Full Cost Analysis Research Articles

Link-based full cost analysis of travel by automobile

This paper develops a link-based full cost model for auto travel, which identifies both internal and external costs of travel, and gives a link-based cost estimate for the Minneapolis – St. Paul (Twin Cities) metropolitan region. The key cost components are time, emissions, crashes, user monetary, and infrastructure. The estimates show that the average full cost of travel is a $0.694/veh-km traffic-weighted average over the study area, of which the time and user monetary costs account for approximately 70% of the total. Except for the infrastructure cost, highways are more cost-effective than other surface roadways considering all the other cost components, as well as the internal and full costs. Quantifying the full costs of auto travel is essential for making sustainable investments.

Interventions to Prevent Hospital Admissions in Long-Term Care Facilities: A Rapid Review of Economic Evidence

ObjectivesHospital admissions can be hazardous for older adults, particularly those living in long-term care facilities. Preventing nonessential admissions can be beneficial for this population, as well as reducing demand on health services. This review summarizes the economic evidence surrounding effective interventions to reduce hospital attendances and admissions for people living in long-term care facilities. DesignRapid review of economic evidence. Setting and ParticipantsPeople living in long-term facilities. MethodsWe searched MEDLINE, CINAHL, Cochrane CENTRAL, PubMed, and Web of Science on September 20, 2022, and again on January 10, 2023. Full economic evaluations and cost analyses reporting on advanced care planning, goals of care setting, nurse practitioner input, palliative care, influenza vaccinations, and enhancing access to intravenous therapies were eligible. Data were extracted using a prepiloted data extraction form and critically appraised using either the Drummond-Jefferson checklist or an amended NIH Critical Appraisal Tool appended with questions from a critical appraisal checklist for cost analyses. Data were synthesized narratively. ResultsWe included 7 studies: 3 full economic evaluations and 4 cost analyses. Because of lack of clarity on the underlying study design, we did not include one of the cost analyses in our synthesis. Advanced care planning, a palliative care program, and a high-dose influenza vaccination reported potential cost savings. Economic evidence for a multicomponent intervention and a nurse practitioner model was inconclusive. The overall quality of the evidence varied between studies. Conclusions and ImplicationsA number of potentially cost-effective approaches to reduce demand on hospital services from long-term care facilities were identified. However, further economic evaluations are needed to overcome limitations of the current evidence base and offer more confident conclusions.

Low Cost, Solvent-Free Lithium-Ion Battery Electrode Manufacturing Based on Electrostatic Dry Powder Coating

Conventional industrial processes for the manufacture of Lithium-Ion Battery (LIB) electrodes are costly and not environmentally friendly. The state-of-the-art slurry casting technique utilizes a large amount of toxic N-methly pyrollidinone (NMP), necessitating significant energy and capital costs associated with electrode drying and solvent recovery.Electrostatic Dry Powder Deposition (EDPD) is well established in many industries as an effective method of achieving well-adhered and uniform coatings of controlled thickness & composition. Recently, a small number of studies have demonstrated the viability of EDPD in LIB electrode manufacture, achieving cell capacities similar to, or exceeding, those from slurry casting. Crucially, this approach eliminates the need for solvent usage. Nevertheless, several challenges remain before EDPD can be adopted within the LIB industry. In particular, achieving adequate dispersion of powder materials and a level of adhesion sufficient for use in standard roll-2-roll lines.With the goal of developing & demonstrating the viability of the EDPD process, this work will present a solvent-free approach, coupled with innovative methods to improve adhesion and overall coating quality. The high voltage spinel cathode Lithium Nickel Manganese Oxide (LNMO) was utilized as a demonstrator material, as it can provide high energy density cells without the use of expensive and rare cobalt. Results will include: (a) development of EDPD equipment and appropriate process parameters, (b) optimization of coating formulation, (c) adhesion enhancement through through the use of in-situ heating and post-deposition treatments, (d) electrochemical analysis of EDPD electrodes and benefits compared with slurry casting, (e) full process cost analysis. The presentation will conclude with a discussion of the potential of this new manufacturing technique to disrupt the LIB industry.Rechargeable lithium-ion batteries (LIBs) are ubiquitous in mostly every electronic device. However, the process of manufacturing LIBs is costly and not environmentally friendly. State of the art LIB electrode manufacturing is carried out using slurry casting. A mixture of active material (most commonly containing Cobalt), a binder and a conductive additive are mixed with a solvent and cast onto a substrate. This process is energy-intensive and requires significant capital for drying equipment and processes and the recovery of toxic solvents, such as N-methyl pyrrolidone (NMP).Utilising an EDPD process with a Cobalt free active material such as LNMO in place of the slurry casting process would eliminate the need to use toxic solvents, thereby significantly reducing the manufacturing time and cost. Additionally, LNMO can work as a replacement for the next-generation lithium-ion battery Cobalt-free cathode materials due to its high lithiation/delithiation potential, > 4.5 V compared with 3 – 4 V in the case of more conventional cathode material.The EDPD process presented has demonstrated that a reduction in cost of over 35% can be achieved when tested with LNMO, polyvinylidene fluoride (PVDF) as binder and Carbon Black (CB) as a conductive additive, by eliminating the use of NMP and Cobalt from the process. This is based on a comparison carried out with 1kg of active material mix. There are challenges associated with dry powder electro manufacture for LIBs, such as achieving good adhesion, tortuosity, and obtaining an even dispersion and thickness of the coating. This work addresses these challenges and develops an innovative dry powder deposition method assisted with a low power laser to improve adhesion in a scalable manner.Using a combination of EDPD, low heat and low power laser as an enhancement for the adhesion process in electrode manufacture create an innovative opportunity to remove the toxic solvents to achieve good dry powder depositions making the process less energy demanding and more environmentally friendly. The present research will focus on how to produce dry electrodes with electrostatic coating manufacture, the process innovation of adding a Laser to improve the adhesion and electrochemical testing to quantify the LIB's performance when using this approach.Early research has shown that the manufactured electrodes have similar capacity retention and improved rate capability in lithium-ion batteries when compared to the current state of the art of slurry casting. The simple process operation offers flexibility in scalable production and modularity for future development and commercial implementation.

