A primer on the cost of quality for improvement of laboratory and pathology specimen processes.

PubMed

Carlson, Richard O; Amirahmadi, Fazlollaah; Hernandez, James S

2012-09-01

In today's environment, many laboratories and pathology practices are challenged to maintain or increase their quality while simultaneously lowering their overall costs. The cost of improving specimen processes is related to quality, and we demonstrate that actual costs can be reduced by designing "quality at the source" into the processes. Various costs are hidden along the total testing process, and we suggest ways to identify opportunities to reduce cost by improving quality in laboratories and pathology practices through the use of Lean, Six Sigma, and industrial engineering.

Mapping patient pathways and estimating resource use for point of care versus standard testing and treatment of chlamydia and gonorrhoea in genitourinary medicine clinics in the UK.

PubMed

Adams, Elisabeth J; Ehrlich, Alice; Turner, Katherine M E; Shah, Kunj; Macleod, John; Goldenberg, Simon; Meray, Robin K; Pearce, Vikki; Horner, Patrick

2014-07-23

We aimed to explore patient pathways using a chlamydia/gonorrhoea point-of-care (POC) nucleic acid amplification test (NAAT), and estimate and compare the costs of the proposed POC pathways with the current pathways using standard laboratory-based NAAT testing. Workshops were conducted with healthcare professionals at four sexual health clinics representing diverse models of care in the UK. They mapped out current pathways that used chlamydia/gonorrhoea tests, and constructed new pathways using a POC NAAT. Healthcare professionals' time was assessed in each pathway. The proposed POC pathways were then priced using a model built in Microsoft Excel, and compared to previously published costs for pathways using standard NAAT-based testing in an off-site laboratory. Pathways using a POC NAAT for asymptomatic and symptomatic patients and chlamydia/gonorrhoea-only tests were shorter and less expensive than most of the current pathways. Notably, we estimate that POC testing as part of a sexual health screen for symptomatic patients, or as stand-alone chlamydia/gonorrhoea testing, could reduce costs per patient by as much as £16 or £6, respectively. In both cases, healthcare professionals' time would be reduced by approximately 10 min per patient. POC testing for chlamydia/gonorrhoea in a clinical setting may reduce costs and clinician time, and may lead to more appropriate and quicker care for patients. Further study is warranted on how to best implement POC testing in clinics, and on the broader clinical and cost implications of this technology. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Design, processing and testing of LSI arrays: Hybrid microelectronics task

NASA Technical Reports Server (NTRS)

Himmel, R. P.; Stuhlbarg, S. M.; Ravetti, R. G.; Zulueta, P. J.

1979-01-01

Mathematical cost factors were generated for both hybrid microcircuit and printed wiring board packaging methods. A mathematical cost model was created for analysis of microcircuit fabrication costs. The costing factors were refined and reduced to formulae for computerization. Efficient methods were investigated for low cost packaging of LSI devices as a function of density and reliability. Technical problem areas such as wafer bumping, inner/outer leading bonding, testing on tape, and tape processing, were investigated.

Cost Analysis of Tuberculosis Diagnosis in Cambodia with and without Xpert® MTB/RIF for People Living with HIV/AIDS and People with Presumptive Multidrug-resistant Tuberculosis.

PubMed

Pallas, Sarah Wood; Courey, Marissa; Hy, Chhaily; Killam, Wm Perry; Warren, Dora; Moore, Brittany

2018-06-04

The Xpert ® MTB/RIF (Xpert) test has been shown to be effective and cost-effective for diagnosing tuberculosis (TB) under conditions with high HIV prevalence and HIV-TB co-infection but less is known about Xpert's cost in low HIV prevalence settings. Cambodia, a country with low HIV prevalence (0.7%), high TB burden, and low multidrug-resistant (MDR) TB burden (1.4% of new TB cases, 11% of retreatment cases) introduced Xpert into its TB diagnostic algorithms for people living with HIV (PLHIV) and people with presumptive MDR TB in 2012. The study objective was to estimate these algorithms' costs pre- and post-Xpert introduction in four provinces of Cambodia. Using a retrospective, ingredients-based microcosting approach, primary cost data on personnel, equipment, maintenance, supplies, and specimen transport were collected at four sites through observation, records review, and key informant consultations. Across the sample facilities, the cost per Xpert test was US$33.88-US$37.11, clinical exam cost US$1.22-US$1.84, chest X-ray cost US$2.02-US$2.14, fluorescent microscopy (FM) smear cost US$1.56-US$1.93, Ziehl-Neelsen (ZN) smear cost US$1.26, liquid culture test cost US$11.63-US$22.83, follow-on work-up for positive culture results and Mycobacterium tuberculosis complex (MTB) identification cost US$11.50-US$14.72, and drug susceptibility testing (DST) cost US$44.26. Specimen transport added US$1.39-US$5.21 per sample. Assuming clinician adherence to the algorithms and perfect test accuracy, the normative cost per patient correctly diagnosed under the post-Xpert algorithms would be US$25-US$29 more per PLHIV and US$34-US$37 more per person with presumptive MDR TB (US$41 more per PLHIV when accounting for variable test sensitivity and specificity). Xpert test unit costs could be reduced through lower cartridge prices, longer usable life of GeneXpert ® (Cepheid, USA) instruments, and increased test volumes; however, epidemiological and test eligibility conditions in Cambodia limit the number of specimens received at laboratories, leading to sub-optimal utilization of current instruments. Improvements to patient referral and specimen transport could increase test volumes and reduce Xpert test unit costs in this setting.

Reducing the staggering costs of environmental disease in children, estimated at $76.6 billion in 2008.

PubMed

Trasande, Leonardo; Liu, Yinghua

2011-05-01

A 2002 analysis documented $54.9 billion in annual costs of environmentally mediated diseases in US children. However, few important changes in federal policy have been implemented to prevent exposures to toxic chemicals. We therefore updated and expanded the previous analysis and found that the costs of lead poisoning, prenatal methylmercury exposure, childhood cancer, asthma, intellectual disability, autism, and attention deficit hyperactivity disorder were $76.6 billion in 2008. To prevent further increases in these costs, efforts are needed to institute premarket testing of new chemicals; conduct toxicity testing on chemicals already in use; reduce lead-based paint hazards; and curb mercury emissions from coal-fired power plants.

Minnesota urban partnership agreement national evaluation : cost benefit analysis test plan.

DOT National Transportation Integrated Search

2009-11-17

This report presents the cost benefit analysis test plan for the Minnesota Urban Partnership Agreement (UPA) under the United States Department of Transportation (U.S. DOT) UPA Program. The Minnesota UPA projects focus on reducing congestion by emplo...

A standard for test reliability in group research.

PubMed

Ellis, Jules L

2013-03-01

Many authors adhere to the rule that test reliabilities should be at least .70 or .80 in group research. This article introduces a new standard according to which reliabilities can be evaluated. This standard is based on the costs or time of the experiment and of administering the test. For example, if test administration costs are 7 % of the total experimental costs, the efficient value of the reliability is .93. If the actual reliability of a test is equal to this efficient reliability, the test size maximizes the statistical power of the experiment, given the costs. As a standard in experimental research, it is proposed that the reliability of the dependent variable be close to the efficient reliability. Adhering to this standard will enhance the statistical power and reduce the costs of experiments.

Cost-effectiveness of Population Screening for BRCA Mutations in Ashkenazi Jewish Women Compared With Family History–Based Testing

PubMed Central

Manchanda, Ranjit; Legood, Rosa; Burnell, Matthew; McGuire, Alistair; Raikou, Maria; Loggenberg, Kelly; Wardle, Jane; Sanderson, Saskia; Gessler, Sue; Side, Lucy; Balogun, Nyala; Desai, Rakshit; Kumar, Ajith; Dorkins, Huw; Wallis, Yvonne; Chapman, Cyril; Taylor, Rohan; Jacobs, Chris; Tomlinson, Ian; Beller, Uziel; Menon, Usha

2015-01-01

Background: Population-based testing for BRCA1/2 mutations detects the high proportion of carriers not identified by cancer family history (FH)–based testing. We compared the cost-effectiveness of population-based BRCA testing with the standard FH-based approach in Ashkenazi Jewish (AJ) women. Methods: A decision-analytic model was developed to compare lifetime costs and effects amongst AJ women in the UK of BRCA founder-mutation testing amongst: 1) all women in the population age 30 years or older and 2) just those with a strong FH (≥10% mutation risk). The model assumes that BRCA carriers are offered risk-reducing salpingo-oophorectomy and annual MRI/mammography screening or risk-reducing mastectomy. Model probabilities utilize the Genetic Cancer Prediction through Population Screening trial/published literature to estimate total costs, effects in terms of quality-adjusted life-years (QALYs), cancer incidence, incremental cost-effectiveness ratio (ICER), and population impact. Costs are reported at 2010 prices. Costs/outcomes were discounted at 3.5%. We used deterministic/probabilistic sensitivity analysis (PSA) to evaluate model uncertainty. Results: Compared with FH-based testing, population-screening saved 0.090 more life-years and 0.101 more QALYs resulting in 33 days’ gain in life expectancy. Population screening was found to be cost saving with a baseline-discounted ICER of -£2079/QALY. Population-based screening lowered ovarian and breast cancer incidence by 0.34% and 0.62%. Assuming 71% testing uptake, this leads to 276 fewer ovarian and 508 fewer breast cancer cases. Overall, reduction in treatment costs led to a discounted cost savings of £3.7 million. Deterministic sensitivity analysis and 94% of simulations on PSA (threshold £20000) indicated that population screening is cost-effective, compared with current NHS policy. Conclusion: Population-based screening for BRCA mutations is highly cost-effective compared with an FH-based approach in AJ women age 30 years and older. PMID:25435542

Appropriate use of screening and diagnostic tests to foster high-value, cost-conscious care.

PubMed

Qaseem, Amir; Alguire, Patrick; Dallas, Paul; Feinberg, Lawrence E; Fitzgerald, Faith T; Horwitch, Carrie; Humphrey, Linda; LeBlond, Richard; Moyer, Darilyn; Wiese, Jeffrey G; Weinberger, Steven

2012-01-17

Unsustainable rising health care costs in the United States have made reducing costs while maintaining high-quality health care a national priority. The overuse of some screening and diagnostic tests is an important component of unnecessary health care costs. More judicious use of such tests will improve quality and reflect responsible awareness of costs. Efforts to control expenditures should focus not only on benefits, harms, and costs but on the value of diagnostic tests-meaning an assessment of whether a test provides health benefits that are worth its costs or harms. To begin to identify ways that practicing clinicians can contribute to the delivery of high-value, cost-conscious health care, the American College of Physicians convened a workgroup of physicians to identify, using a consensus-based process, common clinical situations in which screening and diagnostic tests are used in ways that do not reflect high-value care. The intent of this exercise is to promote thoughtful discussions about these tests and other health care interventions to promote high-value, cost-conscious care.

Effect of Study Design on Sample Size in Studies Intended to Evaluate Bioequivalence of Inhaled Short‐Acting β‐Agonist Formulations

PubMed Central

Zeng, Yaohui; Singh, Sachinkumar; Wang, Kai

2017-01-01

Abstract Pharmacodynamic studies that use methacholine challenge to assess bioequivalence of generic and innovator albuterol formulations are generally designed per published Food and Drug Administration guidance, with 3 reference doses and 1 test dose (3‐by‐1 design). These studies are challenging and expensive to conduct, typically requiring large sample sizes. We proposed 14 modified study designs as alternatives to the Food and Drug Administration–recommended 3‐by‐1 design, hypothesizing that adding reference and/or test doses would reduce sample size and cost. We used Monte Carlo simulation to estimate sample size. Simulation inputs were selected based on published studies and our own experience with this type of trial. We also estimated effects of these modified study designs on study cost. Most of these altered designs reduced sample size and cost relative to the 3‐by‐1 design, some decreasing cost by more than 40%. The most effective single study dose to add was 180 μg of test formulation, which resulted in an estimated 30% relative cost reduction. Adding a single test dose of 90 μg was less effective, producing only a 13% cost reduction. Adding a lone reference dose of either 180, 270, or 360 μg yielded little benefit (less than 10% cost reduction), whereas adding 720 μg resulted in a 19% cost reduction. Of the 14 study design modifications we evaluated, the most effective was addition of both a 90‐μg test dose and a 720‐μg reference dose (42% cost reduction). Combining a 180‐μg test dose and a 720‐μg reference dose produced an estimated 36% cost reduction. PMID:29281130

Cost-effectiveness analysis of cervical cancer prevention based on a rapid human papillomavirus screening test in a high-risk region of China.

PubMed

Levin, Carol E; Sellors, John; Shi, Ju-Fang; Ma, Li; Qiao, You-lin; Ortendahl, Jesse; O'Shea, Meredith K H; Goldie, Sue J

2010-09-01

This study assessed the cost-effectiveness of a new, rapid human papillomavirus (HPV)-DNA screening test for cervical cancer prevention in the high-risk region of Shanxi, China. Using micro-costing methods, we estimated the resources needed to implement preventive strategies using cervical cytology or HPV-DNA testing, including the Hybrid Capture 2 (hc2) test (QIAGEN Corp., Gaithersburg, MD) and the rapid HPV-DNA careHPV test (QIAGEN). Data were used in a previously published model and empirically calibrated to country-specific epidemiological data. Strategies differed by initial test, targeted age, frequency of screening, number of clinic visits required (1, 2 or 3) and service delivery setting (national, county and township levels). Outcomes included lifetime risk of cancer, years of life saved (YLS), lifetime costs and incremental cost-effectiveness ratios (cost per YLS). For all screening frequencies, the most efficient strategy used 2-visit rapid HPV-DNA testing at the county level, including screening and diagnostics in the first visit, and treatment in the second visit. Screening at ages 35, 40 and 45 reduced cancer risk by 50% among women compliant with all 3 screening rounds, and was US$ 150 per YLS, compared with this same strategy applied twice per lifetime. This would be considered very cost-effective evaluated against China's per-capita gross domestic product (US$ 1,702). By enhancing the linkage between screening and treatment through a reduced number of visits, rapid HPV-DNA testing 3 times per lifetime is more effective than traditional cytology, and is likely to be cost-effective in high-risk regions of China.

Costs of fear: Behavioral and life-history responses to risk and their demographic consequences vary across species

USGS Publications Warehouse

LaManna, Joseph A.; Martin, Thomas E.

2016-01-01

Behavioural responses to reduce predation risk might cause demographic ‘costs of fear’. Costs differ among species, but a conceptual framework to understand this variation is lacking. We use a life-history framework to tie together diverse traits and life stages to better understand interspecific variation in responses and costs. We used natural and experimental variation in predation risk to test phenotypic responses and associated demographic costs for 10 songbird species. Responses such as increased parental attentiveness yielded reduced development time and created benefits such as reduced predation probability. Yet, responses to increased risk also created demographic costs by reducing offspring production in the absence of direct predation. This cost of fear varied widely across species, but predictably with the probability of repeat breeding. Use of a life-history framework can aid our understanding of potential demographic costs from predation, both from responses to perceived risk and from direct predation mortality.

Cost effectiveness analysis of HLA-B*58:01 genotyping prior to initiation of allopurinol for gout.

PubMed

Plumpton, Catrin O; Alfirevic, Ana; Pirmohamed, Munir; Hughes, Dyfrig A

2017-10-01

To determine whether prospective testing for HLA-B*58:01, as a strategy to prevent serious adverse reactions to allopurinol in patients with gout, is cost-effective from the perspective of the National Health Service in the UK. A systematic review and meta-analysis for the association of HLA-B*58:01 with cutaneous and hypersensitivity adverse drug reactions informed a decision analytic and Markov model to estimate lifetime costs and outcomes associated with testing vs standard care (with febuxostat prescribed for patients who test positive). Scenario analyses assessed alternative treatment assumptions and patient populations. The number of patients needed to test to prevent one case of adverse drug reaction was 11 286 (95% central range (CR): 2573, 53 594). Cost and quality-adjusted life-year (QALY) gains were small, £103 (95% CR: £98, £106) and 0.0023 (95% CR: -0.0006, 0.0055), respectively, resulting in an incremental cost-effectiveness ratio (ICER) of £44 954 per QALY gained. The probability of testing being cost-effective at a threshold of £30 000 per QALY was 0.25. Reduced costs of testing or febuxostat resulted in an ICER below £30 000 per QALY gained. The ICER for patients with chronic renal insufficiency was £38 478 per QALY gained. Routine testing for HLA-B*58:01 in order to reduce the incidence of adverse drug reactions in patients being prescribed allopurinol for gout is unlikely to be cost-effective in the UK; however testing is expected to become cost-effective with reductions in the cost of genotyping, and with the future availability of cheaper, generic febuxostat. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Cost-effectiveness of using a molecular diagnostic test to improve preoperative diagnosis of thyroid cancer.

PubMed

Najafzadeh, Mehdi; Marra, Carlo A; Lynd, Larry D; Wiseman, Sam M

2012-12-01

Fine-needle aspiration biopsy (FNAB) is a safe and inexpensive diagnostic procedure for evaluating thyroid nodules.Up to 25% of the results from an FNAB, however, may not be diagnostic or may be indeterminate, leading to a subsequent diagnostic thyroid surgery. A new molecularly based diagnostic test could potentially reduce indeterminate cytological results and, with high accuracy, provide a definitive diagnosis for cancer in thyroid nodules. The aim of the study was to estimate the cost-effectiveness of utilizing a molecular diagnostic (DX) test as an adjunct to FNAB, compared with NoDX, to improve the preoperative diagnosis of thyroid nodules. We constructed a patient-level simulation model to estimate the clinical and economic outcomes of using a DX test compared with current practice (NoDX) for the diagnosis of thyroid nodules. By using a cost-effectiveness framework, we measured incremental clinical benefits in terms of quality-adjusted life-years and incremental costs over a 10-year time horizon. Assuming 95% sensitivity and specificity of the Dx test when used as an adjunct to FNAB, the utilization of the DX test resulted in a gain of 0.046 quality-adjusted life-years (95% confidence interval 0.019-0.078) and a saving of $1087 (95% confidence interval $691-$1533) in direct costs per patient. If the cost of the Dx test is less than $1087 per test, we expect to save quality-adjusted life-years and reduce costs when it is utilized. Sensitivity of the DX test, compared with specificity, had a larger influence on the overall outcomes. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Evidence for more cost-effective surveillance options for bovine spongiform encephalopathy (BSE) and scrapie in Great Britain.

PubMed

Wall, Ben A; Arnold, Mark E; Radia, Devi; Gilbert, Will; Ortiz-Pelaez, Angel; Stärk, Katharina Dc; Van Klink, Ed; Guitian, Javier

2017-08-10

Transmissible spongiform encephalopathies (TSEs) are an important public health concern. Since the emergence of bovine spongiform encephalopathy (BSE) during the 1980s and its link with human Creutzfeldt-Jakob disease, active surveillance has been a key element of the European Union's TSE control strategy. Success of this strategy means that now, very few cases are detected compared with the number of animals tested. Refining surveillance strategies would enable resources to be redirected towards other public health priorities. Cost-effectiveness analysis was performed on several alternative strategies involving reducing the number of animals tested for BSE and scrapie in Great Britain and, for scrapie, varying the ratio of sheep sampled in the abattoir to fallen stock (which died on the farm). The most cost-effective strategy modelled for BSE involved reducing the proportion of fallen stock tested from 100% to 75%, producing a cost saving of ca GBP 700,000 per annum. If 50% of fallen stock were tested, a saving of ca GBP 1.4 million per annum could be achieved. However, these reductions are predicted to increase the period before surveillance can detect an outbreak. For scrapie, reducing the proportion of abattoir samples was the most cost-effective strategy modelled, with limited impact on surveillance effectiveness. This article is copyright of The Authors, 2017.

Rocket Design for the Future

NASA Technical Reports Server (NTRS)

Follett, William W.; Rajagopal, Raj

2001-01-01

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

The development of an Infrared Environmental System for TOPEX Solar Panel Testing

NASA Technical Reports Server (NTRS)

Noller, E.

1994-01-01

Environmental testing and flight qualification of the TOPEX/POSEIDON spacecraft solar panels were performed with infrared (IR) lamps and a control system that were newly designed and integrated. The basic goal was more rigorous testing of the costly panels' new composite-structure design without jeopardizing their safety. The technique greatly reduces the costs and high risks of testing flight solar panels.

Budget impact analysis of gene expression tests to aid therapy decisions for breast cancer patients in Germany.

PubMed

Lux, M P; Nabieva, N; Hildebrandt, T; Rebscher, H; Kümmel, S; Blohmer, J-U; Schrauder, M G

2018-02-01

Many women with early-stage, hormone receptor-positive breast cancer may not benefit from adjuvant chemotherapy. Gene expression tests can reduce chemotherapy over- and undertreatment by providing prognostic information on the likelihood of recurrence and, with Oncotype DX, predictive information on chemotherapy benefit. These tests are currently not reimbursed by German healthcare payers. An analysis was conducted to evaluate the budget impact of gene expression tests in Germany. Costs of gene expression tests and medical and non-medical costs associated with treatment were assessed from healthcare payer and societal perspectives. Costs were estimated from data collected at a university hospital and were combined with decision impact data for Oncotype DX, MammaPrint, Prosigna and EndoPredict (EPclin). Changes in chemotherapy use and budget impact were evaluated over 1 year for 20,000 women. Chemotherapy was associated with substantial annual costs of EUR 19,003 and EUR 84,412 per therapy from the healthcare payer and societal perspective, respectively. Compared with standard care, only Oncotype DX was associated with cost savings to healthcare payers and society (EUR 5.9 million and EUR 253 million, respectively). Scenario analysis showed that both women at high clinical but low genomic risk and low clinical but high genomic risk were important contributors to costs. Oncotype DX was the only gene expression test that was estimated to reduce costs versus standard care in Germany. The reimbursement of Oncotype DX testing in standard clinical practice in Germany should be considered. Copyright © 2017 Elsevier Ltd. All rights reserved.

Potential Cost-effectiveness of Early Identification of Hospital-acquired Infection in Critically Ill Patients.

PubMed

Tsalik, Ephraim L; Li, Yanhong; Hudson, Lori L; Chu, Vivian H; Himmel, Tiffany; Limkakeng, Alex T; Katz, Jason N; Glickman, Seth W; McClain, Micah T; Welty-Wolf, Karen E; Fowler, Vance G; Ginsburg, Geoffrey S; Woods, Christopher W; Reed, Shelby D

2016-03-01

Limitations in methods for the rapid diagnosis of hospital-acquired infections often delay initiation of effective antimicrobial therapy. New diagnostic approaches offer potential clinical and cost-related improvements in the management of these infections. We developed a decision modeling framework to assess the potential cost-effectiveness of a rapid biomarker assay to identify hospital-acquired infection in high-risk patients earlier than standard diagnostic testing. The framework includes parameters representing rates of infection, rates of delayed appropriate therapy, and impact of delayed therapy on mortality, along with assumptions about diagnostic test characteristics and their impact on delayed therapy and length of stay. Parameter estimates were based on contemporary, published studies and supplemented with data from a four-site, observational, clinical study. Extensive sensitivity analyses were performed. The base-case analysis assumed 17.6% of ventilated patients and 11.2% of nonventilated patients develop hospital-acquired infection and that 28.7% of patients with hospital-acquired infection experience delays in appropriate antibiotic therapy with standard care. We assumed this percentage decreased by 50% (to 14.4%) among patients with true-positive results and increased by 50% (to 43.1%) among patients with false-negative results using a hypothetical biomarker assay. Cost of testing was set at $110/d. In the base-case analysis, among ventilated patients, daily diagnostic testing starting on admission reduced inpatient mortality from 12.3 to 11.9% and increased mean costs by $1,640 per patient, resulting in an incremental cost-effectiveness ratio of $21,389 per life-year saved. Among nonventilated patients, inpatient mortality decreased from 7.3 to 7.1% and costs increased by $1,381 with diagnostic testing. The resulting incremental cost-effectiveness ratio was $42,325 per life-year saved. Threshold analyses revealed the probabilities of developing hospital-acquired infection in ventilated and nonventilated patients could be as low as 8.4 and 9.8%, respectively, to maintain incremental cost-effectiveness ratios less than $50,000 per life-year saved. Development and use of serial diagnostic testing that reduces the proportion of patients with delays in appropriate antibiotic therapy for hospital-acquired infections could reduce inpatient mortality. The model presented here offers a cost-effectiveness framework for future test development.

Can IR scene projectors reduce total system cost?

NASA Astrophysics Data System (ADS)

Ginn, Robert; Solomon, Steven

2006-05-01

There is an incredible amount of system engineering involved in turning the typical infrared system needs of probability of detection, probability of identification, and probability of false alarm into focal plane array (FPA) requirements of noise equivalent irradiance (NEI), modulation transfer function (MTF), fixed pattern noise (FPN), and defective pixels. Unfortunately, there are no analytic solutions to this problem so many approximations and plenty of "seat of the pants" engineering is employed. This leads to conservative specifications, which needlessly drive up system costs by increasing system engineering costs, reducing FPA yields, increasing test costs, increasing rework and the never ending renegotiation of requirements in an effort to rein in costs. These issues do not include the added complexity to the FPA factory manager of trying to meet varied, and changing, requirements for similar products because different customers have made different approximations and flown down different specifications. Scene generation technology may well be mature and cost effective enough to generate considerable overall savings for FPA based systems. We will compare the costs and capabilities of various existing scene generation systems and estimate the potential savings if implemented at several locations in the IR system fabrication cycle. The costs of implementing this new testing methodology will be compared to the probable savings in systems engineering, test, rework, yield improvement and others. The diverse requirements and techniques required for testing missile warning systems, missile seekers, and FLIRs will be defined. Last, we will discuss both the hardware and software requirements necessary to meet the new test paradigm and discuss additional cost improvements related to the incorporation of these technologies.

Evaluation of Reduced Sediment Volume Procedures for Acute Toxicity Tests Using the Estuarine Amphipod Leptocheirus plumulosus

EPA Science Inventory

The volume of sediment required to perform a sediment toxicity bioassay is a major driver of the overall cost associated with that bioassay. Sediment volume affects bioassay cost due to sediment collection, transportation, storage, and disposal costs as well as labor costs assoc...

Cost-effectiveness analysis of germ-line BRCA testing in women with breast cancer and cascade testing in family members of mutation carriers.

PubMed

Tuffaha, Haitham W; Mitchell, Andrew; Ward, Robyn L; Connelly, Luke; Butler, James R G; Norris, Sarah; Scuffham, Paul A

2018-01-04

PurposeTo evaluate the cost-effectiveness of BRCA testing in women with breast cancer, and cascade testing in family members of BRCA mutation carriers.MethodsA cost-effectiveness analysis was conducted using a cohort Markov model from a health-payer perspective. The model estimated the long-term benefits and costs of testing women with breast cancer who had at least a 10% pretest BRCA mutation probability, and the cascade testing of first- and second-degree relatives of women who test positive.ResultsCompared with no testing, BRCA testing of affected women resulted in an incremental cost per quality-adjusted life-year (QALY) gained of AU$18,900 (incremental cost AU$1,880; incremental QALY gain 0.10) with reductions of 0.04 breast and 0.01 ovarian cancer events. Testing affected women and cascade testing of family members resulted in an incremental cost per QALY gained of AU$9,500 compared with testing affected women only (incremental cost AU$665; incremental QALY gain 0.07) with additional reductions of 0.06 breast and 0.01 ovarian cancer events.ConclusionBRCA testing in women with breast cancer is cost-effective and is associated with reduced risk of cancer and improved survival. Extending testing to cover family members of affected women who test positive improves cost-effectiveness beyond restricting testing to affected women only.GENETICS in MEDICINE advance online publication, 4 January 2018; doi:10.1038/gim.2017.231.

Limitations of Reliability for Long-Endurance Human Spaceflight

NASA Technical Reports Server (NTRS)

Owens, Andrew C.; de Weck, Olivier L.

2016-01-01

Long-endurance human spaceflight - such as missions to Mars or its moons - will present a never-before-seen maintenance logistics challenge. Crews will be in space for longer and be farther way from Earth than ever before. Resupply and abort options will be heavily constrained, and will have timescales much longer than current and past experience. Spare parts and/or redundant systems will have to be included to reduce risk. However, the high cost of transportation means that this risk reduction must be achieved while also minimizing mass. The concept of increasing system and component reliability is commonly discussed as a means to reduce risk and mass by reducing the probability that components will fail during a mission. While increased reliability can reduce maintenance logistics mass requirements, the rate of mass reduction decreases over time. In addition, reliability growth requires increased test time and cost. This paper assesses trends in test time requirements, cost, and maintenance logistics mass savings as a function of increase in Mean Time Between Failures (MTBF) for some or all of the components in a system. In general, reliability growth results in superlinear growth in test time requirements, exponential growth in cost, and sublinear benefits (in terms of logistics mass saved). These trends indicate that it is unlikely that reliability growth alone will be a cost-effective approach to maintenance logistics mass reduction and risk mitigation for long-endurance missions. This paper discusses these trends as well as other options to reduce logistics mass such as direct reduction of part mass, commonality, or In-Space Manufacturing (ISM). Overall, it is likely that some combination of all available options - including reliability growth - will be required to reduce mass and mitigate risk for future deep space missions.

Cost-Effectiveness of POC Coagulation Testing Using Multiple Electrode Aggregometry.

PubMed

Straub, Niels; Bauer, Ekaterina; Agarwal, Seema; Meybohm, Patrick; Zacharowski, Kai; Hanke, Alexander A; Weber, Christian F

2016-01-01

The economic effects of Point-of-Care (POC) coagulation testing including Multiple Electrode Aggregometry (MEA) with the Multiplate device have not been examined. A health economic model with associated clinical endpoints was developed to calculate the effectiveness and estimated costs of coagulation analyses based on standard laboratory testing (SLT) or POC testing offering the possibility to assess platelet dysfunction using aggregometric measures. Cost estimates included pre- and perioperative costs of hemotherapy, intra- and post-operative coagulation testing costs, and hospitalization costs, including the costs of transfusion-related complications. Our model calculation using a simulated true-to-life cohort of 10,000 cardiac surgery patients assigned to each testing alternative demonstrated that there were 950 fewer patients in the POC branch who required any transfusion of red blood cells. The subsequent numbers of massive transfusions and patients with transfusion-related complications were reduced with the POC testing by 284 and 126, respectively. The average expected total cost in the POC branch was 288 Euro lower for every treated patient than that in the SLT branch. Incorporating aggregometric analyses using MEA into hemotherapy algorithms improved medical outcomes in cardiac surgery patients in the presented health economic model. There was an overall better economic outcome associated with POC testing compared with SLT testing despite the higher costs of testing.

Field testing of a low-cost retrofit filter berm to treat stormwater runoff contaminants.

DOT National Transportation Integrated Search

2008-09-01

The goal of this cooperative effort between MaineDOT and the University of New Hampshire was to test a low-cost : retrofit filter berm that would reduce non-point pollution from highway runoff. The retrofit berm would be easy to : construct using rea...

Cost-effectiveness of HPV-based cervical cancer screening in the public health system in Nicaragua.

PubMed

Campos, Nicole G; Mvundura, Mercy; Jeronimo, Jose; Holme, Francesca; Vodicka, Elisabeth; Kim, Jane J

2017-06-15

To evaluate the cost-effectiveness of human papillomavirus (HPV) DNA testing (versus Papanicolaou (Pap)-based screening) for cervical cancer screening in Nicaragua. A previously developed Monte Carlo simulation model of the natural history of HPV infection and cervical cancer was calibrated to epidemiological data from Nicaragua. Cost data inputs were derived using a micro-costing approach in Carazo, Chontales and Chinandega departments; test performance data were from a demonstration project in Masaya department. Nicaragua's public health sector facilities. Women aged 30-59 years. Screening strategies included (1) Pap testing every 3 years, with referral to colposcopy for women with an atypical squamous cells of undetermined significance or worse result ('Pap'); (2) HPV testing every 5 years, with referral to cryotherapy for HPV-positive eligible women (HPV cryotherapy or 'HPV-Cryo'); (3) HPV testing every 5 years, with referral to triage with visual inspection with acetic acid (VIA) for HPV-positive women ('HPV-VIA'); and (4) HPV testing every 5 years, with referral to Pap testing for HPV-positive women ('HPV-Pap'). Reduction in lifetime risk of cancer and incremental cost-effectiveness ratios (ICER; 2015 US$ per year of life saved (YLS)). HPV-based screening strategies were more effective than Pap testing. HPV-Cryo was the least costly and most effective strategy, reducing lifetime cancer risk by 29.5% and outperforming HPV-VIA, HPV-Pap and Pap only, which reduced cancer risk by 19.4%, 12.2% and 10.8%, respectively. With an ICER of US$320/YLS, HPV-Cryo every 5 years would be very cost-effective using a threshold based on Nicaragua's per capita gross domestic product of US$2090. Findings were robust across sensitivity analyses on test performance, coverage, compliance and cost parameters. HPV testing is very cost-effective compared with Pap testing in Nicaragua, due to higher test sensitivity and the relatively lower number of visits required. Increasing compliance with recommended follow-up will further improve the health benefits and value for public health dollars. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Cost-effectiveness of HPV-based cervical cancer screening in the public health system in Nicaragua

PubMed Central

Mvundura, Mercy; Jeronimo, Jose; Holme, Francesca; Vodicka, Elisabeth; Kim, Jane J

2017-01-01

Objectives To evaluate the cost-effectiveness of human papillomavirus (HPV) DNA testing (versus Papanicolaou (Pap)-based screening) for cervical cancer screening in Nicaragua. Design A previously developed Monte Carlo simulation model of the natural history of HPV infection and cervical cancer was calibrated to epidemiological data from Nicaragua. Cost data inputs were derived using a micro-costing approach in Carazo, Chontales and Chinandega departments; test performance data were from a demonstration project in Masaya department. Setting Nicaragua’s public health sector facilities. Participants Women aged 30–59 years. Interventions Screening strategies included (1) Pap testing every 3 years, with referral to colposcopy for women with an atypical squamous cells of undetermined significance or worse result (‘Pap’); (2) HPV testing every 5 years, with referral to cryotherapy for HPV-positive eligible women (HPV cryotherapy or ‘HPV-Cryo’); (3) HPV testing every 5 years, with referral to triage with visual inspection with acetic acid (VIA) for HPV-positive women (‘HPV-VIA’); and (4) HPV testing every 5 years, with referral to Pap testing for HPV-positive women (‘HPV-Pap’). Outcome measures Reduction in lifetime risk of cancer and incremental cost-effectiveness ratios (ICER; 2015 US$ per year of life saved (YLS)). Results HPV-based screening strategies were more effective than Pap testing. HPV-Cryo was the least costly and most effective strategy, reducing lifetime cancer risk by 29.5% and outperforming HPV-VIA, HPV-Pap and Pap only, which reduced cancer risk by 19.4%, 12.2% and 10.8%, respectively. With an ICER of US$320/YLS, HPV-Cryo every 5 years would be very cost-effective using a threshold based on Nicaragua’s per capita gross domestic product of US$2090. Findings were robust across sensitivity analyses on test performance, coverage, compliance and cost parameters. Conclusions HPV testing is very cost-effective compared with Pap testing in Nicaragua, due to higher test sensitivity and the relatively lower number of visits required. Increasing compliance with recommended follow-up will further improve the health benefits and value for public health dollars. PMID:28619772

Stereotype threat can reduce older adults' memory errors.

PubMed

Barber, Sarah J; Mather, Mara

2013-01-01

Stereotype threat often incurs the cost of reducing the amount of information that older adults accurately recall. In the current research, we tested whether stereotype threat can also benefit memory. According to the regulatory focus account of stereotype threat, threat induces a prevention focus in which people become concerned with avoiding errors of commission and are sensitive to the presence or absence of losses within their environment. Because of this, we predicted that stereotype threat might reduce older adults' memory errors. Results were consistent with this prediction. Older adults under stereotype threat had lower intrusion rates during free-recall tests (Experiments 1 and 2). They also reduced their false alarms and adopted more conservative response criteria during a recognition test (Experiment 2). Thus, stereotype threat can decrease older adults' false memories, albeit at the cost of fewer veridical memories, as well.

Reagent and labor cost optimization through automation of fluorescence in situ hybridization (FISH) with the VP 2000: an Italian case study.

PubMed

Zanatta, Lucia; Valori, Laura; Cappelletto, Eleonora; Pozzebon, Maria Elena; Pavan, Elisabetta; Dei Tos, Angelo Paolo; Merkle, Dennis

2015-02-01

In the modern molecular diagnostic laboratory, cost considerations are of paramount importance. Automation of complex molecular assays not only allows a laboratory to accommodate higher test volumes and throughput but also has a considerable impact on the cost of testing from the perspective of reagent costs, as well as hands-on time for skilled laboratory personnel. The following study tracked the cost of labor (hands-on time) and reagents for fluorescence in situ hybridization (FISH) testing in a routine, high-volume pathology and cytogenetics laboratory in Treviso, Italy, over a 2-y period (2011-2013). The laboratory automated FISH testing with the VP 2000 Processor, a deparaffinization, pretreatment, and special staining instrument produced by Abbott Molecular, and compared hands-on time and reagent costs to manual FISH testing. The results indicated significant cost and time saving when automating FISH with VP 2000 when more than six FISH tests were run per week. At 12 FISH assays per week, an approximate total cost reduction of 55% was observed. When running 46 FISH specimens per week, the cost saving increased to 89% versus manual testing. The results demonstrate that the VP 2000 processor can significantly reduce the cost of FISH testing in diagnostic laboratories. © 2014 Society for Laboratory Automation and Screening.

Impact of automatic calibration techniques on HMD life cycle costs and sustainable performance

NASA Astrophysics Data System (ADS)

Speck, Richard P.; Herz, Norman E., Jr.

2000-06-01

Automatic test and calibration has become a valuable feature in many consumer products--ranging from antilock braking systems to auto-tune TVs. This paper discusses HMDs (Helmet Mounted Displays) and how similar techniques can reduce life cycle costs and increase sustainable performance if they are integrated into a program early enough. Optical ATE (Automatic Test Equipment) is already zeroing distortion in the HMDs and thereby making binocular displays a practical reality. A suitcase sized, field portable optical ATE unit could re-zero these errors in the Ready Room to cancel the effects of aging, minor damage and component replacement. Planning on this would yield large savings through relaxed component specifications and reduced logistic costs. Yet, the sustained performance would far exceed that attained with fixed calibration strategies. Major tactical benefits can come from reducing display errors, particularly in information fusion modules and virtual `beyond visual range' operations. Some versions of the ATE described are in production and examples of high resolution optical test data will be discussed.

Cost Estimates For Selected California Smart Traveler Operational Tests, Volume 1, Technical Report

DOT National Transportation Integrated Search

1993-03-01

THIS REPORT ALSO COMPARES THE COSTS OF USING "SMART-TRAVELER" APPROACHES WITH THE COSTS OF EXPANDING CONVENTIONAL TRANSIT SERVICES TO REDUCE TRAFFIC CONGESTION, AIR POLLUTION AND MOBILITY PROBLEMS IN SUBURBAN AREAS, WHERE MOST PEOPLE IN U.S. METROPOL...

Taking Costs and Diagnostic Test Accuracy into Account When Designing Prevalence Studies: An Application to Childhood Tuberculosis Prevalence.

PubMed

Wang, Zhuoyu; Dendukuri, Nandini; Pai, Madhukar; Joseph, Lawrence

2017-11-01

When planning a study to estimate disease prevalence to a pre-specified precision, it is of interest to minimize total testing cost. This is particularly challenging in the absence of a perfect reference test for the disease because different combinations of imperfect tests need to be considered. We illustrate the problem and a solution by designing a study to estimate the prevalence of childhood tuberculosis in a hospital setting. All possible combinations of 3 commonly used tuberculosis tests, including chest X-ray, tuberculin skin test, and a sputum-based test, either culture or Xpert, are considered. For each of the 11 possible test combinations, 3 Bayesian sample size criteria, including average coverage criterion, average length criterion and modified worst outcome criterion, are used to determine the required sample size and total testing cost, taking into consideration prior knowledge about the accuracy of the tests. In some cases, the required sample sizes and total testing costs were both reduced when more tests were used, whereas, in other examples, lower costs are achieved with fewer tests. Total testing cost should be formally considered when designing a prevalence study.

Analytical trade study of the STS payload environment. [design analysis and cost estimates for noise reduction devices for space shuttle orbiter payloads

NASA Technical Reports Server (NTRS)

Rader, W. P.; Barrett, S.; Raratono, J.; Payne, K. R.

1976-01-01

The current predicted acoustic environment for the shuttle orbiter payload bay will produce random vibration environments for payload components and subsystems which potentially will result in design, weight and cost penalties if means of protecting the payloads are not developed. Results are presented of a study to develop, through design and cost effectiveness trade studies, conceptual noise suppression device designs for space shuttle payloads. The impact of noise suppression on environmental levels and associated test costs, and on test philosophy for the various payload classes is considered with the ultimate goal of reducing payload test costs. Conclusions and recommendations are presented.

Reducing liver function tests for statin monitoring: an observational comparison of two clinical commissioning groups.

PubMed

Homer, Kate; Robson, John; Solaiman, Susannah; Davis, Abigail; Khan, Saima Zubeda; McCoy, David; Mathur, Rohini; Hull, Sally; Boomla, Kambiz

2017-03-01

Current liver function testing for statin monitoring is largely unnecessary and costly. Statins do not cause liver disease. Both reduction in test frequency and use of a single alanine transaminase (ALT) rather than a full seven analyte liver function test (LFT) array would reduce cost and may benefit patients. To assess LFT testing in relation to statin use and evaluate an intervention to reduce full-array LFTs ordered by GPs for statin monitoring. Two-year cross-sectional time series in two east London clinical commissioning groups (CCGs) with 650 000 patients. One CCG received the intervention; the other did not. The intervention comprised local guidance on LFTs for statin monitoring and access to a single ALT rather than full LFT array. Of the total population, 17.6% were on statins, accounting for 43.2% of total LFTs. In the population without liver disease, liver function tests were 3.6 times higher for those on statins compared with those who were not. Following intervention there was a significant reduction in the full LFT array per 1000 people on statins, from 70.3 (95% confidence interval [CI] = 66.3 to 74.6) in the pre-intervention year, to 58.1 (95% CI = 55.5 to 60.7) in the post-intervention year ( P <0.001). In the final month, March 2016, the rate was 53.2, a 24.3% reduction on the pre-intervention rate. This simple and generalisable intervention, enabling ordering of a single ALT combined with information recommending prudent rather than periodic testing, reduced full LFT testing by 24.3% in people on statins. This is likely to have patient benefit at reduced cost. © British Journal of General Practice 2017.

Surveillance-guided selective digestive decontamination of carbapenem-resistant Enterobacteriaceae in the intensive care unit: A cost-effectiveness analysis.

PubMed

You, Joyce H S; Li, Hong-Kiu; Ip, Margaret

2018-03-01

Clinical findings have shown effectiveness and safety of selective digestive decontamination (SDD) for eradication of carbapenem-resistant Enterobacteriaceae (CRE) in high-risk carriers. We aimed to evaluate the cost-effectiveness of SDD guided by CRE surveillance in the intensive care unit (ICU). Outcomes of surveillance-guided SDD (test-guided SDD) and no screening (control) in the ICU were compared by Markov model simulations. Model outcomes were CRE infection and mortality rates, direct costs, and quality-adjusted life year (QALY) loss. Model inputs were estimated from clinical literature. Sensitivity analyses were conducted to examine the robustness of base case results. Test-guided SDD reduced infection (4.8% vs 5.0%) and mortality (1.8% vs 2.1%) rates at a higher cost ($1,102 vs $1,074) than the control group in base case analysis, respectively. Incremental cost per QALY saved (incremental cost-effectiveness ratio [ICER]) by the test-guided SDD group was $557 per QALY. Probabilistic sensitivity analysis showed that test-guided SDD was effective in saving QALYs in 100% of 10,000 Monte Carlo simulations, and cost-saving 59.1% of time. The remaining 40.9% of simulations found SDD to be effective at an additional cost, with ICERs accepted as cost-effective per the willingness-to-pay threshold. Surveillance-guided SDD appears to be cost-effective in reducing CRE infection and mortality with QALYs saved. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

An Unpowered Exoskeleton to Reduce Astronaut Hand Fatigue during Microgravity EVA

NASA Astrophysics Data System (ADS)

Carey, Alan John

Improving manufacturing techniques to minimize costs have always been the ultimate goal for engineers since the dawn of technology. Working toward making the end product as affordable as possible without compromising on its quality is not just a skill set to develop but also, art. This thesis deals with changing the approach to the manufacturing of the patented XQ-139 UAV by using alternative materials to reduce production costs and time. Retaining the overall structure and utility of the UAV while eliminating the high costs to produce is the primary goal. It also includes tests performed on the new UAV airframe to prove this hypothesis and compare it to the results of the original airframe. The objective is to prove that the new airframe can cope with the structural and performance demands of the original XQ-139A, while reducing the total costs to manufacture it. This thesis only deals with the processing and manufacturing of the new XQ-139A airframe. No flight tests are involved.

Reducing the Time and Cost of Testing Engines

NASA Technical Reports Server (NTRS)

2004-01-01

Producing a new aircraft engine currently costs approximately $1 billion, with 3 years of development time for a commercial engine and 10 years for a military engine. The high development time and cost make it extremely difficult to transition advanced technologies for cleaner, quieter, and more efficient new engines. To reduce this time and cost, NASA created a vision for the future where designers would use high-fidelity computer simulations early in the design process in order to resolve critical design issues before building the expensive engine hardware. To accomplish this vision, NASA's Glenn Research Center initiated a collaborative effort with the aerospace industry and academia to develop its Numerical Propulsion System Simulation (NPSS), an advanced engineering environment for the analysis and design of aerospace propulsion systems and components. Partners estimate that using NPSS has the potential to dramatically reduce the time, effort, and expense necessary to design and test jet engines by generating sophisticated computer simulations of an aerospace object or system. These simulations will permit an engineer to test various design options without having to conduct costly and time-consuming real-life tests. By accelerating and streamlining the engine system design analysis and test phases, NPSS facilitates bringing the final product to market faster. NASA's NPSS Version (V)1.X effort was a task within the Agency s Computational Aerospace Sciences project of the High Performance Computing and Communication program, which had a mission to accelerate the availability of high-performance computing hardware and software to the U.S. aerospace community for its use in design processes. The technology brings value back to NASA by improving methods of analyzing and testing space transportation components.

Destroying chemical wastes in commercial-scale incinerators. Final report

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

Adams, J.W.; Cunningham, N.J.; Harris, J.C.

1976-12-01

Tests were conducted at Zimpro, Inc., Rothschild, Wisconsin, to determine the effectiveness of wet air oxidation for destruction of two selected aqueous industrial wastes: coke plant waste and Amiben (herbicide) manufacturing waste. A pilot scale facility was tested for the coke plant waste with less than 6g/1 total solids and 5.5 g/1 Biological Oxygen Demand (BOD5), chemical compounds such as cyanides, phenols and cresols were 99% destroyed; BOD5 and Chemical Oxygen Demand (COD) were reduced by about 90%. The concentration of quinoline was reduced by only 66%. Estimated costs for treating 2,120 cu m/day of coke waste were: $12.3 MMmore » capital investment and $9.90/cu m total operating cost. For the Amiben waste, with 55 g/1 total solids and 31 g/1 BOD5, the test showed greater than 99% destruction of the major organic waste components, dichloronitrobenzoic acids, with about 10% conversion to an intermediate degradation product, dichloronitrobenzene. The BOD5 and COD were reduced by 90% and 82%, respectively. Estimated costs for treating 151 cu m/day of Amiben waste were: $2.2 MM capital investment and $18.00/cu m total operating cost.« less

Pooled HIV-1 viral load testing using dried blood spots to reduce the cost of monitoring antiretroviral treatment in a resource-limited setting.

PubMed

Pannus, Pieter; Fajardo, Emmanuel; Metcalf, Carol; Coulborn, Rebecca M; Durán, Laura T; Bygrave, Helen; Ellman, Tom; Garone, Daniela; Murowa, Michael; Mwenda, Reuben; Reid, Tony; Preiser, Wolfgang

2013-10-01

Rollout of routine HIV-1 viral load monitoring is hampered by high costs and logistical difficulties associated with sample collection and transport. New strategies are needed to overcome these constraints. Dried blood spots from finger pricks have been shown to be more practical than the use of plasma specimens, and pooling strategies using plasma specimens have been demonstrated to be an efficient method to reduce costs. This study found that combination of finger-prick dried blood spots and a pooling strategy is a feasible and efficient option to reduce costs, while maintaining accuracy in the context of a district hospital in Malawi.

Strategies to Identify the Lynch Syndrome Among Patients With Colorectal Cancer

PubMed Central

Ladabaum, Uri; Wang, Grace; Terdiman, Jonathan; Blanco, Amie; Kuppermann, Miriam; Boland, C. Richard; Ford, James; Elkin, Elena; Phillips, Kathryn A.

2013-01-01

Background Testing has been advocated for all persons with newly diagnosed colorectal cancer to identify families with the Lynch syndrome, an autosomal dominant cancer-predisposition syndrome that is a paradigm for personalized medicine. Objective To estimate the effectiveness and cost-effectiveness of strategies to identify the Lynch syndrome, with attention to sex, age at screening, and differential effects for probands and relatives. Design Markov model that incorporated risk for colorectal, endometrial, and ovarian cancers. Data Sources Published literature. Target Population All persons with newly diagnosed colorectal cancer and their relatives. Time Horizon Lifetime. Perspective Third-party payer. Intervention Strategies based on clinical criteria, prediction algorithms, tumor testing, or up-front germline mutation testing, followed by tailored screening and risk-reducing surgery. Outcome Measures Life-years, cancer cases and deaths, costs, and incremental cost-effectiveness ratios. Results of Base-Case Analysis The benefit of all strategies accrued primarily to relatives with a mutation associated with the Lynch syndrome, particularly women, whose life expectancy could increase by approximately 4 years with hysterectomy and salpingo-oophorectomy and adherence to colorectal cancer screening recommendations. At current rates of germline testing, screening, and prophylactic surgery, the strategies reduced deaths from colorectal cancer by 7% to 42% and deaths from endometrial and ovarian cancer by 1% to 6%. Among tumor-testing strategies, immunohistochemistry followed by BRAF mutation testing was preferred, with an incremental cost-effectiveness ratio of $36 200 per life-year gained. Results of Sensitivity Analysis The number of relatives tested per proband was a critical determinant of both effectiveness and cost-effectiveness, with testing of 3 to 4 relatives required for most strategies to meet a threshold of $50 000 per life-year gained. Immunohistochemistry followed by BRAF mutation testing was preferred in 59% of iterations in probabilistic sensitivity analysis at a threshold of $100 000 per life-year gained. Screening for the Lynch syndrome with immunohistochemistry followed by BRAF mutation testing only up to age 70 years cost $44 000 per incremental life-year gained compared with screening only up to age 60 years, and screening without an upper age limit cost $88 700 per incremental life-year gained compared with screening only up to age 70 years. Limitation Other types of cancer, uncertain family pedigrees, and genetic variants of unknown significance were not considered. Conclusion Widespread colorectal tumor testing to identify families with the Lynch syndrome could yield substantial benefits at acceptable costs, particularly for women with a mutation associated with the Lynch syndrome who begin regular screening and have risk-reducing surgery. The cost-effectiveness of such testing depends on the participation rate among relatives at risk for the Lynch syndrome. Primary Funding Source National Institutes of Health. PMID:21768580

From accuracy to patient outcome and cost-effectiveness evaluations of diagnostic tests and biomarkers: an exemplary modelling study

PubMed Central

2013-01-01

Background Proper evaluation of new diagnostic tests is required to reduce overutilization and to limit potential negative health effects and costs related to testing. A decision analytic modelling approach may be worthwhile when a diagnostic randomized controlled trial is not feasible. We demonstrate this by assessing the cost-effectiveness of modified transesophageal echocardiography (TEE) compared with manual palpation for the detection of atherosclerosis in the ascending aorta. Methods Based on a previous diagnostic accuracy study, actual Dutch reimbursement data, and evidence from literature we developed a Markov decision analytic model. Cost-effectiveness of modified TEE was assessed for a life time horizon and a health care perspective. Prevalence rates of atherosclerosis were age-dependent and low as well as high rates were applied. Probabilistic sensitivity analysis was applied. Results The model synthesized all available evidence on the risk of stroke in cardiac surgery patients. The modified TEE strategy consistently resulted in more adapted surgical procedures and, hence, a lower risk of stroke and a slightly higher number of life-years. With 10% prevalence of atherosclerosis the incremental cost-effectiveness ratio was €4,651 and €481 per quality-adjusted life year in 55-year-old men and women, respectively. In all patients aged 65 years or older the modified TEE strategy was cost saving and resulted in additional health benefits. Conclusions Decision analytic modelling to assess the cost-effectiveness of a new diagnostic test based on characteristics, costs and effects of the test itself and of the subsequent treatment options is both feasible and valuable. Our case study on modified TEE suggests that it may reduce the risk of stroke in cardiac surgery patients older than 55 years at acceptable cost-effectiveness levels. PMID:23368927

Expanding ART for Treatment and Prevention of HIV in South Africa: Estimated Cost and Cost-Effectiveness 2011-2050

PubMed Central

Granich, Reuben; Kahn, James G.; Bennett, Rod; Holmes, Charles B.; Garg, Navneet; Serenata, Celicia; Sabin, Miriam Lewis; Makhlouf-Obermeyer, Carla; De Filippo Mack, Christina; Williams, Phoebe; Jones, Louisa; Smyth, Caoimhe; Kutch, Kerry A.; Ying-Ru, Lo; Vitoria, Marco; Souteyrand, Yves; Crowley, Siobhan; Korenromp, Eline L.; Williams, Brian G.

2012-01-01

Background Antiretroviral Treatment (ART) significantly reduces HIV transmission. We conducted a cost-effectiveness analysis of the impact of expanded ART in South Africa. Methods We model a best case scenario of 90% annual HIV testing coverage in adults 15–49 years old and four ART eligibility scenarios: CD4 count <200 cells/mm3 (current practice), CD4 count <350, CD4 count <500, all CD4 levels. 2011–2050 outcomes include deaths, disability adjusted life years (DALYs), HIV infections, cost, and cost per DALY averted. Service and ART costs reflect South African data and international generic prices. ART reduces transmission by 92%. We conducted sensitivity analyses. Results Expanding ART to CD4 count <350 cells/mm3 prevents an estimated 265,000 (17%) and 1.3 million (15%) new HIV infections over 5 and 40 years, respectively. Cumulative deaths decline 15%, from 12.5 to 10.6 million; DALYs by 14% from 109 to 93 million over 40 years. Costs drop $504 million over 5 years and $3.9 billion over 40 years with breakeven by 2013. Compared with the current scenario, expanding to <500 prevents an additional 585,000 and 3 million new HIV infections over 5 and 40 years, respectively. Expanding to all CD4 levels decreases HIV infections by 3.3 million (45%) and costs by $10 billion over 40 years, with breakeven by 2023. By 2050, using higher ART and monitoring costs, all CD4 levels saves $0.6 billion versus current; other ART scenarios cost $9–194 per DALY averted. If ART reduces transmission by 99%, savings from all CD4 levels reach $17.5 billion. Sensitivity analyses suggest that poor retention and predominant acute phase transmission reduce DALYs averted by 26% and savings by 7%. Conclusion Increasing the provision of ART to <350 cells/mm3 may significantly reduce costs while reducing the HIV burden. Feasibility including HIV testing and ART uptake, retention, and adherence should be evaluated. PMID:22348000

Discontinuation of reflex testing of stool samples for vancomycin-resistant enterococci resulted in increased prevalence.

PubMed

Bodily, Mandy; McMullen, Kathleen M; Russo, Anthony J; Kittur, Nupur D; Hoppe-Bauer, Joan; Warren, David K

2013-08-01

Discontinuation of reflex testing of stool submitted for Clostridium difficile testing for vancomycin-resistant enterococci (VRE) led to an increase in the number of patients with healthcare-associated VRE bacteremia and bacteriuria (0.21 vs 0.36 cases per 1,000 patient-days; P<.01). Cost-benefit analysis showed reflex screening and isolation of VRE reduced hospital costs.

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

PubMed

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

2017-11-01

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

Effect of Study Design on Sample Size in Studies Intended to Evaluate Bioequivalence of Inhaled Short-Acting β-Agonist Formulations.

PubMed

Zeng, Yaohui; Singh, Sachinkumar; Wang, Kai; Ahrens, Richard C

2018-04-01

Pharmacodynamic studies that use methacholine challenge to assess bioequivalence of generic and innovator albuterol formulations are generally designed per published Food and Drug Administration guidance, with 3 reference doses and 1 test dose (3-by-1 design). These studies are challenging and expensive to conduct, typically requiring large sample sizes. We proposed 14 modified study designs as alternatives to the Food and Drug Administration-recommended 3-by-1 design, hypothesizing that adding reference and/or test doses would reduce sample size and cost. We used Monte Carlo simulation to estimate sample size. Simulation inputs were selected based on published studies and our own experience with this type of trial. We also estimated effects of these modified study designs on study cost. Most of these altered designs reduced sample size and cost relative to the 3-by-1 design, some decreasing cost by more than 40%. The most effective single study dose to add was 180 μg of test formulation, which resulted in an estimated 30% relative cost reduction. Adding a single test dose of 90 μg was less effective, producing only a 13% cost reduction. Adding a lone reference dose of either 180, 270, or 360 μg yielded little benefit (less than 10% cost reduction), whereas adding 720 μg resulted in a 19% cost reduction. Of the 14 study design modifications we evaluated, the most effective was addition of both a 90-μg test dose and a 720-μg reference dose (42% cost reduction). Combining a 180-μg test dose and a 720-μg reference dose produced an estimated 36% cost reduction. © 2017, The Authors. The Journal of Clinical Pharmacology published by Wiley Periodicals, Inc. on behalf of American College of Clinical Pharmacology.

Stereotype threat can reduce older adults' memory errors

PubMed Central

Barber, Sarah J.; Mather, Mara

2014-01-01

Stereotype threat often incurs the cost of reducing the amount of information that older adults accurately recall. In the current research we tested whether stereotype threat can also benefit memory. According to the regulatory focus account of stereotype threat, threat induces a prevention focus in which people become concerned with avoiding errors of commission and are sensitive to the presence or absence of losses within their environment (Seibt & Förster, 2004). Because of this, we predicted that stereotype threat might reduce older adults' memory errors. Results were consistent with this prediction. Older adults under stereotype threat had lower intrusion rates during free-recall tests (Experiments 1 & 2). They also reduced their false alarms and adopted more conservative response criteria during a recognition test (Experiment 2). Thus, stereotype threat can decrease older adults' false memories, albeit at the cost of fewer veridical memories, as well. PMID:24131297

Staged, High-Pressure Oxy-Combustion Technology: Development and Scale-Up

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

Axelbaum, Richard; Kumfer, Benjamin; Gopan, Akshay

The immediate need for a high efficiency, low cost carbon capture process has prompted the recent development of pressurized oxy-combustion. With a greater combustion pressure the dew point of the flue gas is increased, allowing for effective integration of the latent heat of flue gas moisture into the Rankine cycle. This increases the net plant efficiency and reduces costs. A novel, transformational process, named Staged, Pressurized Oxy-Combustion (SPOC), achieves additional step changes in efficiency and cost reduction by significantly reducing the recycle of flue gas. The research and development activities conducted under Phases I and II of this project (FE0009702)more » include: SPOC power plant cost and performance modeling, CFD-assisted design of pressurized SPOC boilers, theoretical analysis of radiant heat transfer and ash deposition, boiler materials corrosion testing, construction of a 100 kWth POC test facility, and experimental testing. The results of this project have advanced the technology readiness level (TRL) of the SPOC technology from 1 to 5.« less

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

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

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

Simple Retrofit High-Efficiency Natural Gas Water Heater Field Test

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

Schoenbauer, Ben

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

Simple Retrofit High-Efficiency Natural Gas Water Heater Field Test

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

Schoenbauer, Ben

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

Cost-effectiveness of risk-reducing surgeries in preventing hereditary breast and ovarian cancer.

PubMed

Schrauder, Michael G; Brunel-Geuder, Lisa; Häberle, Lothar; Wunderle, Marius; Hoyer, Juliane; Reis, André; Schulz-Wendtland, Rüdiger; Beckmann, Matthias W; Lux, Michael P

2017-04-01

Risk-reducing surgeries are a feasible option for mitigating the risk in individuals with inherited susceptibility to cancer, but are the procedures cost-effective in the current health-care system in Germany? This study compared the health-care costs for bilateral risk-reducing mastectomy (BRRM) and risk-reducing (bilateral) salpingo-oophorectomy (RRSO) with cancer treatment costs that could potentially be prevented. The analysis is based on interdisciplinary consultations with individuals with a high familial risk for breast and ovarian cancer at the University Breast Center for Franconia (Germany) between 2009 and 2013 (370 consultations; 44 patients with BRCA1 mutations and 26 with BRCA2 mutations). Health-care costs for risk-reducing surgeries in BRCA mutation carriers were calculated as reimbursements in the German diagnosis-related groups (DRG) hospital pricing system. These costs for the health-care system were compared with the potential cancer treatment costs that could possibly be prevented by risk-reducing surgeries. Long-term health-care costs can be reduced by risk-reducing surgeries after genetic testing in BRCA mutation carriers. The health-care system in Germany would have saved € 136,295 if BRRM had been performed and € 791,653 if RRSO had been performed before the development of cancer in only 50% of the 70 mutation carriers seen in our center. Moreover, in patients with combined RRSO and BRRM (without breast reconstruction), one further life-year for a 40-year-old BRCA mutation carrier would cost € 2,183. Intensive care, including risk-reducing surgeries in BRCA mutation carriers, is cost-effective from the point of view of the health-care system in Germany. Copyright © 2017 Elsevier Ltd. All rights reserved.

The open prototype for educational NanoSats: Fixing the other side of the small satellite cost equation

NASA Astrophysics Data System (ADS)

Berk, Josh; Straub, Jeremy; Whalen, David

Government supported nano-satellite launch programs and emerging commercial small satellite launch services are reducing the cost of access to space for educational and other CubeSat projects. The cost and complexity of designing and building these satellites remains a vexing complication for many would be CubeSat aspirants. The Open Prototype for Educational NanoSats (OPEN), a proposed nano-satellite development platform, is described in this paper. OPEN endeavors to reduce the costs and risks associated with educational, government and commercial nano-satellite development. OPEN provides free and publicly available plans for building, testing and operating a versatile, low-cost satellite, based on the standardized CubeSat form-factor. OPEN consists of public-domain educational reference plans, complete with engineering schematics, CAD files, construction and test instructions as well as ancillary reference materials relevant to satellite building and operation. By making the plan, to produce a small but capable spacecraft freely available, OPEN seeks to lower the barriers to access on the other side (non-launch costs) of the satellite cost equation.

An approach to the design of operations systems

NASA Technical Reports Server (NTRS)

Chafin, Roy L.; Curran, Patrick S.

1993-01-01

The MultiMission Control Team (MMCT) consists of mission controllers which provides Real-Time operations support for the Mars Observer project. The Real-Time Operations task is to insure the integrity of the ground data system, to insure that the configuration is correct to support the mission, and to monitor the spacecraft for the Spacecraft Team. Operations systems are typically developed by adapting operations systems from previous projects. Problems tend to be solved empirically when they are either anticipated or observed in testing. This development method has worked in the past when time was available for extensive Ops testing. In the present NASA budget environment, a more cost conscious design approach has become necessary. Cost is a concern because operations is an ongoing, continuous activity. Reducing costs entails reducing staff. Reducing staffing levels potentially increases the risk of mission failure. Therefore, keeping track of the risk level is necessary.

Costs and cost-effectiveness of full implementation of a biennial faecal occult blood test screening program for bowel cancer in Australia.

PubMed

Pignone, Michael P; Flitcroft, Kathy L; Howard, Kirsten; Trevena, Lyndal J; Salkeld, Glenn P; St John, D James B

2011-02-21

To examine the costs and cost-effectiveness of full implementation of biennial bowel cancer screening for Australian residents aged 50-74 years. Identification of existing economic models from 1993 to 2010 through searches of PubMed and economic analysis databases, and by seeking expert advice; and additional modelling to determine the costs and cost-effectiveness of full implementation of biennial faecal occult blood test screening for the five million adults in Australia aged 50-74 years. Estimated number of deaths from bowel cancer prevented, costs, and cost-effectiveness (cost per life-year gained [LYG]) of biennial bowel cancer screening. We identified six relevant economic analyses, all of which found colorectal cancer (CRC) screening to be very cost-effective, with costs per LYG under $55,000 per year in 2010 Australian dollars. Based on our additional modelling, we conservatively estimate that full implementation of biennial screening for people aged 50-74 years would have gross costs of $150 million, reduce CRC mortality by 15%-25%, prevent 300-500 deaths from bowel cancer, and save 3600-6000 life-years annually, for an undiscounted cost per LYG of $25,000-$41,667, compared with no screening, and not taking cost savings as a result of treatment into consideration. The additional expenditure required, after accounting for reductions in CRC incidence, savings in CRC treatment costs, and existing ad-hoc colonoscopy use, is likely to be less than $50 million annually. Full implementation of biennial faecal occult blood test screening in Australia can reduce bowel cancer mortality, and is an efficient use of health resources that would require modest additional government investment.

Multifaceted intervention including education, rounding checklist implementation, cost feedback, and financial incentives reduces inpatient laboratory costs.

PubMed

Yarbrough, Peter M; Kukhareva, Polina V; Horton, Devin; Edholm, Karli; Kawamoto, Kensaku

2016-05-01

Inappropriate laboratory testing is a contributor to waste in healthcare. To evaluate the impact of a multifaceted laboratory reduction intervention on laboratory costs. A retrospective, controlled, interrupted time series (ITS) study. University of Utah Health Care, a 500-bed academic medical center in Salt Lake City, Utah. All patients 18 years or older admitted to the hospital to a service other than obstetrics, rehabilitation, or psychiatry. Multifaceted quality-improvement initiative in a hospitalist service including education, process change, cost feedback, and financial incentive. Primary outcomes of lab cost per day and per visit. Secondary outcomes of number of basic metabolic panel (BMP), comprehensive metabolic panel (CMP), complete blood count (CBC), and prothrombin time/international normalized ratio tests per day; length of stay (LOS); and 30-day readmissions. A total of 6310 hospitalist patient visits (intervention group) were compared to 25,586 nonhospitalist visits (control group). Among the intervention group, the unadjusted mean cost per day was reduced from $138 before the intervention to $123 after the intervention (P < 0.001), and the unadjusted mean cost per visit decreased from $618 to $558 (P = 0.005). The ITS analysis showed significant reductions in cost per day, cost per visit, and the number of BMP, CMP, and CBC tests per day (P = 0.034, 0.02, <0.001, 0.004, and <0.001). LOS was unchanged and 30-day readmissions decreased in the intervention group. A multifaceted approach to laboratory reduction demonstrated a significant reduction in laboratory cost per day and per visit, as well as common tests per day at a major academic medical center. Journal of Hospital Medicine 2016;11:348-354. © 2016 Society of Hospital Medicine. © 2016 Society of Hospital Medicine.

Opportunities for improving the efficiency of paediatric HIV treatment programmes

PubMed Central

Revill, Paul A.; Walker, Simon; Mabugu, Travor; Nathoo, Kusum J.; Mugyenyi, Peter; Kekitinwa, Adeodata; Munderi, Paula; Bwakura-Dangarembizi, Mutsawashe; Musiime, Victor; Bakeera-Kitaka, Sabrina; Nahirya-Ntege, Patricia; Walker, A. Sarah; Sculpher, Mark J.; Gibb, Diana M.

2015-01-01

Objectives: To conduct two economic analyses addressing whether to: routinely monitor HIV-infected children on antiretroviral therapy (ART) clinically or with laboratory tests; continue or stop cotrimoxazole prophylaxis when children become stabilized on ART. Design and methods: The ARROW randomized trial investigated alternative strategies to deliver paediatric ART and cotrimoxazole prophylaxis in 1206 Ugandan/Zimbabwean children. Incremental cost-effectiveness and value of implementation analyses were undertaken. Scenario analyses investigated whether laboratory monitoring (CD4+ tests for efficacy monitoring; haematology/biochemistry for toxicity) could be tailored and targeted to be delivered cost-effectively. Cotrimoxazole use was examined in malaria-endemic and non-endemic settings. Results: Using all trial data, clinical monitoring delivered similar health outcomes to routine laboratory monitoring, but at a reduced cost, so was cost-effective. Continuing cotrimoxazole improved health outcomes at reduced costs. Restricting routine CD4+ monitoring to after 52 weeks following ART initiation and removing toxicity testing was associated with an incremental cost-effectiveness ratio of $6084 per quality-adjusted life-year (QALY) across all age groups, but was much lower for older children (12+ years at initiation; incremental cost-effectiveness ratio = $769/QALY). Committing resources to improve cotrimoxazole implementation appears cost-effective. A healthcare system that could pay $600/QALY should be willing to spend up to $12.0 per patient-year to ensure continued provision of cotrimoxazole. Conclusion: Clinically driven monitoring of ART is cost-effective in most circumstances. Routine laboratory monitoring is generally not cost-effective at current prices, except possibly CD4+ testing amongst adolescents initiating ART. Committing resources to ensure continued provision of cotrimoxazole in health facilities is more likely to represent an efficient use of resources. PMID:25396263

Cost-Driven Design of a Large Scale X-Plane

NASA Technical Reports Server (NTRS)

Welstead, Jason R.; Frederic, Peter C.; Frederick, Michael A.; Jacobson, Steven R.; Berton, Jeffrey J.

2017-01-01

A conceptual design process focused on the development of a low-cost, large scale X-plane was developed as part of an internal research and development effort. One of the concepts considered for this process was the double-bubble configuration recently developed as an advanced single-aisle class commercial transport similar in size to a Boeing 737-800 or Airbus A320. The study objective was to reduce the contractor cost from contract award to first test flight to less than $100 million, and having the first flight within three years of contract award. Methods and strategies for reduced cost are discussed.

Analysis of Advanced Modular Power Systems (AMPS) for Deep Space Exploration

NASA Technical Reports Server (NTRS)

Oeftering, Richard; Soeder, James F.; Beach, Ray

2014-01-01

The Advanced Modular Power Systems (AMPS) project is developing a modular approach to spacecraft power systems for exploration beyond Earth orbit. AMPS is intended to meet the need of reducing the cost of design development, test and integration and also reducing the operational logistics cost of supporting exploration missions. AMPS seeks to establish modular power building blocks with standardized electrical, mechanical, thermal and data interfaces that can be applied across multiple exploration vehicles. The presentation discusses the results of a cost analysis that compares the cost of the modular approach against a traditional non-modular approach.

HIV Rapid Testing in a VA Emergency Department Setting: Cost Analysis at 5 Years.

PubMed

Knapp, Herschel; Chan, Kee

2015-07-01

To conduct a comprehensive cost-minimization analysis to comprehend the financial attributes of the first 5 years of an implementation wherein emergency department (ED) registered nurses administered HIV oral rapid tests to patients. A health science research implementation team coordinated with ED stakeholders and staff to provide training, implementation guidelines, and support to launch ED registered nurse-administered HIV oral rapid testing. Deidentified quantitative data were gathered from the electronic medical records detailing quarterly HIV rapid test rates in the ED setting spanning the first 5 years. Comprehensive cost analyses were conducted to evaluate the financial impact of this implementation. At 5 years, a total of 2,620 tests were conducted with a quarterly mean of 131 ± 81. Despite quarterly variability in testing rates, regression analysis revealed an average increase of 3.58 tests per quarter. Over the course of this implementation, Veterans Health Administration policy transitioned from written to verbal consent for HIV testing, serving to reduce the time and cost(s) associated with the testing process. Our data indicated salient health outcome benefits for patients with respect to the potential for earlier detection, and associated long-run cost savings. Copyright © 2015. Published by Elsevier Inc.

High-Value, Cost-Conscious Care: Iterative Systems-Based Interventions to Reduce Unnecessary Laboratory Testing.

PubMed

Sadowski, Brett W; Lane, Alison B; Wood, Shannon M; Robinson, Sara L; Kim, Chin Hee

2017-09-01

Inappropriate testing contributes to soaring healthcare costs within the United States, and teaching hospitals are vulnerable to providing care largely for academic development. Via its "Choosing Wisely" campaign, the American Board of Internal Medicine recommends avoiding repetitive testing for stable inpatients. We designed systems-based interventions to reduce laboratory orders for patients admitted to the wards at an academic facility. We identified the computer-based order entry system as an appropriate target for sustainable intervention. The admission order set had allowed multiple routine tests to be ordered repetitively each day. Our iterative study included interventions on the automated order set and cost displays at order entry. The primary outcome was number of routine tests controlled for inpatient days compared with the preceding year. Secondary outcomes included cost savings, delays in care, and adverse events. Data were collected over a 2-month period following interventions in sequential years and compared with the year prior. The first intervention led to 0.97 fewer laboratory tests per inpatient day (19.4%). The second intervention led to sustained reduction, although by less of a margin than order set modifications alone (15.3%). When extrapolating the results utilizing fees from the Centers for Medicare and Medicaid Services, there was a cost savings of $290,000 over 2 years. Qualitative survey data did not suggest an increase in care delays or near-miss events. This series of interventions targeting unnecessary testing demonstrated a sustained reduction in the number of routine tests ordered, without adverse effects on clinical care. Published by Elsevier Inc.

Cost-Savings Analysis of AR-V7 Testing in Patients With Metastatic Castration-Resistant Prostate Cancer Eligible for Treatment With Abiraterone or Enzalutamide.

PubMed

Markowski, Mark C; Frick, Kevin D; Eshleman, James R; Luo, Jun; Antonarakis, Emmanuel S

2016-12-01

Identification of cancer biomarkers that inform clinical decisions and reduce the use of ineffective therapies is a major goal of precision oncology. An abnormal splice variant of the androgen receptor, AR-V7, was recently found to confer resistance to novel hormonal therapies (abiraterone and enzalutamide) in men with metastatic castration-resistant prostate cancer (mCRPC), but did not negatively affect responses to taxane chemotherapies, suggesting that early use of chemotherapy may be a more effective option for AR-V7(+) patients. We calculated the cost savings of performing AR-V7 testing in mCRPC patients prior to starting abiraterone/enzalutamide (and avoiding these drugs in AR-V7(+) men) versus treating all mCRPC patients empirically with abiraterone/enzalutamide (without use of the biomarker). We determined that AR-V7 testing would result in substantial cost savings as long as the true prevalence of AR-V7 was >5%. In our prior studies, we estimated that approximately 30% of mCRPC patients may have detectable AR-V7 in circulating tumor cells (CTCs). In this population, upfront testing of AR-V7 status (at a price of $1,000 per test) would result in a net cost savings of $150 Million in the United States per year. AR-V7 testing in mCRPC patients would be cost-beneficial when considering the current price of treatment, and may reduce the ineffective use of abiraterone/enzalutamide, leading to a significant net cost savings to the healthcare system. Clinical-grade AR-V7 testing is currently available at our institution. Prostate 76:1484-1490, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Cost-effectiveness of quantitative pretest probability intended to reduce unnecessary medical radiation exposure in emergency department patients with chest pain and dyspnea.

PubMed

Troyer, Jennifer L; Jones, Alan E; Shapiro, Nathan I; Mitchell, Alice M; Hewer, Ian; Kline, Jeffrey A

2015-05-01

Quantitative pretest probability (qPTP) incorporated into a decision support tool with advice can reduce unnecessary diagnostic testing among patients with symptoms suggestive of acute coronary syndrome (ACS) and pulmonary embolism (PE), reducing 30-day costs without an increase in 90-day adverse outcomes. This study estimates long-term (beyond 90-day) costs and outcomes associated with qPTP. The authors hypothesized that qPTP reduces lifetime costs and improves outcomes in low-risk patients with symptoms suggestive of ACS and PE. This was a cost-effectiveness analysis of a multicenter, randomized controlled trial of adult emergency patients with dyspnea and chest pain, in which a clinician encountering a low-risk patient with symptoms suggestive of ACS or PE conducted either the intervention (qPTP for ACS and PE with advice) or the sham (no qPTP and no advice). Effect of the intervention over a patient's lifetime was assessed using a Markov microsimulation model. Short-term costs and outcomes were from the trial; long-term outcomes and costs were from the literature. Outcomes included lifetime transition to PE, ACS, and intracranial hemorrhage (ICH); mortality from cancer, ICH, PE, ACS, renal failure, and ischemic stroke; quality-adjusted life-years (QALYs); and total medical costs compared between simulated intervention and sham groups. Markov microsimulation for a 40-year-old patient receiving qPTP found lifetime cost savings of $497 for women and $528 for men, associated with small gains in QALYs (2 and 6 days, respectively) and lower rates of cancer mortality in both sexes, but a reduction in ICH only in males. Sensitivity analysis for patients aged 60 years predicted that qPTP would continue to save costs and also reduce mortality from both ICH and cancer. Use of qPTP significantly reduced the lifetime probability of PE diagnosis, with lower probability of death from PE in both sexes aged 40 to 60 years. However, use of qPTP reduced the rate of ACS diagnosis and death from ACS at age 40, but increased the death rate from ACS at age 60 for both sexes. Widespread use of a combined qPTP for both ACS and PE has the potential to decrease costs by reducing diagnostic testing, while improving most long-term outcomes in emergency patients with chest pain and dyspnea. © 2015 by the Society for Academic Emergency Medicine.

Cost effectiveness of population based BRCA1 founder mutation testing in Sephardi Jewish women.

