Simple Cost Analysis Research Articles

The tailored traits of reclaimed asphalt pavement incorporating maltene: performance analyses

ABSTRACT Environmental issues and fluctuations in the price of asphalt binders have increased the demand in usage of reclaimed asphalt pavement (RAP) material for asphalt mixtures. The RAP binder, nevertheless, is often highly aged and has several drawbacks, for instance, low cracking resistance, low workability, and low fatigue in the resulting mixtures. These issues can be resolved by using rejuvenators. As such, this research work assessed the engineering properties of reclaimed hot-mix asphalt (HMA) mixture rejuvenated by maltene-derived asphalt. The tests examined Marshall properties, moisture damage, resilient modulus (MR), dynamic creep, Cantabro loss, and rutting resistance, including the stripping and coating tests. The results showed that maltene had been effective in mitigating the aging effect of RAP asphalt, while the rejuvenated mixture exhibited considerable enhancement, especially when compared to the virgin and RAP mixtures without maltene. A simple cost analysis revealed that maltene was cost-effective as it compensated for the adverse effects of RAP, hence can be used to raise the content of RAP in asphalt mixture.

The Role of Stereotactic Radiosurgery in the Management of Brain Metastases From a Health-Economic Perspective: A Systematic Review.

Stereotactic radiosurgery (SRS) is an effective option in the management of brain metastases, offering improved overall survival to whole-brain radiation therapy (WBRT). However, given the need for active surveillance and the possibility of repeated interventions for local/distant brain recurrences, the balance between clinical benefit and economic impact must be evaluated. To conduct a systematic review of health-economic analyses of SRS for brain metastases, compared with other existing intervention options, to determine the cost-effectiveness of this treatment across different clinical scenarios. The MEDLINE, EMBASE, Cochrane, CRD, and EconLit databases were searched for health-economic analyses, according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, using terms relevant to brain metastases and radiation-based therapies. Simple cost analysis studies were excluded. Quality analysis was based on BMJ Consolidated Health Economics Reporting Standards (CHEERS) checklist. Eleven eligible studies were identified. For lesions with limited mass effect, SRS was more cost-effective than surgical resection (6 studies). In patients with Karnofsky performance scale (KPS)>70 and good predicted survival, SRS was cost-effective compared to WBRT (7 studies); WBRT became cost-effective with poor performance status or low anticipated life span. Following SRS, routine magnetic resonance imaging surveillance saved $1326/patient compared to symptomatic imaging due to reduced surgical salvage and hospital stay (1 study). Based on our findings, SRS is cost-effective in the management of brain metastases, particularly in high-functioning patients with longer expected survival. However, before an optimal care pathway can be proposed, emerging factors such as tumor molecular subtype, diagnosis-specific graded prognostic assessment, neuroprognostic score, tailored surveillance imaging, and patient utilities need to be studied in greater detail.

Sustainable reuse of dredged sediments as pavement materials by cement and fly ash stabilization

The process of removing sediments from the bottom of dams generates large amounts of dredged sediments, which are considered waste. The purpose of this research was to present the results of testing conducted on dredged sediment stabilized with ordinary Portland cement (OPC) and fly ash (FA) for reuse as pavement materials. The base sediment was high plasticity silt (MH) based on the Unified Soil Classification System (USCS). The experiments in this study consisted of unconfined compression (UC), California bearing ratio (CBR), and resilient modulus (Mr) tests on stabilized dredged sediment. A combination of scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX) was used to investigate the microstructures of the stabilized specimens. Finally, a simple comparative cost analysis between roads using conventional earthen materials and stabilized dredged sediment was performed. The results showed that the unconfined compressive strength (qu), CBR, and Mr improved the pavement materials from unsuitable to suitable, and a 10% FA content provided the optimal strength enhancement. The SEM images showed that the calcium silicate hydrate (CSH) product, which was formed by hydration and pozzolanic reactions, attached to the clay clusters and filled the pore spaces between clay particles, resulting in a denser sediment structure. The EDX analyses showed that the calcium weight proportion and the silica-aluminum ratio were important factors in improving the strength of the dredged sediment treated with OPC and FA. These EDX results agreed with the qu, CBR, and Mr results. For the studied situation, roads using stabilized sediment were 1.5 times more economical than roads using conventional earthen pavement materials. Dredged sediments treated with OPC and FA can be sustainably reused as pavement materials based on the Department of Highways of Thailand standard, as well as the recommendations of Austroads (2017). Thus, for suitable sediments, reuse in road and pavement construction may be considered with appropriate treatment and conditioning.

