Basic Cost Analysis Research Articles

Appropriate Prescribing for older adults with Multimorbidity (Pro-M): protocol for a feasibility study

BackgroundPotentially inappropriate prescribing is common among older adults with multimorbidity due to various reasons, from concurrent application of multiple single-disease clinical guidelines to fragmentation of care. Interventions such as medication review have been implemented worldwide to reduce inappropriate prescribing for older adults. However, the implementability of such interventions are underexplored in the outpatient clinics in Singapore’s public hospitals. Hence, the Pro-M study aims to assess the feasibility of implementing a physician-pharmacist collaborative care intervention in geriatric medicine outpatient clinics to facilitate appropriate prescribing for older adults in Singapore.MethodsThis is a single-arm, non-randomised feasibility study using a pre-post evaluation design. This study consists of two parts: (1) implementation phase of the intervention (6 months) and an (2) evaluation phase (3 months). Eligible patients will be recruited from geriatric medicine outpatient clinics at two public hospitals in Singapore through convenience sampling. The main components of the Pro-M intervention are: (1) pharmacist-facilitated medication reviews with feedback on any medication issues and potential recommendations to physicians, and (2) physicians communicating changes to other relevant prescribers. The evaluation phase will involve surveying and interviewing physicians and pharmacists involved in the implementation of the intervention. A mixed-method approach will be employed for data collection and analysis. The quantitative and qualitative findings will be triangulated and reported using Proctor’s implementation outcomes: appropriateness, penetration, acceptability, fidelity, feasibility, and sustainability. A basic cost analysis will be conducted alongside the study.DiscussionThis is a phase 2 study to test the feasibility of implementing an intervention that was co-created with stakeholders during phase 1 development of an intervention to optimise prescribing for older adults with multimorbidity. The implementation will be assessed using Proctor’s implementation outcomes to provide insights on the process and the feasibility of implementing medication reviews for older adults with multimorbidity as a routine practice in outpatient clinics. Data collected from this study will inform a subsequent scale-up study.Trial registrationClinicalTrials.gov Identifier: NCT05756478. Registered on 06 March 2023.

Short term clinical and patient reported outcomes following Virtual Fracture Clinic management of fifth metatarsal fractures

IntroductionFracture clinics are experiencing increased referrals and decreased capacity. Virtual fracture clinics (VFC) are an efficient, safe, and cost-effective solution for specified injury presentations. There is currently a lack of evidence to support the use of a VFC model in the management of 5th metatarsal base fractures. This study aims to assess clinical outcomes and patient satisfaction with the management of 5th metatarsal base fractures in VFC. We hypothesise that it is both safe and cost effectiveness. MethodsPatients presenting to VFC at our major trauma centre with a 5th metatarsal base fracture, between January 2019 and December 2019, were included. Patient demographics, clinic appointments, complication and operative rates were analysed. Patients received standardised VFC treatment; walker boot/full weight bearing, rehabilitation information and instructions to contact VFC if symptoms of pain persist after 4 months. Minimum follow-up was one year; Manchester-Oxford Foot Questionnaires (MOXFQ) were distributed. A basic cost analysis was performed. Results126 patients met inclusion criteria. Mean age was 41.6 years (18–92). Average time from ED attendance to VFC review was 2 days (1 – 5). Fractures were classified according to the Lawrence and Botte Classification with 104 (82%) zone 1 fractures, 15 (12%) zone 2 fractures and 7 (6%) zone 3 fractures. At VFC, 125/126 were discharged. 12 patients (9.5%) arranged further follow-up after initial discharge; pain the reason in all cases. There was 1 non-union during the study period. Average MOXFQ score post 1 year was 0.4/64, with only 11 patients scoring more than 0. In total, 248 face-to-face clinic visits were saved. ConclusionOur experience demonstrates that the management of 5th metatarsal base fractures in the VFC setting, with a well-defined protocol, can prove safe, efficient, cost effective and yield good short term clinical outcomes.