PubMed

Patel, Shreeya; Legood, Rosa; Evans, D Gareth; Turnbull, Clare; Antoniou, Antonis C; Menon, Usha; Jacobs, Ian; Manchanda, Ranjit

2018-04-01

Population-based BRCA1/BRCA2 founder-mutation testing has been demonstrated as cost effective compared with family history based testing in Ashkenazi Jewish women. However, only 1 of the 3 Ashkenazi Jewish BRCA1/BRCA2 founder mutations (185delAG[c.68_69delAG]), 5382insC[c.5266dupC]), and 6174delT[c.5946delT]) is found in the Sephardi Jewish population (185delAG[c.68_69delAG]), and the overall prevalence of BRCA mutations in the Sephardi Jewish population is accordingly lower (0.7% compared with 2.5% in the Ashkenazi Jewish population). Cost-effectiveness analyses of BRCA testing have not previously been performed at these lower BRCA prevalence levels seen in the Sephardi Jewish population. Here we present a cost-effectiveness analysis for UK and US populations comparing population testing with clinical criteria/family history-based testing in Sephardi Jewish women. A Markov model was built comparing the lifetime costs and effects of population-based BRCA1 testing, with testing using family history-based clinical criteria in Sephardi Jewish women aged ≥30 years. BRCA1 carriers identified were offered magnetic resonance imaging/mammograms and risk-reducing surgery. Costs are reported at 2015 prices. Outcomes include breast cancer, ovarian cancer, and excess deaths from heart disease. All costs and outcomes are discounted at 3.5%. The time horizon is lifetime, and perspective is payer. The incremental cost-effectiveness ratio per quality-adjusted life-year was calculated. Parameter uncertainty was evaluated through 1-way and probabilistic sensitivity analysis. Population testing resulted in gain in life expectancy of 12 months (quality-adjusted life-year = 1.00). The baseline discounted incremental cost-effectiveness ratio for UK population-based testing was £67.04/quality-adjusted life-year and for US population was $308.42/quality-adjusted life-year. Results were robust in the 1-way sensitivity analysis. The probabilistic sensitivity analysis showed 100% of simulations were cost effective at £20,000/quality-adjusted life-year UK and the $100,000/quality-adjusted life-year US willingness-to-pay thresholds. Scenario analysis showed that population testing remains cost effective in UK and US populations, even if premenopausal oophorectomy does not reduce breast cancer risk or if hormone replacement therapy compliance is nil. Population-based BRCA1 testing is highly cost effective compared with clinical criteria-driven approach in Sephardi Jewish women. This supports changing the paradigm to population-based BRCA testing in the Jewish population, regardless of Ashkenazi/Sephardi ancestry. Copyright © 2017 Elsevier Inc. All rights reserved.

Impact of subsidies on cancer genetic testing uptake in Singapore.

PubMed

Li, Shao-Tzu; Yuen, Jeanette; Zhou, Ke; Binte Ishak, Nur Diana; Chen, Yanni; Met-Domestici, Marie; Chan, Sock Hoai; Tan, Yee Pin; Allen, John Carson; Lim, Soon Thye; Soo, Khee Chee; Ngeow, Joanne

2017-04-01

Previous reports cite high costs of clinical cancer genetic testing as main barriers to patient's willingness to test. We report findings of a pilot study that evaluates how different subsidy schemes impact genetic testing uptake and total cost of cancer management. We included all patients who attended the Cancer Genetics Service at the National Cancer Centre Singapore (January 2014-May 2016). Two subsidy schemes, the blanket scheme (100% subsidy to all eligible patients), and the varied scheme (patients received 50%-100% subsidy dependent on financial status) were compared. We estimated total spending on cancer management from government's perspective using a decision model. 445 patients were included. Contrasting against the blanket scheme, the varied scheme observed a higher attendance of patients (34 vs 8 patients per month), of which a higher proportion underwent genetic testing (5% vs 38%), while lowering subsidy spending per person (S$1098 vs S$1161). The varied scheme may potentially save cost by reducing unnecessary cancer surveillance when first-degree relatives uptake rate is above 36%. Provision of subsidy leads to a considerable increase in genetic testing uptake rate. From the government's perspective, subsidising genetic testing may potentially reduce total costs on cancer management. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Delivering maximum clinical benefit at an affordable price: engaging stakeholders in cancer care.

PubMed

Kelly, Ronan J; Smith, Thomas J

2014-03-01

Cancer costs continue to increase alarmingly despite much debate about how they can be reduced. The oncology community needs to take greater responsibility for our own practice patterns, especially when using expensive tests and treatments with marginal value: we cannot continue to accept novel therapeutics with very small benefits for exorbitant prices. Patients, payers, and pharmaceutical communities should be constructively engaged to communicate medically and economically possible goals, and eventually, to reduce use and costs. Diagnostic tests and treatments should have to show true value to be added to existing protocols. In this article, we discuss three key drivers of costs: end-of-life care patterns, medical imaging, and drugs. We propose health-care models that have the potential to decrease costs and discuss solutions to maintain clinical benefit at an affordable price. Copyright © 2014 Elsevier Ltd. All rights reserved.

Space shuttle low cost/risk avionics study

NASA Technical Reports Server (NTRS)

1971-01-01

All work breakdown structure elements containing any avionics related effort were examined for pricing the life cycle costs. The analytical, testing, and integration efforts are included for the basic onboard avionics and electrical power systems. The design and procurement of special test equipment and maintenance and repair equipment are considered. Program management associated with these efforts is described. Flight test spares and labor and materials associated with the operations and maintenance of the avionics systems throughout the horizontal flight test are examined. It was determined that cost savings can be achieved by using existing hardware, maximizing orbiter-booster commonality, specifying new equipments to MIL quality standards, basing redundancy on cost effective analysis, minimizing software complexity and reducing cross strapping and computer-managed functions, utilizing compilers and floating point computers, and evolving the design as dictated by the horizontal flight test schedules.

Measuring the economic costs of discrimination experienced by people with mental health problems: development of the Costs of Discrimination Assessment (CODA).

PubMed

Wright, Steve; Henderson, Claire; Thornicroft, Graham; Sharac, Jessica; McCrone, Paul

2015-05-01

Stigma and discrimination are faced by many with mental health problems and this may affect the uptake of services and engagement in leisure and recreational activities. The aims of this study were to develop a schedule to measure the impact of stigma and discrimination on service use, employment and leisure activities and to estimate the value of such reductions. A questionnaire, the Cost of Discrimination Assessment, was developed and piloted in a sample people with mental health problems. Costs were calculated and test-retest reliability assessed. Test-retest reliability was good for most items. A substantial proportion of the sample had experienced negative impacts on employment as a result of stigma and discrimination. Around one-fifth had reduced contacts with general practitioners in the previous 6 months due to stigma and discrimination and the leisure activity most affected was visiting pubs/restaurants/café. In conclusion, stigma and discrimination result in reduced use of services and reduced engagement in leisure activities. This represents a welfare loss to individuals.

Reverse auction: a potential strategy for reduction of pharmacological therapy cost.

PubMed

Brandão, Sara Michelly Gonçalves; Issa, Victor Sarli; Ayub-Ferreira, Silvia Moreira; Storer, Samantha; Gonçalves, Bianca Gigliotti; Santos, Valter Garcia; Carvas Junior, Nelson; Guimarães, Guilherme Veiga; Bocchi, Edimar Alcides

2015-09-01

Polypharmacy is a significant economic burden. We tested whether using reverse auction (RA) as compared with commercial pharmacy (CP) to purchase medicine results in lower pharmaceutical costs for heart failure (HF) and heart transplantation (HT) outpatients. We compared the costs via RA versus CP in 808 HF and 147 HT patients followed from 2009 through 2011, and evaluated the influence of clinical and demographic variables on cost. The monthly cost per patient for HF drugs acquired via RA was $10.15 (IQ 3.51-40.22) versus $161.76 (IQ 86.05‑340.15) via CP; for HT, those costs were $393.08 (IQ 124.74-774.76) and $1,207.70 (IQ 604.48-2,499.97), respectively. RA may reduce the cost of prescription drugs for HF and HT, potentially making HF treatment more accessible. Clinical characteristics can influence the cost and benefits of RA. RA may be a new health policy strategy to reduce costs of prescribed medications for HF and HT patients, reducing the economic burden of treatment.

Reverse Auction: A Potential Strategy for Reduction of Pharmacological Therapy Cost

PubMed Central

Brandão, Sara Michelly Gonçalves; Issa, Victor Sarli; Ayub-Ferreira, Silvia Moreira; Storer, Samantha; Gonçalves, Bianca Gigliotti; Santos, Valter Garcia; Carvas Junior, Nelson; Guimarães, Guilherme Veiga; Bocchi, Edimar Alcides

2015-01-01

Background Polypharmacy is a significant economic burden. Objective We tested whether using reverse auction (RA) as compared with commercial pharmacy (CP) to purchase medicine results in lower pharmaceutical costs for heart failure (HF) and heart transplantation (HT) outpatients. Methods We compared the costs via RA versus CP in 808 HF and 147 HT patients followed from 2009 through 2011, and evaluated the influence of clinical and demographic variables on cost. Results The monthly cost per patient for HF drugs acquired via RA was $10.15 (IQ 3.51-40.22) versus $161.76 (IQ 86.05‑340.15) via CP; for HT, those costs were $393.08 (IQ 124.74-774.76) and $1,207.70 (IQ 604.48-2,499.97), respectively. Conclusion RA may reduce the cost of prescription drugs for HF and HT, potentially making HF treatment more accessible. Clinical characteristics can influence the cost and benefits of RA. RA may be a new health policy strategy to reduce costs of prescribed medications for HF and HT patients, reducing the economic burden of treatment. PMID:26200898

Screening to prevent spontaneous preterm birth: systematic reviews of accuracy and effectiveness literature with economic modelling.

PubMed

Honest, H; Forbes, C A; Durée, K H; Norman, G; Duffy, S B; Tsourapas, A; Roberts, T E; Barton, P M; Jowett, S M; Hyde, C J; Khan, K S

2009-09-01

To identify combinations of tests and treatments to predict and prevent spontaneous preterm birth. Searches were run on the following databases up to September 2005 inclusive: MEDLINE, EMBASE, DARE, the Cochrane Library (CENTRAL and Cochrane Pregnancy and Childbirth Group trials register) and MEDION. We also contacted experts including the Cochrane Pregnancy and Childbirth Group and checked reference lists of review articles and papers that were eligible for inclusion. Two series of systematic reviews were performed: (1) accuracy of tests for the prediction of spontaneous preterm birth in asymptomatic women in early pregnancy and in women symptomatic with threatened preterm labour in later pregnancy; (2) effectiveness of interventions with potential to reduce cases of spontaneous preterm birth in asymptomatic women in early pregnancy and to reduce spontaneous preterm birth or improve neonatal outcome in women with a viable pregnancy symptomatic of threatened preterm labour. For the health economic evaluation, a model-based analysis incorporated the combined effect of tests and treatments and their cost-effectiveness. Of the 22 tests reviewed for accuracy, the quality of studies and accuracy of tests was generally poor. Only a few tests had LR+ > 5. In asymptomatic women these were ultrasonographic cervical length measurement and cervicovaginal prolactin and fetal fibronectin screening for predicting spontaneous preterm birth before 34 weeks. In this group, tests with LR- < 0.2 were detection of uterine contraction by home uterine monitoring and amniotic fluid C-reactive protein (CRP) measurement. In symptomatic women with threatened preterm labour, tests with LR+ > 5 were absence of fetal breathing movements, cervical length and funnelling, amniotic fluid interleukin-6 (IL-6), serum CRP for predicting birth within 2-7 days of testing, and matrix metalloprotease-9, amniotic fluid IL-6, cervicovaginal fetal fibronectin and cervicovaginal human chorionic gonadotrophin (hCG) for predicting birth before 34 or 37 weeks. In this group, tests with LR- < 0.2 included measurement of cervicovaginal IL-8, cervicovaginal hCG, cervical length measurement, absence of fetal breathing movement, amniotic fluid IL-6 and serum CRP, for predicting birth within 2-7 days of testing, and cervicovaginal fetal fibronectin and amniotic fluid IL-6 for predicting birth before 34 or 37 weeks. The overall quality of the trials included in the 40 interventional topics reviewed for effectiveness was also poor. Antibiotic treatment was generally not beneficial but when used to treat bacterial vaginosis in women with intermediate flora it significantly reduced the incidence of spontaneous preterm birth. Smoking cessation programmes, progesterone, periodontal therapy and fish oil appeared promising as preventative interventions in asymptomatic women. Non-steroidal anti-inflammatory agents were the most effective tocolytic agent for reducing spontaneous preterm birth and prolonging pregnancy in symptomatic women. Antenatal corticosteroids had a beneficial effect on the incidence of respiratory distress syndrome and the risk of intraventricular haemorrhage (28-34 weeks), but the effects of repeat courses were unclear. For asymptomatic women, costs ranged from 1.08 pounds for vitamin C to 1219 pounds for cervical cerclage, whereas costs for symptomatic women were more significant and varied little, ranging from 1645 pounds for nitric oxide donors to 2555 pounds for terbutaline; this was because the cost of hospitalisation was included. The best estimate of additional average cost associated with a case of spontaneous preterm birth was approximately 15,688 pounds for up to 34 weeks and 12,104 pounds for up to 37 weeks. Among symptomatic women there was insufficient evidence to draw firm conclusions for preventing birth at 34 weeks. Hydration given to women testing positive for amniotic fluid IL-6 was the most cost-effective test-treatment combination. Indomethacin given to all women without any initial testing was the most cost-effective option for preventing birth before 37 weeks among symptomatic women. For a symptomatic woman, the most cost-effective test-treatment combination for postponing delivery by at least 48 h was the cervical length (15 mm) measurement test with treatment with indomethacin for all those testing positive. This combination was also the most cost-effective option for postponing delivery by at least 7 days. Antibiotic treatment for asymptomatic bacteriuria of all women without any initial testing was the most cost-effective option for preventing birth before 37 weeks among asymptomatic women but this does not take into account the potential side effects of antibiotics or issues such as increased resistance. For primary prevention, an effective, affordable and safe intervention applied to all mothers without preceding testing is likely to be the most cost-effective approach in asymptomatic women in early pregnancy. For secondary prevention among women at risk of preterm labour in later pregnancy, a management strategy based on the results of testing is likely to be more cost-effective. Implementation of a treat-all strategy with simple interventions, such as fish oils, would be premature for asymptomatic women. Universal provision of high-quality ultrasound machines in labour wards is more strongly indicated for predicting spontaneous preterm birth among symptomatic women than direct management, although staffing issues and the feasibility and acceptability to mothers and health providers of such strategies need to be explored. Further research should include investigations of low-cost and effective tests and treatments to reduce and delay spontaneous preterm birth and reduce the risk of perinatal mortality arising from preterm birth.

Integrated testing and verification system for research flight software

NASA Technical Reports Server (NTRS)

Taylor, R. N.

1979-01-01

The MUST (Multipurpose User-oriented Software Technology) program is being developed to cut the cost of producing research flight software through a system of software support tools. An integrated verification and testing capability was designed as part of MUST. Documentation, verification and test options are provided with special attention on real-time, multiprocessing issues. The needs of the entire software production cycle were considered, with effective management and reduced lifecycle costs as foremost goals.

The Pacific Marine Energy Center - South Energy Test Site (PMEC-SETS)

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

Batten, Belinda; Hellin, Dan

The overall goal of this project was to build on existing progress to establish the Pacific Marine Energy Center South Energy Test Site (PMEC-SETS) as the nation's first fully permitted test site for wave energy converter arrays. Specifically, it plays an essential role in reducing levelized cost of energy for the wave energy industry by providing both the facility and resources to address the challenges of cost reduction.

Research of low cost wind generator rotors

NASA Technical Reports Server (NTRS)

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

1978-01-01

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

A cost-effective interdisciplinary approach to microbiologic send-out test use.

PubMed

Aesif, Scott W; Parenti, David M; Lesky, Linda; Keiser, John F

2015-02-01

Use of reference laboratories for selected laboratory testing (send-out tests) represents a significant source of laboratory costs. As the use of more complex molecular analyses becomes common in the United States, strategies to reduce costs in the clinical laboratory must evolve in order to provide high-value, cost-effective medicine. To report a strategy that employs clinical pathology house staff and key hospital clinicians in the effective use of microbiologic send-out testing. The George Washington University Hospital is a 370-bed academic hospital in Washington, DC. In 2012 all requisitions for microbiologic send-out tests were screened by the clinical pathology house staff prior to final dispensation. Tests with questionable utility were brought to the attention of ordering clinicians through the use of interdisciplinary rounds and direct face-to-face consultation. Screening resulted in a cancellation rate of 38% of send-out tests, with proportional cost savings. Nucleic acid tests represented most of the tests screened and the largest percentage of cost saved through screening. Following consultation, requested send-out tests were most often canceled because of a lack of clinical indication. Direct face-to-face consultation with ordering physicians is an effective, interdisciplinary approach to managing the use of send-out testing in the microbiology laboratory.

Costs of unstructured investigation of unexplained syncope: insights from a micro-costing analysis of the observational PICTURE registry.

PubMed

Edvardsson, Nils; Wolff, Claudia; Tsintzos, Stelios; Rieger, Guido; Linker, Nicholas J

2015-07-01

The observational PICTURE (Place of Reveal In the Care pathway and Treatment of patients with Unexplained Recurrent Syncope) registry enrolled 570 patients with unexplained syncope, documented their care pathway and the various tests they underwent before the insertion of an implantable loop recorder (ILR). The aims were to describe the extent and cost of diagnostic tests performed before the implant. Actual costs of 17 predefined diagnostic tests were characterized based on a combination of data from PICTURE and a micro-costing study performed at a medium-sized UK university hospital in the UK. The median cost of diagnostic tests per patient was £1114 (95% CI £995-£1233). As many patients received more than the median number of tests, the mean expenditure per patient was higher with £1613 (95% CI £1494-£1732), and for 10% of the patients the cost exceeded £3539. Tests were frequently repeated, and early use of specific and expensive tests was common. In the 12% of patients with types of tests entirely within the recommendations for an initial evaluation before ILR implant, the mean cost was £710. Important opportunities to reduce test-related costs before an ILR implant were identified, e.g. by more appropriate use of tests recommended in the initial evaluation, by decreasing repetition of tests, and by avoiding early use of specialized and expensive tests. A structured multidisciplinary approach would be the best model to achieve an optimal outcome. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology.

Costs of unstructured investigation of unexplained syncope: insights from a micro-costing analysis of the observational PICTURE registry

PubMed Central

Edvardsson, Nils; Wolff, Claudia; Tsintzos, Stelios; Rieger, Guido; Linker, Nicholas J.

2015-01-01

Aims The observational PICTURE (Place of Reveal In the Care pathway and Treatment of patients with Unexplained Recurrent Syncope) registry enrolled 570 patients with unexplained syncope, documented their care pathway and the various tests they underwent before the insertion of an implantable loop recorder (ILR). The aims were to describe the extent and cost of diagnostic tests performed before the implant. Methods and results Actual costs of 17 predefined diagnostic tests were characterized based on a combination of data from PICTURE and a micro-costing study performed at a medium-sized UK university hospital in the UK. The median cost of diagnostic tests per patient was £1114 (95% CI £995–£1233). As many patients received more than the median number of tests, the mean expenditure per patient was higher with £1613 (95% CI £1494–£1732), and for 10% of the patients the cost exceeded £3539. Tests were frequently repeated, and early use of specific and expensive tests was common. In the 12% of patients with types of tests entirely within the recommendations for an initial evaluation before ILR implant, the mean cost was £710. Conclusion Important opportunities to reduce test-related costs before an ILR implant were identified, e.g. by more appropriate use of tests recommended in the initial evaluation, by decreasing repetition of tests, and by avoiding early use of specialized and expensive tests. A structured multidisciplinary approach would be the best model to achieve an optimal outcome. PMID:25759408

Impact of a bronchiolitis guideline on ED resource use and cost: a segmented time-series analysis.

PubMed

Akenroye, Ayobami T; Baskin, Marc N; Samnaliev, Mihail; Stack, Anne M

2014-01-01

Bronchiolitis is a major cause of infant morbidity and contributes to millions of dollars in health care costs. Care guidelines may cut costs by reducing unnecessary resource utilization. Through the implementation of a guideline, we sought to reduce unnecessary resource utilization and improve the value of care provided to infants with bronchiolitis in a pediatric emergency department (ED). We conducted an interrupted time series that examined ED visits of 2929 patients with bronchiolitis, aged 1 to 12 months old, seen between November 2007 and April 2013. Outcomes were proportion having a chest radiograph (CXR), respiratory syncytial virus (RSV) testing, albuterol or antibiotic administration, and the total cost of care. Balancing measures included admission rate, returns to the ED resulting in admission within 72 hours of discharge, and ED length of stay (LOS). There were no significant preexisting trends in the outcomes. After guideline implementation, there was an absolute reduction of 23% in CXR (95% confidence interval [CI]: 11% to 34%), 11% in RSV testing (95% CI: 6% to 17%), 7% in albuterol use (95% CI: 0.2% to 13%), and 41 minutes in ED LOS (95% CI: 16 to 65 minutes). Mean cost per patient was reduced by $197 (95% CI: $136 to $259). Total cost savings was $196,409 (95% CI: $135,592 to $258,223) over the 2 bronchiolitis seasons after guideline implementation. There were no significant differences in antibiotic use, admission rates, or returns resulting in admission within 72 hours of discharge. A bronchiolitis guideline was associated with reductions in CXR, RSV testing, albuterol use, ED LOS, and total costs in a pediatric ED.

Costs and benefits of rapid screening of methicillin-resistant Staphylococcus aureus carriage in intensive care units: a prospective multicenter study

PubMed Central

2012-01-01

Introduction Pre-emptive isolation of suspected methicillin-resistant Staphylococcus aureus (MRSA) carriers is a cornerstone of successful MRSA control policies. Implementation of such strategies is hampered when using conventional cultures with diagnostic delays of three to five days, as many non-carriers remain unnecessarily isolated. Rapid diagnostic testing (RDT) reduces the amount of unnecessary isolation days, but costs and benefits have not been accurately determined in intensive care units (ICUs). Methods Embedded in a multi-center hospital-wide study in 12 Dutch hospitals we quantified cost per isolation day avoided using RDT for MRSA, added to conventional cultures, in ICUs. BD GeneOhm™ MRSA PCR (IDI) and Xpert MRSA (GeneXpert) were subsequently used during 17 and 14 months, and their test characteristics were calculated with conventional culture results as reference. We calculated the number of pre-emptive isolation days avoided and incremental costs of adding RDT. Results A total of 163 patients at risk for MRSA carriage were screened and MRSA prevalence was 3.1% (n = 5). Duration of isolation was 27.6 and 21.4 hours with IDI and GeneXpert, respectively, and would have been 96.0 hours when based on conventional cultures. The negative predictive value was 100% for both tests. Numbers of isolation days were reduced by 44.3% with PCR-based screening at the additional costs of €327.84 (IDI) and €252.14 (GeneXpert) per patient screened. Costs per isolation day avoided were €136.04 (IDI) and €121.76 (GeneXpert). Conclusions In a low endemic setting for MRSA, RDT safely reduced the number of unnecessary isolation days on ICUs by 44%, at the costs of €121.76 to €136.04 per isolation day avoided. PMID:22314204

A microcosting study of immunogenicity and tumour necrosis factor alpha inhibitor drug level tests for therapeutic drug monitoring in clinical practice.

PubMed

Jani, Meghna; Gavan, Sean; Chinoy, Hector; Dixon, William G; Harrison, Beverley; Moran, Andrew; Barton, Anne; Payne, Katherine

2016-12-01

To identify and quantify resource required and associated costs for implementing TNF-α inhibitor (TNFi) drug level and anti-drug antibody (ADAb) tests in UK rheumatology practice. A microcosting study, assuming the UK National Health Service perspective, identified the direct medical costs associated with providing TNFi drug level and ADAb testing in clinical practice. Resource use and costs per patient were identified via four stages: identification of a patient pathway with resource implications; estimation of the resources required; identification of the cost per unit of resource (2015 prices); and calculation of the total costs per patient. Univariate and multiway sensitivity analyses were performed using the variation in resource use and unit costs. Total costs for TNFi drug level and concurrent ADAb testing, assessed using ELISAs on trough serum levels, were £152.52/patient (range: £147.68-159.24) if 40 patient samples were tested simultaneously. For the base-case analysis, the pre-testing phase incurred the highest costs, which included booking an additional appointment to acquire trough blood samples. The additional appointment was the key driver of costs per patient (67% of the total cost), and labour accounted for 10% and consumables 23% of the total costs. Performing ELISAs once per patient (rather than in duplicate) reduced the total costs to £133.78/patient. This microcosting study is the first assessing the cost of TNFi drug level and ADAb testing. The results could be used in subsequent cost-effectiveness analyses of TNFi pharmacological tests to target treatments and inform future policy recommendations. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Rheumatology.

Reducing a cost of traumatic insemination: female bedbugs evolve a unique organ.

PubMed Central

Reinhardt, Klaus; Naylor, Richard; Siva-Jothy, Michael T

2003-01-01

The frequent wounding of female bedbugs (Cimex lectularius: Cimicidae) during copulation has been shown to decrease their fitness, but how females have responded to this cost in evolutionary terms is unclear. The evolution of a unique anatomical structure found in female bedbugs, the spermalege, into which the male's intromittent organ passes during traumatic insemination, is a possible counteradaptation to harmful male traits. Several functions have been proposed for this organ, and we test two hypotheses related to its role in sexual conflict. We examine the hypotheses that the spermalege functions to (i) defend against pathogens introduced during traumatic insemination; and (ii) reduce the costs of wound healing during traumatic insemination. Our results support the 'defence against pathogens' hypothesis, suggesting that the evolution of this unique cimicid organ resulted, at least partly, from selection to reduce the costs of mating-associated infection. We found no evidence that the spermalege reduces the costs of wound healing. PMID:14667353

Comparison of sub-scaled to full-scaled aircrafts in simulation environment for air traffic management

NASA Astrophysics Data System (ADS)

Elbakary, Mohamed I.; Iftekharuddin, Khan M.; Papelis, Yiannis; Newman, Brett

2017-05-01

Air Traffic Management (ATM) concepts are commonly tested in simulation to obtain preliminary results and validate the concepts before adoption. Recently, the researchers found that simulation is not enough because of complexity associated with ATM concepts. In other words, full-scale tests must eventually take place to provide compelling performance evidence before adopting full implementation. Testing using full-scale aircraft produces a high-cost approach that yields high-confidence results but simulation provides a low-risk/low-cost approach with reduced confidence on the results. One possible approach to increase the confidence of the results and simultaneously reduce the risk and the cost is using unmanned sub-scale aircraft in testing new concepts for ATM. This paper presents the simulation results of using unmanned sub-scale aircraft in implementing ATM concepts compared to the full scale aircraft. The results of simulation show that the performance of sub-scale is quite comparable to that of the full-scale which validates use of the sub-scale in testing new ATM concepts. Keywords: Unmanned

Optimal tracking and testing of U.S. and Canadian herds for BSE: a value-of-information (VOI) approach.

PubMed

Cox, Louis Anthony; Popken, Douglas A; VanSickle, John J; Sahu, Ranajit

2005-08-01

The U.S. Department of Agriculture (USDA) tests a subset of cattle slaughtered in the United States for bovine spongiform encephalitis (BSE). Knowing the origin of cattle (U.S. vs. Canadian) at testing could enable new testing or surveillance policies based on the origin of cattle testing positive. For example, if a Canadian cow tests positive for BSE, while no U.S. origin cattle do, the United States could subject Canadian cattle to more stringent testing. This article illustrates the application of a value-of-information (VOI) framework to quantify and compare potential economic costs to the United States of implementing tracking cattle origins to the costs of not doing so. The potential economic value of information from a tracking program is estimated to exceed its costs by more than five-fold if such information can reduce future losses in export and domestic markets and reduce future testing costs required to reassure or win back customers. Sensitivity analyses indicate that this conclusion is somewhat robust to many technical, scientific, and market uncertainties, including the current prevalence of BSE in the United States and/or Canada and the likely reactions of consumers to possible future discoveries of BSE in the United States and/or Canada. Indeed, the potential value of tracking information is great enough to justify locating and tracking Canadian cattle already in the United States when this can be done for a reasonable cost. If aggressive tracking and testing can win back lost exports, then the VOI of a tracking program may increase to over half a billion dollars per year.

Factors associated with hospitalisation costs in patients with chronic obstructive pulmonary disease.

PubMed

Li, F; Sun, Z; Li, H; Yang, T; Shi, Z

2018-04-01

Chronic obstructive pulmonary disease (COPD) is a leading cause of hospital admissions, which can result in a significant financial burden. To determine hospitalisation costs and factors associated with higher costs in patients with acute exacerbations of COPD (AE-COPD). Patients hospitalised for a whole year formed the study cohort. Demographic features, clinical data and hospitalisation bills were evaluated retrospectively. Student's t-test or the Mann-Whitney U-test were used to compare the mean values of variables between high-cost and low-cost groups. Logistic regression analysis was used to study the relationship between hospitalisation costs with clinical factors. A total of 188 patients were evaluated. The mean length of stay in hospital (LOSH) was 8.5 days. The mean cost of AE-COPD was US$1722.0. Costs were significantly associated with LOSH and the per cent predicted value of forced expiratory volume in one second. Age, sex, smoking index, partial oxygen pressure, partial carbon dioxide pressure, haemoglobin concentration and white blood cell counts were not associated with hospitalisation costs. Medications and laboratory services are the main drivers of hospitalisation costs in AE-COPD. Longer LOSH and reduced pulmonary function determine the high costs in hospitalised patients with AE-COPD admitted to a general ward. To reduce hospitalisation costs, more emphasis should be placed on shortening LOSH and preventing the worsening of pulmonary function.

Costs of novel tuberculosis diagnostics--will countries be able to afford it?

PubMed

Pantoja, Andrea; Kik, Sandra V; Denkinger, Claudia M

2015-04-01

Four priority target product profiles for the development of diagnostic tests for tuberculosis were identified: 1) Rapid sputum-based (RSP), 2) non-sputum Biomarker-based (BMT), 3) triage test followed by confirmatory test (TT), and 4) drug-susceptibility testing (DST). We assessed the cost of the new tests in suitable strategies and of the conventional diagnosis of tuberculosis as per World Health Organization guidelines, in 36 high tuberculosis and MDR burden countries. Costs were then compared to the available funding for tuberculosis at country level. Costs of diagnosing tuberculosis using RSP ranged US$93-187 million/year; if RSP unit cost is of US$2-4 it would be lower/similar cost than conventional strategy with sputum smear microscopy (US$ 119 million/year). Using BMT (with unit cost of US$2-4) would cost US$70-121 million/year and be lower/comparable cost than conventional diagnostics. Using TT with TPP characteristics (unit cost of US$1-2) followed by Xpert would reduce diagnostic costs up to US$36 million/year. Costs of using different novel DST strategies for the diagnosis of drug resistance would be higher compared with conventional diagnosis. Introducing a TT or a biomarker test with optimal characteristics would be affordable from a cost and affordability perspective at the current available funding for tuberculosis. Additional domestic or donor funding would be needed in most countries to achieve affordability for other new diagnostic tests. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Skid Resistance Research

NASA Technical Reports Server (NTRS)

1977-01-01

Skidding causes many traffic accidents. Streets and highways with skid-resisting surfaces reduce the incidence of such accidents. In fact, resurfacing roads to improve skid resistance is now required by federal law. Skid resistance is measured by road testing with specially equipped skid trailers. A project underway at NASA-Langley may considerably reduce the cost of skid trailers, thus making them more widely available to highway departments. For testing the skid resistance of aircraft runways, Langley engineers developed a relatively inexpensive test vehicle and a "pulsed braking" technique that is now being applied experimentally to road testing. The vehicle is a standard automobile modified to incorporate instrumentation, special test tires and valves, and a trailing fifth wheel for monitoring distance and velocity. The instrumentation includes a low-cost meter, a set of accelerometers that sense motion changes, and a chart recorder.

Integrated HIV testing, malaria, and diarrhea prevention campaign in Kenya: modeled health impact and cost-effectiveness.

PubMed

Kahn, James G; Muraguri, Nicholas; Harris, Brian; Lugada, Eric; Clasen, Thomas; Grabowsky, Mark; Mermin, Jonathan; Shariff, Shahnaaz

2012-01-01

Efficiently delivered interventions to reduce HIV, malaria, and diarrhea are essential to accelerating global health efforts. A 2008 community integrated prevention campaign in Western Province, Kenya, reached 47,000 individuals over 7 days, providing HIV testing and counseling, water filters, insecticide-treated bed nets, condoms, and for HIV-infected individuals cotrimoxazole prophylaxis and referral for ongoing care. We modeled the potential cost-effectiveness of a scaled-up integrated prevention campaign. We estimated averted deaths and disability-adjusted life years (DALYs) based on published data on baseline mortality and morbidity and on the protective effect of interventions, including antiretroviral therapy. We incorporate a previously estimated scaled-up campaign cost. We used published costs of medical care to estimate savings from averted illness (for all three diseases) and the added costs of initiating treatment earlier in the course of HIV disease. Per 1000 participants, projected reductions in cases of diarrhea, malaria, and HIV infection avert an estimated 16.3 deaths, 359 DALYs and $85,113 in medical care costs. Earlier care for HIV-infected persons adds an estimated 82 DALYs averted (to a total of 442), at a cost of $37,097 (reducing total averted costs to $48,015). Accounting for the estimated campaign cost of $32,000, the campaign saves an estimated $16,015 per 1000 participants. In multivariate sensitivity analyses, 83% of simulations result in net savings, and 93% in a cost per DALY averted of less than $20. A mass, rapidly implemented campaign for HIV testing, safe water, and malaria control appears economically attractive.

Predictive Modeling of Developmental Toxicity

EPA Science Inventory

The use of alternative methods in conjunction with traditional in vivo developmental toxicity testing has the potential to (1) reduce cost and increase throughput of testing the chemical universe, (2) prioritize chemicals for further targeted toxicity testing and risk assessment,...

Cost-effectiveness of human papillomavirus vaccination and cervical cancer screening in Thailand.

PubMed

Sharma, M; Ortendahl, J; van der Ham, E; Sy, S; Kim, J J

2012-01-01

To assess the health and economic outcomes of various screening and vaccination strategies for cervical cancer prevention. Cost-effectiveness analysis from a societal perspective. Thailand. Females aged 9 years and older. Using a mathematical model of human papillomavirus (HPV) infection and cervical cancer, calibrated to epidemiological data from Thailand, we estimated the cost-effectiveness of pre-adolescent HPV vaccination, screening [visual inspection with acetic acid (VIA), HPV DNA testing, and cytology] between one and five times per lifetime in adulthood, and combined pre-adolescent vaccination and screening. Vaccine efficacy, coverage, cost, and screening frequency were varied in sensitivity analyses. Incremental cost-effectiveness ratios, expressed as cost per year of life saved (YLS). Assuming lifelong efficacy and 80% coverage, pre-adolescent HPV vaccination alone was projected to reduce the lifetime risk of cervical cancer by 55%, which was greater than any strategy of screening alone. When cost per vaccinated girl was I$10 (approximately $2 per dose) or less, HPV vaccination alone was cost saving. Pre-adolescent vaccination and HPV DNA testing five times per lifetime, starting at age 35 years, reduced the lifetime cervical cancer risk by 70%, and had a cost-effectiveness ratio less than Thailand's GDP per capita (I$8100), provided the cost per vaccinated girl was I$200 or less. Low cost pre-adolescent HPV vaccination followed by HPV screening five times per lifetime is an efficient strategy for Thailand. Costs may need to be lower, however, for this strategy to be affordable. If vaccination is not feasible, HPV DNA testing five times per lifetime is efficient. © 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.

Elevational variation in body-temperature response to immune challenge in a lizard

PubMed Central

Reguera, Senda; Moreno-Rueda, Gregorio

2016-01-01

Immunocompetence benefits animal fitness by combating pathogens, but also entails some costs. One of its main components is fever, which in ectotherms involves two main types of costs: energy expenditure and predation risk. Whenever those costs of fever outweigh its benefits, ectotherms are expected not to develop fever, or even to show hypothermia, reducing costs of thermoregulation and diverting the energy saved to other components of the immune system. Environmental thermal quality, and therefore the thermoregulation cost/benefit balance, varies geographically. Hence, we hypothesize that, in alpine habitats, immune-challenged ectotherms should show no thermal response, given that (1) hypothermia would be very costly, as the temporal window for reproduction is extremely small, and (2) fever would have a prohibitive cost, as heat acquisition is limited in such habitat. However, in temperate habitats, immune-challenged ectotherms might show a febrile response, due to lower cost/benefit balance as a consequence of a more suitable thermal environment. We tested this hypothesis in Psammodromus algirus lizards from Sierra Nevada (SE Spain), by testing body temperature preferred by alpine and non-alpine lizards, before and after activating their immune system with a typical innocuous pyrogen. Surprisingly, non-alpine lizards responded to immune challenge by decreasing preferential body-temperature, presumably allowing them to save energy and reduce exposure to predators. On the contrary, as predicted, immune-challenged alpine lizards maintained their body-temperature preferences. These results match with increased costs of no thermoregulation with elevation, due to the reduced window of time for reproduction in alpine environment. PMID:27168981

Elevational variation in body-temperature response to immune challenge in a lizard.

PubMed

Zamora-Camacho, Francisco Javier; Reguera, Senda; Moreno-Rueda, Gregorio

2016-01-01

Immunocompetence benefits animal fitness by combating pathogens, but also entails some costs. One of its main components is fever, which in ectotherms involves two main types of costs: energy expenditure and predation risk. Whenever those costs of fever outweigh its benefits, ectotherms are expected not to develop fever, or even to show hypothermia, reducing costs of thermoregulation and diverting the energy saved to other components of the immune system. Environmental thermal quality, and therefore the thermoregulation cost/benefit balance, varies geographically. Hence, we hypothesize that, in alpine habitats, immune-challenged ectotherms should show no thermal response, given that (1) hypothermia would be very costly, as the temporal window for reproduction is extremely small, and (2) fever would have a prohibitive cost, as heat acquisition is limited in such habitat. However, in temperate habitats, immune-challenged ectotherms might show a febrile response, due to lower cost/benefit balance as a consequence of a more suitable thermal environment. We tested this hypothesis in Psammodromus algirus lizards from Sierra Nevada (SE Spain), by testing body temperature preferred by alpine and non-alpine lizards, before and after activating their immune system with a typical innocuous pyrogen. Surprisingly, non-alpine lizards responded to immune challenge by decreasing preferential body-temperature, presumably allowing them to save energy and reduce exposure to predators. On the contrary, as predicted, immune-challenged alpine lizards maintained their body-temperature preferences. These results match with increased costs of no thermoregulation with elevation, due to the reduced window of time for reproduction in alpine environment.

Cost and cost effectiveness of vaginal progesterone gel in reducing preterm birth: an economic analysis of the PREGNANT trial.

PubMed

Pizzi, Laura T; Seligman, Neil S; Baxter, Jason K; Jutkowitz, Eric; Berghella, Vincenzo

2014-05-01

Preterm birth (PTB) is a costly public health problem in the USA. The PREGNANT trial tested the efficacy of vaginal progesterone (VP) 8 % gel in reducing the likelihood of PTB among women with a short cervix. We calculated the costs and cost effectiveness of VP gel versus placebo using decision analytic models informed by PREGNANT patient-level data. PREGNANT enrolled 459 pregnant women with a cervical length of 10-20 mm and randomized them to either VP 8 % gel or placebo. We used a cost model to estimate the total cost of treatment per mother and a cost-effectiveness model to estimate the cost per PTB averted with VP gel versus placebo. Patient-level trial data informed model inputs and included PTB rates in low- and high-risk women in each study group at <28 weeks gestation, 28-31, 32-36, and ≥37 weeks. Cost assumptions were based on 2010 US healthcare services reimbursements. The cost model was validated against patient-level data. Sensitivity analyses were used to test the robustness of the cost-effectiveness model. The estimated cost per mother was $US23,079 for VP gel and $US36,436 for placebo. The cost-effectiveness model showed savings of $US24,071 per PTB averted with VP gel. VP gel realized cost savings and cost effectiveness in 79 % of simulations. Based on findings from PREGNANT, VP gel was associated with cost savings and cost effectiveness compared with placebo. Future trials designed to include cost metrics are needed to better understand the value of VP.

Controllable Grid Interface Test System | Energy Systems Integration

Science.gov Websites

Facility | NREL Controllable Grid Interface Test System Controllable Grid Interface Test System NREL's controllable grid interface (CGI) test system can reduce certification testing time and costs grid interface is the first test facility in the United States that has fault simulation capabilities

Managing manifest diseases, but not health risks, saved PepsiCo money over seven years.

PubMed

Caloyeras, John P; Liu, Hangsheng; Exum, Ellen; Broderick, Megan; Mattke, Soeren

2014-01-01

Workplace wellness programs are increasingly popular. Employers expect them to improve employee health and well-being, lower medical costs, increase productivity, and reduce absenteeism. To test whether such expectations are warranted, we evaluated the cost impact of the lifestyle and disease management components of PepsiCo's wellness program, Healthy Living. We found that seven years of continuous participation in one or both components was associated with an average reduction of $30 in health care cost per member per month. When we looked at each component individually, we found that the disease management component was associated with lower costs and that the lifestyle management component was not. We estimate disease management to reduce health care costs by $136 per member per month, driven by a 29 percent reduction in hospital admissions. Workplace wellness programs may reduce health risks, delay or avoid the onset of chronic diseases, and lower health care costs for employees with manifest chronic disease. But employers and policy makers should not take for granted that the lifestyle management component of such programs can reduce health care costs or even lead to net savings.

Screening test recommendations for methicillin-resistant Staphylococcus aureus surveillance practices: A cost-minimization analysis.

PubMed

Whittington, Melanie D; Curtis, Donna J; Atherly, Adam J; Bradley, Cathy J; Lindrooth, Richard C; Campbell, Jonathan D

2017-07-01

To mitigate methicillin-resistant Staphylococcus aureus (MRSA) infections, intensive care units (ICUs) conduct surveillance through screening patients upon admission followed by adhering to isolation precautions. Two surveillance approaches commonly implemented are universal preemptive isolation and targeted isolation of only MRSA-positive patients. Decision analysis was used to calculate the total cost of universal preemptive isolation and targeted isolation. The screening test used as part of the surveillance practice was varied to identify which screening test minimized inappropriate and total costs. A probabilistic sensitivity analysis was conducted to evaluate the range of total costs resulting from variation in inputs. The total cost of the universal preemptive isolation surveillance practice was minimized when a polymerase chain reaction screening test was used ($82.51 per patient). Costs were $207.60 more per patient when a conventional culture was used due to the longer turnaround time and thus higher isolation costs. The total cost of the targeted isolation surveillance practice was minimized when chromogenic agar 24-hour testing was used ($8.54 per patient). Costs were $22.41 more per patient when polymerase chain reaction was used. For ICUs that preemptively isolate all patients, the use of a polymerase chain reaction screening test is recommended because it can minimize total costs by reducing inappropriate isolation costs. For ICUs that only isolate MRSA-positive patients, the use of chromogenic agar 24-hour testing is recommended to minimize total costs. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Impact of Oncotype DX breast Recurrence Score testing on adjuvant chemotherapy use in early breast cancer: Real world experience in Greater Manchester, UK.

PubMed

Loncaster, J; Armstrong, A; Howell, S; Wilson, G; Welch, R; Chittalia, A; Valentine, W J; Bundred, N J

2017-05-01

The National Institute for Health and Clinical Excellence (NICE) recommended the Oncotype DX ® Breast Recurrence Score ® (RS) assay as an option for informing adjuvant chemotherapy decisions in node-negative, oestrogen receptor (ER)+, human epidermal growth factor receptor 2 (HER2)-negative early breast cancer assessed to be at intermediate risk of recurrence based on clinicopathological factors. We evaluated the impact of RS testing on adjuvant chemotherapy decision-making in routine clinical practice in a UK Cancer Network. RS testing was performed in 201 females with newly diagnosed, ER+, HER2-negative, invasive breast cancer who underwent breast surgery with curative intent, were calculated to have a >3% overall survival benefit at 10 years from adjuvant chemotherapy based on PREDICT, and were considered for adjuvant chemotherapy. The impact of RS testing on adjuvant treatment decisions/associated cost was assessed. In all patients, the multi-disciplinary team recommended chemotherapy but the RS result allowed 127/201 patients (63.2%) to avoid unnecessary adjuvant chemotherapy. Amongst ER+, HER2-negative, node-negative patients (eligible for Oncotype DX testing in UK guidelines), 60.3% were spared chemotherapy. In node-positive patients, the assay reduced the use of chemotherapy by 69.2%. The use of RS testing to guide treatment in these 201 patients was associated with significant cost saving (when considering the cost of RS testing for all patients plus chemotherapy and its associated cost for 74 patients). Incorporating RS testing into routine clinical practice for selected node-negative and node-positive breast cancer patients significantly reduces the use of chemotherapy (p < 0.001) with its associated morbidity and costs. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Assessing the costs of mobile voluntary counseling and testing at the work place versus facility based voluntary counseling and testing in Namibia.

PubMed

de Beer, Ingrid; Chani, Kudakwashe; Feeley, Frank G; Rinke de Wit, Tobias F; Sweeney-Bindels, Els; Mulongeni, Pancho

2015-01-01

Bophelo! is a mobile voluntary counseling and testing (VCT) and wellness screening program operated by PharmAccess at workplaces in Namibia, funded from both public and private resources. Publicly funded fixed site New Start centers provide similar services in Namibia. At this time of this study, no comparative information on the cost effectiveness of mobile versus fixed site service provision was available in Namibia to inform future programming for scale-up of VCT. The objectives of the study were to assess the costs of mobile VCT and wellness service delivery in Namibia and to compare the costs and effectiveness with fixed site VCT testing in Namibia. The full direct costs of all resources used by the mobile and fixed site testing programs and data on people tested and outcomes were obtained from PharmAccess and New Start centers in Namibia. Data were also collected on the source of funding, both public donor funding and private funding through contributions from employers. The data were analyzed using Microsoft Excel to determine the average cost per person tested for HIV. In 2009, the average cost per person tested for HIV at the Bophelo! mobile clinic was an estimated US$60.59 (US$310,451 for the 5124 people tested). Private employer contributions to the testing costs reduced the public cost per person tested to US$37.76. The incremental cost per person associated with testing for conditions other than HIV infection was US$11.35, an increase of 18.7%, consisting of the costs of additional tests (US$8.62) and staff time (US$2.73). The cost of testing one person for HIV in 2009 at the New Start centers was estimated at US$58.21 (US$4,082,936 for the 70 143 people tested). Mobile clinics can provide cost-effective wellness testing services at the workplace and have the potential to mobilize local private funding sources. Providing wellness testing in addition to VCT can help address the growing issue of non-communicable diseases.

Impact of Laboratory Test Use Strategies in a Turkish Hospital

PubMed Central

Yılmaz, Fatma Meriç; Kahveci, Rabia; Aksoy, Altan; Özer Kucuk, Emine; Akın, Tezcan; Mathew, Joseph Lazar; Meads, Catherine; Zengin, Nurullah

2016-01-01

Objectives Eliminating unnecessary laboratory tests is a good way to reduce costs while maintain patient safety. The aim of this study was to define and process strategies to rationalize laboratory use in Ankara Numune Training and Research Hospital (ANH) and calculate potential savings in costs. Methods A collaborative plan was defined by hospital managers; joint meetings with ANHTA and laboratory professors were set; the joint committee invited relevant staff for input, and a laboratory efficiency committee was created. Literature was reviewed systematically to identify strategies used to improve laboratory efficiency. Strategies that would be applicable in local settings were identified for implementation, processed, and the impact on clinical use and costs assessed for 12 months. Results Laboratory use in ANH differed enormously among clinics. Major use was identified in internal medicine. The mean number of tests per patient was 15.8. Unnecessary testing for chloride, folic acid, free prostate specific antigen, hepatitis and HIV testing were observed. Test panel use was pinpointed as the main cause of overuse of the laboratory and the Hospital Information System test ordering page was reorganized. A significant decrease (between 12.6–85.0%) was observed for the tests that were taken to an alternative page on the computer screen. The one year study saving was equivalent to 371,183 US dollars. Conclusion Hospital-based committees including laboratory professionals and clinicians can define hospital based problems and led to a standardized approach to test use that can help clinicians reduce laboratory costs through appropriate use of laboratory tests. PMID:27077653

Automated chest-radiography as a triage for Xpert testing in resource-constrained settings: a prospective study of diagnostic accuracy and costs

NASA Astrophysics Data System (ADS)

Philipsen, R. H. H. M.; Sánchez, C. I.; Maduskar, P.; Melendez, J.; Peters-Bax, L.; Peter, J. G.; Dawson, R.; Theron, G.; Dheda, K.; van Ginneken, B.

2015-07-01

Molecular tests hold great potential for tuberculosis (TB) diagnosis, but are costly, time consuming, and HIV-infected patients are often sputum scarce. Therefore, alternative approaches are needed. We evaluated automated digital chest radiography (ACR) as a rapid and cheap pre-screen test prior to Xpert MTB/RIF (Xpert). 388 suspected TB subjects underwent chest radiography, Xpert and sputum culture testing. Radiographs were analysed by computer software (CAD4TB) and specialist readers, and abnormality scores were allocated. A triage algorithm was simulated in which subjects with a score above a threshold underwent Xpert. We computed sensitivity, specificity, cost per screened subject (CSS), cost per notified TB case (CNTBC) and throughput for different diagnostic thresholds. 18.3% of subjects had culture positive TB. For Xpert alone, sensitivity was 78.9%, specificity 98.1%, CSS $13.09 and CNTBC $90.70. In a pre-screening setting where 40% of subjects would undergo Xpert, CSS decreased to $6.72 and CNTBC to $54.34, with eight TB cases missed and throughput increased from 45 to 113 patients/day. Specialists, on average, read 57% of radiographs as abnormal, reducing CSS ($8.95) and CNTBC ($64.84). ACR pre-screening could substantially reduce costs, and increase daily throughput with few TB cases missed. These data inform public health policy in resource-constrained settings.

Demonstration of Advanced CO 2 Capture Process Improvements for Coal-Fired Flue Gas

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

Carroll, John

This document summarizes the activities of Cooperative Agreement DE-FE0026590, “Demonstration of Advanced CO 2 Capture Process Improvements for Coal-Fired Flue Gas” during the performance period of October 1, 2015 through May 31, 2017. This project was funded by the U.S. Department of Energy (DOE) National Energy Technology Laboratory (NETL). Southern Company Services, Inc. (SCS) was the prime contractor and co-funder of the project. Mitsubishi Heavy Industries America (MHIA) and AECOM were project team members. The overall project objective was to improve costs, energy requirements, and performance of an existing amine-based CO 2 capture process. This will occur via improvements inmore » three areas: 1. Reboiler design – The first objective of the program was to demonstrate performance of an integrated stripper/reboiler (termed Built-in Reboiler, or BIR) to reduce footprint, capital costs, and integration issues of the current technology. 2. Particulate management – The second objective was to carry out a Particulate Matter Management (PMM) test. This has the potential to reduce operating costs and capital costs due to the reduced or eliminated need for mechanical filtration. 3. Solvent – The third objective was to carry out a new solvent test plan (referred to as NSL) to demonstrate a new solvent (termed New Solvent A), which is expected to reduce regeneration steam. The bulk price is also expected to be lower than KS-1, which is the current solvent used in this process. NSL testing would include baseline testing, optimization, long term testing, solvent reclamation testing, and final inspection. These combine to form the Advanced Carbon Capture (ACC) technology. Much of this work will be applicable to generic solvent processes, especially in regards to improved reboiler design, and focused to meet or exceed the DOE’s overall carbon capture performance goals of 90% CO 2 capture rate with 95% CO 2 purity at a cost of $40/tonne of CO 2 by 2025 and at a cost of electricity (COE) 30% less than baseline CO 2 capture approaches by 2030. This project was divided into two phases. Phase 1 is the planning phase, and Phase 2 is the construction, operations, testing, and analysis phase. A down select occurred after Phase 1. Phase 1 activities were carried out during this reporting period, and therefore, Phase 1 activities are solely considered in this report. The project was not selected for Phase 2 funding.« less

Point-of-care D-dimer testing in emergency departments.

PubMed

Marquardt, Udo; Apau, Daniel

2015-09-01

Overcrowding and prolonged patient stays in emergency departments (EDs) affect patients' experiences and outcomes, and increase healthcare costs. One way of addressing these problems is through using point-of-care blood tests, laboratory testing undertaken near patient locations with rapidly available results. D-dimer tests are used to exclude venous thromboembolism (VTE), a common presentation in EDs, in low-risk patients. However, data on the effects of point-of-care D-dimer testing in EDs and other urgent care settings are scarce. This article reports the results of a literature review that examined the benefits to patients of point-of-care D-dimer testing in terms of reduced turnaround times (time to results), and time to diagnosis, discharge or referral. It also considers the benefits to organisations in relation to reduced ED crowding and increased cost effectiveness. The review concludes that undertaking point-of-care D-dimer tests, combined with pre-test probability scores, can be a quick and safe way of ruling out VTE and improving patients' experience.

Genetic and economic benefits of selection based on performance recording and genotyping in lower tiers of multi-tiered sheep breeding schemes.

PubMed

Santos, Bruno F S; van der Werf, Julius H J; Gibson, John P; Byrne, Timothy J; Amer, Peter R

2017-01-17

Performance recording and genotyping in the multiplier tier of multi-tiered sheep breeding schemes could potentially reduce the difference in the average genetic merit between nucleus and commercial flocks, and create additional economic benefits for the breeding structure. The genetic change in a multiple-trait breeding objective was predicted for various selection strategies that included performance recording, parentage testing and genomic selection. A deterministic simulation model was used to predict selection differentials and the flow of genetic superiority through the different tiers. Cumulative discounted economic benefits were calculated based on trait gains achieved in each of the tiers and considering the extra revenue and associated costs of applying recording, genotyping and selection practices in the multiplier tier of the breeding scheme. Performance recording combined with genomic or parentage information in the multiplier tier reduced the genetic lag between the nucleus and commercial flock by 2 to 3 years. The overall economic benefits of improved performance in the commercial tier offset the costs of recording the multiplier. However, it took more than 18 years before the cumulative net present value of benefits offset the costs at current test prices. Strategies in which recorded multiplier ewes were selected as replacements for the nucleus flock did modestly increase profitability when compared to a closed nucleus structure. Applying genomic selection is the most beneficial strategy if testing costs can be reduced or by genotyping only a proportion of the selection candidates. When the cost of genotyping was reduced, scenarios that combine performance recording with genomic selection were more profitable and reached breakeven point about 10 years earlier. Economic benefits can be generated in multiplier flocks by implementing performance recording in conjunction with either DNA pedigree recording or genomic technology. These recording practices reduce the long genetic lag between the nucleus and commercial flocks in multi-tiered breeding programs. Under current genotyping costs, the time to breakeven was found to be generally very long, although this varied between strategies. Strategies using either genomic selection or DNA pedigree verification were found to be economically viable provided the price paid for the tests is lower than current prices, in the long-term.

Gas-Centered Swirl Coaxial Liquid Injector Evaluations

NASA Technical Reports Server (NTRS)

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

2005-01-01

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

Effect of Yoga practice on reducing cognitive-motor interference for improving dynamic balance control in healthy adults.

PubMed

Subramaniam, Savitha; Bhatt, Tanvi

2017-02-01

The purpose of our study was to investigate the effects of Yoga on reducing cognitive-motor interference (CMI) for maintaining balance control during varied balance tasks. Yoga (N=10) and age-similar non-practitioners (N=10) performed three balance tasks including the Limits of Stability test (LOS - Intentional balance), Motor Control test (MCT - Reactive balance), and Sensory Organization Test (SOT -condition 6: inducing both somatosensory and visual conflicts) under single-task (ST) and dual-task (DT, addition of a cognitive working memory task) conditions. The motor performance was assessed by recording the response time (RT) and movement velocity (MV) of the center of pressure (CoP) on LOS test, weight symmetry (WS) of CoP on the MCT test and equilibrium (EQ) of CoP on the SOT test. Cognitive performance was recorded as the number of correct responses enumerated in sitting (ST) and under DT conditions. The Motor cost (MC) and cognitive cost (CC) were computed using the formula ([ST-DT]/ST)*100 for all the variables. Greater cost indicates lower performance under DT versus ST condition. The Yoga group showed a significantly lesser MC for both MCT and SOT tests (p<0.05) in comparison to their counterparts. The CC were significantly lower on LOS and MCT test for the Yoga group (p<0.05). Results suggest that Yoga practice can significantly reduce CMI by improving allocation and utilization of attentional resources for both balance control and executive cognitive functioning; thus resulting in better performance under DT conditions. Copyright © 2016. Published by Elsevier Ltd.

Cost-effectiveness of MODY genetic testing: translating genomic advances into practical health applications.

PubMed

Naylor, Rochelle N; John, Priya M; Winn, Aaron N; Carmody, David; Greeley, Siri Atma W; Philipson, Louis H; Bell, Graeme I; Huang, Elbert S

2014-01-01

OBJECTIVE To evaluate the cost-effectiveness of a genetic testing policy for HNF1A-, HNF4A-, and GCK-MODY in a hypothetical cohort of type 2 diabetic patients 25-40 years old with a MODY prevalence of 2%. RESEARCH DESIGN AND METHODS We used a simulation model of type 2 diabetes complications based on UK Prospective Diabetes Study data, modified to account for the natural history of disease by genetic subtype to compare a policy of genetic testing at diabetes diagnosis versus a policy of no testing. Under the screening policy, successful sulfonylurea treatment of HNF1A-MODY and HNF4A-MODY was modeled to produce a glycosylated hemoglobin reduction of -1.5% compared with usual care. GCK-MODY received no therapy. Main outcome measures were costs and quality-adjusted life years (QALYs) based on lifetime risk of complications and treatments, expressed as the incremental cost-effectiveness ratio (ICER) (USD/QALY). RESULTS The testing policy yielded an average gain of 0.012 QALYs and resulted in an ICER of 205,000 USD. Sensitivity analysis showed that if the MODY prevalence was 6%, the ICER would be ~50,000 USD. If MODY prevalence was >30%, the testing policy was cost saving. Reducing genetic testing costs to 700 USD also resulted in an ICER of ~50,000 USD. CONCLUSIONS Our simulated model suggests that a policy of testing for MODY in selected populations is cost-effective for the U.S. based on contemporary ICER thresholds. Higher prevalence of MODY in the tested population or decreased testing costs would enhance cost-effectiveness. Our results make a compelling argument for routine coverage of genetic testing in patients with high clinical suspicion of MODY.

Hospital payroll costs, productivity, and employment under prospective reimbursement.

PubMed

Kidder, D; Sullivan, D

1982-12-01

This paper reports preliminary findings from the National Hospital Rate-Setting Study regarding the effects of State prospective reimbursement (PR) programs on measures of payroll costs and employment in hospitals. PR effects were estimated through reduced-form equations, using American Hospital Association Annual Survey data on over 2,700 hospitals from 1969 through 1978. These tests suggest that hospitals responded to PR by lowering payroll expenditures. PR also seems to have been associated with reductions in full-time equivalent staff per adjusted inpatient day. However, tests did not confirm the hypothesis that hospitals reduce payroll per full-time equivalent staff as a result of PR.

Hospital Payroll Costs, Productivity, and Employment Under Prospective Reimbursement

PubMed Central

Kidder, David; Sullivan, Daniel

1982-01-01

This paper reports preliminary findings from the National Hospital Rate-Setting Study regarding the effects of State prospective reimbursement (PR) programs on measures of payroll costs and employment in hospitals. PR effects were estimated through reduced-form equations, using American Hospital Association Annual Survey data on over 2,700 hospitals from 1969 through 1978. These tests suggest that hospitals responded to PR by lowering payroll expenditures. PR also seems to have been associated with reductions in full-time equivalent staff per adjusted inpatient day. However, tests did not confirm the hypothesis that hospitals reduce payroll per full-time equivalent staff as a result of PR. PMID:10309913

Use of low density lipoprotein particle number levels as an aid in statin treatment decisions for intermediate risk patients: a cost-effectiveness analysis.

PubMed

Shiffman, Dov; Arellano, Andre R; Caulfield, Michael P; Louie, Judy Z; Bare, Lance A; Devlin, James J; Melander, Olle

2016-12-07

The 2013 ACC/AHA guideline recommended either no statin therapy or moderate-intensity statin therapy (MST) for intermediate risk patients-those with 5-7.5% 10-year risk and without cardiovascular disease (CVD), hypercholesterolemia or diabetes. The guideline further suggested that the therapy choice be based on patient-clinician discussions of risks and benefits. Since low-density lipoprotein particle (LDL-P) levels were reported to be associated with CVD independently of traditional risk factors in intermediate and low risk patients, we investigated the cost-effectiveness of using LDL-P levels to identify intermediate risk patients likely to benefit from initiating or intensifying statin therapy. We evaluated 5 care strategies for intermediate risk patients. These included the strategies suggested by the guideline: no-statin therapy and MST. We compared each of these strategies to a related strategy that incorporated LDL-P testing. No-statin therapy was compared with the strategy of MST for those with high LDL-P levels and no statin therapy for all other patients (test-and-MST). MST was compared with the strategy of high-intensity statin therapy (HST) for those with high LDL-P levels and MST for all other patients (test-and-HST). We also evaluated the strategy of HST for all. Costs (payer perspective) and utilities were assessed over a 5-year time horizon in a Markov model of 100,000 hypothetical intermediate risk patients. HST dominated all other strategies, costing less and-despite causing 739 more cases of diabetes than did MST-resulting in more quality adjusted life-years (QALYs). For patient-clinician discussions that would otherwise lead to the MST strategy, we found the test-and-HST strategy reduced costs by $4.67 MM and resulted in 134 fewer CVD events and 115 additional QALYs. For patient-clinician discussions that would otherwise lead to no statin therapy, we found that the test-and-MST strategy reduced costs by $3.25 MM, resulted in 97 fewer CVD events and 44 additional QALYs. The HST strategy was cost saving and improved outcomes in intermediate risk patients. For patient and clinicians concerned about the adverse events associated with HST, using LDL-P levels to target intensified statin therapy could improve outcomes and reduce costs.

Low-Cost Composite Materials and Structures for Aircraft Applications

NASA Technical Reports Server (NTRS)

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

2003-01-01

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

The cost of warfarin treatment for stroke prevention in patients with non-valvular atrial fibrillation in Russia from a collective perspective.

PubMed

Briere, J B; Bowrin, K; Wood, R; Roberts, J; Tatarsky, B

2017-06-01

Vitamin K antagonists (VKAs) are used for stroke prevention in patients with non-valvular atrial fibrillation (NVAF), but necessitate regular monitoring of prothrombin time via international normalized ratio (INR) testing. This study explores the economic burden of VKA therapy for Russian patients with NVAF. Cardiologists provided clinical characteristics and healthcare resource use data relating to the patient's first year of treatment. Data were used to quantify direct medical costs (INR testing, consultations, drug costs). The same patients completed a questionnaire providing data on direct non-medical costs (travel/expenses for attendance at VKA appointments) and indirect costs (opportunity cost and reduced work productivity). Mean costs per patient per year are described (US dollars). Cardiologists (n = 50) provided data on 400 patients (mean age = 63, 47% female), and 351 patients (88%) completed the patient questionnaire. Patients had a mean of nine INR tests. Estimated direct medical costs totaled $151.06, and 18.5% of direct medical costs were attributable to drug costs. Estimated annual direct non-medical costs were $22.89 per patient, and indirect costs were $275.59 per patient. Included patients had been treated for 12-24 months, so are not fully representative of the broader treatment population. Although VKA drugs costs are relatively low, regular INR testing and consultations drive the economic burden for Russian NVAF patients treated with VKA.

Cost-effectiveness analysis of universal noninvasive testing for post-treatment confirmation of Helicobacter pylori eradication and the impact of patient adherence.

PubMed

Boklage, Susan H; Mangel, Allen W; Ramamohan, Varun; Mladsi, Deirdre; Wang, Tao

2016-01-01

The treatment failure rate for Helicobacter pylori eradication therapy is ~20% due to poor patient compliance and increased antibiotic resistance. This analysis assessed the cost-effectiveness of universal post-treatment testing to confirm eradication of H. pylori infection in adults. Decision-analytic models evaluated the cost-effectiveness of universal post-treatment testing (urea breath test [UBT] or monoclonal fecal antigen test [mFAT]) vs no testing (Model 1), and UBT vs mFAT after adjusting for patient adherence to testing (Model 2) in adults who previously received first-line antimicrobial therapy. Patients testing positive received second-line quadruple therapy; no further action was taken for those testing negative or with no testing (Model 1) or for those nonadherent to testing (Model 2). In addition to testing costs, excess lifetime costs and reduced quality-adjusted life-years (QALYs) due to continuing H. pylori infection were considered in the model. Expected total costs per patient were higher for post-treatment testing (UBT: US$325.76; mFAT: US$242.12) vs no testing (US$182.41) in Model 1 and for UBT (US$336.75) vs mFAT (US$326.24) in Model 2. Expected QALYs gained per patient were 0.71 and 0.72 for UBT and mFAT, respectively, vs no testing (Model 1), and the same was 0.37 for UBT vs mFAT (Model 2). The estimated incremental costs per QALY gained for post-treatment testing vs no testing were US$82.90-US$202.45 and, after adjusting for adherence, US$28.13 for UBT vs mFAT. Universal post-treatment testing was found to be cost-effective for confirming eradication of H. pylori infection following first-line therapy. Better adherence to UBT relative to mFAT was the key to its cost-effectiveness.

Cost effectiveness of adding nucleic acid testing to hepatitis B, hepatitis C, and human immunodeficiency virus screening of blood donations in Zimbabwe.

PubMed

Mafirakureva, Nyashadzaishe; Mapako, Tonderai; Khoza, Star; Emmanuel, Jean C; Marowa, Lucy; Mvere, David; Postma, Maarten J; van Hulst, Marinus

2016-12-01

The aim of this study was to assess the cost effectiveness of introducing individual-donation nucleic acid testing (ID-NAT), in addition to serologic tests, compared with the exclusive use of serologic tests for the identification of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) I and II among blood donors in Zimbabwe. The costs, health consequences, and cost effectiveness of adding ID-NAT to serologic tests, compared with serologic testing alone, were estimated from a health care perspective using a decision-analytic model. The introduction of ID-NAT in addition to serologic tests would lower the risk of HBV, HCV, and HIV transmission to 46.9, 0.3, and 2.7 per 100,000 donations, respectively. ID-NAT would prevent an estimated 25, 6, and 9 HBV, HCV, and HIV transfusion-transmitted infections per 100,000 donations, respectively. The introduction of this intervention would result in an estimated 212 quality-adjusted life-years (QALYs) gained. The incremental cost-effectiveness ratio is estimated at US$17,774/QALY, a value far more than three times the gross national income per capita for Zimbabwe. Although the introduction of NAT could further improve the safety of the blood supply, current evidence suggests that it cannot be considered cost effective. Reducing the test costs for NAT through efficient donor recruitment, negotiating the price of reagents, and the efficient use of technology will improve cost effectiveness. © 2016 AABB.

Estimated cost per HIV infection diagnosed through routine HIV testing offered in acute general medical admission units and general practice settings in England.

PubMed

Ong, K J; Thornton, A C; Fisher, M; Hutt, R; Nicholson, S; Palfreeman, A; Perry, N; Stedman-Bryce, G; Wilkinson, P; Delpech, V; Nardone, A

2016-04-01

Following national guidelines to expand HIV testing in high-prevalence areas in England, a number of pilot studies were conducted in acute general medical admission units (ACUs) and general practices (GPs) to assess the feasibility and acceptability of testing in these settings. The aim of this study was to estimate the cost per HIV infection diagnosed through routine HIV testing in these settings. Resource use data from four 2009/2010 Department of Health pilot studies (two ACUs; two GPs) were analysed. Data from the pilots were validated and supplemented with information from other sources. We constructed possible scenarios to estimate the cost per test carried out through expanded HIV testing in ACUs and GPs, and the cost per diagnosis. In the pilots, cost per test ranged from £8.55 to £13.50, and offer time and patient uptake were 2 minutes and 90% in ACUs, and 5 minutes and 60% in GPs, respectively. In scenario analyses we fixed offer time, diagnostic test cost and uptake rate at 2 minutes, £6 and 80% for ACUs, and 5 minutes, £9.60 and 40% for GPs, respectively. The cost per new HIV diagnosis at a positivity of 2/1000 tests conducted was £3230 in ACUs and £7930 in GPs for tests performed by a Band 3 staff member, and £5940 in ACUs and £18 800 in GPs for tests performed by either hospital consultants or GPs. Expanded HIV testing may be more cost-efficient in ACUs than in GPs as a consequence of a shorter offer time, higher patient uptake, higher HIV positivity and lower diagnostic test costs. As cost per new HIV diagnosis reduces at higher HIV positivity, expanded HIV testing should be promoted in high HIV prevalence areas. © 2015 British HIV Association.

Costs of harvesting forest biomass on steep slopes with a small cable yarder: results from field trials and simulations

Treesearch

John E. Baumgras; Chris B. LeDoux

1986-01-01

Cable yarding can reduce the environmental impact of timber harvesting on steep slopes by increasing road spacing and reducing soil disturbance. To determine the cost of harvesting forest biomass with a small cable yarder, a 13.4 kW (18 hp) skyline yarder was tested on two southern Appalachian sites. At both sites, fuelwood was harvested from the boles of hardwood...

Alternative Approach to Vehicle Element Processing

NASA Technical Reports Server (NTRS)

Huether, Jacob E.; Otto, Albert E.

1995-01-01

The National Space Transportation Policy (NSTP), describes the challenge facing today's aerospace industry. 'Assuring reliable and affordable access to space through U.S. space transportation capabilities is a fundamental goal of the U.S. space program'. Experience from the Space Shuttle Program (SSP) tells us that launch and mission operations are responsible for approximately 45 % of the cost of each shuttle mission. Reducing these costs is critical to NSTP goals in the next generation launch vehicle. Based on this, an innovative alternative approach to vehicle element processing was developed with an emphasis on reduced launch costs. State-of-the-art upgrades to the launch processing system (LPS) will enhance vehicle ground operations. To carry this one step further, these upgrade could be implemented at various vehicle element manufacturing sites to ensure system compatibility between the manufacturing facility and the launch site. Design center vehicle stand alone testing will ensure system integrity resulting in minimized checkout and testing at the launch site. This paper will addresses vehicle test requirements, timelines and ground checkout procedures which enable concept implementation.

Independent contractors versus employees: the costs and benefits for your practice.

PubMed

Buzogany, William A; Mueller, Michael J

2010-01-01

Every business is interested in reducing costs. Payroll and employee benefit costs can be reduced through the use of independent contractors, because they are not employees to whom training, overtime wages, and benefits must be provided. Using the services of an independent contractor presents some disadvantages, however, as an independent contractor cannot be controlled and disciplined in the same fashion as an employee. There are a variety of tests applied under various statutes to determine whether an individual is an employee or an independent contractor, and it is important to carefully analyze all of the facts of a given situation in light of these tests before entering into an independent contractor relationship. If you engage an individual as an independent contractor, and that individual is found to actually be an employee, your business may be subject to significant financial penalties.

Economic evaluation of the Good School Toolkit: an intervention for reducing violence in primary schools in Uganda.

PubMed

Greco, Giulia; Knight, Louise; Ssekadde, Willington; Namy, Sophie; Naker, Dipak; Devries, Karen

2018-01-01

This paper presents the cost and cost-effectiveness of the Good School Toolkit (GST), a programme aimed at reducing physical violence perpetrated by school staff to students in Uganda. The effectiveness of the Toolkit was tested with a cluster randomised controlled trial in 42 primary schools in Luwero District, Uganda. A full economic costing evaluation and cost-effectiveness analysis were conducted alongside the trial. Both financial and economic costs were collected retrospectively from the provider's perspective to estimate total and unit costs. The total cost of setting up and running the Toolkit over the 18-month trial period is estimated at US$397 233, excluding process monitor (M&E) activities. The cost to run the intervention is US$7429 per school annually, or US$15 per primary school pupil annually, in the trial intervention schools. It is estimated that the intervention has averted 1620 cases of past-week physical violence during the 18-month implementation period. The total cost per case of violence averted is US$244, and the annual implementation cost is US$96 per case averted during the trial. The GST is a cost-effective intervention for reducing violence against pupils in primary schools in Uganda. It compares favourably against other violence reduction interventions in the region.

Cost-effectiveness of alternative test strategies for the diagnosis of coronary artery disease.

PubMed

Garber, A M; Solomon, N A

1999-05-04

The appropriate roles for several diagnostic tests for coronary disease are uncertain. To evaluate the cost-effectiveness of alternative approaches to diagnosis of coronary disease. Meta-analysis of the accuracy of alternative diagnostic tests plus decision analysis to assess the health outcomes and costs of alternative diagnostic strategies for patients at intermediate pretest risk for coronary disease. Studies of test accuracy that met inclusion criteria; published information on treatment effectiveness and disease prevalence. Men and women 45, 55, and 65 years of age with a 25% to 75% pretest risk for coronary disease. 30 years. Societal. Diagnostic strategies were initial angiography and initial testing with one of five noninvasive tests--exercise treadmill testing, planar thallium imaging, single-photon emission computed tomography (SPECT), stress echocardiography, and positron emission tomography (PET)--followed by coronary angiography if noninvasive test results were positive. Testing was followed by observation, medical treatment, or revascularization. Life-years, quality-adjusted life-years (QALYs), costs, and costs per QALY. Life expectancy varied little with the initial diagnostic test; for a 55-year-old man, the best-performing test increased life expectancy by 7 more days than the worst-performing test. More sensitive tests increased QALYs more. Echocardiography improved health outcomes and reduced costs relative to stress testing and planar thallium imaging. The incremental cost-effectiveness ratio was $75,000/QALY for SPECT relative to echocardiography and was greater than $640,000 for PET relative to SPECT. Compared with SPECT, immediate angiography had an incremental cost-effectiveness ratio of $94,000/QALY. Qualitative findings varied little with age, sex, pretest probability of disease, or the test indeterminancy rate. Results varied most with sensitivity to severe coronary disease. Echocardiography, SPECT, and immediate angiography are cost-effective alternatives to PET and other diagnostic approaches. Test selection should reflect local variation in test accuracy.

Development of a practical costing method for hospitals.

PubMed

Cao, Pengyu; Toyabe, Shin-Ichi; Akazawa, Kouhei

2006-03-01

To realize an effective cost control, a practical and accurate cost accounting system is indispensable in hospitals. In traditional cost accounting systems, the volume-based costing (VBC) is the most popular cost accounting method. In this method, the indirect costs are allocated to each cost object (services or units of a hospital) using a single indicator named a cost driver (e.g., Labor hours, revenues or the number of patients). However, this method often results in rough and inaccurate results. The activity based costing (ABC) method introduced in the mid 1990s can prove more accurate results. With the ABC method, all events or transactions that cause costs are recognized as "activities", and a specific cost driver is prepared for each activity. Finally, the costs of activities are allocated to cost objects by the corresponding cost driver. However, it is much more complex and costly than other traditional cost accounting methods because the data collection for cost drivers is not always easy. In this study, we developed a simplified ABC (S-ABC) costing method to reduce the workload of ABC costing by reducing the number of cost drivers used in the ABC method. Using the S-ABC method, we estimated the cost of the laboratory tests, and as a result, similarly accurate results were obtained with the ABC method (largest difference was 2.64%). Simultaneously, this new method reduces the seven cost drivers used in the ABC method to four. Moreover, we performed an evaluation using other sample data from physiological laboratory department to certify the effectiveness of this new method. In conclusion, the S-ABC method provides two advantages in comparison to the VBC and ABC methods: (1) it can obtain accurate results, and (2) it is simpler to perform. Once we reduce the number of cost drivers by applying the proposed S-ABC method to the data for the ABC method, we can easily perform the cost accounting using few cost drivers after the second round of costing.

The role of gas heat pumps in electric DSM

NASA Astrophysics Data System (ADS)

Fulmer, M.; Hughes, P. J.

1993-05-01

Natural gas-fired heat pumps (GHP's), an emerging technology, may offer environmental economic, and energy benefits relative to standard and advanced space conditioning equipment now on the market. This paper describes an analysis of GHP's for residential space heating, and cooling relative to major competing technologies under an Integrated Resource (IRP) framework. Our study models a hypothetical GHP rebate program using conditions typical of the Great Lakes region. The analysis is performed for a base scenario with sensitivity cases. In the base scenario, the GHP program is cost-effective according to the societal test, total resource cost test (TRC), and the participant test, but is not cost-effective according to the non-participant test. The sensitivity analyses indicate that the results for the TRC test are most sensitive to the season in which electric demand peaks and the technology against which the GHP's are competing, and are less sensitive to changes in the marginal administrative costs. The modeled GHP program would save 900 million kWh over the life of the program and reduce peak load by about 100 MW in winter and about 135 MW in summer. We estimate all of the GHP's in service (both GHP's of program participants and nonparticipants) in the case study region would save 1,900 million kWh and reduce summer peak load by over 350 MW.

A Cost Analysis of Web-Enhanced Training to Reduce Alcohol Sales to Intoxicated Bar Patrons

ERIC Educational Resources Information Center

Page, Timothy F.; Nederhoff, Dawn M.; Ecklund, Alexandra M.; Horvath, Keith J.; Nelson, Toben F.; Erickson, Darin J.; Toomey, Traci L.

2015-01-01

Objective: The purpose of this study was to document the development and testing costs of the Enhanced Alcohol Risk Management (eARM) intervention, a web enhanced training program to prevent alcohol sales to intoxicated bar patrons and to estimate its implementation costs in a "real world", non-research setting. Methods: Data for this…

Impact of Enterovirus Testing on Resource Use in Febrile Young Infants: A Systematic Review.

PubMed

Wallace, Sowdhamini S; Lopez, Michelle A; Caviness, A Chantal

2017-02-01

Enterovirus infection commonly causes fever in infants aged 0 to 90 days and, without testing, is difficult to differentiate from serious bacterial infection. To determine the cost savings of routine enterovirus testing and identify subgroups of infants with greater potential impact from testing among infants 0 to 90 days old with fever. Studies were identified systematically from published and unpublished literature by using Embase, Medline, the Cochrane database, and conference proceedings. Inclusion criteria were original studies, in any language, of enterovirus infection including the outcomes of interest in infants aged 0 to 90 days. Standardized instruments were used to appraise each study. The evidence quality was evaluated using Grading of Recommendations Assessment, Development, and Evaluation criteria. Two investigators independently searched the literature, screened and critically appraised the studies, extracted the data, and applied the Grading of Recommendations Assessment, Development, and Evaluation criteria. Of the 257 unique studies identified and screened, 32 were completely reviewed and 8 were included. Routine enterovirus testing was associated with reduced hospital length of stay and cost savings during peak enterovirus season. Cerebrospinal fluid pleocytosis was a poor predictor of enterovirus meningitis. The studies were all observational and the evidence was of low quality. Enterovirus polymerase chain reaction testing, independent of cerebrospinal fluid pleocytosis, can reduce length of stay and achieve cost savings, especially during times of high enterovirus prevalence. Additional study is needed to identify subgroups that may achieve greater cost savings from testing to additionally enhance the efficiency of testing. Copyright © 2017 by the American Academy of Pediatrics.