Economic Impact of Implementing Malnutrition Screening and Nutritional Management in Older Adults in General Practice

ObjectivesMalnutrition is a common and significant public health problem, especially for older adults, as the consequences are costly. National guidelines (NICE CG32/QS24) highlight the need to identify and manage malnutrition, the implementation of which was deemed “high impact to produce cost savings”. The ‘Malnutrition Pathway’, endorsed by NICE and other professional bodies, is a practical evidence-based guide to help community healthcare professionals (HCP) to implement guidance on malnutrition management. Published evaluations of its use are needed.DesignThis service evaluation in older adults assessed the impact of implementing the ‘Malnutrition Pathway’ on health care use and costs, as well as the acceptability of the management strategies and effect on malnutrition risk.Setting5 GP surgeries in Gloucestershire.Participants163 older adults (80±9 years) with a range of primary diagnoses, living in their own home, were screened using the Malnutrition Universal Screening Tool (‘MUST’) (n50 low risk (LR); n41 medium risk (MR); n72 high risk (HR)). All patients were managed according to risk (LR: no further management; MR: dietary advice (DA); and HR: DA plus two oral nutritional supplements (ONS) (1 serve 300kcal, 18g protein; 125ml).MeasurementsAt each review (6weeks, 3 and 6 months), ‘MUST’ score, compliance and satisfaction to their management plan were recorded. Healthcare use was collected from GP records 6 months before and after implementation of the pathway. A simple cost analysis was completed.ResultsImplementing appropriate management of malnutrition led to significant reductions in hospital admissions (p=0.028), length of hospital stay (p=0.05), GP visits (p=0.007) and antibiotic prescriptions (p=0.05). Over 6 months, the costs to manage malnutrition (HCP time, ONS) were more than offset by the savings associated with these reductions in health care use (per patient savings of −£395.64 MR+HR; −£997.02 HR). The proportion of individuals at risk of malnutrition reduced over time, and patients reported being satisfied with the DA (97%) and ONS (96%), consuming 90% of their ONS prescription.ConclusionManaging malnutrition significantly reduces healthcare use, with a positive budget impact, in older malnourished patients in primary care. This represents an opportunity to improve patient care with benefit on health care spend.

Hot Water Blanching Pre-Treatments: Enhancing Drying of Seaweeds (Kappaphycus alvarezii S.)

It is really important to dry seaweeds in a shorter drying time without affecting its quality. Thus, this research aimed to investigate the effect of the application of hot water blanching pre-treatments on the drying rate, sensory, and nutritional attributes of seaweed (Kappaphycus Alvarezii, S.). Seaweed samples were blanched (88oC) at 5, 15 and 30 seconds duration and dried using solar glass dryer and heated air mechanical dryer. All samples were replicated three times. Complete Randomized Design (CRD) was used in both dryers and T-Test in comparing between dryers. Simple cost analysis was also performed to assess the annual cost and custom rate of using two methods of drying.It revealed that in heated air mechanical dryer, samples blanched for 5 and 15 seconds dry faster (8 hours). In solar glass dryer, seaweed samples blanched at 5 seconds dry earlier (32.67 hours). Results imply that hot water blanching affects drying time in drying seaweeds and hot water blanching pre-treatments increased drying rate at the initial hour of drying. It verified that models fitted show good predicting capacity and reveals a good correlation coefficient. Hot water blanching pre-treatments and types of dryers did not significantly affect the total ash contents of the seaweed powder, while in crude protein levels, it revealed that hot water blanching pre-treatment was not significant within the dryers but significantly different between drying methods. Moreover, pre-treatments undergone within the dryer were significantly different in crude fiber levels but insignificant in comparison between dryers. It also implied that the color of the seaweed powder dried in solar glass dryer was preferred by panels and all seaweed samples dried using heated air mechanical dryer turned to dark color. Results revealed that hot water blanching pre-treatments and types of dryer do not affect the texture and odor preference of the panels and general acceptability scores of the seaweed powder were insignificantly different within dryers. It also showed that using solar glass dryer and heated air mechanical dryer, it is profitable to blanch the seaweeds before drying.

