item is of particular importance to the developing countries.

  10. Marked antigiardial activity of Yucca baccata extracts: a potential natural alternative for treating protozoan infections.

    PubMed

    Quihui-Cota, Luis; León-Trujillo, Rocio; Astiazarán-García, Humberto; Esparza-Romero, Julián; del Refugio Robles, María; Robles-Zepeda, Ramón E; Canett, Rafael; Sánchez-Escalante, Jesús

    2014-01-01

    Human giardiosis is a public health problem in Mexico, where the national prevalence was estimated to be up to 68%. Misuse of antiprotozoal drugs may result in low effectiveness and undesirable side effects. Research on natural products is a good strategy for discovering more effective antiparasitic compounds. This study evaluated the antigiardial activity of extracts of Yucca baccata, which is native to northwestern Mexico. Forty-two gerbils (females) were weighed and orally inoculated with 5 × 10(6) Giardia trophozoites. Two gerbils were selected at random to confirm infection. Forty living gerbils were randomly allocated into 5 treatment groups (8 per group). Gerbils were randomly assigned to be treated with 24.4 mg/mL, 12.2 mg/mL, and 6.1 mg/mL of extracts, metronidazole (2 mg/mL) or PBS, which were intragastrically administered once per day for 3 days. Nine gerbils died during the study course. On day 10 postinfection, gerbils were euthanized and trophozoites were quantified. Yucca extracts reduced, albeit not significantly, the trophozoite counts in the duodenum segment. Only the high-extract concentration significantly reduced the trophozoite counts in the proximal segment and it was similar to that of metronidazole. Extracts of Y. baccata may represent an effective and natural therapeutic alternative for human giardiosis.

  11. The Use of Complementary and Alternative Medicine Supplements of Potential Concern during Breast Cancer Chemotherapy

    PubMed Central

    Dowd, Fred; Zhou, May; Standish, Leanna J.; Andersen, M. Robyn

    2016-01-01

    Objective. While many Complementary and Alternative Medicines (CAM) are unlikely to interact negatively with conventional oncology treatment, some ingestible CAM substances have biological activities that may reduce the effectiveness of chemotherapy or radiation. This study surveyed women with breast cancer in order to document the extent to which women with breast cancer use these CAM substances of concern concurrently with conventional treatments. Methods. A total of 398 women completed a survey describing their use of CAM at various time points in their cancer treatment. This report focuses on a subsample of 250 women receiving chemotherapy or radiation who reported using specific one or more of several chemotherapies. Results. Of those participating, 104 (43.7%) of those receiving chemotherapy (n = 238) and 45 (32.3%) of those receiving radiation (139; 58.4% of all patients) reported using one or more CAM substances that could be cause for concern when taken concurrently. Conclusion. Research is needed to understand the real risks associated with CAM and conventional polypharmacy. If risks associated with CAM conventional polypharmacy use prove to be substantial then improved systems to assure all women get advice regarding herb and supplement use during breast cancer treatment appear to be needed. PMID:27528880

  12. Concluding comments: maximizing good patient care and minimizing potential liability when considering complementary and alternative medicine.

    PubMed

    Gilmour, Joan; Harrison, Christine; Vohra, Sunita

    2011-11-01

    Our goal for this supplemental issue of Pediatrics was to consider what practitioners, parents, patients, institutions, and policy-makers need to take into account to make good decisions about using complementary and alternative medicine (CAM) to treat children and to develop guidelines for appropriate use. We began by explaining underlying concepts and principles in ethical, legal, and clinical reasoning and then used case scenarios to explore how they apply and identify gaps that remain in practice and policy. In this concluding article, we review our major findings, summarize our recommendations, and suggest further research. We focus on several key areas: practitioner and patient/parent relationships; decision-making; dispute resolution; standards of practice; hospital/health facility policies; patient safety; education; and research. Ethical principles, standards, and rules applicable when making decisions about conventional care for children apply to decision-making about CAM as well. The same is true of legal reasoning. Although CAM use has seldom led to litigation, general legal principles relied on in cases involving conventional medical care provide the starting point for analysis. Similarly, with respect to clinical decision-making, clinicians are guided by clinical judgment and the best interests of their patient. Whether a therapy is CAM or conventional, clinicians must weigh the relative risks and benefits of therapeutic options and take into account their patient's values, beliefs, and preferences. Consequently, many of our observations apply to conventional and CAM care and to both adult and pediatric patients.

  13. Marked Antigiardial Activity of Yucca baccata Extracts: A Potential Natural Alternative for Treating Protozoan Infections

    PubMed Central

    Quihui-Cota, Luis; León-Trujillo, Rocio; Astiazarán-García, Humberto; Esparza-Romero, Julián; Robles, María del Refugio; Robles-Zepeda, Ramón E.; Canett, Rafael; Sánchez-Escalante, Jesús

    2014-01-01

    Human Giardiosis is a public health problem in Mexico, where the national prevalence was estimated to be up to 68%. Misuse of antiprotozoal drugs may result in low effectiveness and undesirable side effects. Research on natural products is a good strategy for discovering more effective antiparasitic compounds. This study evaluated the antigiardial activity of extracts of Yucca baccata, which is native to northwestern Mexico. Forty-two gerbils (females) were weighed and orally inoculated with 5 × 106 Giardia trophozoites. Two gerbils were selected at random to confirm infection. Forty living gerbils were randomly allocated into 5 treatment groups (8 per group). Gerbils were randomly assigned to be treated with 24.4 mg/mL, 12.2 mg/mL, and 6.1 mg/mL of extracts, metronidazole (2 mg/mL) or PBS, which were intragastrically administered once per day for 3 days. Nine gerbils died during the study course. On day 10 postinfection, gerbils were euthanized and trophozoites were quantified. Yucca extracts reduced, albeit not significantly, the trophozoite counts in the duodenum segment. Only the high-extract concentration significantly reduced the trophozoite counts in the proximal segment and it was similar to that of metronidazole. Extracts of Y. baccata may represent an effective and natural therapeutic alternative for human giardiosis. PMID:25250335

  14. Artificial neural network model as a potential alternative for groundwater salinity forecasting

    NASA Astrophysics Data System (ADS)

    Banerjee, Pallavi; Singh, V. S.; Chatttopadhyay, Kausik; Chandra, P. C.; Singh, Bhoop

    2011-02-01

    SummaryThe paper evaluates the prospect of artificial neural network (ANN) simulation over mathematical modeling in estimating safe pumping rate to maintain groundwater salinity in island aquifers. Feed-forward ANN model with quick propagation (QP) as training algorithm has been used to forecast the salinity under varied pumping rates. The accuracy, generalization ability and reliability of the model are verified by real-time field data. The model is trained with 2 years of real-time field data and prediction on water quality with varying pumping rate is made for a span of 5 years. The same is then compared with both real-time field data and the prediction based on SUTRA (Saturated-Unsaturated Transport) computations. The proposed ANN model has surfaced as a simpler and more accurate alternative to the numerical method techniques. The ANN methodology using minimal lag and number of hidden nodes, along with the optimal number of spatial and temporal variables consistently produced the best performing network based simulation models. The prediction accuracy of the ANN model has been extended for another 5 years to further define the limit of pumping at a permissible level of groundwater salinity.

  15. Xenopus laevis is a potential alternative model animal species to study reproductive toxicity of phytoestrogens.

    PubMed

    Cong, Lin; Qin, Zhan-Fen; Jing, Xiang-Ning; Yang, Lei; Zhou, Jing-Ming; Xu, Xiao-Bai

    2006-05-10

    This study investigated effects of phytoestrogen quercetin on the gonadal development in Xenopus laevis. X. laevis at Nieuwkoop and Faber stage 46/47 were exposed to 50, 100 and 200 microg/L quercetin till 1 month postmetamorphosis. Gonads from frogs at 1 and 3 months postmetamorphosis were examined in gross morphology and histology. The highest dose of quercetin as well as estradiol (E2) significantly increased the percentages of phenotypic females. Exposure to quercetin at all doses induced abnormal testes with certain ovarian characteristics to some degree in gross morphology, including ovotestes. The abnormality rate exceeded 10% in each quercetin treatment. Histologic examination revealed that some abnormal testes exhibited intersexuality with testicular structure and ovarian structure or oocytes interspersed in testicular structure at 1 month postmetamorphosis. At 3 months postmetamorphosis, testicular abnormalities were more obvious, such as necrosis or apoptosis of spermatogonia, occurrence of developed or undeveloped oocytes, delay of the development of seminiferous tubes without or less late stage spermatocytes. The results have shown that quercetin cannot only feminize but also impair testicular development of X. laevis, i.e. X. laevis is sensitive to phytoestrogen. It is suggested that X. laevis might be an alternative model species to study reproductive toxicity of phytoestrogens.

  16. Transcranial Alternating Current Stimulation: A Potential Risk for Genetic Generalized Epilepsy Patients (Study Case)

    PubMed Central

    San-Juan, Daniel; Sarmiento, Carlos Ignacio; Hernandez-Ruiz, Axel; Elizondo-Zepeda, Ernesto; Santos-Vázquez, Gabriel; Reyes-Acevedo, Gerardo; Zúñiga-Gazcón, Héctor; Zamora-Jarquín, Carol Marina

    2016-01-01

    Transcranial alternating current stimulation (tACS) is a re-emergent neuromodulation technique that consists in the external application of oscillating electrical currents that induces changes in cortical excitability. We present the case of a 16-year-old female with pharmaco-resistant juvenile myoclonic epilepsy to 3 antiepileptic’s drugs characterized by 4 myoclonic and 20 absence seizures monthly. She received tACS at 1 mA at 3 Hz pulse train during 60 min over Fp1–Fp2 (10–20 EEG international system position) during 4 consecutive days using an Endeavor™ IOM Systems device® (Natus Medical Incorporated, Middleton, WI, USA). At the 1-month follow-up, she reported a 75% increase in seizures frequency (only myoclonic and tonic–clonic events) and developed a 24-h myoclonic status epilepticus that resolved with oral clonazepam and intravenous valproate. At the 2-month follow-up, the patient reported a 15-day seizure-free period. PMID:27965623

  17. Cost effective dynamic design and test requirements for Shuttle payloads

    NASA Technical Reports Server (NTRS)

    Stahle, C. V.; Gongloff, H. R.; Bangs, W. F.

    1975-01-01

    The results of a study examining current spacecraft dynamic design and test requirements for the cost effective design and development of Shuttle payloads are presented. Dynamic environments, payload configurations, design/test requirements, test levels, assembly level of testing, simulation methods, prototype role, load limiting, test facilities, and flight measurements are discussed as they relate to the development of a cost effective design and test philosophy for Shuttle Spacelab payloads. It is concluded that changes to current design/test practices will minimize long range payload costs. However, changes to current practices need be quantitatively evaluated before an orderly progression to more cost effective methods can be achieved without undue risk of mission failures. Of major importance is optimization of test levels and plans for payloads and payload subsystems which will result in minimum project costs.

  18. A Layered Decision Model for Cost-Effective System Security

    SciTech Connect

    Wei, Huaqiang; Alves-Foss, James; Soule, Terry; Pforsich, Hugh; Zhang, Du; Frincke, Deborah A.

    2008-10-01

    System security involves decisions in at least three areas: identification of well-defined security policies, selection of cost-effective defence strategies, and implementation of real-time defence tactics. Although choices made in each of these areas affect the others, existing decision models typically handle these three decision areas in isolation. There is no comprehensive tool that can integrate them to provide a single efficient model for safeguarding a network. In addition, there is no clear way to determine which particular combinations of defence decisions result in cost-effective solutions. To address these problems, this paper introduces a Layered Decision Model (LDM) for use in deciding how to address defence decisions based on their cost-effectiveness. To validate the LDM and illustrate how it is used, we used simulation to test model rationality and applied the LDM to the design of system security for an e-commercial business case.

  19. Are our selection and training programs cost effective

    SciTech Connect

    Wroten, S.P.

    1985-01-01

    Recently updated methods for evaluating the cost effectiveness of selection and training programs are applied in two situations. First an API-sponsored study shows that using tests to hire a board operator saves $21,000 per person per year. When these savings are accumulated over people and time, the savings total into the millions of dollars. The cost effectiveness of training programs can be similarly determined. An interpersonal skills workshop was found to have a return-on-investment of over $400,000, or over 300 percent. The savings that result from such training and selection programs definitely argue that the programs are well worthwhile and that the cost-effectiveness studies to demonstrate such savings are also well worth the investment.

  20. Cost-effective conservation planning: lessons from economics.

    PubMed

    Duke, Joshua M; Dundas, Steven J; Messer, Kent D

    2013-08-15

    Economists advocate that the billions of public dollars spent on conservation be allocated to achieve the largest possible social benefit. This is "cost-effective conservation"-a process that incorporates both monetized benefits and costs. Though controversial, cost-effective conservation is poorly understood and rarely implemented by planners. Drawing from the largest publicly financed conservation programs in the United States, this paper seeks to improve the communication from economists to planners and to overcome resistance to cost-effective conservation. Fifteen practical lessons are distilled, including the negative implications of limiting selection with political constraints, using nonmonetized benefit measures or benefit indices, ignoring development risk, using incomplete cost measures, employing cost measures sequentially, and using benefit indices to capture costs. The paper highlights interrelationships between benefits and complications such as capitalization and intertemporal planning. The paper concludes by identifying the challenges at the research frontier, including incentive problems associated with adverse selection, additionality, and slippage.

  1. Cost effective waste management through composting in Africa

    SciTech Connect

    Couth, R.; Trois, C.

    2012-12-15

    Highlights: Black-Right-Pointing-Pointer The financial/social/institutional sustainability of waste management in Africa is analysed. Black-Right-Pointing-Pointer This note is a compendium of a study on the potential for GHG control via improved zero waste in Africa. Black-Right-Pointing-Pointer This study provides the framework for Local Authorities for realizing sustained GHG reductions. - Abstract: Greenhouse gas (GHG) emissions per person from urban waste management activities are greater in sub-Saharan African countries than in other developing countries, and are increasing as the population becomes more urbanised. Waste from urban areas across Africa is essentially dumped on the ground and there is little control over the resulting gas emissions. The clean development mechanism (CDM), from the 1997 Kyoto Protocol has been the vehicle to initiate projects to control GHG emissions in Africa. However, very few of these projects have been implemented and properly registered. A much more efficient and cost effective way to control GHG emissions from waste is to stabilise the waste via composting and to use the composted material as a soil improver/organic fertiliser or as a component of growing media. Compost can be produced by open windrow or in-vessel composting plants. This paper shows that passively aerated open windrows constitute an appropriate low-cost option for African countries. However, to provide an usable compost material it is recommended that waste is processed through a materials recovery facility (MRF) before being composted. The paper demonstrates that material and biological treatment (MBT) are viable in Africa where they are funded, e.g. CDM. However, they are unlikely to be instigated unless there is a replacement to the Kyoto Protocol, which ceases for Registration in December 2012.

  2. Alternative feeding strategies and potential disease transmission in Wisconsin white-tailed deer

    USGS Publications Warehouse

    Thompson, A.K.; Samuel, M.D.; VanDeelen, T.R.

    2008-01-01

    We conducted experimental feeding using 3 feeding methods (pile, spread, trough) and 2 quantities (rationed, ad libitum) of shelled corn to compare deer activity and behavior with control sites and evaluate potential direct and indirect transmission of infectious disease in white-tailed deer (Odocoileus virginianus) in central Wisconsin, USA. Deer use was higher at 2 of the feeding sites than at natural feeding areas (P ??? 0.02). Deer spent a higher proportion of time (P < 0.01) feeding at pile (49%) and spread (61%) treatments than at natural feeding areas (36%). We found higher deer use for rationed than ad libitum feeding quantities and feeding intensity was greatest at rationed piles and lowest at ad libitum spreads. We also observed closer pairwise distances (???0.3 m) among deer when corn was provided in a trough relative to spread (P=0.03). Supplemental feeding poses risks for both direct and indirect disease transmission due to higher deer concentration and more intensive use relative to control areas. Concentrated feeding and contact among deer at feeding sites can also increase risk for disease transmission. Our results indicated that restrictions on feeding quantity would not mitigate the potential for disease transmission None of the feeding strategies we evaluated substantially reduced the potential risk for disease transmission and banning supplemental feeding to reduce transmission is warranted.

  3. Bis-indolic compounds as potential new therapeutic alternatives for tularaemia

    PubMed Central

    Caspar, Yvan; Sutera, Vivien; Boisset, Sandrine; Denis, Jean-Noël; Maurin, Max

    2014-01-01

    Francisella tularensis is the etiological agent of tularaemia and a CDC class A biological threat agent. Few antibiotic classes are currently useful in treating tularaemia, including the aminoglycosides gentamicin and streptomycin, fluoroquinolones, and tetracyclines. However, treatment failures and relapses remain frequent and F. tularensis strains resistant to antibiotics have been easily selected in vitro. In this study, we evaluated the activity of new synthetic bis-indole derivatives against this pathogen. Minimum inhibitory concentrations (MICs) of four compounds (dcm01 to dcm04) were determined for the reference strains F. tularensis subsp. holarctica LVS NCTC10857, F. tularensis subsp. novicida CIP56.12 and F. philomiragia ATCC25015, and for 41 clinical strains of F. tularensis subsp. holarctica isolated in France. Minimal bactericidal concentrations (MBCs) were determined for the dcm02 and dcm04 compounds for the LVS and two clinical strains. Killing curves were also determined for the same three strains exposed to dcm04. All tested bis-indole compounds were bacteriostatic against F. tularensis subsp. holarctica strains, with a MIC90 of 8 μg/mL for dcm01, dcm02, and dcm03, and 2 μg/mL for dcm04. Only one strain was resistant to both dcm01 and dcm03, with MICs > 32 μg/mL. In contrast, F. tularensis subsp. novicida was resistant to all derivatives and F. philomiragia was only susceptible to dcm02 and dcm04, with MICs of 16 and 4 μg/mL, respectively. MBC and killing curve experiments revealed significant bactericidal activity (i.e., 3-log reduction of the bacterial inoculum) of the dcm02 and dcm04 compounds only for the LVS strain. In conclusion, we have identified novel synthetic bis-indole compounds that are active against F. tularensis subsp. holarctica. They may be drug candidates for the development of new therapeutic alternatives for tularaemia treatment. Their further characterization is needed, especially identification of their bacterial targets

  4. Lubrication properties of potential alternative lubricants, glycerin fatty acid esters, to magnesium stearate.

    PubMed

    Uchimoto, Takeaki; Iwao, Yasunori; Ikegami, Yuki; Murata, Takashi; Sonobe, Takashi; Miyagishima, Atsuo; Itai, Shigeru

    2010-02-15

    To study the usefulness of glycerin fatty acid ester Poem TR-FB (TR-FB) and Poem TR-HB (TR-HB) as lubricants, pressure transmission ratio, ejection force, disintegration time, and tensile strength were measured at different concentrations and mixing times for granules and tablets. When each lubricant was mixed at 0.1-3.0%, the increase in the pressure transmission ratio that was equal to or greater than that of Mg-St as well as the reduction in the ejection force was observed at a low concentration in both TR-FB and TR-HB, proving that they have excellent lubrication performance. The granules that were lubricated with TR-FB and TR-HB at even low concentration of 0.4% showed a more stable and sufficiently lower ejection force than with Mg-St from the first tablet after the start of compression. When they were mixed for 5-60 min, while the mixture with Mg-St showed a low pressure transmission ratio of 82% and a high ejection force of 500 N in the first tablet even when the mixing time was 60 min, a high pressure transmission ratio and a low ejection force were observed in TR-FB and TR-HB from the first tablet after mixing for 5-60 min, and these were maintained thereafter. As for the disintegration time and the tensile strength, a prolonged disintegration time and a decreased tensile strength, which are disadvantages of Mg-St, were not observed in TR-FB and TR-HB. Based on these results, it was concluded that TR-FB and TR-HB are useful as alternative lubricants to Mg-St.

  5. Cost effective use of liquid nitrogen in cryogenic wind tunnels

    NASA Technical Reports Server (NTRS)

    Mcintosh, Glen E.; Lombard, David S.; Martindale, David L.; Dunn, Robert P.

    1987-01-01

    A method of reliquefying from 12 to 19% of the nitrogen exhaust gas from a cryogenic wind tunnel has been developed. Technical feasibility and cost effectiveness of the system depends on performance of an innovative positive displacement expander which requires scale model testing to confirm design studies. The existing cryogenic system at the 0.3-m transonic cryogenic tunnel has been surveyed and extensive upgrades proposed. Upgrades are generally cost effective and may be implemented immediately since they are based on established technology.

  6. A concept for cost-effective, satellite servicing

    NASA Astrophysics Data System (ADS)

    Madison, Richard W.

    1999-01-01

    Air, land, and sea vehicles are routinely serviced to increase their availability, flexibility, capability, and life span. Servicing could extend the same benefits to satellites, but is rarely employed because current methods are cost effective only for very expensive satellites. This paper presents a concept to minimize the cost of satellite servicing. It combines requirements for a next-generation of serviceable satellites, with an infrastructure whose cost can be amortized over many servicing missions. This should make servicing cost effective for a wider range of spacecraft.

  7. Decreasing cost effectiveness of testing for latent TB in HIV in a low TB incidence area.

    PubMed

    Capocci, Santino; Smith, Colette; Morris, Stephen; Bhagani, Sanjay; Cropley, Ian; Abubakar, Ibrahim; Johnson, Margaret; Lipman, Marc

    2015-07-01

    Testing for latent tuberculosis infection (LTBI) in HIV-infected persons in low tuberculosis (TB) incidence areas is often recommended. Using contemporary, clinical data, we report the yield and cost-effectiveness of testing all HIV attendees, two current UK strategies and no LTBI testing. Economic modelling was performed utilising 10-year follow up data from a large HIV clinical cohort. Outcomes were numbers of cases of active TB and incremental cost per quality-adjusted life year (QALY) gained. Between 2000 and 2010, 256 people were treated for TB/HIV co-infection. 72 (28%) occurred ≥3 months after HIV diagnosis and may have been prevented by LTBI testing. Between 2000 and 2005, the incremental cost per QALY gained for the British HIV Association (BHIVA) and UK National Institute of Care Excellence (NICE) strategies, and testing all clinic attendees was €6270, €6998 and €33,473, respectively. These rose to €9332, €32,564 and €74,067, respectively, between 2005 and 2010. Probabilistic sensitivity analysis suggested that at a threshold of €24,000 per additional QALY, the most cost-effective strategies would be NICE or testing all in 2000-2005 and BHIVA during 2005-2010. Both UK testing regimens missed cases but are cost-effective compared with no testing. Using recent data, they all became more expensive, suggesting that alternative or more targeted TB testing strategies must be considered.

  8. Decision analysis and cost-effectiveness analysis for comparative effectiveness research--a primer.

    PubMed

    Sher, David J; Punglia, Rinaa S

    2014-01-01

    Although the analysis of real-world data is the foundation of comparative effectiveness analysis, not all clinical questions are easily approached with patient-derived information. Decision analysis is a set of modeling and analytic tools that simulate treatment and disease processes, including the incorporation of patient preferences, thus generating optimal treatment strategies for varying patient, disease, and treatment conditions. Although decision analysis is informed by evidence-derived outcomes, its ability to test treatment strategies under different conditions that are realistic but not necessarily reported in the literature makes it a useful and complementary technique to more standard data analysis. Similarly, cost-effectiveness analysis is a discipline in which the relative costs and benefits of treatment alternatives are rigorously compared. With the well-recognized increase in highly technical, costly radiation therapy technologies, the cost-effectiveness of these different treatments would come under progressively more scrutiny. In this review, we discuss the theoretical and practical aspects of decision analysis and cost-effectiveness analysis, providing examples that highlight their methodology and utility.

