Objectives: To estimate the cost effectiveness of fluvoxamine against desvenlafaxine in Chinese patients with major depressive disorder (MDD). Methods: A cost effectiveness of treating Chinese patients with MDD for 6 ...Objectives: To estimate the cost effectiveness of fluvoxamine against desvenlafaxine in Chinese patients with major depressive disorder (MDD). Methods: A cost effectiveness of treating Chinese patients with MDD for 6 months maintenance period has been estimated by a decision tree model. The relative effectiveness on relapse rates came from a recent network meta analysis by Kishi et al. (2023) along with local drug cost data based on WHO defined daily dose (DDD) and relapse cost for the 6 months estimated from various sources were used in the model. Based on the Quality Adjusted Life Years (QALY) gain reported by Sobocki et al. (2007), QALY loss from a relapse was estimated. Univariate sensitivity analyses were presented by a Tornado diagram and extensive probabilistic sensitivity analysis based on 10,000 simulations was performed. The most recent cost effectiveness threshold of 1.5 times GDP suggested by Cai et al. (2022) was applied. Results: Fluvoxamine dominated desvenlafaxine (cost savings of 4003 CNY and 0.01 QALY higher in 6 months). The most sensitive parameters were relapse rates followed by desvenlafaxine cost and utility loss of relapse. However, the default result of fluvoxamine dominance was not changed for any univariate sensitivity analysis. The probabilistic sensitivity result showed the cost effectiveness acceptability at 1.5 times GDP as 99.93%. Conclusions: The cost effectiveness of fluvoxamine against desvenlafaxine among Chinese patients with MDD in a 6-month maintenance period was cost saving with better effectiveness (i.e., dominating) with low uncertainty.展开更多
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
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
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
Aim: To assess whether the use of direct real- time polymerase chain reaction (PCR) on smear-positive sputa can be cost-effective, by speciating mycobacteria earlier than current methods and thereby preventing unneces...Aim: To assess whether the use of direct real- time polymerase chain reaction (PCR) on smear-positive sputa can be cost-effective, by speciating mycobacteria earlier than current methods and thereby preventing unnecessary screening tests as part of the contact tracing process. Methods: A retrospective study of all patients with smear-positive sputa in a Liverpool teach-ing hospital between 2004 and 2007. All the PCRs performed on these patients were re-viewed and compared them with their myco-bacterial culture results. Unit costs for PCR, chest X-ray (CXR), tuberculin skin test (TST), interferon-gamma (IFN-γ) and medical/nursing time were conservatively estimated at ￡50, ￡11, ￡10, ￡40 and ￡30 respectively. The total PCR costs were compared with the costs of unnec-essary follow up of patients, negative for My-cobacterium tuberculosis (MTB) by PCR, sub-sequently confirmed to be MTB culture nega-tive. Results: 203 smear-positive patients under-went direct PCR testing. 126 (62%) patients grew Mycobacterium tuberculosis (MTB), 74 (37%) had environmental mycobacterial infection (EMI) and 3 (1%) were culture negative. Of the 126 patients’ culture positive MTB patients, 123 were PCR positive and 3 PCR negative. Of the 77 pa-tients that were culture negative for MTB, 75 were PCR negative and 2 PCR positive The sensitivity, specificity, positive and negative predictive values for direct PCR versus MTB culture were 98%, 96%, 98% and 97% respec-tively. Total costs of all PCRs performed amounted to ￡10,150. The cost of contact pro-cedures for PCR-negative and MTB culture- negative index cases was estimated at ￡19,650. This equated to a total saving of ￡9,500 in contact tracing costs. Conclusions: Direct PCR examination testing of smear-positive patients can be cost-effective in areas where there is a high incidence of EMI.展开更多