How much does it cost to combine supply-side and demand-side RBF approaches in a single intervention? Full cost analysis of the Results Based Financing for Maternal and Newborn Health Initiative in Malawi

ObjectiveTo estimate the economic cost associated with implementing the Results Based Financing for Maternal and Newborn Health (RBF4MNH) Initiative in Malawi. No specific hypotheses were formulated ex-ante.SettingPrimary and secondary delivery...

Applications of Sales Analysis for Salesforce Control in Pharmaceutical Industry of India

In this study an effort has been made to study the control of sales force through sales analysis. Sales analysis is a source of important information to the manager, if used properly and with a full sale marketing and cost analysis; its usefulness can be further increased. In a study conducted at all major hospitals in Delhi, It was found that there is significant relationship between size of organization and sales analysis and significant relationship exists between monthly income and sales analysis.

A novel cost-management system for container terminals using a time-driven Activity-Based Costing approach

Cost-management systems play a significant role in the operations management of container terminal companies; however, in complex loading and discharging operations, traditional Activity-Based Costing (ABC) systems are costly and difficult to be built and maintained. A modified Time-Driven ABC method, considering all the procedures required to obtain the final product and estimating resource usage accordingly, has emerged in response to this challenge. This study provides terminal operators with an effective cost analysis tool using a time-driven ABC method to identify bottleneck in handling process and calculate the handling cost of cost objects. Also, this research uses a container vessel and ten shipping lines calling at Shanghai East Container Terminal as case studies, and presents a full cost analysis of the activities and their respective costs. This investigation provides insights into the causes of excessive logistics costs and highlights the benefits of applying Time-Driven ABC method in the container terminal industry, along with shortcomings and potential future research.

Potential evaluation and analysis of near-to-net zero energy building in hot and dry climate