DESIGN, CONSTRUCTION AND PERFORMANCE EVALUATION OF A COCO PEAT BLOCK MAKING MACHINE

The coco peat block making machine is comprised of a compressing rod assembly, mold box, prime mover, and frame with a pair of wheels enabling easier transportability of the machine. Coco peat of different moisture contents (11-14%; 15-18%; and 19-22%) were compressed at different compressing ratios (4:1; 5:1; and 6:1) using the designed and fabricated machine. The study was conducted to (1) evaluate the blocking capacity; (2) establish the moisture content range and compression ratio of blocking; (3) determine the bulk density of the blocked coco peat; and (4) perform a simple cost analysis of the machine. The results showed that the moisture content range and compression ratio have significant effect on the coco peat block recovery and blocking capacity. The operating parameters in blocking the coco peat were established at a moisture content of 15-18% MC and compression ratio of 4:1 giving a blocking capacity of 68.32 blocks per hour.

A Review of Nanomaterials’ Effect on Mechanical Performance and Aging of Asphalt Mixtures

This review addresses the effects of the modifications with nanomaterials, particularly nanosilica, nanoclays, and nanoiron, on the mechanical performance and aging resistance of asphalt mixtures. The desire for high-performance and long-lasting asphalt pavements significantly pushed the modification of the conventional paving asphalt binders. To cope with such demand, the use of nanomaterials for the asphalt binder modification seems promising, as with a small amount of modification an important enhancement of the asphalt mixture mechanical performance can be attained. Several studies already evaluated the effects of the modifications with nanomaterials, mostly focusing on the asphalt binder properties and rheology, and the positive findings encouraged the study of modified asphalt mixtures. This review focuses on the effects attained in the mechanical properties of the asphalt mixtures, under fresh and aged conditions. Generally, the effects of each nanomaterial were evaluated with the current state-of-art tests for the characterization of mechanical performance of asphalt mixtures, such as, permanent deformation, stiffness modulus, fatigue resistance, indirect tensile strength, and Marshall stability. Aging indicators, as the aging sensitivity, were used to evaluate the effects in the asphalt mixture’s aging resistance. Finally, to present a better insight into the economic feasibility of the analyzed nanomaterials, a simple cost analysis is performed.

Electromechanical Analysis of the Medium Voltage Earthing Switch due to Short-Time and Peak Withstand Current Test

The chosen electrical equipment, i.e., the earthing switch has its application in marine switchgear. In this paper, the reduction of dimensions is considered with the purpose of making it more energy efficient in terms of onboard application. This test validates that the earthing switch as an electromechanical device is capable of withstanding electrodynamic forces. Two approaches are applied and compared. Both approaches are based on a simplified three-dimensional (3D) model of the earthing switch. The first approach is analytical: the electrodynamic forces are calculated with the assumption that currents flow in concentrated lines. Maximum static stress is compared to the yield point of the earthing knife material. The second approach applies the finite element method in the time domain. The results show that the rectangular cross-section can withstand the electrodynamic forces produced by the given currents. Simple cost analysis shows how much material is saved by changing the design from standard earthing knifes with C channel profile to the rectangular profile. Material savings make this study interesting for marine switchgear application. The paper shows qualitative influence of the obtained results on the Energy Efficiency Design Index of the ships.