Objective:To develop a rapid,cost effective RT-PCR method for the mass scale diagnosis of such diseases at the vireraia stage to find out the actual disease burden in that area.Methods:For this purpose,cases with the ...Objective:To develop a rapid,cost effective RT-PCR method for the mass scale diagnosis of such diseases at the vireraia stage to find out the actual disease burden in that area.Methods:For this purpose,cases with the history of only short febrile illness were considered.Thus 157 samples with the history of dengue/chikungunya like illness and only 58 samples with a history of acute encephalitis syndrome(AES)were selected.Results:Out of 157 samples,42 and 74 were detected as dengue and chikungunya,respectively and out of 58 AES cases only 23 could be detected as Japanese encephalitis by this RT-PCR method.Conclusions:This cost effective RT-PCR method can detect the total positive cases that remain undetected by EL1SA method.Moreover,this method is capable to detect the viral RNA from patients'sera even after the appearance of IgM antibody at one fifth costs as compared with the other commercially available kits.展开更多
Mesh hernia repair is one of the commonest open techniques of inguinal hernia repair.The main limiting factor in the use of new meshes is the cost.We carried out a prospective randomized double blind study and compris...Mesh hernia repair is one of the commonest open techniques of inguinal hernia repair.The main limiting factor in the use of new meshes is the cost.We carried out a prospective randomized double blind study and comprising of a hundred patients with 100 inguinal hernias admitted consecutively for elective surgery,divided into the polypropylene mesh(PPM)group and the mosquito net mesh(MNM)group each containing fifty patients.All cases were completed successfully and results revealed no difference in two groups.The results of the present study,in consistent with the published literature,reveal that the cheap indigenous mosquito mesh,which has similar properties of an imported mesh,can be safely used for tension-free inguinal hernia repair in adults.Further trials with a larger number of patients and longer follow-ups are justified and recommended.展开更多
Anthrax is an infection caused by bacteria and it affects both human and animal populations. The disease can be categorized under zoonotic diseases and humans can contract infections through contact with infected anim...Anthrax is an infection caused by bacteria and it affects both human and animal populations. The disease can be categorized under zoonotic diseases and humans can contract infections through contact with infected animals, ingest contaminated dairy and animal products. In this paper, we developed a mathematical model for anthrax transmission dynamics in both human and animal populations with optimal control. The qualitative solution of the model behaviour was analyzed by determining Rhv, equilibrium points and sensitivity analysis. A vaccination class was incorporated into the model with waning immunity. Local and global stability of the model’s equilibria was found to be locally asymptotically stable whenever Rhv Rhv. It was revealed that reducing animal and human interaction rate, would decrease Rhv. We extended the model to optimal control in order to find the best control strategy in reducing anthrax infections. It showed that the effective strategy in combating the anthrax epidemics is vaccination of animals and prevention of humans.展开更多
AIM To investigate the cost effectiveness of routine small bowel biopsies(SBBs) in patients with iron deficiency anemia(IDA) independent of their celiac disease(CD) serology test results.METHODS We used a state transi...AIM To investigate the cost effectiveness of routine small bowel biopsies(SBBs) in patients with iron deficiency anemia(IDA) independent of their celiac disease(CD) serology test results.METHODS We used a state transition Markov model. Two strategies were compared: routine SBBs during esophagogastroduodenoscopy(EGD) in all patients with IDA regardless their celiac serology status(strategy A) vs SBBs only in IDA patients with positive serology(strategy B). The main outcomes were quality adjusted life years(QALY),average cost and the incremental cost effectiveness ratio(ICER). One way sensitivity analysis was performed on all variables and two way sensitivity analysis on selected variables were done. In order to validate the results,a Monte Carlo simulation of 100 sample trials with 10,and an acceptability curve were performed.RESULTS Strategy A of routine SBBs yielded 19.888 QALYs with a cost of $218.10 compared to 19.887 QALYs and $234.17 in strategy B. In terms of cost-effectiveness,strategy A was the dominant strategy,as long as the cost of SBBs stayed less than $67. In addition,the ICER of strategy A was preferable,providing the cost of biopsy stays under $77. Monte Carlo simulation demonstrated that strategy A yielded the same QALY but with lower costs than strategy B. CONCLUSION Our model suggests that EGD with routine SBBs is a cost-effective approach with improved QALYs in patients with IDA when the prevalence of CD is 5% or greater. SBBs should be a routine screening tool for CD among patients with IDA,regardless of their celiac antibody status.展开更多