• Near-to-net zero energy building in hot and dry climate has been investigated. • NZEBs model has been developed and simulated using TRNSYS models/components. • Space cooling, space heating, and electrical energy outcomes was developed. • Maximum reduction rate ratio in energy demand 48.2% was achieved. In a hot and dry climate like the weather of Iraq, near-to-net zero energy buildings (NNZEBs) can become one of the effective solutions to reduce energy demands in the residential buildings sector. Therefore, the current work aims to cornerstone of the developed solution combined the different scenarios for residential building with a total living area of 240 m 2 has been considered. The investigated scenarios include different building constructions, orientations, control strategies, and using solar PV panels as renewable energy techniques. The proposed scenarios have been developed and simulated using TRNSYS models/components. The energy demand for space cooling, space heating, and electrical energy outcomes from an NNZEB model was developed using the TRNSYS simulation workspace. The data input of the residential multi-zone building envelope is configured using TRNBuild (i.e., building simulation software) and then introduced into TRNSYS. Moreover, the solar PV panels tool is developed in TRNSYS to evaluate the impact of renewable energy on energy consumptions. A full cost analysis of the energy consumption has been carried out to see if this technology is viable. In terms of maximum energy demand, the preliminary building requires 340 kWh/m 2 per year as a cooling demand compared with 65 kWh/m 2 per year as a heating demand. The results showed that the maximum reduction rate in energy demand for cooling demand of 33.9% was achieved by changing the construction, ventilation, and control systems. The scenarios of using double glaze and insulating the building showed the most significant impact on the reducing of energy demand with a total reduction rate ratio of 34.40% compared with other scenarios. From economic analysis, it can be concluded that the increase in the energy tariff led to an increase in the yearly energy cost for the preliminary building without solar PV panels. The results highlighted that the effects of key investigated scenarios should be considered in combination through a parametric investigation.

Venous Thromboembolism (VTE) Increases the Healthcare Burden in Patients with Malignant Glioma (MG)

Background: The cumulative incidence of symptomatic venous thromboembolism (VTE) among patients with malignant glioma (MG) is high, with estimates ranging from 20-35% during the course of therapy. VTE is the second leading cause of death among ambulatory patients receiving cancer chemotherapy, with a 2-fold or greater increase in mortality compared to those without VTE, even after adjusting for stage. Specific to MG patients, Semrad et al. reported a higher likelihood of death at 2-year follow up (hazard ratio 1.3). The development of VTE is associated with increased mortality, an increased risk of hospitalization, delays in cancer treatment and an increased risk of complications including pain, bleeding, and bruising from high dose therapeutic anticoagulation. As a result, the economic burden of VTE in cancer patients is substantial and is associated with a nearly 2 fold increase in cost. Data regarding VTE burden encompasses all cancer types and additional data is needed to characterize VTE burden in specific cancer types, particularly rarer cancers. The aim of this study was to assess the healthcare burden associated with the development of VTE in MG patients.Methods: A retrospective chart review of patients with MG at an academic medical center was conducted from 2009-2016. Patients 18 years and older with a histologic diagnosis of malignant glioma, WHO grade 3-4 were assessed. A total of 31 patients were identified and information was collected with respect to their healthcare consumption as related to their oncologic care. Specifically, the number of office visits, emergency room visits, inpatient hospitalizations with the associated costs of VTE management and it's complications were collected. Using SPSS, linear regression models and descriptive statistics were used to determine the relationship between the development of VTE and healthcare consumption.Results: Of the 31 patients in the study, 10 developed VTE (32%). All patients who developed a VTE were placed on therapeutic anticoagulation as part of VTE management. Fifty percent of patients developed complications related to anticoagulation, including gastrointestinal, retroperitoneal and intracranial bleeding events. One patient required placement of an IVC filter after experiencing a bleeding complication. Patients that developed VTE had an increase in inpatients days (21.3 inpatients days) as compared to their non-VTE counterparts (10 inpatient days), (p=.04). There was a trend towards increased utilization of the emergency room with an average of 5.1 visits in those patients with VTE as compared to those without (2.89), (p=0.244). A limited cost analysis found that anticoagulation management alone generated an additional $84,335 in healthcare costs with an average of $8,433 per patient. A full cost analysis is currently underway.Discussion: The development of VTE in patients with malignant glioma increases inpatient admissions days and pharmaceutical costs related to anticoagulation. While limited in patient number, this represents the first assessment of health care burden associated with VTE specific to this cancer patient population. Given the significant number of MG patients who develop VTE (approximately 1/3 in this study), increases in health care burden are magnified in this patient population and studies are needed to prevent VTE in this particular group of patients. DisclosuresNo relevant conflicts of interest to declare.

Using HIV self-testing to increase the affordability of community-based HIV testing services.