  9. Cost-Effectiveness of Dapagliflozin versus Acarbose as a Monotherapy in Type 2 Diabetes in China

    PubMed Central

    Gu, Shuyan; Mu, Yiming; Zhai, Suodi; Zeng, Yuhang; Zhen, Xuemei; Dong, Hengjin

    2016-01-01

    Objective To estimate the long-term cost-effectiveness of dapagliflozin versus acarbose as monotherapy in treatment-naïve patients with type 2 diabetes mellitus (T2DM) in China. Methods The Cardiff Diabetes Model, an economic model designed to evaluate the cost-effectiveness of comparator therapies in diabetes was used to simulate disease progression and estimate the long-term effect of treatments on patients. Systematic literature reviews, hospital surveys, meta-analysis and indirect treatment comparison were conducted to obtain model-required patient profiles, clinical data and costs. Health insurance costs (2015¥) were estimated over 40 years from a healthcare payer perspective. Univariate and probabilistic sensitivity analyses were performed. Results The model predicted that dapagliflozin had lower incidences of cardiovascular events, hypoglycemia and mortality events, was associated with a mean incremental benefit of 0.25 quality-adjusted life-years (QALYs) and with a lower cost of ¥8,439 compared with acarbose. This resulted in a cost saving of ¥33,786 per QALY gained with dapagliflozin. Sensitivity analyses determined that the results are robust. Conclusion Dapagliflozin is dominant compared with acarbose as monotherapy for Chinese T2DM patients, with a little QALY gain and lower costs. Dapagliflozin offers a well-tolerated and cost-effective alternative medication for treatment-naive patients in China, and may have a direct impact in reducing the disease burden of T2DM. PMID:27806087

  10. Schizophrenia interventions in Vietnam: primary results from a cost-effectiveness study.

    PubMed

    Anh, Nguyen Quynh; Linh, Bui Ngoc; Ha, Nguyen Thu; Phanthunane, Pudtan; Huong, Nguyen Thanh

    2015-01-01

    Schizophrenia is a highly disabling mental health disorder that imposes a considerable economic burden on a health care system. This paper aimed to examine the cost and effectiveness of alternative pharmaceutical interventions and the effects of family intervention (FI) for schizophrenia from the government perspective in order to introduce the most cost-effective intervention applicable to Vietnam. A Markov model was developed to estimate costs and health outcome over patients' lifetimes when using typical and atypical antipsychotic drugs, alone or in combination with family intervention. Health outcome was measured in terms of disability-adjusted life years averted. Monte Carlo simulation was used for uncertainty analysis. According to our findings, interventions using typical or atypical drugs combined with FI were found to be the most effective and least costly compared to a 'do-nothing' scenario. Interventions using atypical drugs alone were estimated to be much less favourable due to a considerably higher cost. This is a very first attempt on cost-effectiveness analysis of interventions for schizophrenia in Vietnam, and recommendations are made for future research to determine the most cost-effective intervention.

  11. HPV testing for cervical cancer screening appears more cost-effective than Papanicolau cytology in Mexico

    PubMed Central

    Bishai, David M.; Lőrincz, Attila; Shah, Keerti V.; Lazcano-Ponce, Eduardo; Hernández, Mauricio; Granados-García, Víctor; Pérez, Ruth; Salmerón, Jorge

    2010-01-01

    Objective To determine the incremental costs and effects of different HPV testing strategies, when compared to Papanicolau cytology (Pap), for cervical cancer screening in Mexico. Methods A cost-effectiveness analysis (CEA) examined the specific costs and health outcomes associated with (1) no screening; (2) only the Pap test; (3) only self-administered HPV; (4) only clinician administered HPV; and (5) clinician administered HPV plus the Pap test. The costs of self- and clinician-HPV testing, as well as with the Pap test, were identified and quantified. Costs were reported in 2008 US dollars. The health outcome associated with these screening strategies was defined as the number of high-grade cervical intraepithelial neoplasia or cervical cancer cases detected. This CEA was performed using the perspective of the Mexican Institute of Social Security (IMSS) in Morelos, Mexico. Results Screening women between the ages of 30–80 for cervical cancer using clinical-HPV testing or the combination of clinical-HPV testing, and the Pap is always more cost-effective than using the Pap test alone. Conclusions This CEA indicates that HPV testing could be a cost-effective screening alternative for a large health delivery organization such as IMSS. These results may help policy-makers implement HPV testing as part of the IMSS cervical cancer screening program. PMID:21170578

  12. Investigation of potential alternative hydrogen carrier, Mg supported zeolite with temperature programmed desorption of NH3.

    PubMed

    Cho, Sung June; Kim, Tak Hee; Jang, Young Bae; Lee, Jun

    2007-11-01

    Magnesium ion exchanged zeolite A was subject to the measurement of the temperature programmed desorption of NH3 to explore the possibility of the potential hydrogen carrier. The result suggested that the Mg supported NaA zeolite released a significant amount of ammonia corresponding to 1.4 Hwt% hydrogen at around 373 K. Under the same condition after the NH3 adsorption at ambient temperature, the MgCl2 sample released 1.0 Hwt% hydrogen at around 340 K. The present work suggests that the Mg supported zeolite can also be utilized as hydrogen carrier.

  13. Cost-effectiveness of adjunct non-pharmacological interventions for osteoarthritis of the knee

    PubMed Central

    Woods, Beth; Manca, Andrea; Weatherly, Helen; Saramago, Pedro; Sideris, Eleftherios; Giannopoulou, Christina; Rice, Stephen; Corbett, Mark; Vickers, Andrew; Bowes, Matthew; MacPherson, Hugh; Sculpher, Mark

    2017-01-01

    Background There is limited information on the costs and benefits of alternative adjunct non-pharmacological treatments for knee osteoarthritis and little guidance on which should be prioritised for commissioning within the NHS. This study estimates the costs and benefits of acupuncture, braces, heat treatment, insoles, interferential therapy, laser/light therapy, manual therapy, neuromuscular electrical stimulation, pulsed electrical stimulation, pulsed electromagnetic fields, static magnets and transcutaneous electrical nerve Stimulation (TENS), based on all relevant data, to facilitate a more complete assessment of value. Methods Data from 88 randomised controlled trials including 7,507 patients were obtained from a systematic review. The studies reported a wide range of outcomes. These were converted into EQ-5D index values using prediction models, and synthesised using network meta-analysis. Analyses were conducted including firstly all trials and secondly only trials with low risk of selection bias. Resource use was estimated from trials, expert opinion and the literature. A decision analytic model synthesised all evidence to assess interventions over a typical treatment period (constant benefit over eight weeks or linear increase in effect over weeks zero to eight and dissipation over weeks eight to 16). Results When all trials are considered, TENS is cost-effective at thresholds of £20–30,000 per QALY with an incremental cost-effectiveness ratio of £2,690 per QALY vs. usual care. When trials with a low risk of selection bias are considered, acupuncture is cost-effective with an incremental cost-effectiveness ratio of £13,502 per QALY vs. TENS. The results of the analysis were sensitive to varying the intensity, with which interventions were delivered, and the magnitude and duration of intervention effects on EQ-5D. Conclusions Using the £20,000 per QALY NICE threshold results in TENS being cost-effective if all trials are considered. If only higher

  14. Cost-effectiveness analysis using data from multinational trials: The use of bivariate hierarchical modelling

    PubMed Central

    Manca, Andrea; Lambert, Paul C; Sculpher, Mark; Rice, Nigel

    2008-01-01

    Healthcare cost-effectiveness analysis (CEA) often uses individual patient data (IPD) from multinational randomised controlled trials. Although designed to account for between-patient sampling variability in the clinical and economic data, standard analytical approaches to CEA ignore the presence of between-location variability in the study results. This is a restrictive limitation given that countries often differ in factors that could affect the results of CEAs, such as the availability of healthcare resources, their unit costs, clinical practice, and patient case-mix. We advocate the use of Bayesian bivariate hierarchical modelling to analyse multinational cost-effectiveness data. This analytical framework explicitly recognises that patient-level costs and outcomes are nested within countries. Using real life data, we illustrate how the proposed methods can be applied to obtain (a) more appropriate estimates of overall cost-effectiveness and associated measure of sampling uncertainty compared to standard CEA; and (b) country-specific cost-effectiveness estimates which can be used to assess the between-location variability of the study results, while controlling for differences in country-specific and patient-specific characteristics. It is demonstrated that results from standard CEA using IPD from multinational trials display a large degree of variability across the 17 countries included in the analysis, producing potentially misleading results. In contrast, ‘shrinkage estimates’ obtained from the modelling approach proposed here facilitate the appropriate quantification of country-specific cost-effectiveness estimates, while weighting the results based on the level of information available within each country. We suggest that the methods presented here represent a general framework for the analysis of economic data collected from different locations. PMID:17641141

  15. Potential of fructooligosaccharide prebiotics in alternative and nonconventional poultry production systems.

    PubMed

    Ricke, S C

    2015-06-01

    Fructooligosaccharide and inulin prebiotics are carbohydrate-based polymers derived from natural sources that can be utilized by certain gastrointestinal tract bacteria but not by the host animal. They are attractive as feed additives for nonconventional poultry production systems because they select for beneficial microorganisms that are thought to promote nutritional benefits to the bird and potentially limit foodborne pathogen establishment. There have been numerous studies conducted with prebiotic supplements to assess their impact in humans, animals, and conventionally raised poultry but only limited research has been conducted with birds grown under nonconventional production conditions. Much remains unknown about the specific mechanism(s) associated with their impact on the host as well as the gastrointestinal tract microflora. Utilization of several recently developed approaches such as microbiome and metabolomic analyses should offer more insight on how dietary prebiotic additives influence the development of the gastrointestinal tract microbiota and these subsequent changes correspond with alterations in a bird's physiology as it matures. As more detailed and precise studies are done with nonconventional poultry, it is likely that structurally distinct prebiotics will influence not only the gastrointestinal tract microbiota differently, but potentially interact directly and/or indirectly with the bird host in distinguishable patterns as well. These functions will be important to delineate if further applications are to be developed for specific prebiotics in nonconventional poultry production systems.

  16. Perspectives on Non-Animal Alternatives for Assessing Sensitization Potential in Allergic Contact Dermatitis.

    PubMed

    Sharma, Nripen S; Jindal, Rohit; Mitra, Bhaskar; Lee, Serom; Li, Lulu; Maguire, Tim J; Schloss, Rene; Yarmush, Martin L

    2012-03-01

    Skin sensitization remains a major environmental and occupational health hazard. Animal models have been used as the gold standard method of choice for estimating chemical sensitization potential. However, a growing international drive and consensus for minimizing animal usage have prompted the development of in vitro methods to assess chemical sensitivity. In this paper, we examine existing approaches including in silico models, cell and tissue based assays for distinguishing between sensitizers and irritants. The in silico approaches that have been discussed include Quantitative Structure Activity Relationships (QSAR) and QSAR based expert models that correlate chemical molecular structure with biological activity and mechanism based read-across models that incorporate compound electrophilicity. The cell and tissue based assays rely on an assortment of mono and co-culture cell systems in conjunction with 3D skin models. Given the complexity of allergen induced immune responses, and the limited ability of existing systems to capture the entire gamut of cellular and molecular events associated with these responses, we also introduce a microfabricated platform that can capture all the key steps involved in allergic contact sensitivity. Finally, we describe the development of an integrated testing strategy comprised of two or three tier systems for evaluating sensitization potential of chemicals.

  17. Generalized cost-effectiveness analysis for national-level priority-setting in the health sector

    PubMed Central

    Hutubessy, Raymond; Chisholm, Dan; Edejer, Tessa Tan-Torres

    2003-01-01

    Cost-effectiveness analysis (CEA) is potentially an important aid to public health decision-making but, with some notable exceptions, its use and impact at the level of individual countries is limited. A number of potential reasons may account for this, among them technical shortcomings associated with the generation of current economic evidence, political expediency, social preferences and systemic barriers to implementation. As a form of sectoral CEA, Generalized CEA sets out to overcome a number of these barriers to the appropriate use of cost-effectiveness information at the regional and country level. Its application via WHO-CHOICE provides a new economic evidence base, as well as underlying methodological developments, concerning the cost-effectiveness of a range of health interventions for leading causes of, and risk factors for, disease. The estimated sub-regional costs and effects of different interventions provided by WHO-CHOICE can readily be tailored to the specific context of individual countries, for example by adjustment to the quantity and unit prices of intervention inputs (costs) or the coverage, efficacy and adherence rates of interventions (effectiveness). The potential usefulness of this information for health policy and planning is in assessing if current intervention strategies represent an efficient use of scarce resources, and which of the potential additional interventions that are not yet implemented, or not implemented fully, should be given priority on the grounds of cost-effectiveness. Health policy-makers and programme managers can use results from WHO-CHOICE as a valuable input into the planning and prioritization of services at national level, as well as a starting point for additional analyses of the trade-off between the efficiency of interventions in producing health and their impact on other key outcomes such as reducing inequalities and improving the health of the poor. PMID:14687420

  18. Potential of Complementary and Alternative Medicine in Preventive Management of Novel H1N1 Flu (Swine Flu) Pandemic: Thwarting Potential Disasters in the Bud

    PubMed Central

    Arora, Rajesh; Chawla, R.; Marwah, Rohit; Arora, P.; Sharma, R. K.; Kaushik, Vinod; Goel, R.; Kaur, A.; Silambarasan, M.; Tripathi, R. P.; Bhardwaj, J. R.

    2011-01-01

    The emergence of novel H1N1 has posed a situation that warrants urgent global attention. Though antiviral drugs are available in mainstream medicine for treating symptoms of swine flu, currently there is no preventive medicine available. Even when available, they would be in short supply and ineffective in a pandemic situation, for treating the masses worldwide. Besides the development of drug resistance, emergence of mutant strains of the virus, emergence of a more virulent strain, prohibitive costs of available drugs, time lag between vaccine developments, and mass casualties would pose difficult problems. In view of this, complementary and alternative medicine (CAM) offers a plethora of interesting preventive possibilities in patients. Herbs exhibit a diverse array of biological activities and can be effectively harnessed for managing pandemic flu. Potentially active herbs can serve as effective anti influenza agents. The role of CAM for managing novel H1N1 flu and the mode of action of these botanicals is presented here in an evidence-based approach that can be followed to establish their potential use in the management of influenza pandemics. The complementary and alternative medicine approach deliberated in the paper should also be useful in treating the patients with serious influenza in non pandemic situations. PMID:20976081

  19. The cost-effectiveness of influenza vaccination in elderly Australians: an exploratory analysis of the vaccine efficacy required.

    PubMed

    Newall, Anthony T; Dehollain, Juan Pablo

    2014-03-10

    It is important to consider the value for money offered by existing elderly influenza vaccination programs, particularly as doubts persist about the magnitude of the effectiveness of such programs. An informative approach to explore the value of vaccination is to consider what vaccine efficacy would be required for a program to be considered cost-effective. To estimate the cost-effectiveness of the current elderly (65+ years) influenza vaccination program in Australia, we modelled how the hypothetical removal of vaccination would increase current disease burden estimates depending on alternative vaccine efficacy assumptions. The base-case results of the analysis found that the existing elderly vaccination program is likely to be cost-effective (under A$50,000 per quality-adjusted life year gained) if the vaccine efficacy is above ∼30%. This study offers reassurance that the influenza vaccination of elderly Australians is likely to offer value for money.

  20. Cost-Effectiveness of Home Energy Retrofits in Pre-Code Vintage Homes in the United States

    SciTech Connect

    Fairey, P.; Parker, D.

    2012-11-01

    This analytical study examines the opportunities for cost-effective energy efficiency and renewable energy retrofits in residential archetypes constructed prior to 1980 (Pre-Code) in fourteen U.S. cities. These fourteen cities are representative of each of the International Energy Conservation Code (IECC) climate zones in the contiguous U.S. The analysis is conducted using an in-house version of EnergyGauge USA v.2.8.05 named CostOpt that has been programmed to perform iterative, incremental economic optimization on a large list of residential energy efficiency and renewable energy retrofit measures. The principle objectives of the study are as follows: to determine the opportunities for cost effective source energy reductions in this large cohort of existing residential building stock as a function of local climate and energy costs; and to examine how retrofit financing alternatives impact the source energy reductions that are cost effectively achievable.

  1. Alternate approaches for pediatric type 1 diabetes drug development and potential regulatory approval: a perspective.

    PubMed

    Turner, J Rick; Close, Kelly L; Fleming, G Alexander; Wherrett, Diane K; DiMeglio, Linda A

    2015-10-01

    The incidence and prevalence of pediatric type 1 diabetes are increasing globally, including in the U.S. While the increasing number of cases of pediatric diabetes makes expeditious availability of new medical products and therapies for diabetes care essential, there have been many barriers encountered in bringing some drugs and devices to pediatric patients who may benefit. Newer insulins have been studied and approved for use in children. However, hurdles exist in the inclusion of children in studies of therapies aimed at preventing β-cell loss in those with new-onset diabetes and those at risk for type 1 diabetes. This Perspective focuses on potential solutions to the challenges experienced in bringing new drugs for pediatric type 1 diabetes to marketing approval. Given their central importance as the users of medical products, patient perspectives are included along with scientific and regulatory considerations.

  2. Potential of chitosan from Mucor rouxxi UCP064 as alternative natural compound to inhibit Listeria monocytogenes.

    PubMed

    Bento, Roberta A; Stamford, Tânia L M; de Campos-Takaki, Galba M; Stamford, Thayza C M; de Souza, Evandro L

    2009-07-01

    Listeria monocytogenes is widely distributed in nature and the infection listeriosis is recognized as a potential threat for human health because of its mortality rate. The objective of this study was to evaluate the growth profile and chitosan production by Mucor rouxxi UCP 064 grown in yam bean (Pachyrhizus erosus L. Urban) medium. It was also to assess the anti-L. monocytogenes efficacy of the obtained chitosan. Higher values of biomass of M. rouxxi (16.9 g.L(-1)) and best yield of chitosan (62 mg.g(-1)) were found after 48 h of cultivation. Residual glucose and nitrogen in the growth media were 4.1 and 0.02 g.L(-1) after 96 h, respectively. Obtained chitosan presented 85 % of degree of deacetylation and 2.60 x 10(4) g.mol(-1) of viscosimetric molecular weight. Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) values of chitosan against L. monocytogenes ATCC 7644 were, respectively, 2.5 and 5.0 mg.mL(-1). At 2.5 and 5.0 mg.mL(-1) chitosan caused cidal effect in a maximum time of 4 h. Bacterial count below 2 log cfu.mL(-1) were found from 2 h onwards and no recovery in bacterial growth was noted in the remainder period. These results show the biotechnological potential of yam bean medium for chitosan production by Mucor rouxxi and support the possible rational use of chitosan from fungi as natural antimicrobial to control L. monocytogenes.

  3. Spermicidal and Contraceptive Potential of Desgalactotigonin: A Prospective Alternative of Nonoxynol-9

    PubMed Central

    Chakraborty, Debanjana; Maity, Arindam; Jha, Tarun; Mondal, Nirup Bikash

    2014-01-01

    Crude decoction of Chenopodium album seed showed spermicidal effect at MIC 2 mg/ml in earlier studies. Systematic isolation, characterization and evaluation revealed that the major metabolite Desgalactotigonin (DGT) is the most effective principle in both in vitro and in vivo studies. The in vitro studies comprises (a) rat and human sperm motility and immobilizing activity by Sander-Cramer assay; (b) sperm membrane integrity was observed by HOS test and electron microscopy; (c) microbial potential was examined in Lactobacillus broth culture, and (d) the hemolytic index was determined by using rat RBCs. The in vivo contraceptive efficacy was evaluated by intra uterine application of DGT in rat. Lipid peroxidation and induction of apoptosis by DGT on human spermatozoa were also studied. The minimum effective concentration (MEC) of DGT that induced instantaneous immobilization in vitro was 24.18 µM for rat and 58.03 µM for human spermatozoa. Microbial study indicated DGT to be friendly to Lactobacillus acidophilus. Implantation was prevented in DGT treated uterine horn while no hindrance occurred in the untreated contra lateral side. At the level of EC50, DGT induced apoptosis in human spermatozoa as determined by increased labeling with Annexin-V and decreased polarization of sperm mitochondria. Desgalactotigonin emerged 80 and 2×104 times more potent than the decoction and Nonoxynol-9 respectively. It possesses mechanism based detrimental action on both human and rat spermatozoa and spares lactobacilli and HeLa cells at MEC which proves its potential as a superior ingredient for the formulation of a contraceptive safer/compatible to vaginal microflora. PMID:25243914

  4. Potential of chitosan from Mucor rouxxi UCP064 as alternative natural compound to inhibit Listeria monocytogenes

    PubMed Central

    Bento, Roberta A.; Stamford, Tânia L.M.; de Campos-Takaki, Galba M.; Stamford, Thayza C.M.; de Souza, Evandro L.

    2009-01-01

    Listeria monocytogenes is widely distributed in nature and the infection listeriosis is recognized as a potential threat for human health because of its mortality rate. The objective of this study was to evaluate the growth profile and chitosan production by Mucor rouxxi UCP 064 grown in yam bean (Pachyrhizus erosus L. Urban) medium. It was also to assess the anti-L. monocytogenes efficacy of the obtained chitosan. Higher values of biomass of M. rouxxi (16.9 g.L-1) and best yield of chitosan (62 mg.g-1) were found after 48 h of cultivation. Residual glucose and nitrogen in the growth media were 4.1 and 0.02 g.L-1 after 96 h, respectively. Obtained chitosan presented 85 % of degree of deacetylation and 2.60 x 104 g.mol-1 of viscosimetric molecular weight. Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) values of chitosan against L. monocytogenes ATCC 7644 were, respectively, 2.5 and 5.0 mg.mL-1. At 2.5 and 5.0 mg.mL-1 chitosan caused cidal effect in a maximum time of 4 h. Bacterial count below 2 log cfu.mL-1 were found from 2 h onwards and no recovery in bacterial growth was noted in the remainder period. These results show the biotechnological potential of yam bean medium for chitosan production by Mucor rouxxi and support the possible rational use of chitosan from fungi as natural antimicrobial to control L. monocytogenes. PMID:24031403

  5. The polypill in the primary prevention of cardiovascular disease: cost-effectiveness in the Dutch population.

    PubMed

    van Gils, Paul F; Over, Eelco A B; Hamberg-van Reenen, Heleen H; de Wit, G Ardine; van den Berg, Matthijs; Schuit, Albertine J; Engelfriet, Peter M

    2011-01-01

    Objectives The aim of the present study was to estimate the cost-effectiveness of the polypill in the primary prevention of cardiovascular disease. Design A health economic modelling study. Setting Primary healthcare in the Netherlands. Participants Simulated individuals from the general Dutch population, aged 45-75 years. Interventions Opportunistic screening followed by prescription of the polypill to eligible individuals. Eligibility was defined as having a minimum 10-year risk of cardiovascular death as assessed with the Systematic Coronary Risk Evaluation function of alternatively 5%, 7.5% or 10%. Different versions of the polypill were considered, depending on composition: (1) the Indian polycap, with three different types of blood pressure-lowering drugs, a statin and aspirin; (2) as (1) but without aspirin and (3) as (2) but with a double statin dose. In addition, a scenario of (targeted) separate antihypertensive and/or statin medication was simulated. Primary outcome measures Cases of acute myocardial infarction or stroke prevented, quality-adjusted life years (QALYs) gained and the costs per QALY gained. All interventions were compared with usual care. Results All scenarios were cost-effective with an incremental cost-effectiveness ratio between €7900 and 12 300 per QALY compared with usual care. Most health gains were achieved with the polypill without aspirin and containing a double dose of statins. With a 10-year risk of 7.5% as the threshold, this pill would prevent approximately 3.5% of all cardiovascular events. Conclusions Opportunistic screening based on global cardiovascular risk assessment followed by polypill prescription to those with increased risk offers a cost-effective strategy. Most health gain is achieved by the polypill without aspirin and a double statin dose.