Multidisciplinary community coordinated care programs are widely adopted to optimise care of chronic disease patients, but there is a need for further evaluation in the setting of COPD. This observational study evalua...Multidisciplinary community coordinated care programs are widely adopted to optimise care of chronic disease patients, but there is a need for further evaluation in the setting of COPD. This observational study evaluated 147 patients with severe or very severe COPD who were enrolled in a multidisciplinary community respiratory coordinated care program (RCCP) from 2007 to 2012. Comparison was made of hospitalisation rates and length of stay for 12 months prior to joining the program, and the first 12 months after joining the program. This data was used to inform a cost analysis. Enrolment into RCCP halved the annual hospital admission rate from 1.18 to 0.57 admissions per year (relative risk reduction 51.4%, p < 0.001), and annual total length of stay was reduced from 8.06 to 3.59 days per patient per year (p < 0.001). Hospital admissions were reduced from 5.05 days to 2.00 days (p < 0.001). Accounting for the program’s costs, these changes resulted in a $US 906.94 ($AUD 972.80) cost saving per patient per year. A RCCP program can reduce patient hospitalisation and overall costs in the COPD setting.展开更多
Urology has been on the forefront of technological advances in minimally invasive surgery, from laparoscopy to robot-assisted surgeries. As with all new technological advances in medicine, the results of new advances ...Urology has been on the forefront of technological advances in minimally invasive surgery, from laparoscopy to robot-assisted surgeries. As with all new technological advances in medicine, the results of new advances are compared to previously established gold standards. When it comes to robot-assisted urology, morbidity, oncological outcomes, and cost between the same surgeries performed in an open fashion vs with robot-assistance should be assessed. Because healthcare spending is increasingly under more scrutiny, there is debate on the cost effectiveness of robot-assisted surgeries given the high acquisition and maintenance cost of robotic systems. This articles aims to critically evaluate the cost effectiveness of robot-assisted surgeries for prostatectomies, cystectomies, and partial nephrectomies in the United States.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
With the continuous application of new technologies in reconnaissance and attack, false camouflage plays a more important role in improving the survivability of targets, and the number of decoys plays a crucial role i...With the continuous application of new technologies in reconnaissance and attack, false camouflage plays a more important role in improving the survivability of targets, and the number of decoys plays a crucial role in the camouflaging effect. Based on the concept of cost-effectiveness ratio, according to the newly formulated Johnson criterion and the view of discovery and destruction, this paper proposes to take the identification probability as the probability of being destroyed and uses mathematical formulas to calculate the cost of a single use decoy. On this basis, a cost-effectiveness ratio model is established, with the product of the increase in the survival probability of the target and the cost of the target as the benefit, and the sum of the product of the probability of being destroyed and the cost of the decoy and the cost of a single use as the consumption cost. The model is calculated and analyzed, and the number of decoys that conform to the actual situation is obtained.展开更多
Gene synthesis has provided important contributions in various fields including genomics and medicine. Current genes are 7 - 30 cents depending on the assembly and sequencing methods performed. Demand for gene synthes...Gene synthesis has provided important contributions in various fields including genomics and medicine. Current genes are 7 - 30 cents depending on the assembly and sequencing methods performed. Demand for gene synthesis has been increasing for the past few decades, yet available methods remain expensive. A solution to this problem involves microchip-derived oligonucleotides (oligos), an oligo pool with a substantial number of oligo fragments. Microchips have been proposed as a tool for gene synthesis, but this approach has been criticized