AIM To review the early and more recent studies of Bivalirudin, to assess the safety, effectiveness, and cost benefits of this drug.METHODS Literature search of MEDLINE and Pub Med databases from 1990 to 2017 using ke...AIM To review the early and more recent studies of Bivalirudin, to assess the safety, effectiveness, and cost benefits of this drug.METHODS Literature search of MEDLINE and Pub Med databases from 1990 to 2017 using keywords as "bivalirubin" and "angiomax", combined with the words "safety", "effectiveness", "efficiency", "side effects", "toxicity", "adverse effect", and "adverse drug reaction".RESULTS A total of 66 publications were reviewed. The changes in clinical practice and differences in clinical protocols make it difficult to do direct comparisons of studies among each other. However, most trials showed decreased bleeding complications with bivalirudin, although ischemic complications and mortality were mostly comparable, with some favor towards bivalirudin.CONCLUSION Bivalirudin and heparin are both acceptable options according to current ACA/AHA guidelines. Authors conclude however, that that due to bivalirudin safer bleeding profile, it should be the preferred medication for anticoagulation.展开更多
Stroke,which is the second leading cause of mortality worldwide and the third leading cause of death and disability combined,[1]necessitates cost-effective rehabilitation interventions.Acupuncture is a traditional Chi...Stroke,which is the second leading cause of mortality worldwide and the third leading cause of death and disability combined,[1]necessitates cost-effective rehabilitation interventions.Acupuncture is a traditional Chinese medicine therapy that is increasingly recognized as a complementary stroke therapy.展开更多
Gabions are wire baskets filled with rocks and play a critical role in various civil engineering applications.These include roadside stabilization,riverbank protection,erosion control in gullies,dams,reservoirs,and fo...Gabions are wire baskets filled with rocks and play a critical role in various civil engineering applications.These include roadside stabilization,riverbank protection,erosion control in gullies,dams,reservoirs,and foundational support for structures.However,despite their importance,scientific research on gabion technology,particularly in developing countries like Nepal,remains limited.Key challenges include the durability and stability of gabion structures under adverse conditions.To address these gaps,the authors conducted laboratory experiments and field investigations along the Khar Khola River in Gorkha,Nepal.The laboratory experiments compared the performance of Japanese-style gabions and hybrid structures combining Japanese and Nepalese elements,both with and without geotextiles.Meanwhile,field investigations focused on evaluating gabion stability by measuring horizontal deformation.The findings revealed that constructed gabion revetments demonstrated negligible deformation across different designs,signifying high structural stability.However,ensuring long-term effectiveness requires careful installation of base foundations and launching aprons,especially after flooding events,which can destabilize soft foundations and cause bed scouring.The hybrid gabion,blending Japanese and Nepali techniques,emerged as a particularly effective alternative.This design demonstrated improved resilience and stability,retaining its structural integrity even after two years of exposure to flooding and environmental stressors,making it an adaptable and cost-efficient solution for developing regions.展开更多
Introduction:Eliminating hepatitis B virus(HBV)as a major public health threat is a global health priority that requires cost-effective screening strategies.This study evaluated the cost-effectiveness of sequential bi...Introduction:Eliminating hepatitis B virus(HBV)as a major public health threat is a global health priority that requires cost-effective screening strategies.This study evaluated the cost-effectiveness of sequential birth cohort HBV screening strategies in China.Methods:Using a Markov model,we compared five screening strategies with current practice,calculating HBV-related deaths averted,qualityadjusted life years(QALYs)gained,and incremental cost-effectiveness ratios(ICER).One-way deterministic and probabilistic sensitivity analyses were conducted to evaluate the robustness of the results.Results:The sequential birth cohort screening strategy(Sequential Screening 1:screening the 1991–2000 cohort in 2025–2026,the 1971–1990 cohort in 2027–2028,and the 1951–1970 cohort in 2029–2030)was the most cost-effective,with an ICER of 58,523 Chinese Yuan(CNY)per QALY at a willingness-to-pay threshold of three times the percapita Gross Domestic Product(GDP).An alternative strategy that prioritized the 1951–1970 cohort in 2025–2026 averted the most HBV-related deaths(approximately 3.44 million)and gained 24.9 million QALYs,with an ICER of 60,113 CNY per QALY,also showing cost-effectiveness.Discussion:Our findings support sequential birth cohort screening as an optimal and innovative approach to achieving the WHO HBV elimination targets,offering evidence-informed guidance for policymakers to optimize screening programs and resource allocation.展开更多
Introduction:Myopia has emerged as a major public health challenge affecting the visual health of children and adolescents in China.While evidence confirms the effectiveness of outdoor activity in preventing myopia,co...Introduction:Myopia has emerged as a major public health challenge affecting the visual health of children and adolescents in China.While evidence confirms the effectiveness of outdoor activity in preventing myopia,comprehensive economic analyses of its role in mitigating myopia-related diseases remain limited.Methods:This study employed a microsimulation model to evaluate the cost-effectiveness of increasing outdoor activity across different educational stages—primary,middle,and high school—for myopia prevention in China.The model simulated myopia progression among individuals aged 6 to 18 years,with the intervention defined as an additional 40 minutes of daily outdoor activity.Outcomes measured included changes in myopia prevalence,quality-adjusted life years(QALYs),and associated medical costs.Results:All intervention scenarios proved costeffective,except for those targeting only the high school stage.Interventions focused on primary schools and combined primary–middle school stages not only improved health outcomes but also reduced medical costs.While the all-stages intervention yielded the greatest health benefits,its higher implementation costs make it more suitable for regions with greater resources.Conclusion:These findings highlight the critical importance of early intervention in myopia prevention.Policymakers should prioritize outdoor activity programs at the primary school level and develop tailored prevention strategies based on local resource availability.This study provides empirical evidence for developing scientifically sound,cost-effective myopia prevention strategies for children and adolescents,with relevant implications for other developing countries facing a high myopia burden.展开更多