The Diagnosis of Urinary Tract Infection in Young Children (DUTY) Study Clinical Rule: Economic Evaluation.

PubMed

Hollingworth, William; Busby, John; Butler, Christopher C; O'Brien, Kathryn; Sterne, Jonathan A C; Hood, Kerenza; Little, Paul; Lawton, Michael; Birnie, Kate; Thomas-Jones, Emma; Harman, Kim; Hay, Alastair D

2017-04-01

To estimate the cost-effectiveness of a two-step clinical rule using symptoms, signs and dipstick testing to guide the diagnosis and antibiotic treatment of urinary tract infection (UTI) in acutely unwell young children presenting to primary care. Decision analytic model synthesising data from a multicentre, prospective cohort study (DUTY) and the wider literature to estimate the short-term and lifetime costs and healthcare outcomes (symptomatic days, recurrent UTI, quality adjusted life years) of eight diagnostic strategies. We compared GP clinical judgement with three strategies based on a 'coefficient score' combining seven symptoms and signs independently associated with UTI and four strategies based on weighted scores according to the presence/absence of five symptoms and signs. We compared dipstick testing versus laboratory culture in children at intermediate risk of UTI. Sampling, culture and antibiotic costs were lowest in high-specificity DUTY strategies (£1.22 and £1.08) compared to clinical judgement (£1.99). These strategies also approximately halved urine sampling (4.8% versus 9.1% in clinical judgement) without reducing sensitivity (58.2% versus 56.4%). Outcomes were very similar across all diagnostic strategies. High-specificity DUTY strategies were more cost-effective than clinical judgement in the short- (iNMB = £0.78 and £0.84) and long-term (iNMB =£2.31 and £2.50). Dipstick tests had poorer cost-effectiveness than laboratory culture in children at intermediate risk of UTI (iNMB = £-1.41). Compared to GPs' clinical judgement, high specificity clinical rules from the DUTY study could substantially reduce urine sampling, achieving lower costs and equivalent patient outcomes. Dipstick testing children for UTI is not cost-effective. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Catalytic Combustion for Ultra-Low NOx Hydrogen Turbines

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

Etemad, Shahrokh; Baird, Benjamin; Alavandi, Sandeep

2011-06-30

Precision Combustion, Inc., (PCI) in close collaboration with Solar Turbines, Incorporated, has developed and demonstrated a combustion system for hydrogen fueled turbines that reduces NOx to low single digit level while maintaining or improving current levels of efficiency and eliminating emissions of carbon dioxide. Full scale Rich Catalytic Hydrogen (RCH1) injector was developed and successfully tested at Solar Turbines, Incorporated high pressure test facility demonstrating low single digit NOx emissions for hydrogen fuel in the range of 2200F-2750F. This development work was based on initial subscale development for faster turnaround and reduced cost. Subscale testing provided promising results for 42%more » and 52% H2 with NOx emissions of less than 2 ppm with improved flame stability. In addition, catalytic reactor element testing for substrate oxidation, thermal cyclic injector testing to simulate start-stop operation in a gas turbine environment, and steady state 15 atm. operation testing were performed successfully. The testing demonstrated stable and robust catalytic element component life for gas turbine conditions. The benefit of the catalytic hydrogen combustor technology includes capability of delivering near-zero NOx without costly post-combustion controls and without requirement for added sulfur control. In addition, reduced acoustics increase gas turbine component life. These advantages advances Department of Energy (DOE’s) objectives for achievement of low single digit NOx emissions, improvement in efficiency vs. postcombustion controls, fuel flexibility, a significant net reduction in Integrated Gasification Combined Cycle (IGCC) system net capital and operating costs, and a route to commercialization across the power generation field from micro turbines to industrial and utility turbines.« less

Update on Risk Reduction Activities for a Liquid Advanced Booster for NASA's Space Launch System

NASA Technical Reports Server (NTRS)

Crocker, Andrew M.; Greene, William D.

2017-01-01

The stated goals of NASA's Research Announcement for the Space Launch System (SLS) Advanced Booster Engineering Demonstration and/or Risk Reduction (ABEDRR) are to reduce risks leading to an affordable Advanced Booster that meets the evolved capabilities of SLS and enable competition by mitigating targeted Advanced Booster risks to enhance SLS affordability. Dynetics, Inc. and Aerojet Rocketdyne (AR) formed a team to offer a wide-ranging set of risk reduction activities and full-scale, system-level demonstrations that support NASA's ABEDRR goals. During the ABEDRR effort, the Dynetics Team has modified flight-proven Apollo-Saturn F-1 engine components and subsystems to improve affordability and reliability (e.g., reduce parts counts, touch labor, or use lower cost manufacturing processes and materials). The team has built hardware to validate production costs and completed tests to demonstrate it can meet performance requirements. State-of-the-art manufacturing and processing techniques have been applied to the heritage F-1, resulting in a low recurring cost engine while retaining the benefits of Apollo-era experience. NASA test facilities have been used to perform low-cost risk-reduction engine testing. In early 2014, NASA and the Dynetics Team agreed to move additional large liquid oxygen/kerosene engine work under Dynetics' ABEDRR contract. Also led by AR, the objectives of this work are to demonstrate combustion stability and measure performance of a 500,000 lbf class Oxidizer-Rich Staged Combustion (ORSC) cycle main injector. A trade study was completed to investigate the feasibility, cost effectiveness, and technical maturity of a domestically-produced engine that could potentially both replace the RD-180 on Atlas V and satisfy NASA SLS payload-to-orbit requirements via an advanced booster application. Engine physical dimensions and performance parameters resulting from this study provide the system level requirements for the ORSC risk reduction test article. The test article is scheduled to complete fabrication and assembly soon and continue testing through late 2019. Dynetics has also designed, developed, and built innovative tank and structure assemblies using friction stir welding to leverage recent NASA investments in manufacturing tools, facilities, and processes, significantly reducing development and recurring costs. The full-scale cryotank assembly was used to verify the structural design and prove affordable processes. Dynetics performed hydrostatic and cryothermal proof tests on the assembly to verify the assembly meets performance requirements..

Perceived Cost Advantages and Disadvantages of Purchasing HIV Self-Testing Kits among Urban Tanzanian Men: An Inductive Content Analysis

PubMed Central

Jennings, Larissa; Conserve, Donaldson F; Merrill, Jamison; Kajula, Lusajo; Iwelunmor, Juliet; Linnemayr, Sebastian; Maman, Suzanne

2017-01-01

Impoverished men have lower rates of facility-based HIV counseling and testing and higher unknown HIV-positive status than women. Economic theory suggests that individuals will obtain an HIV test if anticipated benefits are greater than anticipated costs. Yet, few studies have investigated the range of financial preferences of HIV self-testing (HIVST) among poor men who decline testing or do not test regularly. Twenty-three interviews were conducted to qualitatively assess perceived costs saved and costs incurred from use of HIVST kits in infrequently- or never-tested Tanzanian men. All men were shown an HIVST kit and video. They were then asked about the costs associated with provider-led HIV testing, financial benefits and concerns of HIVST and willingness to pay for HIVST. Data were transcribed, coded and analyzed using inductive content analyses. We then grouped codes into perceived cost advantages and disadvantages and tabulated the range of prices men were willing to pay for a self-test kit. Perceived cost advantages of HIVST were avoidance of spending money to test in facilities, omission of follow-up fees, affordability relative to private clinics, and increased time for earning income and other activities. Men also discussed the imbalance of the financial benefit of accessing free, public HIV testing with the resources spent for transport, purchasing meals away from home and long wait lines. Perceived cost disadvantages of HIVST were prohibitive kit costs, required prior savings to purchase kits, expenditures relating to death and preferences for free provider-performed testing. Men were also concerned about the psychological costs of inaccurate results. HIVST willingness to pay varied among men. Men’s decisions to self-test for HIV takes into account expected financial gains and losses. Demand generation for HIVST among men should consider use of low fees or free HIVST, while emphasizing potential savings from reduced travel, clinical costs, or time way from work. Efforts are also needed to address anticipated emotional costs of HIVST, such as anxiety from kit errors, purchasing “death” or testing alone, which for some men was a substantial barrier. PMID:29051841

Perceived Cost Advantages and Disadvantages of Purchasing HIV Self-Testing Kits among Urban Tanzanian Men: An Inductive Content Analysis.

PubMed

Jennings, Larissa; Conserve, Donaldson F; Merrill, Jamison; Kajula, Lusajo; Iwelunmor, Juliet; Linnemayr, Sebastian; Maman, Suzanne

2017-08-01

Impoverished men have lower rates of facility-based HIV counseling and testing and higher unknown HIV-positive status than women. Economic theory suggests that individuals will obtain an HIV test if anticipated benefits are greater than anticipated costs. Yet, few studies have investigated the range of financial preferences of HIV self-testing (HIVST) among poor men who decline testing or do not test regularly. Twenty-three interviews were conducted to qualitatively assess perceived costs saved and costs incurred from use of HIVST kits in infrequently- or never-tested Tanzanian men. All men were shown an HIVST kit and video. They were then asked about the costs associated with provider-led HIV testing, financial benefits and concerns of HIVST and willingness to pay for HIVST. Data were transcribed, coded and analyzed using inductive content analyses. We then grouped codes into perceived cost advantages and disadvantages and tabulated the range of prices men were willing to pay for a self-test kit. Perceived cost advantages of HIVST were avoidance of spending money to test in facilities, omission of follow-up fees, affordability relative to private clinics, and increased time for earning income and other activities. Men also discussed the imbalance of the financial benefit of accessing free, public HIV testing with the resources spent for transport, purchasing meals away from home and long wait lines. Perceived cost disadvantages of HIVST were prohibitive kit costs, required prior savings to purchase kits, expenditures relating to death and preferences for free provider-performed testing. Men were also concerned about the psychological costs of inaccurate results. HIVST willingness to pay varied among men. Men's decisions to self-test for HIV takes into account expected financial gains and losses. Demand generation for HIVST among men should consider use of low fees or free HIVST, while emphasizing potential savings from reduced travel, clinical costs, or time way from work. Efforts are also needed to address anticipated emotional costs of HIVST, such as anxiety from kit errors, purchasing "death" or testing alone, which for some men was a substantial barrier.

Automotive Stirling Engine Development Program

NASA Technical Reports Server (NTRS)

Nightingale, N.; Ernst, W.; Richey, A.; Simetkosky, M.; Antonelli, M. (Editor)

1982-01-01

Activities performed on Mod I engine testing and test results; the manufacture, assembly, and test of a Mod I engine in the United States; design initiation of the Mod I-A engine system; transient performance testing; Stirling reference engine manufacturing and reduced size studies; components and subsystems; and the study and test of low cost alloys are summarized.

Cost-effectiveness of Increasing Access to Contraception during the Zika Virus Outbreak, Puerto Rico, 2016.

PubMed

Li, Rui; Simmons, Katharine B; Bertolli, Jeanne; Rivera-Garcia, Brenda; Cox, Shanna; Romero, Lisa; Koonin, Lisa M; Valencia-Prado, Miguel; Bracero, Nabal; Jamieson, Denise J; Barfield, Wanda; Moore, Cynthia A; Mai, Cara T; Korhonen, Lauren C; Frey, Meghan T; Perez-Padilla, Janice; Torres-Muñoz, Ricardo; Grosse, Scott D

2017-01-01

We modeled the potential cost-effectiveness of increasing access to contraception in Puerto Rico during a Zika virus outbreak. The intervention is projected to cost an additional $33.5 million in family planning services and is likely to be cost-saving for the healthcare system overall. It could reduce Zika virus-related costs by $65.2 million ($2.8 million from less Zika virus testing and monitoring and $62.3 million from avoided costs of Zika virus-associated microcephaly [ZAM]). The estimates are influenced by the contraception methods used, the frequency of ZAM, and the lifetime incremental cost of ZAM. Accounting for unwanted pregnancies that are prevented, irrespective of Zika virus infection, an additional $40.4 million in medical costs would be avoided through the intervention. Increasing contraceptive access for women who want to delay or avoid pregnancy in Puerto Rico during a Zika virus outbreak can substantially reduce the number of cases of ZAM and healthcare costs.

Cost-effectiveness of Increasing Access to Contraception during the Zika Virus Outbreak, Puerto Rico, 2016

PubMed Central

Simmons, Katharine B.; Bertolli, Jeanne; Rivera-Garcia, Brenda; Cox, Shanna; Romero, Lisa; Koonin, Lisa M.; Valencia-Prado, Miguel; Bracero, Nabal; Jamieson, Denise J.; Barfield, Wanda; Moore, Cynthia A.; Mai, Cara T.; Korhonen, Lauren C.; Frey, Meghan T.; Perez-Padilla, Janice; Torres-Muñoz, Ricardo; Grosse, Scott D.

2017-01-01

We modeled the potential cost-effectiveness of increasing access to contraception in Puerto Rico during a Zika virus outbreak. The intervention is projected to cost an additional $33.5 million in family planning services and is likely to be cost-saving for the healthcare system overall. It could reduce Zika virus–related costs by $65.2 million ($2.8 million from less Zika virus testing and monitoring and $62.3 million from avoided costs of Zika virus–associated microcephaly [ZAM]). The estimates are influenced by the contraception methods used, the frequency of ZAM, and the lifetime incremental cost of ZAM. Accounting for unwanted pregnancies that are prevented, irrespective of Zika virus infection, an additional $40.4 million in medical costs would be avoided through the intervention. Increasing contraceptive access for women who want to delay or avoid pregnancy in Puerto Rico during a Zika virus outbreak can substantially reduce the number of cases of ZAM and healthcare costs. PMID:27805547

Clinical and Cost Impact Analysis of a Novel Prognostic Test for Early Detection of Preterm Birth

PubMed Central

Caughey, Aaron B.; Zupancic, John A. F.; Greenberg, James M.; Garfield, Susan S.; Thung, Stephen F.; Iams, Jay D.

2016-01-01

Objective The objective of this study was to evaluate the potential impact to the U.S. health care system by adopting a novel test that identifies women at risk for spontaneous preterm birth. Methods A decision-analytic model was developed to assess clinical and cost outcomes over a 1-year period. The use of a prognostic test to predict spontaneous preterm birth in a hypothetical population of women reflective of the U.S. population (predictive arm) was compared with the current baseline rate of spontaneous preterm birth and associated infant morbidity and mortality (baseline care arm). Results In a population of 3,528,593 births, our model predicts a 23.5% reduction in infant mortality (8,300 vs. 6,343 deaths) with use of the novel test. The rate of acute conditions at birth decreased from 11.2 to 8.1%; similarly, the rate of developmental disabilities decreased from 13.2 to 11.5%. The rate of spontaneous preterm birth decreased from 9.8 to 9.1%, a reduction of 23,430 preterm births. Direct medical costs savings was $511.7M (− 2.1%) in the first year of life. Discussion The use of a prognostic test for reducing spontaneous preterm birth is a dominant strategy that could reduce costs and improve outcomes. More research is needed once such a test is available to determine if these results are borne out upon real-world use. PMID:27917307

Entry Descent and Landing Workshop Proceedings. Volume 1; Commercial Sources for EDL Flight Tests

NASA Technical Reports Server (NTRS)

Trombetta, Nick; Horan, Steve

2015-01-01

Commercial Off The Shelf is defined as a Federal Acquisition Regulation (FAR) term for commercial items, including services, available in the commercial marketplace that can be bought and used under government contracts. A need for COTS exists to help in reducing avionics cost associated with applicable missions. In a 2014 a Planetary Science Decadal Survey it was stated that it is imperative that NASA expand its investment in fundamental technology areas. Reduced mass and power requirements for spacecraft and their subsystems. New and improved sensors, instruments, and sampling systems; and Mission and trajectory design and optimization Two goals were written as part of the technology investment: 1. Reducing the cost of planetary missions 2. Improving their scientific capability and reliability...." COTS could certainty aid in reducing cost associated with the instrumentation systems.

New Suborbital Flight Opportunities and Funding

NASA Astrophysics Data System (ADS)

Saltman, Alexander

2013-07-01

New opportunities for suborbital research are on the horizon. Reusable suborbital vehicles will offer immediate and routine space access for scientific payloads, provide access to altitudes around 100 kilometers, create opportunities for low-cost monitoring of upper atmospheric phenomena, as well as small scale solar observation. Reduced operational cost and quick turn-around will enable equipment to be flown opportunistically, in response to specific solar activity, or in continuous test and improvement cycles. Suborbital test flights will also provide opportunities to test prospective satellite instruments in an extended microgravity environment before being launched to orbit, raising the technology readiness level (TRL) of flight hardware and reducing the risk of anomalies during missions. I discuss the capabilities of emerging suborbital vehicles, payload and integration requirements, and funding opportunities for suborbital flights at NASA.

The potential economic value of screening hospital admissions for Clostridium difficile.

PubMed

Bartsch, S M; Curry, S R; Harrison, L H; Lee, B Y

2012-11-01

Asymptomatic Clostridium difficile carriage has a prevalence reported as high as 51-85 %; with up to 84 % of incident hospital-acquired infections linked to carriers. Accurately identifying carriers may limit the spread of Clostridium difficile. Since new technology adoption depends heavily on its economic value, we developed an analytic simulation model to determine the cost-effectiveness screening hospital admissions for Clostridium difficile from the hospital and third party payer perspectives. Isolation precautions were applied to patients testing positive, preventing transmission. Sensitivity analyses varied Clostridium difficile colonization rate, infection probability among secondary cases, contact isolation compliance, and screening cost. Screening was cost-effective (i.e., incremental cost-effectiveness ratio [ICER] ≤ $50,000/QALY) for every scenario tested; all ICER values were ≤ $256/QALY. Screening was economically dominant (i.e., saved costs and provided health benefits) with a ≥10.3 % colonization rate and ≥5.88 % infection probability when contact isolation compliance was ≥25 % (hospital perspective). Under some conditions screening led to cost savings per case averted (range, $53-272). Clostridium difficile screening, coupled with isolation precautions, may be a cost-effective intervention to hospitals and third party payers, based on prevalence. Limiting Clostridium difficile transmission can reduce the number of infections, thereby reducing its economic burden to the healthcare system.

The Potential Economic Value of Screening Hospital Admissions for Clostridium difficile

PubMed Central

Bartsch, Sarah M.; Curry, Scott R.; Harrison, Lee H.; Lee, Bruce Y.

2012-01-01

Purpose Asymptomatic Clostridium difficile carriage has a prevalence reported as high as 51% to 85%; with up to 84% of incident hospital-acquired infections linked to carriers. Accurately identifying carriers may limit the spread of Clostridium difficile. Methods Since new technology adoption depends heavily on its economic value, we developed a analytic simulation model to determine the cost-effectiveness screening hospital admissions for Clostridium difficile from the hospital and third party payer perspectives. Isolation precautions were applied to patients testing positive, preventing transmission. Sensitivity analyses varied Clostridium difficile colonization rate, infection probability among secondary cases, contact isolation compliance, and screening cost. Results Screening was cost-effective [i.e., incremental cost-effectiveness ratio (ICER) ≤$50,000/QALY] for every scenario tested; all ICER values ≤$256/QALY. Screening was economically dominant (i.e., saved costs and provided health benefits) with a ≥10.3% colonization rate and ≥5.88% infection probability when contact isolation compliance was ≥25% (hospital perspective). Under some conditions screening led to cost-savings per case averted (range: $53 to $272). Conclusion Clostridium difficile screening, coupled with isolation precautions, may be a cost-effective intervention to hospitals and third party payers, based on prevalence. Limiting Clostridium difficile transmission can reduce the number of infections, thereby reducing its economic burden to the healthcare system. PMID:22752150

ROC and Loss Function Analysis in Sequential Testing

ERIC Educational Resources Information Center

Muijtjens, Arno M. M.; Van Luijk, Scheltus J.; Van Der Vleuten, Cees P. M.

2006-01-01

Sequential testing is applied to reduce costs in SP-based tests (OSCEs). Initially, all candidates take a screening test consisting of a part of the OSCE. Candidates who fail the screen sit the complete test, whereas those who pass the screen are qualified as a pass of the complete test. The procedure may result in a reduction of testing…

Xpert®MTB/RIF for the Diagnosis of Tuberculosis in a Remote Arctic Setting: Impact on Cost and Time to Treatment Initiation.

PubMed

Oxlade, Olivia; Sugarman, Jordan; Alvarez, Gonzalo G; Pai, Madhukar; Schwartzman, Kevin

2016-01-01

Tuberculosis (TB) remains a significant health problem in the Canadian Arctic. Substantial health system delays in TB diagnosis can occur, in part due to the lack of capacity for onsite microbiologic testing. A study recently evaluated the yield and impact of a rapid automated PCR test (Xpert®MTB/RIF) for the diagnosis of TB in Iqaluit (Nunavut). We conducted an economic analysis to evaluate the expected cost relative to the expected reduction in time to treatment initiation, with the addition of Xpert®MTB/RIF to the current diagnostic and treatment algorithms used in this setting. A decision analysis model compared current microbiologic testing to a scenario where Xpert®MTB/RIF was added to the current diagnostic algorithm for active TB, and incorporated costs and clinical endpoints from the Iqaluit study. Several sensitivity analyses that considered alternative use were also considered. We estimated days to TB diagnosis and treatment initiation, health system costs, and the incremental cost per treatment day gained for each individual evaluated for possible TB. With the addition of Xpert®MTB/RIF, costs increased while days to TB treatment initiation were reduced. The incremental cost per treatment day gained (per individual investigated for TB) was $164 (95% uncertainty range $85, $452). In a sensitivity analysis that considered hospital discharge after a single negative Xpert®MTB/RIF, the Xpert®MTB/RIF scenario was cost saving. Adding Xpert®MTB/RIF to the current diagnostic algorithm for TB in Nunavut appears to reduce time to diagnosis and treatment at reasonable cost. It may be especially well suited to overcome some of the other logistical barriers that are unique to this and other remote communities.

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

PubMed

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

2017-07-18

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

New electrostatic coal cleaning method cuts sulfur content by 40%

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

Not Available

1985-12-01

An emission control system that electrically charges pollutants and coal particles promises to reduce sulfur 40% at half the cost. The dry coal cleaning processes offer superior performance and better economics than conventional flotation cleaning. Advanced Energy Dynamics, Inc. (AED) is developing both fine and ultra fine processes which increase combustion efficiency and boiler reliability and reduced operating costs. The article gives details from the performance tests and comparisons and summarizes the economic analyses. 4 tables.

Optimal triage test characteristics to improve the cost-effectiveness of the Xpert MTB/RIF assay for TB diagnosis: a decision analysis.

PubMed

van't Hoog, Anna H; Cobelens, Frank; Vassall, Anna; van Kampen, Sanne; Dorman, Susan E; Alland, David; Ellner, Jerrold

2013-01-01

High costs are a limitation to scaling up the Xpert MTB/RIF assay (Xpert) for the diagnosis of tuberculosis in resource-constrained settings. A triaging strategy in which a sensitive but not necessarily highly specific rapid test is used to select patients for Xpert may result in a more affordable diagnostic algorithm. To inform the selection and development of particular diagnostics as a triage test we explored combinations of sensitivity, specificity and cost at which a hypothetical triage test will improve affordability of the Xpert assay. In a decision analytical model parameterized for Uganda, India and South Africa, we compared a diagnostic algorithm in which a cohort of patients with presumptive TB received Xpert to a triage algorithm whereby only those with a positive triage test were tested by Xpert. A triage test with sensitivity equal to Xpert, 75% specificity, and costs of US$5 per patient tested reduced total diagnostic costs by 42% in the Uganda setting, and by 34% and 39% respectively in the India and South Africa settings. When exploring triage algorithms with lower sensitivity, the use of an example triage test with 95% sensitivity relative to Xpert, 75% specificity and test costs $5 resulted in similar cost reduction, and was cost-effective by the WHO willingness-to-pay threshold compared to Xpert for all in Uganda, but not in India and South Africa. The gain in affordability of the examined triage algorithms increased with decreasing prevalence of tuberculosis among the cohort. A triage test strategy could potentially improve the affordability of Xpert for TB diagnosis, particularly in low-income countries and with enhanced case-finding. Tests and markers with lower accuracy than desired of a diagnostic test may fall within the ranges of sensitivity, specificity and cost required for triage tests and be developed as such.

Reduction of the use of antimicrobial drugs following the rapid detection of Streptococcus agalactiae in the vagina at delivery by real-time PCR assay.

PubMed

Poncelet-Jasserand, E; Forges, F; Varlet, M-N; Chauleur, C; Seffert, P; Siani, C; Pozzetto, B; Ros, A

2013-08-01

To assess whether the determination of the presence of group B streptococci (GBS) in the vagina using a rapid polymerase chain reaction (PCR) assay at delivery was able to spare useless antimicrobial treatments, as compared with conventional culture at 34-38 weeks of gestation. Practical evaluation and prospective cost-effectiveness analysis. A university hospital in France. A cohort of 225 women in labour at the University-Hospital of Saint-Etienne. Each woman had a conventional culture performed at 34-38 weeks of gestation. At the beginning of labour, two vaginal swabs were sampled for rapid PCR testing and culture. The decision to prescribe a prophylactic antimicrobial treatment or not was taken according to the result of the PCR test. A comparative cost-effectiveness analysis of the two diagnostic strategies was carried out. Number of women receiving inadequate prophylactic antimicrobial drugs following each testing strategy, costs of PCR testing and culture, frequency of vaginal GBS, and diagnostic performance of the PCR test at delivery. The percentage of unnecessarily treated women was significantly reduced using the rapid test versus conventional culture (4.5 and 13.6%, respectively; P < 0.001). The rate of vaginal GBS at delivery was 12.5%. The incremental cost-effectiveness ratio (ICER) for each inadequate management avoided was €36 and €173 from the point of view of the healthcare system and hospital, respectively. The PCR assay reduced the number of inadequate antimicrobial treatments aimed to prevent the early onset of GBS disease. However, this strategy generates extra costs that must be put into balance with its clinical benefits. © 2013 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2013 RCOG.

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

Crabtree, D.J.

Three types of boron/epoxy prepreg tape were prestressed to fracture weak sites along the fiber by winding over 0.3- to 0.6-inch diameter rollers prior to lamination. The prestressed prepreg was then laminated, and design allowable testing was conducted to determine if mechanical strength properties are increased and data scatter is reduced by prestressing. The types of prepreg studied were standard 'Rigidite' 5505/4 prepreg, carbon substrate boron fiber prepreg, and a prepreg made from 'defect' tungsten substrate boron that was manufactured in a high-speed, low-cost, production process. The strength of angleply composites of both 'Rigidite' 5505/4 and carbon substrate boron compositesmore » were unaffected by prestressing. A study was made to determine if prepreg costs could be reduced by manufacturing low-cost 'defect' boron fiber and prestressing it to improve its properties. The results of this study were inconclusive. The test results show prestressing marginally improved some composite properties while others were reduced. On 'Rigidite' 5505/4 unidirectional composites, fatigue strength was significantly improved by prestressing, while longitudinal tensile strength was reduced at room temperature and 350 F. On unidirectional carbon substrate boron composites, the longitudinal tensile strength at room temperature and 350F was increased with attendant variability, while fatigue strength at high stress levels was reduced but not affected at low stress levels.« less

Reducing operating costs for struvite formation with a carbon dioxide stripper.

PubMed

Fattah, K P; Sabrina, N; Mavinic, D S; Koch, F A

2008-01-01

One of the major operational costs of phosphorus recovery as struvite is the cost of caustic chemical that is added to maintain a desired level of operative pH. A study was conducted at the Lulu Island Wastewater Treatment Plant (LIWWTP), Richmond, BC, using a struvite crystallizer and a cascade stripper designed at the University of British Columbia (UBC). The stripper was tested under different operating conditions to determine the effectiveness of CO(2) stripping in increasing the pH of the water matrix and thereby reducing caustic chemical use. This reduction is expected to reduce the operational costs of struvite production. Throughout the project, a high percentage (90%) of phosphorus removal was achieved under each condition. The cascade stripper was very effective in saving caustic usage, ranging from 35% to 86%, depending on the operating conditions. However, the stripper showed relatively poor performance regarding ammonia stripping. Copyright IWA Publishing 2008.

The Effect of Weld Penetration on Blast Performance of Welded Panels

DTIC Science & Technology

2014-08-01

requirements of blast and ballistic protection, structural strength, fatigue resistance, unit mass and production cost. The testing described in this report...UNCLASSIFIED 7 TETRA S 20 9 3-G is an austenitic filler material often selected for welding high strength armour steels to control hydrogen induced...repeatability, lower cost, faster test turnaround and a reduced number of variables to control . Figure 30 is an illustration of the simplifications made

Semi-Automated Pulse-Echo Ultrasonic System for Inspecting Tires

DOT National Transportation Integrated Search

1977-07-01

A nondestructive tire-testing system has been developed using the pulse-echo ultrasonic technique, which offers substantial advantages over all other physical nondestructive-testing methods and shows promise of reducing the cost of production-tire in...

Small, low-cost, expendable turbojet engine. 1: Design, fabrication, and preliminary testing

NASA Technical Reports Server (NTRS)

Dengler, R. P.; Macioce, L. E.

1976-01-01

A small experimental axial-flow turbojet engine in the 2,669-Newton (600-lbf) thrust class was designed, fabricated, and tested to demonstrate the feasibility of several low-cost concepts. Design simplicity was stressed in order to reduce the number of components and machining operations. Four engines were built and tested for a total of 157 hours. Engine testing was conducted at both sea-level static and simulated flight conditions for engine speeds as high as 38,000 rpm and turbine-inlet temperatures as high as 1,255 K (1,800 F).

The cost-effectiveness of 10 antenatal syphilis screening and treatment approaches in Peru, Tanzania, and Zambia.

PubMed

Terris-Prestholt, Fern; Vickerman, Peter; Torres-Rueda, Sergio; Santesso, Nancy; Sweeney, Sedona; Mallma, Patricia; Shelley, Katharine D; Garcia, Patricia J; Bronzan, Rachel; Gill, Michelle M; Broutet, Nathalie; Wi, Teodora; Watts, Charlotte; Mabey, David; Peeling, Rosanna W; Newman, Lori

2015-06-01

Rapid plasma reagin (RPR) is frequently used to test women for maternal syphilis. Rapid syphilis immunochromatographic strip tests detecting only Treponema pallidum antibodies (single RSTs) or both treponemal and non-treponemal antibodies (dual RSTs) are now available. This study assessed the cost-effectiveness of algorithms using these tests to screen pregnant women. Observed costs of maternal syphilis screening and treatment using clinic-based RPR and single RSTs in 20 clinics across Peru, Tanzania, and Zambia were used to model the cost-effectiveness of algorithms using combinations of RPR, single, and dual RSTs, and no and mass treatment. Sensitivity analyses determined drivers of key results. Although this analysis found screening using RPR to be relatively cheap, most (>70%) true cases went untreated. Algorithms using single RSTs were the most cost-effective in all observed settings, followed by dual RSTs, which became the most cost-effective if dual RST costs were halved. Single test algorithms dominated most sequential testing algorithms, although sequential algorithms reduced overtreatment. Mass treatment was relatively cheap and effective in the absence of screening supplies, though treated many uninfected women. This analysis highlights the advantages of introducing RSTs in three diverse settings. The results should be applicable to other similar settings. Copyright © 2015 International Federation of Gynecology and Obstetrics. All rights reserved.

The cost-effectiveness of 10 antenatal syphilis screening and treatment approaches in Peru, Tanzania, and Zambia

PubMed Central

Terris-Prestholt, Fern; Vickerman, Peter; Torres-Rueda, Sergio; Santesso, Nancy; Sweeney, Sedona; Mallma, Patricia; Shelley, Katharine D.; Garcia, Patricia J.; Bronzan, Rachel; Gill, Michelle M.; Broutet, Nathalie; Wi, Teodora; Watts, Charlotte; Mabey, David; Peeling, Rosanna W.; Newman, Lori

2015-01-01

Objective Rapid plasma reagin (RPR) is frequently used to test women for maternal syphilis. Rapid syphilis immunochromatographic strip tests detecting only Treponema pallidum antibodies (single RSTs) or both treponemal and non-treponemal antibodies (dual RSTs) are now available. This study assessed the cost-effectiveness of algorithms using these tests to screen pregnant women. Methods Observed costs of maternal syphilis screening and treatment using clinic-based RPR and single RSTs in 20 clinics across Peru, Tanzania, and Zambia were used to model the cost-effectiveness of algorithms using combinations of RPR, single, and dual RSTs, and no and mass treatment. Sensitivity analyses determined drivers of key results. Results Although this analysis found screening using RPR to be relatively cheap, most (> 70%) true cases went untreated. Algorithms using single RSTs were the most cost-effective in all observed settings, followed by dual RSTs, which became the most cost-effective if dual RST costs were halved. Single test algorithms dominated most sequential testing algorithms, although sequential algorithms reduced overtreatment. Mass treatment was relatively cheap and effective in the absence of screening supplies, though treated many uninfected women. Conclusion This analysis highlights the advantages of introducing RSTs in three diverse settings. The results should be applicable to other similar settings. PMID:25963907

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

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

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

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

Cost and time savings from a rapid access model of care using transient elastography to screen and triage patients with chronic Hepatitis C infection.

PubMed

Whitty, Jennifer A; Tallis, Caroline; Nguyen, Kim-Huong; Scuffham, Paul A; Crosland, Paul; Hewson, Kaye; Pai Mangalore, Rehka; Black, Marrianne; Holtmann, Gerald

2014-02-01

Treatment uptake amongst patients with chronic Hepatitis C virus (HCV) in Australia is relatively low. New approaches to assessment have the potential to reduce public waiting lists, improve access to treatment, and to reduce healthcare costs. To describe the costs to the public hospital system and waiting time associated with a novel integrated rapid access to assessment and treatment (RAAT) model of care that utilizes Transient Elastography (TE) as a specialist outpatient-based approach for a streamlined assessment of patients with chronic HCV, compared to conventional outpatient management with liver biopsy (LB). Time from first medical review to treatment plan and costs associated with detection of fibrosis were recorded for patients receiving RAAT during a 3-month period, and for a similar historical cohort managed conventionally with LB. Costs related to medical and multidisciplinary team reviews and the TE/LB test itself were included. Patients receiving RAAT had lower costs (n = 27, median AU$2716) and shorter time to treatment (median = 194 days) than for conventional management (n = 13, median $5005, 420 days; p < 0.01). Differences related to the lower TE test costs and the lower cost of consults between first medical review and establishment of a treatment plan. Based on real world audit data, this evaluation suggests TE, used as part of a new RAAT model of care, is cost saving to the health system in the short-term and reduces waiting times. The analysis reported here was intended to assess the costs related to detection of fibrosis, and is limited by the small sample size and potential selection bias. Future research should undertake a full economic evaluation at a whole of service level, to consider a more comprehensive and longer-term assessment of the costs and benefits associated with HCV management.

Evaluation of microfabricated deformable mirror systems

NASA Astrophysics Data System (ADS)

Cowan, William D.; Lee, Max K.; Bright, Victor M.; Welsh, Byron M.

1998-09-01

This paper presents recent result for aberration correction and beam steering experiments using polysilicon surface micromachined piston micromirror arrays. Microfabricated deformable mirrors offer a substantial cost reduction for adaptive optic systems. In addition to the reduced mirror cost, microfabricated mirrors typically require low control voltages, thus eliminating high voltage amplifiers. The greatly reduced cost per channel of adaptive optic systems employing microfabricated deformable mirrors promise high order aberration correction at low cost. Arrays of piston micromirrors with 128 active elements were tested. Mirror elements are on a 203 micrometers 12 by 12 square grid. The overall array size is 2.4 mm square. The arrays were fabricated in the commercially available DARPA supported MUMPs surface micromachining foundry process. The cost per mirror array in this prototyping process is less than 200 dollars. Experimental results are presented for a hybrid correcting element comprised of a lenslet array and piston micromirror array, and for a piston micromirror array only. Also presented is a novel digital deflection micromirror which requires no digital to analog converters, further reducing the cost of adaptive optics system.

A telemedicine model for integrating point-of-care testing into a distributed health-care environment.

PubMed

Villalar, J L; Arredondo, M T; Meneu, T; Traver, V; Cabrera, M F; Guillen, S; Del Pozo, F

2002-01-01

Centralized testing demands costly laboratories, which are inefficient and may provide poor services. Recent advances make it feasible to move clinical testing nearer to patients and the requesting physicians, thus reducing the time to treatment. Internet technologies can be used to create a virtual laboratory information system in a distributed health-care environment. This allows clinical testing to be transferred to a cooperative scheme of several point-of-care testing (POCT) nodes. Two pilot virtual laboratories were established, one in Italy (AUSL Modena) and one in Greece (Athens Medical Centre). They were constructed on a three-layer model to allow both technical and clinical verification. Different POCT devices were connected. The pilot sites produced good preliminary results in relation to user acceptance, efficiency, convenience and costs. Decentralized laboratories can be expected to become cost-effective.

A simple and cost effective liquid culture system for the micropropagation of two commercially important apple rootstocks.

PubMed

Mehta, Mohina; Ram, Raja; Bhattacharya, Amita

2014-07-01

The two commercially important apple rootstocks i.e., MM106 and B9 were micropropagated using a liquid culture system. Three different strengths of 0.8% agar solidified PGR free basal MS medium were first tested to optimize the culture media for both the rootstocks. Full strength medium (MS0) supported maximum in vitro growth, multiplication, rooting and survival under field conditions as opposed to quarter and half strength media. When three different volumes of liquid MS0 were tested, highest in vitro growth, multiplication, rooting and also survival under field conditions were achieved in 20 mL liquid MS0. The cost of one litre of liquid medium was also reduced by 8 times to Rs. 6.29 as compared to solid medium. The cost of 20 mL medium was further reduced to Rs. 0.125.

Development of Fully Automated Low-Cost Immunoassay System for Research Applications.

PubMed

Wang, Guochun; Das, Champak; Ledden, Bradley; Sun, Qian; Nguyen, Chien

2017-10-01

Enzyme-linked immunosorbent assay (ELISA) automation for routine operation in a small research environment would be very attractive. A portable fully automated low-cost immunoassay system was designed, developed, and evaluated with several protein analytes. It features disposable capillary columns as the reaction sites and uses real-time calibration for improved accuracy. It reduces the overall assay time to less than 75 min with the ability of easy adaptation of new testing targets. The running cost is extremely low due to the nature of automation, as well as reduced material requirements. Details about system configuration, components selection, disposable fabrication, system assembly, and operation are reported. The performance of the system was initially established with a rabbit immunoglobulin G (IgG) assay, and an example of assay adaptation with an interleukin 6 (IL6) assay is shown. This system is ideal for research use, but could work for broader testing applications with further optimization.

Heparin-induced thrombocytopenia: reducing misdiagnosis via collaboration between an inpatient anticoagulation pharmacy service and hospital reference laboratory.

PubMed

Burnett, Allison E; Bowles, Harmony; Borrego, Matthew E; Montoya, Tiffany N; Garcia, David A; Mahan, Charles

2016-11-01

Misdiagnosis of heparin-induced thrombocytopenia (HIT) is common and exposes patients to high-risk therapies and potentially serious adverse events. The primary objective of this study was to evaluate the impact of collaboration between an inpatient pharmacy-driven anticoagulation management service (AMS) and hospital reference laboratory to reduce inappropriate HIT antibody testing via pharmacist intervention and use of the 4T pre-test probability score. Secondary objectives included clinical outcomes and cost-savings realized through reduced laboratory testing and decreased unnecessary treatment of HIT. This was a single center, pre-post, observational study. The hospital reference laboratory contacted the AMS when they received a blood sample for an enzyme-linked immunosorbent HIT antibody (HIT Ab). Trained pharmacists prospectively scored each HIT Ab ordered by using the 4T score with subsequent communication to physicians recommending for or against processing and reporting of lab results. Utilizing retrospective chart review and a database for all patients with a HIT Ab ordered during the study period, we compared the incidence of HIT Ab testing before and after implementation of the pharmacy-driven 4T score intervention. Our intervention significantly reduced the number of inappropriate HIT Ab tests processed (176 vs. 63, p < 0.0001), with no increase in thrombotic or hemorrhagic events. Overall incidence of suspected and confirmed HIT was <3 and <0.005 %, respectively. Overall cost savings were $75,754 (US) or 62 % per patient exposed to heparin between the pre and post intervention groups. Collaboration between inpatient pharmacy AMS and hospital reference laboratories can result in reduction of misdiagnosis of HIT and significant cost savings with similar safety.

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

PubMed

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

2009-10-01

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

What is the cost of providing outpatient HIV counseling and testing and antiretroviral therapy services in selected public health facilities in Nigeria?

PubMed

Aliyu, Husaina Bello; Chuku, Nkata Nwani; Kola-Jebutu, Abimbola; Abubakar, Zubaida; Torpey, Kwasi; Chabikuli, Otto Nzapfurundi

2012-10-01

Limited data on actual cost of providing HIV/AIDS services in Nigeria makes planning difficult. A study was conducted in 9 public health facilities supported by the Global HIV/AIDS Initiative Nigeria. The objective was to determine the cost of outpatient HIV Testing and Counseling (HTC) and antiretroviral therapy (ART) services per patient. Two tertiary and 7 secondary facilities were purposively selected across the six geopolitical regions. Facilities were distributed in urban and rural settings. Utilization and cost data for a 12-month period (January to December 2010) were analyzed. Cost elements included consumables, human resources, infrastructure, trainings, facility management, and Global HIV/AIDS Initiative Nigeria technical support. Total costs were apportioned based on percentage utilization by services, and unit costs were derived by dividing resource inputs by service outputs. Data were analyzed using Microsoft Excel 2003. A sensitivity analysis was also conducted for key assumptions. Mean costs for HTC and ART were US $7.4 and US $209.0, respectively. Costs were higher in Northern facilities (US $6.9, US $250.8), compared with Southern ones (US $6.7, US $194.7); and in tertiary facilities ($18.5, $338.4), compared with secondary ones ($6.3, $204.9). Major cost drivers for HTC and ART were human resources--ranging from 62% to 50%, and ARV drugs--ranging from 54% to 31%, respectively. Governments' ability to negotiate lower priced antiretroviral drugs will be central to reducing the cost of ART. Additionally, use of lower cadre staff to provide HTC will reduce costs and improves efficiency.

Reducing the healthcare costs of urban air pollution: the South African experience.

PubMed

Leiman, Anthony; Standish, Barry; Boting, Antony; van Zyl, Hugo

2007-07-01

Air pollutants often have adverse effects on human health. This paper investigates and ranks a set of policy and technological interventions intended to reduce such health costs in the high population density areas of South Africa. It initially uses a simple benefit-cost rule, later extended to capture sectoral employment impacts. Although the focus of state air quality legislation is on industrial pollutants, the most efficient interventions were found to be at household level. These included such low-cost interventions as training householders to place kindling above rather than below the coal in a fireplace and insulating roofs. The first non-household policies to emerge involved vehicle fuels and technologies. Most proposed industrial interventions failed a simple cost-benefit test. The paper's policy messages are that interventions should begin with households and that further industry controls are not yet justifiable in their present forms as these relate to the health care costs of such interventions.

High-Speed, High-Temperature Finger Seal Test Results

NASA Technical Reports Server (NTRS)

Proctor, Margaret P.; Kumar, Arun; Delgado, Irebert R.

2002-01-01

Finger seals have significantly lower leakage rates than conventional labyrinth seals used in gas turbine engines and are expected to decrease specific fuel consumption by over 1 percent and to decrease direct operating cost by over 0.5 percent. Their compliant design accommodates shaft growth and motion due to thermal and dynamic loads with minimal wear. The cost to fabricate these finger seals is estimated to be about half the cost to fabricate brush seals. A finger seal has been tested in NASA's High Temperature, High Speed Turbine Seal Test Rig at operating conditions up to 1200 F, 1200 ft/s, and 75 psid. Static, performance and endurance test results are presented. While seal leakage and wear performance are acceptable, further design improvements are needed to reduce the seal power loss.

Using Tablet PC's for the Final Test of Baccalaureate

ERIC Educational Resources Information Center

Laborda, Jesús García; Royo, Teresa Magal

2016-01-01

Online testing is becoming a popular way to deliver language tests, partly because of its reduced cost, partly because of the high quality of test data collection. In language tests, interface validation has received a limited attention in professional literature (García, Magal, da Rocha, & Fernández, 2010). This paper will show the validation…

Impact of rapid methicillin-resistant Staphylococcus aureus polymerase chain reaction testing on mortality and cost effectiveness in hospitalized patients with bacteraemia: a decision model.

PubMed

Brown, Jack; Paladino, Joseph A

2010-01-01

Patients hospitalized with Staphylococcus aureus bacteraemia have an unacceptably high mortality rate. Literature available to date has shown that timely selection of the most appropriate antibacterial may reduce mortality. One tool that may help with this selection is a polymerase chain reaction (PCR) assay that distinguishes methicillin (meticillin)-resistant S. aureus (MRSA) from methicillin-susceptible S. aureus (MSSA) in less than 1 hour. To date, no information is available evaluating the impact of this PCR technique on clinical or economic outcomes. To evaluate the effect of a rapid PCR assay on mortality and economics compared with traditional empiric therapy, using a literature-derived model. A literature search for peer-reviewed European (EU) and US publications regarding treatment regimens, outcomes and costs was conducted. Information detailing the rates of infection, as well as the specificity and sensitivity of a rapid PCR assay (Xpert MRSA/SA Blood Culture PCR) were obtained from the peer-reviewed literature. Sensitivity analysis varied the prevalence rate of MRSA from 5% to 80%, while threshold analysis was applied to the cost of the PCR test. Hospital and testing resource consumption were valued with direct medical costs, adjusted to year 2009 values. Adjusted life-years were determined using US and WHO life tables. The cost-effectiveness ratio was defined as the cost per life-year saved. Incremental cost-effectiveness ratios (ICERs) were calculated to determine the additional cost necessary to produce additional effectiveness. All analyses were performed using TreeAge Software (2008). The mean mortality rates were 23% for patients receiving empiric vancomycin subsequently switched to semi-synthetic penicillin (SSP) for MSSA, 36% for patients receiving empiric vancomycin treatment for MRSA, 59% for patients receiving empiric SSP subsequently switched to vancomycin for MRSA and 12% for patients receiving empiric SSP for MSSA. Furthermore, with an MRSA prevalence of 30%, the numbers of patients needed to test in order to save one life were 14 and 16 compared with empiric vancomycin and SSP, respectively. The absolute mortality difference for MRSA prevalence rates of 80% and 5% favoured the PCR testing group at 2% and 10%, respectively, compared with empiric vancomycin and 18% and 1%, respectively, compared with empiric SSP. In the EU, the cost-effectiveness ratios for empiric vancomycin- and SSP-treated patients were Euro 695 and Euro 687 per life-year saved, respectively, compared with Euro 636 per life-year saved for rapid PCR testing. In the US, the cost-effectiveness ratio was $US 898 per life-year saved for empiric vancomycin and $US 820 per life-year saved for rapid PCR testing. ICERs demonstrated dominance of the PCR test in all instances. Threshold analysis revealed that PCR testing would be less costly overall, even at greatly inflated assay prices. Rapid PCR testing for MRSA appears to have the potential to reduce mortality rates while being less costly than empiric therapy in the EU and US, across a wide range of MRSA prevalence rates and PCR test costs.

Advanced Guidance and Control Methods for Reusable Launch Vehicles: Test Results

NASA Technical Reports Server (NTRS)

Hanson, John M.; Jones, Robert E.; Krupp, Don R.; Fogle, Frank R. (Technical Monitor)

2002-01-01

There are a number of approaches to advanced guidance and control (AG&C) that have the potential for achieving the goals of significantly increasing reusable launch vehicle (RLV) safety/reliability and reducing the cost. In this paper, we examine some of these methods and compare the results. We briefly introduce the various methods under test, list the test cases used to demonstrate that the desired results are achieved, show an automated test scoring method that greatly reduces the evaluation effort required, and display results of the tests. Results are shown for the algorithms that have entered testing so far.

Risk assessment and management of brucellosis in the southern greater Yellowstone area (II): Cost-benefit analysis of reducing elk brucellosis prevalence.

PubMed

Boroff, Kari; Kauffman, Mandy; Peck, Dannele; Maichak, Eric; Scurlock, Brandon; Schumaker, Brant

2016-11-01

Recent cases of bovine brucellosis (Brucella abortus) in cattle (Bos taurus) and domestic bison (Bison bison) of the southern Greater Yellowstone Area (SGYA) have been traced back to free-ranging elk (Cervus elaphus). Several management activities have been implemented to reduce brucellosis seroprevalence in elk, including test-and-slaughter, low-density feeding at elk winter feedgrounds, and elk vaccination. It is unclear which of these activities are most cost-effective at reducing the risk of elk transmitting brucellosis to cattle. In a companion paper, a stochastic risk model was used to translate a reduction in elk seroprevalence to a reduction in the risk of transmission to cattle. Here, we use those results to estimate the expected economic benefits and costs of reducing seroprevalence in elk using three different management activities: vaccination of elk with Brucella strain 19 (S19), low-density feeding of elk, and elk test-and-slaughter. Results indicate that the three elk management activities yield negative expected net benefits, ranging from -$2983 per year for low-density feeding to -$595,471 per year for test-and-slaughter. Society's risk preferences will determine whether strategies that generate small negative net benefit, such as low-density feeding, are worth implementing. However, activities with large negative net benefits, such as test-and-slaughter and S19 vaccination, are unlikely to be economically worthwhile. Given uncertainty about various model parameters, we identify some circumstances in which individual management activities might generate positive expected net benefit. Copyright © 2016 Elsevier B.V. All rights reserved.

Healthcare Use Patterns and Economic Burden of Chronic Musculoskeletal Pain in Children before Diagnosis.

PubMed

Tian, Frances; Guittar, Patsy; Moore-Clingenpeel, Melissa; Higgins, Gloria; Ardoin, Stacy P; Spencer, Charles H; Jones, Karla; Thomas, Bethanne; Akoghlanian, Shoghik; Bout-Tabaku, Sharon

2018-06-01

To evaluate the healthcare use and costs of amplified musculoskeletal pain syndrome (AMPS) in children before diagnosis. We performed a retrospective study in children with AMPS at a pediatric rheumatology clinic between 2010 and 2014. Data were abstracted on 80 patients after primary rheumatic diseases were excluded. Healthcare visits, medications and diagnostic testing that occurred in the years before diagnosis were collected. The Medical Expenditure Panel Survey was used to estimate visit costs. Patients were adolescent females (89%) and white (86%). The median time to diagnosis was 10.2 months. The median pain score was 6.5 and the median Childhood Health Assessment Questionnaire score was 1.1. In this cohort, 29% had at least 1 ED visit and 5% were hospitalized. All patients saw a rheumatologist and 41% had visited another specialist, typically orthopedics and sports medicine. More than one-half had at least 1 radiographic study and 21% had at least 1 magnetic resonance imaging. The total cost for office, emergency department, and hospital visits for AMPS in all 80 patients was $152 853. The mean cost per patient over the entire study period (2008-2014) was $1911 ± $3808, and 43% of costs were outpatient visits. Children with AMPS have high levels of disability and take a long time to be diagnosed. As a result, even before diagnosis, they have high levels of healthcare use, diagnostic testing, and medical costs. Early recognition of disability and quicker referral to trained subspecialists may improve the prognosis, reduce unnecessary testing, and reduce the overall costs of healthcare. Copyright © 2018. Published by Elsevier Inc.

Economic evaluation of the Good School Toolkit: an intervention for reducing violence in primary schools in Uganda

PubMed Central

Knight, Louise; Ssekadde, Willington; Namy, Sophie; Naker, Dipak; Devries, Karen

2018-01-01

Introduction This paper presents the cost and cost-effectiveness of the Good School Toolkit (GST), a programme aimed at reducing physical violence perpetrated by school staff to students in Uganda. Methods The effectiveness of the Toolkit was tested with a cluster randomised controlled trial in 42 primary schools in Luwero District, Uganda. A full economic costing evaluation and cost-effectiveness analysis were conducted alongside the trial. Both financial and economic costs were collected retrospectively from the provider’s perspective to estimate total and unit costs. Results The total cost of setting up and running the Toolkit over the 18-month trial period is estimated at US$397 233, excluding process monitor (M&E) activities. The cost to run the intervention is US$7429 per school annually, or US$15 per primary school pupil annually, in the trial intervention schools. It is estimated that the intervention has averted 1620 cases of past-week physical violence during the 18-month implementation period. The total cost per case of violence averted is US$244, and the annual implementation cost is US$96 per case averted during the trial. Conclusions The GST is a cost-effective intervention for reducing violence against pupils in primary schools in Uganda. It compares favourably against other violence reduction interventions in the region. PMID:29707243

Mission Implementation Constraints on Planetary Muon Radiography

NASA Technical Reports Server (NTRS)

Jones, Cathleen E.; Kedar, Sharon; Naudet, Charles; Webb, Frank

2011-01-01

Cost: Use heritage hardware, especially use a tested landing system to reduce cost (Phoenix or MSL EDL stage). The sky crane technology delivers higher mass to the surface and enables reaching targets at higher elevation, but at a higher mission cost. Rover vs. Stationary Lander: Rover-mounted instrument enables tomography, but the increased weight of the rover reduces the allowable payload weight. Mass is the critical design constraint for an instrument for a planetary mission. Many factors that are minor factors or do not enter into design considerations for terrestrial operation are important for a planetary application. (Landing site, diurnal temperature variation, instrument portability, shock/vibration)

Production of Polyhydroxyalkanoates from Sludge Palm Oil Using Pseudomonas putida S12.

PubMed

Kang, Du-Kyeong; Lee, Cho-Ryong; Lee, Sun Hee; Bae, Jung-Hoon; Park, Young-Kwon; Rhee, Young Ha; Sung, Bong Hyun; Sohn, Jung-Hoon

2017-05-28

Polyhydroxyalkanoates (PHAs) are biodegradable plastics produced by bacteria, but their use in diverse applications is prohibited by high production costs. To reduce these costs, the conversion by Pseudomonas strains of P HAs from crude s ludge p alm oil ( SPO) a s an inexpensive renewable raw material was tested. Pseudomonas putida S12 was found to produce the highest yield (~41%) of elastomeric medium-chain-length (MCL)-PHAs from SPO. The MCL-PHA characteristics were analyzed by gas-chromatography/mass spectrometry, gel permeation chromatography, and differential scanning calorimetry. These findings may contribute to more widespread use of PHAs by reducing PHA production costs.

HIGH EFFICIENCY SYNGAS GENERATION

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

Robert J. Copeland; Yevgenia Gershanovich; Brian Windecker

2005-02-01

This project investigated an efficient and low cost method of auto-thermally reforming natural gas to hydrogen and carbon monoxide. Reforming is the highest cost step in producing products such as methanol and Fisher Tropsch liquids (i.e., gas to liquids); and reducing the cost of reforming is the key to reducing the cost of these products. Steam reforming is expensive because of the high cost of the high nickel alloy reforming tubes (i.e., indirectly fired reforming tubes). Conventional auto-thermal or Partial Oxidation (POX) reforming minimizes the size and cost of the reformers and provides a near optimum mixture of CO andmore » hydrogen. However POX requires pure oxygen, which consumes power and significantly increases the cost to reforming. Our high efficiency process extracts oxygen from low-pressure air with novel oxygen sorbent and transfers the oxygen to a nickel-catalyzed reformer. The syngas is generated at process pressure (typically 20 to 40 bar) without nitrogen dilution and has a 1CO to 2H{sub 2} ratio that is near optimum for the subsequent production of Fisher-Tropsch liquid to liquids and other chemicals (i.e., Gas to Liquids, GTL). Our high process efficiency comes from the way we transfer the oxygen into the reformer. All of the components of the process, except for the oxygen sorbent, are commonly used in commercial practice. A process based on a longlived, regenerable, oxygen transfer sorbent could substantially reduce the cost of natural gas reforming to syngas. Lower cost syngas (CO + 2H{sub 2}) that is the feedstock for GTL would reduce the cost of GTL and for other commercial applications (e.g., methanol, other organic chemicals). The vast gas resources of Alaska's North Slope (ANS) offer more than 22 Tcf of gas and GTL production in this application alone, and could account for as much as 300,000 to 700,000 bpd for 20 to 30+ years. We developed a new sorbent, which is an essential part of the High Efficiency Oxygen Process (HOP). We tested the sorbent and observed that it has both a good oxygen capacity and operates as a highly effective reforming catalyst. We conducted a long duration tests of the sorbent (1,500 hours of continuous operation in the HOP cycle). Although the sorbent lost some oxygen capacity with cycling, the sorbent oxygen capacity stabilized after 1,000 hours and remained constant to the end of the test, 1,500 hour. The activity of the catalyst to reform methane to a hydrogen and carbon monoxide mixture was unchanged through the oxidation/reduction cycling. Our cost and performance analyses indicated a significant reduction in the cost of GTL production when using the HOP process integrated into a GTL plant.« less

The role of technology in reducing health care costs. Phase II and phase III.

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

Cilke, John F.; Parks, Raymond C.; Funkhouser, Donald Ray

2004-04-01

In Phase I of this project, reported in SAND97-1922, Sandia National Laboratories applied a systems approach to identifying innovative biomedical technologies with the potential to reduce U.S. health care delivery costs while maintaining care quality. The effort provided roadmaps for the development and integration of technology to meet perceived care delivery requirements and an economic analysis model for development of care pathway costs for two conditions: coronary artery disease (CAD) and benign prostatic hypertrophy (BPH). Phases II and III of this project, which are presented in this report, were directed at detailing the parameters of telemedicine that influence care deliverymore » costs and quality. These results were used to identify and field test the communication, interoperability, and security capabilities needed for cost-effective, secure, and reliable health care via telemedicine.« less

Additive Manufacturing for Affordable Rocket Engines

NASA Technical Reports Server (NTRS)

West, Brian; Robertson, Elizabeth; Osborne, Robin; Calvert, Marty

2016-01-01

Additive manufacturing (also known as 3D printing) technology has the potential to drastically reduce costs and lead times associated with the development of complex liquid rocket engine systems. NASA is using 3D printing to manufacture rocket engine components including augmented spark igniters, injectors, turbopumps, and valves. NASA is advancing the process to certify these components for flight. Success Story: MSFC has been developing rocket 3D-printing technology using the Selective Laser Melting (SLM) process. Over the last several years, NASA has built and tested several injectors and combustion chambers. Recently, MSFC has 3D printed an augmented spark igniter for potential use the RS-25 engines that will be used on the Space Launch System. The new design is expected to reduce the cost of the igniter by a factor of four. MSFC has also 3D printed and tested a liquid hydrogen turbopump for potential use on an Upper Stage Engine. Additive manufacturing of the turbopump resulted in a 45% part count reduction. To understanding how the 3D printed parts perform and to certify them for flight, MSFC built a breadboard liquid rocket engine using additive manufactured components including injectors, turbomachinery, and valves. The liquid rocket engine was tested seven times in 2016 using liquid oxygen and liquid hydrogen. In addition to exposing the hardware to harsh environments, engineers learned to design for the new manufacturing technique, taking advantage of its capabilities and gaining awareness of its limitations. Benefit: The 3D-printing technology promises reduced cost and schedule for rocket engines. Cost is a function of complexity, and the most complicated features provide the largest opportunities for cost reductions. This is especially true where brazes or welds can be eliminated. The drastic reduction in part count achievable with 3D printing creates a waterfall effect that reduces the number of processes and drawings, decreases the amount of touch labor required, and increases reliability. When certification is achieved, NASA missions will be able to realize these benefits.

Cascaded Microinverter PV System for Reduced Cost

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

Bellus, Daniel R.; Ely, Jeffrey A.

2013-04-29

In this project, a team led by Delphi will develop and demonstrate a novel cascaded photovoltaic (PV) inverter architecture using advanced components. This approach will reduce the cost and improve the performance of medium and large-sized PV systems. The overall project objective is to develop, build, and test a modular 11-level cascaded three-phase inverter building block for photovoltaic applications and to develop and analyze the associated commercialization plan. The system will be designed to utilize photovoltaic panels and will supply power to the electric grid at 208 VAC, 60 Hz 3-phase. With the proposed topology, three inverters, each with anmore » embedded controller, will monitor and control each of the cascade sections, reducing costs associated with extra control boards. This report details the final disposition on this project.« less

A Systematic Review of Economic Evaluations of Pharmacogenetic Testing for Prevention of Adverse Drug Reactions.

PubMed

Plumpton, Catrin O; Roberts, Daniel; Pirmohamed, Munir; Hughes, Dyfrig A

2016-08-01

Pharmacogenetics offers the potential to improve health outcomes by identifying individuals who are at greater risk of harm from certain medicines. Routine adoption of pharmacogenetic tests requires evidence of their cost effectiveness. The present review aims to systematically review published economic evaluations of pharmacogenetic tests that aim to prevent or reduce the incidence of ADRs. We conducted a systematic literature review of economic evaluations of pharmacogenetic tests aimed to reduce the incidence of adverse drug reactions. Literature was searched using Embase, MEDLINE and the NHS Economic Evaluation Database with search terms relating to pharmacogenetic testing, adverse drug reactions, economic evaluations and pharmaceuticals. Titles were screened independently by two reviewers. Articles deemed to meet the inclusion criteria were screened independently on abstract, and full texts reviewed. We identified 852 articles, of which 47 met the inclusion criteria. There was evidence supporting the cost effectiveness of testing for HLA-B*57:01 (prior to abacavir), HLA-B*15:02 and HLA-A*31:01 (prior to carbamazepine), HLA-B*58:01 (prior to allopurinol) and CYP2C19 (prior to clopidogrel treatment). Economic evidence was inconclusive with respect to TPMT (prior to 6-mercaptoputine, azathioprine and cisplatin therapy), CYP2C9 and VKORC1 (to inform genotype-guided dosing of coumarin derivatives), MTHFR (prior to methotrexate treatment) and factor V Leiden testing (prior to oral contraception). Testing for A1555G is not cost effective before prescribing aminoglycosides. Our systematic review identified robust evidence of the cost effectiveness of genotyping prior to treatment with a number of common drugs. However, further analyses and (or) availability of robust clinical evidence is necessary to make recommendations for others.

Revealing Optical Components

NASA Technical Reports Server (NTRS)

2002-01-01

The Optical Vector Analyzer (OVA) 1550 significantly reduces the time and cost of testing sophisticated optical components. The technology grew from the research Luna Technologies' Dr. Mark Froggatt conducted on optical fiber strain measurement while working at Langley Research Center. Dr. Froggatt originally developed the technology for non- destructive evaluation testing at Langley. The new technique can provide 10,000 independent strain measurements while adding less than 10 grams to the weight of the vehicle. The OVA is capable of complete linear characterization of single-mode optical components used in high- bit-rate applications. The device can test most components over their full range in less than 30 seconds, compared to the more than 20 minutes required by other testing methods. The dramatically shortened measurement time results in increased efficiency in final acceptance tests of optical devices, and the comprehensive data produced by the instrument adds considerable value for component consumers. The device eliminates manufacturing bottlenecks, while reducing labor costs and wasted materials during production.

Reducing Suicidal Ideation: Cost-Effectiveness Analysis of a Randomized Controlled Trial of Unguided Web-Based Self-help

PubMed Central

Majo, M. Cristina; Smit, Filip; van Straten, Annemieke; Kerkhof, Ad J.F.M

2012-01-01

Background Suicidal ideation is highly prevalent, but often remains untreated. The Internet can be used to provide accessible interventions. Objective To evaluate the cost-effectiveness of an online, unguided, self-help intervention for reducing suicidal ideation. Methods A total of 236 adults with mild to moderate suicidal thoughts, defined as scores between 1-26 on the Beck Scale for Suicide Ideation (BSS), were recruited in the general population and randomized to the intervention (n = 116) or to a waitlist, information-only, control group (n = 120). The intervention aimed to decrease the frequency and intensity of suicidal ideation and consisted of 6 modules based on cognitive behavioral techniques. Participants in both groups had unrestricted access to care as usual. Assessments took place at baseline and 6 weeks later (post-test). All questionnaires were self-report and administered via the Internet. Treatment response was defined as a clinically significant decrease in suicidal ideation on the BSS. Total per-participant costs encompassed costs of health service uptake, participants’ out-of-pocket expenses, costs stemming from production losses, and intervention costs. These were expressed in Euros (€) for the reference year 2009. Results At post-test, treatment response was 35.3% and 20.8% in the experimental and control conditions, respectively. The incremental effectiveness was 0.35 − 0.21 = 0.15 (SE 0.06, P = .01). The annualized incremental costs were −€5039 per participant. Therefore, the mean incremental cost-effectiveness ratio (ICER) was estimated to be −€5039/0.15 = −€34,727 after rounding (US −$41,325) for an additional treatment response, indicating annual cost savings per treatment responder. Conclusions This is the first trial to indicate that online self-help to reduce suicidal ideation is feasible, effective, and cost saving. Limitations included reliance on self-report and a short timeframe (6 weeks). Therefore, replication with a longer follow-up period is recommended. PMID:23103835

The oxidative cost of reproduction depends on early development oxidative stress and sex in a bird species

PubMed Central

Romero-Haro, A. A.; Sorci, G.; Alonso-Alvarez, C.

2016-01-01

In the early 2000s, a new component of the cost of reproduction was proposed: oxidative stress. Since then the oxidative cost of reproduction hypothesis has, however, received mixed support. Different arguments have been provided to explain this. Among them, the lack of a life-history perspective on most experimental tests was suggested. We manipulated the levels of a key intracellular antioxidant (glutathione) in captive zebra finches (Taeniopygia guttata) during a short period of early life and subsequently tested the oxidative cost of reproduction. Birds were allowed to mate freely in an outdoor aviary for several months. We repeatedly enlarged or reduced their broods to increase or reduce, respectively, breeding effort. Birds whose glutathione levels were reduced during growth showed higher erythrocyte resistance to free radical-induced haemolysis when forced to rear enlarged broods. This supports the hypothesis predicting the occurrence of developing programmes matching early and adult environmental conditions to improve fitness. Moreover, adult males rearing enlarged broods endured higher plasma levels of lipid oxidative damage than control males, whereas adult females showed the opposite trend. As most previous studies reporting non-significant or opposite results used females only, we also discuss some sex-related particularities that may contribute to explain unexpected results. PMID:27358368

Oxidative Stress Mediates Physiological Costs of Begging in Magpie (Pica pica) Nestlings

PubMed Central

Moreno-Rueda, Gregorio; Redondo, Tomás; Trenzado, Cristina E.; Sanz, Ana; Zúñiga, Jesús M.

2012-01-01

Background Theoretical models predict that a cost is necessary to guarantee honesty in begging displays given by offspring to solicit food from their parents. There is evidence for begging costs in the form of a reduced growth rate and immunocompetence. Moreover, begging implies vigorous physical activity and attentiveness, which should increase metabolism and thus the releasing of pro-oxidant substances. Consequently, we predict that soliciting offspring incur a cost in terms of oxidative stress, and growth rate and immune response (processes that generate pro-oxidants substances) are reduced in order to maintain oxidative balance. Methodology/Principal Findings We test whether magpie (Pica pica) nestlings incur a cost in terms of oxidative stress when experimentally forced to beg intensively, and whether oxidative balance is maintained by reducing growth rate and immune response. Our results show that begging provokes oxidative stress, and that nestlings begging for longer bouts reduce growth and immune response, thereby maintaining their oxidative status. Conclusions/Significance These findings help explaining the physiological link between begging and its associated growth and immunocompetence costs, which seems to be mediated by oxidative stress. Our study is a unique example of the complex relationships between the intensity of a communicative display (begging), oxidative stress, and life-history traits directly linked to viability. PMID:22808144

Lean Six Sigma to Reduce Intensive Care Unit Length of Stay and Costs in Prolonged Mechanical Ventilation.

PubMed

Trzeciak, Stephen; Mercincavage, Michael; Angelini, Cory; Cogliano, William; Damuth, Emily; Roberts, Brian W; Zanotti, Sergio; Mazzarelli, Anthony J

Patients with prolonged mechanical ventilation (PMV) represent important "outliers" of hospital length of stay (LOS) and costs (∼$26 billion annually in the United States). We tested the hypothesis that a Lean Six Sigma (LSS) approach for process improvement could reduce hospital LOS and the associated costs of care for patients with PMV. Before-and-after cohort study. Multidisciplinary intensive care unit (ICU) in an academic medical center. Adult patients admitted to the ICU and treated with PMV, as defined by diagnosis-related group (DRG). We implemented a clinical redesign intervention based on LSS principles. We identified eight distinct processes in preparing patients with PMV for post-acute care. Our clinical redesign included reengineering daily patient care rounds ("Lean ICU rounds") to reduce variation and waste in these processes. We compared hospital LOS and direct cost per case in patients with PMV before (2013) and after (2014) our LSS intervention. Among 259 patients with PMV (131 preintervention; 128 postintervention), median hospital LOS decreased by 24% during the intervention period (29 vs. 22 days, p < .001). Accordingly, median hospital direct cost per case decreased by 27% ($66,335 vs. $48,370, p < .001). We found that a LSS-based clinical redesign reduced hospital LOS and the costs of care for patients with PMV.

Abolishing user fees for children and pregnant women trebled uptake of malaria-related interventions in Kangaba, Mali.

PubMed

Ponsar, Frédérique; Van Herp, Michel; Zachariah, Rony; Gerard, Séco; Philips, Mit; Jouquet, Guillaume

2011-11-01

Malaria is the most common cause of morbidity and mortality in children under 5 in Mali. Health centres provide primary care, including malaria treatment, under a system of cost recovery. In 2005, Médecins sans Frontieres (MSF) started supporting health centres in Kangaba with the provision of rapid malaria diagnostic tests and artemisinin-based combination therapy. Initially MSF subsidized malaria tests and drugs to reduce the overall cost for patients. In a second phase, MSF abolished fees for all children under 5 irrespective of their illness and for pregnant women with fever. This second phase was associated with a trebling of both primary health care utilization and malaria treatment coverage for these groups. MSF's experience in Mali suggests that removing user fees for vulnerable groups significantly improves utilization and coverage of essential health services, including for malaria interventions. This effect is far more marked than simply subsidizing or providing malaria drugs and diagnostic tests free of charge. Following the free care strategy, utilization of services increased significantly and under-5 mortality was reduced. Fee removal also allowed for more efficient use of existing resources, reducing average cost per patient treated. These results are particularly relevant for the context of Mali and other countries with ambitious malaria treatment coverage objectives, in accordance with the United Nations Millennium Development Goals. This article questions the effectiveness of the current national policy, and the effectiveness of reducing the cost of drugs only (i.e. partial subsidies) or providing malaria tests and drugs free for under-5s, without abolishing other related fees. National and international budgets, in particular those that target health systems strengthening, could be used to complement existing subsidies and be directed towards effective abolition of user fees. This would contribute to increasing the impact of interventions on population health and, in turn, the effectiveness of aid.

A mathematical model of Clostridium difficile transmission in medical wards and a cost-effectiveness analysis comparing different strategies for laboratory diagnosis and patient isolation.

PubMed

Schechner, Vered; Carmeli, Yehuda; Leshno, Moshe

2017-01-01

Clostridium difficile infection (CDI) is a common and potentially fatal healthcare-associated infection. Improving diagnostic tests and infection control measures may prevent transmission. We aimed to determine, in resource-limited settings, whether it is more effective and cost-effective to allocate resources to isolation or to diagnostics. We constructed a mathematical model of CDI transmission based on hospital data (9 medical wards, 350 beds) between March 2010 and February 2013. The model consisted of three compartments: susceptible patients, asymptomatic carriers and CDI patients. We used our model results to perform a cost-effectiveness analysis, comparing four strategies that were different combinations of 2 test methods (the two-step test and uniform PCR) and 2 infection control measures (contact isolation in multiple-bed rooms or single-bed rooms/cohorting). For each strategy, we calculated the annual cost (of CDI diagnosis and isolation) for a decrease of 1 in the average daily number of CDI patients; the strategy of the two-step test and contact isolation in multiple-bed rooms was the reference strategy. Our model showed that the average number of CDI patients increased exponentially as the transmission rate increased. Improving diagnosis by adopting uniform PCR assay reduced the average number of CDI cases per day per 350 beds from 9.4 to 8.5, while improving isolation by using single-bed rooms reduced the number to about 1; the latter was cost saving. CDI can be decreased by better isolation and more sensitive laboratory methods. From the hospital perspective, improving isolation is more cost-effective than improving diagnostics.

A mathematical model of Clostridium difficile transmission in medical wards and a cost-effectiveness analysis comparing different strategies for laboratory diagnosis and patient isolation

PubMed Central

Carmeli, Yehuda; Leshno, Moshe

2017-01-01

Background Clostridium difficile infection (CDI) is a common and potentially fatal healthcare-associated infection. Improving diagnostic tests and infection control measures may prevent transmission. We aimed to determine, in resource-limited settings, whether it is more effective and cost-effective to allocate resources to isolation or to diagnostics. Methods We constructed a mathematical model of CDI transmission based on hospital data (9 medical wards, 350 beds) between March 2010 and February 2013. The model consisted of three compartments: susceptible patients, asymptomatic carriers and CDI patients. We used our model results to perform a cost-effectiveness analysis, comparing four strategies that were different combinations of 2 test methods (the two-step test and uniform PCR) and 2 infection control measures (contact isolation in multiple-bed rooms or single-bed rooms/cohorting). For each strategy, we calculated the annual cost (of CDI diagnosis and isolation) for a decrease of 1 in the average daily number of CDI patients; the strategy of the two-step test and contact isolation in multiple-bed rooms was the reference strategy. Results Our model showed that the average number of CDI patients increased exponentially as the transmission rate increased. Improving diagnosis by adopting uniform PCR assay reduced the average number of CDI cases per day per 350 beds from 9.4 to 8.5, while improving isolation by using single-bed rooms reduced the number to about 1; the latter was cost saving. Conclusions CDI can be decreased by better isolation and more sensitive laboratory methods. From the hospital perspective, improving isolation is more cost-effective than improving diagnostics. PMID:28187144

The cost-effectiveness of screening for colorectal cancer.

PubMed

Telford, Jennifer J; Levy, Adrian R; Sambrook, Jennifer C; Zou, Denise; Enns, Robert A

2010-09-07

Published decision analyses show that screening for colorectal cancer is cost-effective. However, because of the number of tests available, the optimal screening strategy in Canada is unknown. We estimated the incremental cost-effectiveness of 10 strategies for colorectal cancer screening, as well as no screening, incorporating quality of life, noncompliance and data on the costs and benefits of chemotherapy. We used a probabilistic Markov model to estimate the costs and quality-adjusted life expectancy of 50-year-old average-risk Canadians without screening and with screening by each test. We populated the model with data from the published literature. We calculated costs from the perspective of a third-party payer, with inflation to 2007 Canadian dollars. Of the 10 strategies considered, we focused on three tests currently being used for population screening in some Canadian provinces: low-sensitivity guaiac fecal occult blood test, performed annually; fecal immunochemical test, performed annually; and colonoscopy, performed every 10 years. These strategies reduced the incidence of colorectal cancer by 44%, 65% and 81%, and mortality by 55%, 74% and 83%, respectively, compared with no screening. These strategies generated incremental cost-effectiveness ratios of $9159, $611 and $6133 per quality-adjusted life year, respectively. The findings were robust to probabilistic sensitivity analysis. Colonoscopy every 10 years yielded the greatest net health benefit. Screening for colorectal cancer is cost-effective over conventional levels of willingness to pay. Annual high-sensitivity fecal occult blood testing, such as a fecal immunochemical test, or colonoscopy every 10 years offer the best value for the money in Canada.

Summary of the Sixth Persh Workshop: Corrosion Policy Guiding Science and Technology

DTIC Science & Technology

2016-01-01

mitigating corrosion. Corrosion affects military readiness, so corrosion prevention and control (CPC) have a high priority for the DOD since CPC is a...resulting in high -cost repairs. Corrosion mitigation is thus a key cost-effective approach for system maintainability and reduced life cycle costs. The... treatments . • Develop corrosion databases and corrosion models for predictive evaluation. Testing methods for realistic prediction of performance

Strategies that reduce 90-day readmissions and inpatient costs after liver transplantation.

PubMed

Zeidan, Joseph H; Levi, David M; Pierce, Ruth; Russo, Mark W

2018-04-25

Liver transplantation is hospital-resource intensive and associated with high rates of readmission. We have previously shown a reduction in 30-day readmission rates by implementing a specifically designed protocol to increase access to outpatient care. To determine if strategies that reduce 30-day readmission after liver transplant were effective in also reducing 90-day readmission rates and costs. A protocol was developed to reduce inpatient readmissions after liver transplant that expanded outpatient services and provided alternatives to readmission. The 90-day readmission rates and costs were compared before and implementing strategies outlined in the protocol. Multivariable analysis was used to control for potential confounding factors. Over the study period 304 adult primary liver transplants were performed on patients with a median biologic MELD of 22. 112 (37%) patients were readmitted within 90 days of transplant. The readmission rates before and after implementation of the protocol were 53% and 26% respectively, p<0.001. The most common reason for readmission was elevated liver tests/rejection (24%). In multivariable analysis, the protocol remained associated with avoiding readmission, OR=0.33, [95% CI 0.20,0.55], p<0.001. The median length of stay after transplant preprotocol and postprotocol was 8 and 7 days, respectively. A greater proportion of patients were discharged to hospital lodging post protocol, 10% versus 19%, p=0.03. 90-day readmissions costs were reduced by 55% but total 90 day costs by only 2.7% due to higher outpatient costs and index admission costs. 90-day readmission rates and readmission costs can be reduced by improving access to outpatient services and hospital local lodging. Total 90-day costs were similar between the two groups because of higher outpatient costs after the protocol was introduced. This article is protected by copyright. All rights reserved. © 2018 by the American Association for the Study of Liver Diseases.