for its high error rate during sequencing. This study tests a possible cost-effective method for gene synthesis utilizing fragment assembly and golden gate assembly, which can be employed for quicker manufacturing and efficient execution of genes in the near future. The droplet method was tested in two trials to determine the viability of the method through the accuracy of the oligos sequenced. A preliminary research experiment was performed to determine the efficacy of oligo lengths ranging from two to four overlapping oligos through Gibson assembly. Of the three oligo lengths tested, only two fragment oligos were correctly sequenced. Two fragment oligos were used for the second experiment, which determined the efficacy of the droplet method in reducing gene synthesis cost and speed. The first trial utilized a high-fidelity polymerase and resulted in 3% correctly sequenced oligos, so the second trial utilized a non-high-fidelity polymerase, resulting in 8% correctly sequenced oligos. After calculating, the cost of gene synthesis lowers down to 0.8 cents/base. The final calculated cost of 0.8 cents/base is significantly cheaper than other manufacturing costs of 7 - 30 cents/base. Reducing the cost of gene synthesis provides new insight into the cost-effectiveness of present technologies and protocols and has the potential to benefit the fields of bioengineering and gene therapy.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
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
INTRODUCTION A developer who had chronic asthma as a child built the first LEED^(■)(Leadership in Energy and Environmental Design)Platinum certified apartment complex in Idaho.He has also heard from two residents tha...INTRODUCTION A developer who had chronic asthma as a child built the first LEED^(■)(Leadership in Energy and Environmental Design)Platinum certified apartment complex in Idaho.He has also heard from two residents that their asthma no longer resulted in attacks due to eliminating triggers in the interior environment.Eight years and a dozen multifamily affordable housing projects later,the LEED consultant on these projects has gathered insight on best practices,lessons learned and strate-gies that result in resident,owner and project team satisfaction.Ten projects have achieved LEED Platinum certification(two more are still under construction,but are on track for Platinum),and the HERS(Home Energy Rating System)scores are as low as 48.Feedback has been collected on what works,what doesn’t and what matters most:from low energy bills to living in a healthy home and not having asthma attacks.These projects debunk the assumptions that energy effi-ciency adds too much cost or that green homes are only for the wealthy.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
The United States （U.S.） is facing a national opioid epidemic, and medical systems are in need of non- pharmacologic strategies that can be employed to decrease the public＇s opioid dependence. Acupuncture has emerg...The United States （U.S.） is facing a national opioid epidemic, and medical systems are in need of non- pharmacologic strategies that can be employed to decrease the public＇s opioid dependence. Acupuncture has emerged as a powerful, evidence-based, safe, cost-effective, and available treatment modality suitable to meeting this need. Acupuncture has been shown to be effective for the management of numerous types of pain conditions, and mechanisms of action for acupuncture have been described and are understandable from biomedical, physiologic perspectives. Further, acupuncture＇s cost-effectiveness can dramatically decrease health care expenditures, both from the standpoint of treating acute pain and through avoiding addiction to opioids that requires costly care, destroys quality of life, and can lead to fatal overdose. Numerous federal regulatory agencies have advised or mandated that healthcare systems and providers offer non-pharmacologic treatment options for pain. Acupuncture stands out as the most evidence-based, immediately available choice to fulfil these calls. Acupuncture can safely, easily, and cost-effectively be incorporated into hospital settings as diverse as the emergency department, labor and delivery suites, andneonatal intensive care units to treat a variety of commonly seen pain conditions. Acupuncture is already being successfully and meaningfully utilized by the Veterans Administration and various branches of the U.S. Military, in some studies demonstrably decreasing the volume of opioids prescribed when included in care.展开更多