Introduction:Individuals with excess body weight have elevated colorectal cancer(CRC)risk.This study aimed to evaluate the long-term efficacy and costeffectiveness of CRC screening strategies in populations with exces...Introduction:Individuals with excess body weight have elevated colorectal cancer(CRC)risk.This study aimed to evaluate the long-term efficacy and costeffectiveness of CRC screening strategies in populations with excess weight.Methods:A multistate Markov model was used to evaluate the efficacy and cost-effectiveness of CRC screening.Three hypothetical cohorts were simulated based on body mass index(BMI)subgroups:normal,overweight,and obese.Screening strategies included colonoscopy(every 10 years)or an annual fecal immunochemical test,initiated at ages 45 and 50.Key outcomes included CRC cases,deaths,quality-adjusted life-year(QALY),lifetime costs,endoscopic resource use,and incremental cost-effectiveness ratios.Results:QALY gains increased from 0.097[95%confidence interval(CI):0.091–0.102]in individuals with normal weight to 0.104(0.101–0.107)in those who were overweight and 0.108(0.105–0.111)in those who were obese.Individuals who were overweight or obese demonstrated 6%–14%greater colonoscopy efficiency compared with those of normal weight.All screening strategies were cost-effective(incremental cost-effectiveness ratio=USD 671–USD 949 per QALY gained),with a marginal decrease in cost per QALY gained observed at higher BMI.Despite improved cost-effectiveness,lifetime healthcare expenditures were higher in individuals who were overweight($845.19–$955.00)and obese($1,358.00–$1,467.37)than in those with normal weight($119.62–$229.20).Conclusion:CRC screening in China demonstrated effectiveness and cost-effectiveness across BMI groups,with populations with excess weight showing high colonoscopy resource efficiency.Amid rising lifetime healthcare costs attributable to high BMI,integrating weight management with CRC screening is critical for optimizing health and economic benefits.展开更多
A much more sustainable,cost effective and very flexible process for manufacturing critical fibres based on ultra high molecular weight polyethylene(UHMWPE)is being launched by the UK’s Fibre Extrusion Technologies(F...A much more sustainable,cost effective and very flexible process for manufacturing critical fibres based on ultra high molecular weight polyethylene(UHMWPE)is being launched by the UK’s Fibre Extrusion Technologies(FET).展开更多
A cost-effective ultra-dense wavelength-division-multiplexed passive optical network(UD-WDM PON) with speed of 12.5 Gbit/s and channel spacing of 12.5 GHz is proposed and demonstrated. The distributed feedback(DFB) la...A cost-effective ultra-dense wavelength-division-multiplexed passive optical network(UD-WDM PON) with speed of 12.5 Gbit/s and channel spacing of 12.5 GHz is proposed and demonstrated. The distributed feedback(DFB) lasers modulated in 4-level pulse amplitude modulation(4-PAM) format are used for downstream links, and the reflective semiconductor optical amplifiers(RSOAs) together with an optical frequency comb modulated in quadrature phase shift keying(QPSK) format are used for upstream links. We can achieve the error-free transmission of the upstream signals with speed of 12.5 Gbit/s even after 20 km single-mode fiber(SMF). The power penalty obtained by using the frequency comb generator instead of a tunable laser is around 0.5 d B. By using 11 DFB lasers and a set of intensity and phase modulators, it is possible to provide the seed light for 297 optical network units(ONUs) within the C-band.展开更多
Blindness affected 45 million people globally in 2021,and moderate to severe vision loss a further 295 million.[1]The most common causes,cataract and uncorrected refractive error,are generally the easiest to treat,and...Blindness affected 45 million people globally in 2021,and moderate to severe vision loss a further 295 million.[1]The most common causes,cataract and uncorrected refractive error,are generally the easiest to treat,and are among the most cost-effective procedures in all of medicine and international development.[1-2]Thus,vision impairment is both extremely common and,in principle,readily manageable.展开更多
In today’s world, Cloud Computing (CC) enables the users to accesscomputing resources and services over cloud without any need to own the infrastructure. Cloud Computing is a concept in which a network of devices, lo...In today’s world, Cloud Computing (CC) enables the users to accesscomputing resources and services over cloud without any need to own the infrastructure. Cloud Computing is a concept in which a network of devices, located inremote locations, is integrated to perform operations like data collection, processing, data profiling and data storage. In this context, resource allocation and taskscheduling are important processes which must be managed based on the requirements of a user. In order to allocate the resources effectively, hybrid cloud isemployed since it is a capable solution to process large-scale consumer applications in a pay-by-use manner. Hence, the model is to be designed as a profit-driven framework to reduce cost and make span. With this motivation, the currentresearch work develops a Cost-Effective Optimal Task Scheduling Model(CEOTS). A novel algorithm called Target-based Cost Derivation (TCD) modelis used in the proposed work for hybrid clouds. Moreover, the algorithm workson the basis of multi-intentional task completion process with optimal resourceallocation. The model was successfully simulated to validate its effectivenessbased on factors such as processing time, make span and efficient utilization ofvirtual machines. The results infer that the proposed model outperformed theexisting works and can be relied in future for real-time applications.展开更多
AIM: To analyze the cost-effectiveness of the diagnosis of solitary pulmonary nodule(SPN) in China. METHODS: Decision analysis models were constructed to assess the cost-effectiveness of four strategies for the manage...AIM: To analyze the cost-effectiveness of the diagnosis of solitary pulmonary nodule(SPN) in China. METHODS: Decision analysis models were constructed to assess the cost-effectiveness of four strategies for the management of SPN: computed tomography(CT) alone, CT plus CT-guided automated cutting needle biopsy(ACNB), CT plus positron emission tomography/computed tomography(PET/CT), CT plus diffusionweighted magnetic resonance imaging(DWI) plus PET/CT. RESULTS: The prevalence of lung cancer among SPN discovered in the clinical setting was approximately 50%. The CT plus ACNB strategy had higher diagnostic accuracies(87% vs 81%), with a cost saving of $1945 RMB per patient, and reducing unnecessary thoracotomy by 16.5%; this was associated with a 4.5% missed diagnosis rate. CT plus DWI plus PET/CT strategy also had higher accuracies(95% vs 81%), with a cost saving of $590 RMB per patient, and reducing unneces-sary thoracotomy by 13.5%; this was accompanied by 0.3% missed diagnosis rate. CT plus PET strategy is cost effective at a prevalence rate of 0-34%, but there was a larger prevalence range of lung cancer for CT plus ACNB strategy(from 0 to 0.6) and CT plus DWI plus PET/CT strategy(from 0 to 0.64). CONCLUSION: CT plus DWI plus PET/CT strategy was cost-effective, and had a higher accuracy accompanied by a lower missed diagnosis rate than CT plus ACNB strategy.展开更多