  6. The polypill in the primary prevention of cardiovascular disease: cost-effectiveness in the Dutch population

    PubMed Central

    Over, Eelco A B; Hamberg-van Reenen, Heleen H; de Wit, G Ardine; van den Berg, Matthijs; Schuit, Albertine J; Engelfriet, Peter M

    2011-01-01

    Objectives The aim of the present study was to estimate the cost-effectiveness of the polypill in the primary prevention of cardiovascular disease. Design A health economic modelling study. Setting Primary healthcare in the Netherlands. Participants Simulated individuals from the general Dutch population, aged 45–75 years. Interventions Opportunistic screening followed by prescription of the polypill to eligible individuals. Eligibility was defined as having a minimum 10-year risk of cardiovascular death as assessed with the Systematic Coronary Risk Evaluation function of alternatively 5%, 7.5% or 10%. Different versions of the polypill were considered, depending on composition: (1) the Indian polycap, with three different types of blood pressure-lowering drugs, a statin and aspirin; (2) as (1) but without aspirin and (3) as (2) but with a double statin dose. In addition, a scenario of (targeted) separate antihypertensive and/or statin medication was simulated. Primary outcome measures Cases of acute myocardial infarction or stroke prevented, quality-adjusted life years (QALYs) gained and the costs per QALY gained. All interventions were compared with usual care. Results All scenarios were cost-effective with an incremental cost-effectiveness ratio between €7900 and 12 300 per QALY compared with usual care. Most health gains were achieved with the polypill without aspirin and containing a double dose of statins. With a 10-year risk of 7.5% as the threshold, this pill would prevent approximately 3.5% of all cardiovascular events. Conclusions Opportunistic screening based on global cardiovascular risk assessment followed by polypill prescription to those with increased risk offers a cost-effective strategy. Most health gain is achieved by the polypill without aspirin and a double statin dose. PMID:22189351

  7. Evaluation of an in vitro assay system as a potential alternative to current histamine sensitization test for acellular pertussis vaccines.

    PubMed

    Xing, Dorothy; Yuen, Chun-Ting; Asokanathan, Catpagavalli; Rigsby, Peter; Horiuchi, Yoshinobu

    2012-11-01

    The histamine sensitization test (HIST) is a lethal test for batch release of acellular pertussis or its combination vaccines (ACV). Large numbers of animals have been used and it is difficult to standardize. Therefore there is an urgent need to develop an in vitro alternative to HIST. An in vitro test system has been developed as a potential alternative to HIST, to examine both the functional domains of PT based on a combination of enzyme coupled-HPLC (E-HPLC) and carbohydrate binding assays. We describe here an international collaborative study, which involved sixteen laboratories from 9 countries to assess the methodology transferability of the in vitro test system and its suitability for the testing of three different types of ACV products that are currently used worldwide. This study also evaluated further the relationship between the in vivo activity by HIST and the in vitro assay system. The results showed that the methodology of the E-HPLC and carbohydrate binding assays are transferable between laboratories worldwide and is suitable for the three types of ACV products included in the study. Although direct correlation between the in vitro assay system and the in vivo HIST (temperature reduction assay) for each individual vaccine lot cannot be established due to the large variation in the HIST results, the observation that the mean estimates of the in vitro and in vivo activities gave the same rank order of the three vaccine types included in the study is encouraging. The in vitro systems provide reproducible product specific profiles which supports their use as a potential alternative to the HIST.

  8. The Potential of Solar as Alternative Energy Source for Socio-Economic Wellbeing in Rural Areas, Malaysia

    NASA Astrophysics Data System (ADS)

    Alam, Rashidah Zainal; Siwar, Chamhuri; Ludin, Norasikin Ahmad

    Malaysia's energy sector is highly dependent on fossil fuels as a primary energy source. Economic growth and socio-economic wellbeing also rely on the utilization of energy in daily life routine. Nevertheless, the increasing cost for electricity and declining fossil fuels resources causes various negative impacts to the people and environment especially in rural areas. This prompted Malaysia to shift towards alternative energy sources such as solar energy to ensure social, economic and environmental benefits. The solar energy is one of the potential renewable energy sources in tropical countries particularly in Malaysia. The paper attempts to analyze the benefits and advantages related to energy efficiency of solar for sustainable energy use and socio economic wellbeing in rural areas, Malaysia. The paper uses secondary sources of data such as policies, regulations and research reports from relevant ministries and agencies to attain the objectives. As a signatory country to the UN Convention on Climate Change and the Kyoto Protocol, Malaysia has taken initiatives for decreasing energy dependence on oil to reduce greenhouse gas emissions (GHG) for sustainable development. The paper shows solar energy becomes one of the promising alternative energy sources to alleviate energy poverty in Malaysia for rural areas. Finally, solar energy has increased socio-economic wellbeing and develops green potential and toward achieving energy efficiency in energy sector of Malaysia by preserving environment as well as reducing carbon emission.

  9. 10 CFR 436.18 - Measuring cost-effectiveness.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... water system, considered in determining such matters as the optimal size of a solar energy system, the... 10 Energy 3 2012-01-01 2012-01-01 false Measuring cost-effectiveness. 436.18 Section 436.18 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION FEDERAL ENERGY MANAGEMENT AND PLANNING PROGRAMS Methodology...

  10. 10 CFR 436.18 - Measuring cost-effectiveness.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... water system, considered in determining such matters as the optimal size of a solar energy system, the... 10 Energy 3 2010-01-01 2010-01-01 false Measuring cost-effectiveness. 436.18 Section 436.18 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION FEDERAL ENERGY MANAGEMENT AND PLANNING PROGRAMS Methodology...

  11. 10 CFR 436.18 - Measuring cost-effectiveness.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... water system, considered in determining such matters as the optimal size of a solar energy system, the... 10 Energy 3 2014-01-01 2014-01-01 false Measuring cost-effectiveness. 436.18 Section 436.18 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION FEDERAL ENERGY MANAGEMENT AND PLANNING PROGRAMS Methodology...

  12. Flipping the Calculus Classroom: A Cost-Effective Approach

    ERIC Educational Resources Information Center

    Young, Andrea

    2015-01-01

    This article discusses a cost-effective approach to flipping the calculus classroom. In particular, the emphasis is on low-cost choices, both monetarily and with regards to faculty time, that make the daunting task of flipping a course manageable for a single instructor. Student feedback and overall impressions are also presented.

  13. Neural mechanisms and personality correlates of the sunk cost effect

    PubMed Central

    Fujino, Junya; Fujimoto, Shinsuke; Kodaka, Fumitoshi; Camerer, Colin F.; Kawada, Ryosaku; Tsurumi, Kosuke; Tei, Shisei; Isobe, Masanori; Miyata, Jun; Sugihara, Genichi; Yamada, Makiko; Fukuyama, Hidenao; Murai, Toshiya; Takahashi, Hidehiko

    2016-01-01

    The sunk cost effect, an interesting and well-known maladaptive behavior, is pervasive in real life, and thus has been studied in various disciplines, including economics, psychology, organizational behavior, politics, and biology. However, the neural mechanisms underlying the sunk cost effect have not been clearly established, nor have their association with differences in individual susceptibility to the effect. Using functional magnetic resonance imaging, we investigated neural responses induced by sunk costs along with measures of core human personality. We found that individuals who tend to adhere to social rules and regulations (who are high in measured agreeableness and conscientiousness) are more susceptible to the sunk cost effect. Furthermore, this behavioral observation was strongly mediated by insula activity during sunk cost decision-making. Tight coupling between the insula and lateral prefrontal cortex was also observed during decision-making under sunk costs. Our findings reveal how individual differences can affect decision-making under sunk costs, thereby contributing to a better understanding of the psychological and neural mechanisms of the sunk cost effect. PMID:27611212

  14. 10 CFR 455.63 - Cost-effectiveness testing.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 3 2012-01-01 2012-01-01 false Cost-effectiveness testing. 455.63 Section 455.63 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION GRANT PROGRAMS FOR SCHOOLS AND HOSPITALS AND BUILDINGS OWNED BY UNITS OF LOCAL GOVERNMENT AND PUBLIC CARE INSTITUTIONS Technical Assistance Programs for...

  15. 10 CFR 455.63 - Cost-effectiveness testing.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 3 2014-01-01 2014-01-01 false Cost-effectiveness testing. 455.63 Section 455.63 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION GRANT PROGRAMS FOR SCHOOLS AND HOSPITALS AND BUILDINGS OWNED BY UNITS OF LOCAL GOVERNMENT AND PUBLIC CARE INSTITUTIONS Technical Assistance Programs for...

  16. 10 CFR 455.63 - Cost-effectiveness testing.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 3 2013-01-01 2013-01-01 false Cost-effectiveness testing. 455.63 Section 455.63 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION GRANT PROGRAMS FOR SCHOOLS AND HOSPITALS AND BUILDINGS OWNED BY UNITS OF LOCAL GOVERNMENT AND PUBLIC CARE INSTITUTIONS Technical Assistance Programs for...

  17. Some Measures of Cost Effectiveness in Library Collections.

    ERIC Educational Resources Information Center

    Hamaker, Charles A.

    1992-01-01

    Describes measures of cost effectiveness that are useful for academic library collections, based on experiences at the Louisiana State University libraries. Highlights include circulation analysis of newly cataloged books; current periodical use compared to cost; faculty ranking of journals; and circulation patterns (i.e., use versus cost and…

  18. HIV transmission and the cost-effectiveness of methadone maintenance.

    PubMed Central

    Zaric, G S; Barnett, P G; Brandeau, M L

    2000-01-01

    OBJECTIVES: This study determined the cost-effectiveness of expanding methadone maintenance treatment for heroin addiction, particularly its effect on the HIV epidemic. METHODS: We developed a dynamic epidemic model to study the effects of increased methadone maintenance capacity on health care costs and survival, measured as quality-adjusted life-years (QALYs). We considered communities with HIV prevalence among injection drug users of 5% and 40%. RESULTS: Additional methadone maintenance capacity costs $8200 per QALY gained in the high-prevalence community and $10,900 per QALY gained in the low-prevalence community. More than half of the benefits are gained by individuals who do not inject drugs. Even if the benefits realized by treated and untreated injection drug users are ignored, methadone maintenance expansion costs between $14,100 and $15,200 per QALY gained. Additional capacity remains cost-effective even if it is twice as expensive and half as effective as current methadone maintenance slots. CONCLUSIONS: Expansion of methadone maintenance is cost-effective on the basis of commonly accepted criteria for medical interventions. Barriers to methadone maintenance deny injection drug users access to a cost-effective intervention that generates significant health benefits for the general population. PMID:10897189

  19. Cost-Effectiveness of Case Management in Substance Abuse Treatment

    ERIC Educational Resources Information Center

    Saleh, Shadi S.; Vaughn, Thomas; Levey, Samuel; Fuortes, Laurence; Uden-Holmen, Tanya; Hall, James A.

    2006-01-01

    Objective: The purpose of this study, which is part of a larger clinical trial, was to examine the cost-effectiveness of case management for individuals treated for substance abuse in a residential setting. Method: Clients who agreed to participate were randomly assigned to one of four study groups. Two groups received face-to-face case management…

  20. Modeling and Cost-Effectiveness in HIV Prevention

    PubMed Central

    Jacobsen, Margo M.; Walensky, Rochelle P.

    2016-01-01

    With HIV funding plateauing and the number of people living with HIV increasing due to the roll-out of life-saving antiretroviral therapy, policy makers are faced with increasingly tighter budgets to manage the ongoing HIV epidemic. Cost-effectiveness and modeling analyses can help determine which HIV interventions may be of best value. Incidence remains remarkably high in certain populations and countries, making prevention key to controlling the spread of HIV. This paper briefly reviews concepts in modeling and cost-effectiveness methodology, then examines results of recently published cost-effectiveness analyses on the following HIV prevention strategies: condoms and circumcision, behavioral or community-based interventions, prevention of mother to child transmission, HIV testing, pre-exposure prophylaxis, and treatment as prevention. We find that the majority of published studies demonstrate cost-effectiveness; however, not all interventions are affordable. We urge continued research on combination strategies and methodologies that take into account willingness to pay and budgetary impact. PMID:26830283

  1. Cost Effectiveness of Current Awareness Sources in the Pharmaceutical Industry

    ERIC Educational Resources Information Center

    Ashmole, R. F.; And Others

    1973-01-01

    The cost effectiveness of several commercial data bases, journal scanning by information scientists, and the impact of private communication are compared in this study. A previously developed technique for measuring the usefulness of commercial data bases is utilized. (21 references) (Author/KE)

  2. Modeling and Cost-Effectiveness in HIV Prevention.

    PubMed

    Jacobsen, Margo M; Walensky, Rochelle P

    2016-02-01

    With HIV funding plateauing and the number of people living with HIV increasing due to the rollout of life-saving antiretroviral therapy, policy makers are faced with increasingly tighter budgets to manage the ongoing HIV epidemic. Cost-effectiveness and modeling analyses can help determine which HIV interventions may be of best value. Incidence remains remarkably high in certain populations and countries, making prevention key to controlling the spread of HIV. This paper briefly reviews concepts in modeling and cost-effectiveness methodology and then examines results of recently published cost-effectiveness analyses on the following HIV prevention strategies: condoms and circumcision, behavioral- or community-based interventions, prevention of mother-to-child transmission, HIV testing, pre-exposure prophylaxis, and treatment as prevention. We find that the majority of published studies demonstrate cost-effectiveness; however, not all interventions are affordable. We urge continued research on combination strategies and methodologies that take into account willingness to pay and budgetary impact.

  3. Cost effectiveness studies of environmental technologies: Volume 1

    SciTech Connect

    Silva, E.M.; Booth, S.R.

    1994-02-01

    This paper examines cost effectiveness studies of environmental technologies including the following: (1) In Situ Air Stripping, (2) Surface Towed Ordinance Locator System, (3) Ditch Witch Horizontal Boring Technology, (4) Direct Sampling Ion Trap Mass Spectrometer, (5) In Situ Vitrification, (6) Site Characterization and Analysis Penetrometer System, (7) In Situ Bioremediation, and (8) SEAMIST Membrane System Technology.

  4. Cost-Effective School Alarm Systems. Security Topics Series.

    ERIC Educational Resources Information Center

    Kaufer, Steve

    This document outlines considerations in the selection of a cost-effective school-alarm system. Steps in the planning process include: conducting a district needs assessment; gathering input from all staff levels; consulting technical expertise; and selecting a security system that can be integrated with other site needs. It further describes the…

  5. The Cost Effectiveness of Hepatitis Immunization for US College Students

    ERIC Educational Resources Information Center

    Jacobs, R. Jake; Saab, Sammy; Meyerhoff, Allen S.

    2003-01-01

    Hepatitis B immunization is recommended for all American children, and hepatitis A immunization is recommended for children who live in areas with elevated disease rates. Because hepatitis A and B occur most commonly in young adults, the authors examined the cost effectiveness of college-based vaccination. They developed epidemiologic models to…

  6. Energy Submetering: The Key to Cost-Effective Conservation.

    ERIC Educational Resources Information Center

    Turner, W. D.; McBride, John R.

    1999-01-01

    Examines the monitoring results from two large-scale metering and energy information projects: Texas LoanSTAR Program; and the Texas A & M Campus Project. Data suggest implementing an energy metering system is cost effective, particularly if the system can be coupled with skilled engineering applications such as energy cost allocation and…

  7. The Mexican Telesecundaria: A Cost-Effectiveness Analysis.

    ERIC Educational Resources Information Center

    Mayo, John K.; And Others

    "Telesecundaria" has for the past six years attempted to provide secondary education (grades 7-9) by television to those students who would normally not be able to continue their education beyond the primary level. The study reported here aimed to evaluate the system, especially its cost-effectiveness, suggest strategies for improvement,…

  8. Cost-effectiveness of anterior implants versus fixed dental prostheses.

    PubMed

    Zitzmann, N U; Krastl, G; Weiger, R; Kühl, S; Sendi, P

    2013-12-01

    For the restoration of an anterior missing tooth, implant-supported single crowns (ISCs) or fixed dental prostheses (FDPs) are indicated, but it is not clear which type of restoration is more cost-effective. A self-selected trial was performed with 15 patients with ISCs and 11 with FDPs. Patient preferences were recorded with visual analog scales before treatment, 1 month following restoration, and then annually. Quality-adjusted tooth years (QATYs) were estimated by considering the type of reconstruction for replacing the missing tooth and its effect on the adjacent teeth. A stochastic cost-effectiveness model was developed using Monte Carlo simulation. The expected costs and QATYs were summarized in cost-effectiveness acceptability curves. ISC was the dominant strategy, with a QATY increase of 0.01 over 3 years and 0.04 over 10 years with a higher probability of being cost-effective. While both treatment options provided satisfactory long-term results from the patient's perspective, the lower initial costs, particularly laboratory fees, were responsible for the dominance of ISCs over FDPs.

  9. A Cost-Effectiveness Analysis of Early Literacy Interventions

    ERIC Educational Resources Information Center

    Simon, Jessica

    2011-01-01

    Success in early literacy activities is associated with improved educational outcomes, including reduced dropout risk, in-grade retention, and special education referrals. When considering programs that will work for a particular school and context; cost-effectiveness analysis may provide useful information for decision makers. The study…

  10. Cost Effectiveness of Premium Versus Regular Gasoline in MCPS Buses.

    ERIC Educational Resources Information Center

    Baacke, Clifford M.; Frankel, Steven M.

    The primary question posed in this study is whether premium or regular gasoline is more cost effective for the Montgomery County Public School (MCPS) bus fleet, as a whole, when miles-per-gallon, cost-per-gallon, and repair costs associated with mileage are considered. On average, both miles-per-gallon, and repair costs-per-mile favor premium…

  11. [Cost-effectiveness analysis of professional oral hygiene].

    PubMed

    Olesov, E E; Shaĭmieva, N I; Kononenko, V I; Bersanov, R U; Monakova, N E

    2014-01-01

    Periodontal status and oral hygiene indexes were studied in 125 young employee of Kurchatov Institute. Oral hygiene values dynamic was assessed after professional oral hygiene in persons with unsatisfactory oral hygiene at baseline examination. When compared with the same values in the absence of professional oral hygiene procedures the results allowed calculating cost-effectiveness rate for biannual professional oral hygiene.

  12. Cost-Effectiveness of Two Methods of Job Analysis.

    ERIC Educational Resources Information Center

    Hesse, Cindy G.; Nijhof, Wim J.

    A three-phase study was conducted to compare the cost-effectiveness of two methods for determining job profiles in the publishing business and book trade--the task inventory and the Developing a Curriculum (DACUM) process. In phases 1 and 2, the task inventory and DACUM approaches were used to identify future changes in the technology used in the…

  13. Final report: Compiled MPI. Cost-Effective Exascale Application Development

    SciTech Connect

    Gropp, William Douglas

    2015-12-21

    This is the final report on Compiled MPI: Cost-Effective Exascale Application Development, and summarizes the results under this project. The project investigated runtime enviroments that improve the performance of MPI (Message-Passing Interface) programs; work at Illinois in the last period of this project looked at optimizing data access optimizations expressed with MPI datatypes.

  14. Estimating the Cost-Effectiveness of Coordinated DSM Programs.

    ERIC Educational Resources Information Center

    Hill, Lawrence J.; Brown, Marilyn A.

    1995-01-01

    A methodology for estimating the cost-effectiveness of coordinated programs from the standpoint of an electric or gas utility is described and illustrated. The discussion focuses on demand-side management programs cofunded by the government and utilities, but it can be applied to other types of cofunded programs. (SLD)

  15. 10 CFR 436.18 - Measuring cost-effectiveness.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Procedures for Life Cycle Cost Analyses § 436.18 Measuring cost-effectiveness. (a) In accordance with this...) Federal agencies performing LCC analysis on computers shall use either the Federal Buildings Life Cycle... building energy or water system with an energy or water conservation measure by retrofit to an...

  16. 10 CFR 436.18 - Measuring cost-effectiveness.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Procedures for Life Cycle Cost Analyses § 436.18 Measuring cost-effectiveness. (a) In accordance with this...) Federal agencies performing LCC analysis on computers shall use either the Federal Buildings Life Cycle... building energy or water system with an energy or water conservation measure by retrofit to an...

  17. 10 CFR 436.13 - Presuming cost-effectiveness results.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... in an energy or water conservation measure retrofit to an existing Federal building is not life cycle... Methodology and Procedures for Life Cycle Cost Analyses § 436.13 Presuming cost-effectiveness results. (a) If the investment and other costs for an energy or water conservation measure considered for retrofit...

  18. 10 CFR 436.13 - Presuming cost-effectiveness results.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... in an energy or water conservation measure retrofit to an existing Federal building is not life cycle... Methodology and Procedures for Life Cycle Cost Analyses § 436.13 Presuming cost-effectiveness results. (a) If the investment and other costs for an energy or water conservation measure considered for retrofit...

  19. 10 CFR 436.13 - Presuming cost-effectiveness results.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... in an energy or water conservation measure retrofit to an existing Federal building is not life cycle... Methodology and Procedures for Life Cycle Cost Analyses § 436.13 Presuming cost-effectiveness results. (a) If the investment and other costs for an energy or water conservation measure considered for retrofit...

  20. Cost-effectiveness of a package of interventions for expedited antiretroviral therapy initiation during pregnancy in Cape Town, South Africa.

    PubMed

    Zulliger, Rose; Black, Samantha; Holtgrave, David R; Ciaranello, Andrea L; Bekker, Linda-Gail; Myer, Landon

    2014-04-01

    Initiating antiretroviral therapy (ART) early in pregnancy is an important component of effective interventions to prevent the mother-to-child transmission of HIV (PMTCT). The rapid initiation of ART in pregnancy(RAP) program was a package of interventions to expedite ART initiation in pregnant women in Cape Town, South Africa. Retrospective cost-effectiveness, sensitivity and threshold analyses were conducted of the RAP program to determine the cost-utility thresholds for rapid initiation of ART in pregnancy. Costs were drawn from a detailed micro-costing of the program. The overall programmatic cost was US$880 per woman and the base case cost-effectiveness ratio was US$1,160 per quality-adjusted lifeyear (QALY) saved. In threshold analyses, the RAP program remained cost-effective if mother-to-child transmission was reduced by C0.33 %; if C1.76 QALY were saved with each averted perinatal infection; or if RAP-related costs were under US$4,020 per woman. The package of rapid initiation services was very cost-effective, as compared to standard services in this setting. Threshold analyses demonstrated that the intervention required minimal reductions in perinatal infections in order to be cost-effective. Interventions for the rapid initiation of ART in pregnancy hold considerable potential as a cost-effective use of limited resources for PMTCT in sub-Saharan Africa.

  1. Sporicidal efficacy of genipin: a potential theoretical alternative for biomaterial and tissue graft sterilization.

    PubMed

    Reich, Michael S; Akkus, Ozan

    2013-09-01

    Terminal sterilization of musculoskeletal allografts by gamma radiation minimizes the risk of disease transmission but impairs allograft mechanical properties. Commonly employed crosslinking agents can sterilize tissues without affecting mechanical properties adversely; however, these agents are toxic. Genipin is reported to be a benign crosslinking agent that strengthens mechanical properties of tissues; however, the antimicrobial capacity of genipin is largely unknown. The present study's aims were: (1) to assess the sporicidal potential of genipin, (2) to improve antimicrobial capacity by changing chemical and physical treatment conditions. To establish genipin's sterilization potential Bacillus subtilis var. niger spore strips were treated with 0-10% genipin in PBS or in 1:1 DMSO:PBS up to 72 h at room temperature (RT). Sterilizing doses and concentrations of genipin were used to treat B. pumilus and Geobacillus stearothermophilus spores to assess broader spectrum sporicidal activity of genipin. Scanning electron microscopy (SEM) was performed to evaluate gross morphological changes after genipin treatment. Optimal sterilization conditions were determined by evaluating the effects of temperature (RT-50 °C), DMSO:PBS ratio (0:100-100:0), and treatment duration (24-72 h) on B. subtilis. Genipin penetration of full thickness bovine patellar tendon and cortical bone specimens was observed to assess the feasibility of the agent for treating grafts. Initial studies showed that after 72 h of treatment at RT with 0.63-10% genipin/DMSO:PBS B. subtilis spore strips were sterilized; 0.63% genipin/PBS did not sterilize spore strips at 72 h at RT. Genipin doses and concentrations that sterilized B. subtilis spore strips sterilized B. pumilus and G. stearothermophilus spore strips. SEM revealed no gross morphological differences between untreated and treated spores. Treatment optimization resulted in sterilization within 24 h with 100% PBS, and DMSO facilitated sporicidal

  2. Cost-effectiveness analysis of preoperative transfusion in patients with sickle cell disease using evidence from the TAPS trial.