文摘Objectives: To estimate the cost effectiveness of fluvoxamine against desvenlafaxine in Chinese patients with major depressive disorder (MDD). Methods: A cost effectiveness of treating Chinese patients with MDD for 6 months maintenance period has been estimated by a decision tree model. The relative effectiveness on relapse rates came from a recent network meta analysis by Kishi et al. (2023) along with local drug cost data based on WHO defined daily dose (DDD) and relapse cost for the 6 months estimated from various sources were used in the model. Based on the Quality Adjusted Life Years (QALY) gain reported by Sobocki et al. (2007), QALY loss from a relapse was estimated. Univariate sensitivity analyses were presented by a Tornado diagram and extensive probabilistic sensitivity analysis based on 10,000 simulations was performed. The most recent cost effectiveness threshold of 1.5 times GDP suggested by Cai et al. (2022) was applied. Results: Fluvoxamine dominated desvenlafaxine (cost savings of 4003 CNY and 0.01 QALY higher in 6 months). The most sensitive parameters were relapse rates followed by desvenlafaxine cost and utility loss of relapse. However, the default result of fluvoxamine dominance was not changed for any univariate sensitivity analysis. The probabilistic sensitivity result showed the cost effectiveness acceptability at 1.5 times GDP as 99.93%. Conclusions: The cost effectiveness of fluvoxamine against desvenlafaxine among Chinese patients with MDD in a 6-month maintenance period was cost saving with better effectiveness (i.e., dominating) with low uncertainty.
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.
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Aim: To assess whether the use of direct real- time polymerase chain reaction (PCR) on smear-positive sputa can be cost-effective, by speciating mycobacteria earlier than current methods and thereby preventing unnecessary screening tests as part of the contact tracing process. Methods: A retrospective study of all patients with smear-positive sputa in a Liverpool teach-ing hospital between 2004 and 2007. All the PCRs performed on these patients were re-viewed and compared them with their myco-bacterial culture results. Unit costs for PCR, chest X-ray (CXR), tuberculin skin test (TST), interferon-gamma (IFN-γ) and medical/nursing time were conservatively estimated at ￡50, ￡11, ￡10, ￡40 and ￡30 respectively. The total PCR costs were compared with the costs of unnec-essary follow up of patients, negative for My-cobacterium tuberculosis (MTB) by PCR, sub-sequently confirmed to be MTB culture nega-tive. Results: 203 smear-positive patients under-went direct PCR testing. 126 (62%) patients grew Mycobacterium tuberculosis (MTB), 74 (37%) had environmental mycobacterial infection (EMI) and 3 (1%) were culture negative. Of the 126 patients’ culture positive MTB patients, 123 were PCR positive and 3 PCR negative. Of the 77 pa-tients that were culture negative for MTB, 75 were PCR negative and 2 PCR positive The sensitivity, specificity, positive and negative predictive values for direct PCR versus MTB culture were 98%, 96%, 98% and 97% respec-tively. Total costs of all PCRs performed amounted to ￡10,150. The cost of contact pro-cedures for PCR-negative and MTB culture- negative index cases was estimated at ￡19,650. This equated to a total saving of ￡9,500 in contact tracing costs. Conclusions: Direct PCR examination testing of smear-positive patients can be cost-effective in areas where there is a high incidence of EMI.
基金supported by the Department of Science and Technology,Goverment of West Bengal.India[grant No.705(Sanc.)ST/P/S&T/9G-27/2007]
文摘Objective:To develop a rapid,cost effective RT-PCR method for the mass scale diagnosis of such diseases at the vireraia stage to find out the actual disease burden in that area.Methods:For this purpose,cases with the history of only short febrile illness were considered.Thus 157 samples with the history of dengue/chikungunya like illness and only 58 samples with a history of acute encephalitis syndrome(AES)were selected.Results:Out of 157 samples,42 and 74 were detected as dengue and chikungunya,respectively and out of 58 AES cases only 23 could be detected as Japanese encephalitis by this RT-PCR method.Conclusions:This cost effective RT-PCR method can detect the total positive cases that remain undetected by EL1SA method.Moreover,this method is capable to detect the viral RNA from patients'sera even after the appearance of IgM antibody at one fifth costs as compared with the other commercially available kits.