The NEC （National Emission Ceiling） directive has set targets for the 2010 ammonia emissions from a number of European countries. The target will be reached by most EU-countries and the total emission for EU-27 has ...The NEC （National Emission Ceiling） directive has set targets for the 2010 ammonia emissions from a number of European countries. The target will be reached by most EU-countries and the total emission for EU-27 has been reduced by 22% from 1990 to 2007. Denmark is one of the countries with the largest reductions since 1990 and the article aims at the measures and costs involved. The conclusion is that the costs have been under 3ε per kg NH3-N. Measures in several countries are under 5ε per kg NH3-N, which is a likely minimum for the benefits of reducing NH3-N. The findings suggest that the same measures might be cheaper in the Netherlands and Denmark than in the UK and the USA due to technology advances and stricter regulations in the past. The new Danish application procedure, when increasing the animal production, has tried to make the acceptance procedure quicker and dynamic ensuring that new technology is adopted quicker and that the farm has the right location. It is concluded that the new application process so far has not lived up to the high expectations at the outset. Despite this, the paper concludes that Denmark is likely to reduce emission by 50% from 1990 to 2020 and reach the likely 2020 NEC ceiling.展开更多
Objective: To review our open partial nephrectomy (OPN) experience and compare to known robotic partial nephrectomy (RPN) data to determine whether length of stay (LOS) and morbidity are significant drivers in the sur...Objective: To review our open partial nephrectomy (OPN) experience and compare to known robotic partial nephrectomy (RPN) data to determine whether length of stay (LOS) and morbidity are significant drivers in the surgical approach employed for partial nephrectomy. Methods: We reviewed our OPN experience during the last 3 years examining age, tumor size, LOS, pathology, blood loss, complications, recurences, and deaths. Results: Seventy-five patients underwent OPN during this period. Mean age was 59 years, tumor size 2.8 cm, percent malignant 75%, estimated blood loss 350 cc. With a median follow-up of 18 months, there was one urinoma managed by drain-age, one pseudo aneurysm that required embolization and one pulmonary embolism that required anticoagulation. There were no readmissions, no tumor recurences, and no deaths. Our major complication rate was 4% as compared to other trials that re-ported major complication rates between 1% - 9% for RPN and between 3% - 24% for OPN. In the first half of the experience (n = 37), median LOS was 57 hours. Using a pathway encouraging early ambulation and smaller incisions in the second half of the experience (n = 38), median LOS was 35 hours. This is much shorter than reported RPN LOS of 62 - 67 hours and OPN LOS of 108 - 142 hours. Conclusion: OPN can be performed safely and effectively with one night hospital stay. This provides a more cost-effective approach to partial nephrectomy with similar or better complication rates and calls into question the main value drivers of RPN.展开更多
The extraction of DNA for molecular analyses is often a limiting factor in terms of cost, time, and availability of skilled labor Here the authors describe a simple extraction protocol for obtaining DNA from field and...The extraction of DNA for molecular analyses is often a limiting factor in terms of cost, time, and availability of skilled labor Here the authors describe a simple extraction protocol for obtaining DNA from field and greenhouse grown plants. This method was optimized for sampling mature wild sorghum populations in remote areas of Ethiopia and young greenhouse grown seedlings for genetic studies using microsatellite loci. Initially, the leaf squashes are made on Whatman FTA plant saver cards or small cards of Whatman chromatography paper. After several washes, sufficient DNA to run up to 70 PCR amplifications is eluted from a 6 mm disk. Both types of cards were equally effective for collecting genomic DNA from young and mature sorghum plants for PCR-based analyses. The use of this technology for extracting genomic DNA from seedlings and/or mature plants in situ is particularly attractive for sampling at sites that are far from the laboratory where samples are ultimately analyzed. Moreover, highly skilled personnel are not required to collect DNA samples using this protocol. The Whatman FTA card is more expensive than the Wbatman chromatography paper. Therefore, without compromising efficiency, the lower cost chromatography paper can be used for DNA extraction, especially for institutions in developing countries.展开更多
Discharging patients directly to home from the intensive care unit(ICU)is becoming a new trend.This review examines the feasibility,benefits,challenges,and considerations of directly discharging ICU patients.By analyz...Discharging patients directly to home from the intensive care unit(ICU)is becoming a new trend.This review examines the feasibility,benefits,challenges,and considerations of directly discharging ICU patients.By analyzing available evidence and healthcare professionals'experiences,the review explores the potential impacts on patient outcomes and healthcare systems.The practice of direct discharge from the ICU presents both opportunities and complexities.While it can potentially reduce costs,enhance patient comfort,and mitigate complications linked to extended hospitalization,it necessitates meticulous patient selection and robust post-discharge support mechanisms.Implementing this strategy successfully mandates the availability of home-based care services and a careful assessment of the patient's readiness for the transition.Through critical evaluation of existing literature,this review underscores the significance of tailored patient selection criteria and comprehensive post-discharge support systems to ensure patient safety and optimal recovery.The insights provided contribute evidence-based recommendations for refining the direct discharge approach,fostering improved patient outcomes,heightened satisfaction,and streamlined healthcare processes.Ultimately,the review seeks to balance patientcentered care and effective resource utilization within ICU discharge strategies.展开更多