Nanosilica Coatings to Improve the Tensile Bond Strength of Cementitious Grouts

The use of prefabricated bridge elements (PBEs) is becoming more common as bridge owners strive to construct robust bridges with minimal impacts on the traveling public. Concrete PBEs offer advantages with regards to quality and construction safety; however, to perform adequately, the installed structural system must include strong, durable connections between the components. Typically, field-cast cementitious grouts are used to connect the PBE. This type of material has at times shown serviceability problems associated to dimensional instability, primarily in the form of shrinkage cracking. A direct consequence is the potential bond degradation between the grout connections and the concrete PBE. This study investigated the use of colloidal nanosilica suspensions as a surface preparation technique to increase the bond strength between the precast components and the field-cast grout. Experimental results, including pull-off bond data and a careful microstructural analysis, strongly suggest that nanosilica coatings interact at the concrete–grout interface to increase the bond strength. A simple initial cost analysis is also discussed.

Field Performance and Economic Analysis of Rehabilitated Pavement Sections with Engineered Stress Relief Course Interlayers

Previous studies showed that the use of a stress relief course asphalt concrete (AC) interlayer (fine-graded asphalt mixture) between an AC overlay and the milled AC surface is a promising technique to mitigate reflective cracking. A performance-based mix design specification for an engineered stress relief course (ESRC) AC interlayer was developed and implemented in Nevada on two field projects. The projects were completed in summer of 2015 and 2016 on a U.S. route (US95, Las Vegas) and a residential road (Hidden Valley, Reno) in Nevada, respectively. The performance evaluation of field-produced mixtures collected during construction showed good stability, and increased resistance to fatigue and reflective cracking that can be attributed to the increased asphalt binder content and the finer aggregate gradation, thus making ESRC a promising technique to mitigate reflective cracking. This was also supported by the distress survey data collected throughout the up-to-date service life of the projects. The pavements with ESRC interlayer showed excellent performance thus far (after 2 to 3 years) when compared with the control sections, as demonstrated with a much lower level of cracking reflected in the AC overlay. A simple life cycle cost analysis was performed based on the observed field distresses from each project. The cost analysis showed that even though the ESRC mixture has a higher initial cost of materials, the agency and user life cycle costs per lane mile are lower and resulted in an average cost saving of 23%. In summary, based on the findings from this study, interlayer AC mixes designed using the presented ESRC performance-based mix design method should be used in Nevada.

Manufacturing competitiveness analysis for hydrogen refueling stations

Fuel cell electric vehicles (FCEVs) have now entered the market as zero-emission vehicles. Original equipment manufacturers such as Toyota, Honda, and Hyundai have released commercial cars in parallel with efforts focusing on the development of hydrogen refueling infrastructure to support new FCEV fleets. Persistent challenges for FCEVs include high initial vehicle cost and the availability of hydrogen stations to support FCEV fleets. This study sheds light on the factors that drive manufacturing competitiveness of the principal systems in hydrogen refueling stations, including compressors, storage tanks, precoolers, and dispensers. To explore major cost drivers and investigate possible cost reduction areas, bottom-up manufacturing cost models were developed for these systems. Results from these manufacturing cost models show there is substantial room for cost reductions through economies of scale, as fixed costs can be spread over more units. Results also show that purchasing larger quantities of commodity and purchased parts can drive significant cost reductions. Intuitively, these cost reductions will be reflected in lower hydrogen fuel prices. A simple cost analysis shows there is some room for cost reduction in the manufacturing cost of the hydrogen refueling station systems, which could reach 35% or more when achieving production rates of more than 100 units per year. We estimated the potential cost reduction in hydrogen compression, storage and dispensing as a result of capital cost reduction to reach 5% or more when hydrogen refueling station systems are produced at scale.

SOFC anodes impregnated with noble metal catalyst nanoparticles for high fuel utilization

Redox-stable solid oxide fuel cell (SOFC) anodes are developed in order to improve durability at higher fuel utilization, as a possible alternative to conventional Ni-zirconia cermet anodes. Ce0.9Gd0.1O2 (GDC) is utilized as a mixed ionic and electronic conductor (MIEC), in combination with Sr0.9La0.1TiO3 (LST) as an electronic conductor. The stability of noble metals (Rh, Pt, and Pd) is analyzed via thermochemical calculation of stable phases. Noble metal catalyst nanoparticles are incorporated via co-impregnation with GDC. The electrochemical characteristics of SOFC single cells using these anode materials are investigated in highly-humidified H2 at 800 °C. Their stability at high fuel utilization is analyzed. These co-impregnated anodes with highly dispersed noble metal catalysts on the LST-GDC conducting backbones, achieve high IV performance comparable to conventional Ni-cermet anodes. The co-impregnated anodes also achieve considerably high catalytic mass activity. At higher oxygen partial pressure, where the Ni catalyst can be deactivated by oxidation, these noble catalysts are thermochemically stable in the metallic state, and tolerant against oxidation. This class of alternative catalyst, impregnated with low-loading of noble metals could contribute to stable operation in the downstream region of SOFC systems. A simple cost analysis indicates a tolerance of using noble metals, provided their loading is sufficiently low.