Understanding the complexity of deinking plastic waste: An assessment of the efficiency of different treatments to remove ink resins from printed plastic film

Plastic packaging is usually heavily printed with inks to provide functional benefits. However, the presence of inks strongly impedes the closed-loop recycling of plastic films. Various media have already been studied for the deinking of plastic films, but there is little scientific insight into the effectiveness of different deinking techniques. Therefore, this study aims to obtain a systematic understanding by measuring the liquefaction and maximum solubility of 14 chemically different polymer resins in seven different media typically used in plastic deinking, such as acetone, ethyl acetate, sodium hydroxide solution, cetyltrimethylammonium bromide solution, formic acid, sulfuric acid, and N,N-dimethylcyclohexylamine. Our findings show that acid-based media are able to remove a broader range of polymer resins. Organic solvents are particularly effective against acrylics and related polymer resins. The deinking efficiency tests on pure resins are also confirmed by deinking four printed plastic films containing different classes of polymer resins. A basic cost and environmental impact analysis is given to evaluate scale-up potential of the deinking medium.

Extraction of Essential Oils from Lavandula × intermedia 'Margaret Roberts' Using Steam Distillation, Hydrodistillation, and Cellulase-Assisted Hydrodistillation: Experimentation and Cost Analysis.

Lavender oil is an important essential oil with many applications. The purpose of this study was to compare different methods of essential oil extraction to determine which method would be the most effective and profitable for commercial-scale production from Lavandula × intermedia ('Margret Roberts') flowers and leaves. The lavender from this variety flowers year-round, providing an extended production season compared to some other lavender varieties. Steam distillation, hydrodistillation, and cellulase-assisted hydrodistillation were used to extract oil. The average extraction times for steam distillation, hydrodistillation, and cellulase-assisted hydrodistillation were 57-, 51-, and 49 min, respectively, and the average energy consumption was 15.0-, 13.4-, and 30.8 kJ/g, respectively. Cellulase-assisted hydrodistillation produced the best quality oils, with a lower camphor content and a sweeter, more pleasant smell, while steam-distilled oils had the highest camphor content, as well as a more plant-like smell. Factors affecting scale-up (surface area of cut plants, equipment loading times, energy efficiencies, safety, mixing) have been discussed, while a basic cost analysis of theoretical large-scale processes showed that hydrodistillation and cellulase-assisted hydrodistillation would be the most and least profitable methods, respectively. Overall, hydrodistillation is recommended as the best method for commercial lavender oil production.

Towards sustainable transportation: The development of hyperloop technology in Saudi Arabia

Saudi Arabia aims to achieve the principles of sustainable development goals (SDG) in all aspects of life in accordance with its ambitious vision 2030, especially in the field of sustainable passengers and freight transportation. Hyperloop technology can be considered as an excellent sustainable solution for the future of transportation in Saudi Arabia as a result of the availability of auxiliary ingredients, such renewable energy resources and the necessary infrastructure required enhancing the future mobility technology. Hyperloop can reduce the travel time between Saudi cities at a cost equivalent to ticket prices compatible with forms of mass passenger transportation. Accordingly, the Hyperloop technology can be more efficient in terms of energy consumption through the application of renewable energy resources, which makes this technology very attractive to the Saudi Arabia. The present paper discusses the feasibility of Hyperloop technology in Saudi Arabia in technical and economic perspectives including basic performance and cost analysis. Moreover, the integration of different renewable energy recourses, such as solar and hydrogen energy is also discussed. Three major energy systems were reviewed in depth: electrical energy derived from typical fossil fuels and two renewable energy systems based on solar energy, which can be utilized as a primary source of energy or to produce green hydrogen. The overall estimated cost of the three distinct power supply systems was compared using 2022 prices as a benchmark. In comparison to the electrical system and the solar-hydrogen system, the overall cost of the Hyperloop-hydrogen system is the most expensive power supply system. It is expected that the use of Hyperloop technology in Saudi Arabia will be a motivating factor in achieving the Kingdom’s Vision 2030 in the transportation sector and as a catalyst for high technology through its requirements for artificial intelligence programs and computer-based operational systems. It can also achieve a significant increase in Gross Domestic Product (GDP) by providing jobs and opportunities for young Saudi men and women in the high-technology sector.

Agro Circular Economy: A case of Low-Cost Extraction of Cellulose out of Agro-Wastes

Recent days there is news about agricultural contribution towards air pollution. This is causing chaos among the farmers and general public. The problem is due to the linear system that is adopted by the farmers in agriculture. There is great possibility of reusing and recycling of agro wastes contributing towards circular economy. The present paper addresses the heart of the issue, i.e., economic benefit to farmers from agro waste. Agricultural waste mainly contains Cellulose, Hemi-cellulose and Lignin. The study aimed at developing a low-cost, low-impact, techno feasible procedure of extracting useful cellulose out of agricultural waste. It was also successful in isolating a by-product called lignin which again has many applications as a binding material. These materials have wide Pharmaceutical applications and other second-end commercial product making. The Study outcomes are from the agro waste generated from agricultural fields in Kolhapur district of Maharashtra, India. It has an insight on the cropping patterns, farmer survey outcomes, plans on small scale start-up implementation, basic cost analysis and the barriers in implementation are presented.