Objectives:This study estimates the costs of community-based HIV testing services (HTS) in Lesotho and assesses the potential efficiency gains achieved by adding HIV self-testing (HIVST) and then self-testing booths.Design:Micro-costing analysis using longitudinal data from a real-world intervention.Methods:We collected data prospectively on provider's costs and programmatic outcomes over three time periods of approximately 8 months each, between May 2017 and April 2019. The scope of services was extended during each period as follows: HTS only, HTS and HIVST, HTS and HIVST with individual HIVST booths wherein clients were encouraged to self-test on-site followed by on-site confirmative testing for those with reactive self-test. For each implementation period, we estimated the full financial and economic implementation costs, the incremental costs of adding HIVST onto conventional HTS and the cost per HIV positive case identified.Results:Costs per HIV-positive case identified increased between period 1 (US$956) and period 2 (US$1249) then dropped in period 3 (US$813). Full versus incremental cost analyses resulted in large differences in the magnitude of costs, attributable to methods rather than resource use: for example, in period 3, the average full and incremental cost estimates for HTS were US$34.3 and US$23.5 per person tested, and for HIVST were US$37.7 and US$14.0 per kit provided, respectively.Conclusion:In Lesotho, adding HIVST to community-based HTS improves its overall affordability for HIV-positive case finding. The reporting of both full and incremental cost estimates increase transparency for use in priority setting, budgeting and financial planning for scale-up.

Economic evaluation of individualized nutritional support in medical inpatients: Secondary analysis of the EFFORT trial.

Existing guidelines support the importance of nutritional interventions for medical inpatients at malnutrition risk to alleviate the impact of malnutrition on outcomes. While recent studies have reported positive effects of nutritional support on health outcomes, limited evidence exists on whether in-hospital nutritional support also results in economic advantages. We report the results of the economic evaluation of EFFORT-a pragmatic, investigator-initiated, open-label, multicenter trial. A total of 2028 medical inpatients at nutritional risk were randomly assigned to receive individualized nutritional support to reach protein and energy goals (intervention group; n=1015) or standard hospital food (control group; n=1013). To calculate the economic impact of nutritional support, a Markov model was developed with relevant health states. Costs were estimated for days in normal hospital ward and in the Intensive Care Unit (ICU), hospital-acquired complications, and nutritional support. We used a Euro conversion rate of 0.93216 Euro for 1 Swiss Franc (CHF). The estimated per-patient cost was CHF90 (83.78 €) for the in-hospital nutritional support and CHF283.85 (264.23 €) when also considering dietitian consultation time. Overall costs of care within 30 days of admission averaged CHF29,263 (27,240 €) per-patient in the intervention group versus CHF29,477 (27,439 €) in the control group resulting in per-patient cost savings of CHF214 (199 €). Per-patient cost savings was CHF19.56 (18.21 €) when also accounting for dietician costs (full cost analysis). These cost savings were mainly due to reduced ICU length of stay and fewer complications. We also calculated costs to prevent adverse outcomes, which were CHF276 (256 €) for one severe complication, CHF2,675 (2490 €) for one day in ICU, and CHF7,975 (7423 €) for one death. For the full cost analysis, these numbers were CHF872 (811 €), CHF8,459 (7874 €) and CHF25,219 (23,475 €). Sensitivity analyses confirmed the original findings. Our evaluation demonstrates that in-hospital nutritional support for medical inpatients is a highly cost-effective intervention to reduce risks for ICU admissions and hospital-associated complications, while improving patient survival. The positive clinical and economic benefits of nutritional support in at-risk medical inpatients calls for comprehensive nutrition programs, including malnutrition screening, consultation, and nutritional support. ClinicalTrials.gov number, NCT02517476.

Economic impact of postoperative pancreatic fistula in pancreatic surgery.

Background: Postoperative pancreatic fistula (POPF) is the most important complication after pancreatic surgery and is associated with major morbidity, increased use of resources, and prolonged hospital stay. The true economic impact of POPF is unknown. Methods: We evaluated the economic impact of POPF based on a full cost analysis of hospital expenses and reimbursements for all patients discharged after pancreatic resections at our center in 2015 with billing through the G-DRG-System. For definition and grading of POPF the 2016 update of the international definition was used. Uni- and multivariable analyses of factors associated with a deficit of >1000€ per case were performed. Results: Of 505 patients with pancreatic resections, 78 (15.4%) developed POPF. The occurrence and the grade of POPF were significantly associated with increased treatment costs in all cases and in subgroups of different resections (e.g. mean costs of 15,741.51€ without and of 54,023.20€ with POPF after pancreatoduodenectomy; p< 0.0001). DRG reimbursements significantly increased in parallel but failed to cover the cost increase. POPF resulted in uncovered costs and was associated with a deficit in total, after different resections, and within single DRGs. POPF was the dominant independent risk factor for deficits >1000€/case. Conclusion: POPF has considerable economic impact and results in highly increased treatment costs that are currently not covered by reimbursements through the G-DRG system.

