Home About us Contact
|
Home About us Contact | ||
|
|
||
Cost Effectiveness (cost + effectiveness)
Selected AbstractsCOST EFFECTIVENESS OF VEGETATIVE FILTER STRIPS AND INSTREAM HALF-LOGS FOR ECOLOGICAL RESTORATION,JOURNAL OF THE AMERICAN WATER RESOURCES ASSOCIATION, Issue 5 2006Emmanuel A. Frimpong ABSTRACT: This paper presents the results of cost effectiveness (CE) analysis of vegetative filter strips (VFS) and instream half-logs as tools for recovering scores on a fish Index of Biotic Integrity (IBI) in the upper Wabash River watershed (UW) in Indiana. Three assumptions were made about recovery time for IBI scores (5,15, and 30 years) and social discount rates (1, 3, and 5 percent), which were tested for sensitivity of the estimated CE ratios. Effectiveness of VFS was estimated using fish IBIs and riparian forest cover from 49 first-order to fifth-order stream reaches. Half-log structures had been installed for approximately two years in the UW prior to the study and provided a basis for estimates of cost and maintenance. Cost effectiveness ratios for VFS decreased from $387 to $277 per 100 m for a 1 percent increase in IBI scores from first-to fifth-order streams with 3 percent discount and 30-year recovery. This cost weighted by proportion of stream orders was $360. The ratio decreased with decreasing time of recovery and discount rate. Based on installation costs and an assumption of equal recovery rates, half-logs were two-thirds to one-half as cost-effective as VFS. Half-logs would be a cost-effective supplement to VFS in low order streams if they can be proven to recover IBI scores faster than VFS do. This study provides baseline data and a framework for planning and determining the cost of stream restoration. [source] Frequency of Seborrheic Keratosis Biopsies in the United States: A Benchmark of Skin Lesion Care Quality and Cost EffectivenessDERMATOLOGIC SURGERY, Issue 8 2003Maria I. Duque MD Background. Most seborrheic keratoses may be readily clinically differentiated from skin cancer, but occasional lesions resemble atypical melanocytic neoplasms. Objective. To evaluate the frequency, cost, and intensity of procedures performed that result in the removal and histopathologic evaluation of seborrheic keratoses. Methods. Episodes of surgical removal of lesions that were identified as seborrheic keratoses by histologic identification were determined using Medicare Current Beneficiary Survey data from 1998 to 1999. These episodes were defined by a histopathology procedure code that is associated with a diagnosis code for seborrheic keratosis. We then identified what procedure(s) generated the histopathology specimen. Biopsy and shave procedures were considered "low intensity," whereas excision and repair procedures were considered "high intensity." Results. Dermatologists managed 85% of all episodes of seborrheic keratoses. Dermatologists managed 89% of seborrheic keratosis episodes using low-intensity procedures compared with 51% by other specialties. For nondermatologists, 46% of the treatment cost ($9 million) to Medicare was generated from high-intensity management compared with 15% by dermatologists ($6 million). Conclusion. There is a significant difference in the management of suspicious pigmented lesions between dermatologists and other specialists. This affects both the cost and quality of care. [source] Cost Effectiveness of the Implantable Cardioverter-Defibrillator: Better in Higher-Risk Patients and Extended DurationPREVENTIVE CARDIOLOGY, Issue 3 2006Ezra A. Amsterdam MD Editor in Chief No abstract is available for this article. [source] The Effectiveness and Cost Effectiveness of Public-Access DefibrillationCLINICAL CARDIOLOGY, Issue 7 2010Roger A. Winkle MD Many sudden cardiac deaths are due to ventricular fibrillation (VF). The use of defibrillators in hospitals or by outpatient emergency medical services (EMS) personnel can save many cardiac-arrest victims. Automated external defibrillators (AEDs) permit defibrillation by trained first responders and laypersons. AEDs are available at most public venues, and vast sums of money are spent installing and maintaining these devices. AEDs have been evaluated in a variety of public and private settings. AEDs accurately identify malignant ventricular tachyarrhythmias and frequently result in successful defibrillation. Prompt application of an AED shows a greater number of patients in VF compared with initial rhythms documented by later-arriving EMS personnel. Survival is greatest when the AED is placed within 3 to 5 minutes of a witnessed collapse. Community-based studies show increased cardiac-arrest survival when first responders are equipped with AEDs rather than waiting for paramedics to defibrillate. Wide dissemination of AEDs throughout a community increases survival from cardiac arrest when the AED is used; however, the AEDs are utilized in a very small percentage of all out-of-hospital cardiac arrests. AEDs save very few lives in residential units such as private homes or apartment complexes. AEDs are cost effective at sites where there is a high density of both potential victims and resuscitators. Placement at golf courses, health clubs, and similar venues is not cost effective; however, the visible devices are good for public awareness of the problem of sudden cardiac death and provide reassurance to patrons. Copyright © 2010 Wiley Periodicals, Inc. [source] District health systems in a neoliberal world: a review of five key policy areas,INTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue S1 2003Malcolm Segall Abstract District health systems, comprising primary health care and first referral hospitals, are key to the delivery of basic health services in developing countries. They should be prioritized in resource allocation and in the building of management and service capacity. The relegation in the World Health Report 2000 of primary health care to a ,second generation' reform,to be superseded by third generation reforms with a market orientation,flows from an analysis that is historically flawed and ideologically biased. Primary health care has struggled against economic crisis and adjustment and a neoliberal ideology often averse to its principles. To ascribe failures of primary health care to a weakness in policy design, when the political economy has starved it of resources, is to blame the victim. Improvement in the working and living conditions of health workers is a precondition for the effective delivery of public health services. A multidimensional programme of health worker rehabilitation should be developed as the foundation for health service recovery. District health systems can and should be financed (at least mainly) from public funds. Although in certain situations user fees have improved the quality and increased the utilization of primary care