Cost Of Treatment Time Research Articles

Decentralized approach toward organic pollutants removal using UV radiation in combination with H2O2-based electrochemical water technologies

The current literature lacks a comprehensive discussion on the trade-off between pollutant degradation/mineralization and treatment time costs in utilizing UV light in combination with H2O2-based electrochemical advanced oxidation processes (EAOPs). The present study sheds light on the benefits of using the photoelectro-Fenton (PEF) process with UVA or UVC for methylparaben (MetP) degradation in real drinking water. Although light boosts the photodegradation of refractory Fe(III) complexes and the photolysis of H2O2 (with UVC only), the energy-intensive nature of light-based treatments is acknowledged. To help tackle the high energy consumption issue, a novel approach was employed: partial application of UVA or UVC light after a predetermined electro-Fenton electrolysis time. The proposed treatment approach yielded satisfactory comparable results to those obtained from the application of PEF/UVA or PEF/UVC in terms of total organic carbon removal (ca. 100%), with notably lower energy consumption (ca. 50%). The study delves into the combined method's feasibility, analyzing pollutant degradation/mineralization process and overall energy consumption. The research identifies possible degradation routes based on intermediate detection and radical quenching experiments. Finally, toxicological assessments evaluate the toxicity levels of MetP and its intermediates. The findings of this study bring meaningful contributions to the fore and point to the highly promising potential of the proposed approach, in terms of sustainability and cost-effectiveness, when applied for decentralized water treatment.

Dosimetric comparison of different treatment modalities for stereotactic radiosurgery of arteriovenous malformations and acoustic neuromas

PurposeWe investigated the influence of beam modulation on treatment planning by comparing four available stereotactic radiosurgery (SRS) modalities: Gamma-Knife-Perfexion, Novalis-Tx Dynamic-Conformal-Arc (DCA) and Dynamic-Multileaf-Collimation-Intensity-Modulated-radiotherapy (DMLC-IMRT), and Cyberknife. Material and methodsPatients with arteriovenous malformation (n=10) or acoustic neuromas (n=5) were planned with different treatment modalities. Paddick conformity index (CI), dose heterogeneity (DH), gradient index (GI) and beam-on time were used as dosimetric indices. ResultsGamma-Knife-Perfexion can achieve high degree of conformity (CI=0.77±0.04) with limited low-doses (GI=2.59±0.10) surrounding the inhomogeneous dose distribution (DH=0.84±0.05) at the cost of treatment time (68.1min±27.5). Novalis-Tx-DCA improved this inhomogeneity (DH=0.30±0.03) and treatment time (16.8min±2.2) at the cost of conformity (CI=0.66±0.04) and Novalis-TX-DMLC-IMRT improved the DCA CI (CI=0.68±0.04) and inhomogeneity (DH=0.18±0.05) at the cost of low-doses (GI=3.94±0.92) and treatment time (21.7min±3.4) (p<0.01). Cyberknife achieved comparable conformity (CI=0.77±0.06) at the cost of low-doses (GI=3.48±0.47) surrounding the homogeneous (DH=0.22±0.02) dose distribution and treatment time (28.4min±8.1) (p<0.01). ConclusionsGamma-Knife-Perfexion will comply with all SRS constraints (high conformity while minimizing low-dose spread). Multiple focal entries (Gamma-Knife-Perfexion and Cyberknife) will achieve better conformity than High-Definition-MLC of Novalis-Tx at the cost of treatment time. Non-isocentric beams (Cyberknife) or IMRT-beams (Novalis-Tx-DMLC-IMRT) will spread more low-dose than multiple isocenters (Gamma-Knife-Perfexion) or dynamic arcs (Novalis-Tx-DCA). Inverse planning and modulated fluences (Novalis-Tx-DMLC-IMRT and CyberKnife) will deliver the most homogeneous treatment. Furthermore, Linac-based systems (Novalis and Cyberknife) can perform image verification at the time of treatment delivery.