MP40-01 COST AND DIAGNOSTIC YIELD OF UPPER TRACT IMAGING IN HIGH RISK MICROHEMATURIA; ARE WE STILL DOING TOO MUCH?

You have accessJournal of UrologyCME1 May 2022MP40-01 COST AND DIAGNOSTIC YIELD OF UPPER TRACT IMAGING IN HIGH RISK MICROHEMATURIA; ARE WE STILL DOING TOO MUCH? Clay Martin, Eric Macdonald, Ella Taubenfeld, and Simon Hall Clay MartinClay Martin More articles by this author , Eric MacdonaldEric Macdonald More articles by this author , Ella TaubenfeldElla Taubenfeld More articles by this author , and Simon HallSimon Hall More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002600.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The 2020 AUA guidelines have brought some cost and potentially morbidity-saving changes to the workup and treatment of microhematuria (MH). With these changes comes a call for validating evidence. Herein the new guidelines have been applied to 1,906 patients. METHODS: All patients diagnosed with MH (RBC ≥3/hpf) at a single institution between 2010 and 2019 were retrospectively analyzed. Those with a complete workup including cystoscopy and upper tract imaging within 1 year of diagnosis were included. The new 2020 risk stratification was applied and cancer detection rates by risk group were assessed. A basic cost analysis was performed using the Centers for Medicare & Medicaid Services Physician and Clinical Laboratory Fee Schedule for 2021. RESULTS: Of the total MH cohort (n=1906), 1010 patients were stratified as high risk according to the 2020 guidelines. 770 of the 1010 (76.3%) had cross sectional imaging as part of their workup. Overall, 28 neoplasms were diagnosed in this patient group which corresponds to a detection rate of 2.77%. Of the 28 neoplasms identified, 18 were bladder tumors, 2 were upper tract urothelial malignancies and 8 were solid renal neoplasms. Cross-sectional imaging identified a total of 10 upper tract neoplasms (urothelial and renal) which corresponds to a 1.30% (10/770) detection rate. Furthermore, of the 8 solid renal masses, only 3 were of sufficient radiologic concern to warrant upfront surgical treatment. Additionally, 3 of these 8 patients had renal US in addition to their CT, 2 out of these 3 identified the solid renal mass. Cost analysis suggests that replacement of CT urography with renal US could decrease cost of workup by 38% ($433.04 vs $703.43). CONCLUSIONS: Cross sectional imaging in 770 patients with High-risk MH by the 2020 AUA guidelines yielded a detection rate of only 1.30% for upper tract neoplasms. Only 2 of these were urothelial malignancies that may not have been picked up via renal ultrasonography. Assuming most significant solid renal lesions could be identified by renal US, the utility of cross-sectional imaging is a positive finding in less than 1% of CT scans in this population. These data suggest that cross-sectional imaging may be unnecessary in the workup of MH, even in high-risk patients. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e674 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Clay Martin More articles by this author Eric Macdonald More articles by this author Ella Taubenfeld More articles by this author Simon Hall More articles by this author Expand All Advertisement PDF DownloadLoading ...

An effective treatment method for phosphogypsum.

Phosphogypsum (PG) accumulation occupies huge amounts of land resources and results in serious environmental risks. A new recycling product, the phosphogypsum embedded filler (PGEF) made with calcination-modified phosphogypsum, was developed. The preparation process, hydration mechanism of PG, basic physical performances, environmental safety, engineering application, and cost analysis of the PGEF were studied. The results showed that the stress performance and thermal insulation property of the products were satisfied. Environmental performance tests established their findings that the application of PGEF prepared with calcination-modified PG does not cause any secondary contamination. In addition, the cost of PGEF is far lesser than that of the same volume of reinforced concrete. PGEF prepared with calcination-modified PG has shown a perfect application in cast-in situ concrete hollow floor structure.