services, direct charges deter health care use by the poor and can result in further impoverishment. Direct user fees should be replaced progressively by increased public finance and, where possible, by prepayment schemes based on principles of social health insurance with public subsidization. Priority setting should be driven mainly by the objective to achieve equity in health and wellbeing outcomes. Cost effectiveness should enter into the selection of treatments for people (productive efficiency), but not into the selection of people for treatment (allocative efficiency). Decentralization is likely to be advantageous in most health systems, although the exact form(s) should be selected with care and implementation should be phased in after adequate preparation. The public health service should usually play the lead provider role in district health systems, but non-government providers can be contracted if needed. There is little or no evidence to support proactive privatization, marketization or provider competition. Democratization of political and popular involvement in health enhances the benefits of decentralization and community participation. Integrated district health systems are the means by which specific health programmes can best be delivered in the context of overall health care needs. International assistance should address communicable disease control priorities in ways that strengthen local health systems and do not undermine them. The Global Fund to Fight AIDS, Tuberculosis and Malaria should not repeat the mistakes of the mass compaigns of past decades. In particular, it should not set programme targets that are driven by an international agenda and which are achievable only at the cost of an adverse impact on sustainable health systems. Above all the targets must not retard the development of the district health systems so badly needed by the rural poor. Copyright © 2003 John Wiley & Sons, Ltd. [source] Cost effectiveness of mass screening for coeliac disease is determined by time-delay to diagnosis and quality of life on a gluten-free dietALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 8 2010T. HERSHCOVICI Aliment Pharmacol Ther,31, 901,910 Summary Background, Coeliac disease is frequently diagnosed after a long delay resulting in increased morbidity and mortality. Aims, To define the parameters which have the highest impact on the cost-effectiveness of mass screening for coeliac disease. Methods, A Markov model examined a coeliac disease screening programme of the healthy young-adult general population compared with a no-screening strategy. The main outcome measures were quality adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER). Effects of variables were examined using sensitivity analyses. Results, The screening strategy resulted in a gain of 0.0027 QALYs. The ICER of screening vs. no-screening strategy was US$48 960/QALYs. The variables with the largest impact on cost effectiveness were: the time delay from symptom onset to diagnosis, the utility of adherence to a gluten-free diet (GFD) and the prevalence of coeliac disease. Screening would be cost-effective if the time delay to diagnosis is longer than 6 years and utility of GFD adherence is greater than 0.978. Conclusions, Our model suggests that mass screening for coeliac disease of the young-adult general population is associated with improved QALYs and is a cost effectiveness strategy. Shortening of the time-delay to diagnosis by heightened awareness of health-care professionals may be a valid alternative to screening. [source] Cost-effective Targeting of Riparian BuffersCANADIAN JOURNAL OF AGRICULTURAL ECONOMICS, Issue 1 2004Wanhong Yang This paper develops an integrated economic, hydrologic and GIS modeling framework to examine the cost-effective targeting of land retirement for establishing riparian buffers in agricultural watersheds. Previous studies have examined the efficiency of targeting large land parcels for retirement or targeting management practices such as conservation tillage but have not considered narrow variable buffer strips. An empirical application of the framework in the Canagagigue Creek watershed in Ontario shows that average and marginal costs of sediment abatement increase at an increasing rate as the environmental goal becomes more stringent. The locations of the buffer strips vary across the watershed and are not necessarily located on those sites with greatest slope or those adjacent to visible streams. Cost effectiveness is further increased if the targeting is extended to allow for the width of the buffer strip to vary by location rather than assume a uniform width. The modeling results have important policy implications for the design of conservation stewardship programs such as setting appropriate environmental health goals based on marginal abatement costs relative to marginal benefits, and setting physical characteristics of the riparian buffers for selection along the drainage network in targeted sub-catchments. L'auteur propose un modèle intégrant l'économie, l'hydrologie et les SIG pour déterminer l'efficacité du choix des terres retirées de la production en vue de l'aménagement de zones tampon dans les bassins hydrographiques agricoles. D'autres auteurs se sont déjà penchés sur l'efficacité du retrait de vastes parcelles de la production ou sur certaines pratiques de gestion environnementales comme le non-travail du sol, sans toutefois s'intéresser aux étroites bandes tampon aux propriétés variables. L'application empirique du modèle au bassin du ruisseau Canagagigue, en Ontario, révèle que les coûts moyens et marginaux des mesures de lutte contre la sédimentation augmentent à un taux croissant quand l'objectif environnemental se fait de plus en plus rigoureux. L'emplacement des bandes tampon varie le long du bassin hydrographique et ces derniéres ne se situent pas nécessairement là où la pente est la plus raide ni à proximité des cours d'eau visibles. Le rendement augmente quand on laisse la largeur de la bande tampon varier en fonction de l'endroit, au lieu de présumer une largeur uniforme. Les résultats de la modélisation revêtent une grande importance pour l'élaboration de politiques relatives aux programmes de conservation et d'intendance comme l'établissement d'objectifs de protection de l'environnement fondés sur une comparaison des coûts et des avantages marginaux des mesures de lutte, et le choix de zones riveraines tampon selon leurs caracteristiques physiques dans le réseau de drainage des zones de captage secondaires. [source] Cost effectiveness of pharmacogenetic testing for uridine diphosphate glucuronosyltransferase 1A1 before irinotecan administration for metastatic colorectal cancer,CANCER, Issue 17 2009Heather Taffet Gold PhD Abstract BACKGROUND: The objective of this study was to examine the cost