Advanced launch system. Advanced development oxidizer turbopump program

NASA Technical Reports Server (NTRS)

1993-01-01

On May 19, 1989, Pratt & Whitney was awarded contract NAS8-37595 by the National Aeronautics and Space Administration, Marshall Space Flight Center, Huntsville Alabama for an Advanced Development Program (ADP) to design, develop and demonstrate a highly reliable low cost, liquid oxygen turbopump for the Advanced Launch System (ALS). The ALS had an overall goal of reducing the cost of placing payloads in orbit by an order of magnitude. This goal would require a substantial reduction in life cycle costs, with emphasis on recurring costs, compared to current launch vehicles. Engine studies supporting these efforts were made for the Space Transportation Main Engine (STME). The emphasis on low cost required design simplification of components and subsystems such that the ground maintenance and test operations was minimized. The results of the Oxygen Turbopump ADP technology effort would provide data to be used in the STME. Initially the STME baseline was a gas generator cycle engine with a vacuum thrust level of 580,000 lbf. This was later increased to 650,000 lbf and the oxygen turbopump design approach was changed to reflect the new thrust level. It was intended that this ADP program be conducted in two phases. Phase 1, a basic phase, would encompass the preliminary design effort, and Phase II, an optional contract phase to cover design, fabrication and test evaluation of an oxygen turbopump at a component test facility at the NASA John C. Stennis Space Center in Mississippi. The basic phase included preliminary design and analysis, evaluation of low cost concepts, and evaluation of fabrication techniques. The option phase included design of the pump and support hardware, analysis of the final configuration to ensure design integrity, fabrication of hardware to demonstrate low cost, DVS Testing of hardware to verify the design, assembly of the turbopump and full scale turbopump testing. In December 1990, the intent of this ADP to support the design and development was changed. The design effort for the oxygen turbopump became part of the STME Phase B contract. The status of the pump design funded through this ADP was presented at the Preliminary Design Review (PDR) at the MSFC on October 24, 1990. Advancements in the design of the pump were subsequently continued under the Phase B Contract. The emphasis of this ADP became the demonstration of individual technologies that would have the greatest potential for reducing the recurring cost and increasing reliability. In October of 1992, overall program funding was reduced and work on this ADP was terminated.

Advanced launch system. Advanced development oxidizer turbopump program

NASA Astrophysics Data System (ADS)

1993-10-01

On May 19, 1989, Pratt & Whitney was awarded contract NAS8-37595 by the National Aeronautics and Space Administration, Marshall Space Flight Center, Huntsville Alabama for an Advanced Development Program (ADP) to design, develop and demonstrate a highly reliable low cost, liquid oxygen turbopump for the Advanced Launch System (ALS). The ALS had an overall goal of reducing the cost of placing payloads in orbit by an order of magnitude. This goal would require a substantial reduction in life cycle costs, with emphasis on recurring costs, compared to current launch vehicles. Engine studies supporting these efforts were made for the Space Transportation Main Engine (STME). The emphasis on low cost required design simplification of components and subsystems such that the ground maintenance and test operations was minimized. The results of the Oxygen Turbopump ADP technology effort would provide data to be used in the STME. Initially the STME baseline was a gas generator cycle engine with a vacuum thrust level of 580,000 lbf. This was later increased to 650,000 lbf and the oxygen turbopump design approach was changed to reflect the new thrust level. It was intended that this ADP program be conducted in two phases. Phase 1, a basic phase, would encompass the preliminary design effort, and Phase II, an optional contract phase to cover design, fabrication and test evaluation of an oxygen turbopump at a component test facility at the NASA John C. Stennis Space Center in Mississippi. The basic phase included preliminary design and analysis, evaluation of low cost concepts, and evaluation of fabrication techniques. The option phase included design of the pump and support hardware, analysis of the final configuration to ensure design integrity, fabrication of hardware to demonstrate low cost, DVS Testing of hardware to verify the design, assembly of the turbopump and full scale turbopump testing. In December 1990, the intent of this ADP to support the design and development was changed. The design effort for the oxygen turbopump became part of the STME Phase B contract. The status of the pump design funded through this ADP was presented at the Preliminary Design Review (PDR) at the MSFC on October 24, 1990. Advancements in the design of the pump were subsequently continued under the Phase B Contract. The emphasis of this ADP became the demonstration of individual technologies that would have the greatest potential for reducing the recurring cost and increasing reliability. In October of 1992, overall program funding was reduced and work on this ADP was terminated.

A Simple Exoskeleton That Assists Plantarflexion Can Reduce the Metabolic Cost of Human Walking

PubMed Central

Malcolm, Philippe; Derave, Wim; Galle, Samuel; De Clercq, Dirk

2013-01-01

Background Even though walking can be sustained for great distances, considerable energy is required for plantarflexion around the instant of opposite leg heel contact. Different groups attempted to reduce metabolic cost with exoskeletons but none could achieve a reduction beyond the level of walking without exoskeleton, possibly because there is no consensus on the optimal actuation timing. The main research question of our study was whether it is possible to obtain a higher reduction in metabolic cost by tuning the actuation timing. Methodology/Principal Findings We measured metabolic cost by means of respiratory gas analysis. Test subjects walked with a simple pneumatic exoskeleton that assists plantarflexion with different actuation timings. We found that the exoskeleton can reduce metabolic cost by 0.18±0.06 W kg−1 or 6±2% (standard error of the mean) (p = 0.019) below the cost of walking without exoskeleton if actuation starts just before opposite leg heel contact. Conclusions/Significance The optimum timing that we found concurs with the prediction from a mathematical model of walking. While the present exoskeleton was not ambulant, measurements of joint kinetics reveal that the required power could be recycled from knee extension deceleration work that occurs naturally during walking. This demonstrates that it is theoretically possible to build future ambulant exoskeletons that reduce metabolic cost, without power supply restrictions. PMID:23418524

Strategies for the prevention of perinatal hepatitis B transmission in a marginalized population on the Thailand-Myanmar border: a cost-effectiveness analysis.

PubMed

Devine, Angela; Harvey, Rebecca; Min, Aung Myat; Gilder, Mary Ellen T; Paw, Moo Koh; Kang, Joy; Watts, Isabella; Hanboonkunupakarn, Borimas; Nosten, François; McGready, Rose

2017-08-09

Data on the cost effectiveness of hepatitis B virus (HBV) screening and vaccination strategies for prevention of vertical transmission of HBV in resource limited settings is sparse. A decision tree model of HBV prevention strategies utilised data from a cohort of 7071 pregnant women on the Thailand-Myanmar border using a provider perspective. All options included universal HBV vaccination for newborns in three strategies: (1) universal vaccination alone; (2) universal vaccination with screening of women during antenatal visits with rapid diagnostic test (RDT) plus HBV immune globulin (HBIG) administration to newborns of HBV surface antigen positive women; and (3) universal vaccination with screening of women during antenatal visits plus HBIG administration to newborns of women testing HBV e antigen positive by confirmatory test. At the time of the study, the HBIG after confirmatory test strategy was used. The costs in United States Dollars (US$), infections averted and incremental cost effectiveness ratios (ICERs) were calculated and sensitivity analyses were conducted. A willingness to pay threshold of US$1200 was used. The universal HBV vaccination was the least costly option at US$4.33 per woman attending the clinic. The HBIG after (RDT) strategy had an ICER of US$716.78 per infection averted. The HBIG after confirmatory test strategy was not cost-effective due to extended dominance. The one-way sensitivity analysis showed that while the transmission parameters and cost of HBIG had the biggest impact on outcomes, the HBIG after confirmatory test only became a cost-effective option when a low test cost was used or a high HBIG cost was used. The probabilistic sensitivity analysis showed that HBIG after RDT had an 87% likelihood of being cost-effective as compared to vaccination only at a willingness to pay threshold of US$1200. HBIG following confirmatory test is not a cost-effective strategy for preventing vertical transmission of HBV in the Thailand-Myanmar border population. By switching to HBIG following rapid diagnostic test, perinatal infections will be reduced by nearly one third. This strategy may be applicable to similar settings for marginalized populations where the confirmatory test is not logistically possible.

Viking dynamics experience with application to future payload design

NASA Technical Reports Server (NTRS)

Barrett, S.; Rader, W. P.; Payne, K. R.

1978-01-01

Analytical and test techniques are discussed. Areas in which hindsight indicated erroneous, redundant, or unnecessarily severe design and test specifications are identified. Recommendations are made for improvements in the dynamic design and criteria philosophy, aimed at reducing costs for payloads.

Cost analysis of two community-based HIV testing service modalities led by a Non-Governmental Organization in Cape Town, South Africa.

PubMed

Meehan, Sue-Ann; Beyers, Nulda; Burger, Ronelle

2017-12-02

In South Africa, the financing and sustainability of HIV services is a priority. Community-based HIV testing services (CB-HTS) play a vital role in diagnosis and linkage to HIV care for those least likely to utilise government health services. With insufficient estimates of the costs associated with CB-HTS provided by NGOs in South Africa, this cost analysis explored the cost to implement and provide services at two NGO-led CB-HTS modalities and calculated the costs associated with realizing key HIV outputs for each CB-HTS modality. The study took place in a peri-urban area where CB-HTS were provided from a stand-alone centre and mobile service. Using a service provider (NGO) perspective, all inputs were allocated by HTS modality with shared costs apportioned according to client volume or personnel time. We calculated the total cost of each HTS modality and the cost categories (personnel, capital and recurring goods/services) across each HTS modality. Costs were divided into seven pre-determined project components, used to examine cost drivers. HIV outputs were analysed for each HTS modality and the mean cost for each HIV output was calculated per HTS modality. The annual cost of the stand-alone and mobile modalities was $96,616 and $77,764 respectively, with personnel costs accounting for 54% of the total costs at the stand-alone. For project components, overheads and service provision made up the majority of the costs. The mean cost per person tested at stand-alone ($51) was higher than at the mobile ($25). Linkage to care cost at the stand-alone ($1039) was lower than the mobile ($2102). This study provides insight into the cost of an NGO led CB-HTS project providing HIV testing and linkage to care through two CB-HIV testing modalities. The study highlights; (1) the importance of including all applicable costs (including overheads) to ensure an accurate cost estimate that is representative of the full service implementation cost, (2) the direct link between test uptake and mean cost per person tested, and (3) the need for effective linkage to care strategies to increase linkage and thereby reduce the mean cost per person linked to HIV care.

Assessment of regional management strategies for controlling seawater intrusion

USGS Publications Warehouse

Reichard, E.G.; Johnson, T.A.

2005-01-01

Simulation-optimization methods, applied with adequate sensitivity tests, can provide useful quantitative guidance for controlling seawater intrusion. This is demonstrated in an application to the West Coast Basin of coastal Los Angeles that considers two management options for improving hydraulic control of seawater intrusion: increased injection into barrier wells and in lieu delivery of surface water to replace current pumpage. For the base-case optimization analysis, assuming constant groundwater demand, in lieu delivery was determined to be most cost effective. Reduced-cost information from the optimization provided guidance for prioritizing locations for in lieu delivery. Model sensitivity to a suite of hydrologic, economic, and policy factors was tested. Raising the imposed average water-level constraint at the hydraulic-control locations resulted in nonlinear increases in cost. Systematic varying of the relative costs of injection and in lieu water yielded a trade-off curve between relative costs and injection/in lieu amounts. Changing the assumed future scenario to one of increasing pumpage in the adjacent Central Basin caused a small increase in the computed costs of seawater intrusion control. Changing the assumed boundary condition representing interaction with an adjacent basin did not affect the optimization results. Reducing the assumed hydraulic conductivity of the main productive aquifer resulted in a large increase in the model-computed cost. Journal of Water Resources Planning and Management ?? ASCE.

Too Little or Too Much? Parafoveal Preview Benefits and Parafoveal Load Costs in Dyslexic Adults

ERIC Educational Resources Information Center

Silva, Susana; Faísca, Luís; Araújo, Susana; Casaca, Luis; Carvalho, Loide; Petersson, Karl Magnus; Reis, Alexandra

2016-01-01

Two different forms of parafoveal dysfunction have been hypothesized as core deficits of dyslexic individuals: reduced parafoveal preview benefits ("too little parafovea") and increased costs of parafoveal load ("too much parafovea"). We tested both hypotheses in a single eye-tracking experiment using a modified serial rapid…

Economic evaluation of genomic test-directed chemotherapy for early-stage lymph node-positive breast cancer.

PubMed

Hall, Peter S; McCabe, Christopher; Stein, Robert C; Cameron, David

2012-01-04

Multi-parameter genomic tests identify patients with early-stage breast cancer who are likely to derive little benefit from adjuvant chemotherapy. These tests can potentially spare patients the morbidity from unnecessary chemotherapy and reduce costs. However, the costs of the test must be balanced against the health benefits and cost savings produced. This economic evaluation compared genomic test-directed chemotherapy using the Oncotype DX 21-gene assay with chemotherapy for all eligible patients with lymph node-positive, estrogen receptor-positive early-stage breast cancer. We performed a cost-utility analysis using a state transition model to calculate expected costs and benefits over the lifetime of a cohort of women with estrogen receptor-positive lymph node-positive breast cancer from a UK perspective. Recurrence rates for Oncotype DX-selected risk groups were derived from parametric survival models fitted to data from the Southwest Oncology Group 8814 trial. The primary outcome was the incremental cost-effectiveness ratio, expressed as the cost (in 2011 GBP) per quality-adjusted life-year (QALY). Confidence in the incremental cost-effectiveness ratio was expressed as a probability of cost-effectiveness and was calculated using Monte Carlo simulation. Model parameters were varied deterministically and probabilistically in sensitivity analysis. Value of information analysis was used to rank priorities for further research. The incremental cost-effectiveness ratio for Oncotype DX-directed chemotherapy using a recurrence score cutoff of 18 was £5529 (US $8852) per QALY. The probability that test-directed chemotherapy is cost-effective was 0.61 at a willingness-to-pay threshold of £30 000 per QALY. Results were sensitive to the recurrence rate, long-term anthracycline-related cardiac toxicity, quality of life, test cost, and the time horizon. The highest priority for further research identified by value of information analysis is the recurrence rate in test-selected subgroups. There is substantial uncertainty regarding the cost-effectiveness of Oncotype DX-directed chemotherapy. It is particularly important that future research studies to inform cost-effectiveness-based decisions collect long-term outcome data.

Comparability of Computer Delivered versus Traditional Paper and Pencil Testing

ERIC Educational Resources Information Center

Strader, Douglas A.

2012-01-01

There are many advantages supporting the use of computers as an alternate mode of delivery for high stakes testing: cost savings, increased test security, flexibility in test administrations, innovations in items, and reduced scoring time. The purpose of this study was to determine if the use of computers as the mode of delivery had any…

Product manufacturing, quality, and reliability initiatives to maintain a competitive advantage and meet customer expectations in the semiconductor industry

NASA Astrophysics Data System (ADS)

Capps, Gregory

Semiconductor products are manufactured and consumed across the world. The semiconductor industry is constantly striving to manufacture products with greater performance, improved efficiency, less energy consumption, smaller feature sizes, thinner gate oxides, and faster speeds. Customers have pushed towards zero defects and require a more reliable, higher quality product than ever before. Manufacturers are required to improve yields, reduce operating costs, and increase revenue to maintain a competitive advantage. Opportunities exist for integrated circuit (IC) customers and manufacturers to work together and independently to reduce costs, eliminate waste, reduce defects, reduce warranty returns, and improve quality. This project focuses on electrical over-stress (EOS) and re-test okay (RTOK), two top failure return mechanisms, which both make great defect reduction opportunities in customer-manufacturer relationship. Proactive continuous improvement initiatives and methodologies are addressed with emphasis on product life cycle, manufacturing processes, test, statistical process control (SPC), industry best practices, customer education, and customer-manufacturer interaction.

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

PubMed

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

2017-12-01

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

Cost-effectiveness analysis of microscopic observation drug susceptibility test versus Xpert MTB/Rif test for diagnosis of pulmonary tuberculosis in HIV patients in Uganda.

PubMed

Walusimbi, Simon; Kwesiga, Brendan; Rodrigues, Rashmi; Haile, Melles; de Costa, Ayesha; Bogg, Lennart; Katamba, Achilles

2016-10-10

Microscopic Observation Drug Susceptibility (MODS) and Xpert MTB/Rif (Xpert) are highly sensitive tests for diagnosis of pulmonary tuberculosis (PTB). This study evaluated the cost effectiveness of utilizing MODS versus Xpert for diagnosis of active pulmonary TB in HIV infected patients in Uganda. A decision analysis model comparing MODS versus Xpert for TB diagnosis was used. Costs were estimated by measuring and valuing relevant resources required to perform the MODS and Xpert tests. Diagnostic accuracy data of the tests were obtained from systematic reviews involving HIV infected patients. We calculated base values for unit costs and varied several assumptions to obtain the range estimates. Cost effectiveness was expressed as costs per TB patient diagnosed for each of the two diagnostic strategies. Base case analysis was performed using the base estimates for unit cost and diagnostic accuracy of the tests. Sensitivity analysis was performed using a range of value estimates for resources, prevalence, number of tests and diagnostic accuracy. The unit cost of MODS was US$ 6.53 versus US$ 12.41 of Xpert. Consumables accounted for 59 % (US$ 3.84 of 6.53) of the unit cost for MODS and 84 % (US$10.37 of 12.41) of the unit cost for Xpert. The cost effectiveness ratio of the algorithm using MODS was US$ 34 per TB patient diagnosed compared to US$ 71 of the algorithm using Xpert. The algorithm using MODS was more cost-effective compared to the algorithm using Xpert for a wide range of different values of accuracy, cost and TB prevalence. The cost (threshold value), where the algorithm using Xpert was optimal over the algorithm using MODS was US$ 5.92. MODS versus Xpert was more cost-effective for the diagnosis of PTB among HIV patients in our setting. Efforts to scale-up MODS therefore need to be explored. However, since other non-economic factors may still favour the use of Xpert, the current cost of the Xpert cartridge still needs to be reduced further by more than half, in order to make it economically competitive with MODS.

Optimal policies for aggregate recycling from decommissioned forest roads.

PubMed

Thompson, Matthew; Sessions, John

2008-08-01

To mitigate the adverse environmental impact of forest roads, especially degradation of endangered salmonid habitat, many public and private land managers in the western United States are actively decommissioning roads where practical and affordable. Road decommissioning is associated with reduced long-term environmental impact. When decommissioning a road, it may be possible to recover some aggregate (crushed rock) from the road surface. Aggregate is used on many low volume forest roads to reduce wheel stresses transferred to the subgrade, reduce erosion, reduce maintenance costs, and improve driver comfort. Previous studies have demonstrated the potential for aggregate to be recovered and used elsewhere on the road network, at a reduced cost compared to purchasing aggregate from a quarry. This article investigates the potential for aggregate recycling to provide an economic incentive to decommission additional roads by reducing transport distance and aggregate procurement costs for other actively used roads. Decommissioning additional roads may, in turn, result in improved aquatic habitat. We present real-world examples of aggregate recycling and discuss the advantages of doing so. Further, we present mixed integer formulations to determine optimal levels of aggregate recycling under economic and environmental objectives. Tested on an example road network, incorporation of aggregate recycling demonstrates substantial cost-savings relative to a baseline scenario without recycling, increasing the likelihood of road decommissioning and reduced habitat degradation. We find that aggregate recycling can result in up to 24% in cost savings (economic objective) and up to 890% in additional length of roads decommissioned (environmental objective).

Cost-effectiveness of HIV drug resistance testing to inform switching to second line antiretroviral therapy in low income settings.

PubMed

Phillips, Andrew; Cambiano, Valentina; Nakagawa, Fumiyo; Mabugu, Travor; Magubu, Travor; Miners, Alec; Ford, Debbie; Pillay, Deenan; De Luca, Andrea; Lundgren, Jens; Revill, Paul

2014-01-01

To guide future need for cheap resistance tests for use in low income settings, we assessed cost-effectiveness of drug resistance testing as part of monitoring of people on first line ART - with switching from first to second line ART being conditional on NNRTI drug resistance mutations being identified. An individual level simulation model of HIV transmission, progression and the effect of ART which accounts for adherence and resistance development was used to compare outcomes of various potential monitoring strategies in a typical low income setting in sub-Saharan Africa. Underlying monitoring strategies considered were based on clinical disease, CD4 count or viral load. Within each we considered a strategy in which no further measures are performed, one with a viral load measure to confirm failure, and one with both a viral load measure and a resistance test. Predicted outcomes were assessed over 2015-2025 in terms of viral suppression, first line failure, switching to second line regimen, death, HIV incidence, disability-adjusted-life-years averted and costs. Potential future low costs of resistance tests ($30) were used. The most effective strategy, in terms of DALYs averted, was one using viral load monitoring without confirmation. The incremental cost-effectiveness ratio for this strategy was $2113 (the same as that for viral load monitoring with confirmation). ART monitoring strategies which involved resistance testing did not emerge as being more effective or cost effective than strategies not using it. The slightly reduced ART costs resulting from use of resistance testing, due to less use of second line regimens, was of similar magnitude to the costs of resistance tests. Use of resistance testing at the time of first line failure as part of the decision whether to switch to second line therapy was not cost-effective, even though the test was assumed to be very inexpensive.

Screening for Lynch syndrome and referral to clinical genetics by selective mismatch repair protein immunohistochemistry testing: an audit and cost analysis.

PubMed

Colling, Richard; Church, David N; Carmichael, Juliet; Murphy, Lucinda; East, James; Risby, Peter; Kerr, Rachel; Chetty, Runjan; Wang, Lai Mun

2015-12-01

Lynch syndrome (LS) accounts for around 3% of colorectal cancers (CRCs) and is caused by germline mutations in mismatch repair (MMR) genes. Recently, screening strategies to identify patients with LS have become popular. We audited CRCs screened with MMR immunohistochemistry (IHC) in 2013. 209 tumours had MMR IHC performed at a cost of £12 540. 47/209 (21%) cases showed IHC loss of expression in at least one MMR protein. 28/44 cases with loss of MLH1 had additional BRAF V600E testing, at a cost of £5040. MMR IHC reduced the number of potential clinical genetics referrals from 209 to 47. BRAF mutation testing, performed in a subset of cases with MLH1 loss, further reduced this to 21. At a cost of £1340 per referral, this model of LS screening for clinical genetics referral had significant potential savings (£234 340) and can be easily implemented in parallel with MMR IHC done for prognostication in CRCs. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Health economics of screening for gynaecological cancers.

PubMed

Kulasingam, Shalini; Havrilesky, Laura

2012-04-01

In this chapter, we summarise findings from recent cost-effectiveness analyses of screening for cervical cancer and ovarian cancer. We begin with a brief summary of key issues that affect the cost-effectiveness of screening, including disease burden, and availability and type of screening tests. For cervical cancer, we discuss the potential effect of human papilloma virus vaccines on screening. Outstanding epidemiological and cost-effectiveness issues are included. For cervical cancer, this includes incorporating the long-term effect of treatment (including adverse birth outcomes in treated women who are of reproductive age) into cost-effectiveness models using newly available trial data to identify the best strategy for incorporating human papilloma virus tests. A second issue is the need for additional data on human papilloma virus vaccines, such as effectiveness of reduced cancer incidence and mortality, effectiveness in previously exposed women and coverage. Definitive data on these parameters will allow us to update model-based analyses to include more realistic estimates, and also potentially dramatically alter our approach to screening. For ovarian cancer, outstanding issues include confirming within the context of a trial that screening is effective for reducing mortality and incorporating tests with high specificity into screening into screening algorithms for ovarian cancer. Copyright © 2011 Elsevier Ltd. All rights reserved.

Usability Tests in Medicine: A Cost-Benefit Analysis for Hospitals Before Acquiring Medical Devices for Theatre.

PubMed

Gonser, Phillipp; Fuchsberger, Thomas; Matern, Ulrich

2017-08-01

The use of active medical devices in clinical routine should be as safe and efficient as possible. Usability tests (UTs) help improve these aspects of medical devices during their development, but UTs can be of use for hospitals even after a product has been launched. The present pilot study examines the costs and possible benefits of UT for hospitals before buying new medical devices for theatre. Two active medical devices with different complexity were tested in a standardized UT and a cost-benefit analysis was carried out assuming a different device bought at the same price with a higher usability could increase the efficiency of task solving and due to that save valuable theatre time. The cost of the UT amounted up to €19.400. Hospitals could benefit from UTs before buying new devices for theatre by reducing time-consuming operator errors and thereby increase productivity and patient safety. The possible benefits amounted from €23.300 to €1.570.000 (median = €797.000). Not only hospitals could benefit economically from investing in a UT before deciding to buy a medical device, but especially patients would profit from a higher usability by reducing possible operator errors and increase safety and performance of use.

Development of Camera Electronics for the Advanced Gamma-ray Imaging System (AGIS)

NASA Astrophysics Data System (ADS)

Tajima, Hiroyasu

2009-05-01

AGIS, a next generation of atmospheric Cherenkov telescope arrays, aims to achieve a sensitivity level of a milliCrab for gamma-ray observations in in the energy band of 40 GeV to 100 TeV. Such improvement requires cost reduction of individual components with high reliability in order to equip the order of 100 telescopes necessary to achieve the sensitivity goal. We are exploring several design concepts to reduce the cost of camera electronics while improving their performance. We have developed test systems for some of these concepts and are testing their performance. Here we present test results of the test systems.

Economic Model Predictive Control of Bihormonal Artificial Pancreas System Based on Switching Control and Dynamic R-parameter.

PubMed

Tang, Fengna; Wang, Youqing

2017-11-01

Blood glucose (BG) regulation is a long-term task for people with diabetes. In recent years, more and more researchers have attempted to achieve automated regulation of BG using automatic control algorithms, called the artificial pancreas (AP) system. In clinical practice, it is equally important to guarantee the treatment effect and reduce the treatment costs. The main motivation of this study is to reduce the cure burden. The dynamic R-parameter economic model predictive control (R-EMPC) is chosen to regulate the delivery rates of exogenous hormones (insulin and glucagon). It uses particle swarm optimization (PSO) to optimize the economic cost function and the switching logic between insulin delivery and glucagon delivery is designed based on switching control theory. The proposed method is first tested on the standard subject; the result is compared with the switching PID and the switching MPC. The effect of the dynamic R-parameter on improving the control performance is illustrated by comparing the results of the EMPC and the R-EMPC. Finally, the robustness tests on meal change (size and timing), hormone sensitivity (insulin and glucagon), and subject variability are performed. All results show that the proposed method can improve the control performance and reduce the economic costs. The simulation results verify the effectiveness of the proposed algorithm on improving the tracking performance, enhancing robustness, and reducing economic costs. The method proposed in this study owns great worth in practical application.

[Cost-effectiveness analysis on colorectal cancer screening program].

PubMed

Huang, Q C; Ye, D; Jiang, X Y; Li, Q L; Yao, K Y; Wang, J B; Jin, M J; Chen, K

2017-01-10

Objective: To evaluate the cost-effectiveness of colorectal cancer screening program in different age groups from the view of health economics. Methods: The screening compliance rates, detection rates in different age groups were calculated by using the data from colorectal cancer screening program in Jiashan county, Zhejiang province. The differences in indicator among age groups were analyzed with χ (2) test or trend χ (2) test. The ratios of cost to the number of case were calculated according to cost statistics. Results: The detection rates of immunochemical fecal occult blood test (iFOBT) positivity, advanced adenoma and colorectal cancer and early stage cancer increased with age, while the early diagnosis rates were negatively associated with age. After exclusion the younger counterpart, the cost-effectiveness of individuals aged >50 years could be reduced by 15 %- 30 % . Conclusion: From health economic perspective, it is beneficial to start colorectal cancer screening at age of 50 years to improve the efficiency of the screening.

Low-dosage epoetin in maintenance haemodialysis: costs and quality-of-life improvement.

PubMed

Harris, D C

1994-01-01

Decisions about epoetin (recombinant human erythropoetin) dosage and target haematocrit in dialysis patients have been determined largely by the high acquisition cost of epoetin, but are made with incomplete knowledge about which target haematocrit gives the optimum clinical benefit. Haematopoietic response to epoetin may be determined by pharmacodynamic factors such as rate and frequency of administration, as well as by individual patient characteristics such as ethnicity. Resistance to epoetin may be due to iron or vitamin deficiency, natural or exogenous inhibitors of erythropoiesis and bone marrow fibrosis. The high acquisition cost of epoetin must be considered along with a number of other factors that can influence the true cost of epoetin treatment. Hidden costs of epoetin treatment include administration costs, changes in other treatments, extra laboratory tests and adverse events. Administration costs and extra laboratory surveillance add little to overall cost. Depletion of iron stores, hypertension, increased blood coagulability and reduced dialyser efficiency resulting from epoetin treatment may all add a small additional component to the true cost. Severe complications with significant cost implications are rare. Amongst the various components of true cost, only the acquisition cost can definitely be reduced by low dosage treatment. Balanced against the true and potential costs of epoetin are a number of benefits which can result in potential savings. The need for blood transfusion is all but abolished, avoiding the cost of transfusion and its complications. Sensitisation against histocompatibility antigens is reduced by avoiding transfusion, and so the waiting time for cadaveric transplantation may be reduced. Rates of hospitalisation for all causes, especially those associated with anaemia, may be reduced by epoetin treatment. By improving well-being, epoetin may allow patients to be transferred to minimal-care units or home where dialysis can be performed much more cheaply. Amongst the various potential benefits of epoetin, the one with the greatest potential to save money for society is improved productivity. To date, productivity improvements with epoetin have been demonstrated only in small studies. If the acquisition costs of epoetin are reduced by low dosage therapy, these potential benefits can cover a large proportion of the total cost of epoetin. Epoetin undoubtedly improves quality of life and activity, but it is not clear which level of haematocrit gives optimum improvement.(ABSTRACT TRUNCATED AT 400 WORDS)

Home enteral nutrition reduces complications, length of stay, and health care costs: results from a multicenter study.

PubMed

Klek, Stanislaw; Hermanowicz, Adam; Dziwiszek, Grzegorz; Matysiak, Konrad; Szczepanek, Kinga; Szybinski, Piotr; Galas, Aleksander

2014-08-01

Home enteral nutrition (HEN) has always been recognized as a life-saving procedure, but with the ongoing economic crisis influencing health care, its cost-effectiveness has been questioned recently. The unique reimbursement situation in Poland enabled the otherwise ethically unacceptable, hence unavailable, comparison of the period of no-feeding and long-term feeding and the subsequent analyses of the clinical value of the latter and its cost-effectiveness. The observational multicenter study in the group of 456 HEN patients [142 children: 55 girls and 87 boys, mean (±SD) age 8.7 ± 5.9 y; 314 adults: 151 women and 163 men, mean age 59.3 ± 19.8 y] was performed between January 2007 and July 2013. Two 12-mo periods were compared. During the first period, patients were tube fed a homemade diet and were not monitored; during the other period, patients received HEN. HEN included tube feeding and complex monitoring by a nutrition support team. The number of complications, hospital admissions, length of hospital stay, biochemical and anthropometric variables, and costs of hospitalization were compared. Implementation of HEN enabled weight gain and stabilized liver function in both age groups, but it hardly influenced the other tests. HEN implementation reduced the incidence of infectious complications (37.4% compared with 14.9%; P < 0.001, McNemar test), the number of hospital admissions [1.98 ± 2.42 (mean ± SD) before and 1.26 ± 2.18 after EN; P < 0.001, Wilcoxon's signed-rank test], and length of hospital stay (39.7 ± 71.9 compared with 11.9 ± 28.5 d; P < 0.001, Wilcoxon's signed-rank test). The mean annual costs ($) of hospitalization were reduced from 6500.20 ± 10,402.69 to 2072.58 ± 5497.00. The study showed that HEN improves clinical outcomes and decreases health care costs. It was impossible, however, to determine precisely which factor mattered more: the artificial diet itself or the introduction of complex care. © 2014 American Society for Nutrition.

Automated Low-Cost Smartphone-Based Lateral Flow Saliva Test Reader for Drugs-of-Abuse Detection.

PubMed

Carrio, Adrian; Sampedro, Carlos; Sanchez-Lopez, Jose Luis; Pimienta, Miguel; Campoy, Pascual

2015-11-24

Lateral flow assay tests are nowadays becoming powerful, low-cost diagnostic tools. Obtaining a result is usually subject to visual interpretation of colored areas on the test by a human operator, introducing subjectivity and the possibility of errors in the extraction of the results. While automated test readers providing a result-consistent solution are widely available, they usually lack portability. In this paper, we present a smartphone-based automated reader for drug-of-abuse lateral flow assay tests, consisting of an inexpensive light box and a smartphone device. Test images captured with the smartphone camera are processed in the device using computer vision and machine learning techniques to perform automatic extraction of the results. A deep validation of the system has been carried out showing the high accuracy of the system. The proposed approach, applicable to any line-based or color-based lateral flow test in the market, effectively reduces the manufacturing costs of the reader and makes it portable and massively available while providing accurate, reliable results.

Cost effective launch operations of the SSME

NASA Technical Reports Server (NTRS)

Klatt, F. P.

1985-01-01

The Space Shuttle Main Engine (SSME) represents the beginning of reusable rocket engine operations in the space transportation system (STS). Steps taken to reduce the overall cost of flight operations of the SSME by improving turnaround operations, extending the life of the engine, and improving the cost effectiveness of overhaul operations at the Canoga Park home plant are described. Ground certification testing to ensure safe launch operations is described, as well as certification extension testing that leads to a service life equivalent to 40 flights. The proven flight record of the SSME, which has demonstrated the utility of the SSME as a key component of America's space transportation system, is discussed.

Substituting Sodium Hydrosulfite with Sodium Metabisulfite Improves Long-Term Stability of a Distributable Paper-Based Test Kit for Point-of-Care Screening for Sickle Cell Anemia.

PubMed

Torabian, Kian; Lezzar, Dalia; Piety, Nathaniel Z; George, Alex; Shevkoplyas, Sergey S

2017-09-20

Sickle cell anemia (SCA) is a genetic blood disorder that is particularly lethal in early childhood. Universal newborn screening programs and subsequent early treatment are known to drastically reduce under-five SCA mortality. However, in resource-limited settings, cost and infrastructure constraints limit the effectiveness of laboratory-based SCA screening programs. To address this limitation our laboratory previously developed a low-cost, equipment-free, point-of-care, paper-based SCA test. Here, we improved the stability and performance of the test by replacing sodium hydrosulfite (HS), a key reducing agent in the hemoglobin solubility buffer which is not stable in aqueous solutions, with sodium metabisulfite (MS). The MS formulation of the test was compared to the HS formulation in a laboratory setting by inexperienced users ( n = 3), to determine visual limit of detection (LOD), readout time, diagnostic accuracy, intra- and inter-observer agreement, and shelf life. The MS test was found to have a 10% sickle hemoglobin LOD, 21-min readout time, 97.3% sensitivity and 99.5% specificity for SCA, almost perfect intra- and inter-observer agreement, at least 24 weeks of shelf stability at room temperature, and could be packaged into a self-contained, distributable test kits comprised of off-the-shelf disposable components and food-grade reagents with a total cost of only $0.21 (USD).

Recent Enhancements to the National Transonic Facility (Mixed Mode Operations)

NASA Technical Reports Server (NTRS)

Kilgore, W. Allen; Chan, David; Balakrishna, S.; Wahls, Richard A.

2006-01-01

The U.S. National Transonic Facility continues to make enhancements to provide quality data in a safe, efficient and cost effective method for aerodynamic ground testing. Recent enhancements discussed in this paper include the development of a Mixed-mode of operations that combine Air-mode operations with Nitrogen-mode operations. This implementation and operational results of this new Mixed-mode expands the ambient temperature transonic region of testing beyond the Air-mode limitations at a significantly reduced cost over Nitrogen Mode operation.

Development of a superconducting claw-pole linear test-rig

NASA Astrophysics Data System (ADS)

Radyjowski, Patryk; Keysan, Ozan; Burchell, Joseph; Mueller, Markus

2016-04-01

Superconducting generators can help to reduce the cost of energy for large offshore wind turbines, where the size and mass of the generator have a direct effect on the installation cost. However, existing superconducting generators are not as reliable as the alternative technologies. In this paper, a linear test prototype for a novel superconducting claw-pole topology, which has a stationary superconducting coil that eliminates the cryocooler coupler will be presented. The issues related to mechanical, electromagnetic and thermal aspects of the prototype will be presented.

Clinical laboratory: bigger is not always better.

PubMed

Plebani, Mario

2018-06-27

Laboratory services around the world are undergoing substantial consolidation and changes through mechanisms ranging from mergers, acquisitions and outsourcing, primarily based on expectations to improve efficiency, increasing volumes and reducing the cost per test. However, the relationship between volume and costs is not linear and numerous variables influence the end cost per test. In particular, the relationship between volumes and costs does not span the entire platter of clinical laboratories: high costs are associated with low volumes up to a threshold of 1 million test per year. Over this threshold, there is no linear association between volumes and costs, as laboratory organization rather than test volume more significantly affects the final costs. Currently, data on laboratory errors and associated diagnostic errors and risk for patient harm emphasize the need for a paradigmatic shift: from a focus on volumes and efficiency to a patient-centered vision restoring the nature of laboratory services as an integral part of the diagnostic and therapy process. Process and outcome quality indicators are effective tools to measure and improve laboratory services, by stimulating a competition based on intra- and extra-analytical performance specifications, intermediate outcomes and customer satisfaction. Rather than competing with economic value, clinical laboratories should adopt a strategy based on a set of harmonized quality indicators and performance specifications, active laboratory stewardship, and improved patient safety.

Views of US physicians about controlling health care costs.

PubMed

Tilburt, Jon C; Wynia, Matthew K; Sheeler, Robert D; Thorsteinsdottir, Bjorg; James, Katherine M; Egginton, Jason S; Liebow, Mark; Hurst, Samia; Danis, Marion; Goold, Susan Dorr

2013-07-24

Physicians' views about health care costs are germane to pending policy reforms. To assess physicians' attitudes toward and perceived role in addressing health care costs. A cross-sectional survey mailed in 2012 to 3897 US physicians randomly selected from the AMA Masterfile. Enthusiasm for 17 cost-containment strategies and agreement with an 11-measure cost-consciousness scale. A total of 2556 physicians responded (response rate = 65%). Most believed that trial lawyers (60%), health insurance companies (59%), hospitals and health systems (56%), pharmaceutical and device manufacturers (56%), and patients (52%) have a "major responsibility" for reducing health care costs, whereas only 36% reported that practicing physicians have "major responsibility." Most were "very enthusiastic" for "promoting continuity of care" (75%), "expanding access to quality and safety data" (51%), and "limiting access to expensive treatments with little net benefit" (51%) as a means of reducing health care costs. Few expressed enthusiasm for "eliminating fee-for-service payment models" (7%). Most physicians reported being "aware of the costs of the tests/treatments [they] recommend" (76%), agreed they should adhere to clinical guidelines that discourage the use of marginally beneficial care (79%), and agreed that they "should be solely devoted to individual patients' best interests, even if that is expensive" (78%) and that "doctors need to take a more prominent role in limiting use of unnecessary tests" (89%). Most (85%) disagreed that they "should sometimes deny beneficial but costly services to certain patients because resources should go to other patients that need them more." In multivariable logistic regression models testing associations with enthusiasm for key cost-containment strategies, having a salary plus bonus or salary-only compensation type was independently associated with enthusiasm for "eliminating fee for service" (salary plus bonus: odds ratio [OR], 3.3, 99% CI, 1.8-6.1; salary only: OR, 4.3, 99% CI, 2.2-8.5). In multivariable linear regression models, group or government practice setting (β = 0.87, 95% CI, 0.29 to 1.45, P = .004; and β = 0.99, 95% CI, 0.20 to 1.79, P = .01, respectively) and having a salary plus bonus compensation type (β = 0.82; 95% CI, 0.32 to 1.33; P = .002) were positively associated with cost-consciousness. Finding the "uncertainty involved in patient care disconcerting" was negatively associated with cost-consciousness (β = -1.95; 95% CI, -2.71 to -1.18; P < .001). In this survey about health care cost containment, US physicians reported having some responsibility to address health care costs in their practice and expressed general agreement about several quality initiatives to reduce cost but reported less enthusiasm for cost containment involving changes in payment models.

Update on Multi-Variable Parametric Cost Models for Ground and Space Telescopes

NASA Technical Reports Server (NTRS)

Stahl, H. Philip; Henrichs, Todd; Luedtke, Alexander; West, Miranda

2012-01-01

Parametric cost models can be used by designers and project managers to perform relative cost comparisons between major architectural cost drivers and allow high-level design trades; enable cost-benefit analysis for technology development investment; and, provide a basis for estimating total project cost between related concepts. This paper reports on recent revisions and improvements to our ground telescope cost model and refinements of our understanding of space telescope cost models. One interesting observation is that while space telescopes are 50X to 100X more expensive than ground telescopes, their respective scaling relationships are similar. Another interesting speculation is that the role of technology development may be different between ground and space telescopes. For ground telescopes, the data indicates that technology development tends to reduce cost by approximately 50% every 20 years. But for space telescopes, there appears to be no such cost reduction because we do not tend to re-fly similar systems. Thus, instead of reducing cost, 20 years of technology development may be required to enable a doubling of space telescope capability. Other findings include: mass should not be used to estimate cost; spacecraft and science instrument costs account for approximately 50% of total mission cost; and, integration and testing accounts for only about 10% of total mission cost.

Antitumor Efficacy Testing in Rodents

PubMed Central

2008-01-01

The preclinical research and human clinical trials necessary for developing anticancer therapeutics are costly. One contributor to these costs is preclinical rodent efficacy studies, which, in addition to the costs associated with conducting them, often guide the selection of agents for clinical development. If inappropriate or inaccurate recommendations are made on the basis of these preclinical studies, then additional costs are incurred. In this commentary, I discuss the issues associated with preclinical rodent efficacy studies. These include the identification of proper preclinical efficacy models, the selection of appropriate experimental endpoints, and the correct statistical evaluation of the resulting data. I also describe important experimental design considerations, such as selecting the drug vehicle, optimizing the therapeutic treatment plan, properly powering the experiment by defining appropriate numbers of replicates in each treatment arm, and proper randomization. Improved preclinical selection criteria can aid in reducing unnecessary human studies, thus reducing the overall costs of anticancer drug development. PMID:18957675

Communications systems technology assessment study. Volume 2: Results

NASA Technical Reports Server (NTRS)

Kelley, R. L.; Khatri, R. K.; Kiesling, J. D.; Weiss, J. A.

1977-01-01

The cost and technology characteristics are examined for providing special satellite services at UHF, 2.5 GHz, and 14/12 GHz. Considered are primarily health, educational, informational and emergency disaster type services. The total cost of each configuration including space segment, earth station, installation operation and maintenance was optimized to reduce the user's total annual cost and establish preferred equipment performance parameters. Technology expected to be available between now and 1985 is identified and comparisons made between selected alternatives. A key element of the study is a survey of earth station equipment updating past work in the field, providing new insight into technology, and evaluating production and test methods that can reduce costs in large production runs. Various satellite configurations were examined. The cost impact of rain attenuation at Ku-band was evaluated. The factors affecting the ultimate capacity achievable with the available orbital arc and available bandwidth were analyzed.

Scale models: A proven cost-effective tool for outage planning

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

Lee, R.; Segroves, R.

1995-03-01

As generation costs for operating nuclear stations have risen, more nuclear utilities have initiated efforts to improve cost effectiveness. Nuclear plant owners are also being challenged with lower radiation exposure limits and new revised radiation protection related regulations (10 CFR 20), which places further stress on their budgets. As source term reduction activities continue to lower radiation fields, reducing the amount of time spent in radiation fields becomes one of the most cost-effective ways of reducing radiation exposure. An effective approach for minimizing time spent in radiation areas is to use a physical scale model for worker orientation planning andmore » monitoring maintenance, modifications, and outage activities. To meet the challenge of continued reduction in the annual cumulative radiation exposures, new cost-effective tools are required. One field-tested and proven tool is the physical scale model.« less

Does Targeting Higher Health Risk Employees or Increasing Intervention Intensity Yield Savings in a Workplace Wellness Program?

PubMed

Kapinos, Kandice A; Caloyeras, John P; Liu, Hangsheng; Mattke, Soeren

2015-12-01

This article aims to test whether a workplace wellness program reduces health care cost for higher risk employees or employees with greater participation. The program effect on costs was estimated using a generalized linear model with a log-link function using a difference-in-difference framework with a propensity score matched sample of employees using claims and program data from a large US firm from 2003 to 2011. The program targeting higher risk employees did not yield cost savings. Employees participating in five or more sessions aimed at encouraging more healthful living had about $20 lower per member per month costs relative to matched comparisons (P = 0.002). Our results add to the growing evidence base that workplace wellness programs aimed at primary prevention do not reduce health care cost, with the exception of those employees who choose to participate more actively.

Use of predefined biochemical admission profiles does not reduce the number of tests or total cost: a randomized-controlled pilot study.

PubMed

Pareek, Manan; Haidl, Felix; Folkestad, Lars; Brabrand, Mikkel

2014-02-01

The objective of this pilot study was to evaluate whether the use of predefined biochemical profiles as an alternative to individually ordered blood tests by the treating physicians resulted in fewer tests or a lower total cost. This was a randomized-controlled trial of 191 adult patients admitted to a medical admission unit. Upon admission, the patients were randomized to have their blood tests determined by either using a predefined profile (used routinely and designed by the department head) or ordered individually by the treating physician. All patients were initially assessed by junior physicians. We compared the number of tests, estimated total cost, and length of stay. Data are presented as median (interquartile range). Differences were compared using the Wilcoxon rank-sum test and Fishers' exact test. Ninety-two patients were men, median age 65 years. Patients randomized to the use of the predefined profile had median 17 (14-22) blood tests drawn and patients randomized to physician discretion had median 17 (12-21) tests drawn (P=0.3). The median total cost of tests in the profile group was 618 DKK (493-803) and the cost in the physician group was 564 DKK (434-812) (P=0.19). Length of stay in the profile group was a median of 4 days (2-6 days) and 2 days (2-6 days) in the physician group (P=0.08). The use of a predefined blood test panel did not significantly affect the number of tests, total cost, or length of stay for acutely admitted medical patients compared with tests ordered at the discretion of the treating physician.

Reducing Ultra-Clean Transportation Fuel Costs with HyMelt Hydrogen

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

Donald P. Malone; William R. Renner

2006-07-01

This report describes activities for the fifteenth quarter of work performed under this agreement. MEFOS, the gasification testing subcontractor, reported to EnviRes that the vendor for the pressure vessel for above atmospheric testing plans to deliver it by October 20, 2006. MEFOS performed a hazardous operation review of pressurized testing.

Microhole Test Data

DOE Data Explorer

Su, Jiann

2016-05-23

Drilling results from the microhole project at the Sandia High Operating Temperature test facility. The project is seeking to help reduce the cost of exploration and monitoring of geothermal wells and formations by drilling smaller holes. The tests were part of a control algorithm development to optimize the weight-on-bit (WOB) used during drilling with a percussive hammer.

Unique Tuft Test Facility Dramatically Reduces Brush Seal Development Costs

NASA Technical Reports Server (NTRS)

Fellenstein, James A.

1997-01-01

Brush seals have been incorporated in the latest turbine engines to reduce leakage and improve efficiency. However, the life of these seals is limited by wear. Studies have shown that optimal sealing characteristics for a brush seal occur before the interference fit between the brush and shaft is excessively worn. Research to develop improved tribopairs (brush and coating) with reduced wear and lower friction has been hindered by the lack of an accurate, low-cost, efficient test methodology. Estimated costs for evaluating a new material combination in an engine company seal test program are on the order of $100,000. To address this need, the NASA Lewis Research Center designed, built, and validated a unique, innovative brush seal tuft tester that slides a single tuft of brush seal wire against a rotating shaft under controlled loads, speeds, and temperatures comparable to those in turbine engines. As an initial screening tool, the brush seal tuft tester can tribologicaly evaluate candidate seal materials for 1/10th the cost of full-scale seal tests. Previous to the development of the brush seal tuft tester facility, most relevant tribological data had been obtained from full-scale seal tests conducted primarily to determine seal leakage characteristics. However, from a tribological point of view, these tests included the confounding effects of varying contact pressures, bristle flaring, high-temperature oxidation, and varying bristle contact angles. These confounding effects are overcome in tuft testing. The interface contact pressures can be either constant or varying depending on the tuft mounting device, and bristle wear can be measured optically with inscribed witness marks. In a recent cooperative program with a U.S. turbine engine manufacturer, five metallic wire candidates were tested against a plasma-sprayed Nichrome-bonded chrome carbide. The wire materials used during this collaboration were either nickel-chrome- or cobaltchrome-based superalloys. These tests corroborated full-scale seal test results and provided insight into previously untested combinations. As the cycle temperature for improved efficiency turbine engines increases, new brush seal materials combinations must be considered. Future brush seal tuft testing will include both metallic and ceramic bristles versus commercial and NASA-developed shaft coatings. The ultimate goal of this work is to expand the current data base so that seal designers can tailor brush seal materials to specific applications.

Do adjunct tuberculosis tests, when combined with Xpert MTB/RIF, improve accuracy and the cost of diagnosis in a resource-poor setting?

PubMed Central

Theron, Grant; Pooran, Anil; Peter, Jonny; van Zyl-Smit, Richard; Mishra, Hridesh Kumar; Meldau, Richard; Calligaro, Greg; Allwood, Brian; Sharma, Surendra Kumar; Dawson, Rod; Dheda, Keertan

2017-01-01

Information regarding the utility of adjunct diagnostic tests in combination with Xpert MTB/RIF (Cepheid, Sunnyvale, CA, USA) is limited. We hypothesised adjunct tests could enhance accuracy and/or reduce the cost of tuberculosis (TB) diagnosis prior to MTB/RIF testing, and rule-in or rule-out TB in MTB/RIF-negative individuals. We assessed the accuracy and/or laboratory-associated cost of diagnosis of smear microscopy, chest radiography (CXR) and interferon-γ release assays (IGRAs; T-SPOT-TB (Oxford Immunotec, Oxford, UK) and QuantiFERON-TB Gold In-Tube (Cellestis, Chadstone, Australia)) combined with MTB/RIF for TB in 480 patients in South Africa. When conducted prior to MTB/RIF: 1) smear microscopy followed by MTB/RIF (if smear negative) had the lowest cost of diagnosis of any strategy investigated; 2) a combination of smear microscopy, CXR (if smear negative) and MTB/RIF (if imaging compatible with active TB) did not further reduce the cost per TB case diagnosed; and 3) a normal CXR ruled out TB in 18% of patients (57 out of 324; negative predictive value (NPV) 100%). When downstream adjunct tests were applied to MTB/RIF-negative individuals, radiology ruled out TB in 24% (56 out of 234; NPV 100%), smear microscopy ruled in TB in 21% (seven out of 24) of culture-positive individuals and IGRAs were not useful in either context. In resource-poor settings, smear microscopy combined with MTB/RIF had the highest accuracy and lowest cost of diagnosis compared to either technique alone. In MTB/RIF-negative individuals, CXR has poor rule-in value but can reliably rule out TB in approximately one in four cases. These data inform upon the programmatic utility of MTB/RIF in high-burden settings. PMID:22075479

Update on lifetime tests results and analysis carried out on Thales Cryogenics integral coolers (RM family)

NASA Astrophysics Data System (ADS)

Cauquil, Jean-Marc; Martin, Jean-Yves; Bruins, Peter; Benschop, A. A. J.

2003-01-01

The life time tests realised on the serial production of Rotary Mmonoblock RM2 coolers show a measured MTTF of 4900 hours. The conventional test profile applied to these coolers is representative of operation in typical application. The duration of such life time tests is very long. The results of a design change and its impact on MTTF are available only several months after the assembly of the prototypes. We decided to develop a test method in order to reduce the duration of these life time tests. The principle is to define a test protocol easy to implement, more severe than typical application profile in order to accelerate life time tests. The accelerated test profile was defined and tested successfully. This new technique allows us to reduce life time tests costs and duration and thus the costs involved. As a consequence, we decided to have a screening of our production with this accelerated test. This allows us to master continuously the quality of our serial products and to collect additional data. This paper presents the results of life time tests performed on RM2 coolers according to the conventional and accelerated test profiles as well as the first results on the new RM2 design which show a calculated MTTF of 10000 hours.

Cost-effectiveness of point-of-care C-reactive protein testing to inform antibiotic prescribing decisions

PubMed Central

Oppong, Raymond; Jit, Mark; Smith, Richard D; Butler, Christopher C; Melbye, Hasse; Mölstad, Sigvard; Coast, Joanna

2013-01-01

Background Point-of-care C-reactive protein (POCCRP) is a biomarker of inflammation that offers clinicians a rapid POC test to guide antibiotic prescribing decisions for acute cough and lower respiratory tract infections (LRTI). However, evidence that POCCRP is cost-effective is limited, particularly outside experimental settings. Aim To assess the cost-effectiveness of POCCRP as a diagnostic tool for acute cough and LRTI from the perspective of the health service. Design and setting Observational study of the presentation, management, and outcomes of patients with acute cough and LRTI in primary care settings in Norway and Sweden. Method Using hierarchical regression, data were analysed in terms of the effect on antibiotic use, cost, and patient outcomes (symptom severity after 7 and 14 days, time to recovery, and EQ-5D), while controlling for patient characteristics (self-reported symptom severity, comorbidities, and health-related quality of life) at first attendance. Results POCCRP testing is associated with non-significant positive reductions in antibiotic prescribing (P = 0.078) and increased cost (P = 0.092). Despite the uncertainty, POCCRP testing is also associated with a cost per quality-adjusted life year (QALY) gain of €9391. At a willingness-to-pay threshold of €30 000 per QALY gained, there is a 70% probability of CRP being cost-effective. Conclusion POCCRP testing is likely to provide a cost-effective diagnostic intervention both in terms of reducing antibiotic prescribing and in terms of QALYs gained. PMID:23834883

Varying efficacy of Helicobacter pylori eradication regimens: cost effectiveness study using a decision analysis model.

PubMed

Duggan, A E; Tolley, K; Hawkey, C J; Logan, R F

1998-05-30

To determine how small differences in the efficacy and cost of two antibiotic regimens to eradicate Helicobacter pylori can affect the overall cost effectiveness of H pylori eradication in duodenal ulcer disease. A decision analysis to examine the cost effectiveness of eight H pylori eradication strategies for duodenal ulcer disease with and without 13C-urea breath testing to confirm eradication. Cumulative direct treatment costs per 100 patients with duodenal ulcer disease who were positive for H pylori. In model 1 the strategy of omeprazole, clarithromycin, and metronidazole alone was the most cost effective of the four strategies assessed. The addition of the 13C-urea breath test and a second course of omeprazole, clarithromycin, and metronidazole achieved the highest eradication rate (97%) but was the most expensive (62.63 pounds per patient). The cost of each additional effective eradication was 589.00 pounds (incremental cost per case) when compared with the cost of treating once only with omeprazole, clarithromycin, and metronidazole; equivalent to the cost of a patient receiving ranitidine for duodenal ulcer relapse for more than 15 years. Eradication strategies of omeprazole, amoxycillin, and metronidazole were less cost effective than omeprazole, clarithromycin, and metronidazole alone. In model 2 the addition of the 13C-urea breath test after treatment, and maintenance treatment, increased the cost of all the strategies and reduced the cost advantage of omeprazole, clarithromycin, and metronidazole alone. Small differences in efficacy can influence the comparative cost effectiveness of strategies for eradicating H pylori. Of the strategies tested the most cost effective (omeprazole, clarithromycin, and metronidazole alone) was neither the least expensive (omeprazole, amoxycillin, and metronidazole alone) nor the most effective (omeprazole, clarithromycin, and metronidazole with further treatment for patients found positive for H pylori on 13C-urea breath testing). Cost effectiveness should be an important part of choosing an eradication strategy for H pylori.

National Launch System: Structures and materials

NASA Technical Reports Server (NTRS)

Bunting, Jack O.

1993-01-01

The National Launch System provides an opportunity to realize the potential of Al-Li. Advanced structures can reduce weights by 5-40 percent as well as relax propulsion system performance specifications and reduce requirements for labor and materials. The effect on costs will be substantial. Advanced assembly and process control technologies also offer the potential for greatly reduced labor during the manufacturing and inspection processes. Current practices are very labor-intensive and, as a result, labor costs far outweigh material costs for operational space transportation systems. The technological readiness of new structural materials depends on their commercial availability, producibility and materials properties. Martin Marietta is vigorously pursuing the development of its Weldalite 049 Al-Li alloys in each of these areas. Martin Marietta is also preparing to test an automated work cell concept that it has developed using discrete event simulation.

Cost-effective Diagnostic Checklists for Meningitis in Resource Limited Settings

PubMed Central

Durski, Kara N.; Kuntz, Karen M.; Yasukawa, Kosuke; Virnig, Beth A.; Meya, David B.; Boulware, David R.

2013-01-01

Background Checklists can standardize patient care, reduce errors, and improve health outcomes. For meningitis in resource-limited settings, with high patient loads and limited financial resources, CNS diagnostic algorithms may be useful to guide diagnosis and treatment. However, the cost-effectiveness of such algorithms is unknown. Methods We used decision analysis methodology to evaluate the costs, diagnostic yield, and cost-effectiveness of diagnostic strategies for adults with suspected meningitis in resource limited settings with moderate/high HIV prevalence. We considered three strategies: 1) comprehensive “shotgun” approach of utilizing all routine tests; 2) “stepwise” strategy with tests performed in a specific order with additional TB diagnostics; 3) “minimalist” strategy of sequential ordering of high-yield tests only. Each strategy resulted in one of four meningitis diagnoses: bacterial (4%), cryptococcal (59%), TB (8%), or other (aseptic) meningitis (29%). In model development, we utilized prevalence data from two Ugandan sites and published data on test performance. We validated the strategies with data from Malawi, South Africa, and Zimbabwe. Results The current comprehensive testing strategy resulted in 93.3% correct meningitis diagnoses costing $32.00/patient. A stepwise strategy had 93.8% correct diagnoses costing an average of $9.72/patient, and a minimalist strategy had 91.1% correct diagnoses costing an average of $6.17/patient. The incremental cost effectiveness ratio was $133 per additional correct diagnosis for the stepwise over minimalist strategy. Conclusions Through strategically choosing the order and type of testing coupled with disease prevalence rates, algorithms can deliver more care more efficiently. The algorithms presented herein are generalizable to East Africa and Southern Africa. PMID:23466647

Adaptive function allocation reduces performance costs of static automation

NASA Technical Reports Server (NTRS)

Parasuraman, Raja; Mouloua, Mustapha; Molloy, Robert; Hilburn, Brian

1993-01-01

Adaptive automation offers the option of flexible function allocation between the pilot and on-board computer systems. One of the important claims for the superiority of adaptive over static automation is that such systems do not suffer from some of the drawbacks associated with conventional function allocation. Several experiments designed to test this claim are reported in this article. The efficacy of adaptive function allocation was examined using a laboratory flight-simulation task involving multiple functions of tracking, fuel-management, and systems monitoring. The results show that monitoring inefficiency represents one of the performance costs of static automation. Adaptive function allocation can reduce the performance cost associated with long-term static automation.

Economic evaluation of laboratory testing strategies for hospital-associated Clostridium difficile infection.

PubMed

Schroeder, Lee F; Robilotti, Elizabeth; Peterson, Lance R; Banaei, Niaz; Dowdy, David W

2014-02-01

Clostridium difficile infection (CDI) is the most common cause of infectious diarrhea in health care settings, and for patients presumed to have CDI, their isolation while awaiting laboratory results is costly. Newer rapid tests for CDI may reduce this burden, but the economic consequences of different testing algorithms remain unexplored. We used decision analysis from the hospital perspective to compare multiple CDI testing algorithms for adult inpatients with suspected CDI, assuming patient management according to laboratory results. CDI testing strategies included combinations of on-demand PCR (odPCR), batch PCR, lateral-flow diagnostics, plate-reader enzyme immunoassay, and direct tissue culture cytotoxicity. In the reference scenario, algorithms incorporating rapid testing were cost-effective relative to nonrapid algorithms. For every 10,000 symptomatic adults, relative to a strategy of treating nobody, lateral-flow glutamate dehydrogenase (GDH)/odPCR generated 831 true-positive results and cost $1,600 per additional true-positive case treated. Stand-alone odPCR was more effective and more expensive, identifying 174 additional true-positive cases at $6,900 per additional case treated. All other testing strategies were dominated by (i.e., more costly and less effective than) stand-alone odPCR or odPCR preceded by lateral-flow screening. A cost-benefit analysis (including estimated costs of missed cases) favored stand-alone odPCR in most settings but favored odPCR preceded by lateral-flow testing if a missed CDI case resulted in less than $5,000 of extended hospital stay costs and <2 transmissions, if lateral-flow GDH diagnostic sensitivity was >93%, or if the symptomatic carrier proportion among the toxigenic culture-positive cases was >80%. These results can aid guideline developers and laboratory directors who are considering rapid testing algorithms for diagnosing CDI.

Economic Evaluation of Laboratory Testing Strategies for Hospital-Associated Clostridium difficile Infection

PubMed Central

Robilotti, Elizabeth; Peterson, Lance R.; Banaei, Niaz; Dowdy, David W.

2014-01-01

Clostridium difficile infection (CDI) is the most common cause of infectious diarrhea in health care settings, and for patients presumed to have CDI, their isolation while awaiting laboratory results is costly. Newer rapid tests for CDI may reduce this burden, but the economic consequences of different testing algorithms remain unexplored. We used decision analysis from the hospital perspective to compare multiple CDI testing algorithms for adult inpatients with suspected CDI, assuming patient management according to laboratory results. CDI testing strategies included combinations of on-demand PCR (odPCR), batch PCR, lateral-flow diagnostics, plate-reader enzyme immunoassay, and direct tissue culture cytotoxicity. In the reference scenario, algorithms incorporating rapid testing were cost-effective relative to nonrapid algorithms. For every 10,000 symptomatic adults, relative to a strategy of treating nobody, lateral-flow glutamate dehydrogenase (GDH)/odPCR generated 831 true-positive results and cost $1,600 per additional true-positive case treated. Stand-alone odPCR was more effective and more expensive, identifying 174 additional true-positive cases at $6,900 per additional case treated. All other testing strategies were dominated by (i.e., more costly and less effective than) stand-alone odPCR or odPCR preceded by lateral-flow screening. A cost-benefit analysis (including estimated costs of missed cases) favored stand-alone odPCR in most settings but favored odPCR preceded by lateral-flow testing if a missed CDI case resulted in less than $5,000 of extended hospital stay costs and <2 transmissions, if lateral-flow GDH diagnostic sensitivity was >93%, or if the symptomatic carrier proportion among the toxigenic culture-positive cases was >80%. These results can aid guideline developers and laboratory directors who are considering rapid testing algorithms for diagnosing CDI. PMID:24478478

Cost-effectiveness of HIV and syphilis antenatal screening: a modeling study

PubMed Central

Bristow, Claire C.; Larson, Elysia; Anderson, Laura J.; Klausner, Jeffrey D.

2016-01-01

Objectives The World Health Organization called for the elimination of maternal-to-child transmission (MTCT) of HIV and syphilis, a harmonized approach for the improvement of health outcomes for mothers and children. Testing early in pregnancy, treating seropositive pregnant women, and preventing syphilis re-infection can prevent MTCT of HIV and syphilis. We assessed the health and economic outcomes of a dual testing strategy in a simulated cohort of 100,000 antenatal care patients in Malawi. Methods We compared four screening algorithms: (1) HIV rapid test only, (2) dual HIV and syphilis rapid tests, (3) single rapid tests for HIV and syphilis, and (4) HIV rapid and syphilis laboratory tests. We calculated the expected number of adverse pregnancy outcomes, the expected costs, and the expected newborn disability adjusted life years (DALYs) for each screening algorithm. The estimated costs and DALYs for each screening algorithm were assessed from a societal perspective using Markov progression models. Additionally, we conducted a Monte Carlo multi-way sensitivity analysis, allowing for ranges of inputs. Results Our cohort decision model predicted the lowest number of adverse pregnancy outcomes in the dual HIV and syphilis rapid test strategy. Additionally, from the societal perspective, the costs of prevention and care using a dual HIV and syphilis rapid testing strategy was both the least costly ($226.92 per pregnancy) and resulted in the fewest DALYs (116,639) per 100,000 pregnancies. In the Monte Carlo simulation the dual HIV and syphilis algorithm was always cost saving and almost always reduced disability adjusted life years (DALYs) compared to HIV testing alone. Conclusion The results of the cost-effectiveness analysis showed that a dual HIV and syphilis test was cost saving compared to all other screening strategies. Adding dual rapid testing to the existing prevention of mother-to-child HIV transmission programs in Malawi and similar countries is likely to be advantageous. PMID:26920867

The Role of Demand Response in Reducing Water-Related Power Plant Vulnerabilities

NASA Astrophysics Data System (ADS)

Macknick, J.; Brinkman, G.; Zhou, E.; O'Connell, M.; Newmark, R. L.; Miara, A.; Cohen, S. M.

2015-12-01

The electric sector depends on readily available water supplies for reliable and efficient operation. Elevated water temperatures or low water levels can trigger regulatory or plant-level decisions to curtail power generation, which can affect system cost and reliability. In the past decade, dozens of power plants in the U.S. have curtailed generation due to water temperatures and water shortages. Curtailments occur during the summer, when temperatures are highest and there is greatest demand for electricity. Climate change could alter the availability and temperature of water resources, exacerbating these issues. Constructing alternative cooling systems to address vulnerabilities can be capital intensive and can also affect power plant efficiencies. Demand response programs are being implemented by electric system planners and operators to reduce and shift electricity demands from peak usage periods to other times of the day. Demand response programs can also play a role in reducing water-related power sector vulnerabilities during summer months. Traditionally, production cost modeling and demand response analyses do not include water resources. In this effort, we integrate an electricity production cost modeling framework with water-related impacts on power plants in a test system to evaluate the impacts of demand response measures on power system costs and reliability. Specifically, we i) quantify the cost and reliability implications of incorporating water resources into production cost modeling, ii) evaluate the impacts of demand response measures on reducing system costs and vulnerabilities, and iii) consider sensitivity analyses with cooling systems to highlight a range of potential benefits of demand response measures. Impacts from climate change on power plant performance and water resources are discussed. Results provide key insights to policymakers and practitioners for reducing water-related power plant vulnerabilities via lower cost methods.

The Epidemiologic and Economic Impact of Improving HIV Testing, Linkage, and Retention in Care in the United States.

PubMed

Shah, Maunank; Risher, Kathryn; Berry, Stephen A; Dowdy, David W

2016-01-15

Recent guidelines advocate early antiretroviral therapy (ART) to decrease human immunodeficiency virus (HIV) morbidity and prevent transmission, but suboptimal engagement in care may compromise impact. We sought to determine the economic and epidemiologic impact of incomplete engagement in HIV care in the United States. We constructed a dynamic transmission model of HIV among US adults (aged 15-65 years) and conducted a cost-effectiveness analysis of improvements along the HIV care continuum : We evaluated enhanced HIV testing (annual for high-risk groups), increased 3-month linkage to care (to 90%), and improved retention (50% relative reduction in yearly disengagement and 50% increase in reengagement). Our primary outcomes were HIV incidence, mortality, costs and quality-adjusted life-years (QALYs). Despite early ART initiation, a projected 1.39 million (95% uncertainty range [UR], 0.91-2.2 million) new HIV infections will occur at a (discounted) cost of $256 billion ($199-298 billion) over 2 decades at existing levels of HIV care engagement. Enhanced testing with increased linkage has modest epidemiologic benefits and could reduce incident HIV infections by 21% (95% UR, 13%-26%) at a cost of $65 700 per QALY gained ($44 500-111 000). By contrast, comprehensive improvements that couples enhanced testing and linkage with improved retention would reduce HIV incidence by 54% (95% UR, 37%-68%) and mortality rate by 64% (46%-78%), at a cost-effectiveness ratio of $45 300 per QALY gained ($27 800-72 300). Failure to improve engagement in HIV care in the United States leads to excess infections, treatment costs, and deaths. Interventions that improve not just HIV screening but also retention in care are needed to optimize epidemiologic impact and cost-effectiveness. © The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

Greater Real-Life Diagnostic Efficacy of Allergen Molecule-Based Diagnosis for Prescription of Immunotherapy in an Area with Multiple Pollen Exposure

PubMed Central

Saltabayeva, Ulbosin; Garib, Victoria; Morenko, Marina; Rosenson, Rafail; Ispayeva, Zhanat; Gatauova, Madina; Zulus, Loreta; Karaulov, Alexander; Gastager, Felix; Valenta, Rudolf

2017-01-01

Background Allergen molecule-based diagnosis has been suggested to facilitate the identification of disease-causing allergen sources and the prescription of allergen-specific immunotherapy (AIT). The aim of the current study was to compare allergen molecule-based IgE serology with allergen extract-based skin testing for the identification of the disease-causing allergen sources. The study was conducted in an area where patients are exposed to pollen from multiple sources (trees, grasses, and weeds) at the same time to compare the diagnostic efficiency of the 2 forms of diagnosis. Methods Patients from Astana, Kazakhstan, who suffered from pollen-induced allergy (n = 95) were subjected to skin prick testing (SPT) with a local panel of tree pollen, grass pollen, and weed pollen allergen extracts and IgE antibodies specific for marker allergen molecules (nArt v 1, nArt v 3, rAmb a 1, rPhl p 1, rPhl p 5, rBet v 1) were measured by ImmunoCAP. Direct and indirect costs for diagnosis based on SPT and marker allergen-based IgE serology as well as direct costs for immunotherapy depending on SPT and serological test results were calculated. Results The costs for SPT-based diagnosis per patient were lower than the costs for allergen molecule-based IgE serology. However, allergen molecule-based serology was more precise in detecting the disease-causing allergen sources. A lower number of immunotherapy treatments (n = 119) was needed according to molecular diagnosis as compared to extract-based diagnosis (n = 275), which considerably reduced the total costs for diagnosis and for a 3-year treatment from EUR 1,112.30 to 521.77 per patient. Conclusions The results from this real-life study show that SPT is less expensive than allergen molecule-based diagnostic testing, but molecular diagnosis allowed more precise prescription of immunotherapy which substantially reduced treatment costs and combined costs for diagnosis and treatment. PMID:28654920

The Epidemiologic and Economic Impact of Improving HIV Testing, Linkage, and Retention in Care in the United States

PubMed Central

Shah, Maunank; Risher, Kathryn; Berry, Stephen A.; Dowdy, David W.

2016-01-01

Background. Recent guidelines advocate early antiretroviral therapy (ART) to decrease human immunodeficiency virus (HIV) morbidity and prevent transmission, but suboptimal engagement in care may compromise impact. We sought to determine the economic and epidemiologic impact of incomplete engagement in HIV care in the United States. Methods. We constructed a dynamic transmission model of HIV among US adults (aged 15–65 years) and conducted a cost-effectiveness analysis of improvements along the HIV care continuum. We evaluated enhanced HIV testing (annual for high-risk groups), increased 3-month linkage to care (to 90%), and improved retention (50% relative reduction in yearly disengagement and 50% increase in reengagement). Our primary outcomes were HIV incidence, mortality, costs and quality-adjusted life-years (QALYs). Results. Despite early ART initiation, a projected 1.39 million (95% uncertainty range [UR], 0.91–2.2 million) new HIV infections will occur at a (discounted) cost of $256 billion ($199–298 billion) over 2 decades at existing levels of HIV care engagement. Enhanced testing with increased linkage has modest epidemiologic benefits and could reduce incident HIV infections by 21% (95% UR, 13%–26%) at a cost of $65 700 per QALY gained ($44 500–111 000). By contrast, comprehensive improvements that couples enhanced testing and linkage with improved retention would reduce HIV incidence by 54% (95% UR, 37%–68%) and mortality rate by 64% (46%–78%), at a cost-effectiveness ratio of $45 300 per QALY gained ($27 800–72 300). Conclusions. Failure to improve engagement in HIV care in the United States leads to excess infections, treatment costs, and deaths. Interventions that improve not just HIV screening but also retention in care are needed to optimize epidemiologic impact and cost-effectiveness. PMID:26362321

Operational feasibility of using whole blood in the rapid HIV testing algorithm of a resource-limited settings like Bangladesh.

PubMed

Munshi, Saif U; Oyewale, Tajudeen O; Begum, Shahnaz; Uddin, Ziya; Tabassum, Shahina

2016-03-01

Serum-based rapid HIV testing algorithm in Bangladesh constitutes operational challenge to scaleup HIV testing and counselling (HTC) in the country. This study explored the operational feasibility of using whole blood as alternative to serum for rapid HIV testing in Bangladesh. Whole blood specimens were collected from two study groups. The groups included HIV-positive patients (n = 200) and HIV-negative individuals (n = 200) presenting at the reference laboratory in Dhaka, Bangladesh. The specimens were subjected to rapid HIV tests using the national algorithm with A1 = Alere Determine (United States), A2 = Uni-Gold (Ireland), and A3 = First Response (India). The sensitivity and specificity of the test results, and the operational cost were compared with current serum-based testing. The sensitivities [95% of confidence interval (CI)] for A1, A2, and A3 tests using whole blood were 100% (CI: 99.1-100%), 100% (CI: 99.1-100%), and 97% (CI: 96.4-98.2%), respectively, and specificities of all test kits were 100% (CI: 99.1-100%). Significant (P < 0.05) reduction in the cost of establishing HTC centre and consumables by 94 and 61%, respectively, were observed. The cost of administration and external quality assurance reduced by 39 and 43%, respectively. Overall, there was a 36% cost reduction in total operational cost of rapid HIV testing with blood when compared with serum. Considering the similar sensitivity and specificity of the two specimens, and significant cost reduction, rapid HIV testing with whole blood is feasible. A review of the national HIV rapid testing algorithm with whole blood will contribute toward improving HTC coverage in Bangladesh.

The costs of accessible quality assured syphilis diagnostics: informing quality systems for rapid syphilis tests in a Tanzanian setting.

PubMed

Sweeney, Sedona; Mosha, Jacklin F; Terris-Prestholt, Fern; Sollis, Kimberly A; Kelly, Helen; Changalucha, John; Peeling, Rosanna W

2014-08-01

To determine the costs of Rapid Syphilis Test (RSTs) as compared with rapid plasma reagin (RPR) when implemented in a Tanzanian setting, and to determine the relative impact of a quality assurance (QA) system on the cost of RST implementation. The incremental costs for RPR and RST screening programmes in existing antenatal care settings in Geita District, Tanzania were collected for 9 months in subsequent years from nine health facilities that varied in size, remoteness and scope of antenatal services. The costs per woman tested and treated were estimated for each facility. A sensitivity analysis was constructed to determine the impact of parameter and model uncertainty. In surveyed facilities, a total of 6362 women were tested with RSTs compared with 224 tested with RPR. The range of unit costs was $1.76-$3.13 per woman screened and $12.88-$32.67 per woman treated. Unit costs for the QA system came to $0.51 per woman tested, of which 50% were attributed to salaries and transport for project personnel. Our results suggest that rapid syphilis diagnostics are very inexpensive in this setting and can overcome some critical barriers to ensuring universal access to syphilis testing and treatment. The additional costs for implementation of a quality system were found to be relatively small, and could be reduced through alterations to the programme design. Given the potential for a quality system to improve quality of diagnosis and care, we recommend that QA activities be incorporated into RST roll-out. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

Contamination Sources Effects Analysis (CSEA) - A Tool to Balance Cost/Schedule While Managing Facility Availability

NASA Technical Reports Server (NTRS)

Wilcox, Margaret

2008-01-01

A CSEA is similar to a Failure Modes Effects Analysis (FMEA). A CSEA tracks risk, deterrence, and occurrence of sources of contamination and their mitigation plans. Documentation is provided spanning mechanical and electrical assembly, precision cleaning, thermal vacuum bake-out, and thermal vacuum testing. These facilities all may play a role in contamination budgeting and reduction ultimately affecting test and flight. With a CSEA, visibility can be given to availability of these facilities, test sequencing and trade-offs. A cross-functional team including specialty engineering, contamination control, electrostatic dissipation, manufacturing, testing, and material engineering participate in an exercise that identifies contaminants and minimizes the complexity of scheduling these facilities considering their volatile schedules. Care can be taken in an efficient manner to insure correct cleaning processes are employed. The result is reduction in cycle time ("schedule hits"), reduced cost due to rework, reduced risk and improved communication and quality while achieving adherence to the Contamination Control Plan.

Costs of genetic testing: Supporting Brazilian Public Policies for the incorporating of molecular diagnostic technologies

PubMed Central

Schlatter, Rosane Paixão; Matte, Ursula; Polanczyk, Carisi Anne; Koehler-Santos, Patrícia; Ashton-Prolla, Patricia

2015-01-01

This study identifies and describes the operating costs associated with the molecular diagnosis of diseases, such as hereditary cancer. To approximate the costs associated with these tests, data informed by Standard Operating Procedures for various techniques was collected from hospital software and a survey of market prices. Costs were established for four scenarios of capacity utilization to represent the possibility of suboptimal use in research laboratories. Cost description was based on a single site. The results show that only one technique was not impacted by rising costs due to underutilized capacity. Several common techniques were considerably more expensive at 30% capacity, including polymerase chain reaction (180%), microsatellite instability analysis (181%), gene rearrangement analysis by multiplex ligation probe amplification (412%), non-labeled sequencing (173%), and quantitation of nucleic acids (169%). These findings should be relevant for the definition of public policies and suggest that investment of public funds in the establishment of centralized diagnostic research centers would reduce costs to the Public Health System. PMID:26500437

A simplified fuel control approach for low cost aircraft gas turbines

NASA Technical Reports Server (NTRS)

Gold, H.

1973-01-01

Reduction in the complexity of gas turbine fuel controls without loss of control accuracy, reliability, or effectiveness as a method for reducing engine costs is discussed. A description and analysis of hydromechanical approach are presented. A computer simulation of the control mechanism is given and performance of a physical model in engine test is reported.

Direct Verification of School Meal Applications with Medicaid Data: A Pilot Evaluation of Feasibility, Effectiveness and Costs

ERIC Educational Resources Information Center

Logan, Christopher W.; Cole, Nancy; Kamara, Sheku G.

2010-01-01

Purpose/Objectives: The Direct Verification Pilot tested the feasibility, effectiveness, and costs of using Medicaid and State Children's Health Insurance Program (SCHIP) data to verify applications for free and reduced-price (FRP) school meals instead of obtaining documentation from parents and guardians. Methods: The Direct Verification Pilot…

Reducing electrocoagulation harvesting costs for practical microalgal biodiesel production.

PubMed

Dassey, Adam J; Theegala, Chandra S

2014-01-01

Electrocoagulation has shown potential to be a primary microalgae harvesting technique for biodiesel production. However, methods to reduce energy and electrode costs are still necessary for practical application. Electrocoagulation tests were conducted on Nannochloris sp. and Dunaliella sp. using perforated aluminium and iron electrodes under various charge densities. Aluminium electrodes were shown to be more efficient than iron electrodes when harvesting both algal species. Despite the lower harvesting efficiency, however, the iron electrodes were more energy and cost efficient. Operational costs of less than $0.03/L oil were achieved when harvesting Nannochloris sp. with iron electrodes at 35% harvest efficiency, whereas aluminium electrodes cost $0.75/L oil with 42% harvesting efficiency. Increasing the harvesting efficiencies for both aluminium and iron electrodes also increased the overall cost per litre of oil, therefore lower harvesting efficiencies with lower energy inputs was recommended. Also, increasing the culturing salinity to 2 ppt sodium chloride for freshwater Nannochloris sp. was determined practical to improve the electrocoagulation energy efficiency despite a 25% reduction in cell growth.