The practical application of aqueous zinc-ion batteries(AZIBs)is limited by zinc dendrites,parasitic reactions,and self-discharging.Quasi-solid-state electrolytes(QSSEs)are promising solutions but have high costs,low ...The practical application of aqueous zinc-ion batteries(AZIBs)is limited by zinc dendrites,parasitic reactions,and self-discharging.Quasi-solid-state electrolytes(QSSEs)are promising solutions but have high costs,low conductivity,and inadequate self-discharge-suppression capability.This study introduces a novel“water-in-montmorillonite(Mont)”(WiME)electrolyte to address these limitations.WiME leverages the layered struc-ture of the inexpensive Mont to confine water,achieving a high ionic conductivity of 64.82 mS/cm and remark-able self-discharge suppression capability and maintaining 92.7%capacity after 720 h.The WiME architec-ture facilitates uniform Zn deposition and promotes cycling stability at high current densities.WiME-based symmetric cells show excellent long-term cycling,surpassing 1900 h,and full Zn||MnOOH cells display stable cycling for 500 cycles without capacity decay,demonstrating synergy among mitigated parasitic reactions,homogenous zinc deposition,and enhanced interfacial stability enabled by WiMEs.This study presents a low-cost and high-performance strategy for advancing the practical application of AZIBs for various fields.展开更多
Miniaturization of photoacoustic microscopy(PAM)to portable and wearable levels requires special design of scanning,detection,acquisition,and excitation units.Now the first three can be minimized to gram and millimete...Miniaturization of photoacoustic microscopy(PAM)to portable and wearable levels requires special design of scanning,detection,acquisition,and excitation units.Now the first three can be minimized to gram and millimeter levels,but the excitation sources usually remain bulky and also face different challenges,including low pulse energy,wide pulse width,limited wavelength,or high cost.展开更多
AIM： To discuss the efficacy of endoscopic mass screening for gastric cancer.METHODS： The data used in this study were the results of mass screening programs for gastric cancer in Niigata City from 2002 to 2004. The...AIM： To discuss the efficacy of endoscopic mass screening for gastric cancer.METHODS： The data used in this study were the results of mass screening programs for gastric cancer in Niigata City from 2002 to 2004. The number of participants was 35089 in 2002, 34557 in 2003 and 36600 in 2004. The finding ratio referred to the final diagnosis of gastric cancer after a double check of endoscopic files and histological findings. The costs of identifying one case of gastric cancer were calculated based on the total expense for each screening program and additional close examinations. RESULTS： From the analysis of individual screening program with endoscopy, individual screening program with X-ray （ISX） and mass screening program with photofluorography （MSP） in reference to the finding ratio of gastric cancer, endoscopic examination was the best for detecting early gastric cancer, the finding ratio was 0.87% in 2004, approximately 2.7 and 4.6 times higher than those of the ISX and MSP groups. In addition, this novel method was the cheapest means regarding the cost of identifying one case of gastric cancer, which was estimated to be 1608000 Japanese yen in 2004. CONCLUSION： Endoscopic mass screening is a promising method and can be effectively applied if a sufficient number of skilled endoscopists become available to staff the system and if city offices support it.展开更多
Problems continue to be encountered concerning the traditional vacuum preloading method in field during the treatment of newly deposited dredger fills.In this paper,an improved multiple-vacuum preloading method was de...Problems continue to be encountered concerning the traditional vacuum preloading method in field during the treatment of newly deposited dredger fills.In this paper,an improved multiple-vacuum preloading method was developed to consolidate newly dredger fills that are hydraulically placed in seawater for land reclamation in Lingang Industrial Zone of Tianjin City,China.With this multiplevacuum preloading method,the newly deposited dredger fills could be treated effectively by adopting a novel moisture separator and a rapid improvement technique without sand cushion.A series of model tests was conducted in the laboratory for comparing the results from the multiple-vacuum preloading method and the traditional one.Ten piezometers and settlement plates were installed to measure the variations in excess pore water pressures and moisture content,and vane shear strength was measured at different positions.The testing results indicate that water dischargeetime curves obtained by the traditional vacuum preloading method can be divided into three phases:rapid growth phase,slow growth phase,and steady phase.According to the process of fluid flow concentrated along tiny ripples and building of larger channels inside soils during the whole vacuum loading process,the fluctuations of pore water pressure during each loading step are divided into three phases:steady phase,rapid dissipation phase,and slow dissipation phase.An optimal loading pattern which could have a best treatment effect was proposed for calculating the water discharge and pore water pressure of soil using the improved multiple-vacuum preloading method.For the newly deposited dredger fills at Lingang Industrial Zone of Tianjin City,the best loading step was 20 kPa and the loading of 40-50 k Pa produced the highest drainage consolidation.The measured moisture content and vane shear strength were discussed in terms of the effect of reinforcement,both of which indicate that the multiple-vacuum preloading method has a better treatment effect not only in decreasing the moisture content and increasing the bearing capacity,but also in increasing the process uniformity at different depths of foundation.展开更多
As the gap between a shortage of organs and the im-mense demand for liver grafts persists, every available donor liver needs to be optimized for utility, urgency and equity. To overcome this challenge, decision modell...As the gap between a shortage of organs and the im-mense demand for liver grafts persists, every available donor liver needs to be optimized for utility, urgency and equity. To overcome this challenge, decision modelling might allow us to gather evidence from previous studies as well as compare the costs and consequences of alternative options. For public health policy and clinical intervention assessment, it is a potentially powerful tool. The most commonly used types of decision analytical models include decision trees, the Markov model, microsimulation, discrete event simulation and the system dynamic model. Analytic models could support decision makers in the field of liver transplantation when facing specifc problems by synthesizing evidence, comprising all relevant options, generalizing results to other contexts, extending the time horizon and exploring the uncertainty. For modeling studies of economic evaluation for transplantation, understanding the current nature of the disease is crucial, as well as the selection of appropriate modelling techniques. The quality and availability of data is another key element for the selection and development of decision analytical models. In addition, good practice guidelines should be complied, which is important for standardization and comparability between economic outputs.展开更多