Effect of Testing and Treatment on Emergency Department Length of Stay Using a National Database

Testing and treatment are essential aspects of the delivery of emergency care. Recognition of the effects of these activities on emergency department (ED) length of stay (LOS) has implications for administrators planning efficient operations, providers, and patients regarding expectations for length of visit; researchers in creating better models to predict LOS; and policy-makers concerned about ED crowding. A secondary analysis was performed using years 2006 through 2008 of the National Hospital Ambulatory Medical Care Survey (NHAMCS), a nationwide study of ED services. In univariate and bivariate analyses, the authors assessed ED LOS and frequency of testing (blood test, urinalysis, electrocardiogram [ECG], radiograph, ultrasound, computed tomography [CT], or magnetic resonance imaging [MRI]) and treatment (providing a medication or performance of a procedure) according to disposition (discharged or admitted status). Two sets of multivariable models were developed to assess the contribution of testing and treatment to LOS, also stratified by disposition. The first was a series of logistic regression models to provide an overview of how testing and treatment activity affects three dichotomized LOS cutoffs at 2, 4, and 6 hours. The second was a generalized linear model (GLM) with a log-link function and gamma distribution to fit skewed LOS data, which provided time costs associated with tests and treatment. Among 360 million weighted ED visits included in this analysis, 227 million (63%) involved testing, 304 million (85%) involved treatment, and 201 million (56%) involved both. Overall, visits with any testing were associated with longer LOS (median = 196 minutes; interquartile range [IQR] = 125 to 305 minutes) than those with any treatment (median = 159 minutes; IQR = 91 to 262 minutes). This difference was more pronounced among discharged patients than admitted patients. Obtaining a test was associated with an adjusted odds ratio (OR) of 2.29 (95% confidence interval [CI] = 1.86 to 2.83) for experiencing a more than 4-hour LOS, while performing a treatment had no effect (adjusted OR = 0.84; 95% CI = 0.68 to 1.03). The most time-costly testing modalities included blood test (adjusted marginal effects on LOS = +72 minutes; 95% CI = 66 to 78 minutes), MRI (+64 minutes; 95% CI = 36 to 93 minutes), CT (+59 minutes; 95% CI = 54 to 65 minutes), and ultrasound (US; +56 minutes; 95% CI = 45 to 67 minutes). Treatment time costs were less substantial: performing a procedure (+24 minutes; 95% CI = 20 to 28 minutes) and providing a medication (+15 minutes; 95% CI = 8 to 21 minutes). Testing and less substantially treatment were associated with prolonged LOS in the ED, particularly for blood testing and advanced imaging. This knowledge may better direct efforts at streamlining delivery of care for the most time-costly diagnostic modalities or suggest areas for future research into improving processes of care. Developing systems to improve efficient utilization of these services in the ED may improve patient and provider satisfaction. Such practice improvements could then be examined to determine their effects on ED crowding.

Methods of evaluating dental care costs in the Swedish public dental health care sector.

Twenty-six Swedish dental health care clinics participating in the intervention study "Evaluation of caries preventive measures" have been analysed with focus on costs, with the aim of demonstrating techniques suitable for evaluating direct dental care costs and also finding out whether charges are acceptable as a proxy for real costs. Three different approaches to calculating unit costs are discussed: average treatment time cost and two methods of different allocation of overhead cost. Average treatment time cost shows treatment time cost regardless of who (dentist, dental hygienist or nurse) provides the dental care. The other two methods reflect both the differences of treatment costs depending on practitioners' skill level and competence (salary) and the methods of handling overhead cost allocation. Our conclusions are that the proposed methods seem useful for evaluating costs in cost-effectiveness and cost-benefit analysis. The alternative to average treatment time cost or unit time cost depends on what data is available and the perspective of the analysis. This study also concludes that charges are not sufficient as an alternative to a more detailed cost evaluation, at least not in Swedish public dental health care, since charges do not cover costs.