Comparison of Soy Protein Based and Commercially Available Seed Lubricants for Seed Flowability in Row Crop Planters

Abstract. Seed lubricants play a crucial role in proper seed singulation by ensuring a smooth flow of the seeds through the metering unit. However, the harmful chemicals inadvertently expelled along with the air during the seed metering process have raised concerns regarding the negative effects of available lubricant to the environment. An alternative has been developed from soy protein, however, no knowledge exists regarding its suitability as a potential seed lubricant. Therefore, the objectives of this study was (1) to assess seed flowability by quantifying seed singulation for both corn () and soybean () crops, and (2) to perform a simple cost analysis to determine the cost of usage of each seed lubricant. To address these objectives, two Horsch planter row units were used to run simulated planting scenarios in the laboratory. One row unit was equipped with a seed tube sensor to record seed tube seed count and time interval while the other one was fitted with an encoder to record seed meter motor rpm. These data were used to quantify percentage seed singulation, skips/misses, and multiples. Treatment factors were seed size with three levels: small, medium, large and seed lubricant with four levels: talc, fluency agent; soy protein based, and fourth being no lubricant. Row unit was programmed to plant seeds at 7.2 kph (5 mph) simulated ground speed with a target population of 89,000 seeds/ha for corn and 370,000 seeds/ha for soybean. Each test was replicated three times in a completely randomized design. For corn, result suggests that large seeds of different shapes showed greater singulation irrespective of type of seed lubricant. For soybeans, results suggest that both seed lubricant and seed size could potentially affect seed flowability. Medium size soybeans exhibited greater singulation for all four levels of seed lubricants while Fluency Agent and soy protein resulted in greater singulation along with fewer skips and multiples. A cost analysis shows that usage cost of soy protein as seed lubricant is 63% less expensive as compared to Fluency Agent although slightly expensive by 44% compared to talc. In summary, soy protein could be an alternative seed lubricant for row crop planters in providing equivalent or better seed flowability, cost-effectiveness and environmental stewardship. Keywords: Seed flowability, Row crop planter, Singulation, Seed lubricant, Soy protein.

Spring camelina N rate: balancing agronomics and environmental risk in United States Corn Belt

ABSTRACTCamelina (Camelina sativa (L.) Crantz) seed oil has desirable properties for producing advanced biofuels and as a healthy cooking oil. It has been grown for centuries, but basic recommendations for nitrogen (N) fertilizer requirements are still needed to support widespread industrial cultivation across North America. A replicated N-response plot-scale study was conducted on a northern Mollisol soil for two growing seasons to 1) determine seed and oil yield, seed oil content, and vegetative response; 2) determine indices of N use efficiency; and 3) measure post-harvest residual inorganic soil N as an index of environmental risk. Seed and oil yield response to N fertilization was described with a quadratic function, which predicted maximum seed yield (1450 kg ha−1) and oil yield (580 kg ha−1) at about 130 kg N ha−1. However, seed and oil yield did not differ significantly among N-rates above 34 kg N ha−1. Seed oil content averaged 400 g kg−1 among all N rates. Agronomic efficiency declined above 34 kg N ha−1, which coincided with an increase of post-harvest soil nitrate-N plus ammonium-N (residual N). Considering N use efficiency, simple cost analysis, and risk associated with residual N, a rate of 34 kg N ha−1 is recommended.