Reducing duplicate testing: a comparison of two clinical decision support tools.

PubMed

Procop, Gary W; Keating, Catherine; Stagno, Paul; Kottke-Marchant, Kandice; Partin, Mary; Tuttle, Robert; Wyllie, Robert

2015-05-01

Unnecessary duplicate laboratory testing is common and costly. Systems-based means to avert unnecessary testing should be investigated and employed. We compared the effectiveness and cost savings associated with two clinical decision support tools to stop duplicate testing. The Hard Stop required telephone contact with the laboratory and justification to have the duplicate test performed, whereas the Smart Alert allowed the provider to bypass the alert at the point of order entry without justification. The Hard Stop alert was significantly more effective than the Smart Alert (92.3% vs 42.6%, respectively; P < .0001). The cost savings realized per alert activation was $16.08/alert for the Hard Stop alert vs $3.52/alert for the Smart Alert. Structural and process changes that require laboratory contact and justification for duplicate testing are more effective than interventions that allow providers to bypass alerts without justification at point of computerized physician order entry. Copyright© by the American Society for Clinical Pathology.

Field tests on biochar to reduce emissions from soil fumigation

USDA-ARS?s Scientific Manuscript database

Soil fumigation continues to be one of the most important strategies for pest management in orchards. Although low permeability tarp such as totally impermeable film (TIF) has shown to be the most effective in reducing fumigant emissions, costs are high and tarp disposal is needed after use. The obj...

A Comparison of Machine Learning Algorithms for Chemical Toxicity Classification Using a Simulated Multi-Scale Data Model

EPA Science Inventory

Bioactivity profiling using high-throughput in vitro assays can reduce the cost and time required for toxicological screening of environmental chemicals and can also reduce the need for animal testing. Several public efforts are aimed at discovering patterns or classifiers in hig...

Final Report: The Influence of Novel Behavioral Strategies in Promoting the Diffusion of Solar Energy

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

Gillingham, Kenneth; Bollinger, Bryan

This is the final report for a systematic, evidence-based project using an unprecedented series of large-scale field experiments to examine the effectiveness and cost-effectiveness of novel approaches to reduce the soft costs of solar residential photovoltaics. The approaches were based around grassroots marketing campaigns called ‘Solarize’ campaigns, that were designed to lower costs and increase adoption of solar technology. This study quantified the effectiveness and cost-effectiveness of the Solarize programs and tested new approaches to further improve the model.

High-throughput and automated diagnosis of antimicrobial resistance using a cost-effective cellphone-based micro-plate reader

NASA Astrophysics Data System (ADS)

Feng, Steve; Tseng, Derek; di Carlo, Dino; Garner, Omai B.; Ozcan, Aydogan

2016-12-01

Routine antimicrobial susceptibility testing (AST) can prevent deaths due to bacteria and reduce the spread of multi-drug-resistance, but cannot be regularly performed in resource-limited-settings due to technological challenges, high-costs, and lack of trained professionals. We demonstrate an automated and cost-effective cellphone-based 96-well microtiter-plate (MTP) reader, capable of performing AST without the need for trained diagnosticians. Our system includes a 3D-printed smartphone attachment that holds and illuminates the MTP using a light-emitting-diode array. An inexpensive optical fiber-array enables the capture of the transmitted light of each well through the smartphone camera. A custom-designed application sends the captured image to a server to automatically determine well-turbidity, with results returned to the smartphone in ~1 minute. We tested this mobile-reader using MTPs prepared with 17 antibiotics targeting Gram-negative bacteria on clinical isolates of Klebsiella pneumoniae, containing highly-resistant antimicrobial profiles. Using 78 patient isolate test-plates, we demonstrated that our mobile-reader meets the FDA-defined AST criteria, with a well-turbidity detection accuracy of 98.21%, minimum-inhibitory-concentration accuracy of 95.12%, and a drug-susceptibility interpretation accuracy of 99.23%, with no very major errors. This mobile-reader could eliminate the need for trained diagnosticians to perform AST, reduce the cost-barrier for routine testing, and assist in spatio-temporal tracking of bacterial resistance.

Emergency medicine versus primary care: a case study of three prevalent, costly, and non-emergent diagnoses at a community teaching hospital.

PubMed

Martin, B C

2000-01-01

The high cost of emergency department (ED) care is often viewed as an area for achieving cost savings through reduced utilization for inappropriate conditions. The implementation of outpatient prospective payment for Medicare ED patients heightens scrutiny of costs and utilization in the ED versus primary care settings. Data from hospital clinical records, financial records, and a provider survey was used to develop a costing methodology and complete a comparative analysis of the cost of care for three diagnoses by setting. Total costs were significantly higher in the ED due primarily to differences in ancillary tests and prescription drugs ordered.

Alternative to Nitric Acid for Passivation of Stainless Steel Alloys

NASA Technical Reports Server (NTRS)

Lewis, Pattie L.; Kolody, Mark; Curran, Jerry

2013-01-01

Corrosion is an extensive problem that affects the Department of Defense (DoD) and National Aeronautics and Space Administration (NASA). The deleterious effects of corrosion result in steep costs, asset downtime affecting mission readiness, and safety risks to personnel. Consequently, it is vital to reduce corrosion costs and risks in a sustainable manner. The DoD and NASA have numerous structures and equipment that are fabricated from stainless steel. The standard practice for protection of stainless steel is a process called passivation. Typical passivation procedures call for the use of nitric acid; however, there are a number of environmental, worker safety, and operational issues associated with its use. Citric acid offers a variety of benefits including increased safety for personnel, reduced environmental impact, and reduced operational cost. DoD and NASA agreed to collaborate to validate citric acid as an acceptable passivating agent for stainless steel. This paper details our investigation of prior work developing the citric acid passivation process, development of the test plan, optimization of the process for specific stainless steel alloys, ongoing and planned testing to elucidate the process' resistance to corrosion in comparison to nitric acid, and preliminary results.

Costs of testing for ocular Chlamydia trachomatis infection compared to mass drug administration for trachoma in the Gambia: application of results from the PRET study.

PubMed

Harding-Esch, Emma; Jofre-Bonet, Mireia; Dhanjal, Jaskiran K; Burr, Sarah; Edwards, Tansy; Holland, Martin; Sillah, Ansumana; West, Sheila; Lietman, Tom; Keenan, Jeremy; Mabey, David; Bailey, Robin

2015-04-01

Mass drug administration (MDA) treatment of active trachoma with antibiotic is recommended to be initiated in any district where the prevalence of trachoma inflammation, follicular (TF) is ≥ 10% in children aged 1-9 years, and then to continue for at least three annual rounds before resurvey. In The Gambia the PRET study found that discontinuing MDA based on testing a sample of children for ocular Chlamydia trachomatis(Ct) infection after one MDA round had similar effects to continuing MDA for three rounds. Moreover, one round of MDA reduced disease below the 5% TF threshold. We compared the costs of examining a sample of children for TF, and of testing them for Ct, with those of MDA rounds. The implementation unit in PRET The Gambia was a census enumeration area (EA) of 600-800 people. Personnel, fuel, equipment, consumables, data entry and supervision costs were collected for census and treatment of a sample of EAs and for the examination, sampling and testing for Ct infection of 100 individuals within them. Programme costs and resource savings from testing and treatment strategies were inferred for the 102 EAs in the study area, and compared. Census costs were $103.24 per EA plus initial costs of $108.79. MDA with donated azithromycin cost $227.23 per EA. The mean cost of examining and testing 100 children was $796.90 per EA, with Ct testing kits costing $4.80 per result. A strategy of testing each EA for infection is more expensive than two annual rounds of MDA unless the kit cost is less than $1.38 per result. However stopping or deciding not to initiate treatment in the study area based on testing a sample of EAs for Ct infection (or examining children in a sample of EAs) creates savings relative to further unnecessary treatments. Resources may be saved by using tests for chlamydial infection or clinical examination to determine that initial or subsequent rounds of MDA for trachoma are unnecessary.

Costs of Testing for Ocular Chlamydia trachomatis Infection Compared to Mass Drug Administration for Trachoma in The Gambia: Application of Results from the PRET Study

PubMed Central

Harding-Esch, Emma; Jofre-Bonet, Mireia; Dhanjal, Jaskiran K.; Burr, Sarah; Edwards, Tansy; Holland, Martin; Sillah, Ansumana; West, Sheila; Lietman, Tom; Keenan, Jeremy; Mabey, David; Bailey, Robin

2015-01-01

Background Mass drug administration (MDA) treatment of active trachoma with antibiotic is recommended to be initiated in any district where the prevalence of trachoma inflammation, follicular (TF) is ≥10% in children aged 1–9 years, and then to continue for at least three annual rounds before resurvey. In The Gambia the PRET study found that discontinuing MDA based on testing a sample of children for ocular Chlamydia trachomatis(Ct) infection after one MDA round had similar effects to continuing MDA for three rounds. Moreover, one round of MDA reduced disease below the 5% TF threshold. We compared the costs of examining a sample of children for TF, and of testing them for Ct, with those of MDA rounds. Methods The implementation unit in PRET The Gambia was a census enumeration area (EA) of 600–800 people. Personnel, fuel, equipment, consumables, data entry and supervision costs were collected for census and treatment of a sample of EAs and for the examination, sampling and testing for Ct infection of 100 individuals within them. Programme costs and resource savings from testing and treatment strategies were inferred for the 102 EAs in the study area, and compared. Results Census costs were $103.24 per EA plus initial costs of $108.79. MDA with donated azithromycin cost $227.23 per EA. The mean cost of examining and testing 100 children was $796.90 per EA, with Ct testing kits costing $4.80 per result. A strategy of testing each EA for infection is more expensive than two annual rounds of MDA unless the kit cost is less than $1.38 per result. However stopping or deciding not to initiate treatment in the study area based on testing a sample of EAs for Ct infection (or examining children in a sample of EAs) creates savings relative to further unnecessary treatments. Conclusion Resources may be saved by using tests for chlamydial infection or clinical examination to determine that initial or subsequent rounds of MDA for trachoma are unnecessary. PMID:25901349

The impact on accuracy and cost of ligase chain reaction testing by pooling urine specimens for the diagnosis of Chlamydia trachomatis infections.

PubMed

Krepel, J; Patel, J; Sproston, A; Hopkins, F; Jang, D; Mahony, J; Chernesky, M

1999-10-01

Nucleic acid amplification testing is the most accurate approach to diagnosing Chlamydia trachomatis infections. Our objective was to compare the accuracy and cost savings of pooling urines as opposed to individual testing. Strategies of pooling urine specimens into groups of four (4x pool) or eight (8x pool) followed by testing the positive pools individually were compared to individual specimen testing to determine if significant cost savingS could be realized without compromising the sensitivity and specificity of the LCx C. trachomatis Assay (Abbott Laboratories, Abbott Park, Chicago, IL) performed in a busy private medical laboratory. A total of 1,220 patient urine samples, 1,187 male (97%) and 33 female (3%), were tested using the normal LCx specimen to cutoff ratio (S/CO) of 1.0 and a decreased S/CO value of 0.2. Individual testing identified 98.2% (109/111) of positive urines. The 4x pooling maneuver identified 92.8% (103/111) of positive patients with the regular cutoff and 96.4% (107/111) when the cutoff was decreased. These values were 95.9% (47/49) and 97.9% (48/49), respectively, when eight urines were pooled. Both pooling and individual testing strategies identified all the negative samples accurately. Cost savings of pooling were calculated to be 44.5% for pools of four and 37.5% for pools of eight, applying the lowered cutoff. Pooling urine specimens for testing with the C. trachomatis LCx system is a simple, accurate, and cost-saving approach that can significantly reduce the cost of amplified nucleic acid testing with minimal sacrifice of testing accuracy.

Are there financial savings associated with supplementing current diagnostic practice for preeclampsia with a novel test? Learnings from a modeling analysis from a German payer perspective.

PubMed

Hadker, Nandini; Garg, Suchita; Costanzo, Cory; van der Helm, Wim; Creeden, James

2013-05-01

To quantify the financial impact of adding a novel serum test to the current diagnostic toolkit for preeclampsia (PE) detection in Germany. A decision-analytic model was created to quantify the economic impact of adding a recently developed novel diagnostic test for PE (Roche Diagnostics, Rotkreuz, Switzerland) to current diagnostic practice in Germany. The model simulated a cohort of 1000 pregnant patients receiving obstetric care and quantified the budget impact of adding the novel test to current German PE detection and management practices. The model estimates that the costs associated with managing a typical pregnancy in Germany are €941 when the novel test is used versus €1579 with standard practice. This represents savings of €637 per pregnant woman, even when the test is used as a supplementary diagnostic tool. The savings are attributed to the novel test's ability to better classify patients relative to current practice, specifically, its ability to reduce false negatives by 67% and false positives by 71%. The novel PE test has the potential to provide substantial cost savings to German healthcare payers, even when used as an addition to standard practice. Better classification of patients at risk for developing PE and declassification of those that are not compared to current practice leads to economic savings for the healthcare system. Furthermore, by reducing the rates of false-positive and false-negative classification relative to current standard of care, the test helps better target healthcare spending and lowers overall costs associated with PE care.

Multicenter, randomized trial of quantitative pretest probability to reduce unnecessary medical radiation exposure in emergency department patients with chest pain and dyspnea.

PubMed

Kline, Jeffrey A; Jones, Alan E; Shapiro, Nathan I; Hernandez, Jackeline; Hogg, Melanie M; Troyer, Jennifer; Nelson, R Darrel

2014-01-01

Use of pretest probability can reduce unnecessary testing. We hypothesize that quantitative pretest probability, linked to evidence-based management strategies, can reduce unnecessary radiation exposure and cost in low-risk patients with symptoms suggestive of acute coronary syndrome and pulmonary embolism. This was a prospective, 4-center, randomized controlled trial of decision support effectiveness. Subjects were adults with chest pain and dyspnea, nondiagnostic ECGs, and no obvious diagnosis. The clinician provided data needed to compute pretest probabilities from a Web-based system. Clinicians randomized to the intervention group received the pretest probability estimates for both acute coronary syndrome and pulmonary embolism and suggested clinical actions designed to lower radiation exposure and cost. The control group received nothing. Patients were followed for 90 days. The primary outcome and sample size of 550 was predicated on a significant reduction in the proportion of healthy patients exposed to >5 mSv chest radiation. A total of 550 patients were randomized, and 541 had complete data. The proportion with >5 mSv to the chest and no significant cardiopulmonary diagnosis within 90 days was reduced from 33% to 25% (P=0.038). The intervention group had significantly lower median chest radiation exposure (0.06 versus 0.34 mSv; P=0.037, Mann-Whitney U test) and lower median costs ($934 versus $1275; P=0.018) for medical care. Adverse events occurred in 16% of controls and 11% in the intervention group (P=0.06). Provision of pretest probability and prescriptive advice reduced radiation exposure and cost of care in low-risk ambulatory patients with symptoms of acute coronary syndrome and pulmonary embolism. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01059500.

Optimal screening and donor management in a public stool bank.

PubMed

Kazerouni, Abbas; Burgess, James; Burns, Laura J; Wein, Lawrence M

2015-12-17

Fecal microbiota transplantation is an effective treatment for recurrent Clostridium difficile infection and is being investigated as a treatment for other microbiota-associated diseases. To facilitate these activities, an international public stool bank has been created, which screens donors and processes stools in a standardized manner. The goal of this research is to use mathematical modeling and analysis to optimize screening and donor management at the stool bank. Compared to the current policy of screening active donors every 60 days before releasing their quarantined stools for sale, costs can be reduced by 10.3 % by increasing the screening frequency to every 36 days. In addition, the stool production rate varies widely across donors, and using donor-specific screening, where higher producers are screened more frequently, also reduces costs, as does introducing an interim (i.e., between consecutive regular tests) stool test for just rotavirus and C. difficile. We also derive a donor release (i.e., into the system) policy that allows the supply to approximately match an exponentially increasing deterministic demand. More frequent screening, interim screening for rotavirus and C. difficile, and donor-specific screening, where higher stool producers are screened more frequently, are all cost-reducing measures. If screening costs decrease in the future (e.g., as a result of bringing screening in house), a bottleneck for implementing some of these recommendations may be the reluctance of donors to undergo serum screening more frequently than monthly.

Acceleration Testing: A Better, Faster, Cheaper Alternative for Strength Qualification Testing

NASA Technical Reports Server (NTRS)

Mattiello, Carmine F.

1997-01-01

This paper addresses the advantages of utilizing a centrifuge test over the conventional static load test methods to structurally qualify aerospace structures. Three recent test cases are reviewed and used as examples to highlight these benefits. In addition, the overall capability of Goddard's High Capacity Centrifuge (HCC) is outlined along with some unique features that were designed specifically to reduce costs, test turn around time, and increase test item safety.

Comparing Costs of Traditional and Specialty Probation for People With Serious Mental Illness.

PubMed

Skeem, Jennifer L; Montoya, Lina; Manchak, Sarah M

2018-05-15

Specialty mental health probation reduces the likelihood of rearrest for people with mental illness, who are overrepresented in the justice system. This study tested whether specialty probation was associated with lower costs than traditional probation during the two years after placement in probation. A longitudinal, matched study compared costs of behavioral health care and criminal justice contacts among 359 probationers with mental illness at prototypic specialty or traditional agencies. Compared with traditional officers, specialty officers supervised smaller caseloads, established better relationships with supervisees, and participated more in treatment. Participants and officers were interviewed, and administrative databases were integrated to capture service use and criminal justice contacts. Unit costs were attached to these data to estimate costs incurred by each participant over two years. Cost differences were estimated by using machine-learning algorithms combined with targeted maximum-likelihood estimation (TMLE), a double-robust estimator that accounts for associations between confounders and both treatment assignment and outcomes. Specialty probation cost $11,826 (p<.001) less per participant than traditional probation, with overall savings of about 51%. Specialty and traditional probation did not differ in criminal justice costs because the additional costs for supervision of specialty caseloads were offset by reduced recidivism. However, for behavioral health care, specialty probation cost an estimated $14,049 (p<.001) less per client than traditional probation. Greater outpatient costs were more than offset by reduced emergency, inpatient, and residential costs. Well-implemented specialty probation yielded substantial savings-and should be considered in justice reform efforts for people with mental illness.

Reliability Study of Solder Paste Alloy for the Improvement of Solder Joint at Surface Mount Fine-Pitch Components.

PubMed

Rahman, Mohd Nizam Ab; Zubir, Noor Suhana Mohd; Leuveano, Raden Achmad Chairdino; Ghani, Jaharah A; Mahmood, Wan Mohd Faizal Wan

2014-12-02

The significant increase in metal costs has forced the electronics industry to provide new materials and methods to reduce costs, while maintaining customers' high-quality expectations. This paper considers the problem of most electronic industries in reducing costly materials, by introducing a solder paste with alloy composition tin 98.3%, silver 0.3%, and copper 0.7%, used for the construction of the surface mount fine-pitch component on a Printing Wiring Board (PWB). The reliability of the solder joint between electronic components and PWB is evaluated through the dynamic characteristic test, thermal shock test, and Taguchi method after the printing process. After experimenting with the dynamic characteristic test and thermal shock test with 20 boards, the solder paste was still able to provide a high-quality solder joint. In particular, the Taguchi method is used to determine the optimal control parameters and noise factors of the Solder Printer (SP) machine, that affects solder volume and solder height. The control parameters include table separation distance, squeegee speed, squeegee pressure, and table speed of the SP machine. The result shows that the most significant parameter for the solder volume is squeegee pressure (2.0 mm), and the solder height is the table speed of the SP machine (2.5 mm/s).

Reliability Study of Solder Paste Alloy for the Improvement of Solder Joint at Surface Mount Fine-Pitch Components

PubMed Central

Rahman, Mohd Nizam Ab.; Zubir, Noor Suhana Mohd; Leuveano, Raden Achmad Chairdino; Ghani, Jaharah A.; Mahmood, Wan Mohd Faizal Wan

2014-01-01

The significant increase in metal costs has forced the electronics industry to provide new materials and methods to reduce costs, while maintaining customers’ high-quality expectations. This paper considers the problem of most electronic industries in reducing costly materials, by introducing a solder paste with alloy composition tin 98.3%, silver 0.3%, and copper 0.7%, used for the construction of the surface mount fine-pitch component on a Printing Wiring Board (PWB). The reliability of the solder joint between electronic components and PWB is evaluated through the dynamic characteristic test, thermal shock test, and Taguchi method after the printing process. After experimenting with the dynamic characteristic test and thermal shock test with 20 boards, the solder paste was still able to provide a high-quality solder joint. In particular, the Taguchi method is used to determine the optimal control parameters and noise factors of the Solder Printer (SP) machine, that affects solder volume and solder height. The control parameters include table separation distance, squeegee speed, squeegee pressure, and table speed of the SP machine. The result shows that the most significant parameter for the solder volume is squeegee pressure (2.0 mm), and the solder height is the table speed of the SP machine (2.5 mm/s). PMID:28788270

Galileo battery testing and the impact of test automation

NASA Technical Reports Server (NTRS)

Pertuch, W. T.; Dils, C. T.

1985-01-01

Test complexity, changes of test specifications, and the demand for tight control of tests led to the development of automated testing used for Galileo and other projects. The use of standardized interfacing, i.e., IEEE-488, with desktop computers and test instruments, resulted in greater reliability, repeatability, and accuracy of both control and data reporting. Increased flexibility of test programming has reduced costs by permitting a wide spectrum of test requirements at one station rather than many stations.

Optimizing Data Centre Energy and Environmental Costs

NASA Astrophysics Data System (ADS)

Aikema, David Hendrik

Data centres use an estimated 2% of US electrical power which accounts for much of their total cost of ownership. This consumption continues to grow, further straining power grids attempting to integrate more renewable energy. This dissertation focuses on assessing and reducing data centre environmental and financial costs. Emissions of projects undertaken to lower the data centre environmental footprints can be assessed and the emission reduction projects compared using an ISO-14064-2-compliant greenhouse gas reduction protocol outlined herein. I was closely involved with the development of the protocol. Full lifecycle analysis and verifying that projects exceed business-as-usual expectations are addressed, and a test project is described. Consuming power when it is low cost or when renewable energy is available can be used to reduce the financial and environmental costs of computing. Adaptation based on the power price showed 10--50% potential savings in typical cases, and local renewable energy use could be increased by 10--80%. Allowing a fraction of high-priority tasks to proceed unimpeded still allows significant savings. Power grid operators use mechanisms called ancillary services to address variation and system failures, paying organizations to alter power consumption on request. By bidding to offer these services, data centres may be able to lower their energy costs while reducing their environmental impact. If providing contingency reserves which require only infrequent action, savings of up to 12% were seen in simulations. Greater power cost savings are possible for those ceding more control to the power grid operator. Coordinating multiple data centres adds overhead, and altering at which data centre requests are processed based on changes in the financial or environmental costs of power is likely to increase this overhead. Tests of virtual machine migrations showed that in some cases there was no visible increase in power use while in others power use rose by 20--30W. Estimates of how migration was likely to impact other services used in current cloud environments were derived.

Better health at work? An evaluation of the effects and cost-benefits of a structured workplace health improvement programme in reducing sickness absence.

PubMed

Braun, T; Bambra, C; Booth, M; Adetayo, K; Milne, E

2015-03-01

This paper presents the results of an evaluation of the Better Health at Work Award-a structured regional workplace health programme which combined changes to the work environment with lifestyle interventions. Baseline and follow-up data on sickness-absence rates and programme costs were collected retrospectively via a web survey of all participating organizations. Changes over time were calculated using 95% confidence intervals of the mean, supplemented by hypothesis testing using a t-test. The indicative cost-benefits of the intervention were also calculated. Participation was associated with a mean reduction in sickness absence of 0.26-1.6 days per employee per year depending on the length and level of participation in the programme. The estimated cost for the programme was £3 per sickness-absence day saved. These results suggest that the Better Health at Work Award could be a cost-effective way of improving health and reducing sickness absence particularly in the public sector. However, controlled evaluations of future interventions are needed. © The Author 2014. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Nonprofit Groups Offer Genetic Testing for Jewish Students

ERIC Educational Resources Information Center

Supiano, Beckie

2008-01-01

This article describes how nonprofit organizations like Hillel are offering free genetic testing for Jewish college students. A growing number of colleges, including Pittsburgh, Brandeis University, and Columbia University are offering students free or reduced-cost screenings for diseases common to Jewish population. Genetic diseases common to…

Online Proctored versus Unproctored Low-Stakes Internet Test Administration: Is There Differential Test-Taking Behavior and Performance?

ERIC Educational Resources Information Center

Rios, Joseph A.; Liu, Ou Lydia

2017-01-01

Online higher education institutions are presented with the concern of how to obtain valid results when administering student learning outcomes (SLO) assessments remotely. Traditionally, there has been a great reliance on unproctored Internet test administration (UIT) due to increased flexibility and reduced costs; however, a number of validity…

Too little or too much? Parafoveal preview benefits and parafoveal load costs in dyslexic adults.

PubMed

Silva, Susana; Faísca, Luís; Araújo, Susana; Casaca, Luis; Carvalho, Loide; Petersson, Karl Magnus; Reis, Alexandra

2016-07-01

Two different forms of parafoveal dysfunction have been hypothesized as core deficits of dyslexic individuals: reduced parafoveal preview benefits ("too little parafovea") and increased costs of parafoveal load ("too much parafovea"). We tested both hypotheses in a single eye-tracking experiment using a modified serial rapid automatized naming (RAN) task. Comparisons between dyslexic and non-dyslexic adults showed reduced parafoveal preview benefits in dyslexics, without increased costs of parafoveal load. Reduced parafoveal preview benefits were observed in a naming task, but not in a silent letter-finding task, indicating that the parafoveal dysfunction may be consequent to the overload with extracting phonological information from orthographic input. Our results suggest that dyslexics' parafoveal dysfunction is not based on strict visuo-attentional factors, but nevertheless they stress the importance of extra-phonological processing. Furthermore, evidence of reduced parafoveal preview benefits in dyslexia may help understand why serial RAN is an important reading predictor in adulthood.

Is there scope for cost savings and efficiency gains in HIV services? A systematic review of the evidence from low- and middle-income countries

PubMed Central

Siapka, Mariana; Remme, Michelle; Obure, Carol Dayo; Maier, Claudia B; Dehne, Karl L

2014-01-01

Abstract Objective To synthesize the data available – on costs, efficiency and economies of scale and scope – for the six basic programmes of the UNAIDS Strategic Investment Framework, to inform those planning the scale-up of human immunodeficiency virus (HIV) services in low- and middle-income countries. Methods The relevant peer-reviewed and “grey” literature from low- and middle-income countries was systematically reviewed. Search and analysis followed Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Findings Of the 82 empirical costing and efficiency studies identified, nine provided data on economies of scale. Scale explained much of the variation in the costs of several HIV services, particularly those of targeted HIV prevention for key populations and HIV testing and treatment. There is some evidence of economies of scope from integrating HIV counselling and testing services with several other services. Cost efficiency may also be improved by reducing input prices, task shifting and improving client adherence. Conclusion HIV programmes need to optimize the scale of service provision to achieve efficiency. Interventions that may enhance the potential for economies of scale include intensifying demand-creation activities, reducing the costs for service users, expanding existing programmes rather than creating new structures, and reducing attrition of existing service users. Models for integrated service delivery – which is, potentially, more efficient than the implementation of stand-alone services – should be investigated further. Further experimental evidence is required to understand how to best achieve efficiency gains in HIV programmes and assess the cost–effectiveness of each service-delivery model. PMID:25110375

Biosensor Regeneration: A Review of Common Techniques and Outcomes.

PubMed

Goode, J A; Rushworth, J V H; Millner, P A

2015-06-16

Biosensors are ideally portable, low-cost tools for the rapid detection of pathogens, proteins, and other analytes. The global biosensor market is currently worth over 10 billion dollars annually and is a burgeoning field of interdisciplinary research that is hailed as a potential revolution in consumer, healthcare, and industrial testing. A key barrier to the widespread adoption of biosensors, however, is their cost. Although many systems have been validated in the laboratory setting and biosensors for a range of analytes are proven at the concept level, many have yet to make a strong commercial case for their acceptance. Though it is true with the development of cheaper electrodes, circuits, and components that there is a downward pressure on costs, there is also an emerging trend toward the development of multianalyte biosensors that is pushing in the other direction. One way to reduce the cost that is suitable for certain systems is to enable their reuse, thus reducing the cost per test. Regenerating biosensors is a technique that can often be used in conjunction with existing systems in order to reduce costs and accelerate the commercialization process. This article discusses the merits and drawbacks of regeneration schemes that have been proven in various biosensor systems and indicates parameters for successful regeneration based on a systematic review of the literature. It also outlines some of the difficulties encountered when considering the role of regeneration at the point of use. A brief meta-analysis has been included in this review to develop a working definition for biosensor regeneration, and using this analysis only ∼60% of the reported studies analyzed were deemed a success. This highlights the variation within the field and the need to normalize regeneration as a standard process across the field by establishing a consensus term.

Cost Implications of Using Different ECG Criteria for Screening Young Athletes in the United Kingdom.

PubMed

Dhutia, Harshil; Malhotra, Aneil; Gabus, Vincent; Merghani, Ahmed; Finocchiaro, Gherardo; Millar, Lynne; Narain, Rajay; Papadakis, Michael; Naci, Huseyin; Tome, Maite; Sharma, Sanjay

2016-08-16

High false-positive rates and cost of additional investigations are an obstacle to electrocardiographic (ECG) screening of young athletes for cardiac disease. However, ECG screening costs have never been systematically assessed in a large cohort of athletes. This study investigated the costs of ECG screening in athletes according to the 2010 European Society of Cardiology (ESC) recommendations and the Seattle and refined interpretation criteria. Between 2011 and 2014, 4,925 previously unscreened athletes aged 14 to 35 years were prospectively evaluated with history, physical examination, and ECG (interpreted with the 2010 ESC recommendations). Athletes with abnormal results underwent secondary investigations, the costs of which were based on U.K. National Health Service Tariffs. The impact on cost after applying the Seattle and refined criteria was evaluated retrospectively. Overall, 1,072 (21.8%) athletes had an abnormal ECG on the basis of 2010 ESC recommendations; 11.2% required echocardiography, 1.7% exercise stress test, 1.2% Holter, 1.2% cardiac magnetic resonance imaging, and 0.4% other tests. The Seattle and refined criteria reduced the number of positive ECGs to 6.0% and 4.3%, respectively. Fifteen (0.3%) athletes were diagnosed with potentially serious cardiac disease using all 3 criteria. The overall cost of de novo screening using 2010 ESC recommendations was $539,888 ($110 per athlete and $35,993 per serious diagnosis). The Seattle and refined criteria reduced the cost to $92 and $87 per athlete screened and $30,251 and $28,510 per serious diagnosis, respectively. Contemporary ECG interpretation criteria decrease costs for de novo screening of athletes, which may be cost permissive for some sporting organizations. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Cost and quality of life analysis of HIV self-testing and facility-based HIV testing and counselling in Blantyre, Malawi.

PubMed

Maheswaran, Hendramoorthy; Petrou, Stavros; MacPherson, Peter; Choko, Augustine T; Kumwenda, Felistas; Lalloo, David G; Clarke, Aileen; Corbett, Elizabeth L

2016-02-19

HIV self-testing (HIVST) has been found to be highly effective, but no cost analysis has been undertaken to guide the design of affordable and scalable implementation strategies. Consecutive HIV self-testers and facility-based testers were recruited from participants in a community cluster-randomised trial ( ISRCTN02004005 ) investigating the impact of offering HIVST in addition to facility-based HIV testing and counselling (HTC). Primary costing studies were undertaken of the HIVST service and of health facilities providing HTC to the trial population. Costs were adjusted to 2014 US$ and INT$. Recruited participants were asked about direct non-medical and indirect costs associated with accessing either modality of HIV testing, and additionally their health-related quality of life was measured using the EuroQol EQ-5D. A total of 1,241 participants underwent either HIVST (n = 775) or facility-based HTC (n = 446). The mean societal cost per participant tested through HIVST (US$9.23; 95 % CI: US$9.14-US$9.32) was lower than through facility-based HTC (US$11.84; 95 % CI: US$10.81-12.86). Although the mean health provider cost per participant tested through HIVST (US$8.78) was comparable to facility-based HTC (range: US$7.53-US$10.57), the associated mean direct non-medical and indirect cost was lower (US$2.93; 95 % CI: US$1.90-US$3.96). The mean health provider cost per HIV positive participant identified through HIVST was higher (US$97.50) than for health facilities (range: US$25.18-US$76.14), as was the mean cost per HIV positive individual assessed for anti-retroviral treatment (ART) eligibility and the mean cost per HIV positive individual initiated onto ART. In comparison to the facility-testing group, the adjusted mean EQ-5D utility score was 0.046 (95 % CI: 0.022-0.070) higher in the HIVST group. HIVST reduces the economic burden on clients, but is a costlier strategy for the health provider aiming to identify HIV positive individuals for treatment. The provider cost of HIVST could be substantially lower under less restrictive distribution models, or if costs of oral fluid HIV test kits become comparable to finger-prick kits used in health facilities.

Estimating healthcare costs of acute gastroenteritis and human campylobacteriosis in Switzerland.

PubMed

Schmutz, C; Mäusezahl, D; Bless, P J; Hatz, C; Schwenkglenks, M; Urbinello, D

2017-03-01

Rising numbers of campylobacteriosis case notifications in Switzerland resulted in an increased attention to acute gastroenteritis (AG) in general. Patients with a laboratory-confirmed Campylobacter infection perceive their disease as severe and around 15% of these patients are hospitalized. This study aimed at estimating healthcare costs due to AG and campylobacteriosis in Switzerland. We used official health statistics, data from different studies and expert opinion for estimating individual treatment costs for patients with different illness severity and for extrapolating overall costs due to AG and campylobacteriosis. We estimated that total Swiss healthcare costs resulting from these diseases amount to €29-45 million annually. Data suggest that patients with AG consulting a physician without a stool diagnostic test account for €9·0-24·2 million, patients with a negative stool test result for Campylobacter spp. for €12·3 million, patients testing positive for Campylobacter spp. for €1·8 million and hospitalized campylobacteriosis patients for €6·5 million/year. Healthcare costs of campylobacteriosis are high and most likely increasing in Switzerland considering that campylobacteriosis case notifications steadily increased in the past decade. Costs and potential cost savings for the healthcare system should be considered when designing sectorial and cross-sectorial interventions to reduce the burden of human campylobacteriosis in Switzerland.

Designing a ruggedisation lab to characterise materials for harsh environments.

PubMed

Frazzette, Nicholas; Jethva, Janak; Mehta, Khanjan; Stapleton, Joshua J; Randall, Clive

Designing products for use in developing countries presents a unique set of challenges including harsh operating environments, costly repairs and maintenance, and users with varying degrees of education and device familiarity. For products to be robust, adaptable and durable, they need to be ruggedised for environmental factors such as high temperature and humidity as well as different operational conditions such as shock and chemical exposure. The product characterisation and ruggedisation processes require specific expertise and resources that are seldom available outside of large corporations and elite national research labs. There is no standardised process since product needs strongly depend on the context and user base, making it particularly onerous for underfunded start-ups and academic groups. Standardised protocols that identify essential lab testing regimens for specific contexts and user groups can complement field-testing and accelerate the product development process while reducing costs. This article synthesises current methods and strategies for product testing employed by large corporations as well as defence-related entities. A technological and organisational framework for a service-for-fee product characterisation and ruggedisation lab that reduces costs and shortens the timespan from product invention to commercial launch in harsh settings is presented.

Costs and health consequences of chlamydia management strategies among pregnant women in sub-Saharan Africa.

PubMed

Romoren, M; Hussein, F; Steen, T W; Velauthapillai, M; Sundby, J; Hjortdahl, P; Kristiansen, I S

2007-12-01

Chlamydia is the most common bacterial sexually transmitted infection worldwide and a major cause of morbidity-particularly among women and neonates. We compared costs and health consequences of using point-of-care (POC) tests with current syndromic management among antenatal care attendees in sub-Saharan Africa. We also compared erythromycin with azithromycin treatment and universal with age-based chlamydia management. A decision analytical model was developed to compare diagnostic and treatment strategies, using Botswana as a case. Model input was based upon (1) a study of pregnant women in Botswana, (2) literature reviews and (3) expert opinion. We expressed the study outcome in terms of costs (US$), cases cured, magnitude of overtreatment and successful partner treatment. Azithromycin was less costly and more effective than erythromycin. Compared with syndromic management, testing all attendees on their first visit with a 75% sensitive POC test increased the number of cases cured from 1500 to 3500 in a population of 100,000 women, at a cost of US$38 per additional case cured. This cost was lower in high-prevalence populations or if testing was restricted to teenagers. The specific POC tests provided the advantage of substantial reductions in overtreatment with antibiotics and improved partner management. Using POC tests to diagnose chlamydia during antenatal care in sub-Saharan Africa entails greater health benefits than syndromic management does-and at acceptable costs-especially when restricted to younger women. Changes in diagnostic strategy and treatment regimens may improve people's health and even reduce healthcare budgets.

Tuberculosis Costs in Spain and Related Factors.

PubMed

Gullón, José Antonio; García-García, José María; Villanueva, Manuel Ángel; Álvarez-Navascues, Fernando; Rodrigo, Teresa; Casals, Martí; Anibarro, Luis; García-Clemente, Marta María; Jiménez, María Ángeles; Bustamante, Ana; Penas, Antón; Caminero, José Antonio; Caylà, Joan

2016-12-01

To analyze the direct and indirect costs of diagnosis and management of tuberculosis (TB) and associated factors. Prospective study of patients diagnosed with TB between September 2014 and September 2015. We calculated direct (hospital stays, visits, diagnostic tests, and treatment) and indirect (sick leave and loss of productivity, contact tracing, and rehabilitation) costs. The following cost-related variables were compared: age, gender, country of origin, hospital stays, diagnostic testing, sensitivity testing, treatment, resistance, directed observed therapy (DOT), and days of sick leave. Proportions were compared using the chi-squared test and significant variables were included in a logistic regression analysis to calculate odds ratio (OR) and corresponding 95% confidence intervals. 319 patients were included with a mean age of 56.72±20.79 years. The average cost was €10,262.62±14,961.66, which increased significantly when associated with hospital admission, polymerase chain reaction, sputum smears and cultures, sensitvity testing, chest computed tomography, pleural biopsy, drug treatment longer than nine months, DOT and sick leave. In the multivariate analysis, hospitalization (OR=96.8; CI 29-472), sensitivity testing (OR=4.34; CI 1.71-12.1), chest CT (OR= 2.25; CI 1.08-4.77), DOT (OR=20.76; CI 4.11-148) and sick leave (OR=26,9; CI 8,51-122) showed an independent association with cost. Tuberculosis gives rise to significant health spending. In order to reduce these costs, more control of transmission, and fewer hospital admissions would be required. Copyright © 2016 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

Manned Orbital Transfer Vehicle (MOTV). Volume 5: Turnaround analysis

NASA Technical Reports Server (NTRS)

Boyland, R. E.; Sherman, S. W.; Morfin, H. W.

1979-01-01

The development of a low-cost reliable turnaround process to employ the MOTV in enhancing the utilization of the geosynchronous space region is analyzed. It is indicated that a routine effective turnaround/maintenance plan must make maximum use of flight data for maintenance planning, a high degree of test automation, and MOTV maintainability features in order to minimize tests, facilitate repair, and reduce manpower requirements. An effective turnaround plan provides a payback of reduced risks.

A segmented ion engine design for solar electric propulsion systems

NASA Technical Reports Server (NTRS)

Brophy, John R.

1992-01-01

A new ion engine design, called a segmented ion engine, is described which is capable of reducing the required ion source life time for small body rendezvous missions from 18,000 h to about 8,000 h. The use of SAND ion optics for the engine accelerator system makes it possible to substantially reduce the cost of demonstrating the required engine endurance. It is concluded that a flight test of a 5-kW xenon ion propulsion system on the ELITE spacecraft would enormously reduce the cost and risk of using ion propulsion on a planetary vehicle by addressing systems level issues associated with flying a spacecraft radically different from conventional planetary vehicles.

Assessing the Effectiveness and Cost-Benefit of Test-and-Vaccinate Policy for Supplementary Vaccination against Rubella with Limited Doses

PubMed Central

Saito, Masaya M.; Kinoshita, Ryo

2018-01-01

Elevating herd immunity level against rubella is essential to prevent congenital rubella syndrome (CRS). Insufficient vaccination coverage left susceptible pockets among adults in Japan, and the outbreak of rubella from 2012 to 2013 resulted in 45 observed CRS cases. Given a limited stock of rubella-containing vaccine (RCV) available, the Japanese government recommended healthcare providers to prioritize vaccination to those confirmed with low level of immunity, or to those likely to transmit to pregnant women. Although a test-and-vaccinate policy could potentially help reduce the use of the limited stockpile of vaccines, by selectively elevating herd immunity, the cost of serological testing is generally high and comparable to the vaccine itself. Here, we aimed to examine whether random vaccination would be more cost-beneficial than the test-and-vaccinate strategy. A mathematical model was employed to evaluate the vaccination policy implemented in 2012–2013, quantifying the benefit-to-cost ratio to achieve herd immunity. The modelling exercise demonstrated that, while the test-and-vaccinate strategy can efficiently achieve herd immunity when stockpiles of RCV are limited, random vaccination would be a more cost-beneficial strategy. As long as the herd immunity acts as the goal of vaccination, our findings apply to future supplementary immunization strategy. PMID:29565821

Cost-effectiveness of molecular testing for thyroid nodules with atypia of undetermined significance cytology.

PubMed

Lee, Lawrence; How, Jacques; Tabah, Roger J; Mitmaker, Elliot J

2014-08-01

Novel molecular diagnostics, such as the gene expression classifier (GEC) and gene mutation panel (GMP) testing, may improve the management for thyroid nodules with atypia of undetermined significance (AUS) cytology. The cost-effectiveness of an approach combining both tests in different practice settings in North America is unknown. The aim of the study was to determine the cost-effectiveness of two diagnostic molecular tests, singly or in combination, for AUS thyroid nodules. We constructed a microsimulation model to investigate cost-effectiveness from US (Medicare) and Canadian healthcare system perspectives. Low-risk patients with AUS thyroid nodules were simulated. We examined five management strategies: 1) routine GEC; 2) routine GEC + selective GMP; 3) routine GMP; 4) routine GMP + selective GEC; and 5) standard management. Lifetime costs and quality-adjusted life-years were measured. From the US perspective, the routine GEC + selective GMP strategy was the dominant strategy. From the Canadian perspective, routine GEC + selective GMP cost and additional CAN$24 030 per quality-adjusted life-year gained over standard management, and was dominant over the other strategies. Sensitivity analyses reported that the decisions from both perspectives were sensitive to variations in the probability of malignancy in the nodule and the costs of the GEC and GMP. The probability of cost-effectiveness for routine GEC + selective GMP was low. In the US setting, the most cost-effective strategy was routine GEC + selective GMP. In the Canadian setting, standard management was most likely to be cost effective. The cost of these molecular diagnostics will need to be reduced to increase their cost-effectiveness for practice settings outside the United States.

Automotive Stirling engine development program

NASA Technical Reports Server (NTRS)

Nightingale, N.; Ernst, W.; Richey, A.; Simetkosky, M.; Smith, G.; Rohdenburg, C.; Vatsky, A.; Antonelli, M. (Editor)

1983-01-01

Activities performed on Mod I engine testing and test results, testing of the Mod I engine in the United States, Mod I engine characterization and analyses, Mod I Transient Test Bed fuel economy, upgraded Mod I performance and testing, Stirling engine reference engine manufacturing and reduced size studied, components and subsystems, and the study and test of low cost casting alloys are summarized. The overall program philosophy is outlined, and data and results are presented.

DeepFocus Acoustic Microscope Transducer

ScienceCinema

Taylor, Steven; Kraft, Nancy

2018-02-13

A new nondestructive testing device being used to analyse nuclear fuel could reduce costs for manufacturing and other industry. For more information about INL research projects, visit http://www.facebook.com/idahonationallaboratory.

Design and Demonstration of an Advanced Agricultural Feedstock Supply System for Lignocellulosic Bioenergy Production

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

Clark, Timothy C.; Comer, Kevin S.; Belden, Jr., William S.

2016-04-30

This three-year project developed and demonstrated four innovative, first-of-their-kind pieces of equipment that are aimed at significantly reducing the cost of delivered herbaceous biomass. This equipment included a Self-Propelled Baler (SPB), a Bale Picking Truck (BPT), a Self-Loading Trailer (SLT), and a Heavy Crop Header for harvesting high yielding energy crops. This equipment was designed and fabricated during the first two years of the project and demonstrated on available crops (corn stover, wheat straw, and warm season grasses) across the nation, as available. Operational performance and cost data was collected and analyzed throughout the project to measure the costs ofmore » baseline harvesting (using conventional harvesting equipment) and advanced harvesting with the newly developed equipment. This data revealed that the project met its original goal of developing equipment that is realistically capable of reducing the cost of delivered biomass by $13 per dry ton. Each machine was tested after fabrication and put to the test in one or more commercial harvesting seasons. During these tests, operational flaws were found and fixed through upgrades and improvements. The first new SPB, BPT, and two new SLTs were ready for use during the 2013 harvest season. Since then, over 40 SLTs have been ordered and are currently under fabrication. All of the equipment will be commercially available to the industry as demand increases.« less

Low-Cost Hydrogen Distributed Production System Development

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

C.E.

2011-03-10

H{sub 2}Gen, with the support of the Department of Energy, successfully designed, built and field-tested two steam methane reformers with 578 kg/day capacity, which has now become a standard commercial product serving customers in the specialty metals and PV manufacturing businesses. We demonstrated that this reformer/PSA system, when combined with compression, storage and dispensing (CSD) equipment could produce hydrogen that is already cost-competitive with gasoline per mile driven in a conventional (non-hybrid) vehicle. We further showed that mass producing this 578 kg/day system in quantities of just 100 units would reduce hydrogen cost per mile approximately 13% below the cost of untaxed gasoline per mile used in a hybrid electric vehicle. If mass produced in quantities of 500 units, hydrogen cost per mile in a FCEV would be 20% below the cost of untaxed gasoline in an HEV in the 2015-2020 time period using EIA fuel cost projections for natural gas and untaxed gasoline, and 45% below the cost of untaxed gasoline in a conventional car. This 20% to 45% reduction in fuel cost per mile would accrue even though hydrogen from this 578 kg/day system would cost approximatelymore » $4.14/kg, well above the DOE hydrogen cost targets of $2.50/kg by 2010 and $$2.00/kg by 2015. We also estimated the cost of a larger, 1,500 kg/day SMR/PSA fueling system based on engineering cost scaling factors derived from the two H{sub 2}Gen products, a commercial 115 kg/day system and the 578 kg/day system developed under this DOE contract. This proposed system could support 200 to 250 cars per day, similar to a medium gasoline station. We estimate that the cost per mile from this larger 1,500 kg/day hydrogen fueling system would be 26% to 40% below the cost per mile of untaxed gasoline in an HEV and ICV respectively, even without any mass production cost reductions. In quantities of 500 units, we are projecting per mile cost reductions between 45% (vs. HEVs) and 62% (vs ICVs), with hydrogen costing approximately $$2.87/kg, still above the DOE's 2010 $2.50/kg target. We also began laboratory testing of reforming ethanol, which we showed is currently the least expensive approach to making renewable hydrogen. Extended testing of neat ethanol in micro-reactors was successful, and we also were able to reform E-85 acquired from a local fueling station for 2,700 hours, although some modifications were required to handle the 15% gasoline present in E-85. We began initial tests of a catalyst-coated wall reformer tube that showed some promise in reducing the propensity to coke with E-85. These coated-wall tests ran for 350 hours. Additional resources would be required to commercialize an ethanol reformer operating on E-85, but there is no market for such a product at this time, so this ethanol reformer project was moth-balled pending future government or industry support. The two main objectives of this project were: (1) to design, build and test a steam methane reformer and pressure swing adsorption system that, if scaled up and mass produced, could potentially meet the DOE 2015 cost and efficiency targets for on-site distributed hydrogen generation, and (2) to demonstrate the efficacy of a low-cost renewable hydrogen generation system based on reforming ethanol to hydrogen at the fueling station.« less

An educational intervention to improve cost-effective care among medicine housestaff: a randomized controlled trial.

PubMed

Sommers, Benjamin D; Desai, Nihar; Fiskio, Julie; Licurse, Adam; Thorndike, Mary; Katz, Joel T; Bates, David W

2012-06-01

High medical costs create significant burdens. Research indicates that doctors have little awareness of costs. This study tested whether a brief educational intervention could increase residents' awareness of cost-effectiveness and reduce costs without negatively affecting patient outcomes. The authors conducted a clustered randomized controlled trial of 33 teams (96 residents) at an internal medicine residency program (2009-2010). The intervention was a 45-minute teaching session; residents reviewed the hospital bill of a patient for whom they had cared and discussed reducing unnecessary costs. Primary outcomes were laboratory, pharmacy, radiology, and total hospital costs per admission. Secondary measures were length of stay (LOS), intensive care unit (ICU) admission, 30-day readmission, and 30-day mortality. Multivariate adjustment controlled for patient demographics and health. A follow-up survey assessed resident attitudes three months later. Among 1,194 patients, there were no significant cost differences between intervention and control groups. In the intervention group, 30-day readmission was higher (adjusted odds ratio 1.51, P = .010). There was no effect on LOS or the composite outcome of readmission, mortality, and ICU transfer. In a subgroup analysis of 835 patients newly admitted during the study, the intervention group incurred $163 lower adjusted lab costs per admission (P = .046). The follow-up survey indicated persistent differences in residents' exposure to concepts of cost-effectiveness (P = .041). A brief intervention featuring a discussion of hospital bills can fill a gap in resident education and reduce laboratory costs for a subset of patients, but may increase readmission risk.

Felling and skidding cost estimates for thinnings to reduce gypsy moth impacts

Treesearch

Michael D. Erickson; Curt C. Hassler; Chris B. LeDoux

1991-01-01

The gypsy moth is a serious threat to the hardwood forests of the eastern United States. Although chemical treatments currently exist which can be used to help control the impacts of the moth, silvicultural control measures are just now being proposed and tested. Felling and skidding cost estimates for harvesting merchantable timber under two such proposed...

An Experiment to Test the Feasibility and Quality of a Web-Based Questionnaire of Teachers

ERIC Educational Resources Information Center

Jacob, Robin Tepper

2011-01-01

The use of web-based surveys to gather information from teachers has become increasingly common primarily based on the premise that they can reduce costs. Yet, relatively, little is known about the quality or cost effectiveness of web-based versus mail surveys for teachers. To study the efficacy of web-based teacher surveys, the author randomly…

Controlling the Radon Threat Needn't Be Another Costly Nightmare.

ERIC Educational Resources Information Center

Freije, Matthew R.

1989-01-01

After a study of 3,000 classrooms in 130 schools in 16 states, the Environmental Protection Agency urged all schools to conduct tests for radon. Explains a 6-step screening test, methods of reducing radon concentrations, and how the risk from radon exposure compares with other risks. (MLF)

A reduced transcriptome approach to assess environmental toxicants using zebrafish embryo tests

EPA Science Inventory

This paper reports on the pilot testing of a new bioassay platform that monitors expression of 1600 genes in zebrafish embryos exposed to either single chemicals or complex water samples. The method provides a more cost effective, high throughput means to broadly evaluate the pot...

Costs and Cost Effectiveness of Three Approaches for Cervical Cancer Screening among HIV-Positive Women in Johannesburg, South Africa

PubMed Central

Lince-Deroche, Naomi; Phiri, Jane; Michelow, Pam; Smith, Jennifer S.; Firnhaber, Cindy

2015-01-01

Background South Africa has high rates of HIV and HPV and high incidence and mortality from cervical cancer. However, cervical cancer is largely preventable when early screening and treatment are available. We estimate the costs and cost-effectiveness of conventional cytology (Pap), visual inspection with acetic acid (VIA) and HPV DNA testing for detecting cases of CIN2+ among HIV-infected women currently taking antiretroviral treatment at a public HIV clinic in Johannesburg, South Africa. Methods Method effectiveness was derived from a validation study completed at the clinic. Costs were estimated from the provider perspective using micro-costing between June 2013-April 2014. Capital costs were annualized using a discount rate of 3%. Two different service volume scenarios were considered. Threshold analysis was used to explore the potential for reducing the cost of HPV DNA testing. Results VIA was least costly in both scenarios. In the higher volume scenario, the average cost per procedure was US$ 3.67 for VIA, US$ 8.17 for Pap and US$ 54.34 for HPV DNA. Colposcopic biopsies cost on average US$ 67.71 per procedure. VIA was least sensitive but most cost-effective at US$ 17.05 per true CIN2+ case detected. The cost per case detected for Pap testing was US$ 130.63 using a conventional definition for positive results and US$ 187.52 using a more conservative definition. HPV DNA testing was US$ 320.09 per case detected. Colposcopic biopsy costs largely drove the total and per case costs. A 71% reduction in HPV DNA screening costs would make it competitive with the conservative Pap definition. Conclusions Women need access to services which meet their needs and address the burden of cervical dysplasia and cancer in this region. Although most cost-effective, VIA may require more frequent screening due to low sensitivity, an important consideration for an HIV-positive population with increased risk for disease progression. PMID:26569487

Costs and Cost Effectiveness of Three Approaches for Cervical Cancer Screening among HIV-Positive Women in Johannesburg, South Africa.

PubMed

Lince-Deroche, Naomi; Phiri, Jane; Michelow, Pam; Smith, Jennifer S; Firnhaber, Cindy

2015-01-01

South Africa has high rates of HIV and HPV and high incidence and mortality from cervical cancer. However, cervical cancer is largely preventable when early screening and treatment are available. We estimate the costs and cost-effectiveness of conventional cytology (Pap), visual inspection with acetic acid (VIA) and HPV DNA testing for detecting cases of CIN2+ among HIV-infected women currently taking antiretroviral treatment at a public HIV clinic in Johannesburg, South Africa. Method effectiveness was derived from a validation study completed at the clinic. Costs were estimated from the provider perspective using micro-costing between June 2013-April 2014. Capital costs were annualized using a discount rate of 3%. Two different service volume scenarios were considered. Threshold analysis was used to explore the potential for reducing the cost of HPV DNA testing. VIA was least costly in both scenarios. In the higher volume scenario, the average cost per procedure was US$ 3.67 for VIA, US$ 8.17 for Pap and US$ 54.34 for HPV DNA. Colposcopic biopsies cost on average US$ 67.71 per procedure. VIA was least sensitive but most cost-effective at US$ 17.05 per true CIN2+ case detected. The cost per case detected for Pap testing was US$ 130.63 using a conventional definition for positive results and US$ 187.52 using a more conservative definition. HPV DNA testing was US$ 320.09 per case detected. Colposcopic biopsy costs largely drove the total and per case costs. A 71% reduction in HPV DNA screening costs would make it competitive with the conservative Pap definition. Women need access to services which meet their needs and address the burden of cervical dysplasia and cancer in this region. Although most cost-effective, VIA may require more frequent screening due to low sensitivity, an important consideration for an HIV-positive population with increased risk for disease progression.

Cost-utility of medication withdrawal in older fallers: results from the improving medication prescribing to reduce risk of FALLs (IMPROveFALL) trial.

PubMed

Polinder, Suzanne; Boyé, Nicole D A; Mattace-Raso, Francesco U S; Van der Velde, Nathalie; Hartholt, Klaas A; De Vries, Oscar J; Lips, Paul; Van der Cammen, Tischa J M; Patka, Peter; Van Beeck, Ed F; Van Lieshout, Esther M M

2016-11-04

The use of Fall-Risk-Increasing-Drugs (FRIDs) has been associated with increased risk of falls and associated injuries. This study investigates the effect of withdrawal of FRIDs versus 'care as usual' on health-related quality of life (HRQoL), costs, and cost-utility in community-dwelling older fallers. In a prospective multicenter randomized controlled trial FRIDs assessment combined with FRIDs-withdrawal or modification was compared with 'care as usual' in older persons, who visited the emergency department after experiencing a fall. For the calculation of costs the direct medical costs (intramural and extramural) and indirect costs (travel costs) were collected for a 12 month period. HRQoL was measured at baseline and at 12 months follow-up using the EuroQol-5D and Short Form-12 version 2. The change in EuroQol-5D and Short Form-12 scores over 12 months follow-up within the control and intervention groups was compared using the Wilcoxon Signed Rank test for continuous variables and the McNemar test for dichotomous variables. The change in scores between the control and intervention groups were compared using a two-way analysis of variance. We included 612 older persons who visited an emergency department because of a fall. The mean cost of the FRIDs intervention was €120 per patient. The total fall-related healthcare costs (without the intervention costs) did not differ significantly between the intervention group and the control group (€2204 versus €2285). However, the withdrawal of FRIDs reduced medication costs with a mean of €38 per participant. Furthermore, the control group had a greater decline in EuroQol-5D utility score during the 12-months follow-up than the intervention group (p = 0.02). The change in the Short Form-12 Physical Component Summary and Mental Component Summary scores did not differ significantly between the two groups. Withdrawal of FRID's in older persons who visited an emergency department due to a fall, did not lead to reduction of total health-care costs. However, the withdrawal of FRIDs reduced medication costs with a mean of €38 per participant in combination with less decline in HRQoL is an important result. The trial is registered in the Netherlands Trial Register ( NTR1593 - October 1 st 2008).

A Survey of UML Based Regression Testing

NASA Astrophysics Data System (ADS)

Fahad, Muhammad; Nadeem, Aamer

Regression testing is the process of ensuring software quality by analyzing whether changed parts behave as intended, and unchanged parts are not affected by the modifications. Since it is a costly process, a lot of techniques are proposed in the research literature that suggest testers how to build regression test suite from existing test suite with minimum cost. In this paper, we discuss the advantages and drawbacks of using UML diagrams for regression testing and analyze that UML model helps in identifying changes for regression test selection effectively. We survey the existing UML based regression testing techniques and provide an analysis matrix to give a quick insight into prominent features of the literature work. We discuss the open research issues like managing and reducing the size of regression test suite, prioritization of the test cases that would be helpful during strict schedule and resources that remain to be addressed for UML based regression testing.

Thermionic system evaluated test (TSET) facility description

NASA Astrophysics Data System (ADS)

Fairchild, Jerry F.; Koonmen, James P.; Thome, Frank V.

1992-01-01

A consortium of US agencies are involved in the Thermionic System Evaluation Test (TSET) which is being supported by the Strategic Defense Initiative Organization (SDIO). The project is a ground test of an unfueled Soviet TOPAZ-II in-core thermionic space reactor powered by electrical heat. It is part of the United States' national thermionic space nuclear power program. It will be tested in Albuquerque, New Mexico at the New Mexico Engineering Research Institute complex by the Phillips Laboratoty, Sandia National Laboratories, Los Alamos National Laboratory, and the University of New Mexico. One of TSET's many objectives is to demonstrate that the US can operate and test a complete space nuclear power system, in the electrical heater configuration, at a low cost. Great efforts have been made to help reduce facility costs during the first phase of this project. These costs include structural, mechanical, and electrical modifications to the existing facility as well as the installation of additional emergency systems to mitigate the effects of utility power losses and alkali metal fires.

Tuberculosis screening of new hospital employees: compliance, clearance to work time, and cost using tuberculin skin test and interferon-gamma release assays.

PubMed

Foster-Chang, Sarah A; Manning, Mary L; Chandler, Laura

2014-11-01

Selection of the most suitable test(s) for detection of Mycobacterium tuberculosis (TB) infection should be based on purpose, setting, effectiveness, and cost. Two tests are available to screen for latent TB: the tuberculin skin test (TST) and the more recent interferon-gamma release assays (IGRAs). Based on the administrative, logistic, and technical ease of use, an IGRA trial was initiated by the occupational health department at an urban Veteran's Administration health care facility for TB screening of new employees. As a result, new employees completing the pre-placement process within the organization's designated 14 days increased from 77% to 97%, new employee clearance to work time decreased from 13.18 to 5.91 days, and new employee TB screening costs were reduced by 40%. The IGRA is an acceptable alternative to the TST and has significant potential to improve the process of pre-placement TB screening. Copyright 2014, SLACK Incorporated.

Development of multilayer perceptron networks for isothermal time temperature transformation prediction of U-Mo-X alloys

NASA Astrophysics Data System (ADS)

Johns, Jesse M.; Burkes, Douglas

2017-07-01

In this work, a multilayered perceptron (MLP) network is used to develop predictive isothermal time-temperature-transformation (TTT) models covering a range of U-Mo binary and ternary alloys. The selected ternary alloys for model development are U-Mo-Ru, U-Mo-Nb, U-Mo-Zr, U-Mo-Cr, and U-Mo-Re. These model's ability to predict 'novel' U-Mo alloys is shown quite well despite the discrepancies between literature sources for similar alloys which likely arise from different thermal-mechanical processing conditions. These models are developed with the primary purpose of informing experimental decisions. Additional experimental insight is necessary in order to reduce the number of experiments required to isolate ideal alloys. These models allow test planners to evaluate areas of experimental interest; once initial tests are conducted, the model can be updated and further improve follow-on testing decisions. The model also improves analysis capabilities by reducing the number of data points necessary from any particular test. For example, if one or two isotherms are measured during a test, the model can construct the rest of the TTT curve over a wide range of temperature and time. This modeling capability reduces the cost of experiments while also improving the value of the results from the tests. The reduced costs could result in improved material characterization and therefore improved fundamental understanding of TTT dynamics. As additional understanding of phenomena driving TTTs is acquired, this type of MLP model can be used to populate unknowns (such as material impurity and other thermal mechanical properties) from past literature sources.

Charge-Control Unit for Testing Lithium-Ion Cells

NASA Technical Reports Server (NTRS)

Reid, Concha M.; Mazo, Michelle A.; Button, Robert M.

2008-01-01

A charge-control unit was developed as part of a program to validate Li-ion cells packaged together in batteries for aerospace use. The lithium-ion cell charge-control unit will be useful to anyone who performs testing of battery cells for aerospace and non-aerospace uses and to anyone who manufacturers battery test equipment. This technology reduces the quantity of costly power supplies and independent channels that are needed for test programs in which multiple cells are tested. Battery test equipment manufacturers can integrate the technology into their battery test equipment as a method to manage charging of multiple cells in series. The unit manages a complex scheme that is required for charging Li-ion cells electrically connected in series. The unit makes it possible to evaluate cells together as a pack using a single primary test channel, while also making it possible to charge each cell individually. Hence, inherent cell-to-cell variations in a series string of cells can be addressed, and yet the cost of testing is reduced substantially below the cost of testing each cell as a separate entity. The unit consists of electronic circuits and thermal-management devices housed in a common package. It also includes isolated annunciators to signal when the cells are being actively bypassed. These annunciators can be used by external charge managers or can be connected in series to signal that all cells have reached maximum charge. The charge-control circuitry for each cell amounts to regulator circuitry and is powered by that cell, eliminating the need for an external power source or controller. A 110-VAC source of electricity is required to power the thermal-management portion of the unit. A small direct-current source can be used to supply power for an annunciator signal, if desired.

Use of Activated Carbon for Treatment of Explosives- Contaminated Groundwater at the Milan Army Ammunition Plant (MAAP). Task Order 7

DTIC Science & Technology

1990-05-01

Officer •" COSATI CODES 18. SUBJECT TERMS (Conrrnue on ,....e._ r# ,.cesury •trd .O.nrrfy 0, OJoclr number/ . I FIELD GROUP SUB- GROUP TN’I...hazardous waste. Cost-effectiveness of carbon adsorption is reduced both by the cost of such disposal and by the continuing replacement cost of virgin ...preferential adsorption of component groups . Based on these criteria, two carbon types were selected for continuous flow pilot testing. Groundwater

Automated Low-Cost Smartphone-Based Lateral Flow Saliva Test Reader for Drugs-of-Abuse Detection

PubMed Central

Carrio, Adrian; Sampedro, Carlos; Sanchez-Lopez, Jose Luis; Pimienta, Miguel; Campoy, Pascual

2015-01-01

Lateral flow assay tests are nowadays becoming powerful, low-cost diagnostic tools. Obtaining a result is usually subject to visual interpretation of colored areas on the test by a human operator, introducing subjectivity and the possibility of errors in the extraction of the results. While automated test readers providing a result-consistent solution are widely available, they usually lack portability. In this paper, we present a smartphone-based automated reader for drug-of-abuse lateral flow assay tests, consisting of an inexpensive light box and a smartphone device. Test images captured with the smartphone camera are processed in the device using computer vision and machine learning techniques to perform automatic extraction of the results. A deep validation of the system has been carried out showing the high accuracy of the system. The proposed approach, applicable to any line-based or color-based lateral flow test in the market, effectively reduces the manufacturing costs of the reader and makes it portable and massively available while providing accurate, reliable results. PMID:26610513

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

PubMed Central

2011-01-01

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

Operational response to malaria epidemics: are rapid diagnostic tests cost-effective?

PubMed

Rolland, Estelle; Checchi, Francesco; Pinoges, Loretxu; Balkan, Suna; Guthmann, Jean-Paul; Guerin, Philippe J

2006-04-01

To compare the cost-effectiveness of malaria treatment based on presumptive diagnosis with that of malaria treatment based on rapid diagnostic tests (RDTs). We calculated direct costs (based on experience from Ethiopia and southern Sudan) and effectiveness (in terms of reduced over-treatment) of a free, decentralised treatment programme using artesunate plus amodiaquine (AS + AQ) or artemether-lumefantrine (ART-LUM) in a Plasmodium falciparum epidemic. Our main cost-effectiveness measure was the incremental cost per false positive treatment averted by RDTs. As malaria prevalence increases, the difference in cost between presumptive and RDT-based treatment rises. The threshold prevalence above which the RDT-based strategy becomes more expensive is 21% in the AS + AQ scenario and 55% in the ART-LUM scenario, but these thresholds increase to 58 and 70%, respectively, if the financing body tolerates an incremental cost of 1 euro per false positive averted. However, even at a high (90%) prevalence of malaria consistent with an epidemic peak, an RDT-based strategy would only cost moderately more than the presumptive strategy: +29.9% in the AS + AQ scenario and +19.4% in the ART-LUM scenario. The treatment comparison is insensitive to the age and pregnancy distribution of febrile cases, but is strongly affected by variation in non-biomedical costs. If their unit price were halved, RDTs would be more cost-effective at a malaria prevalence up to 45% in case of AS + AQ treatment and at a prevalence up to 68% in case of ART-LUM treatment. In most epidemic prevalence scenarios, RDTs would considerably reduce over-treatment for only a moderate increase in costs over presumptive diagnosis. A substantial decrease in RDT unit price would greatly increase their cost-effectiveness, and should thus be advocated. A tolerated incremental cost of 1 euro is probably justified given overall public health and financial benefits. The RDTs should be considered for malaria epidemics if logistics and human resources allow.

Application of advanced technologies to small, short-haul aircraft

NASA Technical Reports Server (NTRS)

Andrews, D. G.; Brubaker, P. W.; Bryant, S. L.; Clay, C. W.; Giridharadas, B.; Hamamoto, M.; Kelly, T. J.; Proctor, D. K.; Myron, C. E.; Sullivan, R. L.

1978-01-01

The results of a preliminary design study which investigates the use of selected advanced technologies to achieve low cost design for small (50-passenger), short haul (50 to 1000 mile) transports are reported. The largest single item in the cost of manufacturing an airplane of this type is labor. A careful examination of advanced technology to airframe structure was performed since one of the most labor-intensive parts of the airplane is structures. Also, preliminary investigation of advanced aerodynamics flight controls, ride control and gust load alleviation systems, aircraft systems and turbo-prop propulsion systems was performed. The most beneficial advanced technology examined was bonded aluminum primary structure. The use of this structure in large wing panels and body sections resulted in a greatly reduced number of parts and fasteners and therefore, labor hours. The resultant cost of assembled airplane structure was reduced by 40% and the total airplane manufacturing cost by 16% - a major cost reduction. With further development, test verification and optimization appreciable weight saving is also achievable. Other advanced technology items which showed significant gains are as follows: (1) advanced turboprop-reduced block fuel by 15.30% depending on range; (2) configuration revisions (vee-tail)-empennage cost reduction of 25%; (3) leading-edge flap addition-weight reduction of 2500 pounds.

Decision Models for Determining the Optimal Life Test Sampling Plans

NASA Astrophysics Data System (ADS)

Nechval, Nicholas A.; Nechval, Konstantin N.; Purgailis, Maris; Berzins, Gundars; Strelchonok, Vladimir F.

2010-11-01

Life test sampling plan is a technique, which consists of sampling, inspection, and decision making in determining the acceptance or rejection of a batch of products by experiments for examining the continuous usage time of the products. In life testing studies, the lifetime is usually assumed to be distributed as either a one-parameter exponential distribution, or a two-parameter Weibull distribution with the assumption that the shape parameter is known. Such oversimplified assumptions can facilitate the follow-up analyses, but may overlook the fact that the lifetime distribution can significantly affect the estimation of the failure rate of a product. Moreover, sampling costs, inspection costs, warranty costs, and rejection costs are all essential, and ought to be considered in choosing an appropriate sampling plan. The choice of an appropriate life test sampling plan is a crucial decision problem because a good plan not only can help producers save testing time, and reduce testing cost; but it also can positively affect the image of the product, and thus attract more consumers to buy it. This paper develops the frequentist (non-Bayesian) decision models for determining the optimal life test sampling plans with an aim of cost minimization by identifying the appropriate number of product failures in a sample that should be used as a threshold in judging the rejection of a batch. The two-parameter exponential and Weibull distributions with two unknown parameters are assumed to be appropriate for modelling the lifetime of a product. A practical numerical application is employed to demonstrate the proposed approach.

Point-of-care CD4 testing to inform selection of antiretroviral medications in south african antenatal clinics: a cost-effectiveness analysis.

PubMed

Ciaranello, Andrea L; Myer, Landon; Kelly, Kathleen; Christensen, Sarah; Daskilewicz, Kristen; Doherty, Katie; Bekker, Linda-Gail; Hou, Taige; Wood, Robin; Francke, Jordan A; Wools-Kaloustian, Kara; Freedberg, Kenneth A; Walensky, Rochelle P

2015-01-01

Many prevention of mother-to-child HIV transmission (PMTCT) programs currently prioritize antiretroviral therapy (ART) for women with advanced HIV. Point-of-care (POC) CD4 assays may expedite the selection of three-drug ART instead of zidovudine, but are costlier than traditional laboratory assays. We used validated models of HIV infection to simulate pregnant, HIV-infected women (mean age 26 years, gestational age 26 weeks) in a general antenatal clinic in South Africa, and their infants. We examined two strategies for CD4 testing after HIV diagnosis: laboratory (test rate: 96%, result-return rate: 87%, cost: $14) and POC (test rate: 99%, result-return rate: 95%, cost: $26). We modeled South African PMTCT guidelines during the study period (WHO "Option A"): antenatal zidovudine (CD4 ≤350/μL) or ART (CD4>350/μL). Outcomes included MTCT risk at weaning (age 6 months), maternal and pediatric life expectancy (LE), maternal and pediatric lifetime healthcare costs (2013 USD), and cost-effectiveness ($/life-year saved). In the base case, laboratory led to projected MTCT risks of 5.7%, undiscounted pediatric LE of 53.2 years, and undiscounted PMTCT plus pediatric lifetime costs of $1,070/infant. POC led to lower modeled MTCT risk (5.3%), greater pediatric LE (53.4 years) and lower PMTCT plus pediatric lifetime costs ($1,040/infant). Maternal outcomes following laboratory were similar to POC (LE: 21.2 years; lifetime costs: $23,860/person). Compared to laboratory, POC improved clinical outcomes and reduced healthcare costs. In antenatal clinics implementing Option A, the higher initial cost of a one-time POC CD4 assay will be offset by cost-savings from prevention of pediatric HIV infection.

Equipment for testing automotive lead/acid batteries under SAE J240a conditions

NASA Astrophysics Data System (ADS)

Hamilton, J. A.; Rand, D. A. J.

Battery cycling equipment has been designed and constructed to test lead/acid batteries according to the American Society of Automotive Engineers' (SAE) J240a Standard. This life test simulates automotive service where the battery operates in a voltage-regulated charging system. The CSIRO design uses a master/slave concept to reduce both construction time and cost.

Accelerated test program for sealed nickel-cadmium spacecraft batteries/cells

NASA Technical Reports Server (NTRS)

Goodman, L. A.

1976-01-01

The feasibility was examined of inducing an accelerated test on sealed Nickel-Cadmium batteries or cells as a tool for spacecraft projects and battery users to determine: (1) the prediction of life capability; (2) a method of evaluating the effect of design and component changes in cells; and (3) a means of reducing time and cost of cell testing.

Introducing a Model for Optimal Design of Sequential Objective Structured Clinical Examinations

ERIC Educational Resources Information Center

Mortaz Hejri, Sara; Yazdani, Kamran; Labaf, Ali; Norcini, John J.; Jalili, Mohammad

2016-01-01

In a sequential OSCE which has been suggested to reduce testing costs, candidates take a short screening test and who fail the test, are asked to take the full OSCE. In order to introduce an effective and accurate sequential design, we developed a model for designing and evaluating screening OSCEs. Based on two datasets from a 10-station…

Estimation of stress distribution in ferromagnetic tensile specimens using low cost eddy current stress measurement system and BP neural network.

PubMed

Li, Jianwei; Zhang, Weimin; Zeng, Weiqin; Chen, Guolong; Qiu, Zhongchao; Cao, Xinyuan; Gao, Xuanyi

2017-01-01

Estimation of the stress distribution in ferromagnetic components is very important for evaluating the working status of mechanical equipment and implementing preventive maintenance. Eddy current testing technology is a promising method in this field because of its advantages of safety, no need of coupling agent, etc. In order to reduce the cost of eddy current stress measurement system, and obtain the stress distribution in ferromagnetic materials without scanning, a low cost eddy current stress measurement system based on Archimedes spiral planar coil was established, and a method based on BP neural network to obtain the stress distribution using the stress of several discrete test points was proposed. To verify the performance of the developed test system and the validity of the proposed method, experiment was implemented using structural steel (Q235) specimens. Standard curves of sensors at each test point were achieved, the calibrated data were used to establish the BP neural network model for approximating the stress variation on the specimen surface, and the stress distribution curve of the specimen was obtained by interpolating with the established model. The results show that there is a good linear relationship between the change of signal modulus and the stress in most elastic range of the specimen, and the established system can detect the change in stress with a theoretical average sensitivity of -0.4228 mV/MPa. The obtained stress distribution curve is well consonant with the theoretical analysis result. At last, possible causes and improving methods of problems appeared in the results were discussed. This research has important significance for reducing the cost of eddy current stress measurement system, and advancing the engineering application of eddy current stress testing.

Estimation of stress distribution in ferromagnetic tensile specimens using low cost eddy current stress measurement system and BP neural network

PubMed Central

Li, Jianwei; Zeng, Weiqin; Chen, Guolong; Qiu, Zhongchao; Cao, Xinyuan; Gao, Xuanyi

2017-01-01

Estimation of the stress distribution in ferromagnetic components is very important for evaluating the working status of mechanical equipment and implementing preventive maintenance. Eddy current testing technology is a promising method in this field because of its advantages of safety, no need of coupling agent, etc. In order to reduce the cost of eddy current stress measurement system, and obtain the stress distribution in ferromagnetic materials without scanning, a low cost eddy current stress measurement system based on Archimedes spiral planar coil was established, and a method based on BP neural network to obtain the stress distribution using the stress of several discrete test points was proposed. To verify the performance of the developed test system and the validity of the proposed method, experiment was implemented using structural steel (Q235) specimens. Standard curves of sensors at each test point were achieved, the calibrated data were used to establish the BP neural network model for approximating the stress variation on the specimen surface, and the stress distribution curve of the specimen was obtained by interpolating with the established model. The results show that there is a good linear relationship between the change of signal modulus and the stress in most elastic range of the specimen, and the established system can detect the change in stress with a theoretical average sensitivity of -0.4228 mV/MPa. The obtained stress distribution curve is well consonant with the theoretical analysis result. At last, possible causes and improving methods of problems appeared in the results were discussed. This research has important significance for reducing the cost of eddy current stress measurement system, and advancing the engineering application of eddy current stress testing. PMID:29145500

A simple and cost-effective molecular diagnostic system and DNA probes synthesized by light emitting diode photolithography

NASA Astrophysics Data System (ADS)

Oleksandrov, Sergiy; Kwon, Jung Ho; Lee, Ki-chang; Sujin-Ku; Paek, Mun Cheol

2014-09-01

This work introduces a novel chip to be used in the future as a simple and cost-effective method for creating DNA arrays using light emission diode (LED) photolithography. The DNA chip platform contains 24 independent reaction sites, which allows for the testing of a corresponding amount of patients' samples in hospital. An array of commercial UV LEDs and lens systems was combined with a microfluidic flow system to provide patterning of 24 individual reaction sites, each with 64 independent probes. Using the LED array instead of conventional laser exposure systems or micro-mirror systems significantly reduces the cost of equipment. The microfluidic system together with microfluidic flow cells drastically reduces the amount of used reagents, which is important due to the high cost of commercial reagents. The DNA synthesis efficiency was verified by fluorescence labeling and conventional hybridization.

The importance of operations, risk, and cost assessment to space transfer systems design

NASA Technical Reports Server (NTRS)

Ball, J. M.; Komerska, R. J.; Rowell, L. F.

1992-01-01

This paper examines several methodologies which contribute to comprehensive subsystem cost estimation. The example of a space-based lunar space transfer vehicle (STV) design is used to illustrate how including both primary and secondary factors into cost affects the decision of whether to use aerobraking or propulsion for earth orbit capture upon lunar return. The expected dominant cost factor in this decision is earth-to-orbit launch cost driven by STV mass. However, to quantify other significant cost factors, this cost comparison included a risk analysis to identify development and testing costs, a Taguchi design of experiments to determine a minimum mass aerobrake design, and a detailed operations analysis. As a result, the predicted cost advantage of aerobraking, while still positive, was subsequently reduced by about 30 percent compared to the simpler mass-based cost estimates.