The utility of Stent-On-Strings in clinical practice

Various types of ureteric stents are used in the management of ureteric stones. Stents on strings (SOS) are an attractive option as they may be removed without the need for instrumentation. There is some hesitation using SOS due to perceived complications and the risk of premature dislodgement. The aim of this study was to evaluate the utility of SOS compared with the conventional stent (CS). A retrospective review was performed on all ureteric stents removed in the urology department over a 7-month period. Only stents inserted during the endoscopic management of ureteric stones were included in analysis. Patients were contacted to identify the incidence of those seeking medical attention while the stent was in situ or within 2 weeks of stent removal. A basic cost analysis was performed. One hundred and sixty cases were identified (98 CS, 62 SOS). No SOS was dislodged prematurely. One SOS was removed cystoscopically due to a broken string. There was no significant difference in the number of patients with SOS seeking medical attention following stent placement compared with those with CS (38.1% (12/51) vs 25.6% (22/86), p = 0.48). There was an estimated cost saving of €23,790 associated with the use of SOS during the study period (€390/case). The use of SOS created additional capacity which was utilised for diagnostic cystoscopy. The SOS appeared to be well tolerated and showed similar complication rates as the CS. The use of SOS resulted in a significant cost saving and increased the availability of cystoscopy for other indications.

The utility of stent on strings in clinical practice.

Various types of ureteric stents are used in the management of ureteric stones. Stents on strings (SOS) are an attractive option as they may be removed without the need for instrumentation. There is some hesitation using SOS due to perceived complications and the risk of premature dislodgement. The aim of this study was to evaluate the utility of SOS compared with the conventional stent (CS). A retrospective review was performed on all ureteric stents removed in the urology department over a 7-month period. Only stents inserted during the endoscopic management of ureteric stones were included in analysis. Patients were contacted to identify the incidence of those seeking medical attention while the stent was in situ or within 2weeks of stent removal. A basic cost analysis was performed. One hundred and sixty cases were identified (98 CS, 62 SOS). No SOS was dislodged prematurely. One SOS was removed cystoscopically due to a broken string. There was no significant difference in the number of patients with SOS seeking medical attention following stent placement compared with those with CS (38.1% (12/51) vs 25.6% (22/86), p = 0.48). There was an estimated cost saving of €23,790 associated with the use of SOS during the study period (€390/case). The use of SOS created additional capacity which was utilised for diagnostic cystoscopy. The SOS appeared to be well tolerated and showed similar complication rates as the CS. The use of SOS resulted in a significant cost saving and increased the availability of cystoscopy for other indications.

A selective non-operative approach to thoracic stab wounds is safe and cost effective - a South African experience.

Penetrating thoracic trauma is common and costly. Injuries are frequently and selectively amenable to non-operative management. Our selective approach to penetrating thoracic trauma is reviewed and the effectiveness of our clinical algorithms confirmed. Additionally, a basic cost analysis was undertaken to evaluate the financial impact of a selective nonoperative management approach to penetrating thoracic trauma. The Pietermaritzburg Metropolitan Trauma Services electronic regional trauma registry hybrid electronic medical records were reviewed, highlighted all penetrating thoracic traumas. A micro-cost analysis estimated expenses for active observation, tube thoracostomy for isolated pneumothorax greater than 2 cm and tube thoracostomy for haemothorax. Routine thoracic computed tomography does not form part of these algorithms. Isolated thoracic stab wounds occurred in 589 patients. Eighty per cent (472 cases) were successfully managed nonoperatively. Micro-costing shows that active observation costs 4,370 ZAR (£270), tube thoracostomy for isolated pneumothorax costs 6,630 ZAR (£400) and tube thoracostomy for haemothorax costs 21,850 ZAR (£1,310). Penetrating thoracic trauma places a striking financial burden on our limited resources. Diligent and serial clinical assessments, alongside basic radiology and stringent management criteria, can accurately stratify patients to correct clinical algorithms. Selective nonoperative management for penetrating thoracic trauma is safe and effective. Routine thoracic computed tomography is unnecessary in all patients with isolated thoracic stab wounds, which can be reserved for a select group who are identifiable clinically. Routine thoracic computed tomography would not be financially prudent across Pietermaritzburg Metropolitan Trauma Services. Government action is required to reduce the overall incidence of such trauma to save resources and patients.