Removal of nickel ions from aqueous solutions by manganese dioxide derived from groundwater treatment sludge

Abstract In this study, manganese dioxide (MnO2) derived from groundwater treatment sludge was used in the adsorption of nickel (Ni(II)) ions from aqueous solutions. The synthetic MnO2 was prepared via permanganate reduction using manganese extracted from the sludge by reductive acid leaching and hydroxide precipitation. Scanning electron microscopy images showed aggregated micron-sized MnO2 particles. Fourier transform infrared analysis of MnO2 revealed functional groups at 3,396 cm−1, 1,630 cm−1, 1,427 cm−1 and 468 cm−1 bands. Zeta potential measurements at the pH range of 2–8 confirmed the net negative surface charge of MnO2 particles. Moreover, Ni(II) adsorption by MnO2 was best described by the Langmuir isotherm model, as indicated by the high values for the coefficients of determination (R2> 0.9703). The separation factor (RL) for the range of pH values and initial Ni(II) concentrations considered in this study indicated that Ni(II) adsorption by MnO2 was favorable. The kinetic data of Ni(II) adsorption by MnO2 at pH 6.5 and initial Ni(II) concentrations from 10 to 200 mg L−1 conformed to the pseudo-second order adsorption kinetic model, with R2 > 0.9997. Chemisorption occurred through the complexation of Ni(II) ions with available MnO2 functional groups. The thermodynamic study at temperatures of 298.15, 308.15 and 318.15 K revealed that Ni(II) adsorption by MnO2 was spontaneous and thermodynamically favorable for initial Ni(II) concentrations ranging from 50 to 200 mg L−1. Overall, Ni(II) adsorption by MnO2 was endothermic, as indicated by the positive ΔH° values. In addition, MnO2 had good affinity towards the Ni(II) ions, as shown by the positive ΔS° values at all Ni(II) concentrations. Simple cost analysis revealed that the MnO2 production from groundwater sludge was economically viable and may be scaled up for commercial applications.

Study on wind energy potential for agricultural water pumping system in the middle part of Thailand

A study on wind powered water pumping system aimed for agriculture was carried out in the middle part of Thailand. In this alluvial plain, wind energy potential was determined by making a survey on 21 observation sites. The survey was made in a period of one year, and it has shown that this region locates in a clam climate zone with average wind speeds at about 2 m/s. A wind turbine-water pumping system was installed and evaluated for its performance and efficiency. The result has shown a linear relationship between water discharge capability and the wind speeds. Due to the type of turbine and low wind speed in this region, the system efficiency turned out to be minimal, yet it was practical because the wind power was free. A simple cost analysis from the survey data also has shown that using a wind turbine in this region will be worthwhile when it can be operated for about two decades.

Voltammetric detection of carbofuran determination using screen-printed carbon electrodes modified with gold nanoparticles and graphene oxide

Carbofuran is a highly toxic pesticide that is heavily used in agriculture due to its high effectiveness and low cost. Improved methods that are simpler and lower cost are needed for carbofuran detection in food and agricultural samples. Herein, we describe the development of a unique electrochemical method for carbofuran-phenol, which is the main hydrolysis product of carbofuran. We have successfully developed a highly accurate and precise method in a portable size using a screen-printed carbon electrode (SPCE) that is modified with graphene oxide (GO) and gold nanoparticles (AuNPs). Consequently, the developed electrode is highly sensitive to and selective for carbofuran. Using the central composite design (CCD) approach, we optimized the method for analysis parameters including the electrode surface loadings of GO and AuNPs as well as the working solution pH. The method exhibited a wide linear range of 1–250µM for analyte detection using differential pulse voltammetry (DPV) on AuNPs/GO-SPCE under the optimized conditions. The limits of detection and quantitation were 0.22 and 0.72µM, respectively. In addition, we also report the application of the method for carbofuran determination in real cucumber and rice samples. This sensitive and selective carbofuran detection method is very promising for simple and low cost analysis in real agricultural fields.

Predicting all-cause risk of 30-day hospital readmission using artificial neural networks.