    PubMed

    Spackman, Eldon; Sculpher, Mark; Howard, Jo; Malfroy, Moira; Llewelyn, Charlotte; Choo, Louise; Hodge, Renate; Johnson, Tony; Rees, David C; Fijnvandraat, Karin; Kirby-Allen, Melanie; Davies, Sally; Williamson, Lorna

    2014-03-01

    The study's objective was to assess the cost-effectiveness of preoperative transfusion compared with no preoperative transfusion in patients with sickle cell disease undergoing low- or medium-risk surgery. Seventy patients with sickle cell disease (HbSS/Sß(0) thal genotypes) undergoing elective surgery participated in a multicentre randomised trial, Transfusion Alternatives Preoperatively in Sickle Cell Disease (TAPS). Here, a cost-effectiveness analysis based on evidence from that trial is presented. A decision-analytic model is used to incorporate long-term consequences of transfusions and acute chest syndrome. Costs and health benefits, expressed as quality-adjusted life years (QALYs), are reported from the 'within-trial' analysis and for the decision-analytic model. The probability of cost-effectiveness for each form of management is calculated taking into account the small sample size and other sources of uncertainty. In the range of scenarios considered in the analysis, preoperative transfusion was more effective, with the mean improvement in QALYs ranging from 0.018 to 0.206 per patient, and also less costly in all but one scenario, with the mean cost difference ranging from -£813 to £26. All scenarios suggested preoperative transfusion had a probability of cost-effectiveness >0.79 at a cost-effectiveness threshold of £20 000 per QALY.

  3. Potential contribution of fish restocking to the recovery of deteriorated coral reefs: an alternative restoration method?

    PubMed

    Obolski, Uri; Hadany, Lilach; Abelson, Avigdor

    2016-01-01

    Counteracting the worldwide trend of coral reef degeneration is a major challenge for the scientific community. A crucial management approach to minimizing stress effects on healthy reefs and helping the recovery of disturbed reefs is reef protection. However, the current rapid decline of the world's reefs suggests that protection might be insufficient as a viable stand-alone management approach for some reefs. We thus suggest that the ecological restoration of coral reefs (CRR) should be considered as a valid component of coral reef management, in addition to protection, if the applied method is economically applicable and scalable. This theoretical study examines the potential applicability and outcomes of restocking grazers as a restoration tool for coral reef recovery-a tool that has not been applied so far in reef restoration projects. We studied the effect of restocking grazing fish as a restoration method using a mathematical model of degrading reefs, and analyzed the financial outcomes of the restocking intervention. The results suggest that applying this restoration method, in addition to protection, can facilitate reef recovery. Moreover, our analysis suggests that the restocking approach almost always becomes profitable within several years. Considering the relatively low cost of this restoration approach and the feasibility of mass production of herbivorous fish, we suggest that this approach should be considered and examined as an additional viable restoration tool for coral reefs.

  4. Steroidal Alkaloids as an Emerging Therapeutic Alternative for Investigation of Their Immunosuppressive and Hepatoprotective Potential

    PubMed Central

    Jan, Naeem U.; Ahmad, Bashir; Ali, Safdar; Adhikari, Achyut; Ali, Amjad; Jahan, Azra; Ali, Abid; Ali, Hamid

    2017-01-01

    The compounds, sarcovagine-D, alkaloid-C, and holaphylline isolated from Sarcococca saligna were found to possess immunosuppressive activities. These compounds were characterized for in vitro inhibition on human T-cells proliferation and IL-2 production. The compounds showed significant immunosuppressive effect on IL-2 production as well as on phytohemagglutinin stimulated T-cell proliferation in a dose dependent manner. Of all the tested compounds holaphylline was found to be less toxic and safe. These compounds were then evaluated for their in vivo hepatoprotective potential against CCl4, in which alkaloid-C and holaphylline showed markedly reduced liver inflammation and biochemical parameter (ALT, AST, and ALP) of liver injury. The decrease in the activity of hepatic antioxidant enzyme (SOD) was significantly prevented by holaphylline, likewise gradually the levels of MDA and GSH were also normalized compared to silymarin. The CCl4 induced inflammation and necrosis around the central vein of liver was reduced by sarcovagine-D, alkaloid-C and holaphylline, to 8%, 4% to 1% respectively as assessed by histopathology, thus having better hepatoprotective effect compared to positive control. Steroidal alkaloids attenuated the inflammation of liver around the injured central vein region by down regulating the CCl4 induced activation of hepatic macrophages as well as their number respectively. Therefore, the in vitro and in vivo results suggest that steroidal alkaloids from S. saligna could be excellent immunosuppressive and hepatoprotective agents. PMID:28377714

  5. Analysis of Potential Alternatives to Reduce NASA's Cost of Human Access to Space

    NASA Technical Reports Server (NTRS)

    1998-01-01

    The purpose of this report is to analyze NASA's potential options for significantly reducing the cost of human access to space. The opinions expressed in this report are based on Hawthorne, Krauss & Associates' ("HKA") interaction with NASA and several of its key contractors over the past nine months. This report is not intended to be an exhaustive quantitative analysis of the various options available to NASA. Instead, its purpose is to outline key decision-related issues that the agency should consider prior to making a decision as to which option to pursue. This report attempts to bring a private-sector perspective to bear on the issue of reducing the cost of human access to space. HKA believes that the key to the NASA's success in reducing those costs over the long-term is the involvement of the private-sector incentives and disciplines--which is achieved only through the assumption of risk by the private sector, not through a traditional contractor relationship--is essential to achieve significant long-term cost reductions.

  6. Potential contribution of fish restocking to the recovery of deteriorated coral reefs: an alternative restoration method?

    PubMed Central

    Obolski, Uri; Hadany, Lilach

    2016-01-01

    Counteracting the worldwide trend of coral reef degeneration is a major challenge for the scientific community. A crucial management approach to minimizing stress effects on healthy reefs and helping the recovery of disturbed reefs is reef protection. However, the current rapid decline of the world’s reefs suggests that protection might be insufficient as a viable stand-alone management approach for some reefs. We thus suggest that the ecological restoration of coral reefs (CRR) should be considered as a valid component of coral reef management, in addition to protection, if the applied method is economically applicable and scalable. This theoretical study examines the potential applicability and outcomes of restocking grazers as a restoration tool for coral reef recovery—a tool that has not been applied so far in reef restoration projects. We studied the effect of restocking grazing fish as a restoration method using a mathematical model of degrading reefs, and analyzed the financial outcomes of the restocking intervention. The results suggest that applying this restoration method, in addition to protection, can facilitate reef recovery. Moreover, our analysis suggests that the restocking approach almost always becomes profitable within several years. Considering the relatively low cost of this restoration approach and the feasibility of mass production of herbivorous fish, we suggest that this approach should be considered and examined as an additional viable restoration tool for coral reefs. PMID:26966666

  7. A data-based assessment of alternative strategies for identification of potential human cancer hazards.

    PubMed

    Boobis, Alan R; Cohen, Samuel M; Doerrer, Nancy G; Galloway, Sheila M; Haley, Patrick J; Hard, Gordon C; Hess, Frederick G; Macdonald, James S; Thibault, Stéphane; Wolf, Douglas C; Wright, Jayne

    2009-10-01

    The two-year cancer bioassay in rodents remains the primary testing strategy for in-life screening of compounds that might pose a potential cancer hazard. Yet experimental evidence shows that cancer is often secondary to a biological precursor effect, the mode of action is sometimes not relevant to humans, and key events leading to cancer in rodents from nongenotoxic agents usually occur well before tumorigenesis and at the same or lower doses than those producing tumors. The International Life Sciences Institute (ILSI) Health and Environmental Sciences Institute (HESI) hypothesized that the signals of importance for human cancer hazard identification can be detected in shorter-term studies. Using the National Toxicology Program (NTP) database, a retrospective analysis was conducted on sixteen chemicals with liver, lung, or kidney tumors in two-year rodent cancer bioassays, and for which short-term data were also available. For nongenotoxic compounds, results showed that cellular changes indicative of a tumorigenic endpoint can be identified for many, but not all, of the chemicals producing tumors in two-year studies after thirteen weeks utilizing conventional endpoints. Additional endpoints are needed to identify some signals not detected with routine evaluation. This effort defined critical questions that should be explored to improve the predictivity of human carcinogenic risk.

  8. The Cost-Effectiveness Analysis of Teleglaucoma Screening Device

    PubMed Central

    Thomas, Sera

    2015-01-01

    Glaucoma is the leading cause of irreversible vision loss and costs the American economy $2.9 billion. Teleglaucoma remotely detects glaucoma improving access to ophthalmic care in rural areas. It helps manage glaucoma more efficiently to preserve vision and reduce healthcare costs. A cost-effectiveness analysis was conducted using healthcare provider or third-party payer perspective within rural Canada. The study population were patients at-risk of glaucoma which includes those with diabetes and/or hypertension, family history of glaucoma, adults older than 50 years, and concurrent ocular conditions in rural Alberta. Markov modelling was used to model glaucoma health states. Effectiveness was measured in Quality-Adjusted Life Years (QALYs) and costs were used in Canadian dollars. Using TreeAge Pro 2009, incremental cost-effectiveness ratios (ICER) were developed in dollars per QALYs. Deterministic and probabilistic sensitivity analyses were performed to assess the factors affecting cost-effectiveness. Teleglaucoma had a 20% increase in ophthalmologist-referral rate; it reduced patient travel times by 61 hours and physician wait times by 30% in comparison to in-person examination (standard of care). Teleglaucoma costs $872 per patient screened which was 80% less than in-person examination. Teleglaucoma had a greater incremental effectiveness providing an additional 0.12 QALY per patient examination. It was more sensitive (86.5%) and less specific (78.6%) than in-person examination. Teleglaucoma was more cost-effective than in-person examination with an ICER of-$27,460/QALY. This indicated that teleglaucoma will save $27, 460 for each additional QALY gained. Long term benefits showed teleglaucoma prevents 24% cases of glaucoma blindness after 30 years. Teleglaucoma demonstrated improved health outcomes, as well as, cost benefits. It increases access to ophthalmic care and improves healthcare service efficiency, specifically in rural areas. Teleglaucoma is more cost-effective

  9. Alcohol drinking and mammary cancer: Pathogenesis and potential dietary preventive alternatives.

    PubMed

    Castro, Gerardo Daniel; Castro, José A

    2014-10-10

    Alcohol consumption is associated with an increased risk of breast cancer, increasing linearly even with a moderate consumption and irrespectively of the type of alcoholic beverage. It shows no dependency from other risk factors like menopausal status, oral contraceptives, hormone replacement therapy, or genetic history of breast cancer. The precise mechanism for the effect of drinking alcohol in mammary cancer promotion is still far from being established. Studies by our laboratory suggest that acetaldehyde produced in situ and accumulated in mammary tissue because of poor detoxicating mechanisms might play a role in mutational and promotional events. Additional studies indicated the production of reactive oxygen species accompanied of decreases in vitamin E and GSH contents and of glutathione transferase activity. The resulting oxidative stress might also play a relevant role in several stages of the carcinogenic process. There are reported in literature studies showing that plasmatic levels of estrogens significantly increased after alcohol drinking and that the breast cancer risk is higher in receptor ER-positive individuals. Estrogens are known that they may produce breast cancer by actions on ER and also as chemical carcinogens, as a consequence of their oxidation leading to reactive metabolites. In this review we introduce our working hypothesis integrating the acetaldehyde and the oxidative stress effects with those involving increased estrogen levels. We also analyze potential preventive actions that might be accessible. There remains the fact that alcohol drinking is just one of the avoidable causes of breast cancer and that, at present, the suggested acceptable dose for prevention of this risk is of one drink per day.

  10. Alcohol drinking and mammary cancer: Pathogenesis and potential dietary preventive alternatives

    PubMed Central

    Castro, Gerardo Daniel; Castro, José A

    2014-01-01

    Alcohol consumption is associated with an increased risk of breast cancer, increasing linearly even with a moderate consumption and irrespectively of the type of alcoholic beverage. It shows no dependency from other risk factors like menopausal status, oral contraceptives, hormone replacement therapy, or genetic history of breast cancer. The precise mechanism for the effect of drinking alcohol in mammary cancer promotion is still far from being established. Studies by our laboratory suggest that acetaldehyde produced in situ and accumulated in mammary tissue because of poor detoxicating mechanisms might play a role in mutational and promotional events. Additional studies indicated the production of reactive oxygen species accompanied of decreases in vitamin E and GSH contents and of glutathione transferase activity. The resulting oxidative stress might also play a relevant role in several stages of the carcinogenic process. There are reported in literature studies showing that plasmatic levels of estrogens significantly increased after alcohol drinking and that the breast cancer risk is higher in receptor ER-positive individuals. Estrogens are known that they may produce breast cancer by actions on ER and also as chemical carcinogens, as a consequence of their oxidation leading to reactive metabolites. In this review we introduce our working hypothesis integrating the acetaldehyde and the oxidative stress effects with those involving increased estrogen levels. We also analyze potential preventive actions that might be accessible. There remains the fact that alcohol drinking is just one of the avoidable causes of breast cancer and that, at present, the suggested acceptable dose for prevention of this risk is of one drink per day. PMID:25300769

  11. Practice nurse involvement in primary care depression management: an observational cost-effectiveness analysis

    PubMed Central

    2014-01-01

    Background Most evidence on the effect of collaborative care for depression is derived in the selective environment of randomised controlled trials. In collaborative care, practice nurses may act as case managers. The Primary Care Services Improvement Project (PCSIP) aimed to assess the cost-effectiveness of alternative models of practice nurse involvement in a real world Australian setting. Previous analyses have demonstrated the value of high level practice nurse involvement in the management of diabetes and obesity. This paper reports on their value in the management of depression. Methods General practices were assigned to a low or high model of care based on observed levels of practice nurse involvement in clinical-based activities for the management of depression (i.e. percentage of depression patients seen, percentage of consultation time spent on clinical-based activities). Linked, routinely collected data was used to determine patient level depression outcomes (proportion of depression-free days) and health service usage costs. Standardised depression assessment tools were not routinely used, therefore a classification framework to determine the patient’s depressive state was developed using proxy measures (e.g. symptoms, medications, referrals, hospitalisations and suicide attempts). Regression analyses of costs and depression outcomes were conducted, using propensity weighting to control for potential confounders. Results Capacity to determine depressive state using the classification framework was dependent upon the level of detail provided in medical records. While antidepressant medication prescriptions were a strong indicator of depressive state, they could not be relied upon as the sole measure. Propensity score weighted analyses of total depression-related costs and depression outcomes, found that the high level model of care cost more (95% CI: -$314.76 to $584) and resulted in 5% less depression-free days (95% CI: -0.15 to 0.05), compared to the

  12. Potential control of human immunodeficiency virus type 1 asp expression by alternative splicing in the upstream untranslated region.

    PubMed

    Barbagallo, Michael S; Birch, Katherine E; Deacon, Nicholas J; Mosse, Jennifer A

    2012-07-01

    The negative-sense asp open reading frame (ORF) positioned opposite to the human immunodeficiency virus type 1 (HIV-1) env gene encodes the 189 amino acid, membrane-associated ASP protein. Negative-sense transcription, regulated by long terminal repeat sequences, has been observed early in HIV-1 infection in vitro. All subtypes of HIV-1 were scanned to detect the negative-sense asp ORF and to identify potential regulatory sequences. A series of highly conserved upstream short open reading frames (sORFs) was identified. This potential control region from HIV-1(NL4-3), containing six sORFs, was cloned upstream of the reporter gene EGFP. Expression by transfection of HEK293 cells indicated that the introduction of this sORF region inhibits EGFP reporter expression; analysis of transcripts revealed no significant changes in levels of EGFP mRNA. Reverse transcriptase-polymerase chain reaction analysis (RT-PCR) further demonstrated that the upstream sORF region undergoes alternative splicing in vitro. The most abundant product is spliced to remove sORFs I to V, leaving only the in-frame sORF VI upstream of asp. Sequence analysis revealed the presence of typical splice donor- and acceptor-site motifs. Mutation of the highly conserved splice donor and acceptor sites modulates, but does not fully relieve, inhibition of EGFP production. The strong conservation of asp and its sORFs across all HIV-1 subtypes suggests that the asp gene product may have a role in the pathogenesis of HIV-1. Alternative splicing of the upstream sORF region provides a potential mechanism for controlling expression of the asp gene.

  13. A Cost-Effective Virtual Environment for Simulating and Training Powered Wheelchairs Manoeuvres.

    PubMed

    Headleand, Christopher J; Day, Thomas; Pop, Serban R; Ritsos, Panagiotis D; John, Nigel W

    2016-01-01

    Control of a powered wheelchair is often not intuitive, making training of new users a challenging and sometimes hazardous task. Collisions, due to a lack of experience can result in injury for the user and other individuals. By conducting training activities in virtual reality (VR), we can potentially improve driving skills whilst avoiding the risks inherent to the real world. However, until recently VR technology has been expensive and limited the commercial feasibility of a general training solution. We describe Wheelchair-Rift, a cost effective prototype simulator that makes use of the Oculus Rift head mounted display and the Leap Motion hand tracking device. It has been assessed for face validity by a panel of experts from a local Posture and Mobility Service. Initial results augur well for our cost-effective training solution.

  14. Cost effective Internet access and video conferencing for a community cancer network.

    PubMed Central

    London, J. W.; Morton, D. E.; Marinucci, D.; Catalano, R.; Comis, R. L.

    1995-01-01

    Utilizing the ubiquitous personal computer as a platform, and Integrated Services Digital Network (ISDN) communications, cost effective medical information access and consultation can be provided for physicians at geographically remote sites. Two modes of access are provided: information retrieval via the Internet, and medical consultation video conferencing. Internet access provides general medical information such as current treatment options, literature citations, and active clinical trials. During video consultations, radiographic and pathology images, and medical text reports (e.g., history and physical, pathology, radiology, clinical laboratory reports), may be viewed and simultaneously annotated by either video conference participant. Both information access modes have been employed by physicians at community hospitals which are members of the Jefferson Cancer Network, and oncologists at Thomas Jefferson University Hospital. This project has demonstrated the potential cost effectiveness and benefits of this technology. Images Figure 1 Figure 2 Figure 3 PMID:8563397

  15. Cost-Effectiveness of Chagas Disease Vector Control Strategies in Northwestern Argentina

    PubMed Central

    Vazquez-Prokopec, Gonzalo M.; Spillmann, Cynthia; Zaidenberg, Mario; Kitron, Uriel; Gürtler, Ricardo E.

    2009-01-01

    Background Control and prevention of Chagas disease rely mostly on residual spraying of insecticides. In Argentina, vector control shifted from a vertical to a fully horizontal strategy based on community participation between 1992 and 2004. The effects of such strategy on Triatoma infestans, the main domestic vector, and on disease transmission have not been assessed. Methods and Findings Based on retrospective (1993–2004) records from the Argentinean Ministry of Health for the Moreno Department, Northwestern Argentina, we performed a cost-effectiveness (CE) analysis and compared the observed CE of the fully horizontal vector control strategy with the expected CE for a vertical or a mixed (i.e., vertical attack phase followed by horizontal surveillance) strategy. Total direct costs (in 2004 US$) of the horizontal and mixed strategies were, respectively, 3.3 and 1.7 times lower than the costs of the vertical strategy, due to reductions in personnel costs. The estimated CE ratios for the vertical, mixed and horizontal strategies were US$132, US$82 and US$45 per averted human case, respectively. When per diems were excluded from the costs (i.e., simulating the decentralization of control activities), the CE of vertical, mixed and horizontal strategies was reduced to US$60, US$42 and US$32 per averted case, respectively. Conclusions and Significance The mixed strategy would have averted between 1.6 and 4.0 times more human cases than the fully horizontal strategy, and would have been the most cost-effective option to interrupt parasite transmission in the Department. In rural and dispersed areas where waning vertical vector programs cannot accomplish full insecticide coverage, alternative strategies need to be developed. If properly implemented, community participation represents not only the most appealing but also the most cost-effective alternative to accomplish such objectives. PMID:19156190

  16. PERSONAL COMPUTER MONITORS: A SCREENING EVALUATION OF VOLATILE ORGANIC EMISSIONS FROM EXISTING PRINTED CIRCUIT BOARD LAMINATES AND POTENTIAL POLLUTION PREVENTION ALTERNATIVES

    EPA Science Inventory

    The report gives results of a screening evaluation of volatile organic emissions from printed circuit board laminates and potential pollution prevention alternatives. In the evaluation, printed circuit board laminates, without circuitry, commonly found in personal computer (PC) m...

  17. Examining the cost-effectiveness of cancer screening promotion.

    PubMed

    Andersen, M Robyn; Urban, Nicole; Ramsey, Scott; Briss, Peter A

    2004-09-01

    Cost-effectiveness analyses (CEAs) can help to quantify the contribution of the promotion of a screening program to increased participation in screening. The cost-effectiveness (C/E) of screening promotion depends in large part on the endpoints of interest. At the most fundamental level, the C/E of a strategy for promoting screening would focus on the attendance rate, or cost per person screened, and the C/E would be influenced by the costs of promotion, as well as by the size and responsiveness of the target population. In addition, the costs of screening promotion (measured as the cost per additional participant in screening) can be included in a CEA estimate of the screening technology. In this case, depending on the efficacy of the screening test and the costs and influence of the promotion, the C/E of screening may improve or become poorer. In the current study, the authors reviewed the literature on the C/E of cancer screening promotion. The following lessons were learned regarding the C/E of screening and its promotion: 1) high-quality information on the C/E of screening is increasingly available; 2) cost-effective promotion of screening is dependent on cost-effective screening strategies; 3) quality-of-life effects may be important in assessing the overall C/E of screening programs; 4) research efforts aimed at identifying cost-effective approaches to screening promotion are useful but sparse; 5) C/E studies should be better incorporated into well designed effectiveness research efforts; 6) variations in C/E according to intervention characteristics, population characteristics, and context should be evaluated in greater depth; 7) the long-term effects of screening promotion are critical to assessing C/E; 8) the effects of promotion on costs of screening must be better understood; and 9) CEA must be interpreted in light of other information. The authors showed that CEA can be a valuable tool for understanding the merits of health promotion interventions and

  18. Cost-effectiveness of Project ADAM: a project to prevent sudden cardiac death in high school students.

    PubMed

    Berger, S; Whitstone, B N; Frisbee, S J; Miner, J T; Dhala, A; Pirrallo, R G; Utech, L M; Sachdeva, R C

    2004-01-01

    Public access defibrillation (PAD) in the adult population is thought to be both efficacious and cost-effective. Similar programs aimed at children and adolescents have not been evaluated for their cost-effectiveness. This study evaluates the potential cost-effectiveness of implementing Project ADAM, a program targeting children and adolescents in high schools in the Milwaukee Public School System. Project ADAM provides education about cardiopulmonary resuscitation (CPR) and the warning signs of sudden cardiac death (SCD) and training in the use and placement of automated external defibrillators (AEDs) in high schools. We developed decision analysis models to evaluate the cost-effectiveness of the decision to implement Project ADAM in public high schools in Milwaukee. We examined clinical model and public policy applications. Data on costs included estimates of hospital-based charges derived from a pediatric medical center where a series of patients were treated for SCD, educational programming, and the direct costs of one AED and training for 15 personnel per school. We performed sensitivity analyses to assess the variation in outputs with respect to changes to input data. The main outcome measures were Life years saved and incremental cost-effectiveness ratios. At an arbitrary societal willingness to pay $100,000 per life year saved, the policy to implement Project ADAM in schools is a cost-effective strategy at a threshold of approximately 5 patients over 5 years for the clinical model and approximately 8 patients over 5 years for the public policy model. Implementation of Project ADAM in high schools in the United States is potentially associated with an incremental cost-effectiveness ratio that is favorable.