Routine use of PICO dressings may reduce overall groin wound complication rates following peripheral vascular surgery

Approximately 19% of morbidity in peripheral vascular surgery is attributable to wound complications, which can result in delayed healing, and also arterial or graft infection leading to limb loss and even mortality in extreme cases. To determine whether groin wound complications were reduced following the routine introduction of PICO negative pressure wound therapy dressings in patients who underwent peripheral vascular surgery. Patients who underwent peripheral vascular surgery from 2011 to 2016 were identified and divided into PICO and non-PICO groups. Patient, procedure and wound characteristics were tabulated and analysed. Patients were followed-up for at least six weeks postoperatively. Wound complication rates, infection confirmed by microbiology, and requirement for re-admission due to wound complications were noted. Basic cost analysis was performed. In total, 151 patients were analysed (N=73 PICO, N=78 non-PICO). No difference in age (P=0.862), body mass index (P=0.673), diabetes (P=0.339), pre-operative albumin (P=0.196), use of drain (P=0.343) and history of meticillin-resistant Staphylococcus aureus (P=0.281) was observed between groups. The PICO group contained more smokers than the non-PICO group (45% vs 29%, P=0.034). Wound complications were seen in 8% (N=6) of the PICO group and 19% (N=15) of the non-PICO group (P=0.042). No significant difference in infection was found between the two groups (3% vs 6%, P=0.249), but fewer seromas were observed when PICO dressings were used (1.4% vs 7.7%, P=0.069). Haematoma (2.7% vs 3.8%, P=0.531) and dehiscence rates (1.4% vs 1.3%, P=0.735) were similar between the two groups. Routine use of PICO dressings is associated with a reduction in wound complication rates following peripheral vascular surgery, and is cost-effective.

A methodological framework of eco-efficiency based on fuzzy logic and Life Cycle Assessment applied to a Mexican SME

In this paper an eco-efficiency analysis methodology that takes into account Life Cycle Assessment (LCA) and fuzzy logic is presented. It consists of four stages: (1) perform LCA and basic cost analysis, (2) normalize the environmental and economic impact categories results, (3) integrate economic and environmental impact categories by means of a fuzzy treatment and (4) obtaining the fuzzy eco-efficiency index. The result is a preference hierarchy that indicates an order of scenarios according to their degree of eco-efficiency. The methodology proposed is applied to a Mexican SME: a plastic products manufacturer. Six different supplier locations of polypropylene were considered: United States of America (transporting by land and by water), China, Singapore, Europe, and United Arab Emirates. The robustness of the methodological framework was tested by means of a comparative analysis with a decision surface graph, an eco-efficiency index, and random runs to prove their variability. Results show that USA is the most preferable supplier location when polypropylene is transported by land. The comparative analysis with the random series results and the decision surface graph, allowed to corroborate the stability of the fuzzy preference orders and to identify clusters of scenarios with an equally eco-efficient performance. Thus, the robustness of the methodology proposed was validated.

The analysis of management of radioactive waste arisen from steam generator's dismantling from radiological and economical point of view

As a result of the application of decontamination and dismantling techniques the radioactive waste of various form and activity content is generated. These hazardous materials are mostly in solid form (primary waste) but also in liquid form (secondary waste) which has to be fixed in a solid matrix. From this reason the complex analysis of the dismantling process has to take into account also this phenomenon. The paper analyses the expected radioactive waste arisen from the dismantling of steam generator used in Slovak nuclear power plant V1 in Jaslovské Bohunice from the perspective of waste streams and evaluates the expected exposure of the workers. Moreover, the basic cost analysis is presented in order to analyse the waste management scenarios also from economical point of view. The results show that the maximal collective effective dose is at the order of ones man-mSv which is below the respective exposure limit. In the case of the relative costs of waste management scenarios, the influence of the application of decontamination techniques is significant. The calculation methodology applied in the case of assessment of external exposure reflects the expected changes of the input data, for instance the amount, activity and nuclide composition of secondary waste.

On the use of SAFT-VR Mie for assessing large-glide fluorocarbon working-fluid mixtures in organic Rankine cycles