Higher levels of knowledge reduce health care costs in patients with inflammatory bowel disease.

PubMed

Colombara, Federica; Martinato, Matteo; Girardin, Giulia; Gregori, Dario

2015-03-01

The potentially high costs of care associated with inflammatory bowel disease are recognized. A knowledge-based self-management approach seems to reduce health care costs, improve disease control, and reduce indirect costs. The aim of this study was to determine whether there is a significant association between patient knowledge and health care costs. Patients diagnosed with inflammatory bowel disease, Crohn's disease (CD), ulcerative colitis, or indeterminate colitis, in 2010 to 2011 were included. Direct costs were investigated for each patient, including costs of blood tests, procedures, medications, hospitalization, and visits. Specific prices were reported according to the hospital billing database for 2010. For medical and surgical hospital admissions, DRG 19 prices were reported. A validated questionnaire (CCKNOW) was used to assess disease-related knowledge. Ninety-one patients (38 men), mean age 47 years (range, 33-63 yr) were studied (14 indeterminate colitis, 33 CD, and 44 ulcerative colitis). Median cost for patients is higher in CD (&OV0556;4099.02). The mean overall CCKNOW score was 8.00 (8.50 for indeterminate colitis, 7.50 for CD, and 7.50 for ulcerative colitis). An increase of 5 points on the CCKNOW corresponds to a cost decrease of &OV0556;1099.53 in the first year of disease. Higher levels of knowledge were shown to be associated with significantly lower health care costs. The data suggest that better information could lead to better choices and improved outcomes; thus, patient information and education is a key priority for managing patients with inflammatory bowel disease, perhaps planning structured and formal patient education programs in the future.

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

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

Alvarado, J. S.

1998-06-11

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

Automotive Stirling Engine Development Program

NASA Technical Reports Server (NTRS)

Nightingale, N.; Ernst, W.; Richey, A.; Simetkosky, M.; Smith, G.; Antonelli, M. (Editor)

1983-01-01

Mod I engine testing and test results, the test of a Mod I engine in the United States, Mod I engine characterization and analysis, Mod I Transient Test Bed fuel economy, Mod I-A engine performance are discussed. Stirling engine reference engine manufacturing and reduced size studies, components and subsystems, and the study and test of low-cost casting alloys are also covered. The overall program philosophy is outlined, and data and results are presented.

Handheld ultrasound versus physical examination in patients referred for transthoracic echocardiography for a suspected cardiac condition.

PubMed

Mehta, Manish; Jacobson, Timothy; Peters, Dawn; Le, Elizabeth; Chadderdon, Scott; Allen, Allison J; Caughey, Aaron B; Kaul, Sanjiv

2014-10-01

The purpose of this study was to test the hypothesis that handheld ultrasound (HHU) provides a more accurate diagnosis than physical examination in patients with suspected cardiovascular abnormalities and that its use thus reduces additional testing and overall costs. Despite the limitations of physical examination and the demonstrated superiority of HHU for detecting cardiac abnormalities, it is not routinely used for the bedside diagnosis of cardiac conditions. Patients referred for a standard echocardiogram for common indications (cardiac function, murmur, stroke, arrhythmias, and miscellaneous) underwent physical examination and HHU by different cardiologists, who filled out a form that also included suggestions for additional testing, if necessary, based on their findings. Of 250 patients, 142 had an abnormal finding on standard echocardiogram. Of these, HHU correctly identified 117 patients (82%), and physical examination correctly identified 67 (47%, p < 0.0001). HHU was superior to physical examination (p < 0.0001) for both normal and abnormal cardiac function. It was also superior to physical examination in correctly identifying the presence of substantial valve disease (71% vs. 31%, p = 0.0003) and in identifying miscellaneous findings (47% vs. 3%, p < 0.0001). Of 108 patients without any abnormalities on standard echocardiography, further testing was suggested for 89 (82%) undergoing physical examination versus only 60 (56%) undergoing HHU (p < 0.0001). Cost modeling showed that HHU had an average cost of $644.43 versus an average cost of $707.44 for physical examination. This yielded a savings of $63.01 per patient when HHU was used versus physical examination. When used by cardiologists, HHU provides a more accurate diagnosis than physical examination for the majority of common cardiovascular abnormalities. The finding of no significant abnormality on HHU is also likely to result in less downstream testing and thus potentially reduce the overall cost for patients being evaluated for a cardiovascular diagnosis. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Improving health care, Part 4: Concepts for improving any clinical process.

PubMed

Batalden, P B; Mohr, J J; Nelson, E C; Plume, S K

1996-10-01

One promising method for streamlining the generation of "good ideas" is to formulate what are sometimes called change concepts-general notions or approaches to change found useful in developing specific ideas for changes that lead to improvement. For example, in current efforts to reduce health care costs by discounting provider charges, the underlying generic concept is "reducing health care costs," and the specific idea is "discounting provider charges." Short-term gains in health care cost reduction can occur by pursuing discounts. After some time, however, limits to such reduction in costs are experienced. Persevering and continuing to travel down the "discounting provider charges" path is less likely to produce further substantial improvement than returning to the basic concept of "reducing health care costs." An interdisciplinary team aiming to reduce costs while improving quality of care for patients in need of hip joint replacement generated ideas for changing "what's done (process) to get better results." After team members wrote down their improvement ideas, they deduced the underlying change concepts and used them to generate even more ideas for improvement. Such change concepts include reordering the sequence of steps (preadmission physical therapy "certification"), eliminating failures at hand-offs between steps (transfer of information from physician's office to hospital), and eliminating a step (epidural pain control). Learning about making change, encouraging change, managing the change within and across organizations, and learning from the changes tested will characterize the sustainable, thriving health systems of the future.

Cost and Efficacy Assessment of an Alternative Medication Compliance Urine Drug Testing Strategy.

PubMed

Doyle, Kelly; Strathmann, Frederick G

2017-02-01

This study investigates the frequency at which quantitative results provide additional clinical benefit compared to qualitative results alone. A comparison between alternative urine drug screens and conventional screens including the assessment of cost-to-payer differences, accuracy of prescription compliance or polypharmacy/substance abuse was also included. In a reference laboratory evaluation of urine specimens from across the United States, 213 urine specimens with provided prescription medication information (302 prescriptions) were analyzed by two testing algorithms: 1) conventional immunoassay screen with subsequent reflexive testing of positive results by quantitative mass spectrometry; and 2) a combined immunoassay/qualitative mass-spectrometry screen that substantially reduced the need for subsequent testing. The qualitative screen was superior to immunoassay with reflex to mass spectrometry in confirming compliance per prescription (226/302 vs 205/302), and identifying non-prescription abuse (97 vs 71). Pharmaceutical impurities and inconsistent drug metabolite patterns were detected in only 3.8% of specimens, suggesting that quantitative results have limited benefit. The percentage difference between the conventional testing algorithm and the alternative screen was projected to be 55%, and a 2-year evaluation of test utilization as a measure of test order volume follows an exponential trend for alternative screen test orders over conventional immunoassay screens that require subsequent confirmation testing. Alternative, qualitative urine drug screens provide a less expensive, faster, and more comprehensive evaluation of patient medication compliance and drug abuse. The vast majority of results were interpretable with qualitative results alone indicating a reduced need to automatically reflex to quantitation or provide quantitation for the majority of patients. This strategy highlights a successful approach using an alternative strategy for both the laboratory and physician to align clinical needs while being mindful of costs.

Rotational Thromboelastometry or Conventional Coagulation Tests in Liver Transplantation: Comparing Blood Loss, Transfusions, and Cost.

PubMed

Smart, Laura; Mumtaz, Khalid; Scharpf, Danielle; Gray, Nicole O'Bleness; Traetow, Daniel; Black, Sylvester; Michaels, Anthony J; Elkhammas, Elmahdi; Kirkpatrick, Robert; Hanje, A James

Orthotopic liver transplantation (OLT) can be associated with significant bleeding requiring multiple blood product transfusions. Rotational thromboelastometry (ROTEM) is a point-of-care device that has been used to monitor coagulation during OLT. Whether it reduces blood loss/transfusions during OLT remains controversial. We aim to compare ROTEM with conventional coagulation tests (aPTT, PT, INR, platelet count, fibrinogen) to guide transfusion of platelets, cryoprecipitate, and fresh frozen plasma (FFP) during OLT over 3 years. Thirty-four patients who had transfusions guided by ROTEM were compared to 34 controls who received transfusions guided by conventional coagulation tests (CCT). Intraoperative blood loss, type/ amount of blood products transfused, and direct costs were compared between the two groups. The ROTEM group had significantly less intra-operative blood loss (2.0 vs. 3.0 L, p = 0.04) and fresh frozen plasma (FFP) transfusion (4 units vs. 6.5 units, p = 0.015) compared to the CCT group (2.0L vs. 3.0L, p = 0.04). However, total number of patients transfused cryoprecipitate was increased in ROTEM (n = 25;73%) as compared to CCT (n = 19; 56%), p = 0.033. The direct cost of blood products plus testing was reduced in the ROTEM group ($113,142.89 vs. $127,814.77). In conclusion implementation of a ROTEM-guided transfusion algorithm resulted in a reduction in intra-operative blood loss, FFP transfusion and a decrease in direct cost during OLT. ROTEM is a useful and safe point of care device in OLT setting.

Payer view of personalized medicine.

PubMed

Pezalla, Edmund J

2016-12-01

The process and methods used by payers when evaluating coverage of personalized medicine testing are described. Personalized medicine encompasses a number of diagnostic tools that measure drug metabolism, genetic risk for disease development, and tumor type or markers that can guide oncology treatments. However, whole genome testing, tumor marker testing, and testing for drug metabolism are additional costs to the healthcare system. In order to justify these costs, payers and health technology assessment bodies must evaluate the individual tests or groups of tests on their own merits. In order for a test to be covered by payers, test developers must demonstrate clinical utility as measured by improved outcomes or well-informed decision-making. In the United States, payers generally focus on clinical benefit to individual patients and benefits to the healthcare system. Clinical benefits include improved outcomes. Benefits to the healthcare system are generally considered to be cost offsets, which may be due to reductions in the use of unnecessary interventions or to more efficient use of resources. Provider organizations have been assuming more responsibility and liability for healthcare costs through various risk arrangements, including accountable care organizations and patient-centered medical homes. Diagnostic tests that increase efficiency, reduce unnecessary interventions, and improve outcomes will be chosen by specialists in provider organizations. For personalized medicine approaches to be adopted and covered by health plans, the methods must be shown to be analytically and clinically valid and provide clinical utility at a reasonable level of cost-effectiveness to payers. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

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

PubMed

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

2017-01-01

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

Delimbing hybrid poplar prior to processing with a flail/chipper

Treesearch

Bruce Hartsough; Raffaele Spinelli; Steve Pottle

2000-01-01

We compared the performance of a flail/chipper for processing a) whole poplar trees and b) poplar trees that had been roughly delimbed with a pull-through delimber. Production rate was about 10% higher for the delimbed trees. The reduced cost of flail/chipping would not cover the additional cost of delimbing with the machine mix tested, but changes to equipment might...

Flight Software Implementation of the Beacon Monitor Expreiment On the NASA New Millennium Deep Space 1 (DS-1) Mission

NASA Technical Reports Server (NTRS)

Foster, R.; Schlutsmeyer, A.

1997-01-01

A new technology that can lower the cost of mission operations on future spacecraft will be tested on the NASA New Millennium Deep Space 1 (DS-1) Mission. This technology, the Beacon Monitor Experiment (BMOX), can be used to reduce the Deep Space Network (DSN) tracking time and its associated costs on future missions.

Risk/Requirements Trade-off Guidelines for Low Cost Satellite Systems

NASA Technical Reports Server (NTRS)

Cornford, Steven L.; Man, Kin F.

1996-01-01

The accelerating trend toward faster, better, cheaper missions places increasing emphasis on the trade-offs between requirements and risk to reduce cost and development times, while still improving quality and reliability. The Risk/Requirement Trade-off Guidelines discussed in this paper are part of an integrated approach to address the main issues by focusing on the sum of prevention, analysis, control, or test (PACT) processes.

COMMERCIALIZATION OF AN ATMOSPHERIC IRON-BASED CDCL PROCESS FOR POWER PRODUCTION. PHASE I: TECHNOECONOMIC ANALYSIS

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

Vargas, Luis

Coal Direct Chemical Looping (CDCL) is an advanced oxy-combustion technology that has potential to enable substantial reductions in the cost and energy penalty associated with carbon dioxide (CO2) capture from coal-fired power plants. Through collaborative efforts, the Babcock & Wilcox Power Generation Group (B&W) and The Ohio State University (OSU) developed a conceptual design for a 550 MWe (net) supercritical CDCL power plant with greater than 90% CO2 capture and compression. Process simulations were completed to enable an initial assessment of its technical performance. A cost estimate was developed following DOE’s guidelines as outlined in NETL’s report “Quality Guidelines formore » Energy System Studies: Cost Estimation Methodology for NETL Assessments of Power Plant Performance”, (2011/1455). The cost of electricity for the CDCL plant without CO2 Transportation and Storage cost resulted in $ $102.67 per MWh, which corresponds to a 26.8 % increase in cost of electricity (COE) when compared to an air-fired pulverized-coal supercritical power plant. The cost of electricity is strongly depending on the total plant cost and cost of the oxygen carrier particles. The CDCL process could capture further potential savings by increasing the performance of the particles and reducing the plant size. During the techno-economic analysis, the team identified technology and engineering gaps that need to be closed to bring the technology to commercialization. The technology gaps were focused in five critical areas: (i) moving bed reducer reactor, (ii) fluidized bed combustor, (iii) particle riser, (iv) oxygen-carrier particle properties, and (v) process operation. The key technology gaps are related to particle performance, particle manufacturing cost, and the operation of the reducer reactor. These technology gaps are to be addressed during Phase II of project. The project team is proposing additional lab testing to be completed on the particle and a 3MWth pilot facility be built to evaluate the reducer reactor performance among other aspects of the technology. A Phase II proposal was prepared and submitted to DOE. The project team proposed a three year program in Phase II. Year 1 includes lab testing and particle development work aimed at improving the chemical and mechanical properties of the oxygen carrier particle. In parallel, B&W will design the 3MWt pilot plant. Any improvements to the particle performance discovered in year 1 that would impact the design of the pilot will be incorporated into the final design. Year 2 will focus on procurement of materials and equipment, and construction of the pilot plant. Year 3 will include, commissioning, start-up, and testing in the pilot. Phase I work was successfully completed and a design and operating philosophy for a 550 MWe commercial scale coal-direct chemical looping power plant was developed. Based on the results of the techno-economic evaluation, B&W projects that the CDCL process can achieve 96.5% CO2 capture with a« less

Iodine Propulsion Advantages for Low Cost Mission Applications and the Iodine Satellite (ISAT) Technology Demonstration

NASA Technical Reports Server (NTRS)

Dankanich, John W.; Schumacher, Daniel M.

2015-01-01

The NASA Marshall Space Flight Center Science and Technology Office is continuously exploring technology options to increase performance or reduce cost and risk to future NASA missions including science and exploration. Electric propulsion is a prevalent technology known to reduce mission costs by reduction in launch costs and spacecraft mass through increased post launch propulsion performance. The exploration of alternative propellants for electric propulsion continues to be of interest to the community. Iodine testing has demonstrated comparable performance to xenon. However, iodine has a higher storage density resulting in higher ?V capability for volume constrained systems. Iodine's unique properties also allow for unpressurized storage yet sublimation with minimal power requirements to produce required gas flow rates. These characteristics make iodine an ideal propellant for secondary spacecraft. A range of mission have been evaluated with a focus on low-cost applications. Results highlight the potential for significant cost reduction over state of the art. Based on the potential, NASA has been developing the iodine Satellite for a near-term iodine Hall propulsion technology demonstration. Mission applications and progress of the iodine Satellite project are presented.

The Milieu Manager: A Nursing Staffing Strategy to Reduce Observer Use in the Acute Psychiatric Inpatient Setting.

PubMed

Triplett, Patrick; Dearholt, Sandra; Cooper, Mary; Herzke, John; Johnson, Erin; Parks, Joyce; Sullivan, Patricia; Taylor, Karin F; Rohde, Judith

Rising acuity levels in inpatient settings have led to growing reliance on observers and increased the cost of care. Minimizing use of observers, maintaining quality and safety of care, and improving bed access, without increasing cost. Nursing staff on two inpatient psychiatric units at an academic medical center pilot-tested the use of a "milieu manager" to address rising patient acuity and growing reliance on observers. Nursing cost, occupancy, discharge volume, unit closures, observer expense, and incremental nursing costs were tracked. Staff satisfaction and reported patient behavioral/safety events were assessed. The pilot initiatives ran for 8 months. Unit/bed closures fell to zero on both units. Occupancy, patient days, and discharges increased. Incremental nursing cost was offset by reduction in observer expense and by revenue from increases in occupancy and patient days. Staff work satisfaction improved and measures of patient safety were unchanged. The intervention was effective in reducing observation expense and improved occupancy and patient days while maintaining patient safety, representing a cost-effective and safe approach for management of acuity on inpatient psychiatric units.

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

PubMed

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

2018-02-07

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

Array automated assembly task, phase 2. Low cost silicon solar array project

NASA Technical Reports Server (NTRS)

Rhee, S. S.; Jones, G. T.; Allison, K. T.

1978-01-01

Several modifications instituted in the wafer surface preparation process served to significantly reduce the process cost to 1.55 cents per peak watt in 1975 cents. Performance verification tests of a laser scanning system showed a limited capability to detect hidden cracks or defects, but with potential equipment modifications this cost effective system could be rendered suitable for applications. Installation of electroless nickel plating system was completed along with an optimization of the wafer plating process. The solder coating and flux removal process verification test was completed. An optimum temperature range of 500-550 C was found to produce uniform solder coating with the restriction that a modified dipping procedure is utilized. Finally, the construction of the spray-on dopant equipment was completed.

Cost-effectiveness of precision medicine in the fourth-line treatment of metastatic lung adenocarcinoma: An early decision analytic model of multiplex targeted sequencing.

PubMed

Doble, Brett; John, Thomas; Thomas, David; Fellowes, Andrew; Fox, Stephen; Lorgelly, Paula

2017-05-01

To identify parameters that drive the cost-effectiveness of precision medicine by comparing the use of multiplex targeted sequencing (MTS) to select targeted therapy based on tumour genomic profiles to either no further testing with chemotherapy or no further testing with best supportive care in the fourth-line treatment of metastatic lung adenocarcinoma. A combined decision tree and Markov model to compare costs, life-years, and quality-adjusted life-years over a ten-year time horizon from an Australian healthcare payer perspective. Data sources included the published literature and a population-based molecular cohort study (Cancer 2015). Uncertainty was assessed using deterministic sensitivity analyses and quantified by estimating expected value of perfect/partial perfect information. Uncertainty due to technological/scientific advancement was assessed through a number of plausible future scenario analyses. Point estimate incremental cost-effective ratios indicate that MTS is not cost-effective for selecting fourth-line treatment of metastatic lung adenocarcinoma. Lower mortality rates during testing and for true positive patients, lower health state utility values for progressive disease, and targeted therapy resulting in reductions in inpatient visits, however, all resulted in more favourable cost-effectiveness estimates for MTS. The expected value to decision makers of removing all current decision uncertainty was estimated to be between AUD 5,962,843 and AUD 13,196,451, indicating that additional research to reduce uncertainty may be a worthwhile investment. Plausible future scenarios analyses revealed limited improvements in cost-effectiveness under scenarios of improved test performance, decreased costs of testing/interpretation, and no biopsy costs/adverse events. Reductions in off-label targeted therapy costs, when considered together with the other scenarios did, however, indicate more favourable cost-effectiveness of MTS. As more clinical evidence is generated for MTS, the model developed should be revisited and cost-effectiveness re-estimated under different testing scenarios to further understand the value of precision medicine and its potential impact on the overall health budget. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Magnetic suspension and balance system advanced study

NASA Technical Reports Server (NTRS)

Boom, R. W.; Eyssa, Y. M.; Mcintosh, G. E.; Abdelsalam, M. K.

1985-01-01

An improved compact design for a superconducting magnetic suspension and balance system for an 8 ft. x 8 ft. transonic wind tunnel is developed. The original design of an MSBS in NASA Cr-3802 utilized 14 external superconductive coils and a superconductive solenoid in the airplane test model suspended in a wind tunnel. The improvements are in the following areas: test model solenoid options, dynamic force limits on the model, magnet cooling options, structure and cryogenic designs, power supply specifications, and cost and performance evaluations. The improvements are: MSBS cost reduction of 28%, weight; reduction of 43%, magnet system ampere-meter reduction of 38%, helium liquifier capacity reduction by 33%, magnet system stored energy reduction by 55%, AC loss to liquid helium reduced by 76%, system power supply reduced by 68%, test coil pole strength increased by 19%, wing magnetization increased by 40%, and control frequency limit increased by 200% from 10 Hz to 30 Hz. The improvements are due to: magnetic holmium coil forms in the test model, better rare earth permanent magnets in the wings, fiberglass-epoxy structure replacing stainless steel, better coil configuration, and new saddle roll coil design.

The price of performance: a cost and performance analysis of the implementation of cell-free fetal DNA testing for Down syndrome in Ontario, Canada.

PubMed

Okun, N; Teitelbaum, M; Huang, T; Dewa, C S; Hoch, J S

2014-04-01

To examine the cost and performance implications of introducing cell-free fetal DNA (cffDNA) testing within modeled scenarios in a publicly funded Canadian provincial Down syndrome (DS) prenatal screening program. Two clinical algorithms were created: the first to represent the current screening program and the second to represent one that incorporates cffDNA testing. From these algorithms, eight distinct scenarios were modeled to examine: (1) the current program (no cffDNA), (2) the current program with first trimester screening (FTS) as the nuchal translucency-based primary screen (no cffDNA), (3) a program substituting current screening with primary cffDNA, (4) contingent cffDNA with current FTS performance, (5) contingent cffDNA at a fixed price to result in overall cost neutrality,(6) contingent cffDNA with an improved detection rate (DR) of FTS, (7) contingent cffDNA with higher uptake of FTS, and (8) contingent cffDNA with optimized FTS (higher uptake and improved DR). This modeling study demonstrates that introducing contingent cffDNA testing improves performance by increasing the number of cases of DS detected prenatally, and reducing the number of amniocenteses performed and concomitant iatrogenic pregnancy loss of pregnancies not affected by DS. Costs are modestly increased, although the cost per case of DS detected is decreased with contingent cffDNA testing. Contingent models of cffDNA testing can improve overall screening performance while maintaining the provision of an 11- to 13-week scan. Costs are modestly increased, but cost per prenatally detected case of DS is decreased. © 2013 John Wiley & Sons, Ltd.

Cost-effectiveness of cervical cancer screening in women living with HIV in South Africa: A mathematical modeling study.

PubMed

Campos, Nicole G; Lince-Deroche, Naomi; Chibwesha, Carla J; Firnhaber, Cynthia; Smith, Jennifer S; Michelow, Pam; Meyer-Rath, Gesine; Jamieson, Lise; Jordaan, Suzette; Sharma, Monisha; Regan, Catherine; Sy, Stephen; Liu, Gui; Tsu, Vivien; Jeronimo, Jose; Kim, Jane J

2018-06-15

Women with HIV face an increased risk of human papillomavirus (HPV) acquisition and persistence, cervical intraepithelial neoplasia, and invasive cervical cancer. Our objective was to determine the cost-effectiveness of different cervical cancer screening strategies among women with HIV in South Africa. We modified a mathematical model of HPV infection and cervical disease to reflect co-infection with HIV. The model was calibrated to epidemiologic data from HIV-infected women in South Africa. Clinical and economic data were drawn from in-country data sources. The model was used to project reductions in the lifetime risk of cervical cancer and incremental cost-effectiveness ratios (ICERs) of Pap and HPV DNA screening and management algorithms beginning at HIV diagnosis, at one-, two-, or three-year intervals. Strategies with an ICER below South Africa's 2016 per capita GDP (US$5,270) were considered 'cost-effective.' HPV testing followed by treatment (test-and-treat) at two-year intervals was the most effective strategy that was also cost-effective, reducing lifetime cancer risk by 56·6% with an ICER of US$3,010 per year of life saved (YLS). Other cost-effective strategies included Pap (referral threshold: HSIL+) at one-, two-, and three-year intervals, and HPV test-and-treat at three-year intervals. Pap (ASCUS+), HPV testing with 16/18 genotyping, and HPV testing with Pap or visual triage of HPV-positive women were less effective and more costly than alternatives. Considering per capita GDP as the benchmark for cost-effectiveness, HPV test-and-treat is optimal in South Africa. At lower cost-effectiveness benchmarks, Pap (HSIL+) would be optimal.This is an open access article distributed under the terms of the Creative Commons Attribution License 4.0 (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Greater Real-Life Diagnostic Efficacy of Allergen Molecule-Based Diagnosis for Prescription of Immunotherapy in an Area with Multiple Pollen Exposure.

PubMed

Saltabayeva, Ulbosin; Garib, Victoria; Morenko, Marina; Rosenson, Rafail; Ispayeva, Zhanat; Gatauova, Madina; Zulus, Loreta; Karaulov, Alexander; Gastager, Felix; Valenta, Rudolf

2017-01-01

Allergen molecule-based diagnosis has been suggested to facilitate the identification of disease-causing allergen sources and the prescription of allergen-specific immunotherapy (AIT). The aim of the current study was to compare allergen molecule-based IgE serology with allergen extract-based skin testing for the identification of the disease-causing allergen sources. The study was conducted in an area where patients are exposed to pollen from multiple sources (trees, grasses, and weeds) at the same time to compare the diagnostic efficiency of the 2 forms of diagnosis. Patients from Astana, Kazakhstan, who suffered from pollen-induced allergy (n = 95) were subjected to skin prick testing (SPT) with a local panel of tree pollen, grass pollen, and weed pollen allergen extracts and IgE antibodies specific for marker allergen molecules (nArt v 1, nArt v 3, rAmb a 1, rPhl p 1, rPhl p 5, rBet v 1) were measured by ImmunoCAP. Direct and indirect costs for diagnosis based on SPT and marker allergen-based IgE serology as well as direct costs for immunotherapy depending on SPT and serological test results were calculated. The costs for SPT-based diagnosis per patient were lower than the costs for allergen molecule-based IgE serology. However, allergen molecule-based serology was more precise in detecting the disease-causing allergen sources. A lower number of immunotherapy treatments (n = 119) was needed according to molecular diagnosis as compared to extract-based diagnosis (n = 275), which considerably reduced the total costs for diagnosis and for a 3-year treatment from EUR 1,112.30 to 521.77 per patient. The results from this real-life study show that SPT is less expensive than allergen molecule-based diagnostic testing, but molecular diagnosis allowed more precise prescription of immunotherapy which substantially reduced treatment costs and combined costs for diagnosis and treatment. © 2017 The Author(s) Published by S. Karger AG, Basel.

Provider-directed imaging stress testing reduces health care expenditures in lower-risk chest pain patients presenting to the emergency department.

PubMed

Miller, Chadwick D; Hoekstra, James W; Lefebvre, Cedric; Blumstein, Howard; Hamilton, Craig A; Harper, Erin N; Mahler, Simon; Diercks, Deborah B; Neiberg, Rebecca; Hundley, W Gregory

2012-01-01

Among intermediate- to high-risk patients with chest pain, we have shown that a cardiac magnetic resonance (CMR) stress test strategy implemented in an observation unit (OU) reduces 1-year health care costs compared with inpatient care. In this study, we compare 2 OU strategies to determine among lower-risk patients if a mandatory CMR stress test strategy was more effective than a physicians' ability to select a stress test modality. On emergency department arrival and referral to the OU for management of low- to intermediate-risk chest pain, 120 individuals were randomly assigned to receive (1) a CMR stress imaging test (n=60) or (2) a provider-selected stress test (n=60: stress echo [62%], CMR [32%], cardiac catheterization [3%], nuclear [2%], and coronary CT [2%]). No differences were detected in length of stay (median CMR=24.2 hours versus 23.8 hours, P=0.75), catheterization without revascularization (CMR=0% versus 3%), appropriateness of admission decisions (CMR 87% versus 93%, P=0.36), or 30-day acute coronary syndrome (both 3%). Median cost was higher among those randomly assigned to the CMR-mandated group ($2005 versus $1686, P<0.001). In patients with lower-risk chest pain receiving emergency department-directed OU care, the ability of a physician to select a cardiac stress imaging modality (including echocardiography, CMR, or radionuclide testing) was more cost-effective than a pathway that mandates a CMR stress test. Contrary to prior observations in individuals with intermediate- to high-risk chest pain, in those with lower-risk chest pain, these results highlight the importance of physician-related choices during acute coronary syndrome diagnostic protocols. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00869245.

The role of total laboratory automation in a consolidated laboratory network.

PubMed

Seaberg, R S; Stallone, R O; Statland, B E

2000-05-01

In an effort to reduce overall laboratory costs and improve overall laboratory efficiencies at all of its network hospitals, the North Shore-Long Island Health System recently established a Consolidated Laboratory Network with a Core Laboratory at its center. We established and implemented a centralized Core Laboratory designed around the Roche/Hitachi CLAS Total Laboratory Automation system to perform the general and esoteric laboratory testing throughout the system in a timely and cost-effective fashion. All remaining STAT testing will be performed within the Rapid Response Laboratories (RRLs) at each of the system's hospitals. Results for this laboratory consolidation and implementation effort demonstrated a decrease in labor costs and improved turnaround time (TAT) at the core laboratory. Anticipated system savings are approximately $2.7 million. TATs averaged 1.3 h within the Core Laboratory and less than 30 min in the RRLs. When properly implemented, automation systems can reduce overall laboratory expenses, enhance patient services, and address the overall concerns facing the laboratory today: job satisfaction, decreased length of stay, and safety. The financial savings realized are primarily a result of labor reductions.

Low-cost directionally-solidified turbine blades, volume 2. [TFE731-3 turbofan engine

NASA Technical Reports Server (NTRS)

Dennis, R. E.; Hoppin, G. S., III; Hurst, L. G.

1979-01-01

An endothermically heated technology was used to manufacture low cost, directionally solidified, uncooled nickel-alloy blades for the TFE731-3 turbofan engine. The MAR-M 247 and MER-M 100+Hf blades were finish processed through heat treatment, machining, and coating operations prior to 150 hour engine tests consisting of the following sequences: (1) 50 hours of simulated cruise cycling (high fatigue evaluation); (2) 50 hours at the maximum continuous power rating (stress rupture endurance (low cycle fatigue). None of the blades visually showed any detrimental effects from the test. This was verified by post test metallurgical evaluation. The specific fuel consumption was reduced by 2.4% with the uncooled blades.

Cost-effectiveness of school support for orphan girls to prevent HIV infection in Zimbabwe.

PubMed

Miller, Ted; Hallfors, Denise; Cho, Hyunsan; Luseno, Winnie; Waehrer, Geetha

2013-10-01

This cost-effectiveness study analyzes the cost per quality-adjusted life year (QALY) gained in a randomized controlled trial that tested school support as a structural intervention to prevent HIV risk factors among Zimbabwe orphan girl adolescents. The intervention significantly reduced early marriage, increased years of schooling completed, and increased health-related quality of life. By reducing early marriage, the literature suggests the intervention reduced HIV infection. The intervention yielded an estimated US$1,472 in societal benefits and an estimated gain of 0.36 QALYs per orphan supported. It cost an estimated US$6/QALY gained, about 1 % of annual per capita income in Zimbabwe. That is well below the maximum price that the World Health Organization (WHO) Commission on Macroeconomics and Health recommends paying for health gains in low and middle income countries. About half the girls in the intervention condition were boarded when they reached high school. For non-boarders, the intervention's financial benefits exceeded its costs, yielding an estimated net cost savings of $502 per pupil. Without boarding, the intervention would yield net savings even if it were 34 % less effective in replication. Boarding was not cost-effective. It cost an additional $1,234 per girl boarded (over the 3 years of the study, discounted to present value at a 3 % discount rate) but had no effect on any of the outcome measures relative to girls in the treatment group who did not board. For girls who did not board, the average cost of approximately 3 years of school support was US$973.

Full-Scale Accelerated Testing of Multi-axial Geogrid Stabilized Flexible Pavements

DTIC Science & Technology

2017-06-01

costs and reduced budgets, transportation officials are often tasked with applying innovative solutions to pavement design and construction projects... pavement designers . 1.2 Objective The objective of this effort was to construct and traffic full-scale flexible pavement sections to provide...Development Center (ERDC) constructed the full-scale test section as designed by Tensar under shelter in its Hangar 2 Pavement Test Facility. During

A Low-Cost Data Acquisition System for Automobile Dynamics Applications

PubMed Central

González, Alejandro; Vinolas, Jordi

2018-01-01

This project addresses the need for the implementation of low-cost acquisition technology in the field of vehicle engineering: the design, development, manufacture, and verification of a low-cost Arduino-based data acquisition platform to be used in <80 Hz data acquisition in vehicle dynamics, using low-cost accelerometers. In addition to this, a comparative study is carried out of professional vibration acquisition technologies and low-cost systems, obtaining optimum results for low- and medium-frequency operations with an error of 2.19% on road tests. It is therefore concluded that these technologies are applicable to the automobile industry, thereby allowing the project costs to be reduced and thus facilitating access to this kind of research that requires limited resources. PMID:29382039

A Low-Cost Data Acquisition System for Automobile Dynamics Applications.

PubMed

González, Alejandro; Olazagoitia, José Luis; Vinolas, Jordi

2018-01-27

This project addresses the need for the implementation of low-cost acquisition technology in the field of vehicle engineering: the design, development, manufacture, and verification of a low-cost Arduino-based data acquisition platform to be used in <80 Hz data acquisition in vehicle dynamics, using low-cost accelerometers. In addition to this, a comparative study is carried out of professional vibration acquisition technologies and low-cost systems, obtaining optimum results for low- and medium-frequency operations with an error of 2.19% on road tests. It is therefore concluded that these technologies are applicable to the automobile industry, thereby allowing the project costs to be reduced and thus facilitating access to this kind of research that requires limited resources.

The Economics of NASA Mission Cost Reserves

NASA Technical Reports Server (NTRS)

Whitley, Sally; Shinn, Stephen

2012-01-01

Increases in NASA mission costs have led to analysis of the causes and magnitude of historical mission overruns as well as mitigation and prevention attempts. This paper hypothesizes that one cause is that the availability of reserves may reduce incentives to control costs. We draw a comparison to the insurance concept of moral hazard, and we use actuarial techniques to better understand the increase in mission costs due to the availability of reserves. NASA's CADRe database provided the data against which we tested our hypothesis and discovered that there is correlation between the amount of available reserves and project overruns, particularly for mission hardware cost increases. We address the question of how to prevent reserves from increasing mission spending without increasing cost risk to projects.

Analysis of current thyroid function test ordering practices.

PubMed

Kluesner, Joseph K; Beckman, Darrick J; Tate, Joshua M; Beauvais, Alexis A; Kravchenko, Maria I; Wardian, Jana L; Graybill, Sky D; Colburn, Jeffrey A; Folaron, Irene; True, Mark W

2018-04-01

Current guidelines recommend thyroid stimulating hormone (TSH) alone as the best test to detect and monitor thyroid dysfunction, yet free thyroxine (FT4) and free triiodothyronine (FT3) are commonly ordered when not clinically indicated. Excessive testing can lead to added economic burden in an era of rising healthcare costs, while rarely contributing to the evaluation or management of thyroid disease. To evaluate our institution's practice in ordering thyroid function tests (TFTs) and to identify strategies to reduce inappropriate FT4 and FT3 testing. A record of all TFTs obtained in the San Antonio Military Health System during a 3-month period was extracted from the electronic medical record. The TFTs of interest were TSH, FT4, thyroid panel (TSH + FT4), FT3, total thyroxine (T4), and total triiodothyronine (T3). These were categorized based on the presence or absence of hypothyroidism. Between August 1 and October 31, 2016, there were 38 214 individual TFTs ordered via 28 597 total laboratory requests; 11 486 of these requests were in patients with a history of hypothyroidism. The number (percent) of laboratory requests fell into these patterns: TSH alone 14 919 (52.14%), TSH + FT4 7641 (26.72%), FT3 alone 3039 (10.63%), FT4 alone 1219 (4.26%), TSH + FT4 + FT3 783 (2.74%), and others 996 (3.48%); 36.0% of TFTs ordered were free thyroid hormones. Projected out to a year, using Department of Defense laboratory costs, $317 429 worth of TFTs would be ordered, with free thyroid hormone testing accounting for $107 720. Inappropriate ordering of free thyroid hormone tests is common. In an era of rising healthcare costs, inappropriate thyroid function testing is an ideal target for efforts to reduce laboratory overutilization, which in our system, could save up to $120 000 per year. Further evaluation is needed to determine strategies that can reduce excessive thyroid hormone testing. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

Safety and Suitability for Service Assessment Testing for Aircraft Launched Munitions

DTIC Science & Technology

2013-07-01

2013 12 benefits in terms of cost and test efficiency that tend to associate the Analytical S3 Test Approach with complex missile systems and the... systems containing expensive, non-safety related components. c. When using the Analytical S3 Test Approach for aircraft launched bombs, full BTCA is...establish safety margin of the system . Details of the Empirical Test Flow with full and reduced BTCA options are provided in Appendix B, Annexes 3 and

Design and test of aircraft engine isolators for reduced interior noise

NASA Technical Reports Server (NTRS)

Unruh, J. F.; Scheidt, D. C.

1982-01-01

Improved engine vibration isolation was proposed to be the most weight and cost efficient retrofit structure-borne noise control measure for single engine general aviation aircraft. A study was carried out the objectives: (1) to develop an engine isolator design specification for reduced interior noise transmission, (2) select/design candidate isolators to meet a 15 dB noise reduction design goal, and (3) carry out a proof of concept evaluation test. Analytical model of the engine, vibration isolators and engine mount structure were coupled to an empirical model of the fuselage for noise transmission evaluation. The model was used to develop engine isolator dynamic properties design specification for reduced noise transmission. Candidate isolators ere chosen from available product literature and retrofit to a test aircraft. A laboratory based test procedure was then developed to simulate engine induced noise transmission in the aircraft for a proof of concept evaluation test. Three candidate isolator configurations were evaluated for reduced structure-borne noise transmission relative to the original equipment isolators.

SW-846 Test Method 3511: Organic Compounds in Water by Microextraction

EPA Pesticide Factsheets

a procedure for extracting selected volatile and semivolatileorganic compounds from water. The microscale approach minimizes sample size and solventusage, thereby reducing the supply costs, health and safety risks, and waste generated.

A test of the metabolic cost of cushioning hypothesis during unshod and shod running.

PubMed

Tung, Kryztopher David; Franz, Jason R; Kram, Rodger

2014-02-01

This study aimed to investigate the effects of surface and shoe cushioning on the metabolic cost of running. In running, the leg muscles generate force to cushion the impact with the ground. External cushioning (surfaces or shoes) may reduce the muscular effort needed for cushioning and thus reduce metabolic cost. Our primary hypothesis was that the metabolic cost of unshod running would decrease with a more cushioned running surface. We also hypothesized that because of the counteracting effects of shoe cushioning and mass, unshod running on a hard surface would have approximately the same metabolic cost as running in lightweight, cushioned shoes. To test these hypotheses, we attached 10- and 20-mm-thick slats of the same foam cushioning used in running shoe midsoles to the belt of a treadmill that had a rigid deck. Twelve subjects who preferred a midfoot strike pattern and had substantial barefoot/minimalist running experience ran without shoes on the normal treadmill belt and on each thickness of foam. They also ran with lightweight, cushioned shoes on the normal belt. We collected V˙O2 and V˙CO2 to calculate the metabolic power demand and used a repeated-measures ANOVA to compare between conditions. Compared to running unshod on the normal belt, running unshod on the 10-mm-thick foam required 1.63% ± 0.67% (mean ± SD) less metabolic power (P = 0.034) but running on the 20-mm-thick foam had no significant metabolic effect. Running with and without shoes on the normal belt had similar metabolic power demands, likely because the beneficial energetic effects of cushioning counterbalanced the detrimental effects of shoe mass. On average, surface and shoe cushioning reduce the metabolic power required for submaximal running.

Using best practice to create a pathway to improve management of irritable bowel syndrome: aiming for timely diagnosis, effective treatment and equitable care.

PubMed

Williams, Marianne; Barclay, Yvonne; Benneyworth, Rosie; Gore, Steve; Hamilton, Zoe; Matull, Rudi; Phillips, Iain; Seamark, Leah; Staveley, Kate; Thole, Steve; Greig, Emma

2016-10-01

Irritable bowel syndrome (IBS) costs the National Health Service almost £12 million per annum. Despite national guidelines advising primary care management, these have failed to stem secondary care referrals of patients with likely IBS for unnecessary and costly assessment and investigation without necessarily achieving resolution of their symptoms. In 2011, an integrated team from primary and secondary care developed a business case using baseline data to create a Somerset-wide IBS pathway using Clinical Commissioning Group funding. This provided face-to-face general practitioners (GP) education, developed a diagnostic pathway and funded faecal calprotectin (FC) testing to exclude inflammatory pathology for patients aged 16-45 years with likely IBS and no alarm symptoms. For those with FC≤50 μg/g, we provided a management algorithm and community-based dietetic treatment. Audit results measured usage and outcomes from FC testing, changes in patterns and costs of new patients reviewed in gastroenterology outpatients and dietetic IBS treatment outcomes. The proportion of new patient slots used reduced from 14.3% to 8.7% over 10 months while overall costs reduced by 25% for patients with no alarm symptoms and likely IBS aged 16-45 years. FC results confirmed research findings with no inflammatory pathology, if FC≤50 μg/g over 2 years. 63% of patients had satisfactory control of their IBS after specialist dietetic input with 74% reporting improved quality of life. The combination of GP education, providing diagnosis and management pathways, using FC to exclude inflammatory pathology and providing an effective treatment for patients with likely IBS appeared successful in our pilot. This proved cost-effective, reduced secondary care involvement and improved patient care.

Pathfinder

NASA Image and Video Library

1997-06-04

This shot offers a bird's eye-view of a Fastrac II engine duration test at Marshall's Test Stand 116. The Fastrac II engine was designed as a part of the low cost X-34 Reusable Launch Vehicle (RLV). The purpose for these tests was to test the different types of metal alloys in the nozzle. Beside the engine were six additional nozzels which spray a continuous stream of water onto the test stand to reduce damage to the test stand and the engines. The X-34 program was cancelled in 2001.

Economics of the solid rocket booster for space shuttle

NASA Technical Reports Server (NTRS)

Rice, W. C.

1979-01-01

The paper examines economics of the solid rocket booster for the Space Shuttle. Costs have been held down by adapting existing technology to the 146 in. SRB selected, with NASA reducing the cost of expendables and reusing the expensive nonexpendable hardware. Drop tests of Titan III motor cases and nozzles proved that boosters can survive water impact at vertical velocities of 100 ft/sec so that SRB components can be reused. The cost of expendables was minimized by selecting proven propellants, insulation, and nozzle ablatives of known costs; the propellant has the lowest available cost formulation, and low cost ablatives, such as pitch carbon fibers, will be used when available. Thus, the use of proven technology and low cost expendables will make the SRB an economical booster for the Space Shuttle.

Alpha LAMP Integration Facility

NASA Technical Reports Server (NTRS)

Oshiro, Richard; Sowers, Dennis; Gargiulo, Joe; Mcgahey, Mark

1994-01-01

This paper describes the activity recently completed to meet the simulated space environment requirements for the ground-based testing of an integrated Space Based Laser (SBL) system experiment. The need to maintain optical alignment in the challenging dynamic environment of the pressure recovery system required to simulate space dominated the design requirements. A robust system design was established which minimized the total program costs, most notably by reducing the cost of integrating the components of the experiment. The components of the experiment are integrated on an optical bench in a clean area adjacent to the vacuum chamber and moved on air bearings into the chamber for testing.

Value for money in drug treatment: economic evaluation of prison methadone.

PubMed

Warren, Emma; Viney, Rosalie; Shearer, James; Shanahan, Marian; Wodak, Alex; Dolan, Kate

2006-09-15

Although methadone maintenance treatment in community settings is known to reduce heroin use, HIV infection and mortality among injecting drug users (IDU), little is known about prison methadone programs. One reason for this is the complexity of undertaking evaluations in the prison setting. This paper estimates the cost-effectiveness of the New South Wales (NSW) prison methadone program. Information from the NSW prison methadone program was used to construct a model of the costs of the program. The information was combined with data from a randomised controlled trial of provision of prison methadone in NSW. The total program cost was estimated from the perspective of the treatment provider/funder. The cost per heroin free day, compared with no prison methadone, was estimated. Assumptions regarding resource use were tested through sensitivity analysis. The annual cost of providing prison methadone in NSW was estimated to be 2.9 million Australian dollars (or 3,234 Australian dollars per inmate per year). The incremental cost effectiveness ratio is 38 Australian dollars per additional heroin free day. From a treatment perspective, prison methadone is no more costly than community methadone, and provides benefits in terms of reduced heroin use in prisons, with associated reduction in morbidity and mortality.

Small Habitat Commonality Reduces Cost for Human Mars Missions

NASA Technical Reports Server (NTRS)

Griffin, Brand N.; Lepsch, Roger; Martin, John; Howard, Robert; Rucker, Michelle; Zapata, Edgar; McCleskey, Carey; Howe, Scott; Mary, Natalie; Nerren, Philip (Inventor)

2015-01-01

Most view the Apollo Program as expensive. It was. But, a human mission to Mars will be orders of magnitude more difficult and costly. Recently, NASA's Evolvable Mars Campaign (EMC) mapped out a step-wise approach for exploring Mars and the Mars-moon system. It is early in the planning process but because approximately 80% of the total life cycle cost is committed during preliminary design, there is an effort to emphasize cost reduction methods up front. Amongst the options, commonality across small habitat elements shows promise for consolidating the high bow-wave costs of Design, Development, Test and Evaluation (DDT&E) while still accommodating each end-item's functionality. In addition to DDT&E, there are other cost and operations benefits to commonality such as reduced logistics, simplified infrastructure integration and with inter-operability, improved safety and simplified training. These benefits are not without a cost. Some habitats are sub-optimized giving up unique attributes for the benefit of the overall architecture and because the first item sets the course for those to follow, rapidly developing technology may be excluded. The small habitats within the EMC include the pressurized crew cabins for the ascent vehicle,

HIV Treatment as Prevention: Modelling the Cost of Antiretroviral Treatment—State of the Art and Future Directions

PubMed Central

Meyer-Rath, Gesine; Over, Mead

2012-01-01

Policy discussions about the feasibility of massively scaling up antiretroviral therapy (ART) to reduce HIV transmission and incidence hinge on accurately projecting the cost of such scale-up in comparison to the benefits from reduced HIV incidence and mortality. We review the available literature on modelled estimates of the cost of providing ART to different populations around the world, and suggest alternative methods of characterising cost when modelling several decades into the future. In past economic analyses of ART provision, costs were often assumed to vary by disease stage and treatment regimen, but for treatment as prevention, in particular, most analyses assume a uniform cost per patient. This approach disregards variables that can affect unit cost, such as differences in factor prices (i.e., the prices of supplies and services) and the scale and scope of operations (i.e., the sizes and types of facilities providing ART). We discuss several of these variables, and then present a worked example of a flexible cost function used to determine the effect of scale on the cost of a proposed scale-up of treatment as prevention in South Africa. Adjusting previously estimated costs of universal testing and treatment in South Africa for diseconomies of small scale, i.e., more patients being treated in smaller facilities, adds 42% to the expected future cost of the intervention. PMID:22802731

Cost-effectiveness of home-based care versus hospital care for chronically ill tuberculosis patients, Francistown, Botswana.

PubMed

Moalosi, G; Floyd, K; Phatshwane, J; Moeti, T; Binkin, N; Kenyon, T

2003-09-01

Francistown, Botswana, 1999. To determine the affordability and cost-effectiveness of home-based directly observed therapy (DOT) compared to hospital-based DOT for chronically ill tuberculosis (TB) patients, and to describe the characteristics of patients and their caregivers. Costs for each alternative strategy were analysed from the perspective of the health system and caregivers, in 1998 US dollars. Caregiver costs were assessed using a structured questionnaire administered to a sample of 50 caregivers. Health system costs were assessed using interviews with relevant staff and documentary data such as medical records and expenditure files. These data were used to calculate the average cost of individual components of care, and, for each alternative strategy, the average cost per patient treated. Cost-effectiveness was calculated as the cost per patient compliant with treatment. The characteristics of caregivers and patients were assessed using demographic and socio-economic data collected during interviews, and medical records. Overall, home-based care reduced the cost per patient treated by 44% compared with hospital-based treatment (dollars 1657 vs. dollars 2970). The cost to the caregiver was reduced by 23% (dollars 551 vs. dollars 720), while the cost to the health system was reduced by 50% (dollars 1106 vs. dollars 2206). The cost per patient complying with treatment was dollars 1726 for home-based care and dollars 2970 for hospitalisation. Caregivers were predominantly female relatives (88%), unemployed (48%), with primary school education or less (82%), and with an income of less than dollars 1000 per annum (71%). Of those patients with an HIV test result, 98% were HIV-positive. Home-based care is more affordable and cost-effective than hospital-based care for chronically ill TB patients, although costs to caregivers remain high in relation to their incomes. Structured home-based DOT should be included as a component of the National Tuberculosis Control Programme in Botswana.

Development of multilayer perceptron networks for isothermal time temperature transformation prediction of U-Mo-X alloys

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

Johns, Jesse M.; Burkes, Douglas

In this work, a multilayered perceptron (MLP) network is used to develop predictive isothermal time-temperature-transformation (TTT) models covering a range of U-Mo binary and ternary alloys. The selected ternary alloys for model development are U-Mo-Ru, U-Mo-Nb, U-Mo-Zr, U-Mo-Cr, and U-Mo-Re. These model’s ability to predict 'novel' U-Mo alloys is shown quite well despite the discrepancies between literature sources for similar alloys which likely arise from different thermal-mechanical processing conditions. These models are developed with the primary purpose of informing experimental decisions. Additional experimental insight is necessary in order to reduce the number of experiments required to isolate ideal alloys. Thesemore » models allow test planners to evaluate areas of experimental interest; once initial tests are conducted, the model can be updated and further improve follow-on testing decisions. The model also improves analysis capabilities by reducing the number of data points necessary from any particular test. For example, if one or two isotherms are measured during a test, the model can construct the rest of the TTT curve over a wide range of temperature and time. This modeling capability reduces the cost of experiments while also improving the value of the results from the tests. The reduced costs could result in improved material characterization and therefore improved fundamental understanding of TTT dynamics. As additional understanding of phenomena driving TTTs is acquired, this type of MLP model can be used to populate unknowns (such as material impurity and other thermal mechanical properties) from past literature sources.« less

Systematic neonatal screening for severe combined immunodeficiency and severe T-cell lymphopenia: Analysis of cost-effectiveness based on French real field data.

PubMed

Clément, Marie Caroline; Mahlaoui, Nizar; Mignot, Cécile; Le Bihan, Christine; Rabetrano, Hasina; Hoang, Ly; Neven, Bénédicte; Moshous, Despina; Cavazzana, Marina; Blanche, Stéphane; Fischer, Alain; Audrain, Marie; Durand-Zaleski, Isabelle

2015-06-01

The inclusion of severe combined immunodeficiency (SCID) in a Europe-wide screening program is currently debated. In making a case for inclusion in the French newborn screening program, we explored the costs incurred and potentially saved by early management of SCID. For test costs, a microcosting study documented the resources used in a laboratory piloting a newborn screening test on Guthrie cards using the T-cell receptor excision circle quantification method. For treatment costs, patients with SCID admitted to the national reference center for primary immunodeficiency in France between 2006 and 2010 were included. Costs of admission were estimated from actual national production costs. We estimated the costs for patients who underwent early versus delayed hematopoietic stem cell transplantation (HSCT; age, ≤3 vs. >3 months, respectively). The unit cost of the test varied between €4.69 and €6.79 for 33,800 samples per year, depending on equipment use and saturation. Of the 30 patients included, 27 underwent HSCT after age 3 months. At 1 year after HSCT, 10 of these had died, and all 3 patients undergoing early transplantation survived. The medical costs for HSCT after 3 months were €195,776 (interquartile range, €165,884-€257,160) versus €86,179 (range, €59,014-€272,577) when performed before 3 months of age. In patients undergoing late transplantation, active infection contributed to high cost and poor outcome. Early detection of SCID could reduce the cost of treatment by €50,000-100,000 per case. Assuming a €5 unit cost per test, the incidence required to break even is 1:20,000; however, if the survival advantage of HSCT before 3 months is confirmed, universal screening is likely to be cost-effective. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Comparative analysis of Mouse Inoculation Test and Virus Isolation in Cell Culture for rabies diagnosis in animals of Parana, Brazil.

PubMed

Corona, Thaila Francini; Böger, Beatriz; Rocha, Tatiana Carneiro da; Svoboda, Walfrido Külh; Gomes, Eliane Carneiro

2018-01-01

Rabies is an acute zoonotic disease, caused by a rhabdovirus that can affect all mammals, and is commonly transmitted by the bite of a rabid animal. The definitive diagnosis is laboratorial, by the Fluorescent Antibody Test (FAT) as a quick test and Mouse Inoculation Test (MIT) as a confirmatory test (gold standard). Studies conducted over the past three decades indicate that MIT and Virus Isolation in Cell Culture (VICC) can provide the same effectiveness, the latter being considered superior in bioethics and animal welfare. The aim of this study was to compare VICC with MIT, in terms of accuracy, biosafety and occupational health, supply and equipment costs, bioethics and animal welfare, in a Brazilian public health lab. We utilized 400 samples of animal neurological tissue to compare the performance of VICC against MIT. The variables analyzed were accuracy, biosafety and occupational health, time spent in performing the tests, supply and equipment costs, bioethics and animal welfare evaluation. Both VICC and MIT had almost the same accuracy (99.8%), although VICC presented fewer risks regarding biosafety and mental health of the technicians, and reduced time between inoculation and obtaining the results (approximately 22 days less). In addition, VICC presented lower supply costs (86.5% less), equipment costs (32.6% less), and the advantage of not using animals. These results confirm that VICC can replace MIT, offering the same accuracy and better features regarding cost, results, biosafety and occupational health, and bioethics and animal welfare.

Development of a Thin Film Primary Surface Heat Exchanger for Advanced Power Cycles

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

Allison, Tim; Beck, Griffin; Bennett, Jeffrey

This project objective is to develop a high-temperature design upgrade for an existing primary surface heat exchanger so that the redesigned hardware is capable of operation in CO 2 at temperatures up to 1,510°F (821°C) and pressure differentials up to 130 psi (9 bar). The heat exchanger is proposed for use as a recuperator in an advanced low-pressure oxy-fuel Brayton cycle that is predicted to achieve over 50% thermodynamic efficiency, although the heat exchanger could also be used in other high-temperature, low-differential pressure cycles. This report describes the progress to date, which includes continuing work performed to select and testmore » new candidate materials for the recuperator redesign, final mechanical and thermal performance analysis results of various redesign concepts, and the preliminary design of a test loop for the redesigned recuperator including a budgetary estimate for detailed test loop design, procurement, and test operation. A materials search was performed in order to investigate high-temperature properties of many candidate materials, including high-temperature strength and nickel content. These properties were used to rank the candidate materials, resulting in a reduced list of nine materials for corrosion testing. Multiple test rigs were considered and analyzed for short-term corrosion testing and Thermal Gravimetric Analysis (TGA) was selected as the most cost-effective option for evaluating corrosion resistance of the candidate materials. In addition, tantalum, niobium, and chromium coatings were identified as potential options for increased corrosion resistance. The test results show that many materials exhibit relatively low weight gain rates, and that niobium and tantalum coatings may improve corrosion resistance for many materials, while chromium coatings appear to oxidize and debond quickly. Metallurgical analysis of alloys was also performed, showing evidence of intergranular attack in 282 that may cause long-term reliability problems in CO 2 service at these temperatures. However, long-term testing in a flowing environment is recommended in order to understand accurately the severity of the attack. Detailed economic modeling of the existing air cycle recuperator and CO 2 cycle recuperator options was also completed, including costs for material, fabrication, fuel, maintenance, and operation. The analysis results show that the increased capital cost for high-temperature materials may be offset by higher cycle efficiencies, decreasing the overall lifetime cost of the system. The economic analysis also examines costs associated with increased pressure drop and material changes for two redesign options. These results show that, even with slightly reduced performance and/or higher material costs, the lifetime cost per energy production may still be reduced by over 12%. The existing recuperator design information was provided by Solar Turbines, Inc. via several models, drawings, and design handoff meetings. Multiple fluid/thermal and structural models were created in order to analyze critical recuperator performance and mechanical strength in critical areas throughout the redesign process. These models were analyzed for a baseline condition (consistent with current Mercury 50 operation) for validation purposes. Results are presented for heat transfer coefficients and pressure drops, matching well with the existing operational data. Simulation of higher-temperature CO 2 conditions was also performed, showing a slight expected increase in both heat transfer and pressure drop. Mechanical analysis results for critical areas on the cross-flow and counter-flow sheets have also been obtained for air and CO 2 cases. These results show similar stresses in both cases but significantly reduced safety factors for the CO 2 case due to reduced yield and creep rupture strengths of alloy 625 at the higher temperatures. A concept brainstorm session and initial down-selection were completed in order to identify promising redesign options for further analysis. Detailed analysis of all promising redesign options was performed via finite element and computational fluid dynamic simulations in order to characterize mechanical and thermal-fluid performance of each option. These options included material change, various sheet thickness configurations, pitch and phasing of cross-flow and counter-flow sheets, and separator sheets. The analysis results have identified two viable redesign options that maintain existing safety margins optimally through a material change to Haynes 282 and (A) sheet thickness increases of 40% on the counter-flow sheet and 75% on the hot side cross-flow corrugation sheet or (B) addition of a separator sheet in the counter-flow section while maintaining the original counter-flow sheet thickness and increasing the cross-flow corrugation sheet thickness by 90% to account for the increase in cell height. While both options satisfy mechanical stress constraints, the separator sheet design has a higher part count, slightly reduced heat transfer, and slightly higher pressure drop than the first option and is not preferred. Finally, several test loop concepts have been developed for different full-scale and reduced-scale recuperator testing options. For each option, various loop components, such as heat exchangers, valves, heaters, and compressors, were evaluated in an effort to maximize utilization of existing resources. All concepts utilize an existing 3-MW CO 2 compressor, heater, and loop coolers, but the concepts vary by incorporating different amounts of new equipment for achieving various flow rates (all concepts operate at design pressure and temperature). The third concept achieves a 1 kg/s test without purchasing any costly equipment (coolers, heaters, blowers, etc.). Since the stacked cell design of the recuperator results in the same flow conditions at each core cell (even for a reduced-scale test). Thus, test loop Concept #3 was selected for the preliminary design. This loop design is detailed within the report, culminating in a budgetary estimate of $1,013,000.00 for the detailed design, construction, commissioning, and operation of a high-temperature recuperator test loop.« less

Challenges and solutions for high-volume testing of silicon photonics

NASA Astrophysics Data System (ADS)

Polster, Robert; Dai, Liang Yuan; Oikonomou, Michail; Cheng, Qixiang; Rumley, Sebastien; Bergman, Keren

2018-02-01

The first generation of silicon photonic products is now commercially available. While silicon photonics possesses key economic advantages over classical photonic platforms, it has yet to become a commercial success because these advantages can be fully realized only when high-volume testing of silicon photonic devices is made possible. We discuss the costs, challenges, and solutions of photonic chip testing as reported in the recent research literature. We define and propose three underlying paradigms that should be considered when creating photonic test structures: Design for Fast Coupling, Design for Minimal Taps, and Design for Parallel Testing. We underline that a coherent test methodology must be established prior to the design of test structures, and demonstrate how an optimized methodology dramatically reduces the burden when designing for test, by reducing the needed complexity of test structures.

Thermal control of power supplies with electronic packaging techniques. [using low cost heat pipes

NASA Technical Reports Server (NTRS)

1977-01-01

The integration of low-cost commercial heat pipes in the design of a NASA candidate standard modular power supply with a 350 watt output resulted in a 44% weight reduction. Part temperatures were also appreciably reduced, increasing the environmental capability of the unit. A complete 350- watt modular power converter was built and tested to evaluate thermal performance of the redesigned supply.

Analyzing Sustainable Energy Opportunities for a Small Scale Off-Grid Facility: A Case Study at Experimental Lakes Area (ELA), Ontario

NASA Astrophysics Data System (ADS)

Duggirala, Bhanu

This thesis explored the opportunities to reduce energy demand and renewable energy feasibility at an off-grid science "community" called the Experimental Lakes Area (ELA) in Ontario. Being off-grid, ELA is completely dependent on diesel and propane fuel supply for all its electrical and heating needs, which makes ELA vulnerable to fluctuating fuel prices. As a result ELA emits a large amount of greenhouse gases (GHG) for its size. Energy efficiency and renewable energy technologies can reduce energy consumption and consequently energy cost, as well as GHG. Energy efficiency was very important to ELA due to the elevated fuel costs at this remote location. Minor upgrades to lighting, equipment and building envelope were able to reduce energy costs and reduce load. Efficient energy saving measures were recommended that save on operating and maintenance costs, namely, changing to LED lights, replacing old equipment like refrigerators and downsizing of ice makers. This resulted in a 4.8% load reduction and subsequently reduced the initial capital cost for biomass by 27,000, by 49,500 for wind power and by 136,500 for solar power. Many alternative energies show promise as potential energy sources to reduce the diesel and propane consumption at ELA including wind energy, solar heating and biomass. A biomass based CHP system using the existing diesel generators as back-up has the shortest pay back period of the technologies modeled. The biomass based CHP system has a pay back period of 4.1 years at 0.80 per liter of diesel, as diesel price approaches $2.00 per liter the pay back period reduces to 0.9 years, 50% the generation cost compared to present generation costs. Biomass has been successfully tried and tested in many off-grid communities particularly in a small-scale off-grid setting in North America and internationally. Also, the site specific solar and wind data show that ELA has potential to harvest renewable resources and produce heat and power at competitive rates compared to diesel and propane.

Incorporating DNA Sequencing into Current Prenatal Screening Practice for Down's Syndrome

PubMed Central

Wald, Nicholas J.; Bestwick, Jonathan P.

2013-01-01

Background Prenatal screening for Down's syndrome is performed using biochemical and ultrasound markers measured in early pregnancy such as the Integrated test using first and second trimester markers. Recently, DNA sequencing methods have been introduced on free DNA in maternal plasma, yielding a high screening performance. These methods are expensive and there is a test failure rate. We determined the screening performance of merging the Integrated test with the newer DNA techniques in a protocol that substantially reduces the cost compared with universal DNA testing and still achieves high screening performance with no test failures. Methods Published data were used to model screening performance of a protocol in which all women receive the first stage of the Integrated test at about 11 weeks of pregnancy. On the basis of this higher risk women have reflex DNA testing and lower risk women as well as those with a failed DNA test complete the Integrated test at about 15 weeks. Results The overall detection rate was 95% with a 0.1% false-positive rate if 20% of women were selected to receive DNA testing. If all women had DNA testing the detection rate would be 3 to 4 percentage points higher with a false-positive rate 30 times greater if women with failed tests were treated as positive and offered a diagnostic amniocentesis, or 3 times greater if they had a second trimester screening test (Quadruple test) and treated as positive only if this were positive. The cost per women screened would be about one-fifth, compared with universal DNA testing, if the DNA test were 20 times the cost of the Integrated test. Conclusion The proposed screening protocol achieves a high screening performance without programme test failures and at a substantially lower cost than offering all women DNA testing. PMID:23527014

HIV prevention costs and their predictors: evidence from the ORPHEA Project in Kenya

PubMed Central

Galárraga, Omar; Wamai, Richard G; Sosa-Rubí, Sandra G; Mugo, Mercy G; Contreras-Loya, David; Bautista-Arredondo, Sergio; Nyakundi, Helen; Wang’ombe, Joseph K

2017-01-01

Abstract We estimate costs and their predictors for three HIV prevention interventions in Kenya: HIV testing and counselling (HTC), prevention of mother-to-child transmission (PMTCT) and voluntary medical male circumcision (VMMC). As part of the ‘Optimizing the Response of Prevention: HIV Efficiency in Africa’ (ORPHEA) project, we collected retrospective data from government and non-governmental health facilities for 2011–12. We used multi-stage sampling to determine a sample of health facilities by type, ownership, size and interventions offered totalling 144 sites in 78 health facilities in 33 districts across Kenya. Data sources included key informants, registers and time-motion observation methods. Total costs of production were computed using both quantity and unit price of each input. Average cost was estimated by dividing total cost per intervention by number of clients accessing the intervention. Multivariate regression methods were used to analyse predictors of log-transformed average costs. Average costs were $7 and $79 per HTC and PMTCT client tested, respectively; and $66 per VMMC procedure. Results show evidence of economies of scale for PMTCT and VMMC: increasing the number of clients per year by 100% was associated with cost reductions of 50% for PMTCT, and 45% for VMMC. Task shifting was associated with reduced costs for both PMTCT (59%) and VMMC (54%). Costs in hospitals were higher for PMTCT (56%) in comparison to non-hospitals. Facilities that performed testing based on risk factors as opposed to universal screening had higher HTC average costs (79%). Lower VMMC costs were associated with availability of male reproductive health services (59%) and presence of community advisory board (52%). Aside from increasing production scale, HIV prevention costs may be contained by using task shifting, non-hospital sites, service integration and community supervision. PMID:29029086

Screening for Colorectal Cancer With Fecal Immunochemical Testing With and Without Postpolypectomy Surveillance Colonoscopy: A Cost-Effectiveness Analysis.

PubMed

Greuter, Marjolein J E; de Klerk, Clasine M; Meijer, Gerrit A; Dekker, Evelien; Coupé, Veerle M H

2017-10-17

Population-based screening to prevent colorectal cancer (CRC) death is effective, but the effectiveness of postpolypectomy surveillance is unclear. To evaluate the additional benefit in terms of cost-effectiveness of colonoscopy surveillance in a screening setting. Microsimulation using the ASCCA (Adenoma and Serrated pathway to Colorectal CAncer) model. Dutch CRC screening program and published literature. Asymptomatic persons aged 55 to 75 years without a prior CRC diagnosis. Lifetime. Health care payer. Fecal immunochemical test (FIT) screening with colonoscopy surveillance performed according to the Dutch guideline was simulated. The comparator was no screening or surveillance. FIT screening without colonoscopy surveillance and the effect of extending surveillance intervals were also evaluated. CRC burden, colonoscopy demand, life-years, and costs. FIT screening without surveillance reduced CRC mortality by 50.4% compared with no screening or surveillance. Adding surveillance to FIT screening reduced mortality by an additional 1.7% to 52.1% but increased lifetime colonoscopy demand by 62% (from 335 to 543 colonoscopies per 1000 persons) at an additional cost of €68 000, for an increase of 0.9 life-year. Extending the surveillance intervals to 5 years reduced CRC mortality by 51.8% and increased colonoscopy demand by 42.7% compared with FIT screening without surveillance. In an incremental analysis, incremental cost-effectiveness ratios (ICERs) for screening plus surveillance exceeded the Dutch willingness-to-pay threshold of €36 602 per life-year gained. When using a parameter set representing low colorectal lesion prevalence or when colonoscopy costs were halved or colorectal lesion incidence was doubled, screening plus surveillance became cost-effective compared with screening without surveillance. Limited data on FIT performance and background CRC risk in the surveillance population. Adding surveillance to FIT screening is not cost-effective based on the Dutch ICER threshold and substantially increases colonoscopy demand. Extending surveillance intervals to 5 years would decrease colonoscopy demand without substantial loss of effectiveness. Alpe d'HuZes, Dutch Cancer Society, and Stand Up To Cancer.

Modelling the Costs and Effects of Selective and Universal Hospital Admission Screening for Methicillin-Resistant Staphylococcus aureus

PubMed Central

Hubben, Gijs; Bootsma, Martin; Luteijn, Michiel; Glynn, Diarmuid; Bishai, David

2011-01-01

Background Screening at hospital admission for carriage of methicillin-resistant Staphylococcus aureus (MRSA) has been proposed as a strategy to reduce nosocomial infections. The objective of this study was to determine the long-term costs and health benefits of selective and universal screening for MRSA at hospital admission, using both PCR-based and chromogenic media-based tests in various settings. Methodology/Principal Findings A simulation model of MRSA transmission was used to determine costs and effects over 15 years from a US healthcare perspective. We compared admission screening together with isolation of identified carriers against a baseline policy without screening or isolation. Strategies included selective screening of high risk patients or universal admission screening, with PCR-based or chromogenic media-based tests, in medium (5%) or high nosocomial prevalence (15%) settings. The costs of screening and isolation per averted MRSA infection were lowest using selective chromogenic-based screening in high and medium prevalence settings, at $4,100 and $10,300, respectively. Replacing the chromogenic-based test with a PCR-based test costs $13,000 and $36,200 per additional infection averted, and subsequent extension to universal screening with PCR would cost $131,000 and $232,700 per additional infection averted, in high and medium prevalence settings respectively. Assuming $17,645 benefit per infection averted, the most cost-saving strategies in high and medium prevalence settings were selective screening with PCR and selective screening with chromogenic, respectively. Conclusions/Significance Admission screening costs $4,100–$21,200 per infection averted, depending on strategy and setting. Including financial benefits from averted infections, screening could well be cost saving. PMID:21483492

Fuzzy logic for plant-wide control of biological wastewater treatment process including greenhouse gas emissions.

PubMed

Santín, I; Barbu, M; Pedret, C; Vilanova, R

2018-06-01

The application of control strategies is increasingly used in wastewater treatment plants with the aim of improving effluent quality and reducing operating costs. Due to concerns about the progressive growth of greenhouse gas emissions (GHG), these are also currently being evaluated in wastewater treatment plants. The present article proposes a fuzzy controller for plant-wide control of the biological wastewater treatment process. Its design is based on 14 inputs and 6 outputs in order to reduce GHG emissions, nutrient concentration in the effluent and operational costs. The article explains and shows the effect of each one of the inputs and outputs of the fuzzy controller, as well as the relationship between them. Benchmark Simulation Model no 2 Gas is used for testing the proposed control strategy. The results of simulation results show that the fuzzy controller is able to reduce GHG emissions while improving, at the same time, the common criteria of effluent quality and operational costs. Copyright © 2018 ISA. Published by Elsevier Ltd. All rights reserved.

Small satellite product assurance

NASA Astrophysics Data System (ADS)

Demontlivault, J.; Cadelec, Jacques

1993-01-01

In order to increase the interest in small satellites, their cost must be reduced; reducing product assurance costs induced by quality requirements is a major objective. For a logical approach, small satellites are classified in three main categories: satellites for experimental operations with a short lifetime, operational satellites manufactured in small mass with long lifetime requirements, operational satellites (long lifetime required), of which only a few models are produced. The various requirements as regards the product assurance are examined for each satellite category: general requirements for space approach, reliability, electronic components, materials and processes, quality assurance, documentation, tests, and management. Ideal product assurance system integrates quality teams and engineering teams.

Low-cost optical interconnect module for parallel optical data links

NASA Astrophysics Data System (ADS)

Noddings, Chad; Hirsch, Tom J.; Olla, M.; Spooner, C.; Yu, Jason J.

1995-04-01

We have designed, fabricated, and tested a prototype parallel ten-channel unidirectional optical data link. When scaled to production, we project that this technology will satisfy the following market penetration requirements: (1) up to 70 meters transmission distance, (2) at least 1 gigabyte/second data rate, and (3) 0.35 to 0.50 MByte/second volume selling price. These goals can be achieved by means of the assembly innovations described in this paper: a novel alignment method that is integrated with low-cost, few chip module packaging techniques, yielding high coupling and reducing the component count. Furthermore, high coupling efficiency increases projected reliability reducing the driver's power requirements.

On the eve of war: authoritarianism, social dominance, and American students' attitudes toward attacking Iraq.

PubMed

McFarland, Sam G

2005-03-01

In the week before the 2003 American attack on Iraq, the effects of authoritarianism and the social dominance orientation on support for the attack were examined. Based on prior research on the nature of these constructs, a structural model was developed and tested. As predicted, authoritarianism strengthened support for the attack by intensifying the perception that Iraq threatened America. Social dominance increased support by reducing concern for the likely human costs of the war. Both also increased blind patriotism, which in turn reduced concern for the war's human costs and was reciprocally related to the belief that Iraq threatened America.

Health economic evaluation of a serum-based blood test for brain tumour diagnosis: exploration of two clinical scenarios.

PubMed

Gray, Ewan; Butler, Holly J; Board, Ruth; Brennan, Paul M; Chalmers, Anthony J; Dawson, Timothy; Goodden, John; Hamilton, Willie; Hegarty, Mark G; James, Allan; Jenkinson, Michael D; Kernick, David; Lekka, Elvira; Livermore, Laurent J; Mills, Samantha J; O'Neill, Kevin; Palmer, David S; Vaqas, Babar; Baker, Matthew J

2018-05-24

To determine the potential costs and health benefits of a serum-based spectroscopic triage tool for brain tumours, which could be developed to reduce diagnostic delays in the current clinical pathway. A model-based health pre-trial economic assessment. Decision tree models were constructed based on simplified diagnostic pathways. Models were populated with parameters identified from rapid reviews of the literature and clinical expert opinion. Explored as a test in both primary and secondary care (neuroimaging) in the UK health service, as well as application to the USA. Calculations based on an initial cohort of 10 000 patients. In primary care, it is estimated that the volume of tests would approach 75 000 per annum. The volume of tests in secondary care is estimated at 53 000 per annum. The primary outcome measure was quality-adjusted life-years (QALY), which were employed to derive incremental cost-effectiveness ratios (ICER) in a cost-effectiveness analysis. Results indicate that using a blood-based spectroscopic test in both scenarios has the potential to be highly cost-effective in a health technology assessment agency decision-making process, as ICERs were well below standard threshold values of £20 000-£30 000 per QALY. This test may be cost-effective in both scenarios with test sensitivities and specificities as low as 80%; however, the price of the test would need to be lower (less than approximately £40). Use of this test as triage tool in primary care has the potential to be both more effective and cost saving for the health service. In secondary care, this test would also be deemed more effective than the current diagnostic pathway. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

A time and imaging cost analysis of low-risk ED observation patients: a conservative 64-section computed tomography coronary angiography "triple rule-out" compared to nuclear stress test strategy.

PubMed

Takakuwa, Kevin M; Halpern, Ethan J; Shofer, Frances S

2011-02-01

The study aimed to examine time and imaging costs of 2 different imaging strategies for low-risk emergency department (ED) observation patients with acute chest pain or symptoms suggestive of acute coronary syndrome. We compared a "triple rule-out" (TRO) 64-section multidetector computed tomography protocol with nuclear stress testing. This was a prospective observational cohort study of consecutive ED patients who were enrolled in our chest pain observation protocol during a 16-month period. Our standard observation protocol included a minimum of 2 sets of cardiac enzymes at least 6 hours apart followed by a nuclear stress test. Once a week, observation patients were offered a TRO (to evaluate for coronary artery disease, thoracic dissection, and pulmonary embolus) multidetector computed tomography with the option of further stress testing for those patients found to have evidence of coronary artery disease. We analyzed 832 consecutive observation patients including 214 patients who underwent the TRO protocol. Mean total length of stay was 16.1 hours for TRO patients, 16.3 hours for TRO plus other imaging test, 22.6 hours for nuclear stress testing, 23.3 hours for nuclear stress testing plus other imaging tests, and 23.7 hours for nuclear stress testing plus TRO (P < .0001 for TRO and TRO + other test compared to stress test ± other test). Mean imaging times were 3.6, 4.4, 5.9, 7.5, and 6.6 hours, respectively (P < .05 for TRO and TRO + other test compared to stress test ± other test). Mean imaging costs were $1307 for TRO patients vs $945 for nuclear stress testing. Triple rule-out reduced total length of stay and imaging time but incurred higher imaging costs. A per-hospital analysis would be needed to determine if patient time savings justify the higher imaging costs. Copyright © 2011 Elsevier Inc. All rights reserved.

Solar furnaces or swamp coolers: costs and benefits of water use by solar-tracking flowers of the alpine snow buttercup, Ranunculus adoneus.

PubMed

Galen, Candace

2006-06-01

Solar tracking or heliotropism simultaneously raises organ temperature and light interception. For leaves and flowers carbon gain is maximized at the expense of water loss. In this study I explore how costs and benefits associated with water use by solar-tracking flowers of the alpine snow buttercup, Ranunculus adoneus change with ambient temperature. First, I test whether heliotropism increases the water cost of reproduction in the snow buttercup under extant alpine conditions. I then explore whether water use for evaporative cooling in solar-tracking flowers reduces the risk of over-heating as temperatures increase. Solar tracking, by elevating floral temperature and irradiance causes a 29% increase in water uptake by flowers. Gas exchange measurements suggest that the extra water taken up by solar-tracking flowers is released through transpiration. Transpirational cooling in turn allows solar-tracking flowers to gain advantages of enhanced light interception and warmth while reducing the risk of over-heating. Transpiration reduces excess temperature in solar-tracking flowers, but at a water cost. Results show that even in cool alpine habitats, flower heliotropism has water costs to balance its reproductive advantages. Plants with solar-tracking flowers may tolerate hotter conditions if soil moisture is plentiful, but not under drought.

Analytical validation of an ultra low-cost mobile phone microplate reader for infectious disease testing.

PubMed

Wang, Li-Ju; Naudé, Nicole; Demissie, Misganaw; Crivaro, Anne; Kamoun, Malek; Wang, Ping; Li, Lei

2018-07-01

Most mobile health (mHealth) diagnostic devices for laboratory tests only analyze one sample at a time, which is not suitable for large volume serology testing, especially in low-resource settings with shortage of health professionals. In this study, we developed an ultra-low-cost clinically-accurate mobile phone microplate reader (mReader), and clinically validated this optical device for 12 infectious disease tests. The mReader optically reads 96 samples on a microplate at one time. 771 de-identified patient samples were tested for 12 serology assays for bacterial/viral infections. The mReader and the clinical instrument blindly read and analyzed all tests in parallel. The analytical accuracy and the diagnostic performance of the mReader were evaluated across the clinical reportable categories by comparison with clinical laboratorial testing results. The mReader exhibited 97.59-99.90% analytical accuracy and <5% coefficient of variation (CV). The positive percent agreement (PPA) in all 12 tests achieved 100%, negative percent agreement (NPA) was higher than 83% except for one test (42.86%), and overall percent agreement (OPA) ranged 89.33-100%. We envision the mReader can benefit underserved areas/populations and low-resource settings in rural clinics/hospitals at a low cost (~$50 USD) with clinical-level analytical quality. It has the potential to improve health access, speed up healthcare delivery, and reduce health disparities and education disparities by providing access to a low-cost spectrophotometer. Copyright © 2018 Elsevier B.V. All rights reserved.