  19. Targeted hepatitis B vaccination--a cost effective immunisation strategy for the UK?

    PubMed Central

    Williams, J R; Nokes, D J; Anderson, R M

    1996-01-01

    OBJECTIVE: To compare the potential cost effectiveness of vaccination against hepatitis B virus (HBV) targeted at genitourinary clinic (GU) attendees with that of universal infant vaccination. DESIGN: A mathematical model of sexual and perinatal transmission of HBV was used to compare the effectiveness among heterosexual and homosexual populations of programmes of mass infant vaccination and targeted immunisation of genitourinary medicine (GU) clinic attendees. Each was applied to 90% of the eligible population with differing assumptions about rates of compliance and seroconversion - problems of delivery (obtaining high compliance) was considered a significant drawback of targeted vaccination. Observed relationships between GU clinic attendance and sex partner change rates for heterosexuals and for homosexuals were used to define the rates of vaccination uptake within sexual activity risk groups. SETTING: England and Wales. RESULTS: Model results showed that for heterosexuals universal infant vaccination became more effective than clinic based vaccination only approximately 40 years after the start of the programme and that the predicted cost effectiveness of GU clinic vaccination was greater at all times. For homosexuals, clinic vaccination was always more effective over the time frame considered, but by 50 years if it were carried out without prior screening it had become appreciably less cost effective than a mass infant programme. With prior screening in GU clinics this cost effectiveness deficit was only marginal. CONCLUSIONS: Targeted vaccination might have a much greater potential than is realised at present, particularly if it were possible to improve compliance of clinic attendees. A fuller comparison between mass infant and targeted vaccination must await the specific inclusion in the model of other risk groups such as intravenous drug users. An important determinant of the relative merits of the two approaches is the relationship between rates of

  20. Synthesis of amphiphilic alternating polyesters with oligo(ethylene glycol) side chains and potential use for sustained release drug delivery.

    PubMed

    Wang, Wei; Ding, Jianxun; Xiao, Chunsheng; Tang, Zhaohui; Li, Di; Chen, Jie; Zhuang, Xiuli; Chen, Xuesi

    2011-07-11

    Novel amphiphilic alternating polyesters, poly((N-phthaloyl-l-glutamic anhydride)-co-(2-(2-(2-methoxyethoxy)ethoxy)methyl)oxirane) (P(PGA-co-ME(2)MO)), were synthesized by alternating copolymerization of PGA and ME(2)MO. The structures of the synthesized polyesters were characterized by (1)H NMR, (13)C NMR, FT-IR, and GPC analyses. Because of the presence of oligo(ethylene glycol) (OEG) side chains, the polyesters could self-assemble into thermosensitive micelles. Dynamic light scattering (DLS) showed that these micelles underwent thermoinduced size decrease without intermicellar aggregation. In vitro methyl thiazolyl tetrazolium (MTT) assay demonstrated that the polyesters were biocompatible to Henrietta Lacks (HeLa) cells, rendering their potential for drug delivery applications. Two hydrophobic drugs, rifampin and doxorubicin (DOX), were loaded into the polyester micelles and observed to be released in a zero-order sustained manner. The sustained release could be accelerated in lower pH or in the presence of proteinase K, due to the degradation of the polyester under these conditions. Remarkably, in vitro cell experiments showed that the polyester micelles accomplished fast release of DOX inside cells and higher anticancer efficacy as compared with the free DOX. With enhanced stability during circulation condition and accelerated drug release at the target sites (e.g., low pH or enzyme presence), these novel polyesters with amphiphilic structures are promising to be used in sustained release drug delivery systems.

  1. No Clinic Left Behind: Providing Cost-Effective In-Services Via Distance Learning.

    PubMed

    Knapp, Herschel; Fletcher, Michael; Taylor, Anne; Chan, Kee; Goetz, Matthew Bidwell

    2010-11-23

    Based on the successful pilot implementation of a Veterans Affairs Quality Enhancement Research Initiative (QUERI) aimed at increasing HIV testing throughout four local facilities and their associated satellite clinics, we expanded our efforts to deploy our methods to substantially more sites spanning six states. Our goal was to implement and examine the cost effectiveness of a distance-learning model to offer provider education to geographically remote (sub)facilities. We developed and implemented an equivalent interactive online version of our in-person presentation. Handouts were shipped to each site before the day of the in-service. Remote participants were receptive to this cost-effective form of provider activation. The technology functioned dependably; no presentation anomalies were encountered. Participants rated in-person presentations higher than online, however, mean scores for both methods were >80%. Online presentations were found to be considerably more affordable than in-person. These findings suggest that this alternate approach may offer a feasible alternative for a variety of subjects.

  2. No clinic left behind: providing cost-effective in-services via distance learning.

    PubMed

    Knapp, Herschel; Fletcher, Michael; Taylor, Anne; Chan, Kee; Goetz, Matthew Bidwell

    2011-09-01

    Based on the successful pilot implementation of a Veterans Affairs Quality Enhancement Research Initiative (QUERI) aimed at increasing HIV testing throughout four local facilities and their associated satellite clinics, we expanded our efforts to deploy our methods to substantially more sites spanning six states. Our goal was to implement and examine the cost effectiveness of a distance-learning model to offer provider education to geographically remote (sub)facilities. We developed and implemented an equivalent interactive online version of our in-person presentation. Handouts were shipped to each site before the day of the in-service. Remote participants were receptive to this cost-effective form of provider activation. The technology functioned dependably; no presentation anomalies were encountered. Participants rated in-person presentations higher than online, however, mean scores for both methods were >80%. Online presentations were found to be considerably more affordable than in-person. These findings suggest that this alternate approach may offer a feasible alternative for a variety of subjects.

  3. Assessment of the cost-effectiveness of photovoltaic systems for telecommunications in Nigeria

    NASA Astrophysics Data System (ADS)

    Oparaku, O. U.

    2002-03-01

    Developing countries seeking relevance in the international community have to adopt programmes in order to achieve cost-effective economic growth. Telecommunications is one area where emphasis must be laid because of its impact on development. Since the power supply forms an essential part of any communication system it is important to chose the power supply option that has the lowest life-cycle cost. The life-cycle costs of several power supply alternatives to some telecommunication systems in Nigeria have been evaluated. A hybrid (Solar/Gen. Set) power supply option is shown to be cost-effective when compared with diesel generating systems powering telecommunication equipment and airconditioning loads. The cost of PV power supply option used for a celluphone system is about 10% of the cost of the alternative of daily battery replacement and haulage. The low teledensity in the country creates a need for bold initiatives to incorporate solar power in telecommunications network, particularly in the remote rural communities where conventional electricity is not only unavailable, but is unreliable and very costly to maintain.

  4. Cost-benefit and cost-effectiveness analysis of drug therapy.

    PubMed

    Dao, T D

    1985-04-01

    A model for cost-benefit analysis and cost-effectiveness analysis (CBA-CEA) of pharmaceutical intervention is presented, and CBA-CEA research methods reported in the literature are reviewed. The cost versus benefit and the cost effectiveness of drug therapy can be analyzed in societal as well as private terms. Since CBA measures costs and outcomes in monetary terms, it can be used to compare net benefits of all types of interventions. CEA, however, can be used only in comparing alternative interventions that can produce a similar health outcome. Research activities needed for identification of treatment protocols, alternative therapies and their respective outcomes, and resource use are described. Quantification of benefits and costs is discussed and inherent strengths and weaknesses of CBA-CEA are summarized. For the wide variety of research activities involved in CBA-CEA, the expertise of economists, physicians, clinical pharmacists and pharmacologists, epidemiologists, sociologists, and psychologists is needed. Inherent in CBA-CEA for drug therapy are judgments, either by analysts or by policy decision makers, about how to value life, pain, anxiety, and happiness and how to distribute health-care resources. When results of CBA-CEA are presented and interpreted with care, this analysis can be an important tool for policy decision makers.

  5. Cost-effectiveness of algorithms for confirmation test of human African trypanosomiasis.

    PubMed

    Lutumba, Pascal; Meheus, Filip; Robays, Jo; Miaka, Constantin; Kande, Victor; Büscher, Philippe; Dujardin, Bruno; Boelaert, Marleen

    2007-10-01

    The control of Trypanosoma brucei gambiense human African trypanosomiasis (HAT) is compromised by low sensitivity of the routinely used parasitologic confirmation tests. More sensitive alternatives, such as mini-anion exchange centrifugation technique (mAECT) or capillary tube centrifugation (CTC), are more expensive. We used formal decision analysis to assess the cost-effectiveness of alternative HAT confirmation algorithms in terms of cost per life saved. The effectiveness of the standard method, a combination of lymph node puncture (LNP), fresh blood examination (FBE), and thick blood film (TBF), was 36.8%; the LNP-FBE-CTC-mAECT sequence reached almost 80%. The cost per person examined ranged from euro1.56 for LNP-FBE-TBF to euro2.99 for LNP-TBF-CTC-mAECT-CATT (card agglutination test for trypanosomiasis) titration. LNP-TBF-CTC-mAECT was the most cost-effective in terms of cost per life saved. HAT confirmation algorithms that incorporate concentration techniques are more effective and efficient than the algorithms that are currently and routinely used by several T.b. gambiense control programs.

  6. Cost-effectiveness analysis of TxDOT CNG fleet conversion, volume 2

    NASA Astrophysics Data System (ADS)

    Euritt, M. A.; Taylor, D. B.; Mahmassani, H.

    1992-08-01

    Increased emphasis on energy efficiency and air quality has resulted in a number of state and federal initiatives examining the use of alternative fuels for motor vehicles. Texas' program for alternate fuels includes compressed natural gas (CNG). Based on an analysis of 30-year life-cycle costs, development of a natural gas vehicle (NGV) program for the Texas Department of Transportation (TxDOT) would cost about $47 million (in 1991 dollars). These costs include savings from lower priced natural gas, infrastructure costs for a fast-fueling station, vehicle costs, and operating costs. The 30-year life-cycle costs translate into an average annual vehicle cost increase of $596, or about 4.9 cents more per vehicle mile of travel. Based on the cost-effectiveness analysis and assumptions, there are currently no TxDOT stations suitable for conversion to compressed natural gas.

  7. Energy potential and alternative usages of biogas and sludge from UASB reactors: case study of the Laboreaux wastewater treatment plant.

    PubMed

    Rosa, A P; Conesa, J A; Fullana, A; Melo, G C B; Borges, J M; Chernicharo, C A L

    2016-01-01

    This work assessed the energy potential and alternative usages of biogas and sludge generated in upflow anaerobic sludge blanket reactors at the Laboreaux sewage treatment plant (STP), Brazil. Two scenarios were considered: (i) priority use of biogas for the thermal drying of dehydrated sludge and the use of the excess biogas for electricity generation in an ICE (internal combustion engine); and (ii) priority use of biogas for electricity generation and the use of the heat of the engine exhaust gases for the thermal drying of the sludge. Scenario 1 showed that the electricity generated is able to supply 22.2% of the STP power demand, but the thermal drying process enables a greater reduction or even elimination of the final volume of sludge to be disposed. In Scenario 2, the electricity generated is able to supply 57.6% of the STP power demand; however, the heat in the exhaust gases is not enough to dry the total amount of dehydrated sludge.

  8. Estimating long-term regional groundwater recharge for the evaluation of potential solution alternatives to waterlogging and salinisation

    NASA Astrophysics Data System (ADS)

    Singh, Ajay

    2011-09-01

    SummaryAccurate estimation of the groundwater recharge is essential for efficient and sustainable groundwater management in arid and semi-arid regions, as water resources are critical to economic development in these areas. Various techniques are available to quantify recharge. The hydrological budget model proposed herein is unique, simple, and easy to apply. It uses data on groundwater level, groundwater extraction, and distributed specific yield information for estimating groundwater recharge. The Model is employed to estimate the seasonal long-term (35 years, e.g., from 1974 to 2009) groundwater recharge of an irrigated semi-arid area located in Haryana State of India, where groundwater levels are rising, continuously. The results are analysed to provide an overview of the process dynamics that led to imbalance of the system. Groundwater recharge analysis during the study period reveals that percolation from irrigated fields is the main recharge component with 49% contribution to the total recharge. An annual groundwater table rise of 0.14 m has been estimated for the study area. Various potential solution alternatives are evaluated to mitigate the problems of waterlogging and salinisation, considering the socio-economic issues which have wider policy significance on sustainability. Several suitable water management strategies such as reduction in rice area, increase in pumping volume and using the groundwater conjunctively with higher quality canal water, and lining of canal networks are suggested to bring the watertable down to a safe limit and to prevent further rising of the watertable. Among the potential solution alternatives studied, the one which considers 10% reduction in rice area along with 2% increase in pumping volume and 20% canal lining, yields best result for mitigating the waterlogging problems.

  9. Development of cost-effective biocompatible packaging for microelectronic devices.

    PubMed

    Qian, Karen; Malachowski, Karl; Fiorini, Paolo; Velenis, Dimitrios; de Beeck, Maaike Op; Van Hoof, Chris

    2011-01-01

    A cost-effective, miniaturized and biocompatible packaging method for medical devices is proposed, resulting in a small, soft and comfortable implantable package. Towards this end, the barrier materials and fabrication process for the individual die encapsulation are largely explored. We demonstrate that various common clean room materials are good candidates for preventing metal leaching into body. In accelerated tests at higher temperature, several conductive barrier materials are damaged by the test bio-fluid, suggesting insufficient resistance to body fluids in long term. Covering electrodes by noble metals will solve this problem. For metallization, noble metals as Pt are best candidates. CoO calculations showed that selective plating of Pt is more cost-effective than sputtering. To reduce the cost of a sputter process, Pt recycling is very important.

  10. Power and sample size in cost-effectiveness analysis.

    PubMed

    Laska, E M; Meisner, M; Siegel, C

    1999-01-01

    For resource allocation under a constrained budget, optimal decision rules for mutually exclusive programs require that the treatment with the highest incremental cost-effectiveness ratio (ICER) below a willingness-to-pay (WTP) criterion be funded. This is equivalent to determining the treatment with the smallest net health cost. The designer of a cost-effectiveness study needs to select a sample size so that the power to reject the null hypothesis, the equality of the net health costs of two treatments, is high. A recently published formula derived under normal distribution theory overstates sample-size requirements. Using net health costs, the authors present simple methods for power analysis based on conventional normal and on nonparametric statistical theory.

  11. Cost-Effective TiAl based Materials

    NASA Technical Reports Server (NTRS)

    Moxson, V. S.; Sun, Fusheng; Draper, Susan L.; Froes, F. H.; Duz, V.

    2003-01-01

    Because of their inherent low ductility, TiAl-based materials are difficult to fabricate, especially thin gage titanium gamma aluminide (TiAl) sheet and foil. In this paper, an innovative powder metallurgy approach for producing cost-effective thin gage TiAl sheets (with 356 mm long and 235 mm wide, and a thickness of 0.74, 1.09, 1.55, and 2.34 mm, respectively) is presented. The microstructures and tensile properties at room and elevated temperatures of the thin gage TiAl are studied. Results show that these TiAl sheets have a relatively homogenous chemistry, uniform microstructure, and acceptable mechanical properties. This work demonstrates a cost-effective method for producing both flat products (sheet/foil) and complex chunky parts of TiAl for various advanced applications including aerospace and automotive industries.

  12. The cost-effectiveness of bevacizumab for the treatment of advanced ovarian cancer in Canada

    PubMed Central

    Duong, M.; Wright, E.; Yin, L.; Martin-Nunez, I.; Ghatage, P.; Fung-Kee-Fung, M.

    2016-01-01

    Background The overall survival (os) analysis of the icon7 trial demonstrated that frontline ovarian cancer patients with a high risk of progression (stage iii suboptimally debulked, and stage iii or iv with unresectable disease) benefited from the addition of bevacizumab to standard chemotherapy compared with standard chemotherapy alone. The objective of the present study was to investigate the cost-effectiveness, from a Canadian publicly funded perspective, of adding bevacizumab to frontline treatment of ovarian cancer at high risk of progression. Methods An area-under-the-curve, Markov-structured model was used to estimate the cost-effectiveness of the treatments. Long-term progression-free survival (pfs) and os were extracted from the icon7 trial (subgroup at high risk of relapse) and extrapolated by parametric time-to-event functions over a time horizon of 10 years. Canadian pfs health state utility values were obtained from the EQ-5D (EuroQoL Group, Rotterdam, Netherlands) questionnaires in the icon7 high-risk patient population. Canadian post-progression utility values were consistent with those for other gynecologic cancers. Cost inputs were informed by public sources. An annual 5% efficacy and cost discount rate was applied. A probabilistic sensitivity analysis and one-way sensitivity analyses were conducted. Results Ovarian cancer patients at high risk of progression receiving bevacizumab plus standard chemotherapy experienced a mean incremental quality-adjusted life year (qaly) gain of 0.374 years. At an additional cost of $35,901.54, the incremental cost-effectiveness ratio (icer) for the addition of bevacizumab to standard chemotherapy, relative to standard chemotherapy alone, was $95,942 per qaly. Conclusions No formal health technology assessment willingness-to-pay threshold exists in Canada. However, at a threshold of $100,000 per qaly, bevacizumab in addition to chemotherapy is a cost-effective alternative for ovarian cancer patients who are at

  13. Cost-Effectiveness of Antivenoms for Snakebite Envenoming in 16 Countries in West Africa

    PubMed Central

    Hamza, Muhammad; Idris, Maryam A.; Maiyaki, Musa B.; Lamorde, Mohammed; Chippaux, Jean-Philippe; Warrell, David A.; Kuznik, Andreas; Habib, Abdulrazaq G.

    2016-01-01

    Background Snakebite poisoning is a significant medical problem in agricultural societies in Sub Saharan Africa. Antivenom (AV) is the standard treatment, and we assessed the cost-effectiveness of making it available in 16 countries in West Africa. Methods We determined the cost-effectiveness of AV based on a decision-tree model from a public payer perspective. Specific AVs included in the model were Antivipmyn, FAV Afrique, EchiTab-G and EchiTab-Plus. We derived inputs from the literature which included: type of snakes causing bites (carpet viper (Echis species)/non-carpet viper), AV effectiveness against death, mortality without AV, probability of Early Adverse Reactions (EAR), likelihood of death from EAR, average age at envenomation in years, anticipated remaining life span and likelihood of amputation. Costs incurred by the victims include: costs of confirming and evaluating envenomation, AV acquisition, routine care, AV transportation logistics, hospital admission and related transportation costs, management of AV EAR compared to the alternative of free snakebite care with ineffective or no AV. Incremental Cost Effectiveness Ratios (ICERs) were assessed as the cost per death averted and the cost per Disability-Adjusted-Life-Years (DALY) averted. Probabilistic Sensitivity Analyses (PSA) using Monte Carlo simulations were used to obtain 95% Confidence Intervals of ICERs. Results The cost/death averted for the 16 countries of interest ranged from $1,997 in Guinea Bissau to $6,205 for Liberia and Sierra Leone. The cost/DALY averted ranged from $83 (95% Confidence Interval: $36-$240) for Benin Republic to $281 ($159–457) for Sierra-Leone. In all cases, the base-case cost/DALY averted estimate fell below the commonly accepted threshold of one time per capita GDP, suggesting that AV is highly cost-effective for the treatment of snakebite in all 16 WA countries. The findings were consistent even with variations of inputs in 1—way sensitivity analyses. In addition

  14. Clinical Benefits, Costs, and Cost-Effectiveness of Neonatal Intensive Care in Mexico

    PubMed Central

    Profit, Jochen; Lee, Diana; Zupancic, John A.; Papile, LuAnn; Gutierrez, Cristina; Goldie, Sue J.; Gonzalez-Pier, Eduardo; Salomon, Joshua A.

    2010-01-01

    Background Neonatal intensive care improves survival, but is associated with high costs and disability amongst survivors. Recent health reform in Mexico launched a new subsidized insurance program, necessitating informed choices on the different interventions that might be covered by the program, including neonatal intensive care. The purpose of this study was to estimate the clinical outcomes, costs, and cost-effectiveness of neonatal intensive care in Mexico. Methods and Findings A cost-effectiveness analysis was conducted using a decision analytic model of health and economic outcomes following preterm birth. Model parameters governing health outcomes were estimated from Mexican vital registration and hospital discharge databases, supplemented with meta-analyses and systematic reviews from the published literature. Costs were estimated on the basis of data provided by the Ministry of Health in Mexico and World Health Organization price lists, supplemented with published studies from other countries as needed. The model estimated changes in clinical outcomes, life expectancy, disability-free life expectancy, lifetime costs, disability-adjusted life years (DALYs), and incremental cost-effectiveness ratios (ICERs) for neonatal intensive care compared to no intensive care. Uncertainty around the results was characterized using one-way sensitivity analyses and a multivariate probabilistic sensitivity analysis. In the base-case analysis, neonatal intensive care for infants born at 24–26, 27–29, and 30–33 weeks gestational age prolonged life expectancy by 28, 43, and 34 years and averted 9, 15, and 12 DALYs, at incremental costs per infant of US$11,400, US$9,500, and US$3,000, respectively, compared to an alternative of no intensive care. The ICERs of neonatal intensive care at 24–26, 27–29, and 30–33 weeks were US$1,200, US$650, and US$240, per DALY averted, respectively. The findings were robust to variation in parameter values over wide ranges in

  15. Cost-Effectiveness of Complementary Therapies in the United Kingdom—A Systematic Review†

    PubMed Central

    Canter, Peter H.; Coon, Joanna Thompson; Ernst, Edzard

    2006-01-01

    Objectives: The aim of this review is to systematically summarize and assess all prospective, controlled, cost-effectiveness studies of complementary therapies carried out in the UK. Data sources: Medline (via PubMed), Embase, CINAHL, Amed (Alternative and Allied Medicine Database, British Library Medical Information Centre), The Cochrane Library, National Health Service Economic Evaluation Database (via Cochrane) and Health Technology Assessments up to October 2005. Review methods: Articles describing prospective, controlled, cost-effectiveness studies of any type of complementary therapy for any medical condition carried out in the UK were included. Data extracted included the main outcomes for health benefit and cost. These data were extracted independently by two authors, described narratively and also presented as a table. Results: Six cost-effectiveness studies of complementary medicine in the UK were identified: four different types of spinal manipulation for back pain, one type of acupuncture for chronic headache and one type of acupuncture for chronic back pain. Four of the six studies compared the complementary therapy with usual conventional treatment in pragmatic, randomized clinical trials without sham or placebo arms. Main outcome measures of effectiveness favored the complementary therapies but in the case of spinal manipulation (four studies) and acupuncture (one study) for back pain, effect sizes were small and of uncertain clinical relevance. The same four studies included a cost-utility analyses in which the incremental cost per quality adjusted life year (QALY) was less than £10 000. The complementary therapy represented an additional health care cost in five of the six studies. Conclusions: Prospective, controlled, cost-effectiveness studies of complementary therapies have been carried out in the UK only for spinal manipulation (four studies) and acupuncture (two studies). The limited data available indicate that the use of these therapies

  16. Cost-effectiveness analysis of risk-reduction measures to reach water safety targets.

    PubMed

    Lindhe, Andreas; Rosén, Lars; Norberg, Tommy; Bergstedt, Olof; Pettersson, Thomas J R

    2011-01-01

    Identifying the most suitable risk-reduction measures in drinking water systems requires a thorough analysis of possible alternatives. In addition to the effects on the risk level, also the economic aspects of the risk-reduction alternatives are commonly considered important. Drinking water supplies are complex systems and to avoid sub-optimisation of risk-reduction measures, the entire system from source to tap needs to be considered. There is a lack of methods for quantification of water supply risk reduction in an economic context for entire drinking water systems. The aim of this paper is to present a novel approach for risk assessment in combination with economic analysis to evaluate risk-reduction measures based on a source-to-tap approach. The approach combines a probabilistic and dynamic fault tree method with cost-effectiveness analysis (CEA). The developed approach comprises the following main parts: (1) quantification of risk reduction of alternatives using a probabilistic fault tree model of the entire system; (2) combination of the modelling results with CEA; and (3) evaluation of the alternatives with respect to the risk reduction, the probability of not reaching water safety targets and the cost-effectiveness. The fault tree method and CEA enable comparison of risk-reduction measures in the same quantitative unit and consider costs and uncertainties. The approach provides a structured and thorough analysis of risk-reduction measures that facilitates transparency and long-term planning of drinking water systems in order to avoid sub-optimisation of available resources for risk reduction.

  17. Transplastomic expression of a modified human papillomavirus L1 protein leading to the assembly of capsomeres in tobacco: a step towards cost-effective second-generation vaccines.