文摘AIM To review the early and more recent studies of Bivalirudin, to assess the safety, effectiveness, and cost benefits of this drug.METHODS Literature search of MEDLINE and Pub Med databases from 1990 to 2017 using keywords as "bivalirubin" and "angiomax", combined with the words "safety", "effectiveness", "efficiency", "side effects", "toxicity", "adverse effect", and "adverse drug reaction".RESULTS A total of 66 publications were reviewed. The changes in clinical practice and differences in clinical protocols make it difficult to do direct comparisons of studies among each other. However, most trials showed decreased bleeding complications with bivalirudin, although ischemic complications and mortality were mostly comparable, with some favor towards bivalirudin.CONCLUSION Bivalirudin and heparin are both acceptable options according to current ACA/AHA guidelines. Authors conclude however, that that due to bivalirudin safer bleeding profile, it should be the preferred medication for anticoagulation.
基金supported by the social development project of the National Social Science Fund Project(No.17BTQ063)National Natural Science Foundation of China(72174094).
文摘Stroke,which is the second leading cause of mortality worldwide and the third leading cause of death and disability combined,[1]necessitates cost-effective rehabilitation interventions.Acupuncture is a traditional Chinese medicine therapy that is increasingly recognized as a complementary stroke therapy.
文摘Gabions are wire baskets filled with rocks and play a critical role in various civil engineering applications.These include roadside stabilization,riverbank protection,erosion control in gullies,dams,reservoirs,and foundational support for structures.However,despite their importance,scientific research on gabion technology,particularly in developing countries like Nepal,remains limited.Key challenges include the durability and stability of gabion structures under adverse conditions.To address these gaps,the authors conducted laboratory experiments and field investigations along the Khar Khola River in Gorkha,Nepal.The laboratory experiments compared the performance of Japanese-style gabions and hybrid structures combining Japanese and Nepalese elements,both with and without geotextiles.Meanwhile,field investigations focused on evaluating gabion stability by measuring horizontal deformation.The findings revealed that constructed gabion revetments demonstrated negligible deformation across different designs,signifying high structural stability.However,ensuring long-term effectiveness requires careful installation of base foundations and launching aprons,especially after flooding events,which can destabilize soft foundations and cause bed scouring.The hybrid gabion,blending Japanese and Nepali techniques,emerged as a particularly effective alternative.This design demonstrated improved resilience and stability,retaining its structural integrity even after two years of exposure to flooding and environmental stressors,making it an adaptable and cost-efficient solution for developing regions.
文摘Introduction:Eliminating hepatitis B virus(HBV)as a major public health threat is a global health priority that requires cost-effective screening strategies.This study evaluated the cost-effectiveness of sequential birth cohort HBV screening strategies in China.Methods:Using a Markov model,we compared five screening strategies with current practice,calculating HBV-related deaths averted,qualityadjusted life years(QALYs)gained,and incremental cost-effectiveness ratios(ICER).One-way deterministic and probabilistic sensitivity analyses were conducted to evaluate the robustness of the results.Results:The sequential birth cohort screening strategy(Sequential Screening 1:screening the 1991–2000 cohort in 2025–2026,the 1971–1990 cohort in 2027–2028,and the 1951–1970 cohort in 2029–2030)was the most cost-effective,with an ICER of 58,523 Chinese Yuan(CNY)per QALY at a willingness-to-pay threshold of three times the percapita Gross Domestic Product(GDP).An alternative strategy that prioritized the 1951–1970 cohort in 2025–2026 averted the most HBV-related deaths(approximately 3.44 million)and gained 24.9 million QALYs,with an ICER of 60,113 CNY per QALY,also showing cost-effectiveness.Discussion:Our findings support sequential birth cohort screening as an optimal and innovative approach to achieving the WHO HBV elimination targets,offering evidence-informed guidance for policymakers to optimize screening programs and resource allocation.
基金supported by the National Natural Science Foundation of China(72293585,72404183).
文摘Introduction:Myopia has emerged as a major public health challenge affecting the visual health of children and adolescents in China.While evidence confirms the effectiveness of outdoor activity in preventing myopia,comprehensive economic analyses of its role in mitigating myopia-related diseases remain limited.Methods:This study employed a microsimulation model to evaluate the cost-effectiveness of increasing outdoor activity across different educational stages—primary,middle,and high school—for myopia prevention in China.The model simulated myopia progression among individuals aged 6 to 18 years,with the intervention defined as an additional 40 minutes of daily outdoor activity.Outcomes measured included changes in myopia prevalence,quality-adjusted life years(QALYs),and associated medical costs.Results:All intervention scenarios proved costeffective,except for those targeting only the high school stage.Interventions focused on primary schools and combined primary–middle school stages not only improved health outcomes but also reduced medical costs.While the all-stages intervention yielded the greatest health benefits,its higher implementation costs make it more suitable for regions with greater resources.Conclusion:These findings highlight the critical importance of early intervention in myopia prevention.Policymakers should prioritize outdoor activity programs at the primary school level and develop tailored prevention strategies based on local resource availability.This study provides empirical evidence for developing scientifically sound,cost-effective myopia prevention strategies for children and adolescents,with relevant implications for other developing countries facing a high myopia burden.