By employing the SAFT-VR Mie equation of state, molecular-based models are developed from which the thermodynamic properties of pure (i.e., single-component) organic fluids and their mixtures are calculated. This approach can enable the selection of optimal working fluids in organic Rankine cycle (ORC) applications, even in cases for which experimental data relating to mixture properties are not available. After developing models for perfluoroalkane (n-C4F10+n-C10F22) mixtures, and validating these against available experimental data, SAFT-VR Mie is shown to predict accurately both the single-phase and saturation properties of these fluids. In particular, second-derivative properties (e.g., specific heat capacities), which are less reliably calculated by cubic equations of state (EoS), are accurately described using SAFT-VR Mie, thereby enabling an accurate prediction of important working-fluid properties such as the specific entropy. The property data are then used in thermodynamic cycle analyses for the evaluation of ORC performance and cost. The approach is applied to a specific case study in which a sub-critical, non-regenerative ORC system recovers and converts waste heat from a refinery flue-gas stream with fixed, predefined conditions. Results are compared with those obtained when employing analogue alkane mixtures (n-C4H10+n-C10H22) for which sufficient thermodynamic property data exist. When unlimited quantities of cooling water are utilized, pure perfluorobutane (and pure butane) cycles exhibit higher power outputs and higher thermal efficiencies compared to mixtures with perfluorodecane (or decane), respectively. The effect of the composition of a working-fluid mixture in the aforementioned performance indicators is non-trivial. Only at low evaporator pressures (<10bar) do the investigated mixtures perform better than the pure fluids. A basic cost analysis reveals that systems with pure perfluorobutane (and butane) fluids are associated with relatively high total costs, but are nevertheless more cost effective per unit power output than the fluid mixtures (due to the higher generated power). When the quantity of cooling water is constrained by the application, overall performance deteriorates, and mixtures emerge as the optimal working fluids.

Methodologies to Reduce Cooling Load using Heat Balance Analysis: A Case Study in an Office Building in a Tropical Country

Abstract The world is experiencing energy crisis since the 1970s due to the limitation in fossil fuel resources and increasing energy demand as a result of industrialisation and development which have taken place all over the world [1]. It is reported by International Energy Agency (IEA) that 32% of the total worldwide energy consumption was contributed by building sector [2]. Researchers found that Heating Ventilation and Air Conditioning (HVAC) system consumed the highest amount of energy in commercial building [3–7] meanwhile in tropical countries more than 50% of the building's energy were used for air conditioning [8]. This research found that standard building can be transformed into Low Energy Office building by applying heat gain reduction methodologies draws from heat balance analysis. An office building in Malaysia was audited and modelled in Design Builder software for heat balance analysis. It is found that 75% of the building's heat gain was radiated from lighting system and solar heat gain through window. It is estimated that 45.85% of building's energy can be saved by changing the zones temperature set point, modification in lighting system and building's glazing for daylight optimization and minimizing solar heat gain. Besides energy saving, the building's indoor environmental quality based on MS1525:2007 and occupants’ comfort was ensured too. A basic cost analysis estimated in the software shows that the highest increment in initial cost for the methodologies suggested was only 1.32%, hence this study shows that a sustainable building does not necessarily induced high cost for the technologies implementation if the right technologies were chosen to suit the building's condition.

Study of Techno-Economic of Corn Sheller Type MPJ-01-TEP-2014 Design of Study Program Agricultural Engineering Program, University of Andalas

This study aims to evaluate the performance of the machine corn sheller and perform basic cost analysis and break-even point. Sheller was done on three varieties of maize in Padang and surrounding areas. Corn used is corn that has a moisture content (17-20)% with three repetitions. Based on research, capacity sheller machine Maxpro NK 99 varieties obtained 80.49 kg / h with the cost of Rp.120,88 / kg and breakeven 38135.59 kg / year. Pioner 24 varieties of working capacity of 67.52 kg / h with the basic cost of Rp 114.48 / kg and the breakeven point at 66399.66 kg / year, and the work capacity of NK Maxpro 22 varieties of 55.40 kg / h with a cost of Rp. 139.53 / kg with a breakeven point 40186.26 kg / year.

A prospective audit of emergency urology activity in a university teaching hospital.

Urology cover is commonly available out-of-hours in most teaching hospitals. However, increased pressure to reduce hospital expenditure has forced many institutions to consider removing middle grade cover outside of normal working hours. The aim of this study was to audit the emergency urology activity in our institution over a 12-month period. A prospective logbook was maintained for all urology referrals from the emergency department between August 2012 and March 2013. The diagnosis and patient outcome was recorded for each referral. The emergency theatre logbook was retrospectively evaluated for all emergency urology procedures carried out over the same time period. A basic cost analysis was performed to calculate the cost of providing the on-call service. A total of 752 patients were referred to the urology service over a 12-month period. The most common reasons for referral were renal colic and scrotal pain. Approximately 41 % of referrals were discharged directly from the emergency department. There were 167 emergency operations performed in total. The majority of emergency operations and referrals from the emergency department took place outside of normal working hours. A basic cost analysis revealed an associated cost saving of €58,120. Emergency urology activity constitutes a large proportion of the workload at our institution. Restricting emergency urology cover would limit essential training opportunities for urology trainees, increases length of stay and delay treatment of urological emergencies. Urology "out of hours" cover is a cost-efficient method of service provision.