Increased Health Care Cost Associated with Venous Thromboembolism in Patients with Malignant Glioma

Background: The cumulative incidence of symptomatic venous thromboembolism (VTE) among patients with malignant glioma (MG) is high, with estimates ranging from 20-35% during the course of therapy. VTE is the second leading cause of death among ambulatory patients receiving cancer chemotherapy, with a 2-fold or greater increase in mortality compared to those without VTE, even after adjusting for stage. In patients with MG and VTE the chance of two-year survival is significantly reduced. The development of VTE is also associated with increased morbidity, including increased risk of hospitalization, delays in cancer treatment, and an increased risk of complications including pain, bleeding, and bruising from high dose therapeutic anticoagulation. The economic burden of VTE in cancer patients is estimated at a 2-fold increase in cost. Data regarding VTE burden encompasses all cancer types and additional data is needed to characterize VTE burden in specific cancer types, particularly rarer cancers. The aim of this study was to assess the healthcare burden associated with the development of VTE in patients with MG.Methods: A retrospective chart review of patients with MG at an academic medical center was conducted from 2009-2017. Sixty-seven patients, age 18 years and older, with a histologic diagnosis of MG (WHO grade III-IV) were assessed. The number of office visits, emergency room visits, and inpatient hospitalizations with the associated costs of VTE management and its complications were collected. Using SPSS, linear regression models and descriptive statistics were used to determine the relationship between the development of VTE and healthcare consumption.Results: Of the 67 patients in the study, 18 developed VTE (27%). All patients who developed a VTE were placed on therapeutic anticoagulation. Fifty percent of patients developed complications related to anticoagulation, including gastrointestinal, retroperitoneal and intracranial bleeding events. Two patients required placement of an IVC filter after experiencing a bleeding complication. Patients that developed VTE had an increase in inpatient days (16.6 inpatient days) as compared to their non-VTE counterparts (8.8 inpatient days), (p=0.012). There was increased utilization of the emergency room with an average of 3.94 visits in those patients with VTE as compared to those without (1.84), (p=0.003). A full cost analysis found that the average primary total cost for ED visits and inpatient hospitalizations in patients with VTE was $48,863 while those without VTE averaged $35,948. This represented a 26% increase in the average primary total cost in those patients with VTE.Discussion: The development of VTE in patients with MG increases inpatient admissions days and incurs additional pharmaceutical costs related to anticoagulation. This study represents the first assessment of VTE-associated health care burden specific to primary brain cancer. We confirm that VTE affects a large number of patients with MG (27%) and limits the time spent at home due to increased hospitalizations and emergency room visits. VTE may be a preventable complication and further studies are needed to investigate safe prevention strategies for patients with MG. DisclosuresNo relevant conflicts of interest to declare.

Bases for the Preferential Plan from an Integrated Energy Resources Planning

This study presents the bases of a Preferential Plan obtained through a new methodology for energy planning, the IRP (Integrated Resources Planning of Energy) for the Power Sector, developed in GEPEA/EPUSP, Brazil. This Integrated Energy Resources Preferential Plan is a systemic compilation of energy resources obtained through an integrated in-time and geographic energy planning, denominated Integrated Resource Planning. The plan is developed using the methodology of Environmental and Energy Inventory; Listing and Drafting of Energy Resources; Calculation and Valuation of Energy Resources Full Potentials, Full Cost Analysis, Demand Forecasting and Resources Integration, after which the construction of plan effectively starts. Finally, the IRP Preferential Plan is a continuous up to date plan and a proposal for an alternative methodology for an energy planning for the power sector aimed at sustainable development through a complete overview among energy, environment and society, with its balanced importance.