Automatic Radiated Susceptibility Test System for Payload Equipment

NASA Technical Reports Server (NTRS)

Ngo, Hoai T.; Sturman, John C.; Sargent, Noel B.

1995-01-01

An automatic radiated susceptibility test system (ARSTS) was developed for NASA Lewis Research Center's Electro-magnetic Interference laboratory. According to MSFC-SPEC 521B, any electrical or electronic equipment that will be transported by the spacelab and space shuttle must be tested for susceptibility to electromagnetic interference. This state-of-the-art automatic test system performs necessary calculations; analyzes, processes, and records a great quantity of measured data; and monitors the equipment being tested in real-time and with minimal user intervention. ARSTS reduces costly test time, increases test accuracy, and provides reliable test results.

Comparison of anti-plaque efficacy between a low and high cost dentifrice: A short term randomized double-blind trial

PubMed Central

Ganavadiya, Rahul; Shekar, B. R. Chandra; Goel, Pankaj; Hongal, Sudheer G.; Jain, Manish; Gupta, Ruchika

2014-01-01

Objective: The aim of this study was to compare the anti-plaque efficacy of a low and high cost commercially available tooth paste among 13-20 years old adolescents in a Residential Home, Bhopal, India. Materials and Methods: The study was randomized double-blind parallel clinical trial conducted in a Residential Home, Bhopal, India. A total of 65 patients with established dental plaque and gingivitis were randomly assigned to either low cost or high cost dentifrice group for 4 weeks. The plaque and gingival scores at baseline and post-intervention were assessed and compared. Statistical analysis was performed using paired t-test and the independent sample t-test. The statistical significance was fixed at 0.05. Results: Results indicated a significant reduction in plaque and gingival scores in both groups post-intervention compared with the baseline. Difference between the groups was not significant. No adverse events were reported and both the dentifrices were well-tolerated. Conclusion: Low cost dentifrice is equally effective to the high cost dentifrice in reducing plaque and gingival inflammation. PMID:25202220

Projecting the potential impact of the Cap-Score™ on clinical pregnancy, live births, and medical costs in couples with unexplained infertility.

PubMed

Babigumira, Joseph B; Sharara, Fady I; Garrison, Louis P

2018-01-01

The Cap-Score™ was developed to assess the capacitation status of men, thereby enabling personalized management of unexplained infertility by choosing timed intrauterine insemination (IUI), versus immediate in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) in individuals with a low Cap-Score™. The objective of this study was to estimate the differences in outcomes and costs comparing the use of the Cap-Score™ with timed IUI (CS-TI) and the standard of care (SOC), which was assumed to be three IUI cycles followed by three IVF-ICSI cycles. We developed and parameterized a decision-analytic model of management of unexplained infertility for women based on data from the published literature. We calculated the clinical pregnancy rates, live birth rates, and medical costs comparing CS-TI and SOC. We used Monte Carlo simulation to quantify uncertainty in projected estimates and performed univariate sensitivity analysis. Compared to SOC, CS-TI was projected to increase the pregnancy rate by 1-26%, marginally reduce live birth rates by 1-3% in couples with women below 40 years, increase live birth rates by 3-7% in couples with women over 40 years, reduce mean medical costs by $4000-$19,200, reduce IUI costs by $600-$1370, and reduce IVF costs by $3400-$17,800, depending on the woman's age. The Cap-Score™ is a potentially valuable clinical tool for management of unexplained infertility because it is projected to improve clinical pregnancy rates, save money, and, depending on the price of the test, increase access to treatment for infertility.

Use of molecular and milk production information for the cost-effective diagnosis of bovine viral diarrhoea infection in New Zealand dairy cattle.

PubMed

Hill, F I; Reichel, M P; Tisdall, D J

2010-04-21

An increase in veterinary and farmer interest in bovine viral diarrhoea (BVD) in New Zealand over recent years led to requests for cost-effective identification of BVD virus (BVDV) infected herds and individuals. This study was undertaken to determine if the use of real-time reverse transcriptase polymerase chain reaction (RT-PCR) technology and dairy cow production data could identify persistently infected (PI) animals in milking herds. Milk samples were collected from the vats of dairy herds and tested for the presence of BVDV by RT-PCR till four herds were found containing PI animals. Individual serum samples were then collected from every cow in the herd and tested by both RT-PCR and antigen capture enzyme-linked immunosorbent assays (ACE) to identify the PI animals. Individual animal testing found 1/223, 1/130, 2/800 and 1/275 PI's respectively in the four herds. Based on these results a maximum pool size of 400 cows contributing to the bulk tank milk was selected. After removal of the PI from the herds, further bulk milk samples were shown to be BVDV negative by RT-PCR. All the PI animals identified by this method were found in the lowest producing 10-20% of herd. This approach of targeted testing of dairy herds using PCR technology, in conjunction with animal production information, markedly reduced the cost of diagnostic testing for BVDV in dairy herds in New Zealand. Questionnaire follow-up on 81 BVDV-positive herds (15% of those tested) indicated the stratification approach identified milking PIs successfully over 90% of the time and reduced the number of individual tests to 12% of the milking herd. Copyright 2009 Elsevier B.V. All rights reserved.

Implementation of a rapid HIT immunoassay at a university hospital - Retrospective analysis of HIT laboratory orders in patients with thrombocytopenia.

PubMed

Black, Anne; Heimerl, Susanne; Oertli, Linnéa; Wilczek, Wolf; Greinacher, Andreas; Spannagl, Michael; Herr, Wolfgang; Hart, Christina

2017-10-01

Heparin-induced thrombocytopenia (HIT) is a rare cause of thrombocytopenia and a potentially life-threatening adverse drug reaction. Clinical overdiagnosis of HIT results in costly laboratory tests and anticoagulation. Criteria and algorithms for diagnosis are established, but their translation into clinical practice is still challenging. In a retrospective approach we studied all HIT related laboratory test requests within four years and evaluated data before (1st period, 24month) and after (2nd period, 24month) replacing particle gel immunoassay (PaGIA) and enzyme-linked immunosorbent assay (ELISA) by a chemiluminescent immunoassay (CLIA). HIT was confirmed by heparin-induced platelet activation (HIPA) test. Clinical pretest probability for HIT using an implemented simplified 4Ts score and platelet count were evaluated. Costs for laboratory tests and alternative anticoagulation were calculated. In 1850 patients with suspected HIT, 2327 laboratory orders were performed. In 87.2% of these orders an intermediate/high simplified 4Ts score was found. Thrombocytopenia was present in 87.1%. After replacing PaGIA and ELISA by CLIA the number of immunological and functional laboratory tests was reduced by 38.2%. The number of positive HIT immunoassays declined from 22.6% to 6.0%, while the number of positive HIPA tests among positive immunological tests increased by 19%. Altogether, acute HIT was confirmed in 59 patients. A decline in the use of alternative anticoagulants was observed in the 2nd period. Our study shows that in a university hospital setting HIT is well-known, but diagnosis requires a precise laboratory confirmation. Replacing PaGIA and ELISA by CLIA did not influence laboratory order behavior but results in reduced overall costs for laboratory diagnostics and alternative anticoagulation. Copyright © 2017 Elsevier Ltd. All rights reserved.

Methods for testing Zernike phase plates and a report on silicon-based phase plates with reduced charging and improved ageing characteristics

PubMed Central

Marko, Michael; Meng, Xing; Hsieh, Chyongere; Roussie, James; Striemer, Christopher

2013-01-01

Imaging with Zernike phase plates is increasingly being used in cryo-TEM tomography and cryo-EM single-particle applications. However, rapid ageing of the phase plates, together with the cost and effort in producing them, present serious obstacles to widespread adoption. We are experimenting with phase plates based on silicon chips that have thin windows; such phase plates could be mass-produced and made available at moderate cost. The windows are coated with conductive layers to reduce charging, and this considerably extends the useful life of the phase plates compared to traditional pure-carbon phase plates. However, a compromise must be reached between robustness and transmission through the phase-plate film. Details are given on testing phase-plate performance by means of imaging an amorphous thin film and evaluating the power spectra of the images. PMID:23994351

Space Suit Performance: Methods for Changing the Quality of Quantitative Data

NASA Technical Reports Server (NTRS)

Cowley, Matthew; Benson, Elizabeth; Rajulu, Sudhakar

2014-01-01

NASA is currently designing a new space suit capable of working in deep space and on Mars. Designing a suit is very difficult and often requires trade-offs between performance, cost, mass, and system complexity. To verify that new suits will enable astronauts to perform to their maximum capacity, prototype suits must be built and tested with human subjects. However, engineers and flight surgeons often have difficulty understanding and applying traditional representations of human data without training. To overcome these challenges, NASA is developing modern simulation and analysis techniques that focus on 3D visualization. Early understanding of actual performance early on in the design cycle is extremely advantageous to increase performance capabilities, reduce the risk of injury, and reduce costs. The primary objective of this project was to test modern simulation and analysis techniques for evaluating the performance of a human operating in extra-vehicular space suits.

Milk Technological Properties as Affected by Including Artichoke By-Products Silages in the Diet of Dairy Goats

PubMed Central

Muelas, Raquel; Romero, Gema; Sayas-Barberá, Estrella; Navarro, Casilda; Díaz, José Ramón

2017-01-01

Traditional farming practices include the use of local agricultural by-products in the diet of ruminants. Artichoke harvesting and transformation yield high amounts of by-products that, if properly used, may reduce farming costs and the environmental impact of farming. The present study tests the inclusion of silages from artichoke by-products (plant and outer bracts) in the diet of dairy goats (0%, 12.5% and 25% inclusion) on the technological and sensory properties of milk during a five-month study. Milk composition, color, stability, coagulation and fermentation properties remained unaffected by diet changes. Panelists were not able to differentiate among yogurts obtained from those milks by discriminant triangular sensory tests. Silages of artichoke by-products can be included in isoproteic and isoenergetic diets for dairy goats, up to a 25% (feed dry matter), without negatively affecting milk technological and sensory properties whereas reducing feeding costs. PMID:29258226

The development of large-aperture test system of infrared camera and visible CCD camera

NASA Astrophysics Data System (ADS)

Li, Yingwen; Geng, Anbing; Wang, Bo; Wang, Haitao; Wu, Yanying

2015-10-01

Infrared camera and CCD camera dual-band imaging system is used in many equipment and application widely. If it is tested using the traditional infrared camera test system and visible CCD test system, 2 times of installation and alignment are needed in the test procedure. The large-aperture test system of infrared camera and visible CCD camera uses the common large-aperture reflection collimator, target wheel, frame-grabber, computer which reduces the cost and the time of installation and alignment. Multiple-frame averaging algorithm is used to reduce the influence of random noise. Athermal optical design is adopted to reduce the change of focal length location change of collimator when the environmental temperature is changing, and the image quality of the collimator of large field of view and test accuracy are also improved. Its performance is the same as that of the exotic congener and is much cheaper. It will have a good market.

Reducing Overutilization of Testing for Clostridium difficile Infection in a Pediatric Hospital System: A Quality Improvement Initiative.

PubMed

Klatte, J Michael; Selvarangan, Rangaraj; Jackson, Mary Anne; Myers, Angela L

2016-01-01

Study objectives included addressing overuse of Clostridium difficile laboratory testing by decreasing submission rates of nondiarrheal stool specimens and specimens from children ≤12 months of age and determining resultant patient and laboratory cost savings associated with decreased testing. A multifaceted initiative was developed, and components included multiple provider education methods, computerized order entry modifications, and automatic declination from laboratory on testing stool specimens of nondiarrheal consistency and from children ≤12 months old. A run chart, demonstrating numbers of nondiarrheal plus infant stool specimens submitted over time, was developed to analyze the initiative's impact on clinicians' test-ordering practices. A p-chart was generated to evaluate the percentage of these submitted specimens tested biweekly over a 12-month period. Cost savings for patients and the laboratory were assessed at the study period's conclusion. Run chart analysis revealed an initial shift after the interventions, suggesting a temporary decrease in testing submission; however, no sustained differences in numbers of specimens submitted biweekly were observed over time. On the p-chart, the mean percentage of specimens tested before the intervention was 100%. After the intervention, the average percentage of specimens tested dropped to 53.8%. Resultant laboratory cost savings totaled nearly $3600, and patient savings on testing charges were ∼$32 000. Automatic laboratory declination of nondiarrheal stools submitted for CDI testing resulted in a sustained decrease in the number of specimens tested, resulting in significant laboratory and patient cost savings. Despite multiple educational efforts, no sustained changes in physician ordering practices were observed. Copyright © 2016 by the American Academy of Pediatrics.

The Evaluation and Implementation of a Water Containment System to Support Aerospace Flywheel Testing

NASA Technical Reports Server (NTRS)

Trase, Larry M.

2002-01-01

High-energy flywheel systems for aerospace power storage and attitude control applications are being developed because of the potential for increasing the energy density and reducing operational costs. A significant challenge facing the development of the test hardware is containment of the rotating elements in the event of a failure during the development and qualification stages of testing. This containment is critical in order to ensure the safety of the test personnel and the facility. A containment system utilizing water as the containment media is presented. Water containment was found to be a low cost, flexible, and highly effective containment system. Ballistic test results and analytical results are discussed along with a description of a flywheel test facility that was designed and built utilizing the water containment system at the NASA Glenn Research Center at Lewis Field in Cleveland, Ohio.

Process, cost, and clinical quality: the initial oral contraceptive visit.

PubMed

McMullen, Michael J; Woolford, Samuel W; Moore, Charles L; Berger, Barry M

2013-01-01

To demonstrate how the analysis of clinical process, cost, and outcomes can identify healthcare improvements that reduce cost without sacrificing quality, using the example of the initial visit associated with oral contraceptive pill use. Cross-sectional study using data collected by HealthMETRICS between 1996 and 2009. Using data collected from 106 sites in 24 states, the unintended pregnancy (UIP) rate, effectiveness of patient education, and unit visit cost were calculated. Staff type providing education and placement of education were recorded. Two-way analysis of variance models were created and tested for significance to identify differences between groups. Sites using nonclinical staff to provide education outside the exam were associated with lower cost, higher education scores, and a UIP rate no different from that of sites using clinical staff. Sites also providing patient education during the physical examination were associated with higher cost, lower education scores, and a UIP rate no lower than that of sites providing education outside of the exam. Through analyzing process, cost, and quality, lower-cost processes that did not reduce clinical quality were identified. This methodology is applicable to other clinical services for identifying low-cost processes that do not result in lower clinical quality. By using nonclinical staff educators to provide education outside of the physical examination, sites could save an average of 32% of the total cost of the visit.

Update on Risk Reduction Activities for a Liquid Advanced Booster for NASA's Space Launch System

NASA Technical Reports Server (NTRS)

Crocker, Andrew M.; Doering, Kimberly B; Meadows, Robert G.; Lariviere, Brian W.; Graham, Jerry B.

2015-01-01

The stated goals of NASA's Research Announcement for the Space Launch System (SLS) Advanced Booster Engineering Demonstration and/or Risk Reduction (ABEDRR) are to reduce risks leading to an affordable Advanced Booster that meets the evolved capabilities of SLS; and enable competition by mitigating targeted Advanced Booster risks to enhance SLS affordability. Dynetics, Inc. and Aerojet Rocketdyne (AR) formed a team to offer a wide-ranging set of risk reduction activities and full-scale, system-level demonstrations that support NASA's ABEDRR goals. For NASA's SLS ABEDRR procurement, Dynetics and AR formed a team to offer a series of full-scale risk mitigation hardware demonstrations for an affordable booster approach that meets the evolved capabilities of the SLS. To establish a basis for the risk reduction activities, the Dynetics Team developed a booster design that takes advantage of the flight-proven Apollo-Saturn F-1. Using NASA's vehicle assumptions for the SLS Block 2, a two-engine, F-1-based booster design delivers 150 mT (331 klbm) payload to LEO, 20 mT (44 klbm) above NASA's requirements. This enables a low-cost, robust approach to structural design. During the ABEDRR effort, the Dynetics Team has modified proven Apollo-Saturn components and subsystems to improve affordability and reliability (e.g., reduce parts counts, touch labor, or use lower cost manufacturing processes and materials). The team has built hardware to validate production costs and completed tests to demonstrate it can meet performance requirements. State-of-the-art manufacturing and processing techniques have been applied to the heritage F-1, resulting in a low recurring cost engine while retaining the benefits of Apollo-era experience. NASA test facilities have been used to perform low-cost risk-reduction engine testing. In early 2014, NASA and the Dynetics Team agreed to move additional large liquid oxygen/kerosene engine work under Dynetics' ABEDRR contract. Also led by AR, the objectives of this work are to demonstrate combustion stability and measure performance of a 500,000 lbf class Oxidizer-Rich Staged Combustion (ORSC) cycle main injector. A trade study was completed to investigate the feasibility, cost effectiveness, and technical maturity of a domestically produced Atlas V engine that could also potentially satisfy NASA SLS payload-to-orbit requirements via an advanced booster application. Engine physical dimensions and performance parameters resulting from this study provide the system level requirements for the ORSC risk reduction test article. The test article is scheduled to complete critical design review this fall and begin testing in 2017. Dynetics has also designed, developed, and built innovative tank and structure assemblies using friction stir welding to leverage recent NASA investments in manufacturing tools, facilities, and processes, significantly reducing development and recurring costs. The full-scale cryotank assembly was used to verify the structural design and prove affordable processes. Dynetics performed hydrostatic and cryothermal proof tests on the assembly to verify the assembly meets performance requirements. This paper will discuss the ABEDRR engine task and structures task achievements to date and the remaining effort through the end of the contract.

Learning to not know: results of a program for ancillary cost reduction in surgical critical care.

PubMed

Barie, P S; Hydo, L J

1996-10-01

Compelling internal and external influences are stimulating global re-evaluations of care standards for efficacy and cost. Critical care uses huge amounts of resources despite widespread shortages of beds and nurses. This study tested the hypothesis that ancillary expenditures can be decreased without compromising care. Costs for laboratory tests, radiographs, blood products, nutritional supplements, and drugs were compared prospectively for all surgical intensive care unit care for two 4-month periods (January 1 to April 30, 1994 and January 1 to April 30, 1995) at a urban university center. A systematic, multidisciplinary cost-reduction program began May 1, 1994, with emphasis on laboratory and radiographic testing and procedures, and blood product, nutritional, and drug therapies. Cohorts were compared by age, Acute Physiology and Chronic Health Evaluation (APACHE) II and III admission scores, and case mix. Outcome variables were hospital mortality, days in the intensive care unit and hospital, the development of multiple organ dysfunction syndrome, and expenditures. Cost data were taken weekly from the hospital's clinical information system. No new equipment was introduced during the study period except for pumps for patient-controlled analgesia, and there were no new critical pathways or other patient care guidelines. Case mix and all noncost variables were identical. Overall costs were reduced by 29% when normalized by the number of patient-days in each period. Laboratory testing was reduced in frequency by 24 to 32%, and cost by 26 to 28%. Comparable reductions in the cost of blood products (32%) were exceeded by the reductions in expenditures for nutritional supplements (49%) and pharmaceuticals (45%) (all, p < 0.01 or less). Modestly increased (2%) x-ray charges in 1995 were owing entirely to insertion of prophylactic inferior vena cava filters (each, $2,800, n = 5) and computed tomography scans for sinusitis (each, $350, n = 5), although the 7% reduction in portable chest radiographs that was achieved did not meet expectations. Substantial reductions in physician-ordered ancillary expenditures are possible without compromising the standard of care of critically ill patients, or the support of an elaborate framework of defined care plans. With additional experience, incremental savings may accrue from refinement of successful strategies and new approaches to intractable problems.

Cost-effectiveness of sacubitril/valsartan versus enalapril in patients with heart failure and reduced ejection fraction.

PubMed

Liang, Lin; Bin-Chia Wu, David; Aziz, Mohamed Ismail Abdul; Wong, Raymond; Sim, David; Leong, Kui Toh Gerard; Wei, Yong Quek; Tan, Doreen; Ng, Kwong

2018-02-01

Sacubitril/valsartan reduces cardiovascular death and hospitalizations for heart failure (HF). However, decision-makers need to determine whether its benefits are worth the additional costs, given the low-cost generic status of traditional standard of care. To evaluate the cost-effectiveness of sacubitril/valsartan compared to enalapril in patients with HF and reduced ejection fraction, from the Singapore healthcare payer perspective. A Markov model was developed to project clinical and economic outcomes of sacubitril/valsartan vs enalapril for 66-year-old patients with HF over 10 years. Key health states included New York Heart Association classes I-IV and deaths; patients in each state incurred a monthly risk of hospitalization for HF and cardiovascular death. Sacubitril/valsartan benefits were modeled by applying the hazard ratios (HRs) in PARADIGM-HF trial to baseline probabilities. Primary model outcomes were total and incremental costs and quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER) for sacubitril/valsartan relative to enalapril Results: Compared to enalapril, sacubitril/valsartan was associated with an ICER of SGD 74,592 (USD 55,198) per QALY gained. A major driver of cost-effectiveness was the cardiovascular mortality benefit of sacubitril/valsartan. The uncertainty of this treatment benefit in the Asian sub-group was tested in sensitivity analyses using a HR of 1 as an upper limit, where the ICERs ranged from SGD 41,019 (USD 30,354) to SGD 1,447,103 (USD 1,070,856) per QALY gained. Probabilistic sensitivity analyses showed the probability of sacubitril/valsartan being cost-effective was below 1%, 12%, and 71% at SGD 20,000, SGD 50,000, and SGD 100,000 per QALY gained, respectively. At the current daily price sacubitril/valsartan may not represent good value for limited healthcare dollars compared to enalapril in reducing cardiovascular morbidity and mortality in HF in the Singapore healthcare setting. This study highlights the cost-benefit trade-off that healthcare professionals and patients face when considering therapy.

Final Report - Assessment of Testing Options for the NTR at the INL

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

Howe, Steven D; McLing, Travis L; McCurry, Michael

One of the main technologies that can be developed to dramatically enhance the human exploration of space is the nuclear thermal rocket (NTR). Several studies over the past thirty years have shown that the NTR can reduce the cost of a lunar outpost, reduce the risk of a human mission to Mars, enable fast transits for most missions throughout the solar system, and reduce the cost and time for robotic probes to deep space. Three separate committees of the National Research Council of the National Academy of Sciences have recommended that NASA develop the NTR. One of the primary issuesmore » in development of the NTR is the ability to verify a flight ready unit. Three main methods can be used to validate safe operation of a NTR: 1) Full power, full duration test in an above ground facility that scrubs the rocket exhaust clean of any fission products; 2) Full power , full duration test using the Subsurface Active Filtering of Exhaust (SAFE) technique to capture the exhaust in subsurface strata; 3) Test of the reactor fuel at temperature and power density in a driver reactor with subsequent first test of the fully integrated NTR in space. The first method, the above ground facility, has been studied in the past. The second method, SAFE, has been examined for application at the Nevada Test Site. The third method relies on the fact that the Nuclear Furnace series of tests in 1971 showed that the radioactive exhaust coming from graphite based fuel for the NTR could be completely scrubbed of fission products and the clean hydrogen flared into the atmosphere. Under funding from the MSFC, the Center for Space Nuclear Research (CSNR) at the Idaho National laboratory (INL) has completed a reexamination of Methods 2 and 3 for implementation at the INL site. In short, the effort performed the following: 1) Assess the geology of the INL site and determine a location suitable SAFE testing; 2) Perform calculations of gas transport throughout the geology; 3) Produce a cost estimate of a non-nuclear , sub-scale test using gas injection to validate the computational models; 4) Produce a preliminary cost estimate to build a nuclear furnace equivalent facility to test NTR fuel on a green field location on the INL site. The results show that the INL geology is substantially better suited to the SAFE testing method than the NTS site. The existence of impermeable interbeds just above the sub-surface aquifer ensure that no material from the test, radioactive or not, can enter the water table. Similar beds located just below the surface will prevent any gaseous products from reaching the surface for dispersion. The extremely high permeability of the strata between the interbeds allows rapid dispersion of the rocket exhaust. In addition, the high permeability suggests that a lower back-pressure may develop in the hole against the rocket thrust, which increases safety of operations. Finally, the cost of performing a sub-scale, non-nuclear verification experiment was determined to be $3M. The third method was assessed through discussions with INL staff resident at the site. In essence, any new Category I facility on any DOE site will cost in excess of $250M. Based on the results of this study, a cost estimate for testing a nuclear rocket at the INL site appears to be warranted. Given the fact that a new nuclear fuel may be possible that does not release any fission products, the SAFE testing option appears to be the most affordable.« less

Logistic and Multiple Regression: A Two-Pronged Approach to Accurately Estimate Cost Growth in Major DoD Weapon Systems

DTIC Science & Technology

2004-03-01

Breusch - Pagan test for constant variance of the residuals. Using Microsoft Excel® we calculate a p-value of 0.841237. This high p-value, which is above...our alpha of 0.05, indicates that our residuals indeed pass the Breusch - Pagan test for constant variance. In addition to the assumption tests , we...Wilk Test for Normality – Support (Reduced) Model (OLS) Finally, we perform a Breusch - Pagan test for constant variance of the residuals. Using

Estimated Costs for Delivery of HIV Antiretroviral Therapy to Individuals with CD4+ T-Cell Counts >350 cells/uL in Rural Uganda.

PubMed

Jain, Vivek; Chang, Wei; Byonanebye, Dathan M; Owaraganise, Asiphas; Twinomuhwezi, Ellon; Amanyire, Gideon; Black, Douglas; Marseille, Elliot; Kamya, Moses R; Havlir, Diane V; Kahn, James G

2015-01-01

Evidence favoring earlier HIV ART initiation at high CD4+ T-cell counts (CD4>350/uL) has grown, and guidelines now recommend earlier HIV treatment. However, the cost of providing ART to individuals with CD4>350 in Sub-Saharan Africa has not been well estimated. This remains a major barrier to optimal global cost projections for accelerating the scale-up of ART. Our objective was to compute costs of ART delivery to high CD4+count individuals in a typical rural Ugandan health center-based HIV clinic, and use these data to construct scenarios of efficient ART scale-up. Within a clinical study evaluating streamlined ART delivery to 197 individuals with CD4+ cell counts >350 cells/uL (EARLI Study: NCT01479634) in Mbarara, Uganda, we performed a micro-costing analysis of administrative records, ART prices, and time-and-motion analysis of staff work patterns. We computed observed per-person-per-year (ppy) costs, and constructed models estimating costs under several increasingly efficient ART scale-up scenarios using local salaries, lowest drug prices, optimized patient loads, and inclusion of viral load (VL) testing. Among 197 individuals enrolled in the EARLI Study, median pre-ART CD4+ cell count was 569/uL (IQR 451-716). Observed ART delivery cost was $628 ppy at steady state. Models using local salaries and only core laboratory tests estimated costs of $529/$445 ppy (+/-VL testing, respectively). Models with lower salaries, lowest ART prices, and optimized healthcare worker schedules reduced costs by $100-200 ppy. Costs in a maximally efficient scale-up model were $320/$236 ppy (+/- VL testing). This included $39 for personnel, $106 for ART, $130/$46 for laboratory tests, and $46 for administrative/other costs. A key limitation of this study is its derivation and extrapolation of costs from one large rural treatment program of high CD4+ count individuals. In a Ugandan HIV clinic, ART delivery costs--including VL testing--for individuals with CD4>350 were similar to estimates from high-efficiency programs. In higher efficiency scale-up models, costs were substantially lower. These favorable costs may be achieved because high CD4+ count patients are often asymptomatic, facilitating more efficient streamlined ART delivery. Our work provides a framework for calculating costs of efficient ART scale-up models using accessible data from specific programs and regions.

Advanced Launch System advanced development oxidizer turbopump program: Technical implementation plan

NASA Technical Reports Server (NTRS)

Ferlita, F.

1989-01-01

The Advanced Launch Systems (ALS) Advanced Development Oxidizer Turbopump Program has designed, fabricated and demonstrated a low cost, highly reliable oxidizer turbopump for the Space Transportation Engine that minimizes the recurring cost for the ALS engines. Pratt and Whitney's (P and W's) plan for integrating the analyses, testing, fabrication, and other program efforts is addressed. This plan offers a comprehensive description of the total effort required to design, fabricate, and test the ALS oxidizer turbopump. The proposed ALS oxidizer turbopump reduces turbopump costs over current designs by taking advantage of design simplicity and state-of-the-art materials and producibility features without compromising system reliability. This is accomplished by selecting turbopump operating conditions that are within known successful operating regions and by using proven manufacturing techniques.

Costs and clinical outcomes for non-invasive versus invasive diagnostic approaches to patients with suspected in-stent restenosis.

PubMed

Min, James K; Hasegawa, James T; Machacz, Susanne F; O'Day, Ken

2016-02-01

This study compared costs and clinical outcomes of invasive versus non-invasive diagnostic evaluations for patients with suspected in-stent restenosis (ISR) after percutaneous coronary intervention. We developed a decision model to compare 2 year diagnosis-related costs for patients who presented with suspected ISR and were evaluated by: (1) invasive coronary angiography (ICA); (2) non-invasive stress testing strategy of myocardial perfusion imaging (MPI) with referral to ICA based on MPI; (3) coronary CT angiography-based testing strategy with referral to ICA based on CCTA. Costs were modeled from the payer's perspective using 2014 Medicare rates. 56 % of patients underwent follow-up diagnostic testing over 2 years. Compared to ICA, MPI (98.6 %) and CCTA (98.1 %) exhibited lower rates of correct diagnoses. Non-invasive strategies were associated with reduced referrals to ICA and costs compared to an ICA-based strategy, with diagnostic costs lower for CCTA than MPI. Overall 2-year costs were highest for ICA for both metallic as well as BVS stents ($1656 and $1656, respectively) when compared to MPI ($1444 and $1411) and CCTA. CCTA costs differed based upon stent size and type, and were highest for metallic stents >3.0 mm followed by metallic stents <3.0 mm, BVS < 3.0 mm and BVS > 3.0 mm ($1466 vs. $1242 vs. $855 vs. $490, respectively). MPI for suspected ISR results in lower costs and rates of complications than invasive strategies using ICA while maintaining high diagnostic performance. Depending upon stent size and type, CCTA results in lower costs than MPI.

Active tower damping and pitch balancing - design, simulation and field test

NASA Astrophysics Data System (ADS)

Duckwitz, Daniel; Shan, Martin

2014-12-01

The tower is one of the major components in wind turbines with a contribution to the cost of energy of 8 to 12% [1]. In this overview the load situation of the tower will be described in terms of sources of loads, load components and fatigue contribution. Then two load reduction control schemes are described along with simulation and field test results. Pitch Balancing is described as a method to reduce aerodynamic asymmetry and the resulting fatigue loads. Active Tower Damping is reducing the tower oscillations by applying appropiate pitch angle changes. A field test was conducted on an Areva M5000 wind turbine.

Cost-effectiveness of a repeat HIV test in pregnancy in India.

PubMed

Joshi, Smita; Kulkarni, Vinay; Gangakhedkar, Raman; Mahajan, Uma; Sharma, Sushma; Shirole, Devendra; Chandhiok, Nomita

2015-06-11

To evaluate cost-effectiveness of second HIV test in pregnancy. Current strategy of single HIV test during pregnancy in India can miss new HIV infections acquired after the first test or those HIV infections that were missed in the first test due to a false-negative HIV test. Between August 2011 and April 2013, 9097 pregnant HIV uninfected women were offered a second HIV test near term (34 weeks or beyond) or within 4 weeks of postpartum period. A decision analysis model was used to evaluate cost-effectiveness of a second HIV test in pregnant women near term. Our key outcome measures include programme cost with addition of second HIV test in pregnant women and quality-adjusted life years (QALYs) gained. We detected 4 new HIV infections in the second test. Thus HIV incidence among pregnant women was 0.12 (95% 0.032 to 0.297) per 100 person women years (PWY). Current strategy of a single HIV test is 8.2 times costlier for less QALYs gained as compared to proposed repeat HIV testing of pregnant women who test negative during the first test. Our results warrant consideration at the national level for including a second HIV test of all pregnant women in the national programme. However prior to allocation of resources for a second HIV test in pregnancy, appropriate strategies will have to be planned for improving compliance for prevention of mother-to-child transmission of HIV and reducing loss-to-follow-up of those women detected with HIV. CTRI/2013/12/004183. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Cost-effectiveness of a repeat HIV test in pregnancy in India

PubMed Central

Joshi, Smita; Kulkarni, Vinay; Gangakhedkar, Raman; Mahajan, Uma; Sharma, Sushma; Shirole, Devendra; Chandhiok, Nomita

2015-01-01

Objective To evaluate cost-effectiveness of second HIV test in pregnancy. Background Current strategy of single HIV test during pregnancy in India can miss new HIV infections acquired after the first test or those HIV infections that were missed in the first test due to a false-negative HIV test. Methods Between August 2011 and April 2013, 9097 pregnant HIV uninfected women were offered a second HIV test near term (34 weeks or beyond) or within 4 weeks of postpartum period. A decision analysis model was used to evaluate cost-effectiveness of a second HIV test in pregnant women near term. Primary and secondary outcome Our key outcome measures include programme cost with addition of second HIV test in pregnant women and quality-adjusted life years (QALYs) gained. Results We detected 4 new HIV infections in the second test. Thus HIV incidence among pregnant women was 0.12 (95% 0.032 to 0.297) per 100 person women years (PWY). Current strategy of a single HIV test is 8.2 times costlier for less QALYs gained as compared to proposed repeat HIV testing of pregnant women who test negative during the first test. Conclusions Our results warrant consideration at the national level for including a second HIV test of all pregnant women in the national programme. However prior to allocation of resources for a second HIV test in pregnancy, appropriate strategies will have to be planned for improving compliance for prevention of mother-to-child transmission of HIV and reducing loss-to-follow-up of those women detected with HIV. Trial registration number CTRI/2013/12/004183. PMID:26068507

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

Scholbrock, A. K.; Fleming, P. A.; Fingersh, L. J.

Wind turbines are complex, nonlinear, dynamic systems driven by aerodynamic, gravitational, centrifugal, and gyroscopic forces. The aerodynamics of wind turbines are nonlinear, unsteady, and complex. Turbine rotors are subjected to a chaotic three-dimensional (3-D) turbulent wind inflow field with imbedded coherent vortices that drive fatigue loads and reduce lifetime. In order to reduce cost of energy, future large multimegawatt turbines must be designed with lighter weight structures, using active controls to mitigate fatigue loads, maximize energy capture, and add active damping to maintain stability for these dynamically active structures operating in a complex environment. Researchers at the National Renewable Energymore » Laboratory (NREL) and University of Stuttgart are designing, implementing, and testing advanced feed-back and feed-forward controls in order to reduce the cost of energy for wind turbines.« less

Cost-effectiveness of supplementing a broth-enriched culture test with the Xpert meticillin-resistant Staphylococcus aureus (MRSA) assay for screening inpatients at high risk of MRSA.

PubMed

Li, J; Ulvin, K; Biboh, H; Kristiansen, I S

2012-12-01

Meticillin-resistant Staphylococcus aureus (MRSA) represents a considerable challenge for health care in terms of complications and costs. Whilst bacteriological culture remains the most common method for detecting MRSA, the polymerase-chain-reaction-based Xpert MRSA assay was introduced to Ullevål Oslo University Hospital, Norway in 2009. To estimate the cost-effectiveness of supplementing a broth-enriched culture test with the Xpert MRSA assay in comparison with using the culture test alone as part of an active surveillance strategy. A decision-tree model was developed to compare the current strategy (broth-enriched culture test) with two new strategies using the Xpert MRSA assay (daytime and 24 h). Costs and outcomes (length of pre-emptive isolation, number of unavailable room-hours, quality of life) were measured. The current strategy was more expensive (NOK16,984 per patient) than the daytime Xpert strategy and 24 h Xpert strategy (NOK7360 and NOK3690 per patient, respectively). The new strategies reduced the length of pre-emptive isolation per patient (by 43.9 h and 57.5 h for the daytime Xpert strategy and 24 h Xpert strategy, respectively), and also the number of unavailable room-hours per case (by 57.1 h and 77.7 h, respectively). The improvement in patients' quality-adjusted life years (QALYs) was nominal (2.4*10(-4) and 3.0*10(-4) QALYs per patient for the daytime Xpert strategy and 24 h Xpert strategy, respectively). The sensitivity analyses indicated that these results were robust to reasonable changes in the model parameters. The 24 h Xpert strategy appears to be the best strategy for active surveillance as it reduces costs and unfavourable outcomes compared with the other strategies, while improving favourable outcomes under reasonable assumptions. Copyright © 2012 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Using CCSDS Standards to Reduce Mission Costs

NASA Technical Reports Server (NTRS)

Wilmot, Jonathan

2017-01-01

NASA's open source Core Flight System (cFS) software framework has been using several Consultative Committee for Space Data Systems (CCSDS) standards since its inception. Recently developed CCSDS standards are now being applied by NASA, ESA and other organizations to streamline and automate aspects of mission development, test, and operations, speeding mission schedules and reducing mission costs. This paper will present the new CCSDS Spacecraft Onboard Interfaces Services (SOIS) Electronic Data Sheet (EDS) standards and show how they are being applied to data interfaces in the cFS software framework, tool chain, and ground systems across a range of missions at NASA. Although NASA is focusing on the cFS, it expected that these technologies are well suited for use in other system architectures and can lower costs for a wide range of both large and small satellites.

[Health technology assessment report: Computer-assisted Pap test for cervical cancer screening].

PubMed

Della Palma, Paolo; Moresco, Luca; Giorgi Rossi, Paolo

2012-01-01

HEALTH PROBLEM: Cervical cancer is a disease which is highly preventable by means of Pap test screening for the precancerous lesions, which can be easily treated. Furthermore, in the near future, control of the disease will be enhanced by the vaccination which prevents the infection of those human papillomavirus types that cause the vast majority of cervical cancers. The effectiveness of screening in drastically reducing cervical cancer incidence has been clearly demonstrated. The epidemiology of cervical cancer in industrialised countries is now determined mostly by the Pap test coverage of the female population and by the ability of health systems to assure appropriate follow up after an abnormal Pap test. Today there are two fully automated systems for computer-assisted Pap test: the BD FocalPoint and the Hologic Imager. Recently, the Hologic Integrated Imager, a semi-automated system, was launched. The two fully automated systems are composed of a central scanner, where the machine examines the cytologic slide, and of one or more review stations, where the cytologists analyze the slides previously centrally scanned. The softwares used by the two systems identify the fields of interest so that the cytologists can look only at those points, automatically pointed out by the review station. Furthermore, the FocalPoint system classifies the slides according to their level of risk of containing signs of relevant lesions. Those in the upper classes--about one fifth of the slides--are labelled as « further review », while those in the lower level of risk, i.e. slides that have such a low level of risk that they can be considered as negative with no human review, are labelled as « no further review ». The aim of computer-assisted Pap test is to reduce the time of slide examination and to increase productivity. Furthermore, the number of errors due to lack of attention may decrease. Both the systems can be applied to liquidbased cytology, while only the BD Focal Point can be used on conventional smears. Cytology screening has some critical points: there is a shortage of cytologists/cytotechnicians; the quality strongly depends on the experience and ability of the cytologist; there is a subjective component in the cytological diagnosis; in highly screened populations, the prevalence of lesions is very low and the activity of cytologists is very monotonous. On the other hand, a progressive shift to molecular screening using HPV-DNA test as primary screening test is very likely in the near future; cytology will be used as triage test, dramatically reducing the number of slides to process and increasing the prevalence of lesions in those Pap tests. In this Report we assume that the diagnostic accuracy of computer-assisted Pap test is equal to the accuracy of manual Pap test and, consequently, that screening using computer-assisted Pap test has the same efficacy in reducing cervical cancer incidence and mortality. Under this assumption, the effectiveness/ benefit/utility is the same for the two screening modes, i.e. the economic analysis will be a cost minimization study. Furthermore, the screening process is identical for the two modalities in all the phases except for slide interpretation. The cost minimization analysis will be limited to the only phase differing between the two modes, i.e. the study will be a differential cost analysis between a labour-intensive strategy (traditional Pap test) and a technology-intensive strategy (the computer-assisted Pap test). Briefly, the objectives of this HTA Report are: to determine the break even point of computer-assisted Pap test systems, i.e. the volume of slides processed per year at which putting in place a computer-assisted Pap test system becomes economically convenient; to quantify the cost per Pap test in different scenarios according to screening centre activity volume, productivity of cytologist, type of cytology (conventional smear or liquid-based, fully automated or semi-automated computer-assisted); to analyse the computer-assisted Pap test in the Italian context, through a survey of the centres using the technology, collecting data useful for the sensitivity analysis of the economic evaluation; to evaluate the acceptability of the technology in the screening services; to evaluate the organizational and financial impact of the computer-assisted Pap test in different scenarios; to illustrate the ideal organization to implement computer-assisted Pap test in terms of volume of activity, productivity, and human and technological resources. to produce this Report, the following process was adopted: application to the Ministry of health for a grant « Analysis of the impact of professional involvement in evidence generation for the HTA process »; within this project, the sub-project « Cost effectiveness evaluation of the computer-assisted Pap test in the Italian screening programmes » was financed; constitution of the Working Group, which included the project coordinator, the principal investigator, and the health economist; identification of the centres using the computer-assisted Pap test and which had published scientific reports on the subject; identification of the Consulting Committee (stakeholder), which included screening programmes managers, pathologists, economists, health policy-makers, citizen organizations, and manufacturers. Once the evaluation was concluded, a plenary meeting with Working Group and Consulting Committee was held. The working group drafted the final version of this Report, which took into account the comments received. the fully automated computer-assisted Pap test has an important financial and organizational impact on screening programmes. The assessment of this health technology reached the following conclusions: according to the survey results, after some distrust, cytologists accepted the use of the machine and appreciated the reduction in interpretation time and the reliability in identifying the fields of interest; from an economic point of view, the automated computer-assisted Pap test can be convenient only with conventional smears if the screening centre has a volume of more than 49,000 slides/year and the cytologist productivity increases about threefold. It must be highlighted that it is not sufficient to adopt the automated Pap test to reach such an increase in productivity; the laboratory must be organised or re-organised to optimise the use of the review stations and the person time. In the case of liquid-based cytology, the adoption of automated computer- assisted Pap test can only increase the costs. In fact, liquid-based cytology increases the cost of consumable materials but reduces the interpretation time, even in manual screening. Consequently, the reduction of human costs is smaller in the case of computer-assisted screening. Liquid-based cytology has other implications and advantages not linked to the use of computer-assisted Pap test that should be taken into account and are beyond the scope of this Report; given that the computer-assisted Pap test reduces human costs, it may be more advantageous where the cost of cytologists is higher; given the relatively small volume of activity of screening centres in Italy, computer-assisted Pap test may be reasonable for a network using only one central scanner and several remote review stations; the use of automated computer-assisted Pap test only for quality control in a single centre is not economically sustainable. In this case as well, several centres, for example at the regional level, may form a consortium to reach a reasonable number of slides to achieve the break even point. Regarding the use of a machine rather than human intelligence to interpret the slides, some ethical issues were initially raised, but both the scientific community and healthcare professionals have accepted this technology. The identification of fields of interest by the machine is highly reproducible, reducing subjectivity in the diagnostic process. The Hologic system always includes a check by the human eye, while the FocalPoint system identifies about one fifth of the slides as No Further Review. Several studies, some of which conducted in Italy, confirmed the reliability of this classification. There is still some resistance to accept the practice of No Further Review. A check of previous slides and clinical data can be useful to make the cytologist and the clinician more confident. Computer-assisted automated Pap test may be introduced only if there is a need to increase the volume of slides screened to cover the screening target population and sufficient human resources are not available. Switching a programme using conventional slides to automatic scanning can only lead to a reduction in costs if the volume of slides per year exceeds 49,000 slides/annum and cytologist productivity is optimised to more than 20,000 slides per year. At a productivity of 15,000 or fewer, the automated computer-assisted Pap test cannot be convenient. Switching from manual screening with conventional slides to automatic scanning with liquid-based cytology cannot generate any economic saving, but the system could increase output with a given number of staff. The transition from manual to computer assisted automated screening of liquid based cytology will not generate savings and the increase in productivity will be lower than that of the switch from manual/conventional to automated/conventional. The use of biologists or pathologists as cytologists is more costly than the use of cytoscreeners. Given that the automated computer-assisted Pap test reduces human resource costs, its adoption in a model using only biologists and pathologists for screening is more economically advantageous. (ABSTRACT TRUNCATED)

What Were They Thinking? Reducing Sunk-Cost Bias in a Life-Span Sample

PubMed Central

Strough, JoNell; Bruine de Bruin, Wändi; Parker, Andrew M.; Karns, Tara; Lemaster, Philip; Pichayayothin, Nipat; Delaney, Rebecca; Stoiko, Rachel

2016-01-01

We tested interventions to reduce “sunk-cost bias,” the tendency to continue investing in failing plans even when those plans have soured and are no longer rewarding. We showed members of a national U.S. life-span panel a hypothetical scenario about a failing plan that was halfway complete. Participants were randomly assigned to an intervention to focus on how to improve the situation, an intervention to focus on thoughts and feelings, or a no-intervention control group. First, we found that the thoughts and feelings intervention reduced sunk-cost bias in decisions about project completion, as compared to the improvement intervention and the no-intervention control. Second, older age was associated with greater willingness to cancel the failing plan across all three groups. Third, we found that introspection processes helped to explain the effectiveness of the interventions. Specifically, the larger reduction in sunk-cost bias as observed in the thoughts and feelings intervention (vs. the improvement intervention) was associated with suppression of future-oriented thoughts of eventual success, and with suppression of augmentations of the scenario that could make it seem reasonable to continue the plan. Fourth, we found that introspection processes were related to age differences in decisions. Older people were less likely to mention future-oriented thoughts of eventual success associated with greater willingness to continue the failing plan. We discuss factors to consider when designing interventions for reducing sunk-cost bias. PMID:27831712

Impact of standardized clinical assessment and management plans on resource utilization and costs in children after the arterial switch operation.

PubMed

Rathod, Rahul H; Jurgen, Brittney; Hamershock, Rose A; Friedman, Kevin G; Marshall, Audrey C; Samnaliev, Mihail; Graham, Dionne A; Jenkins, Kathy; Lock, James E; Powell, Andrew J

2017-12-01

Standardized Clinical Assessment and Management Plans (SCAMPs) are a quality improvement initiative designed to reduce unnecessary utilization, decrease practice variation, and improve patient outcomes. We created a novel methodology, the SCAMP managed episode of care (SMEOC), which encompasses multiple encounters to assess the impact of the arterial switch operation (ASO) SCAMP on total costs. All ASO SCAMP patients (dates March 2009 to July 2015) were compared to a control group of ASO patients (January 2001 to February 2009). Patients were divided into "younger" (<2 years) and "older" (2-18 years) subgroups. Utilization included all cardiology visits, tests, and procedures. Standardized costs were applied to each unit of utilization. There were 100 historical and 63 SCAMP patients in the younger subgroup, and 163 historical and 165 SCAMP patients in the older subgroup. In the younger subgroup, the SCAMP had a 28% reduction in outpatient clinic visits (P < .001), a 52% reduction in chest radiographs (P < .001), a 21% reduction in electrocardiograms (P < .001), and a 30% total reduction in costs. In the older subgroup, the SCAMP had a 21% reduction in outpatient clinic visits (P < .001), a 20% reduction in chest radiographs (P = .05), a 10% reduction in echocardiograms (P = .05), a 25% reduction in exercise stress tests (P = .01), and a 14% total reduction in costs. The total cost savings of the ASO SCAMP was $216 649 in the first 6 years of the SCAMP. There was no difference in clinical outcomes between the historical and SCAMP cohorts. SCAMPs can improve resource utilization and reduce costs after the ASO operation while maintaining quality of care. © 2017 Wiley Periodicals, Inc.

Clinical Impact and Cost-effectiveness of Diagnosing HIV Infection During Early Infancy in South Africa: Test Timing and Frequency.

PubMed

Francke, Jordan A; Penazzato, Martina; Hou, Taige; Abrams, Elaine J; MacLean, Rachel L; Myer, Landon; Walensky, Rochelle P; Leroy, Valériane; Weinstein, Milton C; Parker, Robert A; Freedberg, Kenneth A; Ciaranello, Andrea

2016-11-01

 Diagnosis of human immunodeficiency virus (HIV) infection during early infancy (commonly known as "early infant HIV diagnosis" [EID]) followed by prompt initiation of antiretroviral therapy dramatically reduces mortality. EID testing is recommended at 6 weeks of age, but many infant infections are missed.  We simulated 4 EID testing strategies for HIV-exposed infants in South Africa: no EID (diagnosis only after illness; hereafter, "no EID"), testing once (at birth alone or at 6 weeks of age alone; hereafter, "birth alone" and "6 weeks alone," respectively), and testing twice (at birth and 6 weeks of age; hereafter "birth and 6 weeks"). We calculated incremental cost-effectiveness ratios (ICERs), using discounted costs and life expectancies for all HIV-exposed (infected and uninfected) infants.  In the base case (guideline-concordant care), the no EID strategy produced a life expectancy of 21.1 years (in the HIV-infected group) and 61.1 years (in the HIV-exposed group); lifetime cost averaged $1430/HIV-exposed infant. The birth and 6 weeks strategy maximized life expectancy (26.5 years in the HIV-infected group and 61.4 years in the HIV-exposed group), costing $1840/infant tested. The ICER of the 6 weeks alone strategy versus the no EID strategy was $1250/year of life saved (19% of South Africa's per capita gross domestic product); the ICER for the birth and 6 weeks strategy versus the 6 weeks alone strategy was $2900/year of life saved (45% of South Africa's per capita gross domestic product). Increasing the proportion of caregivers who receive test results and the linkage of HIV-positive infants to antiretroviral therapy with the 6 weeks alone strategy improved survival more than adding a second test.  EID at birth and 6 weeks improves outcomes and is cost-effective, compared with EID at 6 weeks alone. If scale-up costs are comparable, programs should add birth testing after strengthening 6-week testing programs. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

Use of hypofractionated post-mastectomy radiotherapy reduces health costs by over $2000 per patient: An Australian perspective.

PubMed

Mortimer, Joshua W; McLachlan, Craig S; Hansen, Carmen J; Assareh, Hassan; Last, Andrew; McKay, Michael J; Shakespeare, Thomas P

2016-02-01

The most recent clinical practice guidelines released by Cancer Australia draw attention to unanswered questions concerning the health economic considerations associated with hypofractionated radiotherapy. This study aimed to quantify and compare the healthcare costs at a regional Australian radiotherapy institute with respect to conventionally fractionated post-mastectomy radiotherapy (Cf-PMRT) versus hypofractionated post-mastectomy radiotherapy (Hf-PMRT) administration. Medical records of 196 patients treated with post-mastectomy radiotherapy at the NSW North Coast Cancer Institute from February 2008 to June 2014 were retrospectively reviewed. Australian Medicare item numbers billed for patients receiving either Cf-PMRT of 50 Gy in 25 daily fractions or Hf-PMRT of 40.05 Gy in 15 daily fractions were calculated. Decision tree analysis was used to model costs. Independent-samples t-tests and Mann-Whitney U-tests were used to compare crude average costs for Cf-PMRT and Hf-PMRT and determine which treatment components accounted for any differences. Hf-PMRT, with or without irradiation to the regional lymph nodes, was associated with significantly reduced Medicare costs ($5613 AUD per patient for Hf-PMRT vs $8272 AUD per patient for Cf-PMRT; P < 0.001). Savings associated with Hf-PMRT ranged from $1353 (22.1%) for patients receiving no regional irradiation to $2898 (32.0%) for patients receiving both axillary and supraclavicular therapy. Hf-PMRT results in a significant reduction in the financial costs associated with treating breast cancer patients in a regional Australian setting when compared with Cf-PMRT. © 2015 The Royal Australian and New Zealand College of Radiologists.

Physician consideration of patients' out-of-pocket costs in making common clinical decisions.

PubMed

Pham, Hoangmai H; Alexander, G Caleb; O'Malley, Ann S

2007-04-09

Patients face growing cost-sharing through higher deductibles and other out-of-pocket (OP) expenses, with uncertain effects on clinical decision making. We analyzed data on 6628 respondents to the nationally representative 2004-2005 Community Tracking Study Physician Survey to examine how frequently physicians report considering their insured patients' OP expenses when prescribing drugs, selecting diagnostic tests, and choosing inpatient vs outpatient care settings. Responses were dichotomized as always/usually vs sometimes/rarely/never. In separate multivariate logistic regressions, we examined associations between physicians' reported frequency of considering OP costs for each type of decision and characteristics of individual physicians and their practices. Seventy-eight percent of physicians reported routinely considering OP costs when prescribing drugs, while 51.2% reported doing so when selecting care settings, and 40.2% when selecting diagnostic tests. In adjusted analyses, primary care physicians were more likely than medical specialists to consider patients' OP costs in choosing prescription drugs (85.3% vs 74.5%) (P<.001), care settings (53.9% vs 43.1%) (P<.001), and diagnostic tests (46.3% vs 29.9%) (P<.001). Physicians working in large groups or health maintenance organizations were more likely to consider OP costs in prescribing generic drugs (P<.001 for comparisons with solo and 2-person practices), but those in solo or 2-person practices were more likely to do so in choosing tests and care settings (P<.05 for all comparisons with other practice types). Physicians providing at least 10 hours of charity care a month were more likely than those not providing any to consider OP costs in both diagnostic testing (40.7% vs 35.8%) (P<.001) and care setting decisions (51.4% vs 47.6%) (P<.005). Cost-sharing arrangements targeting patients are likely to have limited effects in safely reducing health care spending because physicians do not routinely consider patients' OP costs when making decisions regarding more expensive medical services.

Accessing medical and surgical first-trimester abortion services: women's experiences and costs from an operations research study in KwaZulu-Natal Province, South Africa.

PubMed

Lince-Deroche, Naomi; Fetters, Tamara; Sinanovic, Edina; Blanchard, Kelly

2017-08-01

To explore women's experiences accessing services and estimate costs incurred for first-trimester abortion at four public hospitals in KwaZulu-Natal Province, South Africa. Subanalysis from a prospective cohort study (2009-2011) of women aged 18-49years accessing abortion services through 12weeks' gestation. Trained study personnel conducted structured interviews with women about their reason for having an abortion, experiences accessing services and costs incurred. Women who were 9weeks' gestation or less were eligible to choose medication abortion or manual vacuum aspiration (MVA); women 10-12weeks' gestation all had MVA. We enrolled 1167 women; 923 (79.1%) were eligible to choose their procedure. The median age was 25years; most were black African, single and unemployed. Many women reported concerns about the affordability of raising a(nother) child (58.9%) or not being ready for (more) children (43.4%) as their reason for having an abortion. In total, women incurred a median cost of US$9.99 (interquartile range 6.46-14.85) for their procedure which usually required two facility visits. Many had to pay for transportation, a pregnancy test, sanitary pads or pain medication. Despite the availability of government assistance for children through South Africa's "child grant," the affordability of raising a child was a major concern for women. Although theoretically available free of charge in the public sector, women experienced challenges accessing abortion services and incurred costs which may have been burdensome given average local earnings. These potential barriers could be addressed by reducing the number of required visits and improving availability of pregnancy tests and supplies in public facilities. Many women cited concerns about the affordability of having a(nother) child when requesting an abortion. Although public services are technically free or low-cost in South Africa, women incurred costs for first-trimester abortions. Women's costs could be lowered by reducing facility visits and improving availability of pregnancy tests and supplies. Copyright © 2017 Ipas. Published by Elsevier Inc. All rights reserved.

The application of the Luus-Jaakola direct search method to the optimization of a hybrid renewable energy system

NASA Astrophysics Data System (ADS)

Jatzeck, Bernhard Michael

2000-10-01

The application of the Luus-Jaakola direct search method to the optimization of stand-alone hybrid energy systems consisting of wind turbine generators (WTG's), photovoltaic (PV) modules, batteries, and an auxiliary generator was examined. The loads for these systems were for agricultural applications, with the optimization conducted on the basis of minimum capital, operating, and maintenance costs. Five systems were considered: two near Edmonton, Alberta, and one each near Lethbridge, Alberta, Victoria, British Columbia, and Delta, British Columbia. The optimization algorithm used hourly data for the load demand, WTG output power/area, and PV module output power. These hourly data were in two sets: seasonal (summer and winter values separated) and total (summer and winter values combined). The costs for the WTG's, PV modules, batteries, and auxiliary generator fuel were full market values. To examine the effects of price discounts or tax incentives, these values were lowered to 25% of the full costs for the energy sources and two-thirds of the full cost for agricultural fuel. Annual costs for a renewable energy system depended upon the load, location, component costs, and which data set (seasonal or total) was used. For one Edmonton load, the cost for a renewable energy system consisting of 27.01 m2 of WTG area, 14 PV modules, and 18 batteries (full price, total data set) was 6873/year. For Lethbridge, a system with 22.85 m2 of WTG area, 47 PV modules, and 5 batteries (reduced prices, seasonal data set) cost 2913/year. The performance of renewable energy systems based on the obtained results was tested in a simulation using load and weather data for selected days. Test results for one Edmonton load showed that the simulations for most of the systems examined ran for at least 17 hours per day before failing due to either an excessive load on the auxiliary generator or a battery constraint being violated. Additional testing indicated that increasing the generator capacity and reducing the maximum allowed battery charge current during the time of the day at which these failures occurred allowed the simulation to successfully operate.

Low Cost Injection Mold Creation via Hybrid Additive and Conventional Manufacturing

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

Dehoff, Ryan R.; Watkins, Thomas R.; List, III, Frederick Alyious

2015-12-01

The purpose of the proposed project between Cummins and ORNL is to significantly reduce the cost of the tooling (machining and materials) required to create injection molds to make plastic components. Presently, the high cost of this tooling forces the design decision to make cast aluminum parts because Cummins typical production volumes are too low to allow injection molded plastic parts to be cost effective with the amortized cost of the injection molding tooling. In addition to reducing the weight of components, polymer injection molding allows the opportunity for the alternative cooling methods, via nitrogen gas. Nitrogen gas cooling offersmore » an environmentally and economically attractive cooling option, if the mold can be manufactured economically. In this project, a current injection molding design was optimized for cooling using nitrogen gas. The various components of the injection mold tooling were fabricated using the Renishaw powder bed laser additive manufacturing technology. Subsequent machining was performed on the as deposited components to form a working assembly. The injection mold is scheduled to be tested in a projection setting at a commercial vendor selected by Cummins.« less

Use of the DISST Model to Estimate the HOMA and Matsuda Indexes Using Only a Basal Insulin Assay

PubMed Central

Docherty, Paul D.; Chase, J. Geoffrey

2014-01-01

Background: It is hypothesized that early detection of reduced insulin sensitivity (SI) could prompt intervention that may reduce the considerable financial strain type 2 diabetes mellitus (T2DM) places on global health care. Reduction of the cost of already inexpensive SI metrics such as the Matsuda and HOMA indexes would enable more widespread, economically feasible use of these metrics for screening. The goal of this research was to determine a means of reducing the number of insulin samples and therefore the cost required to provide an accurate Matsuda Index value. Method: The Dynamic Insulin Sensitivity and Secretion Test (DISST) model was used with the glucose and basal insulin measurements from an Oral Glucose Tolerance Test (OGTT) to predict patient insulin responses. The insulin response to the OGTT was determined via population based regression analysis that incorporated the 60-minute glucose and basal insulin values. Results: The proposed method derived accurate and precise Matsuda Indices as compared to the fully sampled Matsuda (R = .95) using only the basal assay insulin-level data and 4 glucose measurements. Using a model employing the basal insulin also allows for determination of the 1-day HOMA value. Conclusion: The DISST model was successfully modified to allow for the accurate prediction an individual’s insulin response to the OGTT. In turn, this enabled highly accurate and precise estimation of a Matsuda Index using only the glucose and basal insulin assays. As insulin assays account for the majority of the cost of the Matsuda Index, this model offers a significant reduction in assay cost. PMID:24876431

A model-based assessment of the cost-utility of strategies to identify Lynch syndrome in early-onset colorectal cancer patients.

PubMed

Snowsill, Tristan; Huxley, Nicola; Hoyle, Martin; Jones-Hughes, Tracey; Coelho, Helen; Cooper, Chris; Frayling, Ian; Hyde, Chris

2015-04-25

Lynch syndrome is an autosomal dominant cancer predisposition syndrome caused by mutations in the DNA mismatch repair genes MLH1, MSH2, MSH6 and PMS2. Individuals with Lynch syndrome have an increased risk of colorectal cancer, endometrial cancer, ovarian and other cancers. Lynch syndrome remains underdiagnosed in the UK. Reflex testing for Lynch syndrome in early-onset colorectal cancer patients is proposed as a method to identify more families affected by Lynch syndrome and offer surveillance to reduce cancer risks, although cost-effectiveness is viewed as a barrier to implementation. The objective of this project was to estimate the cost-utility of strategies to identify Lynch syndrome in individuals with early-onset colorectal cancer in the NHS. A decision analytic model was developed which simulated diagnostic and long-term outcomes over a lifetime horizon for colorectal cancer patients with and without Lynch syndrome and for relatives of those patients. Nine diagnostic strategies were modelled which included microsatellite instability (MSI) testing, immunohistochemistry (IHC), BRAF mutation testing (methylation testing in a scenario analysis), diagnostic mutation testing and Amsterdam II criteria. Biennial colonoscopic surveillance was included for individuals diagnosed with Lynch syndrome and accepting surveillance. Prophylactic hysterectomy with bilateral salpingo-oophorectomy (H-BSO) was similarly included for women diagnosed with Lynch syndrome. Costs from NHS and Personal Social Services perspective and quality-adjusted life years (QALYs) were estimated and discounted at 3.5% per annum. All strategies included for the identification of Lynch syndrome were cost-effective versus no testing. The strategy with the greatest net health benefit was MSI followed by BRAF followed by diagnostic genetic testing, costing £5,491 per QALY gained over no testing. The effect of prophylactic H-BSO on health-related quality of life (HRQoL) is uncertain and could outweigh the health benefits of testing, resulting in overall QALY loss. Reflex testing for Lynch syndrome in early-onset colorectal cancer patients is predicted to be a cost-effective use of limited financial resources in England and Wales. Research is recommended into the cost-effectiveness of reflex testing for Lynch syndrome in other associated cancers and into the impact of prophylactic H-BSO on HRQoL.

A new fetal RHD genotyping test: Costs and benefits of mass testing to target antenatal anti-D prophylaxis in England and Wales

PubMed Central

2011-01-01

Background Postnatal and antenatal anti-D prophylaxis have dramatically reduced maternal sensitisations and cases of rhesus disease in babies born to women with RhD negative blood group. Recent scientific advances mean that non-invasive prenatal diagnosis (NIPD), based on the presence of cell-free fetal DNA in maternal plasma, could be used to target prophylaxis on "at risk" pregnancies where the fetus is RhD positive. This paper provides the first assessment of cost-effectiveness of NIPD-targeted prophylaxis compared to current policies. Methods We conducted an economic analysis of NIPD implementation in England and Wales. Two scenarios were considered. Scenario 1 assumed that NIPD will be only used to target antenatal prophylaxis with serology tests continuing to direct post-delivery prophylaxis. In Scenario 2, NIPD would also displace postnatal serology testing if an RhD negative fetus was identified. Costs were estimated from the provider's perspective for both scenarios together with a threshold royalty fee per test. Incremental costs were compared with clinical implications. Results The basic cost of an NIPD in-house test is £16.25 per sample (excluding royalty fee). The two-dose antenatal prophylaxis policy recommended by NICE is estimated to cost the NHS £3.37 million each year. The estimated threshold royalty fee is £2.18 and £8.83 for Scenarios 1 and 2 respectively. At a £2.00 royalty fee, mass NIPD testing would produce no saving for Scenario 1 and £507,154 per annum for Scenario 2. Incremental cost-effectiveness analysis indicates that, at a test sensitivity of 99.7% and this royalty fee, NIPD testing in Scenario 2 will generate one additional sensitisation for every £9,190 saved. If a single-dose prophylaxis policy were implemented nationally, as recently recommended by NICE, Scenario 2 savings would fall. Conclusions Currently, NIPD testing to target anti-D prophylaxis is unlikely to be sufficiently cost-effective to warrant its large scale introduction in England and Wales. Only minor savings are calculated and, balanced against this, the predicted increase in maternal sensitisations may be unacceptably high. Reliability of NIPD assays still needs to be demonstrated rigorously in different ethnic minority populations. First trimester testing is unlikely to alter this picture significantly although other emerging technologies may. PMID:21244652

A new fetal RHD genotyping test: costs and benefits of mass testing to target antenatal anti-D prophylaxis in England and Wales.

PubMed

Szczepura, Ala; Osipenko, Leeza; Freeman, Karoline

2011-01-18

Postnatal and antenatal anti-D prophylaxis have dramatically reduced maternal sensitisations and cases of rhesus disease in babies born to women with RhD negative blood group. Recent scientific advances mean that non-invasive prenatal diagnosis (NIPD), based on the presence of cell-free fetal DNA in maternal plasma, could be used to target prophylaxis on "at risk" pregnancies where the fetus is RhD positive. This paper provides the first assessment of cost-effectiveness of NIPD-targeted prophylaxis compared to current policies. We conducted an economic analysis of NIPD implementation in England and Wales. Two scenarios were considered. Scenario 1 assumed that NIPD will be only used to target antenatal prophylaxis with serology tests continuing to direct post-delivery prophylaxis. In Scenario 2, NIPD would also displace postnatal serology testing if an RhD negative fetus was identified. Costs were estimated from the provider's perspective for both scenarios together with a threshold royalty fee per test. Incremental costs were compared with clinical implications. The basic cost of an NIPD in-house test is £16.25 per sample (excluding royalty fee). The two-dose antenatal prophylaxis policy recommended by NICE is estimated to cost the NHS £3.37 million each year. The estimated threshold royalty fee is £2.18 and £8.83 for Scenarios 1 and 2 respectively. At a £2.00 royalty fee, mass NIPD testing would produce no saving for Scenario 1 and £507,154 per annum for Scenario 2. Incremental cost-effectiveness analysis indicates that, at a test sensitivity of 99.7% and this royalty fee, NIPD testing in Scenario 2 will generate one additional sensitisation for every £9,190 saved. If a single-dose prophylaxis policy were implemented nationally, as recently recommended by NICE, Scenario 2 savings would fall. Currently, NIPD testing to target anti-D prophylaxis is unlikely to be sufficiently cost-effective to warrant its large scale introduction in England and Wales. Only minor savings are calculated and, balanced against this, the predicted increase in maternal sensitisations may be unacceptably high. Reliability of NIPD assays still needs to be demonstrated rigorously in different ethnic minority populations. First trimester testing is unlikely to alter this picture significantly although other emerging technologies may.

Study 2.6 operations analysis mission characterization

NASA Technical Reports Server (NTRS)

Wolfe, R. R.

1973-01-01

An analysis of the current operations concepts of NASA and DoD is presented to determine if alternatives exist which may improve the utilization of resources. The final product is intended to show how sensitive these ground rules and design approaches are relative to the total cost of doing business. The results are comparative in nature, and assess one concept against another as opposed to establishing an absolute cost value for program requirements. An assessment of the mission characteristics is explained to clarify the intent, scope, and direction of this effort to improve the understanding of what is to be accomplished. The characterization of missions is oriented toward grouping missions which may offer potential economic benefits by reducing overall program costs. Program costs include design, development, testing, and engineering, recurring unit costs for logistic vehicles, payload costs. and direct operating costs.

Predictive models reduce talent development costs in female gymnastics.

PubMed

Pion, Johan; Hohmann, Andreas; Liu, Tianbiao; Lenoir, Matthieu; Segers, Veerle

2017-04-01

This retrospective study focuses on the comparison of different predictive models based on the results of a talent identification test battery for female gymnasts. We studied to what extent these models have the potential to optimise selection procedures, and at the same time reduce talent development costs in female artistic gymnastics. The dropout rate of 243 female elite gymnasts was investigated, 5 years past talent selection, using linear (discriminant analysis) and non-linear predictive models (Kohonen feature maps and multilayer perceptron). The coaches classified 51.9% of the participants correct. Discriminant analysis improved the correct classification to 71.6% while the non-linear technique of Kohonen feature maps reached 73.7% correctness. Application of the multilayer perceptron even classified 79.8% of the gymnasts correctly. The combination of different predictive models for talent selection can avoid deselection of high-potential female gymnasts. The selection procedure based upon the different statistical analyses results in decrease of 33.3% of cost because the pool of selected athletes can be reduced to 92 instead of 138 gymnasts (as selected by the coaches). Reduction of the costs allows the limited resources to be fully invested in the high-potential athletes.

Materials Genome Initiative Element

NASA Technical Reports Server (NTRS)

Vickers, John

2015-01-01

NASA is committed to developing new materials and manufacturing methods that can enable new missions with ever increasing mission demands. Typically, the development and certification of new materials and manufacturing methods in the aerospace industry has required more than 20 years of development time with a costly testing and certification program. To reduce the cost and time to mature these emerging technologies, NASA is developing computational materials tools to improve understanding of the material and guide the certification process.

Introduction: Aims and Requirements of Future Aerospace Vehicles. Chapter 1

NASA Technical Reports Server (NTRS)

Rodriguez, Pedro I.; Smeltzer, Stanley S., III; McConnaughey, Paul (Technical Monitor)

2001-01-01

The goals and system-level requirements for the next generation aerospace vehicles emphasize safety, reliability, low-cost, and robustness rather than performance. Technologies, including new materials, design and analysis approaches, manufacturing and testing methods, operations and maintenance, and multidisciplinary systems-level vehicle development are key to increasing the safety and reducing the cost of aerospace launch systems. This chapter identifies the goals and needs of the next generation or advanced aerospace vehicle systems.

Design, fabrication, and test of a steel spar wind turbine blade

NASA Technical Reports Server (NTRS)

Sullivan, T. L.; Sirocky, P. J., Jr.; Viterna, L. A.

1979-01-01

The design and fabrication of wind turbine blades based on 60 foot steel spars are discussed. Performance and blade load information is given and compared to analytical prediction. In addition, performance is compared to that of the original MOD-O aluminum blades. Costs for building the two blades are given, and a projection is made for the cost in mass production. Design improvements to reduce weight and improve fatigue life are suggested.

Strategies for SEE Hardness Assurance From Buy-It-And-Fly-It to Bullet Proof

NASA Technical Reports Server (NTRS)

Ladbury, Raymond

2017-01-01

This part of the course first outlines the conventional Single Event Effect (SEE), radiation hardness assurance (RHA) approach, which emphasizes mission success. Next, Dr. Ladbury will discuss the challenges posed by new satellite platforms (e.g., cubesats, nanosats, etc.), where cost and schedule receive emphasis equal to if not greater than mission success. These additional pressures, along with growing demands to reduce size, weight and power, coupled with increased performance, drive many projects toward expanding their use of commercial-off-the-shelf (COTS) technologies. While this may reduce direct parts cost and procurement lead times, it undermines many cost-reduction strategies used for conventional SEE RHA and can make radiation testing and analysis one of the most significant risksor worse, a risk neglected altogether. That section will end with some approaches for restoring balance in the troika of mission success, cost, and schedule. This is captured in SEE RHA as risk management: identify the threat, evaluate the threat, and mitigate the threat.

The nature of surgeon human capital depreciation.

PubMed

Hockenberry, Jason M; Helmchen, Lorens A

2014-09-01

To test how practice interruptions affect worker productivity, we estimate how temporal breaks affect surgeons' performance of coronary artery bypass grafting (CABG). Examining 188 surgeons who performed 56,315 CABG surgeries in Pennsylvania between 2006 and 2010, we find that a surgeon's additional day away from the operating room raised patients' inpatient mortality by up to 0.067 percentage points (2.4% relative effect) but reduced total hospitalization costs by up to 0.59 percentage points. Among emergent patients treated by high-volume providers, where temporal distance is most plausibly exogenous, an additional day away raised mortality risk by 0.398 percentage points (11.4% relative effect) but reduced cost by up to 1.4 percentage points. This is consistent with the hypothesis that as temporal distance increases, surgeons are less likely to recognize and address life-threatening complications. Our estimates imply additional intraprocedural treatment intensity has a cost per life-year preserved of $7871-18,500, well within conventional cost-effectiveness cutoffs. Copyright © 2014 Elsevier B.V. All rights reserved.

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

Sager, P.H.

Studies were carried out on the FED Baseline to improve design definition, establish feasibility, and reduce cost. Emphasis was placed on cost reduction, but significant feasibility concerns existed in several areas, and better design definition was required to establish feasibility and provide a better basis for cost estimates. Design definition and feasibility studies included the development of a labyrinth shield ring concept to prevent radiation streaming between the torus spool and the TF coil cryostat. The labyrinth shield concept which was developed reduced radiation streaming sufficiently to permit contact maintenance of the inboard EF coils. Various concepts of preventing arcingmore » between adjacent shield sectors were also explored. It was concluded that installation of copper straps with molybdenum thermal radiation shields would provide the most reliable means of preventing arcing. Other design studies included torus spool electrical/structural concepts, test module shielding, torus seismic response, poloidal conditions in the magnets, disruption characteristics, and eddy current effects. These additional studies had no significant impact on cost but did confirm the feasibility of the basic FED Baseline concept.« less

Strategies for SEE Hardness Assurance - From Buy-It-And-Fly-It to Bullet Proof

NASA Technical Reports Server (NTRS)

Ladbury, Ray

2017-01-01

This part of the course first outlines the conventional Single Event Effect (SEE), radiation hardness assurance (RHA) approach, which emphasizes mission success. Next, Dr. Ladbury will discuss the challenges posed by new satellite platforms (e.g., cubesats, nanosats, etc.), where cost and schedule receive emphasis equal to if not greater than mission success. These additional pressures, along with growing demands to reduce size, weight and power, coupled with increased performance, drive many projects toward expanding their use of commercial-off-the-shelf (COTS) technologies. While this may reduce direct parts cost and procurement lead times, it undermines many cost-reduction strategies used for conventional SEE RHA and can make radiation testing and analysis one of the most significant risks or worse, a risk neglected altogether. That section will end with some approaches for restoring balance in the troika of mission success, cost, and schedule. This is captured in SEE RHA as risk management: identify the threat, evaluate the threat, and mitigate the threat.

Cell-Free DNA-Based Non-invasive Prenatal Screening for Common Aneuploidies in a Canadian Province: A Cost-Effectiveness Analysis.

PubMed

Nshimyumukiza, Léon; Beaumont, Jean-Alexandre; Duplantie, Julie; Langlois, Sylvie; Little, Julian; Audibert, François; McCabe, Christopher; Gekas, Jean; Giguère, Yves; Gagné, Christian; Reinharz, Daniel; Rousseau, François

2018-01-01

Yearly, 450 000 pregnant Canadians are eligible for voluntary prenatal screening for trisomy 21. Different screening strategies select approximately 4% of women for invasive fetal chromosome testing. Non-invasive prenatal testing (NIPT) using maternal blood cell-free DNA could reduce those invasive procedures but is expensive. This study evaluated the cost-effectiveness of NIPT strategies compared with conventional strategies. This study used a decision analytic model to estimate the cost-effectiveness of 13 prenatal screening strategies for fetal aneuploidies: six frequently used strategies, universal NIPT, and six strategies incorporating NIPT as a second-tier test. The study considered a virtual cohort of pregnant women of similar size and age as women in Quebec. Model data were obtained from published sources and government databases. The study predicted the number of chromosomal anomalies detected (trisomies 21, 13, and 18), invasive procedures and euploid fetal losses, direct costs, and incremental cost-effectiveness ratios. Of the 13 strategies compared, eight identified fewer cases at a higher cost than at least one of the remaining five strategies. Integrated serum screening with conditional NIPT had the lowest cost, and the cost per case detected was $63 139, with a 90% reduction of invasive procedures. The number of cases identified was improved with four other screening strategies, but with increasing of incremental costs per case (from $61 623 to $1 553 615). Results remained robust, except when NIPT costs and risk cut-offs varied. NIPT as a second-tier test for high-risk women is likely to be cost-effective as compared with screening algorithms not involving NIPT. Copyright © 2018 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.

Cost-effectiveness of cervical-cancer screening in five developing countries.

PubMed

Goldie, Sue J; Gaffikin, Lynne; Goldhaber-Fiebert, Jeremy D; Gordillo-Tobar, Amparo; Levin, Carol; Mahé, Cédric; Wright, Thomas C

2005-11-17

Cervical-cancer screening strategies that involve the use of conventional cytology and require multiple visits have been impractical in developing countries. We used computer-based models to assess the cost-effectiveness of a variety of cervical-cancer screening strategies in India, Kenya, Peru, South Africa, and Thailand. Primary data were combined with data from the literature to estimate age-specific incidence and mortality rates for cancer and the effectiveness of screening for and treatment of precancerous lesions. We assessed the direct medical, time, and program-related costs of strategies that differed according to screening test, targeted age and frequency, and number of clinic visits required. Single-visit strategies involved the assumption that screening and treatment could be provided in the same day. Outcomes included the lifetime risk of cancer, years of life saved, lifetime costs, and cost-effectiveness ratios (cost per year of life saved). The most cost-effective strategies were those that required the fewest visits, resulting in improved follow-up testing and treatment. Screening women once in their lifetime, at the age of 35 years, with a one-visit or two-visit screening strategy involving visual inspection of the cervix with acetic acid or DNA testing for human papillomavirus (HPV) in cervical cell samples, reduced the lifetime risk of cancer by approximately 25 to 36 percent, and cost less than 500 dollars per year of life saved. Relative cancer risk declined by an additional 40 percent with two screenings (at 35 and 40 years of age), resulting in a cost per year of life saved that was less than each country's per capita gross domestic product--a very cost-effective result, according to the Commission on Macroeconomics and Health. Cervical-cancer screening strategies incorporating visual inspection of the cervix with acetic acid or DNA testing for HPV in one or two clinical visits are cost-effective alternatives to conventional three-visit cytology-based screening programs in resource-poor settings. Copyright 2005 Massachusetts Medical Society.

Reduction in Costs after Treating Comorbid Panic Disorder with Agoraphobia and Generalized Anxiety Disorder.