    PubMed

    Waheed, M Tahir; Thönes, Nadja; Müller, Martin; Hassan, S Waqas; Razavi, N Mona; Lössl, Elke; Kaul, Hans-Peter; Lössl, Andreas G

    2011-04-01

    Certain types of human papillomaviruses (HPV) are causatively associated with cervical carcinoma, the second most common cancer in women worldwide. Due to limitations in the availability of currently used virus-like particle (VLP)-based vaccines against HPV to women of developing countries, where most cases of cervical cancer occur, the development of a cost-effective second-generation vaccine is a necessity. Capsomeres have recently been demonstrated to be highly immunogenic and to have a number of advantages as a potential cost-effective alternative to VLP-based HPV vaccines. We have expressed a mutated HPV-16 L1 (L1_2xCysM) gene that retained the ability to assemble L1 protein to capsomeres in tobacco chloroplasts. The recombinant protein yielded up to 1.5% of total soluble protein. The assembly of capsomeres was examined and verified by cesium chloride density gradient centrifugation and sucrose sedimentation analysis. An antigen capture enzyme-linked immunosorbent assay confirmed the formation of capsomeres by using a conformation-specific monoclonal antibody which recognized the conformational epitopes. Transplastomic tobacco plants exhibited normal growth and morphology, but all such lines showed male sterility in the T₀, T₁ and T₂ generations. Taken together, these results indicate the possibility of producing a low-cost capsomere-based vaccine by plastids.

  18. An Alternative Approach to Estimating the Geothermal Potential of an Area: Applications to the Northeast and Elsewhere

    NASA Astrophysics Data System (ADS)

    Rhodes, J. M.; Koteas, C.; Mabee, S. B.

    2011-12-01

    Conventionally, heat flow data is the prime parameter for estimating the potential of Enhanced Geothermal Systems (EGS). From this, together with knowledge, or assumptions, regarding the stratigraphy, heat production and thermal conductivity, it is possible to calculate temperature - depth profiles and assess the geothermal potential of an area. According to conventional wisdom, Massachusetts (and most of the northeastern U.S. and eastern Canada) has little or no geothermal resources. This is based on the low values of very sparse heat flow measurements from mainly shallow wells. There may, however, be local pockets with geothermal potential missed by the regional heat flow coverage. For example, granite bodies constitute about 30% of the bedrock of Massachusetts and are abundant throughout New England. We suspect that some granites may provide potential local geothermal resources, especially when covered by thick sediments. This is because granites and meta-granites typically contain more of the heat-producing elements K, U, Th than other crustal rocks. We have therefore adopted an alternative approach for estimating the geothermal potential of an area. We are systematically sampling these granite bodies and measuring the concentrations of their heat-producing elements and their density, in order to determine their heat production. Not all granites are created equal and some are potentially hotter than others. Then, with measurements of thermal conductivity and knowledge, or assumptions, about stratigraphy and heat flow from the lower crust and mantle, we can estimate temperature-depth profiles and the geothermal potential of the area. A useful outcome of this approach is an estimate of heat flow, which could serve as a test of the method if appropriate targets are discovered. To date, we estimate that the temperatures of most granites at depths between 4 and 6 km range from 70 to 110 degrees C (see Koteas et al., this session). These are possible low

  19. Cost-effective method of DNA extraction from taeniid eggs.

    PubMed

    Dyachenko, V; Beck, E; Pantchev, N; Bauer, C

    2008-03-01

    A new cost-effective method using silicon dioxide- and guanidine isothiocyanate-containing buffers, after previous alkaline lysis, was established for the DNA extraction from taeniid eggs isolated from canine faeces. The purified DNA can be used to amplify the species-specific 12S mitochondrial DNA of Echinococcus multilocularis in direct and nested polymerase chain reaction in order to differentiate between E. multilocularis and Taenia spp.

  20. DEVELOPMENT AND MANUFACTURE OF COST EFFECTIVE COMPOSITE DRILL PIPE

    SciTech Connect

    Dr. James C. Leslie; Mr. Jeffrey R. Jean; Hans Neubert; Lee Truong

    2000-10-30

    This annual, technical report will discuss the engineering research and data accomplishments that have transpired in support of the development of Cost Effective Composite Drill Pipe (CDP). The report discusses and illustrates the first iteration design of the tube and the tool joint interface. The report discusses standards and specifications to which the CDP design will be tailored and tested, and discusses conclusions of the first iteration design for future design enhancements.

  1. Development and Manufacture of Cost Effective Composite Drill Pipe

    SciTech Connect

    James C. Leslie; James C. Leslie, II; Lee Truong; James T. Heard

    2006-09-29

    This technical report presents the engineering research, process development and data accomplishments that have transpired to date in support of the development of Cost Effective Composite Drill Pipe (CDP). The report presents progress made from October 1, 2005 through September 30, 2006 and contains the following discussions: Qualification Testing; Prototype Development and Testing of ''Smart Design'' Configuration; Field Test Demonstration; Development of Ultra-Short Radius Composite Drill Pipe (USR-CDP); and Development of Smart USR-CDP.

  2. The cost effectiveness of rotavirus vaccination in Iran

    PubMed Central

    Mousavi Jarrahi, Yasaman; Zahraei, Seyed Mohsen; Sadigh, Nader; Esmaeelpoor Langeroudy, Keyhan; Khodadost, Mahmoud; Ranjbaran, Mehdi; Sanjari Moghaddam, Ali; Besharat, Mehdi; Mosavi Jarrahi, Alireza

    2016-01-01

    ABSTRACT Rotavirus is the most common cause of severe diarrhea leading to hospitalization or disease-specific death among young children. Effective vaccines have recently been approved and successful vaccination program implemented. The aim of this study was to evaluate the cost effectiveness of mass rotavirus vaccination program in Iran. We developed a Markov model that reflects key features of rotavirus natural history. Parameters of the model were assessed by field study or developed through literature search and published data. We applied the model to the 2009 Iranian birth cohort and evaluated the cost-effectiveness of including the rotavirus vaccine (Rotarix®) into Iranian expanded immunization program (EPI). With an estimated hospitalization rate of 0.05 and outpatient rate of 0.23 cases per person-year, vaccinating cohort of 1231735 infants in Iran with 2 doses of (Rotarix®), would prevent 32092 hospitalizations, 158750 outpatient visits, and 1591 deaths during 5 y of follow-up. Under base-case assumption of $10 cost per course of vaccine, the vaccination would incur an extra cost of $1,019,192 from health care perspective and would avert 54680 DALYs. From societal perspective, there would be $15,192,568 saving for the society with the same averted DALYs. The incremental cost effectiveness ratio showed a cost of $19 US dollars per averted DALY from health care perspective and a saving of $278 US dollars for each averted DALY from societal perspective. Introducing rotavirus vaccine into EPI program would be highly cost-effective public health intervention in Iran. PMID:26360331

  3. Ensuring cost-effective investments for the future.

    PubMed

    Borger, T

    1997-01-01

    According to an analyst report from Smith Barney, the market for managed care information systems is about $2 billion, growing to more than $5 billion by 2000. Nonetheless, these systems must prove a cost-effective for managed care organizations. Systems should add value and, over time, offer a return on investment. These goals are accomplished through solutions that recognize and anticipate expanding information requirements in the evolving healthcare market.

  4. Developing a customer-service and cost-effectiveness team.

    PubMed

    Haynie, L; Garrett, B

    1999-01-01

    A healthcare organization in northeast Georgia developed a team approach to meet the challenge of unacceptable customer service scores, improve numerous system inefficiencies, promote staff accountability, and maintain an emphasis on cost-effective and efficient utilization of resources. This article describes the development of a team comprising a variety of staff members to support all managers in this effort. The outcome was an improvement in customer satisfaction scores from the lower half of the survey database to the top third.

  5. Cost-effectiveness of screening for hepatitis C in Canada

    PubMed Central

    Wong, William W.L.; Tu, Hong-Anh; Feld, Jordan J.; Wong, Tom; Krahn, Murray

    2015-01-01

    Background: The seroprevalence of hepatitis C virus (HCV) infection among Canadians is estimated at 0.3% to 0.9%. Of those with chronic HCV infection, 10% to 20% will experience advanced liver disease by 30 years of infection. Targeted screening seems a plausible strategy. We aimed to estimate the health and economic effects of various screening and treatment strategies for chronic HCV infection in Canada. Methods: We used a state-transition model to examine the cost-effectiveness of 4 screening strategies: no screening; screen and treat with pegylated interferon plus ribavarin; screen and treat with pegylated interferon and ribavarin–based direct-acting antiviral agents; and screen and treat with interferon-free direct-acting antivirals. We considered Canadian residents in 2 age groups: 25–64 and 45–64 years of age. We obtained model data from the literature. We predicted deaths related to chronic HCV infection, costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios. Results: We found that screening and treating would prevent at least 9 HCV-related deaths per 10 000 persons screened over the lifetime of the cohort. Screening was associated with QALY increases of 0.0032 to 0.0095 and cost increases of $124 to $338 per person, which translated to an incremental cost-effectiveness ratio of $34 359 to $44 034 per QALY gained, relative to no screening, depending on age group screened and antiviral therapy received. Interpretation: A selective one-time HCV screening program for people 25–64 or 45–64 years of age in Canada would likely be cost-effective. Identification of silent cases of chronic HCV infection and the offer of treatment when appropriate could extend the lives of Canadians at reasonable cost. PMID:25583667

  6. An Instructional Management Guide to Cost Effective Decision Making,

    DTIC Science & Technology

    1974-01-01

    PD’A116 209 WISCONSIN UNIV-MADISON F/S 111/1 AN INSTRUCTIONAL MAGEMENT GUIDE TO COST EFFECTIVE DECISION MA-ETC(U) 1974 R H PEARSON LW-LASSIFIFn TR73...Educa- tional Technology that in improving learning, cost and cost- benefit relationships were the areas of greatest uncertainty (Carpenter, 1970, p. 5...that the goals/objectives originator may specify a goal/objective that is unattainable by means of current technology . STEP 2: REVIEW THE

  7. Cost effectiveness of routine duodenal biopsies in iron deficiency anemia

    PubMed Central

    Broide, Efrat; Matalon, Shay; Kriger-Sharabi, Ofra; Richter, Vered; Shirin, Haim; Leshno, Moshe

    2016-01-01

    AIM To investigate the cost effectiveness of routine small bowel biopsies (SBBs) in patients with iron deficiency anemia (IDA) independent of their celiac disease (CD) serology test results. METHODS We used a state transition Markov model. Two strategies were compared: routine SBBs during esophagogastroduodenoscopy (EGD) in all patients with IDA regardless their celiac serology status (strategy A) vs SBBs only in IDA patients with positive serology (strategy B). The main outcomes were quality adjusted life years (QALY), average cost and the incremental cost effectiveness ratio (ICER). One way sensitivity analysis was performed on all variables and two way sensitivity analysis on selected variables were done. In order to validate the results, a Monte Carlo simulation of 100 sample trials with 10, and an acceptability curve were performed. RESULTS Strategy A of routine SBBs yielded 19.888 QALYs with a cost of $218.10 compared to 19.887 QALYs and $234.17 in strategy B. In terms of cost-effectiveness, strategy A was the dominant strategy, as long as the cost of SBBs stayed less than $67. In addition, the ICER of strategy A was preferable, providing the cost of biopsy stays under $77. Monte Carlo simulation demonstrated that strategy A yielded the same QALY but with lower costs than strategy B. CONCLUSION Our model suggests that EGD with routine SBBs is a cost-effective approach with improved QALYs in patients with IDA when the prevalence of CD is 5% or greater. SBBs should be a routine screening tool for CD among patients with IDA, regardless of their celiac antibody status. PMID:27678365

  8. Human papillomavirus vaccines: key factors in planning cost-effective vaccination programs.

    PubMed

    Isidean, Sandra D; Tota, Joseph E; Gagnon, Julien A; Franco, Eduardo L

    2015-01-01

    Prophylactic HPV vaccines hold tremendous potential for reducing cervical and non-cervical HPV-related disease burden worldwide. To maximize on this potential, policy officials will need to carefully consider available evidence, existing uncertainties and the cost-effectiveness of mass HPV vaccination programs in the context of their respective nations and/or regions. Proper harmonization of primary prevention strategies with secondary prevention efforts will also be important. Decisions following such considerations may ultimately depend on programmatic objectives, infrastructure and available resources. Continued research and surveillance surrounding HPV vaccination will be essential for filling current knowledge gaps, and forcing ongoing reconsiderations of selected immunization strategies.

  9. Cost-effectiveness analysis for health communication programs.

    PubMed

    Guilkey, David K; Hutchinson, Paul; Lance, Peter

    2006-01-01

    This article describes methods for analyzing the cost-effectiveness of health communication programs, focusing in particular on estimating program effectiveness with econometric methods that address experimental and quasi-experimental designs (and their absence), national or subnational program coverage, and endogenously targeting of programs. Experimental designs provide a gold standard for assessing effectiveness but are seldom feasible for large-scale health communication programs. Even in the absence of such designs, however, fairly simple methods can be used to examine intermediate objectives, such as program reach, which in turn can be linked to program costs to estimate cost effectiveness. When moving beyond program reach to behavioral or other outcome measures, such as contraceptive use or fertility, or when faced with full-coverage national programs, more elaborate data and methods are required. We discuss data requirements and assumptions necessary in each case, focusing on single-equation multiple regression models, structural equations models, and fixed effects estimators for use with longitudinal data, and then describing how cost information can be incorporated into econometric models so as to get measures of the cost-effectiveness of communication interventions.

  10. Technology Improvement Pathways to Cost-Effective Vehicle Electrification

    SciTech Connect

    Brooker, A.; Thornton, M.; Rugh, J. P.

    2010-04-01

    Electrifying transportation can reduce or eliminate dependence on foreign fuels, emission of green house gases, and emission of pollutants. One challenge is finding a pathway for vehicles that gains wide market acceptance to achieve a meaningful benefit. This paper evaluates several approaches aimed at making plug-in electric vehicles (EV) and plug-in hybrid electric vehicles (PHEVs) cost-effective including opportunity charging, replacing the battery over the vehicle life, improving battery life, reducing battery cost, and providing electric power directly to the vehicle during a portion of its travel. Many combinations of PHEV electric range and battery power are included. For each case, the model accounts for battery cycle life and the national distribution of driving distances to size the battery optimally. Using the current estimates of battery life and cost, only the dynamically plugged-in pathway was cost-effective to the consumer. Significant improvements in battery life and battery cost also made PHEVs more cost-effective than today's hybrid electric vehicles (HEVs) and conventional internal combustion engine vehicles (CVs).

  11. A cost-effectiveness analysis of interactive paediatric telecardiology.

    PubMed

    Sicotte, Claude; Lehoux, Pascale; Van Doesburg, Nicolaas; Cardinal, Godefroy; Leblanc, Yves

    2004-01-01

    We analysed the cost-effectiveness of a teleconsultation service after five years of operation. The service provides diagnostic consultation at a distance for children suffering from cardiac pathologies. A retrospective study was performed with all 78 infants who had received a paediatric cardiology teleconsultation over a four-year period from January 1998. The cost-effectiveness of telecardiology was compared with that of the conventional means of providing services. Teleconsultation proved to be an effective and reliable method of enhancing access to tertiary care. The number of patient journeys (both emergency transfers and semi-urgent or elective visits to the tertiary care centre) was reduced by 42%. However, the cost analysis demonstrated that teleconsultation did not result in overall cost savings: the total cost of telecardiology was C dollars 272,327 and the total cost of conventional care would have been C dollars 157,212. There were direct savings for patients but not for the health-care system, because of the high cost of the equipment and telecommunication fees. Telemedicine therefore represented a supplementary cost of C dollars 1500 per patient. In summary, telemedicine added to cost but increased effectiveness. The incremental cost-effectiveness ratio of teleconsultation was estimated to C dollars 3488 per patient journey avoided.

  12. Antivenom: the most cost-effective treatment in the world?

    PubMed

    Brown, N; Landon, J

    2010-06-15

    Antivenom is the only effective treatment for envenoming by snakes, scorpions and other venomous creatures. Unfortunately, supplies of this life-saving drug in many countries are critically low, and the tragic consequence of untreated envenoming exacts a chronic humanitarian and economic burden on those communities affected. This neglected health crisis struggles to compete with higher profile illnesses for recognition, research attention and funding. Sound strategies to improve the provision of antivenoms repeatedly fail because of an inability to attract the requisite financial investment. In the highly competitive international health landscape, the greatest challenge for stakeholders is to demonstrate that antivenom constitutes an affordable, cost-effective and worthwhile investment of healthcare resources. Recent collaborations in the UK, Africa and South America, have proven that lowering the production costs of antivenom to affordable levels is sustainable. A simple healthcare-economic calculation can be used to demonstrate the superior cost-effectiveness of antivenoms in preventing death and disability. These advances may lead to antivenom becoming one of the most cost-effective treatments available to modern medicine, and provides strong justification for its inclusion in international health funding initiatives.

  13. Recruitment of mental health survey participants using Internet advertising: content, characteristics and cost effectiveness.

    PubMed

    Batterham, Philip J

    2014-06-01

    Postal and telephone survey research is threatened by declining response rates and high cost. Online recruitment is becoming more popular, although there is little empirical evidence about its cost-effectiveness or the representativeness of online samples. There is also limited research on optimal strategies for developing advertising content for online recruitment. The present study aimed to assess these aspects of online recruitment. Two mental health surveys used advertisements within a social network website (Facebook) to recruit adult Australian participants. The initial survey used advertisements linking directly to an external survey website, and recruited 1283 participants at $9.82 per completed survey. A subsequent survey used advertisements linking to a Facebook page that featured links to the external survey, recruiting 610 participants at $1.51 per completion. Both surveys were more cost-effective than similar postal surveys conducted previously, which averaged $19.10 per completion. Online and postal surveys both had somewhat unrepresentative samples. However, online surveys tended to be more successful in recruiting hard-to-reach populations. Advertising using "problem" terminology was more effective than "positive" terminology, while there was no significant effect of altruistic versus self-gain terminology. Online recruitment is efficient, flexible and cost-effective, suggesting that online recruitment has considerable potential for specific research designs.

  14. Vaccinating women previously exposed to human papillomavirus: a cost-effectiveness analysis of the bivalent vaccine.

    PubMed

    Turner, Hugo C; Baussano, Iacopo; Garnett, Geoff P

    2013-01-01

    Recent trials have indicated that women with prior exposure to Human papillomavirus (HPV) subtypes 16/18 receive protection against reinfection from the HPV vaccines. However, many of the original models investigating the cost effectiveness of different vaccination strategies for the protection of cervical cancer assumed, based on the trial results at that time, that these women received no protection. We developed a deterministic, dynamic transmission model that incorporates the vaccine-induced protection of women with prior exposure to HPV. The model was used to estimate the cost effectiveness of progressively extending a vaccination programme using the bivalent vaccine to older age groups both with and without protection of women with prior exposure. We did this under a range of assumptions on the level of natural immunity. Our modelling projections indicate that including the protection of women with prior HPV exposure can have a profound effect on the cost effectiveness of vaccinating adults. The impact of this protection is inversely related to the level of natural immunity. Our results indicate that adult vaccination strategies should potentially be reassessed, and that it is important to include the protection of non-naive women previously infected with HPV in future studies. Furthermore, they also highlight the need for a more thorough investigation of this protection.

  15. Cost-effectiveness of ocriplasmin for the treatment of vitreomacular traction and macular hole

    PubMed Central

    Bennison, Craig; Stephens, Stephanie; Lescrauwaet, Benedicte; Van Hout, Ben; Jackson, Timothy L.

    2016-01-01

    Background If left untreated, vitreomacular traction (VMT) will infrequently improve through spontaneous resolution of vitreomacular adhesion (VMA), and patients remain at risk of further deterioration in vision. The mainstay of treatment for VMT is vitrectomy, an invasive procedure that carries the risk of rare but serious complications and further vision loss. As such, a ‘watch and wait’ approach is often adopted before this surgical intervention is performed. Ocriplasmin (microplasmin) is a potential alternative treatment for patients with symptomatic VMA/VMT that may remove the requirement for vitrectomy. Objective The purpose of this study was to evaluate the cost-effectiveness of ocriplasmin for the treatment of VMT in comparison to standard of care. Study design A cohort-based computer simulation model was developed, capturing three mutually exclusive subgroups: 1) VMT without epiretinal membrane (ERM) or full thickness macular hole (FTMH), 2) VMT with ERM but no FTMH, and 3) VMT with FTMH. Transition probabilities between health states, utilities, and resource utilisation were estimated based on clinical trial results, the literature, and expert opinion. The cost per quality-adjusted life year (QALY) gained was estimated over a lifetime, using UK unit costs and utilities associated with visual acuity, adverse events, metamorphopsia, and surgical interventions. Setting Analyses were conducted from a UK payer perspective. Population Transition probabilities for the model were primarily estimated from patient-level data from the combined Phase 3 MIVI-TRUST trials in patients with symptomatic VMA/VMT, including when associated with a FTMH ≤400 µm. Intervention Ocriplasmin (microplasmin) is a one-time intravitreal injection designed specifically to release the abnormal traction between the macula and the vitreous and thereby treat VMT, as well as macular hole with persistent vitreous attachment. Main outcome measure The main outcome measure of the

  16. Cost-effectiveness of provider-based HIV partner notification in urban Malawi.

    PubMed

    Rutstein, Sarah E; Brown, Lillian B; Biddle, Andrea K; Wheeler, Stephanie B; Kamanga, Gift; Mmodzi, Pearson; Nyirenda, Naomi; Mofolo, Innocent; Rosenberg, Nora E; Hoffman, Irving F; Miller, William C

    2014-01-01

    -based notification strategies are potentially cost-effective for identifying new cases of HIV. These strategies offer a simple, effective and easily implementable opportunity to control HIV transmission.

  17. Impact and cost-effectiveness of new tuberculosis vaccines in low- and middle-income countries.

    PubMed

    Knight, Gwenan M; Griffiths, Ulla K; Sumner, Tom; Laurence, Yoko V; Gheorghe, Adrian; Vassall, Anna; Glaziou, Philippe; White, Richard G

    2014-10-28

    To help reach the target of tuberculosis (TB) disease elimination by 2050, vaccine development needs to occur now. We estimated the impact and cost-effectiveness of potential TB vaccines in low- and middle-income countries using an age-structured transmission model. New vaccines were assumed to be available in 2024, to prevent active TB in all individuals, to have a 5-y to lifetime duration of protection, to have 40-80% efficacy, and to be targeted at "infants" or "adolescents/adults." Vaccine prices were tiered by income group (US $1.50-$10 per dose), and cost-effectiveness was assessed using incremental cost per disability adjusted life year (DALY) averted compared against gross national income per capita. Our results suggest that over 2024-2050, a vaccine targeted to adolescents/adults could have a greater impact than one targeted at infants. In low-income countries, a vaccine with a 10-y duration and 60% efficacy targeted at adolescents/adults could prevent 17 (95% range: 11-24) million TB cases by 2050 and could be considered cost-effective at $149 (cost saving to $387) per DALY averted. If targeted at infants, 0.89 (0.42-1.58) million TB cases could be prevented at $1,692 ($634-$4,603) per DALY averted. This profile targeted at adolescents/adults could be cost-effective at $4, $9, and $20 per dose in low-, lower-middle-, and upper-middle-income countries, respectively. Increased investments in adult-targeted TB vaccines may be warranted, even if only short duration and low efficacy vaccines are likely to be feasible, and trials among adults should be powered to detect low efficacies.

  18. Cost-Effectiveness of Preventive Interventions to Reduce Alcohol Consumption in Denmark

    PubMed Central

    Holm, Astrid Ledgaard; Veerman, Lennert; Cobiac, Linda; Ekholm, Ola; Diderichsen, Finn

    2014-01-01

    Introduction Excessive alcohol consumption increases the risk of many diseases and injuries, and the Global Burden of Disease 2010 study estimated that 6% of the burden of disease in Denmark is due to alcohol consumption. Alcohol consumption thus places a considerable economic burden on society. Methods We analysed the cost-effectiveness of six interventions aimed at preventing alcohol abuse in the adult Danish population: 30% increased taxation, increased minimum legal drinking age, advertisement bans, limited hours of retail sales, and brief and longer individual interventions. Potential health effects were evaluated as changes in incidence, prevalence and mortality of alcohol-related diseases and injuries. Net costs were calculated as the sum of intervention costs and cost offsets related to treatment of alcohol-related outcomes, based on health care costs from Danish national registers. Cost-effectiveness was evaluated by calculating incremental cost-effectiveness ratios (ICERs) for each intervention. We also created an intervention pathway to determine the optimal sequence of interventions and their combined effects. Results Three of the analysed interventions (advertising bans, limited hours of retail sales and taxation) were cost-saving, and the remaining three interventions were all cost-effective. Net costs varied from € -17 million per year for advertisement ban to € 8 million for longer individual intervention. Effectiveness varied from 115 disability-adjusted life years (DALY) per year for minimum legal drinking age to 2,900 DALY for advertisement ban. The total annual effect if all interventions were implemented would be 7,300 DALY, with a net cost of € -30 million. Conclusion Our results show that interventions targeting the whole population were more effective than individual-focused interventions. A ban on alcohol advertising, limited hours of retail sale and increased taxation had the highest probability of being cost-saving and should thus

  19. Chemical Ecology of the Colorado Potato Beetle, Leptinotarsa decemlineata (Say) (Coleoptera: Chrysomelidae), and Potential for Alternative Control Methods

    PubMed Central

    Sablon, Ludovic; Dickens, Joseph C.; Haubruge, Éric; Verheggen, François J.