Full Flood Cost: Insights from a Risk Analysis Perspective

Traditionally, flood protection measures have focused on high investment alternatives for control infrastructures that will benefit a certain amount of people, based in a gross cost-benefit (GCB) for the defined design flood. This gross cost-benefit approach, however, does not fully incorporate risk assessment into the analysis, given that it assumes that the chosen flood protection measures will provide protection against a design flood by avoiding flood damage every year during the project’s lifespan. This paper presents a probabilistic view of the benefits of implementing flood control measures, incorporating the risk concept to a full flood cost analysis, for an example region in Brazil. By combining analysis on annual expected damage, which considered the likelihood of n flood events along the year—and not only the project one—and two flood management measures (levee and land zoning flood hazard), this paper evaluates why, and by how much, the inclusion of the probability of effectiveness of a given flood protection measure differs from traditional methods based on gross benefit. Results demonstrated a large difference between verifying a measure’s benefits by the GCB and the expected damage: whereas the former indicates the levee structure resulting in a lower accumulated damage from the fifth year of measure implementation, if the expected damage is used, investing in land zoning will be always most cost effective. These findings are useful to highlight that full flood costs should be based on risk evaluation, which is consonant with the latest perception of the assessment and management of flood risks, such as the Floods Directive present in the EU Water Framework Directive.

Effects of oncological care pathways in primary and secondary care on patient, professional, and health systems outcomes: protocol for a systematic review and meta-analysis

BackgroundThe high impact of a cancer diagnosis on patients and their families and the increasing costs of cancer treatment call for optimal and efficient oncological care. To improve the quality of care and to minimize healthcare costs and its economic burden, many healthcare organizations introduce care pathways to improve efficiency across the continuum of cancer care. However, there is limited research on the effects of cancer care pathways in different settings.MethodsThe aim of this systematic review and meta-analysis described in this protocol is to synthesize existing literature on the effects of oncological care pathways. We will conduct a systematic search strategy to identify all relevant literature in several biomedical databases, including Cochrane library, MEDLINE, Embase, and CINAHL. We will follow the methodology of Cochrane Effective Practice and Organisation of Care (EPOC), and we will include randomized trials, non-randomized trials, controlled before-after studies, and interrupted time series studies. In addition, we will include full economic evaluations (cost-effectiveness analyses, cost-utility analyses, and cost-benefit analyses), cost analyses, and comparative resource utilization studies, if available. Two reviewers will independently screen all studies and evaluate those included for risk of bias. From these studies, we will extract data regarding patient, professional, and health systems outcomes. Our systematic review will follow the PRISMA set of items for reporting in systematic reviews and meta-analyses.DiscussionFollowing the protocol outlined in this article, we aim to identify, assess, and synthesize all available evidence in order to provide an evidence base on the effects of oncological care pathways as reported in the literature.Systematic review registrationPROSPERO CRD42017057592.

Measuring User Compliance and Cost Effectiveness of Safe Drinking Water Programs: A Cluster-Randomized Study of Household Ultraviolet Disinfection in Rural Mexico.

Low adoption and compliance levels for household water treatment and safe storage (HWTS) technologies have made it challenging for these systems to achieve measurable health benefits in the developing world. User compliance remains an inconsistently defined and poorly understood feature of HWTS programs. In this article, we develop a comprehensive approach to understanding HWTS compliance. First, our Safe Drinking Water Compliance Framework disaggregates and measures the components of compliance from initial adoption of the HWTS to exclusive consumption of treated water. We apply this framework to an ultraviolet (UV)-based safe water system in a cluster-randomized controlled trial in rural Mexico. Second, we evaluate a no-frills (or "Basic") variant of the program as well as an improved (or "Enhanced") variant, to test if subtle changes in the user interface of HWTS programs could improve compliance. Finally, we perform a full-cost analysis of both variants to assess their cost effectiveness (CE) in achieving compliance. We define "compliance" strictly as the habit of consuming safe water. We find that compliance was significantly higher in the groups where the UV program variants were rolled out than in the control groups. The Enhanced variant performed better immediately postintervention than the Basic, but compliance (and thus CE) degraded with time such that no effective difference remained between the two versions of the program.

Javanese House’s Roof (Joglo) with the Opening as a Cooling Energy Provider

Natural ventilation and air movement could be considered under the heading structural controls as it does not rely on any form of energy supply or mechanical installation but due to its importance for human comfort, it deserves a separate section. Air infiltration can destroy the performance of ventilation systems. Good ventilation design combined with optimum air tightness is needed to ensure energy efficient ventilation. Ultimately, ventilation needs depend on occupancy pattern and building use. A full cost and energy analysis is therefore needed to select an optimum ventilation strategy.The contains of paper is about the element of Javanese house (the roof) as the element of natural ventilation and a cooling energy provider. In this research, The Computational Fluid Dynamics Program, is used to draw and analysis. That tool can be track the pattern and the direction of movement of air also the air velocity in the object of ventilation of the roof Javanese house based. Finally, the ventilation of the roof of this Javanese house can add the velocity of air at indoor, average 0.4 m/s and give the effect of cooling, average 0.7°C.