文摘Mesh hernia repair is one of the commonest open techniques of inguinal hernia repair.The main limiting factor in the use of new meshes is the cost.We carried out a prospective randomized double blind study and comprising of a hundred patients with 100 inguinal hernias admitted consecutively for elective surgery,divided into the polypropylene mesh(PPM)group and the mosquito net mesh(MNM)group each containing fifty patients.All cases were completed successfully and results revealed no difference in two groups.The results of the present study,in consistent with the published literature,reveal that the cheap indigenous mosquito mesh,which has similar properties of an imported mesh,can be safely used for tension-free inguinal hernia repair in adults.Further trials with a larger number of patients and longer follow-ups are justified and recommended.
文摘Anthrax is an infection caused by bacteria and it affects both human and animal populations. The disease can be categorized under zoonotic diseases and humans can contract infections through contact with infected animals, ingest contaminated dairy and animal products. In this paper, we developed a mathematical model for anthrax transmission dynamics in both human and animal populations with optimal control. The qualitative solution of the model behaviour was analyzed by determining Rhv, equilibrium points and sensitivity analysis. A vaccination class was incorporated into the model with waning immunity. Local and global stability of the model’s equilibria was found to be locally asymptotically stable whenever Rhv Rhv. It was revealed that reducing animal and human interaction rate, would decrease Rhv. We extended the model to optimal control in order to find the best control strategy in reducing anthrax infections. It showed that the effective strategy in combating the anthrax epidemics is vaccination of animals and prevention of humans.
文摘AIM To investigate the cost effectiveness of routine small bowel biopsies(SBBs) in patients with iron deficiency anemia(IDA) independent of their celiac disease(CD) serology test results.METHODS We used a state transition Markov model. Two strategies were compared: routine SBBs during esophagogastroduodenoscopy(EGD) in all patients with IDA regardless their celiac serology status(strategy A) vs SBBs only in IDA patients with positive serology(strategy B). The main outcomes were quality adjusted life years(QALY),average cost and the incremental cost effectiveness ratio(ICER). One way sensitivity analysis was performed on all variables and two way sensitivity analysis on selected variables were done. In order to validate the results,a Monte Carlo simulation of 100 sample trials with 10,and an acceptability curve were performed.RESULTS Strategy A of routine SBBs yielded 19.888 QALYs with a cost of $218.10 compared to 19.887 QALYs and $234.17 in strategy B. In terms of cost-effectiveness,strategy A was the dominant strategy,as long as the cost of SBBs stayed less than $67. In addition,the ICER of strategy A was preferable,providing the cost of biopsy stays under $77. Monte Carlo simulation demonstrated that strategy A yielded the same QALY but with lower costs than strategy B. CONCLUSION Our model suggests that EGD with routine SBBs is a cost-effective approach with improved QALYs in patients with IDA when the prevalence of CD is 5% or greater. SBBs should be a routine screening tool for CD among patients with IDA,regardless of their celiac antibody status.
文摘Multidisciplinary community coordinated care programs are widely adopted to optimise care of chronic disease patients, but there is a need for further evaluation in the setting of COPD. This observational study evaluated 147 patients with severe or very severe COPD who were enrolled in a multidisciplinary community respiratory coordinated care program (RCCP) from 2007 to 2012. Comparison was made of hospitalisation rates and length of stay for 12 months prior to joining the program, and the first 12 months after joining the program. This data was used to inform a cost analysis. Enrolment into RCCP halved the annual hospital admission rate from 1.18 to 0.57 admissions per year (relative risk reduction 51.4%, p < 0.001), and annual total length of stay was reduced from 8.06 to 3.59 days per patient per year (p < 0.001). Hospital admissions were reduced from 5.05 days to 2.00 days (p < 0.001). Accounting for the program’s costs, these changes resulted in a $US 906.94 ($AUD 972.80) cost saving per patient per year. A RCCP program can reduce patient hospitalisation and overall costs in the COPD setting.