    2012-01-01

    The Colorado potato beetle (CPB) has been a major insect pest to potato farming for over 150 years and various control methods have been established to reduce its impact on potato fields. Crop rotation and pesticide use are currently the most widely used approaches, although alternative methods are being developed. Here we review the role of various volatile and nonvolatile chemicals involved in behavior changes of CPB that may have potential for their control. First, we describe all volatile and nonvolatile chemicals involved in host plant localization and acceptance by CPB beetles, including glycoalcaloids and host plant volatiles used as kairomones. In the second section, we present the chemical signals used by CPB in intraspecific communication, including sex and aggregation pheromones. Some of these chemicals are used by natural enemies of CPBs to locate their prey and are presented in the third section. The last section of this review is devoted a discussion of the potential of some natural chemicals in biological control of CPB and to approaches that already reached efficient field applications. PMID:26466794

  20. Effect of dense plasmas on exchange-energy shifts in highly charged ions: An alternative approach for arbitrary perturbation potentials

    SciTech Connect

    Rosmej, F.; Bennadji, K.; Lisitsa, V. S.

    2011-09-15

    An alternative method of calculation of dense plasma effects on exchange-energy shifts {Delta}E{sub x} of highly charged ions is proposed which results in closed expressions for any plasma or perturbation potential. The method is based on a perturbation theory expansion for the inner atomic potential produced by charged plasma particles employing the Coulomb Green function method. This approach allows us to obtain analytic expressions and scaling laws with respect to the electron temperature T, density n{sub e}, and nuclear charge Z. To demonstrate the power of the present method, two specific models were considered in detail: the ion sphere model (ISM) and the Debye screening model (DSM). We demonstrate that analytical expressions can be obtained even for the finite temperature ISM. Calculations have been carried out for the singlet 1s2p{sup 1} P{sub 1} and triplet 1s2p{sup 3} P{sub 1} configurations of He-like ions with charge Z that can be observed in dense plasmas via the He-like resonance and intercombination lines. Finally we discuss recently available purely numerical calculations and experimental data.

  1. Cost effectiveness of group follow-up after structured education for type 1 diabetes: a cluster randomised controlled trial

    PubMed Central

    2014-01-01

    Background This study examines the cost effectiveness of group follow-up after participation in the Dose Adjustment for Normal Eating (DAFNE) structured education programme for type 1 diabetes. Methods Economic evaluation conducted alongside a cluster randomised controlled trial involving 437 adults with type 1 diabetes in Ireland. Group follow-up involved two group education ‘booster’ sessions post-DAFNE. Individual follow-up involved two standard one-to-one hospital clinic visits. Incremental costs, quality-adjusted life years (QALYs) gained and cost effectiveness were estimated at 18 months. Uncertainty was explored using sensitivity analysis and by estimating cost effectiveness acceptability curves. Results Group follow-up was associated with a mean reduction in QALYs gained of 0.04 per patient (P value, 0.052; 95% CI, −0.08 to 0.01, intra-class correlation (ICC), 0.033) and a mean reduction in total healthcare costs of €772 (P value, 0.020; 95% CI, −1,415 to −128: ICC, 0.016) per patient. At alternative threshold values of €5,000, €15,000, €25,000, €35,000, and €45,000, the probability of group follow-up being cost effective was estimated to be 1.000, 0.762, 0.204, 0.078, and 0.033 respectively. Conclusions The results do not support implementation of group follow-up as the sole means of follow-up post-DAFNE. Given the reported cost savings, future studies should explore the cost effectiveness of alternative models of group care for diabetes. Trial registration Current Controlled Trials ISRCTN79759174 (assigned: 9 February 2007). PMID:24927851

  2. Costs, effects and cost-effectiveness analysis of a mobile maternal health care service in West Kiang, The Gambia.

    PubMed

    Fox-Rushby, J A; Foord, F

    1996-02-01

    The costs, effects and cost-effectiveness of a new mobile maternal care service offered in The Gambia at a government-run health centre in Karantaba were compared with the usual pattern of maternal care offered (at Ngayen Sanjal). Routinely collected data were supplemented by research on time allocation of staff by activity, use of drugs, medical consumables and vehicles, out-of-pocket payments by patients and a range of effectiveness indicators. To account for a differential effect on hospital referrals, maternity care at the main referral hospital was assessed. In 1991, the annual total cost of maternity care at Karantaba was US$64 800 compared with US$25 300 at Ngayen Sanjal. The largest proportion of this difference was attributed to training. Whilst average cost/attendance was higher at Karantaba, the marginal cost of expanding the service to other villages was lower than the marginal cost at Ngayen Sanjal. Incremental cost-effectiveness of the mobile service at Karantaba was calculated according to best and worst case scenarios which showed that the extra cost/extra death averted per year ranged between US$459 and US$2134. Using discounted life years gained reduced the figures to US$42.9 and US$206.3. Various suggestions are offered for reducing the cost of the new service, and a number of methodological points are raised for discussion.

  3. Cost-Effectiveness of Opportunistic Screening and Minimal Contact Psychotherapy to Prevent Depression in Primary Care Patients

    PubMed Central

    van den Berg, Matthijs; Smit, Filip; Vos, Theo; van Baal, Pieter H. M.

    2011-01-01

    Background Depression causes a large burden of disease worldwide. Effective prevention has the potential to reduce that burden considerably. This study aimed to investigate the cost-effectiveness of minimal contact psychotherapy, based on Lewinsohn's ‘Coping with depression’ course, targeted at opportunistically screened individuals with sub-threshold depression. Methods and Results Using a Markov model, future health effects and costs of an intervention scenario and a current practice scenario were estimated. The time horizon was five years. Incremental cost-effectiveness ratios were expressed in euro per Disability Adjusted Life Year (DALY) averted. Probabilistic sensitivity analysis was employed to study the effect of uncertainty in the model parameters. From the health care perspective the incremental cost-effectiveness ratio was € 1,400 per DALY, and from the societal perspective the intervention was cost-saving. Although the estimated incremental costs and effects were surrounded with large uncertainty, given a willingness to pay of € 20,000 per DALY, the probability that the intervention is cost-effective was around 80%. Conclusion This modelling study showed that opportunistic screening in primary care for sub-threshold depression in combination with minimal contact psychotherapy may be cost-effective in the prevention of major depression. PMID:21853053

  4. Home-based viewing (el velorio) after death: a cost-effective alternative for some families.

    PubMed

    Gonzalez, Faustino; Hereira, Mildreys

    2008-01-01

    After the death of a loved one, giving an opportunity to view the body helps bring families and friends together to celebrate the life and mourn the passing of a person. This gathering, known as a Wake or a Viewing, precedes the burial and usually lasts from 1 to several days. In the United States, the viewing now takes place in funeral parlors, away from the decedent's home. However, there are still several countries and people who keep the body at home where the family and friends are invited to say their goodbyes. We present here 2 cases for which our Hospice assisted the families with a home viewing. These were indigent people who could not afford embalming or the additional cost of a viewing in a parlor and who, without this opportunity, would have not had time to get together and mourn and celebrate life as friends, family, and community.

  5. An alternative for cost-effective remediation of depleted uranium (DU) at certain environmental restoration sites

    SciTech Connect

    Miller, M.; Galloway, B.; VanDerpoel, G.; Johnson, E.; Copland, J.; Salazar, M.

    2000-02-01

    Numerous sites in the United States and around the world are contaminated with depleted uranium (DU) in various forms. A prevalent form is fragmented DU originating from various scientific tests involving high explosives and DU during weapon development programs, at firing practice ranges, or war theaters where DU was used in armor-piercing projectiles. The contamination at these sites is typically very heterogeneous, with discreet, visually identifiable DU fragments mixed with native soil. That is, the bulk-averaged DU activity is quite low, while specific DU fragments, which are distinct from the soil matrix, have much higher specific activity. DU is best known as a dark, black metal that is nearly twice as dense as lead, but DU in the environment readily weathers to a distinctive bright yellow color that is readily visible. While the specific activity of DU is relatively low and presents only a minor radiological hazard, the fact that it is radioactive and visually identifiable makes it desirable to remove the DU contamination from the environment.

  6. Uterine sperm-egg transfer: a cost-effective alternative to IVF?

    PubMed

    Katayama, K Paul; Jambor, Varya; Milosavljevic, Sue; Vanschaick, Mary; Katayama, Alyce

    2010-06-01

    Direct transcervical transfer of spermatozoa and oocytes to the uterine cavity has been carried out in the past. This procedure could be a more appropriate approach than IVF for some anovulatory patients who require gonadotrophin stimulation, since the number of oocytes could be limited, thus reducing the occurrence of multiple gestations. However, most of the clinical pregnancy rates reported in the literature for gamete intrauterine transfer appear to be inferior to IVF pregnancy rates. This study attempted to improve the outcome of gamete intrauterine transfer by modifying some aspects of the procedure. This procedure is referred to as uterine sperm-egg transfer (U-SET) to imply that U (you the patient) set (determine) the number of oocytes to be transferred to the uterus. In this study's series of 16 anovulatory patients under the age of 36 years, the clinical pregnancy rate was 69% and the live birth rate was 50%.

  7. Build Your Own Board: Brightboards Offer a Cost-Effective Alternative to Interactive Whiteboards

    ERIC Educational Resources Information Center

    Vallis, Keith; Williamson, Peter

    2009-01-01

    Interactive whiteboards are all the rage in classrooms across the world these days, and for good reason. Like most technology, they hold students' attention much better than a traditional lecture-and-blackboard lesson ever could. They also solve the problem of having only one classroom computer for 30 students by projecting the screen at the front…

  8. Cost-effectiveness analysis appraisal and application: an emergency medicine perspective.

    PubMed

    April, Michael D; Murray, Brian P

    2017-03-10

    Cost-effectiveness is an important goal for emergency care delivery. The many diagnostic, treatment, and disposition decisions made in the emergency department (ED) have a significant impact upon healthcare resource utilization. Cost-effectiveness analysis (CEA) is an analytic tool to optimize these resource allocation decisions through the systematic comparison of costs and effects of alternative healthcare decisions. Yet few emergency medicine leaders and policy-makers have any formal training in CEA methodology. This paper provides an introduction to the interpretation and use of CEA with a focus on application to emergency medicine problems and settings. It applies a previously-published CEA to the hypothetical case of a patient presenting to the ED with chest pain who requires risk stratification. This paper uses a widely-cited checklist to appraise the CEA. This checklist serves as a vehicle for presenting basic CEA terminology and concepts. General topics of focus include measurement of costs and outcomes, incremental analysis, and sensitivity analysis. Integrated throughout the paper are recommendations for good CEA practice with emphasis on the guidelines published by the United States Panel on Cost-Effectiveness in Health and Medicine. Unique challenges for emergency medicine CEAs discussed include the projection of long-term outcomes from emergent interventions, costing ED services, and applying study results to diverse patient populations across various ED settings. The discussion also includes an overview of the limitations inherent in applying CEA results to clinical practice to include the lack of incorporation of non-cost considerations in CEA (e.g., ethics). After reading this article, emergency medicine leaders and researchers will have an enhanced understanding of the basics of CEA critical appraisal and application. The paper concludes with an overview of economic evaluation resources for readers interested in conducting ED-based economic

  9. Cost-effectiveness of digital mammography screening before the age of 50 in The Netherlands.

    PubMed

    Sankatsing, Valérie D V; Heijnsdijk, Eveline A M; van Luijt, Paula A; van Ravesteyn, Nicolien T; Fracheboud, Jacques; de Koning, Harry J

    2015-10-15

    In the Netherlands, routine mammography screening starts at age 50. This starting age may have to be reconsidered because of the increasing breast cancer incidence among women aged 40 to 49 and the recent implementation of digital mammography. We assessed the cost-effectiveness of digital mammography screening that starts between age 40 and 49, using a microsimulation model. Women were screened before age 50, in addition to the current programme (biennial 50-74). Screening strategies varied in starting age (between 40 and 50) and frequency (annual or biennial). The numbers of breast cancers diagnosed, life-years gained (LYG) and breast cancer deaths averted were predicted and incremental cost-effectiveness ratios (ICERs) were calculated to compare screening scenarios. Biennial screening from age 50 to 74 (current strategy) was estimated to gain 157 life years per 1,000 women with lifelong follow-up, compared to a situation without screening, and cost €3,376/LYG (3.5% discounted). Additional screening increased the number of LYG, compared to no screening, ranging from 168 to 242. The costs to generate one additional LYG (i.e., ICER), comparing a screening strategy to the less intensive alternative, were estimated at €5,329 (biennial 48-74 vs. current strategy), €7,628 (biennial 45-74 vs. biennial 48-74), €10,826 (biennial 40-74 vs. biennial 45-74) and €18,759 (annual 40-49 + biennial 50-74 vs. biennial 40-74). Other strategies (49 + biennial 50-74 and annual 45-49 + biennial 50-74) resulted in less favourable ICERs. These findings show that extending the Dutch screening programme by screening between age 40 and 49 is cost-effective, particularly for biennial strategies.

  10. Cost-effectiveness of combination therapy umeclidinium/vilanterol versus tiotropium in symptomatic COPD Spanish patients

    PubMed Central

    Miravitlles, Marc; Gáldiz, Juan B; Huerta, Alicia; Villacampa, Alba; Carcedo, David; Garcia-Rio, Francisco

    2016-01-01

    Purpose Umeclidinium/vilanterol (UMEC/VI) is a novel fixed dose combination of a long-acting muscarinic receptor antagonist (LAMA) and a long-acting beta 2 receptor antagonist (LABA) agent. This analysis evaluated the incremental cost-effectiveness ratio (ICER) of UMEC/VI compared with tiotropium (TIO), from the Spanish National Health System (NHS) perspective. Methods A previously published linked equations cohort model based on the epidemiological longitudinal study ECLIPSE (Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points) was used. Patients included were COPD patients with a post-bronchodilator forced expiratory volume in 1 second (FEV1) ≤70% and the presence of respiratory symptoms measured with the modified Medical Research Council dyspnea scale (modified Medical Research Council ≥2). Treatment effect, expressed as change in FEV1 from baseline, was estimated from a 24-week head-to-head phase III clinical trial comparing once-daily UMEC/VI with once-daily TIO and was assumed to last 52 weeks following treatment initiation (maximum duration of UMEC/VI clinical trials). Spanish utility values were derived from a published local observational study. Unitary health care costs (€2015) were obtained from local sources. A 3-year time horizon was selected, and 3% discount was applied to effects and costs. Results were expressed as cost/quality-adjusted life years (QALYs). Univariate and probabilistic sensitivity analysis (PSA) was performed. Results UMEC/VI produced additional 0.03 QALY and €590 vs TIO, leading to an ICER of €21,475/QALY. According to PSA, the probability of UMEC/VI being cost-effective was 80.3% at a willingness-to-pay of €30,000/QALY. Conclusion UMEC/VI could be considered as a cost-effective treatment alternative compared with TIO in symptomatic COPD patients from the Spanish NHS perspective. PMID:26848262

  11. Using Cost-Effectiveness Analysis to Address Health Equity Concerns.

    PubMed

    Cookson, Richard; Mirelman, Andrew J; Griffin, Susan; Asaria, Miqdad; Dawkins, Bryony; Norheim, Ole Frithjof; Verguet, Stéphane; J Culyer, Anthony

    2017-02-01

    This articles serves as a guide to using cost-effectiveness analysis (CEA) to address health equity concerns. We first introduce the "equity impact plane," a tool for considering trade-offs between improving total health-the objective underpinning conventional CEA-and equity objectives, such as reducing social inequality in health or prioritizing the severely ill. Improving total health may clash with reducing social inequality in health, for example, when effective delivery of services to disadvantaged communities requires additional costs. Who gains and who loses from a cost-increasing health program depends on differences among people in terms of health risks, uptake, quality, adherence, capacity to benefit, and-crucially-who bears the opportunity costs of diverting scarce resources from other uses. We describe two main ways of using CEA to address health equity concerns: 1) equity impact analysis, which quantifies the distribution of costs and effects by equity-relevant variables, such as socioeconomic status, location, ethnicity, sex, and severity of illness; and 2) equity trade-off analysis, which quantifies trade-offs between improving total health and other equity objectives. One way to analyze equity trade-offs is to count the cost of fairer but less cost-effective options in terms of health forgone. Another method is to explore how much concern for equity is required to choose fairer but less cost-effective options using equity weights or parameters. We hope this article will help the health technology assessment community navigate the practical options now available for conducting equity-informative CEA that gives policymakers a better understanding of equity impacts and trade-offs.

  12. Cost-effectiveness analysis of farmers' rice straw management practices considering CH4 and N2O emissions.

    PubMed

    Launio, Cheryll C; Asis, Constancio A; Manalili, Rowena G; Javier, Evelyn F

    2016-12-01

    This study assessed the environmental consequences of burning and other rice straw management practices in terms of non-CO2 greenhouse gas (GHG) emissions, and evaluated the cost-effectiveness of selected rice straw management alternatives. On a per-hectare basis and considering a time horizon of five years, incorporating stubble more than 30 days before crop establishment, and incorporating composted rice straw in the field yielded the lowest cumulative CH4 and N2O emissions. Considering the associated costs and secondary benefits, the most cost-effective option for farmers is to incorporate stubble and straw in the soil more than 30 days before crop establishment. Rapid straw composting and incorporation of rice straw compost entails much higher additional cost but it also significantly mitigates GHG emission, hence it is the next most cost-effective option. Incorporating rice stubble and straw less than a month before crop establishment and removing rice straw for use as animal feed, on the other hand, appear to result in a net increase in ton CO2-eq given the assumed time horizon. The results underscore the impacts on the environment of small changes in straw management practices entailing minimal costs. Cost-effectiveness analysis considering rice straw for power generation and bio ethanol production is recommended. Further study on water management and tillage practice as mitigation options is recommended for a broader perspective useful for farmers, policy-makers, and other rice stakeholders.

  13. Facilitating Sound, Cost-Effective Federal Energy Management (Fact Sheet)

    SciTech Connect

    Not Available

    2012-03-01

    This fact sheet is an overview of the U.S. Department of Energy's Federal Energy Management Program (FEMP). The Federal Government, as the nation's largest energy consumer, has a tremendous opportunity and acknowledged responsibility to lead by example. The U.S. Department of Energy's (DOE's) Federal Energy Management Program (FEMP) plays a critical role in this effort. FEMP facilitates the Federal Government's implementation of sound, cost-effective energy management and investment practices to enhance the nation's energy security and environmental stewardship. FEMP does this by focusing on the needs of its Federal customers, delivering an array of services across a variety of program areas.

  14. DEVELOPMENT AND MANUFACTURE OF COST EFFECTIVE COMPOSITE DRILL PIPE

    SciTech Connect

    James C. Leslie; James C. Leslie II; Lee Truong; James T. Heard; Peter Manekas

    2005-03-18

    This technical report presents the engineering research, process development and data accomplishments that have transpired to date in support of the development of Cost Effective Composite Drill Pipe (CDP). The report presents progress made from October 1, 2003 through September 30, 2004 and contains the following discussions: (1) Direct Electrical Connection for Rotary Shoulder Tool Joints; (2) Conductors for inclusion in the pipe wall (ER/DW-CDP); (3) Qualify fibers from Zoltek; (4) Qualify resin from Bakelite; (5) First commercial order for SR-CDP from Integrated Directional Resources (SR-CDP); and (6) Preparation of papers for publication and conference presentations.

  15. Studying the Cost Effects of The Shrinking Industrial Base

    DTIC Science & Technology

    1993-09-01

    89) Prescrbed by AIM St. Z39-IS 290-102 STUDYING THE COST EFFECTS OF THE SHRINKING INDUSTRIAL BASE Downsizing the Army has the effect of reducing the...dicesarr@tacom.emhl.army.mil INTRODUCTION For cost analysts, one of the most puzzling aspects of the downsizing of the military is the effect of...changes in the size of the defense industrial base on cost. It is common knowledge that the downsizing is having an effect on unit vehicle cost, but there

  16. Finding Alternatives to the Dogma of Power Based Sample Size Calculation: Is a Fixed Sample Size Prospective Meta-Experiment a Potential Alternative?

    PubMed Central

    Tavernier, Elsa; Trinquart, Ludovic; Giraudeau, Bruno

    2016-01-01

    Sample sizes for randomized controlled trials are typically based on power calculations. They require us to specify values for parameters such as the treatment effect, which is often difficult because we lack sufficient prior information. The objective of this paper is to provide an alternative design which circumvents the need for sample size calculation. In a simulation study, we compared a meta-experiment approach to the classical approach to assess treatment efficacy. The meta-experiment approach involves use of meta-analyzed results from 3 randomized trials of fixed sample size, 100 subjects. The classical approach involves a single randomized trial with the sample size calculated on the basis of an a priori-formulated hypothesis. For the sample size calculation in the classical approach, we used observed articles to characterize errors made on the formulated hypothesis. A prospective meta-analysis of data from trials of fixed sample size provided the same precision, power and type I error rate, on average, as the classical approach. The meta-experiment approach may provide an alternative design which does not require a sample size calculation and addresses the essential need for study replication; results may have greater external validity. PMID:27362939

  17. Estimating the cost-effectiveness of lifestyle intervention programmes to prevent diabetes based on an example from Germany: Markov modelling

    PubMed Central

    2011-01-01

    Background Type 2 diabetes mellitus (T2D) poses a large worldwide burden for health care systems. One possible tool to decrease this burden is primary prevention. As it is unethical to wait until perfect data are available to conclude whether T2D primary prevention intervention programmes are cost-effective, we need a model that simulates the effect of prevention initiatives. Thus, the aim of this study is to investigate the long-term cost-effectiveness of lifestyle intervention programmes for the prevention of T2D using a Markov model. As decision makers often face difficulties in applying health economic results, we visualise our results with health economic tools. Methods We use four-state Markov modelling with a probabilistic cohort analysis to calculate the cost per quality-adjusted life year (QALY) gained. A one-year cycle length and a lifetime time horizon are applied. Best available evidence supplies the model with data on transition probabilities between glycaemic states, mortality risks, utility weights, and disease costs. The costs are calculated from a societal perspective. A 3% discount rate is used for costs and QALYs. Cost-effectiveness acceptability curves are presented to assist decision makers. Results The model indicates that diabetes prevention interventions have the potential to be cost-effective, but the outcome reveals a high level of uncertainty. Incremental cost-effectiveness ratios (ICERs) were negative for the intervention, ie, the intervention leads to a cost reduction for men and women aged 30 or 50 years at initiation of the intervention. For men and women aged 70 at initiation of the intervention, the ICER was EUR27,546/QALY gained and EUR19,433/QALY gained, respectively. In all cases, the QALYs gained were low. Cost-effectiveness acceptability curves show that the higher the willingness-to-pay threshold value, the higher the probability that the intervention is cost-effective. Nonetheless, all curves are flat. The threshold value of

  18. Cost-effectiveness of superficial femoral artery endovascular interventions in the UK and Germany: a modelling study

    PubMed Central

    Kearns, Benjamin C; Thomas, Steven M

    2017-01-01

    Objectives To assess the lifetime costs and cost-effectiveness of 5 endovascular interventions to treat superficial femoral arterial disease. Design A model-based health economic evaluation. An existing decision analytical model was used, with updated effectiveness data taken from the literature, and updated costs based on purchasing prices. Setting UK and German healthcare perspectives were considered. Participants Patients with intermittent claudication of the femoropopliteal arteries eligible for endovascular treatment. Methods UK and German healthcare perspectives were considered, as were different strategies for re-intervention. Interventions Percutaneous transluminal angioplasty (PTA) with bail-out bare metal stenting (assumed to represent the existing standard of care, and 4 alternatives: primary bare metal stents, drug-eluting stents, drug-eluting balloons (DEBs) and biomimetic stents). Primary outcome measures The incremental cost-effectiveness ratio between 2 treatments, defined as the incremental costs divided by the incremental quality-adjusted life years (QALYs). Results Use of a biomimetic stent, BioMimics 3D, was always estimated to dominate the other interventions, having lower lifetime costs and greater effectiveness, as measured by QALYs. Of the remaining interventions, DEBs were always the most effective, and PTA the least effective. There was uncertainty in the cost-effectiveness results, with key drivers being the costs and effectiveness of the biomimetic stent along with the costs of DEBs. Conclusions All 4 of the alternatives to PTA were more effective, with the biomimetic stent being the most cost-effective. As there was uncertainty in the results, and all of the interventions have different mechanisms of action, all 4 may be considered to be alternatives to PTA. PMID:28087551

  19. An assessment of potential degradation products in the gas-phase reactions of alternative fluorocarbons in the troposphere

    NASA Technical Reports Server (NTRS)

    Niki, Hiromi

    1990-01-01

    Tropospheric chemical transformations of alternative hydrofluorocarbons (HCF's) and hydrochlorofluorocarbons (HCFC's) are governed by hydroxyl radical initiated oxidation processes, which are likely to be analogous to those known for alkanes and chloroalkanes. A schematic diagram is used to illustrate plausible reaction mechanisms for their atmospheric degradation, where R, R', and R'' denote the F- and/or Cl-substituted alkyl groups derived from HCF's and HCFC's subsequent th the initial H atom abstraction by HO radicals. At present, virtually no kinetic data exist for the majority of these reactions, particularly for those involving RO. Potential degradation intermediates and final products include a large variety of fluorine- and/or chlorine-containing carbonyls, acids, peroxy acids, alcohols, hydrogen peroxides, nitrates and peroxy nitrates, as summarized in the attached table. Probably atmospheric lifetimes of these compounds were also estimated. For some carbonyl and nitrate products shown in this table, there seem to be no significant gas-phase removal mechanisms. Further chemical kinetics and photochemical data are needed to quantitatively assess the atmospheric fate of HCF's and HCFC's, and of the degradation products postulated in this report.