基金Supported by the National Natural Science Foundation of China(grant number:82404340)Peking Union Medical College Union Youth Research Fund(grant number:3332024216)CAMS Innovation Fund for Medical Science(grant numbers:2021-I2M-1-067 and 2021-I2M-1-011).
文摘Introduction:Individuals with excess body weight have elevated colorectal cancer(CRC)risk.This study aimed to evaluate the long-term efficacy and costeffectiveness of CRC screening strategies in populations with excess weight.Methods:A multistate Markov model was used to evaluate the efficacy and cost-effectiveness of CRC screening.Three hypothetical cohorts were simulated based on body mass index(BMI)subgroups:normal,overweight,and obese.Screening strategies included colonoscopy(every 10 years)or an annual fecal immunochemical test,initiated at ages 45 and 50.Key outcomes included CRC cases,deaths,quality-adjusted life-year(QALY),lifetime costs,endoscopic resource use,and incremental cost-effectiveness ratios.Results:QALY gains increased from 0.097[95%confidence interval(CI):0.091–0.102]in individuals with normal weight to 0.104(0.101–0.107)in those who were overweight and 0.108(0.105–0.111)in those who were obese.Individuals who were overweight or obese demonstrated 6%–14%greater colonoscopy efficiency compared with those of normal weight.All screening strategies were cost-effective(incremental cost-effectiveness ratio=USD 671–USD 949 per QALY gained),with a marginal decrease in cost per QALY gained observed at higher BMI.Despite improved cost-effectiveness,lifetime healthcare expenditures were higher in individuals who were overweight($845.19–$955.00)and obese($1,358.00–$1,467.37)than in those with normal weight($119.62–$229.20).Conclusion:CRC screening in China demonstrated effectiveness and cost-effectiveness across BMI groups,with populations with excess weight showing high colonoscopy resource efficiency.Amid rising lifetime healthcare costs attributable to high BMI,integrating weight management with CRC screening is critical for optimizing health and economic benefits.
文摘A much more sustainable,cost effective and very flexible process for manufacturing critical fibres based on ultra high molecular weight polyethylene(UHMWPE)is being launched by the UK’s Fibre Extrusion Technologies(FET).
基金supported by the National Natural Science Foundation of China(No.61475015)
文摘A cost-effective ultra-dense wavelength-division-multiplexed passive optical network(UD-WDM PON) with speed of 12.5 Gbit/s and channel spacing of 12.5 GHz is proposed and demonstrated. The distributed feedback(DFB) lasers modulated in 4-level pulse amplitude modulation(4-PAM) format are used for downstream links, and the reflective semiconductor optical amplifiers(RSOAs) together with an optical frequency comb modulated in quadrature phase shift keying(QPSK) format are used for upstream links. We can achieve the error-free transmission of the upstream signals with speed of 12.5 Gbit/s even after 20 km single-mode fiber(SMF). The power penalty obtained by using the frequency comb generator instead of a tunable laser is around 0.5 d B. By using 11 DFB lasers and a set of intensity and phase modulators, it is possible to provide the seed light for 297 optical network units(ONUs) within the C-band.
文摘Blindness affected 45 million people globally in 2021,and moderate to severe vision loss a further 295 million.[1]The most common causes,cataract and uncorrected refractive error,are generally the easiest to treat,and are among the most cost-effective procedures in all of medicine and international development.[1-2]Thus,vision impairment is both extremely common and,in principle,readily manageable.
文摘In today’s world, Cloud Computing (CC) enables the users to accesscomputing resources and services over cloud without any need to own the infrastructure. Cloud Computing is a concept in which a network of devices, located inremote locations, is integrated to perform operations like data collection, processing, data profiling and data storage. In this context, resource allocation and taskscheduling are important processes which must be managed based on the requirements of a user. In order to allocate the resources effectively, hybrid cloud isemployed since it is a capable solution to process large-scale consumer applications in a pay-by-use manner. Hence, the model is to be designed as a profit-driven framework to reduce cost and make span. With this motivation, the currentresearch work develops a Cost-Effective Optimal Task Scheduling Model(CEOTS). A novel algorithm called Target-based Cost Derivation (TCD) modelis used in the proposed work for hybrid clouds. Moreover, the algorithm workson the basis of multi-intentional task completion process with optimal resourceallocation. The model was successfully simulated to validate its effectivenessbased on factors such as processing time, make span and efficient utilization ofvirtual machines. The results infer that the proposed model outperformed theexisting works and can be relied in future for real-time applications.