Avoidable hospital readmissions not only contribute to the high costs of healthcare in the US, but also have an impact on the quality of care for patients. Large scale adoption of Electronic Health Records (EHR) has created the opportunity to proactively identify patients with high risk of hospital readmission, and apply effective interventions to mitigate that risk. To that end, in the past, numerous machine-learning models have been employed to predict the risk of 30-day hospital readmission. However, the need for an accurate and real-time predictive model, suitable for hospital setting applications still exists. Here, using data from more than 300,000 hospital stays in California from Sutter Health’s EHR system, we built and tested an artificial neural network (NN) model based on Google’s TensorFlow library. Through comparison with other traditional and non-traditional models, we demonstrated that neural networks are great candidates to capture the complexity and interdependency of various data fields in EHRs. LACE, the current industry standard, showed a precision (PPV) of 0.20 in identifying high-risk patients in our database. In contrast, our NN model yielded a PPV of 0.24, which is a 20% improvement over LACE. Additionally, we discussed the predictive power of Social Determinants of Health (SDoH) data, and presented a simple cost analysis to assist hospitalists in implementing helpful and cost-effective post-discharge interventions.

005 Non-invasive stress imaging as a gatekeeper to complete revascularisation in stemi patients with moderate bystander disease at primary percutaneous coronary intervention

Introduction 40% of patients presenting with STEMI have multivessel disease (MVD). Current international guidelines recommend revascularisation of the culprit artery only. However recent trials (PRAMI/CVLPRIT) have shown a superiority of complete in-hospital revascularisation. Objective: Assess the role of non-invasive stress imaging as a gatekeeper to complete revascularisation in STEMI patients with moderate bystander disease. Methods A registry study of consecutive patients who underwent Primary Percutaneous Coronary Intervention (P-PCI) of the culprit artery. Significant MVD was defined as non-culprit stenosis ≥50% in large proximal epicardial vessel, or ≥75% elsewhere (moderate if 50–74% stenosis in large proximal epicardial vessel, or 75–94% elsewhere). Non-invasive stress imaging was performed at 4 weeks. Patients with severe or critical bystander disease were excluded from the study. A simple cost analysis model was built for UK and USA. Results 1,167 patients were included (74% males, 64 years), 33% demonstrating MVD. 40% of MVD underwent stress CMR, and 36% a stress echocardiogram. The remaining 93 patients underwent direct revascularisation or were lost to follow up. Only 47% had evidence of inducible myocardial ischaemia in moderate bystander coronary artery disease (61/157 in stress CMR and 78/141 in stress echocardiogram). When PCI in MVD is performed only in the presence of inducible myocardial ischemia, there is saving. (UK or US). Conclusions

Parafricta Bootees and Undergarments to Reduce Skin Breakdown in People with or at Risk of Pressure Ulcers: A NICE Medical Technologies Guidance.

As part of the development of the National Institute for Health and Care Excellence (NICE) Medical Technologies Guidance on Parafricta Bootees and Undergarments to reduce skin breakdown in people with, or at risk of, pressure ulcers, the manufacturer (APA Parafricta Ltd) submitted clinical and economic evidence, which was critically appraised by an External Assessment Centre (EAC) and subsequently used by the Medical Technologies Advisory Committee (MTAC) to develop recommendations for further research. The University of Birmingham and Brunel University, acting as a consortium, were commissioned to act as the EAC, independently appraising the submission. This article is an overview of the original evidence submitted, the EAC's findings and the final NICE guidance. Very little comparative evidence was submitted to demonstrate the effectiveness of Parafricta Bootees or Undergarments. The sponsor submitted a simple cost analysis to estimate the costs of using Parafricta in addition to current practice-in comparison with current practice alone-in hospital and community settings separately. The analysis took a National Health Service (NHS) perspective. The basis of the analysis was a previously published comparative study, which showed no statistical difference in average lengths of stay between patients who wore Parafricta Undergarments and Bootees, and those who did not. The economic model incorporated the costs of Parafricta but assumed shorter lengths of stay with Parafricta. The sponsor concluded that Parafricta was cost saving relative to the comparators. The EAC made amendments to the sponsor's analysis to correct for errors and to reflect alternative assumptions. Parafricta remained cost saving in most analyses, and the savings per prevalent case ranged from £757 in the hospital model to £3455 in the community model. All analyses were severely limited by the available data on effectiveness-in particular, a lack of good-quality comparative studies.