effectiveness of using a pharmacogenetic test for uridine diphosphate glycosyltransferase 1A1*28 (UGT1A1*28) variant homozygosity before administering irinotecan to patients with metastatic colorectal cancer. METHODS: A decision-analytic model from the Medicare payer perspective followed hypothetical patients who were treated with combined 5-fluorouracil, leucovorin, and irinotecan. Under usual care, patients received a full dose of irinotecan. With genetic testing, irinotecan dosage was reduced 25% in homozygotes with the UGT1A1*28 variant allele. Test performance, chemotherapy toxicity, and quality-of-life weights were derived from clinical literature and product labels, and costs were derived from 2007 Medicare fee schedules. Chemotherapy efficacy after dose reduction, adverse event risk, and other parameters were varied in 1-way and probabilistic sensitivity analyses. The authors also calculated the value of investing in further studies of chemotherapy efficacy after homozygote dose reductions. RESULTS: Pretreatment genetic testing costs less ($272 savings per patient tested) and yields slightly improved quality-adjusted life expectancy (0.1 quality-adjusted day per patient tested; approximately 2 quality-adjusted hours). Results depended on treatment efficacy but not adverse event risk assumptions. The results indicated that testing would avoid 84 cases of severe neutropenia, including 4.4 deaths. At a threshold of $100,000 per quality-adjusted life year, the therapeutic efficacy of irinotecan in homozygotes after dose reduction had to be ,98.4% of full-dose efficacy for genetic testing to remain preferred. Future studies to determine whether this efficacy level can be achieved have an economic value of $22 million. CONCLUSIONS: The current results indicated that pharmacogenetic testing for UGT1A1*28 variant homozygosity may be cost effective, but only if irinotecan dose reduction in homozygotes does not reduce efficacy. Future studies to evaluate reduced-dose efficacy in homozygotes should be considered. Cancer 2009. © 2009 American Cancer Society. [source] European guidelines for quality assurance in cervical cancer screening: recommendations for cytology laboratories,CYTOPATHOLOGY, Issue 2 2007H. G. Wiener The quality of a cervical cytology laboratory depends on adequate handling and staining of the samples, screening and interpretation of the slides and reporting of the results. These guidelines give an overview of procedures recommended in Europe to manage the balance between best patient care possible, laboratory quality assurance and cost effectiveness and will be published as a chapter 4 in the European Guidelines for Quality Assurance in Cervical Cancer Screening. The laboratory guidelines include protocols for personnel and organisation, material requirements, handling and analysing cervical samples, recording of results, quality management and communication. The section on quality management is comprehensive and includes protocols for all aspects of internal and external quality assurance. The guidelines are extensively referenced and as far as possible the recommendations are evidence-based. [source] A national retinal screening programme for diabetes in ScotlandDIABETIC MEDICINE, Issue 12 2003G. P. Leese Abstract The Health Technology Board Scotland (HTBS) have issued recommendations for eye screening in patients with diabetes. These are based on evidence-based clinical studies. Evidence-based studies do not answer all the practical issues, and some conclusions have thus been extrapolated from the known evidence base. Other factors such as patient issues, organizational issues and cost effectiveness have also been incorporated into the recommendations. HTBS recommend single-field digital retinal photography. Retinal photography best addresses the issues of adequate sensitivity and accountable quality assurance. Non-mydriatic photography is recommended, followed by immediate use of dilating eye drops if it is unsuccessful, followed by slit-lamp examination if both of these approaches fail. An independent grading scheme has been established, which is similar to the ,Global', and compatible with the National Screening Committee (NSC) grading scheme. The rationale for these recommendations, and debate behind some of the decisions, is laid out in this article. [source] The cost-effectiveness of continuous subcutaneous insulin infusion compared with multiple daily injections for the management of diabetesDIABETIC MEDICINE, Issue 7 2003P. Scuffham Abstract Aims To estimate the cost effectiveness of continuous subcutaneous insulin infusion (CSII) compared with multiple daily injections (MDI) for patients using insulin pumps. Methods We constructed a Markov model to estimate the costs and outcomes for patients with insulin-dependent diabetes (IDDM) treated with CSII using an insulin pump compared with MDI. Key parameters were obtained from the published scientific literature. The primary outcome was quality-adjusted life years (QALYs). Monte Carlo simulations were undertaken for 10 000 hypothetical patients over 8 years of monthly cycles (the expected life of a pump). Results Over an 8-year period an average patient could expect to gain 0.48 [standard deviation (sd) 0.20] QALYs using CSII compared with MDI. The additional cost over 8 years for this gain was £5462 (sd£897). The incremental cost per QALY was £11 461 (sd£3656). CSII was most cost-effective in patients who had more than two severe hypoglycaemic events per year and who required admission to hospital at least once every year. Cases where CSII might be not economically viable are cases where diabetes is well controlled with few severe hypoglycaemic events. Results were most sensitive to the number of hypoglycaemic events per patient and the utility weights used to estimate QALYs. Conclusion CSII is a worthwhile investment when targeted to those who might benefit most. Diabet. Med. 20, 586,593 (2003) [source] Fine-needle aspiration of primary osseous lesions: A cost effectiveness studyDIAGNOSTIC CYTOPATHOLOGY, Issue 4 2010Lester J. Layfield M.D. Abstract Fine-needle aspiration (FNA) is not widely used in the work-up of osseous lesions because of concerns regarding its high incidence of nondiagnostic specimens. Although several studies have shown that FNA is less expensive than surgical biopsy, the authors are aware of only one prior study evaluating the cost effectiveness of FNA, which includes the cost of incisional or core needle biopsies necessary to establish a diagnosis when the initial FNA was noncontributory. A computerized search of the pathology records of three medical centers was performed to obtain all FNAs of primary osseous lesions. For each FNA case, all subsequent core needle, incisional or excisional biopsies were recorded as was the result of the definitive operative procedure. The cost of obtaining the definitive diagnosis was calculated for each case including the cost of FNA, imaging guidance utilized, and cost of subsequent surgical biopsy when necessary. The cost of an alternate approach using only surgical biopsy was calculated. The average per patient costs of these two protocols were compared. A total of 165 primary bone tumors underwent FNA. One hundred six of these yielded a definitive cytologic diagnosis. In 59 cases, FNA yielded a result insufficient for definitive therapy necessitating surgical biopsy. FNA investigation of the 165 bone lesions cost 575,932 (average of 3,490 per patient). Surgical biopsy alone would have cost 5,760 per patient. FNA resulted in a cost savings of 2,215 per patient. Diagn. Cytopathol. 