3D printable optomechanical cage system with enclosure

Abstract The advent of the computer-age in the mid to late 20th century brought the development of sophisticated scientific equipment for myriad chemical analyses. The field of spectroscopy alone has seen significant advances in data collection, processing, and analysis due principally to the incorporation of microprocessors. While it is clear computers have revolutionized the field of instrumental chemical analysis their impact is pervasive through every segment of our lives. From word processing, data management, and Computer Aided Design in our work environments to social media, crowd funding, and digital news at home, technology is everywhere. This work seeks to incorporate the relatively new field of 3D printing into the design and “at-home” manufacture of optomechanical equipment for open-space spectroscopy. The primary goals were the design of an optical cage system, with associated accessories, that is printable on any entry-level commercially available 3D printer. All components except the optics, light source, camera, breadboard, and integrated fluorescence accessory mount were either parametrically designed and printed or purchasable at a local hardware store. The components were assembled into a Michelson interferometer and a liquid sample accessory for Raman spectroscopy. Results of both configurations are discussed along with full cost analysis.

A randomized phase II study of individualized stereotactic body radiation therapy (SBRT) versus transarterial chemoembolization (TACE) as a bridge to transplant in hepatocellular carcinoma (HCC).

e15677 Background: For HCC pts undergoing LT, local treatment as a "bridge" is standard to decrease likelihood of tumor progression. The most common treatment is TACE, but the safest and most effective bridging modality is unclear. Recently, SBRT has been shown to be both safe and effective when used in pts with locally advanced HCC. We prospectively compare SBRT to TACE as a bridge for HCC pts undergoing LT. Methods: 60 pts are planned for accrual. Pts with C-P &lt; 9 and HCC within Milan Criteria were randomized between two arms. TACE pts received 2 treatments one month apart using DEBDOX beads. TACE pts were hospitalized after each treatment. Pts randomized to SBRT, after fiducial placement, received a median total dose of 45 Gy delivered over 5 fractions. Mean liver dose, Veff, and NTCP were utilized to determine the prescription dose. Pts were assessed by imaging using mRECIST criteria at 2 months and every 3 months thereafter until LT or death. Toxicity and quality of life (QOL) were assessed before treatment, during treatment, 2 weeks post-treatment, and then every 3 months using the PIQ-6 Pain Impact Questionnaire and the SF-36v2 Health Survey. Primary endpoint was need for retreatment of the previously treated lesion(s). Secondary endpoints include toxicity, pathologic response, radiologic response, QOL, and cost. Results: From 9/2014-1/17, 33 pts within Milan Criteria with C-P Class A/B cirrhosis were randomized to TACE (n = 18) vs. SBRT (15). Data on evaluable pts is summarized in the table below. Conclusions: For HCC patients with C-P Class A/B liver cirrhosis, SBRT appears at least equally effective as TACE as a bridge to liver transplantation. SBRT may engender less toxicity, better maintain QOL, and eliminate the need for hospitalization. An update along with a full cost analysis will be presented in June. Clinical trial information: nct02182687. [Table: see text]

Economic evaluation of infection control activities

Healthcare-associated infections by drug-resistant bacteria affect a patient's prognosis. Infection control activities at medical institutions in Japan are increasingly focused on the threat from these bacteria. To undertake a full cost analysis that included the costs of consumables and labour required for infection control activities. The cost of infection control activities undertaken by the infection control team (ICT) at Nishimino Kosei Hospital in Japan was surveyed from January 2013 to December 2015. The evaluation index of infection control activities used the meticillin-resistant Staphylococcus aureus detection rate. The cost:effectiveness ratio (CER) of each intervention was calculated. Consumables and labour costs increased over time, as did the ratio of labour cost to total cost over time. However, the CER of interventions was found to have decreased, from ¥164,177 in 2014 to ¥57,989 in 2015. There were increases not only in the amount of consumables, but also in ICT time, suggesting the possibility of improvements in the economic efficiency of infection control. Increasing the amount of consumables and the time input of the ICT could help improve the economic efficiency of infection control. Our research suggests the possibility for improvements in the economic efficiency of infection control.