  20. In vitro potential of equine DEFA1 and eCATH1 as alternative antimicrobial drugs in rhodococcosis treatment.

    PubMed

    Schlusselhuber, Margot; Jung, Sascha; Bruhn, Oliver; Goux, Didier; Leippe, Matthias; Leclercq, Roland; Laugier, Claire; Grötzinger, Joachim; Cauchard, Julien

    2012-04-01

    Rhodococcus equi, the causal agent of rhodococcosis, is a severe pathogen of foals but also of immunodeficient humans, causing bronchopneumonia. The pathogen is often found together with Klebsiella pneumoniae or Streptococcus zooepidemicus in foals. Of great concern is the fact that some R. equi strains are already resistant to commonly used antibiotics. In the present study, we evaluated the in vitro potential of two equine antimicrobial peptides (AMPs), eCATH1 and DEFA1, as new drugs against R. equi and its associated pathogens. The peptides led to growth inhibition and death of R. equi and S. zooepidemicus at low micromolar concentrations. Moreover, eCATH1 was able to inhibit growth of K. pneumoniae. Both peptides caused rapid disruption of the R. equi membrane, leading to cell lysis. Interestingly, eCATH1 had a synergic effect together with rifampin. Furthermore, eCATH1 was not cytotoxic against mammalian cells at bacteriolytic concentrations and maintained its high killing activity even at physiological salt concentrations. Our data suggest that equine AMPs, especially eCATH1, may be promising candidates for alternative drugs to control R. equi in mono- and coinfections.

  1. Platelet-rich plasma gel composited with nondegradable porous polyurethane scaffolds as a potential auricular cartilage alternative.

    PubMed

    Wang, Zhongshan; Qin, Haiyan; Feng, Zhihong; Zhao, Yimin

    2016-02-01

    Total auricular reconstruction is still a challenge, and autologous cartilage transplant is the main therapy so far. Tissue engineering provides a promising method for auricular cartilage reconstruction. However, although degradable framework demonstrated excellent initial cosmetic details, it is difficult to maintain the auricular contour over time and the metabolites tended to be harmful to human body. In this study, biocompatible and safe nondegradable elastic polyurethane was used to make porous scaffold in specific details by rapid prototyping technology. Platelet-rich plasma contains fibrin and abundant autologous growth factors, which was used as cell carriers for in vitro expanded cells. When crosslinking polyurethane framework, platelet-rich plasma and cells together, we successfully made polyurethane/platelet-rich plasma/cell composites, and implanted them into dorsal subcutaneous space of nude mice. The results showed that this method resulted in more even cell distribution and higher cell density, promoted chondrocyte proliferation, induced higher level expressions of aggrecan and type II collagen gene, increased content of newly developed glycosaminoglycans, and produced high-quality cartilaginous tissue. This kind of cartilage tissue engineering approach may be a potential promising alternative for external ear reconstruction.

  2. Establishment of alternative potency test for botulinum toxin type A using compound muscle action potential (CMAP) in rats.

    PubMed

    Torii, Yasushi; Goto, Yoshitaka; Nakahira, Shinji; Ginnaga, Akihiro

    2014-11-01

    The biological activity of botulinum toxin type A has been evaluated using the mouse intraperitoneal (ip) LD50 test. This method requires a large number of mice to precisely determine toxin activity, and, as such, poses problems with regard to animal welfare. We previously developed a compound muscle action potential (CMAP) assay using rats as an alternative method to the mouse ip LD50 test. In this study, to evaluate this quantitative method of measuring toxin activity using CMAP, we assessed the parameters necessary for quantitative tests according to ICH Q2 (R1). This assay could be used to evaluate the activity of the toxin, even when inactive toxin was mixed with the sample. To reduce the number of animals needed, this assay was set to measure two samples per animal. Linearity was detected over a range of 0.1-12.8 U/mL, and the measurement range was set at 0.4-6.4 U/mL. The results for accuracy and precision showed low variability. The body weight was selected as a variable factor, but it showed no effect on the CMAP amplitude. In this study, potency tests using the rat CMAP assay of botulinum toxin type A demonstrated that it met the criteria for a quantitative analysis method.

  3. Cost-effectiveness of the stream-gaging program in New Jersey

    USGS Publications Warehouse

    Schopp, R.D.; Ulery, R.L.

    1984-01-01

    The results of a study of the cost-effectiveness of the stream-gaging program in New Jersey are documented. This study is part of a 5-year nationwide analysis undertaken by the U.S. Geological Survey to define and document the most cost-effective means of furnishing streamflow information. This report identifies the principal uses of the data and relates those uses to funding sources, applies, at selected stations, alternative less costly methods (that is flow routing, regression analysis) for furnishing the data, and defines a strategy for operating the program which minimizes uncertainty in the streamflow data for specific operating budgets. Uncertainty in streamflow data is primarily a function of the percentage of missing record and the frequency of discharge measurements. In this report, 101 continuous stream gages and 73 crest-stage or stage-only gages are analyzed. A minimum budget of $548,000 is required to operate the present stream-gaging program in New Jersey with an average standard error of 27.6 percent. The maximum budget analyzed was $650,000, which resulted in an average standard error of 17.8 percent. The 1983 budget of $569,000 resulted in a standard error of 24.9 percent under present operating policy. (USGS)

  4. Advanced Oxyfuel Boilers and Process Heaters for Cost Effective CO2 Capture and Sequestration

    SciTech Connect

    Max Christie; Rick Victor; Bart van Hassel; Nagendra Nagabushana; Juan Li; Joseph Corpus; Jamie Wilson

    2007-03-31

    The purpose of the advanced boilers and process heaters program is to assess the feasibility of integrating Oxygen Transport Membranes (OTM) into combustion processes for cost effective CO{sub 2} capture and sequestration. Introducing CO{sub 2} capture into traditional combustion processes can be expensive, and the pursuit of alternative methods, like the advanced boiler/process heater system, may yield a simple and cost effective solution. In order to assess the integration of an advanced boiler/process heater process, this program addressed the following tasks: Task 1--Conceptual Design; Task 2--Laboratory Scale Evaluation; Task 3--OTM Development; Task 4--Economic Evaluation and Commercialization Planning; and Task 5--Program Management. This Final report documents and summarizes all of the work performed for the DOE award DE-FC26-01NT41147 during the period from January 2002-March 2007. This report outlines accomplishments for the following tasks: conceptual design and economic analysis, oxygen transport membrane (OTM) development, laboratory scale evaluations, and program management.

  5. Cost-effectiveness of glaucoma management with monotherapy medications in Egypt

    PubMed Central

    El-Khamery, Amal Abd-Elaal; Mohamed, Amir Ibrahim; Swify, Hassan Eisa Hassan; Mohamed, Alaa Ibrahim

    2017-01-01

    Glaucoma is a serious chronic ophthalmic disease since it causes irreversible visual disability if untreated can lead to blindness. Treatment options include medications (classified into five major classes of drugs which are muscarinic cholinergic agonists, alpha-2 adrenergic agonists, beta-1 adrenergic antagonists, prostaglandins [PGs], and carbonic anhydrase inhibitors); use of laser therapy or conventional surgery. Pharmacoeconomic analysis helps in choosing among this variety of treatments. There is a great need for such analysis in Egypt since undergoing of it in different countries or societies may produce different results. This work aimed to compare cost-effectiveness of bimatoprost 0.03% once daily versus brimonidine 0.2% twice daily and timolol 0.5% twice daily as monotherapy treatment in Egyptian patients with open-angle glaucoma or ocular hypertension. Clinical data revealed that all treatments decreased intraocular pressure (IOP) significantly but bimatoprost 0.03% showed the highest efficacy (27.7% decrease in IOP from baseline), while timolol 0.5% reduced IOP by 22.5% then brimonidine 0.2% which decreased IOP by 20.8%. From the cost-effectiveness view, it would be preferable to initiate treatment with timolol in case of absence of any contraindications. PG analog can be used as add-on therapy in low responder patients or as alternative treatment in case of presence of contraindication to use of beta blockers. PMID:28217551

  6. Analysis of U.S. produced water controls -- Are they cost-effective?

    SciTech Connect

    Veil, J.A.

    1995-12-31

    The US Environmental Protection Agency (EPA) establishes controls on produced water discharges into US waters through effluent limitations guidelines (ELGs), and general and individual discharge permits. Over the past 20 years, produced water controls have become much stricter, and in some areas, no discharge of produced water is allowed. In setting discharge standards, EPA considers vast amounts of data, makes assumptions regarding which data and what approaches are representative, selects the most appropriate analytical methods, and interprets the analytical results. Despite EPA`s considerable efforts to accurately understand and characterize the economic and environmental impacts of produced water discharges before proposing and adopting ELGs and issuing permits, current US produced water controls may be overly restrictive and not cost-effective. This paper summarizes several studies that have reviewed in detail EPA`s data, assumptions, and analytical methods for earlier proposed regulations and general permits. These include the offshore oil and gas ELGs, EPA`s Region 6 general permit for coastal waters, and most recently, the proposed ELGs for the coastal oil and gas industry. By substituting different data, using revised assumptions, and reanalyzing data that are equally or more valid, the studies reach alternate conclusions on the cost-effectiveness of current produced water controls.

  7. Could CT screening for lung cancer ever be cost effective in the United Kingdom?

    PubMed Central

    Whynes, David K

    2008-01-01

    Background The absence of trial evidence makes it impossible to determine whether or not mass screening for lung cancer would be cost effective and, indeed, whether a clinical trial to investigate the problem would be justified. Attempts have been made to resolve this issue by modelling, although the complex models developed to date have required more real-world data than are currently available. Being founded on unsubstantiated assumptions, they have produced estimates with wide confidence intervals and of uncertain relevance to the United Kingdom. Method I develop a simple, deterministic, model of a screening regimen potentially applicable to the UK. The model includes only a limited number of parameters, for the majority of which, values have already been established in non-trial settings. The component costs of screening are derived from government guidance and from published audits, whilst the values for test parameters are derived from clinical studies. The expected health gains as a result of screening are calculated by combining published survival data for screened and unscreened cohorts with data from Life Tables. When a degree of uncertainty over a parameter value exists, I use a conservative estimate, i.e. one likely to make screening appear less, rather than more, cost effective. Results The incremental cost effectiveness ratio of a single screen amongst a high-risk male population is calculated to be around £14,000 per quality-adjusted life year gained. The average cost of this screening regimen per person screened is around £200. It is possible that, when obtained experimentally in any future trial, parameter values will be found to differ from those previously obtained in non-trial settings. On the basis both of differing assumptions about evaluation conventions and of reasoned speculations as to how test parameters and costs might behave under screening, the model generates cost effectiveness ratios as high as around £20,000 and as low as around

  8. A modified and cost-effective method for hair cortisol analysis.

    PubMed

    Xiang, Lianbin; Sunesara, Imran; Rehm, Kristina E; Marshall, Gailen D

    2016-01-01

    Hair cortisol may hold potential as a biomarker for assessment of chronic psychological stress. We report a modified and cost-effective method to prepare hair samples for cortisol assay. Hair samples were ground using an inexpensive ball grinder - ULTRA-TURRAX tube drive. Cortisol was extracted from the powder under various defined conditions. The data showed that the optimal conditions for this method include cortisol extraction at room temperature and evaporation using a stream of room air. These findings should allow more widespread research using economical technology to validate the utility of hair cortisol as a biomarker for assessing chronic stress status.

  9. Systematic process synthesis and design methods for cost effective waste minimization

    SciTech Connect

    Biegler, L.T.; Grossman, I.E.; Westerberg, A.W.

    1995-12-31

    We present progress on our work to develop synthesis methods to aid in the design of cost effective approaches to waste minimization. Work continues to combine the approaches of Douglas and coworkers and of Grossmann and coworkers on a hierarchical approach where bounding information allows it to fit within a mixed integer programming approach. We continue work on the synthesis of reactors and of flexible separation processes. In the first instance, we strive for methods we can use to reduce the production of potential pollutants, while in the second we look for ways to recover and recycle solvents.

  10. Evaluating the cost effectiveness of environmental projects: Case studies in aerospace and defense

    NASA Technical Reports Server (NTRS)

    Shunk, James F.

    1995-01-01

    Using the replacement technology of high pressure waterjet decoating systems as an example, a simple methodology is presented for developing a cost effectiveness model. The model uses a four-step process to formulate an economic justification designed for presentation to decision makers as an assessment of the value of the replacement technology over conventional methods. Three case studies from major U.S. and international airlines are used to illustrate the methodology and resulting model. Tax and depreciation impacts are also presented as potential additions to the model.

  11. Remediation alternatives for low-level herbicide contaminated groundwater

    SciTech Connect

    Conger, R.M.

    1995-10-01

    In early 1995, an evaluation of alternatives for remediation of a shallow groundwater plume containing low-levels of an organic herbicide was conducted at BASF Corporation, a petrochemical facility located in Ascension Parish, Louisiana. The contaminated site is located on an undeveloped portion of property within 1/4 mile of the east bank of the Mississippi River near the community of Geismar. Environmental assessment data indicated that about two acres of the thirty acre site had been contaminated from past waste management practices with the herbicide bentazon. Shallow soils and groundwater between 5 to 15 feet in depth were affected. Maximum concentrations of bentazon in groundwater were less than seven parts per million. To identify potentially feasible remediation alternatives, the environmental assessment data, available research, and cost effectiveness were reviewed. After consideration of a preliminary list of alternatives, only two potentially feasible alternatives could be identified. Groundwater pumping, the most commonly used remediation alternative, followed by carbon adsorption treatment was identified as was a new innovative alternative known as vegetative transpiration. This alternative relies on the natural transpiration processes of vegetation to bioremediate organic contaminants. Advantages identified during screening suggest that the transpiration method could be the best remediation alternative to address both economic and environmental factors. An experiment to test critical factors of the vegetatived transpiration alternative with bentazon was recommended before a final decision on feasibility can be made.

  12. Cost effectiveness of the 1993 Model Energy Code in Colorado

    SciTech Connect

    Lucas, R.G.

    1995-06-01

    This report documents an analysis of the cost effectiveness of the Council of American Building Officials` 1993 Model Energy Code (MEC) building thermal-envelope requirements for single-family homes in Colorado. The goal of this analysis was to compare the cost effectiveness of the 1993 MEC to current construction practice in Colorado based on an objective methodology that determined the total life-cycle cost associated with complying with the 1993 MEC. This analysis was performed for the range of Colorado climates. The costs and benefits of complying with the 1993 NIEC were estimated from the consumer`s perspective. The time when the homeowner realizes net cash savings (net positive cash flow) for homes built in accordance with the 1993 MEC was estimated to vary from 0.9 year in Steamboat Springs to 2.4 years in Denver. Compliance with the 1993 MEC was estimated to increase first costs by $1190 to $2274, resulting in an incremental down payment increase of $119 to $227 (at 10% down). The net present value of all costs and benefits to the home buyer, accounting for the mortgage and taxes, varied from a savings of $1772 in Springfield to a savings of $6614 in Steamboat Springs. The ratio of benefits to costs ranged from 2.3 in Denver to 3.8 in Steamboat Springs.

  13. Development and Manufacture of Cost Effective Composite Drill Pipe

    SciTech Connect

    James C. Leslie; James C. Leslie II; Lee Truong; James T. Heard; Steve Loya

    2006-02-20

    This technical report presents the engineering research, process development and data accomplishments that have transpired to date in support of the development of Cost Effective Composite Drill Pipe (CDP). The report presents progress made from October 1, 2004 through September 30, 2005 and contains the following discussions: (1) Qualification Testing; (2) Prototype Development and Testing of ''Smart Design'' Configuration; (3) Field Test Demonstration; and (4) Commercial order for SR-CDP from Torch International. The objective of this contract is to develop and demonstrate ''cost effective'' Composite Drill Pipe. It is projected that this drill pipe will weigh less than half of its steel counter part. The resultant weight reduction will provide enabling technology that will increase the lateral distance that can be reached from an offshore drilling platform and the depth of water in which drilling and production operations can be carried out. Further, composite drill pipe has the capability to carry real time signal and power transmission within the pipe walls. CDP can also accommodate much shorter drilling radius than is possible with metal drill pipe. As secondary benefits, the lighter weight drill pipe can increase the storage capability of floating off shore drilling platforms and provide substantial operational cost savings.

  14. Cost effectiveness of the stream-gaging program in Pennsylvania

    USGS Publications Warehouse

    Flippo, H.N.; Behrendt, T.E.

    1985-01-01

    This report documents a cost-effectiveness study of the stream-gaging program in Pennsylvania. Data uses and funding were identified for 223 continuous-record stream gages operated in 1983; four are planned for discontinuance at the close of water-year 1985; two are suggested for conversion, at the beginning of the 1985 water year, for the collection of only continuous stage records. Two of 11 special-purpose short-term gages are recommended for continuation when the supporting project ends; eight of these gages are to be discontinued and the other will be converted to a partial-record type. Current operation costs for the 212 stations recommended for continued operation is $1,199,000 per year in 1983. The average standard error of estimation for instantaneous streamflow is 15.2%. An overall average standard error of 9.8% could be attained on a budget of $1,271,000, which is 6% greater than the 1983 budget, by adopted cost-effective stream-gaging operations. (USGS)

  15. Cost effectiveness of the stream-gaging program in Nevada

    USGS Publications Warehouse

    Arteaga, F.E.

    1990-01-01

    The stream-gaging network in Nevada was evaluated as part of a nationwide effort by the U.S. Geological Survey to define and document the most cost-effective means of furnishing streamflow information. Specifically, the study dealt with 79 streamflow gages and 2 canal-flow gages that were under the direct operation of Nevada personnel as of 1983. Cost-effective allocations of resources, including budget and operational criteria, were studied using statistical procedures known as Kalman-filtering techniques. The possibility of developing streamflow data at ungaged sites was evaluated using flow-routing and statistical regression analyses. Neither of these methods provided sufficiently accurate results to warrant their use in place of stream gaging. The 81 gaging stations were being operated in 1983 with a budget of $465,500. As a result of this study, all existing stations were determined to be necessary components of the program for the foreseeable future. At the 1983 funding level, the average standard error of streamflow records was nearly 28%. This same overall level of accuracy could have been maintained with a budget of approximately $445,000 if the funds were redistributed more equitably among the gages. The maximum budget analyzed, $1,164 ,000 would have resulted in an average standard error of 11%. The study indicates that a major source of error is lost data. If perfectly operating equipment were available, the standard error for the 1983 program and budget could have been reduced to 21%. (Thacker-USGS, WRD)

  16. Simulating school closure policies for cost effective pandemic decision making

    PubMed Central

    2012-01-01

    Background Around the globe, school closures were used sporadically to mitigate the 2009 H1N1 influenza pandemic. However, such closures can detrimentally impact economic and social life. Methods Here, we couple a decision analytic approach with a mathematical model of influenza transmission to estimate the impact of school closures in terms of epidemiological and cost effectiveness. Our method assumes that the transmissibility and the severity of the disease are uncertain, and evaluates several closure and reopening strategies that cover a range of thresholds in school-aged prevalence (SAP) and closure durations. Results Assuming a willingness to pay per quality adjusted life-year (QALY) threshold equal to the US per capita GDP ($46,000), we found that the cost effectiveness of these strategies is highly dependent on the severity and on a willingness to pay per QALY. For severe pandemics, the preferred strategy couples the earliest closure trigger (0.5% SAP) with the longest duration closure (24 weeks) considered. For milder pandemics, the preferred strategies also involve the earliest closure trigger, but are shorter duration (12 weeks for low transmission rates and variable length for high transmission rates). Conclusions These findings highlight the importance of obtaining early estimates of pandemic severity and provide guidance to public health decision-makers for effectively tailoring school closures strategies in response to a newly emergent influenza pandemic. PMID:22713694

  17. Cost-effectiveness analysis in markets with high fixed costs.

    PubMed

    Cutler, David M; Ericson, Keith M Marzilli

    2010-01-01

    We consider how to conduct cost-effectiveness analysis when the social cost of a resource differs from the posted price. From the social perspective, the true cost of a medical intervention is the marginal cost of delivering another unit of a treatment, plus the social cost (deadweight loss) of raising the revenue to fund the treatment. We focus on pharmaceutical prices, which have high markups over marginal cost due to the monopoly power granted to pharmaceutical companies when drugs are under patent. We find that the social cost of a branded drug is approximately one-half the market price when the treatment is paid for by a public insurance plan and one-third the market price for mandated coverage by private insurance. We illustrate the importance of correctly accounting for social costs using two examples: coverage for statin drugs and approval for a drug to treat kidney cancer (sorafenib). In each case, we show that the correct social perspective for cost-effectiveness analysis would be more lenient than researcher recommendations.

  18. Cost effectiveness of the 1995 model energy code in Massachusetts

    SciTech Connect

    Lucas, R.G.

    1996-02-01

    This report documents an analysis of the cost effectiveness of the Council of American Building Officials` 1995 Model Energy Code (MEC) building thermal-envelope requirements for single-family houses and multifamily housing units in Massachusetts. The goal was to compare the cost effectiveness of the 1995 MEC to the energy conservation requirements of the Massachusetts State Building Code-based on a comparison of the costs and benefits associated with complying with each.. This comparison was performed for three cities representing three geographical regions of Massachusetts--Boston, Worcester, and Pittsfield. The analysis was done for two different scenarios: a ``move-up`` home buyer purchasing a single-family house and a ``first-time`` financially limited home buyer purchasing a multifamily condominium unit. Natural gas, oil, and electric resistance heating were examined. The Massachusetts state code has much more stringent requirements if electric resistance heating is used rather than other heating fuels and/or equipment types. The MEC requirements do not vary by fuel type. For single-family homes, the 1995 MEC has requirements that are more energy-efficient than the non-electric resistance requirements of the current state code. For multifamily housing, the 1995 MEC has requirements that are approximately equally energy-efficient to the non-electric resistance requirements of the current state code. The 1995 MEC is generally not more stringent than the electric resistance requirements of the state code, in fact; for multifamily buildings the 1995 MEC is much less stringent.