2010 © 2009 Wiley-Liss, Inc. [source] ENDOSCOPIC DIAGNOSIS OF INTRAEPITHELIAL SQUAMOUS NEOPLASIA IN HEAD AND NECK AND ESOPHAGEAL MUCOSAL SITESDIGESTIVE ENDOSCOPY, Issue 2006Manabu Muto In the multistep process of squamous epithelial carcinogenesis, squamous epithelial dysplasia has been considered to be a preinvasive stage of squamous cell carcinoma. If we could distinguish a dysplasia at high risk, such lesions could be targets for local treatment such as endoscopic mucosal resection to avoid the transformation to invasive carcinoma. Narrow-band imaging, a new optical technology, is useful to identify the cancerous lesion compared to conventional white light image. In addition, narrow-band imaging combined with magnifying endoscopy makes it possible to visualize the changes of microvascular architecture occurring in the epithelium. To evaluate whether these endoscopic findings are reliable to diagnose a dysplasia at high risk, a prospective study on the basis of the standards for reporting diagnostic accuracy initiative is needed. If endoscopic assessment of intraepithelial squamous neoplasia is reliable, it would be of benefit to the patients' outcome and improve cost effectiveness of care because of the avoidance of developing invasive carcinoma and the reduction of unnecessary biopsies. [source] The Role of Research Institutions in Seed,related Disaster Relief: Seeds of Hope Experiences in RwandaDISASTERS, Issue 4 2002Robin A. Buruchara The article describes the efforts of a coalition of agricultural research centres, Seeds of Hope (SOH) in the rebuilding of Rwanda, after the genocide and war of 1994. Research involvement in emergency relief and rehabilitation was unusual at the time and SOH had to forge its unique complementary role. Focusing on crop and variety development and conservation it: provided technical advice to relief agencies on seed procurement; used its baseline ken to assess the effects of war on seed diversity and seed security; made preparations to restore specific germplasm (which, fortunately, proved unnecessary) and spent substantial effort on rebuilding human resource capacity in research as well as basic scientific facilities. The involvement of SOH highlighted the critical, yet very different, roles for research during emergency versus rehabilitation periods and demonstrated the cost effectiveness of building in a diagnostic component , before massive seed or germplasm distributions are programmed. [source] Effect of cumulative seismic damage and corrosion on the life-cycle cost of reinforced concrete bridgesEARTHQUAKE ENGINEERING AND STRUCTURAL DYNAMICS, Issue 7 2009R. Kumar Abstract Bridge design should take into account not only safety and functionality, but also the cost effectiveness of investments throughout a bridge life-cycle. This paper presents a probabilistic approach to compute the life-cycle cost (LCC) of corroding reinforced concrete (RC) bridges in earthquake-prone regions. The approach is developed by combining cumulative seismic damage and damage associated with corrosion due to environmental conditions. Cumulative seismic damage is obtained from a low-cycle fatigue analysis. Chloride-induced corrosion of steel reinforcement is computed based on Fick's second law of diffusion. The proposed methodology accounts for the uncertainties in the ground motion parameters, the distance from the source, the seismic demand on the bridge, and the corrosion initiation time. The statistics of the accumulated damage and the cost of repairs throughout the bridge life-cycle are obtained by Monte-Carlo simulation. As an illustration of the proposed approach, the effects of design parameters on the LCC of an example RC bridge are studied. The results are valuable in better estimating the condition of existing bridges and, therefore, can help to schedule inspection and maintenance programs. In addition, by taking into consideration the two deterioration processes over a bridge life-cycle, it is possible to estimate the optimal design parameters by minimizing, for example, the expected cost throughout the life of the structure. A comparison between the effects of the two deterioration processes shows that, in seismic regions, the cumulative seismic damage affects the reliability of bridges over time more than the corrosion even for corrosive environments. Copyright © 2008 John Wiley & Sons, Ltd. [source] A survey of tobacco dependence treatment guidelines in 31 countriesADDICTION, Issue 7 2009Martin Raw ABSTRACT Aims The Framework Convention on Tobacco Control (FCTC) asks countries to develop and disseminate comprehensive evidence-based guidelines and promote adequate treatment for tobacco dependence, yet to date no summary of the content of existing guidelines exists. This paper describes the national tobacco dependence treatment guidelines of 31 countries. Design, setting, participants A questionnaire on tobacco dependence treatment guidelines was sent by e-mail to a convenience sample of contacts working in tobacco control in 31 countries in 2007. Completed questionnaires were received from respondents in all 31 countries. During the course of these enquiries we also made contact with people in 14 countries that did not have treatment guidelines and sent them a short questionnaire asking about their plans to produce guidelines. Measurements The survey instrument was a 17-item questionnaire asking the following key questions: do the guidelines recommend brief interventions, intensive behavioural support, medications; which medications; do the guidelines apply to the whole health-care system and all professionals; do they refer explicitly to the Cochrane database; are they based on another country's guidelines; are they national or more local; are they endorsed formally by government; did they undergo peer review; who funded them; where were they published; do they include evidence on cost effectiveness of treatment? Findings According to respondents, all their countries' guidelines recommended brief advice, intensive behavioural support and nicotine replacement therapy (NRT); 84% recommended bupropion; 19% recommended varenicline; and 35% recommended telephone quitlines. Nearly half (48%) included cost-effectiveness evidence. Seventy-one per cent were supported formally by their government and 65% were supported financially by the government. Most (84%) used the Cochrane reviews as a source of evidence, 84% underwent a peer review process and 55% were based on the guidelines of other countries, most often the United States and England. Conclusion Overall, the guidelines reviewed followed the evidence base closely, recommending brief interventions, intensive behavioural support and NRT, and most recommended bupropion. Varenicline was not on the market in most of the countries in this survey when their guidelines were written, illustrating the need for guidelines to be updated periodically. None recommended interventions not proven to be effective, and some recommended explicitly against specific interventions (for lack of evidence). Most were peer-reviewed, many through lengthy and rigorous procedures, and most were endorsed or supported formally by their governments. Some countries that did not have guidelines expressed a need for technical support, emphasizing the need for countries to share experience, something the FCTC process is well placed to support. [source] Simultaneous determination of low-molecular-weight organic acids and chlorinated acid herbicides in environmental water by a portable CE system with contactless conductivity detectionELECTROPHORESIS, Issue 10 2007Yan Xu Abstract This report describes a method to simultaneously determine 11 low-molecular-weight (LMW) organic acids and 16 chlorinated acid herbicides within a single run by a portable CE system with contactless conductivity detection (CCD) in a poly(vinyl alcohol) (PVA)-coated capillary. Under the optimized condition, the LODs of CE-CCD ranged from 0.056 to 0.270,ppm, which were better than for indirect UV (IUV) detection of the 11 LMW organic acids or UV detection of the 16 chlorinated acid herbicides. Combined with an on-line field-amplified sample stacking (FASS) procedure, sensitivity enhancement of 632- to 1078-fold was achieved, with satisfactory reproducibility (RSDs of migration times less than 2.2%, and RSDs of peak areas less than 5.1%). The FASS-CE-CCD method was successfully applied to determine the two groups of acidic pollutants in two kinds of environmental water samples. The portable CE-CCD system shows advantages such as simplicity, cost effectiveness, and miniaturization. Therefore, the method presented in this report has great potential for onsite analysis of various pollutants at the trace level. [source] Cryogenic condensation: A cost-effective technology for controlling VOC emissionsENVIRONMENTAL PROGRESS & SUSTAINABLE ENERGY, Issue 2 2002Robert J. Davis Cryogenic condensation is an extremely cost-effective technology for controlling emissions of Volatile Organic Compounds (VOCs) from chemical processing facilities under certain conditions. This paper describes the technology and provides the case history of an application in the pharmaceutical industry, in which its cost effectiveness was compared with a range of alternative technologies, including thermal oxidation, catalytic oxidation, flaring, carbon adsorption, and scrubbing. Because the facility already used significant quantities of liquid and gaseous nitrogen for inerting, blanketing, and purging, a very convenient cold source for cryogenic condensation was already present. On a lifetime cost basis, cryogenic condensation was significantly less costly than all other technologies evaluated. [source] Beyond the center: Intel gives employees more choices through family child careGLOBAL BUSINESS AND ORGANIZATIONAL EXCELLENCE, Issue 4 2005Adam Sorensen Flexibility and cost effectiveness became priorities for semiconductor giant Intel when it sought employee child care options in the midst of its worst business downturn. An innovative solution leverages community resources at Intel sites around the country to offer locally managed home-based programs as an alternative to center-based child care. In the process, the new program has improved the quality of at-home child care, created more child care spaces, and given providers access to more clients and resources, to the benefit of the community as a whole. © 2005 Wiley Periodicals, Inc. [source] International survey on willingness-to-pay (WTP) for one additional QALY gained: what is the threshold of cost effectiveness?HEALTH ECONOMICS, Issue 4 2010Takeru Shiroiwa Abstract Although the threshold of cost effectiveness of medical interventions is thought to be £20,000,£30,000 in the UK, and $50,000,$100,000 in the US, it is well known that these values are unjustified, due to lack of explicit scientific evidence. We measured willingness-to-pay (WTP) for one additional quality-adjusted life-year gained to determine the threshold of the incremental cost-effectiveness ratio. Our study used the Internet to compare WTP for the additional year of survival in a perfect status of health in Japan, the Republic of Korea (ROK), Taiwan, Australia, the UK, and the US. The research utilized a double-bound dichotomous choice, and analysis by the nonparametric Turnbull method. WTP values were JPY 5 million (Japan), KWN 68 million (ROK), NT$ 2.1 million (Taiwan), £23,000 (UK), AU$ 64,000 (Australia), and US$ 62,000 (US). The discount rates of outcome were estimated at 6.8% (Japan), 3.7% (ROK), 1.6% (Taiwan), 2.8% (UK), 1.9% (Australia), and 3.2% (US). Based on the current study, we suggest new classification of cost-effectiveness plane and methodology for decision making. Copyright © 2009 John Wiley & Sons, Ltd. [source] Valuing health: a new proposalHEALTH ECONOMICS, Issue 3 2010Daniel M. Hausman Abstract After criticizing existing systems of health measurement for their unargued commitment to evaluating health states in terms of preferences or well-being, this essay argues that public rather than private values of health states should help guide the allocation of health-related resources. Private evaluation of health states is relative to a prior individual choice of specific activities and goals, while public evaluation is relative to the whole range of important activities and goals. Public evaluation is concerned with securing a wide range of choices as well as with success given one's choice. A reasonable simplification from the public perspective is to focus on just two features of health states: the subjective feelings attached to health states and the limitations that health states imply on the range of important activities that individuals can pursue. Focusing on just these two dimensions permits the construction of a parsimonious classification of health states with regard to what matters most from the public perspective. This