文摘AIM: To analyze the cost-effectiveness of the diagnosis of solitary pulmonary nodule(SPN) in China. METHODS: Decision analysis models were constructed to assess the cost-effectiveness of four strategies for the management of SPN: computed tomography(CT) alone, CT plus CT-guided automated cutting needle biopsy(ACNB), CT plus positron emission tomography/computed tomography(PET/CT), CT plus diffusionweighted magnetic resonance imaging(DWI) plus PET/CT. RESULTS: The prevalence of lung cancer among SPN discovered in the clinical setting was approximately 50%. The CT plus ACNB strategy had higher diagnostic accuracies(87% vs 81%), with a cost saving of $1945 RMB per patient, and reducing unnecessary thoracotomy by 16.5%; this was associated with a 4.5% missed diagnosis rate. CT plus DWI plus PET/CT strategy also had higher accuracies(95% vs 81%), with a cost saving of $590 RMB per patient, and reducing unneces-sary thoracotomy by 13.5%; this was accompanied by 0.3% missed diagnosis rate. CT plus PET strategy is cost effective at a prevalence rate of 0-34%, but there was a larger prevalence range of lung cancer for CT plus ACNB strategy(from 0 to 0.6) and CT plus DWI plus PET/CT strategy(from 0 to 0.64). CONCLUSION: CT plus DWI plus PET/CT strategy was cost-effective, and had a higher accuracy accompanied by a lower missed diagnosis rate than CT plus ACNB strategy.
文摘The NEC （National Emission Ceiling） directive has set targets for the 2010 ammonia emissions from a number of European countries. The target will be reached by most EU-countries and the total emission for EU-27 has been reduced by 22% from 1990 to 2007. Denmark is one of the countries with the largest reductions since 1990 and the article aims at the measures and costs involved. The conclusion is that the costs have been under 3ε per kg NH3-N. Measures in several countries are under 5ε per kg NH3-N, which is a likely minimum for the benefits of reducing NH3-N. The findings suggest that the same measures might be cheaper in the Netherlands and Denmark than in the UK and the USA due to technology advances and stricter regulations in the past. The new Danish application procedure, when increasing the animal production, has tried to make the acceptance procedure quicker and dynamic ensuring that new technology is adopted quicker and that the farm has the right location. It is concluded that the new application process so far has not lived up to the high expectations at the outset. Despite this, the paper concludes that Denmark is likely to reduce emission by 50% from 1990 to 2020 and reach the likely 2020 NEC ceiling.
文摘Objective: To review our open partial nephrectomy (OPN) experience and compare to known robotic partial nephrectomy (RPN) data to determine whether length of stay (LOS) and morbidity are significant drivers in the surgical approach employed for partial nephrectomy. Methods: We reviewed our OPN experience during the last 3 years examining age, tumor size, LOS, pathology, blood loss, complications, recurences, and deaths. Results: Seventy-five patients underwent OPN during this period. Mean age was 59 years, tumor size 2.8 cm, percent malignant 75%, estimated blood loss 350 cc. With a median follow-up of 18 months, there was one urinoma managed by drain-age, one pseudo aneurysm that required embolization and one pulmonary embolism that required anticoagulation. There were no readmissions, no tumor recurences, and no deaths. Our major complication rate was 4% as compared to other trials that re-ported major complication rates between 1% - 9% for RPN and between 3% - 24% for OPN. In the first half of the experience (n = 37), median LOS was 57 hours. Using a pathway encouraging early ambulation and smaller incisions in the second half of the experience (n = 38), median LOS was 35 hours. This is much shorter than reported RPN LOS of 62 - 67 hours and OPN LOS of 108 - 142 hours. Conclusion: OPN can be performed safely and effectively with one night hospital stay. This provides a more cost-effective approach to partial nephrectomy with similar or better complication rates and calls into question the main value drivers of RPN.
文摘The extraction of DNA for molecular analyses is often a limiting factor in terms of cost, time, and availability of skilled labor Here the authors describe a simple extraction protocol for obtaining DNA from field and greenhouse grown plants. This method was optimized for sampling mature wild sorghum populations in remote areas of Ethiopia and young greenhouse grown seedlings for genetic studies using microsatellite loci. Initially, the leaf squashes are made on Whatman FTA plant saver cards or small cards of Whatman chromatography paper. After several washes, sufficient DNA to run up to 70 PCR amplifications is eluted from a 6 mm disk. Both types of cards were equally effective for collecting genomic DNA from young and mature sorghum plants for PCR-based analyses. The use of this technology for extracting genomic DNA from seedlings and/or mature plants in situ is particularly attractive for sampling at sites that are far from the laboratory where samples are ultimately analyzed. Moreover, highly skilled personnel are not required to collect DNA samples using this protocol. The Whatman FTA card is more expensive than the Wbatman chromatography paper. Therefore, without compromising efficiency, the lower cost chromatography paper can be used for DNA extraction, especially for institutions in developing countries.
文摘Discharging patients directly to home from the intensive care unit(ICU)is becoming a new trend.This review examines the feasibility,benefits,challenges,and considerations of directly discharging ICU patients.By analyzing available evidence and healthcare professionals'experiences,the review explores the potential impacts on patient outcomes and healthcare systems.The practice of direct discharge from the ICU presents both opportunities and complexities.While it can potentially reduce costs,enhance patient comfort,and mitigate complications linked to extended hospitalization,it necessitates meticulous patient selection and robust post-discharge support mechanisms.Implementing this strategy successfully mandates the availability of home-based care services and a careful assessment of the patient's readiness for the transition.Through critical evaluation of existing literature,this review underscores the significance of tailored patient selection criteria and comprehensive post-discharge support systems to ensure patient safety and optimal recovery.The insights provided contribute evidence-based recommendations for refining the direct discharge approach,fostering improved patient outcomes,heightened satisfaction,and streamlined healthcare processes.Ultimately,the review seeks to balance patientcentered care and effective resource utilization within ICU discharge strategies.
基金supported by National Key Research and Development Program of China(Grant No.2022YFB2404500)Shenzhen Outstanding Talents Training Fund(Grant No.01090100002)+1 种基金National Natural Science Foundation of China(Grant No.52201280)Natural Science Foundation of Shandong Province(Grant No.ZR2021QB200).