The utility of plain radiographs in the initial evaluation of knee pain amongst sports medicine patients.

To evaluate whether screening radiographs as part of the initial workup of knee pain impacts clinical decision-making in a sports medicine practice. A questionnaire was completed by the attending orthopaedic surgeon following the initial office visit for 499 consecutive patients presenting to the sports medicine centre with a chief complaint of knee pain. The questionnaire documented patient age, duration of symptoms, location of knee pain, associated mechanical symptoms, history of trauma within the past 2weeks, positive findings on plain radiographs, whether magnetic resonance imaging was ordered, and whether plain radiographs impacted the management decisions for the patient. Patients were excluded if they had prior X-rays, history of malignancy, ongoing pregnancy, constitutional symptoms as well as those patients with prior knee surgery or intra-articular infections. Statistical analyses were then performed to determine which factors were more likely do correspond with diagnostic radiographs. Overall, initial screening radiographs did not change management in 72% of the patients assessed in the office. The mean age of patients in whom radiographs did change management was 57.9years compared to 37.1years in those patients where plain radiograph did not change management (p<0.0001). Plain radiographs had no impact on clinical management in 97.3% of patients younger than 40. In patients whom radiographs did change management, radiographs were more likely to influence management if patients were over age forty, had pain for over 6months, had medial or diffuse pain, or had mechanical symptoms. A basic cost analysis revealed that the cost of a clinically useful radiographic series in a patient under 40years of age was $7,600, in contrast to $413 for a useful series in patients above the age of 40. Data from the current study support the hypothesis that for the younger patient population, routine radiographic imaging as a screening tool may be of little clinical benefit. Factors supporting obtaining screening radiographs include age greater than 40, knee pain for greater than 6months, the presence of medial or diffuse knee pain, and the presence of mechanical symptoms. II.

ECO FRIENDLY SEWERAGE SYSTEM FOR A LOW INCOME COASTAL COMMUNITY

The purpose of a sewerage disposal system is to carry human excreta &amp; urine (Black water) and wastewater (Gray water) back to nature in a proper way without any harm to the environment as well as to human beings. But the implementing and operating costs of the sewerage disposal systems are normally very high which make low income communities unable to access these techniques. The aim of this study was to find a proper sewerage system for a low income coastal community, “Pittaniya Watta” in Moratuwa Municipal Council. The community consists of 142 families with about 710 people spreading over a 5051m2 limited area. At first the real situation and the problems prevailing were found through a questionnaire survey considering a proper cross section. Questionnaires were analyzed and evaluated and daily water consumption, sewerage disposal capacities, communicannt’s desire were found. Finally Eco-sanitation units and simplified sewerage system were selected as the most economical solutions for the problem.Number of Eco-sanitation units required for the said community was 142. The simplified sewerage system (“off-site disposal system”) was designed considering both self cleansing velocity (0.5 m/s) as well as tractive tension (1 Pa). The results revealed that the best fitted minimum sewer gradient and the minimum sewer diameter were 1 in 208 and 100mm respectively. The collected sewage will be treated in primary and secondary stages in anaerobic digestion units. Three units were provided with each dimension length, width and depth of 6.2mx 3mx4m respectively and 0.2 m of free board. Using a lift station a head was added to the effluent to take it from 5m below the ground to the ground surface where the Reed bed was provided before it is released to the existing drains that are directed to the sea. Estimated hydraulic retention time of the reed bed is 6.79 hours while dimensions are water depth = 0.6m and surface area of the bed=78m2. According to the basic cost analysis on two systems Eco-san unit for each house is Rs 47925. When considering the whole community, the total cost for Eco-san was Rs 6,805,350 while the simplified sewerage system was Rs 2,886,000. However, at the operational stage of simplified sewerage system, with maintenance cost, the total cost was estimated as Rs 16,606,390.00. Therefore, based on the cost the most suitable system for the subjected community is Eco-san. But according to communicant’s desire, land scarcity, and population growth as well as future forecast on water consumption, improvement of the living standards etc. simplified sewerage system was selected as the best sewerage disposal system to implement at Pitaniya Watta low income community.