classification, which resembles those in the HALex and the Rosser and Kind Disability and Distress Index, might best be built on top of existing health-state classifications, by mapping the health states they define to activity-limitation/feeling pairs. To assign values to these pairs, I propose relying on deliberative groups to make comparisons among the pairs with respect to the relation ,is a more serious limitation on the range of objectives and good lives available to members of the population'. A ranking according to this property, is not a preference ranking, because it is not a ranking in terms of everything that matters to individuals. Working back from the weights attached to the activity-limitation/feeling pairs, one can impute weights for the health states in other classification systems that were mapped to those pairs. If those weights coincide roughly with current weights, then one legitimizes current weights and provides a vehicle for their public discussion and possible revision. If those weights do not coincide, then one has both an argument for revising current views of the cost effectiveness of treatments and policies and a method to carry out such a revision. Copyright © 2009 John Wiley & Sons, Ltd. [source] Performance of algebraic multi-grid solvers based on unsmoothed and smoothed aggregation schemesINTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN FLUIDS, Issue 7 2001R. WebsterArticle first published online: 31 JUL 200 Abstract A comparison is made of the performance of two algebraic multi-grid (AMG0 and AMG1) solvers for the solution of discrete, coupled, elliptic field problems. In AMG0, the basis functions for each coarse grid/level approximation (CGA) are obtained directly by unsmoothed aggregation, an appropriate scaling being applied to each CGA to improve consistency. In AMG1 they are assembled using a smoothed aggregation with a constrained energy optimization method providing the smoothing. Although more costly, smoothed basis functions provide a better (more consistent) CGA. Thus, AMG1 might be viewed as a benchmark for the assessment of the simpler AMG0. Selected test problems for D'Arcy flow in pipe networks, Fick diffusion, plane strain elasticity and Navier,Stokes flow (in a Stokes approximation) are used in making the comparison. They are discretized on the basis of both structured and unstructured finite element meshes. The range of discrete equation sets covers both symmetric positive definite systems and systems that may be non-symmetric and/or indefinite. Both global and local mesh refinements to at least one order of resolving power are examined. Some of these include anisotropic refinements involving elements of large aspect ratio; in some hydrodynamics cases, the anisotropy is extreme, with aspect ratios exceeding two orders. As expected, AMG1 delivers typical multi-grid convergence rates, which for all practical purposes are independent of mesh bandwidth. AMG0 rates are slower. They may also be more discernibly mesh-dependent. However, for the range of mesh bandwidths examined, the overall cost effectiveness of the two solvers is remarkably similar when a full convergence to machine accuracy is demanded. Thus, the shorter solution times for AMG1 do not necessarily compensate for the extra time required for its costly grid generation. This depends on the severity of the problem and the demanded level of convergence. For problems requiring few iterations, where grid generation costs represent a significant penalty, AMG0 has the advantage. For problems requiring a large investment in iterations, AMG1 has the edge. However, for the toughest problems addressed (vector and coupled vector,scalar fields discretized exclusively using finite elements of extreme aspect ratio) AMG1 is more robust: AMG0 has failed on some of these tests. However, but for this deficiency AMG0 would be the preferred linear approximation solver for Navier,Stokes solution algorithms in view of its much lower grid generation costs. Copyright © 2001 John Wiley & Sons, Ltd. [source] A randomized comparison of cognitive behavioral therapy and behavioral weight loss treatment for overweight individuals with binge eating disorderINTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 2 2007Simone Munsch PhD Abstract Objectives: The aim of this study was to determine the efficacy of cognitive-behavioral therapy (CBT) and behavioral weight loss treatment (BWLT) for overweight patients with binge eating disorder (BED). Method: Eighty obese patients meeting criteria of BED according to DSM-IV-TR were randomly assigned to either CBT or BWLT consisting of 16 weekly treatments and 6 monthly follow-up sessions. Binge eating, general psychopathology, and body mass index (BMI) were assessed before, during, and after treatment, and at 12-month follow-up. Results: At posttreatment results favored CBT as the more effective treatment. Analysis of the course of treatments pointed to a faster improvement of binge eating in CBT based on the number of self-reported weekly binges, but faster reduction of BMI in BWLT. At 12-month follow-up, no substantial differences between the two treatment conditions existed. Conclusion: CBT was somewhat more efficacious than BWLT in treating binge eating but this superior effect was barely maintained in the long term. Further research into cost effectiveness is needed to assess which treatment should be considered the treatment of choice. © 2006 by Wiley Periodicals, Inc. Int J Eat Disord 2006 [source] Effectiveness of nurse-led cardiac clinics in adult patients with a diagnosis of coronary heart diseaseINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 1 2005Tamara Page RN BN HyperbaricNursCert GradDipNSc(HighDep) MNSc Executive summary Background, Coronary heart disease is the major cause of illness and death in Western countries and this is likely to increase as the average age of the population rises. Consumers with established coronary heart disease are at the highest risk of experiencing further coronary events. Lifestyle measures can contribute significantly to a reduction in cardiovascular mortality in established coronary heart disease. Improved management of cardiac risk factors by providing education and referrals as required has been suggested as one way of maintaining quality care in patients with established coronary heart disease. There is a need to ascertain whether or not nurse-led clinics would be an effective adjunct for patients with coronary heart disease to supplement general practitioner advice and care. Objectives, The objective of this review was to present the best available evidence related to nurse-led cardiac clinics. Inclusion criteria, This review considered any randomised controlled trials that evaluated cardiac nurse-led clinics. In the absence of randomised controlled trials, other