文摘The practical application of aqueous zinc-ion batteries(AZIBs)is limited by zinc dendrites,parasitic reactions,and self-discharging.Quasi-solid-state electrolytes(QSSEs)are promising solutions but have high costs,low conductivity,and inadequate self-discharge-suppression capability.This study introduces a novel“water-in-montmorillonite(Mont)”(WiME)electrolyte to address these limitations.WiME leverages the layered struc-ture of the inexpensive Mont to confine water,achieving a high ionic conductivity of 64.82 mS/cm and remark-able self-discharge suppression capability and maintaining 92.7%capacity after 720 h.The WiME architec-ture facilitates uniform Zn deposition and promotes cycling stability at high current densities.WiME-based symmetric cells show excellent long-term cycling,surpassing 1900 h,and full Zn||MnOOH cells display stable cycling for 500 cycles without capacity decay,demonstrating synergy among mitigated parasitic reactions,homogenous zinc deposition,and enhanced interfacial stability enabled by WiMEs.This study presents a low-cost and high-performance strategy for advancing the practical application of AZIBs for various fields.
基金National Natural Science Foundation of China(62305274,62475222,62205163)NaturalScience Foundation of Xiamen Municipality(3502Z202371001,3502Z20227162)+1 种基金Natural Science Foundation of Fujian Province(2024J01056)Xiamen University(20720240025).
文摘Miniaturization of photoacoustic microscopy(PAM)to portable and wearable levels requires special design of scanning,detection,acquisition,and excitation units.Now the first three can be minimized to gram and millimeter levels,but the excitation sources usually remain bulky and also face different challenges,including low pulse energy,wide pulse width,limited wavelength,or high cost.
文摘AIM： To discuss the efficacy of endoscopic mass screening for gastric cancer.METHODS： The data used in this study were the results of mass screening programs for gastric cancer in Niigata City from 2002 to 2004. The number of participants was 35089 in 2002, 34557 in 2003 and 36600 in 2004. The finding ratio referred to the final diagnosis of gastric cancer after a double check of endoscopic files and histological findings. The costs of identifying one case of gastric cancer were calculated based on the total expense for each screening program and additional close examinations. RESULTS： From the analysis of individual screening program with endoscopy, individual screening program with X-ray （ISX） and mass screening program with photofluorography （MSP） in reference to the finding ratio of gastric cancer, endoscopic examination was the best for detecting early gastric cancer, the finding ratio was 0.87% in 2004, approximately 2.7 and 4.6 times higher than those of the ISX and MSP groups. In addition, this novel method was the cheapest means regarding the cost of identifying one case of gastric cancer, which was estimated to be 1608000 Japanese yen in 2004. CONCLUSION： Endoscopic mass screening is a promising method and can be effectively applied if a sufficient number of skilled endoscopists become available to staff the system and if city offices support it.
基金the National Natural Science Foundation of China(NSFC)(Grant Nos.51378344 and 51578371)Tianjin Research Program of Application Foundation and Advanced Technology(Grant No.14JCYBJC21700)Beijing-Tianjin-Hebei Special Projects of Cooperation(Grant No.16JCJDJC40000) for their financial supports
文摘Problems continue to be encountered concerning the traditional vacuum preloading method in field during the treatment of newly deposited dredger fills.In this paper,an improved multiple-vacuum preloading method was developed to consolidate newly dredger fills that are hydraulically placed in seawater for land reclamation in Lingang Industrial Zone of Tianjin City,China.With this multiplevacuum preloading method,the newly deposited dredger fills could be treated effectively by adopting a novel moisture separator and a rapid improvement technique without sand cushion.A series of model tests was conducted in the laboratory for comparing the results from the multiple-vacuum preloading method and the traditional one.Ten piezometers and settlement plates were installed to measure the variations in excess pore water pressures and moisture content,and vane shear strength was measured at different positions.The testing results indicate that water dischargeetime curves obtained by the traditional vacuum preloading method can be divided into three phases:rapid growth phase,slow growth phase,and steady phase.According to the process of fluid flow concentrated along tiny ripples and building of larger channels inside soils during the whole vacuum loading process,the fluctuations of pore water pressure during each loading step are divided into three phases:steady phase,rapid dissipation phase,and slow dissipation phase.An optimal loading pattern which could have a best treatment effect was proposed for calculating the water discharge and pore water pressure of soil using the improved multiple-vacuum preloading method.For the newly deposited dredger fills at Lingang Industrial Zone of Tianjin City,the best loading step was 20 kPa and the loading of 40-50 k Pa produced the highest drainage consolidation.The measured moisture content and vane shear strength were discussed in terms of the effect of reinforcement,both of which indicate that the multiple-vacuum preloading method has a better treatment effect not only in decreasing the moisture content and increasing the bearing capacity,but also in increasing the process uniformity at different depths of foundation.
基金Supported by a grant from the German Federal Ministry of Education and Research,No.01EO1302
文摘As the gap between a shortage of organs and the im-mense demand for liver grafts persists, every available donor liver needs to be optimized for utility, urgency and equity. To overcome this challenge, decision modelling might allow us to gather evidence from previous studies as well as compare the costs and consequences of alternative options. For public health policy and clinical intervention assessment, it is a potentially powerful tool. The most commonly used types of decision analytical models include decision trees, the Markov model, microsimulation, discrete event simulation and the system dynamic model. Analytic models could support decision makers in the field of liver transplantation when facing specifc problems by synthesizing evidence, comprising all relevant options, generalizing results to other contexts, extending the time horizon and exploring the uncertainty. For modeling studies of economic evaluation for transplantation, understanding the current nature of the disease is crucial, as well as the selection of appropriate modelling techniques. The quality and availability of data is another key element for the selection and development of decision analytical models. In addition, good practice guidelines should be complied, which is important for standardization and comparability between economic outputs.