PubMed

Ikic, Vedrana; Belanger, Claude; Bouchard, Stephane; Gosselin, Patrick; Langlois, Frederic; Labrecque, Joane; Dugas, Michel J; Marchand, Andre

2017-03-01

Panic disorder with agoraphobia (PDA) and generalized anxiety disorder (GAD) are impairing and costly disorders that are often misdiagnosed and left untreated despite multiple consultations. These disorders frequently co-occur, but little is known about the costs associated with their comorbidity and the impact of cognitive-behavioral therapy (CBT) on cost reduction. The first objective of this study was to assess the mental health-related costs associated with the specific concomitance of PDA and GAD. The second aim was to determine whether there is a reduction in direct and indirect mental health-related costs following conventional CBT for the primary disorder only (PDA or GAD) or combined CBT adapted to the comorbidity (PDA and GAD). A total of 123 participants with a double diagnosis of PDA and GAD participated in this study. Direct and indirect mental health-related costs were assessed and calculated from a societal perspective at the pre-test, the post-test, and the three-month, six-month and one-year follow-ups. At the pre-test, PDA-GAD comorbidity was found to generate a mean total cost of CADUSD 2,000.48 (SD = USD 2,069.62) per participant over a three-month period. The indirect costs were much higher than the direct costs. Both treatment modalities led to significant and similar decreases in all cost categories from the pre-test to the post-test. This reduction was maintained until the one-year follow-up. Methodological choices may have underestimated cost evaluations. Nonetheless, this study supports the cost offset effects of both conventional CBT for primary PDA or GAD and combined CBT for PDA-GAD comorbidity. Treatment of comorbid and costly disorders with evidence-based treatments such as CBT may lead to considerable economic benefits for society. Considering the limited resources of healthcare systems, it is important to make choices that will lead to better accessibility of quality services. The application of CBT for PDA, GAD or both disorders and training mental health professionals in this therapeutic approach should be encouraged. Additionally, it would be favorable for insurance plans to reimburse employees for expenses associated with psychological treatment for anxiety disorders. In addition to symptom reduction, it would be of great pertinence to explore which factors can contribute to reducing direct and indirect mental health-related costs.

Costs and Cost-Effectiveness of Plasmodium vivax Control.

PubMed

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

2016-12-28

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. © The American Society of Tropical Medicine and Hygiene.

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

Adaptive salinity management in the Murray-Darling Basin: a transaction cost study

NASA Astrophysics Data System (ADS)

Loch, A. J.

2017-12-01

Transaction costs hinder or promote effective management of common good resource intertemporal externalities. Appropriate policy choices may reduce externalities and improve social welfare, and transaction cost analysis can help to evaluate policy choices. However, without measurement of relevant transaction costs such policy evaluation remains challenging. This article uses a time series dataset of salinity management program to test theory aimed at transaction cost-based policy evaluation and adaptive resource management over a period of 30 years worth of data. We identify peaks and troughs in transaction costs over time, lag-effects in program expenditure, and calculate the decay in transaction cost impacts. We conclude that Australian salinity management programs are achieving flexible institutional outcomes and effective policy arrangements with long-term benefits. Proposed changes to the program moving forward add weight to our assertions of adaptive strategies, and illustrate the value of the novel data-driven tracnsaction cost analysis approach for other jurisdictions.

Rheumatoid factor testing in Spanish primary care: A population-based cohort study including 4.8 million subjects and almost half a million measurements.

PubMed

Morsley, Klara; Miller, Anne; Luqmani, Raashid; Fina-Aviles, Francesc; Javaid, Muhammad Kassim; Edwards, Christopher J; Pinedo-Villanueva, Rafael; Medina, Manuel; Calero, Sebastian; Cooper, Cyrus; Arden, Nigel; Prieto-Alhambra, Daniel

2018-02-26

Rheumatoid factor (RF) testing is used in primary care in the diagnosis of rheumatoid arthritis (RA); however a positive RF may occur without RA. Incorrect use of RF testing may lead to increased costs and delayed diagnoses. The aim was to assess the performance of RF as a test for RA and to estimate the costs associated with its use in a primary care setting. A retrospective cohort study using the Information System for the Development of Research in Primary Care database (contains primary care records and laboratory results of >80% of the Catalonian population, Spain). Participants were patients ≥18 years with ≥1 RF test performed between 01/01/2006 and 31/12/2011, without a pre-existing diagnosis of RA. Outcome measures were an incident diagnosis of RA within 1 year of testing, and the cost of testing per case of RA. 495,434/4,796,498 (10.3%) patients were tested at least once. 107,362 (21.7%) of those tested were sero-positive of which 2768 (2.6%) were diagnosed with RA within 1 year as were 1141/388,072 (0.3%) sero-negative participants. The sensitivity of RF was 70.8% (95% CI 69.4-72.2), specificity 78.7% (78.6-78.8), and positive and negative predictive values 2.6% (2.5-2.7) and 99.7% (99.6-99.7) respectively. Approximately €3,963,472 was spent, with a cost of €1432 per true positive case. Although 10% of patients were tested for RF, most did not have RA. Limiting testing to patients with a higher pre-test probability would significantly reduce the cost of testing. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

A Wireless Electroceutical Dressing Lowers Cost of Negative Pressure Wound Therapy

PubMed Central

Ghatak, Piya Das; Schlanger, Richard; Ganesh, Kasturi; Lambert, Lynn; Gordillo, Gayle M.; Martinsek, Patsy; Roy, Sashwati

2015-01-01

Objective: To test whether the use of a wireless electroceutical dressing (WED) (Procellera®) in conjunction with a 5-day negative pressure wound therapy (NPWT) may reduce the number of dressing changes required per week with this therapy. Approach: At the Ohio State University Comprehensive Wound Center, chronic wound patients (n=30) undergoing NPWT were randomized into two arms following consent as approved by the institutional review board. The control arm received standard of care NPWT, where the dressing change was performed thrice a week. The test arm received the same care except that the WED was added as an interface layer and dressing change was limited to twice a week. Results: A reduced cost of care was achieved using the WED in conjunction with NPWT. Despite fewer dressing changes in wounds dressed with the WED, closure outcomes were comparable with no overt signs of any wound complication, including infection. The cost of NPWT care during the week was significantly lower (from $2918 to $2346) in the WED-treated group compared with patients in the control arm. Innovation: This work introduces a novel technology platform involving a WED, which may be used in conjunction with NPWT. If used as such, NPWT is effective in decreasing the frequency of dressing change and lowering the cost of care. Conclusion: This work points toward the benefit of using the WED combined with NPWT. A larger clinical trial investigating the cost-effectiveness of WED in wound care is warranted. PMID:26005596

Analysis, development and testing of a fixed tilt solar collector employing reversible Vee-Trough reflectors and vacuum tube receivers

NASA Technical Reports Server (NTRS)

Selcuk, M. K.

1979-01-01

The Vee-Trough/Vacuum Tube Collector (VTVTC) aimed to improve the efficiency and reduce the cost of collectors assembled from evacuated tube receivers. The VTVTC was analyzed rigorously and a mathematical model was developed to calculate the optical performance of the vee-trough concentrator and the thermal performance of the evacuated tube receiver. A test bed was constructed to verify the mathematical analyses and compare reflectors made out of glass, Alzak and aluminized GEB Teflon. Tests were run at temperatures ranging from 95 to 180 C during the months of April, May, June, July and August 1977. Vee-trough collector efficiencies of 35-40 per cent were observed at an operating temperature of about 175 C. Test results compared well with the calculated values. Test data covering a complete day are presented for selected dates throughout the test season. Predicted daily useful heat collection and efficiency values are presented for a year's duration at operation temperatures ranging from 65 to 230 C. Estimated collector costs and resulting thermal energy costs are presented. Analytical and experimental results are discussed along with an economic evaluation.

Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India

PubMed Central

Diaz, M; Kim, J J; Albero, G; de Sanjosé, S; Clifford, G; Bosch, F X; Goldie, S J

2008-01-01

Cervical cancer is a leading cause of cancer death among women in low-income countries, with ∼25% of cases worldwide occurring in India. We estimated the potential health and economic impact of different cervical cancer prevention strategies. After empirically calibrating a cervical cancer model to country-specific epidemiologic data, we projected cancer incidence, life expectancy, and lifetime costs (I$2005), and calculated incremental cost-effectiveness ratios (I$/YLS) for the following strategies: pre-adolescent vaccination of girls before age 12, screening of women over age 30, and combined vaccination and screening. Screening differed by test (cytology, visual inspection, HPV DNA testing), number of clinical visits (1, 2 or 3), frequency (1 × , 2 × , 3 × per lifetime), and age range (35–45). Vaccine efficacy, coverage, and costs were varied in sensitivity analyses. Assuming 70% coverage, mean reduction in lifetime cancer risk was 44% (range, 28–57%) with HPV 16,18 vaccination alone, and 21–33% with screening three times per lifetime. Combining vaccination and screening three times per lifetime provided a mean reduction of 56% (vaccination plus 3-visit conventional cytology) to 63% (vaccination plus 2-visit HPV DNA testing). At a cost per vaccinated girl of I$10 (per dose cost of $2), pre-adolescent vaccination followed by screening three times per lifetime using either VIA or HPV DNA testing, would be considered cost-effective using the country's per capita gross domestic product (I$3452) as a threshold. In India, if high coverage of pre-adolescent girls with a low-cost HPV vaccine that provides long-term protection is achievable, vaccination followed by screening three times per lifetime is expected to reduce cancer deaths by half, and be cost-effective. PMID:18612311

Feasibility and potential effect of a low-cost virtual reality system on reducing pain and anxiety in adult burn injury patients during physiotherapy in a developing country.

PubMed

Morris, Linzette Deidré; Louw, Quinette Abegail; Crous, Lynette Christine

2010-08-01

The purpose of this study was to ascertain the feasibility and potential effect of a low-cost VR system (eMagin Z800 3DVisor), used in conjunction with pharmacological analgesia, on reducing pain and anxiety in adult burn patients undergoing physiotherapy treatment, compared to pharmacologic analgesia alone at a South African hospital. Single-blind, within-subject study design. Pain and anxiety outcome measures were measured by a blinded assessor using the Numeric Pain Rating Scale and Burn Specific Pain and Anxiety Scale. Box-and-whisker plot method, Chi-square tests as well as the Student's paired t-test were used to analyze data. Eleven eligible adult burn patients consented to participate in this study (3 female, 8 male; median age 33 years: range 23-54 years). A marginal (p=0.06) to insignificant (p=0.13) difference between the two sessions (analgesia with VR and analgesia without VR) in reducing pain was found. No significant difference (p=0.58) was found between the two sessions (analgesia with VR and analgesia without VR) for anxiety. There seems to be a trend that the low-cost VR system, when added to routine pharmacological analgesics, is a safe technique and could be of considerable benefit if implemented into the pain management regime of burn units at a South African hospital.

Accessory costs of seed production and the evolution of angiosperms.

PubMed

Lord, Janice M; Westoby, Mark

2012-01-01

Accessory costs of reproduction frequently equal or exceed direct investment in offspring, and can limit the evolution of small offspring sizes. Early angiosperms had minimum seed sizes, an order of magnitude smaller than their contemporaries. It has been proposed that changes to reproductive features at the base of the angiosperm clade reduced accessory costs thus removing the fitness disadvantage of small seeds. We measured accessory costs of reproduction in 25 extant gymnosperms and angiosperms, to test whether angiosperms can produce small seeds more economically than gymnosperms. Total accessory costs scaled isometrically to seed mass for angiosperms but less than isometrically for gymnosperms, so that smaller seeds were proportionally more expensive for gymnosperms to produce. In particular, costs of abortions and packaging structures were significantly higher in gymnosperms. Also, the relationship between seed:ovule ratio and seed size was negative in angiosperms but positive in gymnosperms. We argue that the carpel was a key evolutionary innovation reducing accessory costs in angiosperms by allowing sporophytic control of pre- and postzygotic mate selection and timing of resource allocation. The resulting reduction in costs of aborting unfertilized ovules or genetically inferior embryos would have lowered total reproductive costs enabling early angiosperms to evolve small seed sizes and short generation times. © 2011 The Author(s). Evolution © 2011 The Society for the Study of Evolution.

Thermal Management Design for the X-33 Lifting Body

NASA Technical Reports Server (NTRS)

Bouslog, S.; Mammano, J.; Strauss, B.

1998-01-01

The X-33 Advantage Technology Demonstrator offers a rare and exciting opportunity in Thermal Protection System development. The experimental program incorporates the latest design innovation in re-useable, low life cycle cost, and highly dependable Thermal Protection materials and constructions into both ground based and flight test vehicle validations. The unique attributes of the X-33 demonstrator for design application validation for the full scale Reusable Launch Vehicle, (RLV), are represented by both the configuration of the stand-off aeroshell, and the extreme exposures of sub-orbital hypersonic re-entry simulation. There are several challenges of producing a sub-orbital prototype demonstrator of Single Stage to Orbit/Reusable Launch Vehicle (SSTO/RLV) operations. An aggressive schedule with budgetary constraints precludes the opportunity for an extensive verification and qualification program of vehicle flight hardware. However, taking advantage of off the shelf components with proven technologies reduces some of the requirements for additional testing. The effects of scale on thermal heating rates must also be taken into account during trajectory design and analysis. Described in this document are the unique Thermal Protection System (TPS) design opportunities that are available with the lifting body configuration of the X-33. The two principal objectives for the TPS are to shield the primary airframe structure from excessive thermal loads and to provide an aerodynamic mold line surface. With the relatively benign aeroheating capability of the lifting body, an integrated stand-off aeroshell design with minimal weight and reduced procurement and operational costs is allowed. This paper summarizes the design objectives of the X-33 TPS, the flight test requirements driven configuration, and design benefits. Comparisons are made of the X-33 flight profiles and Space Shuttle Orbiter, and lifting body Reusable Launch Vehicle aerothermal environments. The X-33 TPS is based on a design to cost configuration concept. Only RLV critical technologies are verified to conform to cost and schedule restrictions. The one-off prototype vehicle configuration has evolved to minimize the tooling costs by reducing the number of unique components. Low cost approaches such as a composite/blanket leeward aeroshell and the use of Shuttle technology are implemented where applicable. The success of the X-33 will overcome the ballistic re-entry TPS mindset. The X-33 TPS is tailored to an aircraft type mission while maintaining sufficient operational margins. The flight test program for the X-33 will demonstrate that TPS for the RLV is not simply a surface insulation but rather an integrated aeroshell system.

A model to estimate cost-savings in diabetic foot ulcer prevention efforts.

PubMed

Barshes, Neal R; Saedi, Samira; Wrobel, James; Kougias, Panos; Kundakcioglu, O Erhun; Armstrong, David G

2017-04-01

Sustained efforts at preventing diabetic foot ulcers (DFUs) and subsequent leg amputations are sporadic in most health care systems despite the high costs associated with such complications. We sought to estimate effectiveness targets at which cost-savings (i.e. improved health outcomes at decreased total costs) might occur. A Markov model with probabilistic sensitivity analyses was used to simulate the five-year survival, incidence of foot complications, and total health care costs in a hypothetical population of 100,000 people with diabetes. Clinical event and cost estimates were obtained from previously-published trials and studies. A population without previous DFU but with 17% neuropathy and 11% peripheral artery disease (PAD) prevalence was assumed. Primary prevention (PP) was defined as reducing initial DFU incidence. PP was more than 90% likely to provide cost-savings when annual prevention costs are less than $50/person and/or annual DFU incidence is reduced by at least 25%. Efforts directed at patients with diabetes who were at moderate or high risk for DFUs were very likely to provide cost-savings if DFU incidence was decreased by at least 10% and/or the cost was less than $150 per person per year. Low-cost DFU primary prevention efforts producing even small decreases in DFU incidence may provide the best opportunity for cost-savings, especially if focused on patients with neuropathy and/or PAD. Mobile phone-based reminders, self-identification of risk factors (ex. Ipswich touch test), and written brochures may be among such low-cost interventions that should be investigated for cost-savings potential. Published by Elsevier Inc.

Discussing Out-of-Pocket Expenses During Clinical Appointments: An Observational Study of Patient-Psychiatrist Interactions.

PubMed

Brown, Gregory D; Hunter, Wynn G; Hesson, Ashley; Davis, J Kelly; Kirby, Christine; Barnett, Jamison A; Byelmac, Dmytro; Ubel, Peter A

2017-06-01

High out-of-pocket expenses for medical treatment have been associated with worse quality of life, decreased treatment adherence, and increased risk of adverse health outcomes. Treatment of depression potentially has high out-of-pocket expenses. Limited data characterize psychiatrist-patient conversations about health care costs. The authors conducted content analysis from 422 outpatient psychiatrist-patient visits for medication management of major depressive disorder in community-based private practices nationwide from 2010 to 2014. Patients' health care expenses were discussed in 38% of clinic visits (95% confidence interval [CI]= 33%-43%). Uninsured patients were significantly more likely to discuss expenses than were patients enrolled in private or public plans (64%, 44%, and 30%, respectively; p<.001). Sixty-nine percent of cost conversations lasted less than one minute (median=36 seconds; interquartile range [IQR]=16-81 seconds). Cost conversations most frequently addressed psychotropic medications (51%). Physicians initiated 50% of cost conversations and brought up costs for psychotropic medications more often than did patients (62% versus 38%, p=.009). Conversely, a greater percentage of patient-initiated cost conversations addressed provider visit costs (27% versus 10%, p=.008). Overall, 45% of cost conversations mentioned cost-reducing strategies (CI=37%-53%). The most frequently discussed cost-reducing strategies were lowering cost by changing the source or timing of an intervention (for example, changing pharmacies), providing free samples, and switching to a lower-cost therapy or diagnostic test. Psychiatrists and patients regularly discuss patients' health care costs in visits for depression. These discussions cover a variety of clinical topics and frequently include strategies to lower patients' costs.

Large, Prospective Analysis of the Reasons Patients Do Not Pursue BRCA Genetic Testing Following Genetic Counseling.

PubMed

Hayden, Sommer; Mange, Sarah; Duquette, Debra; Petrucelli, Nancie; Raymond, Victoria M

2017-08-01

Genetic counseling (GC) and genetic testing (GT) identifies high-risk individuals who benefit from enhanced medical management. Not all individuals undergo GT following GC and understanding the reasons why can impact clinical efficiency, reduce GT costs through appropriate identification of high-risk individuals, and demonstrate the value of pre-GT GC. A collaborative project sponsored by the Michigan Department of Health and Human Services prospectively collects anonymous data on BRCA-related GC visits performed by providers in Michigan, including demographics, patient/family cancer history, GT results, and reasons for declining GT. From 2008 to 2012, 10,726 patients underwent GC; 3476 (32.4%) did not pursue GT. Primary reasons included: not the best test candidate (28.1%), not clinically indicated (23.3%), and insurance/out of pocket cost concerns (13.6%). Patient disinterest was the primary reason for declining in 17.1%. Insurance/out of pocket cost concerns were the primary reason for not testing in 13.4% of untested individuals with private insurance. Among untested individuals with breast and/or ovarian cancer, 22.5% reported insurance/out of pocket cost concerns as the primary reason for not testing and 6.6% failed to meet Medicare criteria. In a five-year time period, nearly one-third of patients who underwent BRCA GC did not pursue GT. GT was not indicated in almost half of patients. Insurance/out of pocket cost concerns continue to be barriers.

Finding a needle in the haystack: the costs and cost-effectiveness of syphilis diagnosis and treatment during pregnancy to prevent congenital syphilis in Kalomo District of Zambia.

PubMed

Larson, Bruce A; Lembela-Bwalya, Deophine; Bonawitz, Rachael; Hammond, Emily E; Thea, Donald M; Herlihy, Julie

2014-01-01

In March 2012, The Elizabeth Glaser Pediatric AIDS Foundation trained maternal and child health workers in Southern Province of Zambia to use a new rapid syphilis test (RST) during routine antenatal care. A recent study by Bonawitz et al. (2014) evaluated the impact of this roll out in Kalomo District. This paper estimates the costs and cost-effectiveness from the provider's perspective under the actual conditions observed during the first year of the RST roll out. Information on materials used and costs were extracted from program records. A decision-analytic model was used to evaluate the costs (2012 USD) and cost-effectiveness. Basic parameters needed for the model were based on the results from the evaluation study. During the evaluation study, 62% of patients received a RST, and 2.8% of patients tested were positive (and 10.4% of these were treated). Even with very high RST sensitivity and specificity (98%), true prevalence of active syphilis would be substantially less (estimated at <0.7%). For 1,000 new ANC patients, costs of screening and treatment were estimated at $2,136, and the cost per avoided disability-adjusted-life year lost (DALY) was estimated at $628. Costs change little if all positives are treated (because prevalence is low and treatment costs are small), but the cost-per-DALY avoided falls to just $66. With full adherence to guidelines, costs increase to $3,174 per 1,000 patients and the cost-per-DALY avoided falls to $60. Screening for syphilis is only useful for reducing adverse birth outcomes if patients testing positive are actually treated. Even with very low prevalence of syphilis (a needle in the haystack), cost effectiveness improves dramatically if those found positive are treated; additional treatment costs little but DALYs avoided are substantial. Without treatment, the needle is essentially found and thrown back into the haystack.

Using a cost-benefit analysis to estimate outcomes of a clinical treatment guideline: testing theBrain Trauma Foundation guidelines for the treatment of severe traumatic brain injury.

PubMed

Faul, Mark; Wald, Marlena M; Rutland-Brown, Wesley; Sullivent, Ernest E; Sattin, Richard W

2007-12-01

A decade after promulgation of treatment guidelines by the Brain Trauma Foundation (BTF), few studies exist that examine the application of these guidelines for severe traumatic brain injury (TBI) patients. These studies have reported both cost savings and reduced mortality. We projected the results of previous studies of BTF guideline adoption to estimate the impact of widespread adoption across the United States. We used surveillance systems and national surveys to estimate the number of severely injured TBI patients and compared the lifetime costs of BTF adoption to the current state of treatment. After examining the health outcomes and costs, we estimated that a substantial savings in annual medical costs ($262 million), annual rehabilitation costs ($43 million) and lifetime societal costs ($3.84 billion) would be achieved if treatment guidelines were used more routinely. Implementation costs were estimated to be $61 million. The net savings were primarily because of better health outcomes and a decreased burden on lifetime social support systems. We also estimate that mortality would be reduced by 3,607 lives if the guidelines were followed. Widespread adoption of the BTF guidelines for the treatment of severe TBI would result in substantial savings in costs and lives. The majority of cost savings are societal costs. Further validation work to identify the most effective aspects of the BTF guidelines is warranted.

High-Temperature Optical Window Design

NASA Technical Reports Server (NTRS)

Roeloffs, Norman; Taranto, Nick

1995-01-01

A high-temperature optical window is essential to the optical diagnostics of high-temperature combustion rigs. Laser Doppler velocimetry, schlieren photography, light sheet visualization, and laser-induced fluorescence spectroscopy are a few of the tests that require optically clear access to the combustor flow stream. A design was developed for a high-temperature window that could withstand the severe environment of the NASA Lewis 3200 F Lean Premixed Prevaporized (LPP) Flame Tube Test Rig. The development of this design was both time consuming and costly. This report documents the design process and the lessons learned, in an effort to reduce the cost of developing future designs for high-temperature optical windows.

Development of a thyroid function strategy for general practice.

PubMed Central

Ramachandran, S; Milles, J J; Wells, M B; Hall, R A

1998-01-01

A study was carried out to investigate a thyroid stimulating hormone (TSH) frontline strategy that could potentially result in a more straightforward interpretation of thyroid function tests, a reduction in the number of inappropriate referrals to medical outpatients, an improvement in the 'turnaround time' of results, and a reduction in the number of unnecessary tests carried out, thereby reducing costs. PMID:10071403

Brushless dc motors. [applications in non-space technology

NASA Technical Reports Server (NTRS)

1975-01-01

Brushless dc motors were intensively developed and tested over several years before qualification as the prime movers for Apollo Spacecraft life support blowers, and for circulating oxygen in the lunar portable life support system. Knowledge gained through prototype development and critical testing has significantly influenced the technology employed, broadened markets and applications, and reduced the cost of present day motors.

Evaluation of moisture reduction in small diameter trees after crushing

Treesearch

Donald L. Sirois; Cynthia L. Rawlins; Bryce J. Stokes

1991-01-01

Past studies have suggested that processing small diameter whole trees like those foumd on rights-of-way (ROWs) would help reduce transportion costs and increase energy value by lowering stem moisture content. Small stems were crushed by a roller crusher/splitter test bench machine and allowed dry under field conditions in Alabama. Tests were conducted in winter and...

Pathfinder

NASA Image and Video Library

1966-05-21

The Delta Clipper-Experimental Advanced (DC-XA) is a single-stage-to-orbit, vertical takeoff / vertical landing launch vehicle concept, whose development was geared to significantly reduce launch cost and provided a test bed for NASA Reusable Launch Vehicle (RLV) technology. This photograph shows the descending vehicle landing during the first successful test flight at White Sands Missile Range, New Mexico. The program was discontinued in 2003.

Is procalcitonin-guided antimicrobial use cost-effective in adult patients with suspected bacterial infection and sepsis?

PubMed

Harrison, Michelle; Collins, Curtis D

2015-03-01

Procalcitonin has emerged as a promising biomarker of bacterial infection. Published literature demonstrates that use of procalcitonin testing and an associated treatment pathway reduces duration of antibiotic therapy without impacting mortality. The objective of this study was to determine the financial impact of utilizing a procalcitonin-guided treatment algorithm in hospitalized patients with sepsis. Cost-minimization and cost-utility analysis. Hypothetical cohort of adult ICU patients with suspected bacterial infection and sepsis. Utilizing published clinical and economic data, a decision analytic model was developed from the U.S. hospital perspective. Effectiveness and utility measures were defined using cost-per-clinical episode and cost per quality-adjusted life years (QALYs). Upper and lower sensitivity ranges were determined for all inputs. Univariate and probabilistic sensitivity analyses assessed the robustness of our model and variables. Incremental cost-effectiveness ratios (ICERs) were calculated and compared to predetermined willingness-to-pay thresholds. Base-case results predicted the use of a procalcitonin-guided treatment algorithm dominated standard care with improved quality (0.0002 QALYs) and decreased overall treatment costs ($65). The model was sensitive to a number of key variables that had the potential to impact results, including algorithm adherence (<42.3%), number and cost of procalcitonin tests ordered (≥9 and >$46), days of antimicrobial reduction (<1.6 d), incidence of nephrotoxicity and rate of nephrotoxicity reduction. The combination of procalcitonin testing with an evidence-based treatment algorithm may improve patients' quality of life while decreasing costs in ICU patients with suspected bacterial infection and sepsis; however, results were highly dependent on a number of variables and assumptions.

Cost-benefit and cost-savings analyses of antiarrhythmic medication monitoring.

PubMed

Snider, Melissa; Carnes, Cynthia; Grover, Janel; Davis, Rich; Kalbfleisch, Steven

2012-09-15

The economic impact of pharmacist-managed antiarrhythmic drug therapy monitoring on an academic medical center's electrophysiology (EP) program was investigated. Data were collected for the initial two years of patient visits (n = 816) to a pharmacist-run clinic for antiarrhythmic drug therapy monitoring. A retrospective cost analysis was conducted to assess the direct costs associated with three appointment models: (1) a clinic office visit only, (2) a clinic visit involving electrocardiography and basic laboratory tests, and (3) a clinic visit including pulmonary function testing and chest x-rays in addition to electrocardiography and laboratory testing. A subset of patient cases (n = 18) were included in a crossover analysis comparing pharmacist clinic care and usual care in an EP physician clinic. The primary endpoints were the cost benefits and cost savings associated with pharmacy-clinic care versus usual care. A secondary endpoint was improvement of overall EP program efficiency. The payer mix was 61.6% (n = 498) Medicare, 33.2% (n = 268) managed care, and 5.2% (n = 42) other. Positive contribution margins were demonstrated for all appointment models. The pharmacist-managed clinic also yielded cost savings by reducing overall patient care charges by 21% relative to usual care. By the second year, the pharmacy clinic improved EP program efficiency by scheduling an average of 24 patients per week, in effect freeing up one day per week of EP physician time to spend on other clinical activities. Pharmacist monitoring of antiarrhythmic drug therapy in an out-patient clinic provided cost benefits, cost savings, and improved overall EP program efficiency.

Costs of HIV/AIDS treatment in Indonesia by time of treatment and stage of disease.

PubMed

Siregar, Adiatma Y M; Tromp, Noor; Komarudin, Dindin; Wisaksana, Rudi; van Crevel, Reinout; van der Ven, Andre; Baltussen, Rob

2015-09-30

We report an economic analysis of Human Immunodeficiency Virus (HIV) care and treatment in Indonesia to assess the options and limitations of costs reduction, improving access, and scaling up services. We calculated the cost of providing HIV care and treatment in a main referral hospital in West Java, Indonesia from 2008 to 2010, differentiated by initiation of treatment at different CD4 cell count levels (0-50, 50-100, 100-150, 150-200, and >200 cells/mm(3)); time of treatment; HIV care and opportunistic infections cost components; and the costs of patients for seeking and undergoing care. Before antiretroviral treatment (ART) initiation, costs were dominated by laboratory tests (>65 %), and after initiation, by antiretroviral drugs (≥60 %). Average treatment costs per patient decreased with time on treatment (e.g. from US$580 per patient in the first 6 month to US$473 per patient in months 19-24 for those with CD4 cell counts under 50 cells/mm(3)). Higher CD4 cell counts at initiation resulted in lower laboratory and opportunistic infection treatment costs. Transportation cost dominated the costs of patients for seeking and undergoing care (>40 %). Costs of providing ART are highest during the early phase of treatment. Costs reductions can potentially be realized by early treatment initiation and applying alternative laboratory tests with caution. Scaling up ART at the community level in certain high prevalence settings may improve early uptake, adherence, and reduce transportation costs.

Development of advanced manufacturing technologies for low cost hydrogen storage vessels

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

Leavitt, Mark; Lam, Patrick

2014-12-29

The U.S. Department of Energy (DOE) defined a need for low-cost gaseous hydrogen storage vessels at 700 bar to support cost goals aimed at 500,000 units per year. Existing filament winding processes produce a pressure vessel that is structurally inefficient, requiring more carbon fiber for manufacturing reasons, than would otherwise be necessary. Carbon fiber is the greatest cost driver in building a hydrogen pressure vessel. The objective of this project is to develop new methods for manufacturing Type IV pressure vessels for hydrogen storage with the purpose of lowering the overall product cost through an innovative hybrid process of optimizingmore » composite usage by combining traditional filament winding (FW) and advanced fiber placement (AFP) techniques. A numbers of vessels were manufactured in this project. The latest vessel design passed all the critical tests on the hybrid design per European Commission (EC) 79-2009 standard except the extreme temperature cycle test. The tests passed include burst test, cycle test, accelerated stress rupture test and drop test. It was discovered the location where AFP and FW overlap for load transfer could be weakened during hydraulic cycling at 85°C. To design a vessel that passed these tests, the in-house modeling software was updated to add capability to start and stop fiber layers to simulate the AFP process. The original in-house software was developed for filament winding only. Alternative fiber was also investigated in this project, but the added mass impacted the vessel cost negatively due to the lower performance from the alternative fiber. Overall the project was a success to show the hybrid design is a viable solution to reduce fiber usage, thus driving down the cost of fuel storage vessels. Based on DOE’s baseline vessel size of 147.3L and 91kg, the 129L vessel (scaled to DOE baseline) in this project shows a 32% composite savings and 20% cost savings when comparing Vessel 15 hybrid design and the Quantum baseline all filament wound vessel. Due to project timing, there was no additional time available to fine tune the design to improve the load transfer between AFP and FW. Further design modifications will likely help pass the extreme temperature cycle test, the remaining test that is critical to the hybrid design.« less

Outpatient Psychotherapy Improves Symptoms and Reduces Health Care Costs in Regularly and Prematurely Terminated Therapies

PubMed Central

Altmann, Uwe; Thielemann, Désirée; Zimmermann, Anna; Steffanowski, Andrés; Bruckmeier, Ellen; Pfaffinger, Irmgard; Fembacher, Andrea; Strauß, Bernhard

2018-01-01

Background: In view of a shortage of health care costs, monetary aspects of psychotherapy become increasingly relevant. The present study examined the pre-post reduction of impairment and direct health care costs depending on therapy termination (regularly terminated, dropout with an unproblematic reason, and dropout with a quality-relevant reason) and the association of symptom and cost reduction. Methods: In a naturalistic longitudinal study, we examined a disorder heterogeneous sample of N = 584 outpatients who were either treated with cognitive-behavioral, psychodynamic, or psychoanalytic therapy. Depression, anxiety, stress, and somatization were assessed with the Patient Health Questionnaire (PHQ). Annual amounts of inpatient costs, outpatient costs, medication costs, days of hospitalization, work disability days, utilization of psychotherapy, and utilization of pharmacotherapy 1 year before therapy and 1 year after therapy were provided by health care insurances. Symptom and cost reduction were analyzed using t-tests. Associations between symptom and cost reduction were examined using partial correlations and hierarchical linear models. Results: Patients who terminated therapy regularly showed the largest symptom reduction (d = 0.981–1.22). Patients who dropped out due to an unproblematic reason and patients who terminated early due to a quality-relevant reason showed significant but small effects of symptom reductions (e.g., depression: d = 0.429 vs. d = 0.366). For patients with a regular end and those dropping out due to a quality-relevant reason, we observed a significant reduction of work disability (diff in % of pre-test value = 56.3 vs. 42.9%) and hospitalization days (52.8 vs. 35.0%). Annual inpatient costs decreased in the group with a regular therapy end (31.5%). Furthermore, reduction of symptoms on the one side and reduction of work disability days and psychotherapy utilization on the other side were significant correlated (r = 0.091–0.135). Conclusion: Health care costs and symptoms were reduced in each of the three groups. The average symptom and cost reduction of patients with a quality-relevant dropout suggested that not each dropout might be seen as therapy failure. PMID:29867697

A Multi-Year Plan for Research, Development, and Prototype Testing of Standard Modular Hydropower Technology

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

Smith, Brennan T.; Welch, Tim; Witt, Adam M.

The Multi-Year Plan for Research, Development, and Prototype Testing of Standard Modular Hydropower Technology (MYRP) presents a strategy for specifying, designing, testing, and demonstrating the efficacy of standard modular hydropower (SMH) as an environmentally compatible and cost-optimized renewable electricity generation technology. The MYRP provides the context, background, and vision for testing the SMH hypothesis: if standardization, modularity, and preservation of stream functionality become essential and fully realized features of hydropower technology, project design, and regulatory processes, they will enable previously unrealized levels of new project development with increased acceptance, reduced costs, increased predictability of outcomes, and increased value to stakeholders.more » To achieve success in this effort, the MYRP outlines a framework of stakeholder-validated criteria, models, design tools, testing facilities, and assessment protocols that will facilitate the development of next-generation hydropower technologies.« less

Prevention of sudden death in adolescent athletes: Incremental diagnostic value and cost-effectiveness of diagnostic tests.

PubMed

Grazioli, Gonzalo; Sanz de la Garza, Maria; Vidal, Barbara; Montserrat, Silvia; Sarquella-Brugada, Georgia; Pi, Ramon; Til, Lluis; Gutierrez, Josep; Brugada, Josep; Sitges, Marta

2017-09-01

Introduction Pre-participation screening in athletes attempts to reduce the incidence of sudden death during sports by identifying susceptible individuals. The objective of this study was to evaluate the diagnostic capacity of the different pre-participation screening points in adolescent athletes and the cost effectiveness of the programme. Methods Athletes were studied between 12-18 years old. Pre-participation screening included the American Heart Association questionnaire, electrocardiogram, echocardiogram, and stress test. The cost of test was established by the Catalan public health system. Results Of 1650 athletes included, 57% were men and mean age was 15.09 ± 1.82 years. Positive findings were identified as follows: in American Heart Association questionnaire 5.09% of subjects, in electrocardiogram 3.78%, in echocardiogram 4.96%, and in exercise test 1.75%. Six athletes (0.36%) were disqualified from participation and 10 (0.60%) were referred for interventional treatment. Diagnostic capacity was assessed by the area under the curve for detection of diseases that motivated disqualification for sport practice (American Heart Association questionnaire, 0.55; electrocardiogram, 0.72; echocardiogram, 0.88; stress test, 0.57). The cost for each athlete disqualified from the sport for a disease causing sudden death was €45,578. Conclusion The electrocardiogram and echocardiogram were the most useful studies to detect athletes susceptible to sudden death, and the stress test best diagnosed arrhythmias with specific treatment. In our country, pre-participatory screening was cost effective to detect athletes who might experience sudden death in sports.

Vibration and Thermal Cycling Effects on Bulk-fill Insulation Materials for Cryogenic Tanks

NASA Astrophysics Data System (ADS)

Fesmire, J. E.; Augustynowicz, S. D.; Nagy, Z. F.; Sojourner, S. J.; Morris, D. L.

2006-04-01

Large-scale (1,000,000 liters or more) cryogenic storage tanks are typically perlite-insulated double-walled vessels. Associated problems with perlite, such as mechanical compaction and settling, could be greatly reduced by using newer bulk-fill materials such as glass bubbles or aerogel beads. Using the newer materials should translate to lower life cycle costs and improved system reliability. NASA Kennedy Space Center is leveraging its experience in the areas of materials development, insulation testing, and cryogenic systems design to develop an insulation retrofit option that will meet both industry and NASA requirements. A custom 10-liter dewar test apparatus, developed by the KSC Cryogenics Test Laboratory, was used to determine the vibration and thermal cycling effects on different bulk-fill insulation materials for cryogenic tanks. The testing included liquid-nitrogen boiloff testing and thermal cycling (with vibration) of a number of test dewars. Test results show that glass bubbles have better thermal performance and less mechanical compaction compared to perlite powder. The higher cost of the bulk material should be offset by reduced commodity loss from boiloff and improvements in material handling, evacuation, and vacuum retention. The long-term problem with settling and compaction of perlite should also be eliminated. Aerogel beads are superior for the no-vacuum condition and can now be considered in some applications. Further studies on large-scale systems are presently being pursued.

A novel semi-transductive learning framework for efficient atypicality detection in chest radiographs

NASA Astrophysics Data System (ADS)

Alzubaidi, Mohammad; Balasubramanian, Vineeth; Patel, Ameet; Panchanathan, Sethuraman; Black, John A., Jr.

2012-03-01

Inductive learning refers to machine learning algorithms that learn a model from a set of training data instances. Any test instance is then classified by comparing it to the learned model. When the set of training instances lend themselves well to modeling, the use of a model substantially reduces the computation cost of classification. However, some training data sets are complex, and do not lend themselves well to modeling. Transductive learning refers to machine learning algorithms that classify test instances by comparing them to all of the training instances, without creating an explicit model. This can produce better classification performance, but at a much higher computational cost. Medical images vary greatly across human populations, constituting a data set that does not lend itself well to modeling. Our previous work showed that the wide variations seen across training sets of "normal" chest radiographs make it difficult to successfully classify test radiographs with an inductive (modeling) approach, and that a transductive approach leads to much better performance in detecting atypical regions. The problem with the transductive approach is its high computational cost. This paper develops and demonstrates a novel semi-transductive framework that can address the unique challenges of atypicality detection in chest radiographs. The proposed framework combines the superior performance of transductive methods with the reduced computational cost of inductive methods. Our results show that the proposed semitransductive approach provides both effective and efficient detection of atypical regions within a set of chest radiographs previously labeled by Mayo Clinic expert thoracic radiologists.

Rapid molecular diagnostics for multi-drug resistant tuberculosis in India.

PubMed

Ramachandran, Rajeswari; Muniyandi, M

2018-03-01

Rapid molecular diagnostic methods help in the detection of TB and Rifampicin resistance. These methods detect TB early, are accurate and play a crucial role in reducing the burden of drug resistant tuberculosis. Areas covered: This review analyses rapid molecular diagnostic tools used in the diagnosis of MDR-TB in India, such as the Line Probe Assay and GeneXpert. We have discussed the burden of MDR-TB and the impact of recent diagnostic tools on case detection and treatment outcomes. This review also discusses the costs involved in establishing these new techniques in India. Expert commentary: Molecular methods have considerable advantages for the programmatic management of drug resistant TB. These include speed, standardization of testing, potentially high throughput and reduced laboratory biosafety requirements. There is a desperate need for India to adopt modern, rapid, molecular tools with point-of-care tests being currently evaluated. New molecular diagnostic tests appear to be cost effective and also help in detecting missing cases. There is enough evidence to support the scaling up of these new tools in India.

Preliminary Test Results of a Non-Contacting Finger Seal on a Herringbone-Grooved Rotor

NASA Technical Reports Server (NTRS)

Proctor, Margaret P.; Degado, Irebert R.

2008-01-01

Low leakage, non-contacting finger seals have potential to reduce gas turbine engine specific fuel consumption by 2 to 3 percent and to reduce direct operating costs by increasing the time between engine overhauls. A non-contacting finger seal with concentric lift-pads operating adjacent to a test rotor with herringbone grooves was statically tested at 300, 533, and 700 K inlet air temperatures at pressure differentials up to 576 kPa. Leakage flow factors were approximately 70 percent less than state-of-the-art labyrinth seals. Leakage rates are compared to first order predictions. Initial spin tests at 5000 rpm, 300 K inlet air temperature and pressure differentials to 241 kPa produced no measurable wear.

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

NASA Technical Reports Server (NTRS)

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

2000-01-01

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

Additively Manufactured Low Cost Upper Stage Combustion Chamber

NASA Technical Reports Server (NTRS)

Protz, Christopher; Cooper, Ken; Ellis, David; Fikes, John; Jones, Zachary; Kim, Tony; Medina, Cory; Taminger, Karen; Willingham, Derek

2016-01-01

Over the past two years NASA's Low Cost Upper Stage Propulsion (LCUSP) project has developed Additive Manufacturing (AM) technologies and design tools aimed at reducing the costs and manufacturing time of regeneratively cooled rocket engine components. High pressure/high temperature combustion chambers and nozzles must be regeneratively cooled to survive their operating environment, causing their design fabrication to be costly and time consuming due to the number of individual steps and different processes required. Under LCUSP, AM technologies in Sintered Laser Melting (SLM) GRCop-84 and Electron Beam Freeform Fabrication (EBF3) Inconel 625 have been significantly advanced, allowing the team to successfully fabricate a 25k-class regenerative chamber. Estimates of the costs and schedule of future builds indicate cost reductions and significant schedule reductions will be enabled by this technology. Characterization of the microstructural and mechanical properties of the SLM-produced GRCop-84, EBF3 Inconel 625 and the interface layer between the two has been performed and indicates the properties will meet the design requirements. The LCUSP chamber is to be tested with a previously demonstrated SLM injector in order to advance the Technology Readiness Level (TRL) and demonstrate the capability of the application of these processes. NASA is advancing these technologies to reduce cost and schedule for future engine applications and commercial needs.

Evaluation of financial burden following complications after major surgery in France: Potential return after perioperative goal-directed therapy.

PubMed

Landais, Alain; Morel, Morgane; Goldstein, Jacques; Loriau, Jerôme; Fresnel, Annie; Chevalier, Corinne; Rejasse, Gilles; Alfonsi, Pascal; Ecoffey, Claude

2017-06-01

Perioperative goal-directed therapy (PGDT) has been demonstrated to improve postoperative outcomes and reduce the length of hospital stays. The objective of our analysis was to evaluate the cost of complications, derived from French hospital payments, and calculate the potential cost savings and length of hospital stay reductions. The billing of 2388 patients who underwent scheduled high-risk surgery (i.e. major abdominal, gynaecologic, urological, vascular, and orthopaedic interventions) over three years was retrospectively collected from three French hospitals (one public-teaching, one public, and one private hospital). A relationship between mortality, length of hospital stays, cost/patient, and severity scores, based mainly on postoperative complications but also on preoperative clinical status, were analysed. Statistical analysis was performed using Student's t-tests or Wilcoxon tests. Our analyses determined that a severity score of 3 or 4 was associated with complications in 90% of cases and this represented 36% of patients who, compared with those with a score of 1 or 2, were associated with significantly increased costs (€ 8205±3335 to € 22,081±16,090; P<0.001, delta of € 13,876) and a prolonged length of hospital stay (mean of 10 to 27 days; P<0.001, delta of 17 days). According to estimates for complications avoided by PGDT, there was a projected reduction in average healthcare costs of between € 854 and € 1458 per patient and a reduction in total hospital bed days from 1755 to 4423 over three years. Based on French National data (47,000 high risk surgeries per year), the potential financial savings ranged from € 40M to € 68M, not including the costs of PGDT and its implementation. Our analysis demonstrates that patients with complications are significantly more expensive to care for than those without complications. In our model, it was projected that implementing PGDT during high-risk surgery may significantly reduce healthcare costs and the length of hospital stays in France while probably improving patient access to care and reducing waiting times for procedures. Copyright © 2017. Published by Elsevier Masson SAS.

Cost-effectiveness of an HPV self-collection campaign in Uganda: comparing models for delivery of cervical cancer screening in a low-income setting

PubMed Central

Campos, Nicole G; Tsu, Vivien; Jeronimo, Jose; Njama-Meya, Denise; Mvundura, Mercy; Kim, Jane J

2017-01-01

Abstract With the availability of a low-cost HPV DNA test that can be administered by either a healthcare provider or a woman herself, programme planners require information on the costs and cost-effectiveness of implementing cervical cancer screening programmes in low-resource settings under different models of healthcare delivery. Using data from the START-UP demonstration project and a micro-costing approach, we estimated the health and economic impact of once-in-a-lifetime HPV self-collection campaign relative to clinic-based provider-collection of HPV specimens in Uganda. We used an individual-based Monte Carlo simulation model of the natural history of HPV and cervical cancer to estimate lifetime health and economic outcomes associated with screening with HPV DNA testing once in a lifetime (clinic-based provider-collection vs a self-collection campaign). Test performance and cost data were obtained from the START-UP demonstration project using a micro-costing approach. Model outcomes included lifetime risk of cervical cancer, total lifetime costs (in 2011 international dollars [I$]), and life expectancy. Cost-effectiveness ratios were expressed using incremental cost-effectiveness ratios (ICERs). When both strategies achieved 75% population coverage, ICERs were below Uganda’s per capita GDP (self-collection: I$80 per year of life saved [YLS]; provider-collection: I$120 per YLS). When the self-collection campaign achieved coverage gains of 15–20%, it was more effective than provider-collection, and had a lower ICER unless coverage with both strategies was 50% or less. Findings were sensitive to cryotherapy compliance among screen-positive women and relative HPV test performance. The primary limitation of this analysis is that self-collection costs are based on a hypothetical campaign but are based on unit costs from Uganda. Once-in-a-lifetime screening with HPV self-collection may be very cost-effective and reduce cervical cancer risk by > 20% if coverage is high. Demonstration projects will be needed to confirm the validity of our logistical, costing and compliance assumptions. PMID:28369405

Cost-effectiveness of an HPV self-collection campaign in Uganda: comparing models for delivery of cervical cancer screening in a low-income setting.

PubMed

Campos, Nicole G; Tsu, Vivien; Jeronimo, Jose; Njama-Meya, Denise; Mvundura, Mercy; Kim, Jane J

2017-09-01

With the availability of a low-cost HPV DNA test that can be administered by either a healthcare provider or a woman herself, programme planners require information on the costs and cost-effectiveness of implementing cervical cancer screening programmes in low-resource settings under different models of healthcare delivery. Using data from the START-UP demonstration project and a micro-costing approach, we estimated the health and economic impact of once-in-a-lifetime HPV self-collection campaign relative to clinic-based provider-collection of HPV specimens in Uganda. We used an individual-based Monte Carlo simulation model of the natural history of HPV and cervical cancer to estimate lifetime health and economic outcomes associated with screening with HPV DNA testing once in a lifetime (clinic-based provider-collection vs a self-collection campaign). Test performance and cost data were obtained from the START-UP demonstration project using a micro-costing approach. Model outcomes included lifetime risk of cervical cancer, total lifetime costs (in 2011 international dollars [I$]), and life expectancy. Cost-effectiveness ratios were expressed using incremental cost-effectiveness ratios (ICERs). When both strategies achieved 75% population coverage, ICERs were below Uganda's per capita GDP (self-collection: I$80 per year of life saved [YLS]; provider-collection: I$120 per YLS). When the self-collection campaign achieved coverage gains of 15-20%, it was more effective than provider-collection, and had a lower ICER unless coverage with both strategies was 50% or less. Findings were sensitive to cryotherapy compliance among screen-positive women and relative HPV test performance. The primary limitation of this analysis is that self-collection costs are based on a hypothetical campaign but are based on unit costs from Uganda. Once-in-a-lifetime screening with HPV self-collection may be very cost-effective and reduce cervical cancer risk by > 20% if coverage is high. Demonstration projects will be needed to confirm the validity of our logistical, costing and compliance assumptions. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

MCCx C3I Control Center Interface Emulator

NASA Technical Reports Server (NTRS)

Mireles, James R.

2010-01-01

This slide presentation reviews the project to develop and demonstrate alternate Information Technologies and systems for new Mission Control Centers that will reduce the cost of facility development, maintenance and operational costs and will enable more efficient cost and effective operations concepts for ground support operations. The development of a emulator for the Control Center capability will enable the facilities to conduct the simulation requiring interactivity with the Control Center when it is off line or unavailable, and it will support testing of C3I interfaces for both command and telemetry data exchange messages (DEMs).

Adherence to European Association of Urology Guidelines on Prophylactic Antibiotics: An Important Step in Antimicrobial Stewardship.

PubMed

Cai, Tommaso; Verze, Paolo; Brugnolli, Anna; Tiscione, Daniele; Luciani, Lorenzo Giuseppe; Eccher, Cristina; Lanzafame, Paolo; Malossini, Gianni; Wagenlehner, Florian M E; Mirone, Vincenzo; Bjerklund Johansen, Truls E; Pickard, Robert; Bartoletti, Riccardo

2016-02-01

The evolution of resistant pathogens is a worldwide health crisis and adherence to European Association of Urology (EAU) guidelines on antibiotic prophylaxis may be an important way to improve antibiotic stewardship and reduce patient harm and costs. To evaluate the prevalence of antibiotic-resistant bacterial strains and health care costs during a period of adherence to EAU guidelines in a tertiary referral urologic institution. A protocol for adherence to EAU guidelines for antibiotic prophylaxis for all urologic procedures was introduced in January 2011. Data for 3529 urologic procedures performed between January 2011 and December 2013 after protocol introduction were compared with data for 2619 procedures performed between January 2008 and December 2010 before protocol implementation. The prevalence of bacterial resistance and health care costs were compared between the two periods. The outcome measures were the proportion of resistant uropathogens and costs related to antibiotic consumption and symptomatic postoperative infection. We used χ2 and Fisher's exact tests to test the significance of differences. The proportion of patients with symptomatic postoperative infection did not differ (180/3529 [5.1%] vs. 117/2619 [4.5%]; p=0.27). A total of 342 isolates from all patients with symptomatic postoperative infections were analysed. The rate of resistance of Escherichia coli to piperacillin/tazobactam (9.1% vs. 5.4%; p=0.03), gentamicin (18.3% vs. 11.2%; p=0.02), and ciprofloxacin (32.3% vs. 19.1%; p=0.03) decreased significantly after protocol introduction. The defined daily dose (DDD) use of ciprofloxacin fell from 4.2 to 0.2 DDD per 100 patient-days after implementation (p<0.001). Antibiotic drug costs (€76,980 vs. €36,700) and costs related to postoperative infections (€45,870 vs. €29,560) decreased following introduction of the protocol (p<0.001). Adherence to EAU guidelines on antibiotic prophylaxis reduced antibiotic usage without increasing post-operative infection rate and lowered the prevalence of resistant uropathogens. We analysed the impact of adherence to European Association of Urology guidelines on antibiotic prophylaxis for all surgical urologic procedures on the prevalence of infections and resistant bacterial strains and on costs. We found that adherence to the guidelines reduced the rate of bacterial resistance, in particular against piperacillin/tazobactam, gentamicin, and ciprofloxacin, and reduced costs without increasing the risk of postoperative infection after urologic procedures. We recommend adherence to the guidelines as an important part of antibiotic stewardship programmes. Copyright © 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.

VERIFICATION TESTING OF WET-WEATHER FLOW TECHNOLOGIES

EPA Science Inventory

A number of technological solutions are being offered by vendors to communities and industries seeking cost-effective means for characterizing and reducing the impacts of wet-weather sources of pollution. Whether considering an emerging technology or a new application of an exist...

QSAR PRIORITIZATION OF CHEMICAL INVENTORIES FOR ENDOCRINE DISRUPTOR TESTING

EPA Science Inventory

Binding affinity between chemicals and the estrogen receptor (ER) serves as an indicator of the potential to cause endocrine disruption through this receptor-mediated endocrine pathway. Estimating ER binding affinity is, therefore, one strategic approach to reducing the costs of ...

Process-Based Cost Modeling of Photonics Manufacture: The Cost Competitiveness of Monolithic Integration of a 1550-nm DFB Laser and an Electroabsorptive Modulator on an InP Platform

NASA Astrophysics Data System (ADS)

Fuchs, Erica R. H.; Bruce, E. J.; Ram, R. J.; Kirchain, Randolph E.

2006-08-01

The monolithic integration of components holds promise to increase network functionality and reduce packaging expense. Integration also drives down yield due to manufacturing complexity and the compounding of failures across devices. Consensus is lacking on the economically preferred extent of integration. Previous studies on the cost feasibility of integration have used high-level estimation methods. This study instead focuses on accurate-to-industry detail, basing a process-based cost model of device manufacture on data collected from 20 firms across the optoelectronics supply chain. The model presented allows for the definition of process organization, including testing, as well as processing conditions, operational characteristics, and level of automation at each step. This study focuses on the cost implications of integration of a 1550-nm DFB laser with an electroabsorptive modulator on an InP platform. Results show the monolithically integrated design to be more cost competitive over discrete component options regardless of production scale. Dominant cost drivers are packaging, testing, and assembly. Leveraging the technical detail underlying model projections, component alignment, bonding, and metal-organic chemical vapor deposition (MOCVD) are identified as processes where technical improvements are most critical to lowering costs. Such results should encourage exploration of the cost advantages of further integration and focus cost-driven technology development.

NASA Stennis Space Center integrated system health management test bed and development capabilities

NASA Astrophysics Data System (ADS)

Figueroa, Fernando; Holland, Randy; Coote, David

2006-05-01

Integrated System Health Management (ISHM) capability for rocket propulsion testing is rapidly evolving and promises substantial reduction in time and cost of propulsion systems development, with substantially reduced operational costs and evolutionary improvements in launch system operational robustness. NASA Stennis Space Center (SSC), along with partners that includes NASA, contractor, and academia; is investigating and developing technologies to enable ISHM capability in SSC's rocket engine test stands (RETS). This will enable validation and experience capture over a broad range of rocket propulsion systems of varying complexity. This paper describes key components that constitute necessary ingredients to make possible implementation of credible ISHM capability in RETS, other NASA ground test and operations facilities, and ultimately spacecraft and space platforms and systems: (1) core technologies for ISHM, (2) RETS as ISHM testbeds, and (3) RETS systems models.

Multifamily Psychoeducation for First-Episode Psychosis: A Cost-Effectiveness Analysis

PubMed Central

Breitborde, Nicholas J. K.; Woods, Scott W.; Srihari, Vinod H.

2017-01-01

Objective Family psychoeducation is considered part of optimal treatment for first-episode psychosis, but concerns about the cost of this intervention have limited its availability. Although evidence suggests that family psychoeducation is cost-effective, many cost-effectiveness analyses have suffered from limitations that reduce their utility in guiding decisions to incorporate this intervention within existing clinical services. These include not presenting results in present-day dollars and not examining whether the intervention would remain cost-effective in situations where the clinical benefits achieved were smaller than those reported in past studies. Thus the goal of this study was to investigate the cost of providing a specific psychoeducation program—multifamily group psychoeducation—to individuals with first-episode psychosis and their families. Methods Statistical simulation was used to estimate the cost and burden of illness associated with usual treatment versus usual treatment plus multifamily group psychoeducation. In addition, the simulation model was rerun to test whether multifamily psychoeducation would remain cost-effective in situations where the clinical benefits achieved were smaller than those reported in past studies. Results When provided for two years, multifamily group psychoeducation ranged from a cost-effective to a cost-saving intervention, depending on the clinical benefits achieved by staff delivering the intervention. When provided for longer durations (five, ten, or 20 years), multifamily psychoeducation was a cost-saving intervention even in scenarios where the clinical benefits of the intervention were reduced by 90%. Conclusions The results suggest that multifamily group psychoeducation may not only be a cost-effective intervention for first-episode psychosis but may often be a cost-saving intervention. PMID:19880465

Multifamily psychoeducation for first-episode psychosis: a cost-effectiveness analysis.

PubMed

Breitborde, Nicholas J K; Woods, Scott W; Srihari, Vinod H

2009-11-01

Family psychoeducation is considered part of optimal treatment for first-episode psychosis, but concerns about the cost of this intervention have limited its availability. Although evidence suggests that family psychoeducation is cost-effective, many cost-effectiveness analyses have suffered from limitations that reduce their utility in guiding decisions to incorporate this intervention within existing clinical services. These include not presenting results in present-day dollars and not examining whether the intervention would remain cost-effective in situations where the clinical benefits achieved were smaller than those reported in past studies. Thus the goal of this study was to investigate the cost of providing a specific psychoeducation program-multifamily group psychoeducation-to individuals with first-episode psychosis and their families. Statistical simulation was used to estimate the cost and burden of illness associated with usual treatment versus usual treatment plus multifamily group psychoeducation. In addition, the simulation model was rerun to test whether multifamily psychoeducation would remain cost-effective in situations where the clinical benefits achieved were smaller than those reported in past studies. When provided for two years, multifamily group psychoeducation ranged from a cost-effective to a cost-saving intervention, depending on the clinical benefits achieved by staff delivering the intervention. When provided for longer durations (five, ten, or 20 years), multifamily psychoeducation was a cost-saving intervention even in scenarios where the clinical benefits of the intervention were reduced by 90%. The results suggest that multifamily group psychoeducation may not only be a cost-effective intervention for first-episode psychosis but may often be a cost-saving intervention.

Impact of a hospitalist system on length of stay and cost for children with common conditions.

PubMed

Srivastava, Rajendu; Landrigan, Christopher P; Ross-Degnan, Dennis; Soumerai, Stephen B; Homer, Charles J; Goldmann, Donald A; Muret-Wagstaff, Sharon

2007-08-01

This study examined mechanisms of efficiency in a managed care hospitalist system on length of stay and total costs for common pediatric conditions. We conducted a retrospective cohort study (October 1993 to July 1998) of patients in a not-for-profit staff model (HMO 1) and a non-staff-model (HMO 2) managed care organization at a freestanding children's hospital. HMO 1 introduced a hospitalist system for patients in October 1996. Patients were included if they had 1 of 3 common diagnoses: asthma, dehydration, or viral illness. Linear regression models examining length-of-stay-specific costs for prehospitalist and posthospitalist systems were built. Distribution of length of stay for each diagnosis before and after the system change in both study groups was calculated. Interrupted time series analysis tested whether changes in the trends of length of stay and total costs occurred after implementation of the hospitalist system by HMO1 (HMO 2 as comparison group) for all 3 diagnoses combined. A total of 1970 patients with 1 of the 3 study conditions were cared for in HMO 1, and 1001 in HMO 2. After the hospitalist system was introduced in HMO 1, length of stay was reduced by 0.23 days (13%) for asthma and 0.19 days (11%) for dehydration; there was no difference for patients with viral illness. The largest relative reduction in length of stay occurred in patients with a shorter length of stay whose hospitalizations were reduced from 2 days to 1 day. This shift resulted in an average cost-per-case reduction of $105.51 (9.3%) for patients with asthma and $86.22 (7.8%) for patients with dehydration. During the same period, length of stay and total cost rose in HMO 2. Introduction of a hospitalist system in one health maintenance organization resulted in earlier discharges and reduced costs for children with asthma and dehydration compared with another one, with the largest reductions occurring in reducing some 2-day hospitalizations to 1 day. These findings suggest that hospitalists can increase efficiency and reduce costs for children with common pediatric conditions.

Digital Control Technologies for Modular DC-DC Converters

NASA Technical Reports Server (NTRS)

Button, Robert M.; Kascak, Peter E.; Lebron-Velilla, Ramon

2002-01-01

Recent trends in aerospace Power Management and Distribution (PMAD) systems focus on using commercial off-the-shelf (COTS) components as standard building blocks. This move to more modular designs has been driven by a desire to reduce costs and development times, but is also due to the impressive power density and efficiency numbers achieved by today's commercial DC-DC converters. However, the PMAD designer quickly learns of the hidden "costs" of using COTS converters. The most significant cost is the required addition of external input filters to meet strict electromagnetic interference (MIAMI) requirements for space systems. In fact, the high power density numbers achieved by the commercial manufacturers are greatly due to the lack of necessary input filters included in the COTS module. The NASA Glenn Research Center is currently pursuing a digital control technology that addresses this problem with modular DC-DC converters. This paper presents the digital control technologies that have been developed to greatly reduce the input filter requirements for paralleled, modular DC-DC converters. Initial test result show that the input filter's inductor size was reduced by 75 percent, and the capacitor size was reduced by 94 percent while maintaining the same power quality specifications.

An extended Kalman filter approach to non-stationary Bayesian estimation of reduced-order vocal fold model parameters.

PubMed

Hadwin, Paul J; Peterson, Sean D

2017-04-01

The Bayesian framework for parameter inference provides a basis from which subject-specific reduced-order vocal fold models can be generated. Previously, it has been shown that a particle filter technique is capable of producing estimates and associated credibility intervals of time-varying reduced-order vocal fold model parameters. However, the particle filter approach is difficult to implement and has a high computational cost, which can be barriers to clinical adoption. This work presents an alternative estimation strategy based upon Kalman filtering aimed at reducing the computational cost of subject-specific model development. The robustness of this approach to Gaussian and non-Gaussian noise is discussed. The extended Kalman filter (EKF) approach is found to perform very well in comparison with the particle filter technique at dramatically lower computational cost. Based upon the test cases explored, the EKF is comparable in terms of accuracy to the particle filter technique when greater than 6000 particles are employed; if less particles are employed, the EKF actually performs better. For comparable levels of accuracy, the solution time is reduced by 2 orders of magnitude when employing the EKF. By virtue of the approximations used in the EKF, however, the credibility intervals tend to be slightly underpredicted.

Synchronous activity lowers the energetic cost of nest escape for sea turtle hatchlings.

PubMed

Rusli, Mohd Uzair; Booth, David T; Joseph, Juanita

2016-05-15

A potential advantage of group movement in animals is increased locomotion efficiency. This implies a reduced energetic cost for individuals that occur in larger groups such as herds, flocks and schools. When chelonian hatchlings hatch in the underground nest with finite energy for their post-hatching dispersal phase, they face the challenge of minimizing energetic expenditure while escaping the nest. The term 'social facilitation' has been used to describe the combined digging effort of sea turtle hatchlings during nest escape. Given that in a normal clutch, a substantial part of the energy reserve within the residual yolk is used by hatchlings in the digging out process, a decreased cohort size may reduce the energy reserve available to cross the beach and sustain the initial swimming frenzy. This hypothesis was experimentally tested by varying cohort size in hatchling green turtles (Chelonia mydas) and measuring energy expenditure during the nest escape process using open-flow respirometry. The energetic cost of escaping through 40 cm of sand was calculated to vary between 4.4 and 28.3 kJ per individual, the cost decreasing as the number of individuals in the cohort increased. This represents 11-68% of the energy contained in a hatchling's residual yolk at hatching. The reduced energetic cost associated with large cohorts resulted from both a lower metabolic rate per individual and a shortened nest escape time. We conclude that synchronous digging activity of many hatchlings during nest escape evolved not only to facilitate rapid nest emergence but also to reduce the energetic cost to individuals. © 2016. Published by The Company of Biologists Ltd.

A cost-benefit analysis of a proposed overseas refugee latent tuberculosis infection screening and treatment program.

PubMed

Wingate, La'Marcus T; Coleman, Margaret S; de la Motte Hurst, Christopher; Semple, Marie; Zhou, Weigong; Cetron, Martin S; Painter, John A

2015-12-01

This study explored the effect of screening and treatment of refugees for latent tuberculosis infection (LTBI) before entrance to the United States as a strategy for reducing active tuberculosis (TB). The purpose of this study was to estimate the costs and benefits of LTBI screening and treatment in United States bound refugees prior to arrival. Costs were included for foreign and domestic LTBI screening and treatment and the domestic treatment of active TB. A decision tree with multiple Markov nodes was developed to determine the total costs and number of active TB cases that occurred in refugee populations that tested 55, 35, and 20 % tuberculin skin test positive under two models: no overseas LTBI screening and overseas LTBI screening and treatment. For this analysis, refugees that tested 55, 35, and 20 % tuberculin skin test positive were divided into high, moderate, and low LTBI prevalence categories to denote their prevalence of LTBI relative to other refugee populations. For a hypothetical 1-year cohort of 100,000 refugees arriving in the United States from regions with high, moderate, and low LTBI prevalence, implementation of overseas screening would be expected to prevent 440, 220, and 57 active TB cases in the United States during the first 20 years after arrival. The cost savings associated with treatment of these averted cases would offset the cost of LTBI screening and treatment for refugees from countries with high (net cost-saving: $4.9 million) and moderate (net cost-saving: $1.6 million) LTBI prevalence. For low LTBI prevalence populations, LTBI screening and treatment exceed expected future TB treatment cost savings (net cost of $780,000). Implementing LTBI screening and treatment for United States bound refugees from countries with high or moderate LTBI prevalence would potentially save millions of dollars and contribute to United States TB elimination goals. These estimates are conservative since secondary transmission from tuberculosis cases in the United States was not considered in the model.

In-situ Testing of the EHT High Gain and Frequency Ultra-Stable Integrators

NASA Astrophysics Data System (ADS)

Miller, Kenneth; Ziemba, Timothy; Prager, James; Slobodov, Ilia; Lotz, Dan

2014-10-01

Eagle Harbor Technologies (EHT) has developed a long-pulse integrator that exceeds the ITER specification for integration error and pulse duration. During the Phase I program, EHT improved the RPPL short-pulse integrators, added a fast digital reset, and demonstrated that the new integrators exceed the ITER integration error and pulse duration requirements. In Phase II, EHT developed Field Programmable Gate Array (FPGA) software that allows for integrator control and real-time signal digitization and processing. In the second year of Phase II, the EHT integrator will be tested at a validation platform experiment (HIT-SI) and tokamak (DIII-D). In the Phase IIB program, EHT will continue development of the EHT integrator to reduce overall cost per channel. EHT will test lower cost components, move to surface mount components, and add an onboard Field Programmable Gate Array and data acquisition to produce a stand-alone system with lower cost per channel and increased the channel density. EHT will test the Phase IIB integrator at a validation platform experiment (HIT-SI) and tokamak (DIII-D). Work supported by the DOE under Contract Number (DE-SC0006281).

Audit of Use and Overuse of Serum Protein Immunofixation Electrophoresis and Serum Free Light Chain Assay in Tertiary Health Care: A Case for Algorithmic Testing to Optimize Laboratory Utilization.

PubMed

Heaton, Christopher; Vyas, Shikhar G; Singh, Gurmukh

2016-04-01

Overuse of laboratory tests is a persistent issue. We examined the use and overuse of serum immunofixation electrophoresis and serum free light chain assays to develop an algorithm for optimizing utilization. A retrospective review of all tests, for investigation of monoclonal gammopathies, for all patients who had any of these tests done from April 24, 2014, through July 25, 2014, was carried out. The test orders were categorized as warranted or not warranted according to criteria presented in the article. A total of 237 patients were tested, and their historical records included 1,503 episodes of testing for one or more of serum protein electrophoresis, serum immunofixation electrophoresis, and serum free light chain assays. Only 46% of the serum immunofixation and 42% serum free light chain assays were warranted. Proper utilization, at our institution alone, would have obviated $64,182.95/year in health care costs, reduced laboratory cost of reagent alone by $26,436.04/year, and put $21,904.92/year of part B reimbursement at risk. Fewer than half of the serum immunofixation and serum free light chain assays added value. The proposed algorithm for testing should improve utilization. Risk to part B billing may be a disincentive to reducing test utilization. © American Society for Clinical Pathology, 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Validation Test Report For The CRWMS Analysis and Logistics Visually Interactive Model Calvin Version 3.0, 10074-Vtr-3.0-00

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

S. Gillespie

2000-07-27

This report describes the tests performed to validate the CRWMS ''Analysis and Logistics Visually Interactive'' Model (CALVIN) Version 3.0 (V3.0) computer code (STN: 10074-3.0-00). To validate the code, a series of test cases was developed in the CALVIN V3.0 Validation Test Plan (CRWMS M&O 1999a) that exercises the principal calculation models and options of CALVIN V3.0. Twenty-five test cases were developed: 18 logistics test cases and 7 cost test cases. These cases test the features of CALVIN in a sequential manner, so that the validation of each test case is used to demonstrate the accuracy of the input to subsequentmore » calculations. Where necessary, the test cases utilize reduced-size data tables to make the hand calculations used to verify the results more tractable, while still adequately testing the code's capabilities. Acceptance criteria, were established for the logistics and cost test cases in the Validation Test Plan (CRWMS M&O 1999a). The Logistics test cases were developed to test the following CALVIN calculation models: Spent nuclear fuel (SNF) and reactivity calculations; Options for altering reactor life; Adjustment of commercial SNF (CSNF) acceptance rates for fiscal year calculations and mid-year acceptance start; Fuel selection, transportation cask loading, and shipping to the Monitored Geologic Repository (MGR); Transportation cask shipping to and storage at an Interim Storage Facility (ISF); Reactor pool allocation options; and Disposal options at the MGR. Two types of cost test cases were developed: cases to validate the detailed transportation costs, and cases to validate the costs associated with the Civilian Radioactive Waste Management System (CRWMS) Management and Operating Contractor (M&O) and Regional Servicing Contractors (RSCs). For each test case, values calculated using Microsoft Excel 97 worksheets were compared to CALVIN V3.0 scenarios with the same input data and assumptions. All of the test case results compare with the CALVIN V3.0 results within the bounds of the acceptance criteria. Therefore, it is concluded that the CALVIN V3.0 calculation models and options tested in this report are validated.« less

Novel Structured Metal Bipolar Plates for Low Cost Manufacturing

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

Wang, Conghua

2013-08-15

Bipolar plates are an important component in fuel cell stacks and accounts for more than 75% of stack weight and volume, and 20% of the stack cost. The technology development of metal bipolar plates can effectively reduce the fuel cells stack weight and volume over 50%. The challenge is to protect metal plate from corrosion at low cost for the broad commercial applications. While most of today’s PEM fuel cell metallic bipolar plate technologies use some precious metal, the focus of this SBIR project is to develop a low cost, novel nano-structured metal bipolar plate technology without using any preciousmore » metal. The technology will meet the performance and cost requirements for automobile applications. Through the Phase I project, TreadStone has identified the corrosion resistant and electrically conductive titanium oxide for the metal bipolar plate surface protection for automotive PEM fuel cell applications. TreadStone has overcome the manufacturing issues to apply the coating on metal substrate surface, and has demonstrated the feasibility of the coated stainless steel plates by ex-situ evaluation tests and the in-situ fuel cell long term durability test. The test results show the feasibility of the proposed nano-structured coating as the low cost metal bipolar plates of PEM fuel cells. The plan for further technology optimization is also outlined for the Phase II project.« less

The cost effectiveness of a quality improvement program to reduce maternal and fetal mortality in a regional referral hospital in Accra, Ghana.

PubMed

Goodman, David M; Ramaswamy, Rohit; Jeuland, Marc; Srofenyoh, Emmanuel K; Engmann, Cyril M; Olufolabi, Adeyemi J; Owen, Medge D

2017-01-01

To evaluate the cost-effectiveness of a quality improvement intervention aimed at reducing maternal and fetal mortality in Accra, Ghana. Quasi-experimental, time-sequence intervention, retrospective cost-effectiveness analysis. Data were collected on the cost and outcomes of a 5-year Kybele-Ghana Health Service Quality Improvement (QI) intervention conducted at Ridge Regional Hospital, a tertiary referral center in Accra, Ghana, focused on systems, personnel, and communication. Maternal deaths prevented were estimated comparing observed rates with counterfactual projections of maternal mortality and case-fatality rates for hypertensive disorders of pregnancy and obstetric hemorrhage. Stillbirths prevented were estimated based on counterfactual estimates of stillbirth rates. Cost-effectiveness was then calculated using estimated disability-adjusted life years averted and subjected to Monte Carlo and one-way sensitivity analyses to test the importance of assumptions inherent in the calculations. Incremental Cost-effectiveness ratio (ICER), which represents the cost per disability-adjusted life-year (DALY) averted by the intervention compared to a model counterfactual. From 2007-2011, 39,234 deliveries were affected by the QI intervention implemented at Ridge Regional Hospital. The total budget for the program was $2,363,100. Based on program estimates, 236 (±5) maternal deaths and 129 (±13) intrapartum stillbirths were averted (14,876 DALYs), implying an ICER of $158 ($129-$195) USD. This value is well below the highly cost-effective threshold of $1268 USD. Sensitivity analysis considered DALY calculation methods, and yearly prevalence of risk factors and case fatality rates. In each of these analyses, the program remained highly cost-effective with an ICER ranging from $97-$218. QI interventions to reduce maternal and fetal mortality in low resource settings can be highly cost effective. Cost-effectiveness analysis is feasible and should regularly be conducted to encourage fiscal responsibility in the pursuit of improved maternal and child health.

Low-Cost High-Pressure Hydrogen Generator

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

Cropley, Cecelia C.; Norman, Timothy J.

Electrolysis of water, particularly in conjunction with renewable energy sources, is potentially a cost-effective and environmentally friendly method of producing hydrogen at dispersed forecourt sites, such as automotive fueling stations. The primary feedstock for an electrolyzer is electricity, which could be produced by renewable sources such as wind or solar that do not produce carbon dioxide or other greenhouse gas emissions. However, state-of-the-art electrolyzer systems are not economically competitive for forecourt hydrogen production due to their high capital and operating costs, particularly the cost of the electricity used by the electrolyzer stack. In this project, Giner Electrochemical Systems, LLC (GES)more » developed a low cost, high efficiency proton-exchange membrane (PEM) electrolysis system for hydrogen production at moderate pressure (300 to 400 psig). The electrolyzer stack operates at differential pressure, with hydrogen produced at moderate pressure while oxygen is evolved at near-atmospheric pressure, reducing the cost of the water feed and oxygen handling subsystems. The project included basic research on catalysts and membranes to improve the efficiency of the electrolysis reaction as well as development of advanced materials and component fabrication methods to reduce the capital cost of the electrolyzer stack and system. The project culminated in delivery of a prototype electrolyzer module to the National Renewable Energy Laboratory for testing at the National Wind Technology Center. Electrolysis cell efficiency of 72% (based on the lower heating value of hydrogen) was demonstrated using an advanced high-strength membrane developed in this project. This membrane would enable the electrolyzer system to exceed the DOE 2012 efficiency target of 69%. GES significantly reduced the capital cost of a PEM electrolyzer stack through development of low cost components and fabrication methods, including a 60% reduction in stack parts count. Economic analysis indicates that hydrogen could be produced for $3.79 per gge at an electricity cost of $0.05/kWh by the lower-cost PEM electrolyzer developed in this project, assuming high-volume production of large-scale electrolyzer systems.« less

On development of an inexpensive, lightweight thermal micrometeroid garment for space suits

NASA Technical Reports Server (NTRS)

1975-01-01

A lightweight and inexpensive coverlayer developed for space suits is described. Material selection, procurement, and testing, pattern design, and prototype fabrication are discussed. By using the minimum required cross section necessary for earth orbital mission, by utilizing the lightest weight materials possible, and by decreasing the use of weight costly taping a lightweight and economical thermal micrometeroid garment was developed. Simplification of manufacturing techniques and use of off-the-shelf materials helped to reduce costs.

Cost of Irradiating Bacon and the Associated Energy Savings

DTIC Science & Technology

1979-03-01

Irradiated Food(s) Consumers Irradiation Cost Analysis Energy Savings Stan 1 izatlon Consumer Acceptance Meat ~~~~~~~~~~~~~~~~~ ~ ô. ~ iii~- ) I I...eliminating nitrites in bacon would reduce or eliminate the formation of highly carcinogenic nitrosami~es, but would Increase the threatof botulism...Sterilized by Irradiation, bacon without nitrite does not contain nitrosamines and does not cause botulism. Consumer panel taste tests show no difference

Genomics and proteomics: the next generation of health care.

PubMed

Sica, Joanne M

2002-12-01

Biotechnology research will dramatically impact health care, and the pharmaceutical industry in particular, in the coming decade. Health outcomes may be improved in a cost-effective manner through the ability to selectively prescribe medications; safer, more effective treatment may reduce long-term health care costs. As genetic testing becomes the standard of care, new challenges will surface around how genetic information will be used or misused, and how and where health care dollars are spent.

Fission Power System Technology for NASA Exploration Missions

NASA Technical Reports Server (NTRS)

Mason, Lee; Houts, Michael

2011-01-01

Under the NASA Exploration Technology Development Program, and in partnership with the Department of Energy (DOE), NASA is conducting a project to mature Fission Power System (FPS) technology. A primary project goal is to develop viable system options to support future NASA mission needs for nuclear power. The main FPS project objectives are as follows: 1) Develop FPS concepts that meet expected NASA mission power requirements at reasonable cost with added benefits over other options. 2) Establish a hardware-based technical foundation for FPS design concepts and reduce overall development risk. 3) Reduce the cost uncertainties for FPS and establish greater credibility for flight system cost estimates. 4) Generate the key products to allow NASA decisionmakers to consider FPS as a preferred option for flight development. In order to achieve these goals, the FPS project has two main thrusts: concept definition and risk reduction. Under concept definition, NASA and DOE are performing trade studies, defining requirements, developing analytical tools, and formulating system concepts. A typical FPS consists of the reactor, shield, power conversion, heat rejection, and power management and distribution (PMAD). Studies are performed to identify the desired design parameters for each subsystem that allow the system to meet the requirements with reasonable cost and development risk. Risk reduction provides the means to evaluate technologies in a laboratory test environment. Non-nuclear hardware prototypes are built and tested to verify performance expectations, gain operating experience, and resolve design uncertainties.