research designs such as non-randomised controlled trials and before and after studies were considered for inclusion. Participants were adults (18 years and older) with new or existing coronary heart disease. The interventions of interest to the review included education, assessment, consultation, referral and administrative structures. Outcomes measured included adverse event rates, readmissions, admissions, clinical and cost effectiveness, consumer satisfaction and compliance with therapy. Results, Based on the search terms used, 80 papers were initially identified and reviewed for inclusion; full reports of 24 of these papers were retrieved. There were no papers included that addressed cost effectiveness or adverse events; and none addressed the outcome of referrals. A critical appraisal of the 24 remaining papers identified a total of six randomised controlled trials that met the inclusion criteria. Two studies addressed nurse-led clinics for patients diagnosed with angina, one looked at medication administration and the other looked at educational plans. A further four studies compared secondary preventative care with a nurse-led clinic and general practitioner clinic. One specifically compared usual care versus shared care introduced by nurses for patients awaiting coronary artery bypass grafting. Of the remaining three studies, two have been combined in the results section, as they are an interim report and a final report of the same study. Because of inconsistencies in reporting styles and outcome measurements, meta-analysis could not be performed on all outcomes. However, a narrative summary of each study and comparisons of specific outcomes assessed from within each study has been developed. Although not all outcomes obtained statistical significance, nurse-led clinics were at least as effective as general practitioner clinics for most outcomes. Recommendations, The following recommendations are made: ,The use of nurse-led clinics is recommended for patients with coronary heart disease (Level II). ,Utilise nurse-led clinics to increase clinic attendance and follow-up rates (Level II). ,Nurse-led clinics are recommended for patients who require lifestyle changes to decrease their risk of adverse outcomes associated with coronary heart disease (Level II). [source] Effectiveness and acceptability of non-pharmacological interventions to reduce wandering in dementia: a systematic reviewINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 1 2007L. Robinson Abstract Background Wandering occurs in 15,60% of people with dementia. Psychosocial interventions rather than pharmacological methods are recommended, but evidence for their effectiveness is limited and there are ethical concerns associated with some non-pharmacological approaches, such as electronic tracking devices. Objective To determine the clinical and cost effectiveness and acceptability of non-pharmacological interventions to reduce wandering in dementia. Design A systematic review to evaluate effectiveness of the interventions and to assess acceptability and ethical issues associated with their use. The search and review strategy, data extraction and analysis followed recommended guidance. Papers of relevance to effectiveness, acceptability and ethical issues were sought. Results (i) Clinical effectiveness. Eleven studies, including eight randomised controlled trials, of a variety of interventions, met the inclusion criteria. There was no robust evidence to recommend any intervention, although there was some weak evidence for exercise. No relevant studies to determine cost effectiveness met the inclusion criteria. (ii) Acceptability/ethical issues. None of the acceptability papers reported directly the views of people with dementia. Exercise and music therapy were the most acceptable interventions and raised no ethical concerns. Tracking and tagging devices were acceptable to carers but generated considerable ethical debate. Physical restraints were considered unacceptable. Conclusions In order to reduce unsafe wandering high quality research is needed to determine the effectiveness of non-pharmacological interventions that are practically and ethically acceptable to users. It is important to establish the views of people with dementia on the acceptability of such interventions prior to evaluating their effectiveness through complex randomised controlled trials. Copyright © 2006 John Wiley & Sons, Ltd. [source] Optimal setpoint chasing in dynamic positioning of deep-water drilling and intervention vesselsINTERNATIONAL JOURNAL OF ROBUST AND NONLINEAR CONTROL, Issue 13 2001Asgeir J. Sørensen Abstract Conventional controller designs for dynamic positioning of ships and floating marine structures have so far been based on the principle on automatic positioning in the horizontal-plane about desired position and heading co-ordinates defined by the operator. A three degrees-of-freedom multivariable controller either of linear or nonlinear type, normally with feedback signals from surge, sway and yaw position and velocities, has been regarded as adequate for the control objective. For floating structures with small waterplane area such as semi-submersibles, feedback from roll and pitch angular rotation velocity may also be included to avoid thrust-induced roll and pitch motions that are caused by the hydrodynamic and the geometrical couplings between the horizontal and vertical planes. However, for certain marine operations this control philosophy may not be the most appropriate approach ensuring safety and cost effectiveness. For drilling and work-over operations the main positioning objective is to minimize the bending stresses along the riser and the riser angle magnitudes at the well head on the subsea structure, and at the top joint as well. A positioning control strategy solely based on manual setting of the desired position co-ordinates may not be the most optimal solution for these applications. In this paper a new hybrid dynamic positioning controller, that also accounts for riser angle offsets and bending stresses is proposed. It is shown that a significant reduction in riser angle magnitude can be achieved. Simulations with a drilling semi-submersible demonstrate the effect of the proposed control strategy. Copyright © 2001 John Wiley & Sons, Ltd. [source] Psychosocial interventions for non-professional carers of people with Parkinson's disease: a systematic scoping reviewJOURNAL OF ADVANCED NURSING, Issue 3 2008Susanne Hempel Abstract Title.,Psychosocial interventions for non-professional carers of people with Parkinson's disease: a systematic scoping review. Aim., This paper is a report of a scoping review to systematically identify and collate the evidence on psychosocial interventions for non-professional carers of people with Parkinson's disease. Background., Carers are critical to people with Parkinson's disease maintaining independent living and quality of life. Parkinson's disease imposes a challenging constellation of symptoms and no summary of effective interventions for carers and their unique support needs exists. Data sources., Thirty electronic databases were searched from their inception to July 2006, and bibliographies and specific internet sites were scanned. Methods., Eligible studies were categorized according to design, type of economic evaluation where applicable, number of participants, country of evaluation, intervention, orientation, provider, setting, method of delivery, carer population, patient population, carer outcomes, patient outcomes and authors' conclusions. Data were extracted by one reviewer and checked by another reviewer; discrepancies were resolved through discussion or arbitration by a third reviewer. Findings., Thirty studies met the inclusion criteria. Most investigated relatively unique interventions involving multiple elements; the majority were not aimed primarily at carers but were embedded in patient treatment programmes. Many were pilot studies, employing weak research designs and involving very small numbers of participants and most were not designed to assess the clinical or cost effectiveness of the intervention for the carers. Conclusion., Several interventions merit further investigation but there is currently little evidence to show which approaches are effective and cost effective in supporting carers. Future studies need to employ appropriate and rigorous research designs with adequate samples and outcome measures, and with more focus on the carer. [source] Synthesis of processible doped polyaniline-polyacrylic acid compositesJOURNAL OF APPLIED POLYMER SCIENCE, Issue 2 2009Bhavana Gupta Abstract Processible composites of emeraldine salt form of polyaniline (PANI) with polyacrylic acid (PAA) are synthesized and studied for their structural, electrical, mechanical, thermal, and electrochemical properties. The processible conducting composites of various weight percentage from 20 wt % to 90 wt % (of PANI) have been prepared by mixing the PANI and PAA under vigorous stirring and sonication conditions. Self-standing films of electroactive homogeneous composites are obtained by solution casting method. A significant improvement in processibility, crystallinity, and thermal stability is observed in the composites; however, the electrical conductivity decreased remarkably as the percentage of PANI is decreased in the composites. The 60 wt % PANI-PAA composite showed crystalline structural property with orthorhombic crystal system and cell parameters as a = 5.93Å, b = 7.57Å, and c = 10.11Å. The 60 wt % PANI-PAA composite also showed better thermal stability and highest capacitance amongst all the composites and used as an active material for development of electrochemical capacitors (parallel plate assembly). The processible composites based electrochemical capacitors using 0.5 M NaClO4 -Acetonitril electrolyte showed super capacitance with ease in fabrication and cost effectiveness in comparison to other similar materials based capacitors. © 2009 Wiley Periodicals, Inc. J Appl Polym Sci, 2009 [source] Removal of heavy metals and cyanide from gold mine wastewaterJOURNAL OF CHEMICAL TECHNOLOGY & BIOTECHNOLOGY, Issue 5 2010Mike A. Acheampong Abstract This paper reviews the technology and biotechnology to remove heavy metals (such as copper, arsenic, lead and zinc) and cyanide from contaminated wastewater. The paper places special emphasis on gold mine wastewater and the use of low cost materials as sorbent. Various biological as well as physicochemical treatment processes are discussed and compared on the basis of costs, energy requirement, removal efficiency, limitations and advantages. Sorption using natural plant materials, industrial and agricultural waste has been demonstrated to have the potential to replace conventional methods for the removal of heavy metals because of its cost effectiveness, efficiency and the local availability of these materials as biosorbent. The parameters affecting sorption, such as initial ion concentration, pH, sorbent dosage, particle size and temperature, are discussed. The overall treatment cost of metal and cyanide contaminated wastewater depends on the process employed and the local conditions. In general, technical applicability, cost-effectiveness and plant simplicity are the key factors in selecting the most suitable treatment method. Copyright © 2010 Society of Chemical Industry [source] A review of the impact and effectiveness of nurse-led care in dermatologyJOURNAL OF CLINICAL NURSING, Issue 1 2007Cert Ed, Molly Courtenay BSc Aims and objectives., To identify systematically, summarize and critically appraise the current evidence regarding the impact and effectiveness of nurse-led care in dermatology. Background., A diverse range of nurse-led models of care exist in dermatology. Primary studies have been conducted evaluating these models, but review and synthesis of the findings from these studies have not been undertaken. Method., Systematic searches of CINAHL, MEDLINE, British Nursing Index (BNI) and the RCN Library Catalogue from 1990 until March 2005. The searches were supplemented by an extensive hand search of the literature through references identified from retrieved articles and by contact with experts in the field. Results., Fourteen relevant publications were identified and included findings from both primary and secondary care. The evidence indicates that nurses are treating a number of dermatological conditions, primarily using treatment protocols, across a broad range of clinical settings. However, some nurses working in primary care, lack confidence to treat some of these conditions and the educational needs of these nurses are frequently unmet. A reduction in the severity of the condition and more effective use of topical therapies are benefits of nurse interventions on service delivery. Faster access to treatment, a reduction in referrals to the general practitioner or dermatologist and an increase in knowledge of their condition are benefits reported by patients. Conclusions., Findings of the review are generally positive. However, there are methodological weaknesses and under researched issues, e.g. cost effectiveness of nurse-led care and the prescription of medicines by nurses for patients with dermatological conditions that point to the need for further rigorous evaluation. Relevance to clinical practice., Nurse-led care is an integral element of the dermatology service offered to patients. This review highlights the impact of this care and the issues that require consideration by those responsible for the development of nurse-led models of care in dermatology. [source] | ||||||||||||||||||||||||||||||||||||||||||||||||||||