文摘Urology has been on the forefront of technological advances in minimally invasive surgery, from laparoscopy to robot-assisted surgeries. As with all new technological advances in medicine, the results of new advances are compared to previously established gold standards. When it comes to robot-assisted urology, morbidity, oncological outcomes, and cost between the same surgeries performed in an open fashion vs with robot-assistance should be assessed. Because healthcare spending is increasingly under more scrutiny, there is debate on the cost effectiveness of robot-assisted surgeries given the high acquisition and maintenance cost of robotic systems. This articles aims to critically evaluate the cost effectiveness of robot-assisted surgeries for prostatectomies, cystectomies, and partial nephrectomies in the United States.
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With the continuous application of new technologies in reconnaissance and attack, false camouflage plays a more important role in improving the survivability of targets, and the number of decoys plays a crucial role in the camouflaging effect. Based on the concept of cost-effectiveness ratio, according to the newly formulated Johnson criterion and the view of discovery and destruction, this paper proposes to take the identification probability as the probability of being destroyed and uses mathematical formulas to calculate the cost of a single use decoy. On this basis, a cost-effectiveness ratio model is established, with the product of the increase in the survival probability of the target and the cost of the target as the benefit, and the sum of the product of the probability of being destroyed and the cost of the decoy and the cost of a single use as the consumption cost. The model is calculated and analyzed, and the number of decoys that conform to the actual situation is obtained.
文摘Gene synthesis has provided important contributions in various fields including genomics and medicine. Current genes are 7 - 30 cents depending on the assembly and sequencing methods performed. Demand for gene synthesis has been increasing for the past few decades, yet available methods remain expensive. A solution to this problem involves microchip-derived oligonucleotides (oligos), an oligo pool with a substantial number of oligo fragments. Microchips have been proposed as a tool for gene synthesis, but this approach has been criticized for its high error rate during sequencing. This study tests a possible cost-effective method for gene synthesis utilizing fragment assembly and golden gate assembly, which can be employed for quicker manufacturing and efficient execution of genes in the near future. The droplet method was tested in two trials to determine the viability of the method through the accuracy of the oligos sequenced. A preliminary research experiment was performed to determine the efficacy of oligo lengths ranging from two to four overlapping oligos through Gibson assembly. Of the three oligo lengths tested, only two fragment oligos were correctly sequenced. Two fragment oligos were used for the second experiment, which determined the efficacy of the droplet method in reducing gene synthesis cost and speed. The first trial utilized a high-fidelity polymerase and resulted in 3% correctly sequenced oligos, so the second trial utilized a non-high-fidelity polymerase, resulting in 8% correctly sequenced oligos. After calculating, the cost of gene synthesis lowers down to 0.8 cents/base. The final calculated cost of 0.8 cents/base is significantly cheaper than other manufacturing costs of 7 - 30 cents/base. Reducing the cost of gene synthesis provides new insight into the cost-effectiveness of present technologies and protocols and has the potential to benefit the fields of bioengineering and gene therapy.
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INTRODUCTION A developer who had chronic asthma as a child built the first LEED^(■)(Leadership in Energy and Environmental Design)Platinum certified apartment complex in Idaho.He has also heard from two residents that their asthma no longer resulted in attacks due to eliminating triggers in the interior environment.Eight years and a dozen multifamily affordable housing projects later,the LEED consultant on these projects has gathered insight on best practices,lessons learned and strate-gies that result in resident,owner and project team satisfaction.Ten projects have achieved LEED Platinum certification(two more are still under construction,but are on track for Platinum),and the HERS(Home Energy Rating System)scores are as low as 48.Feedback has been collected on what works,what doesn’t and what matters most:from low energy bills to living in a healthy home and not having asthma attacks.These projects debunk the assumptions that energy effi-ciency adds too much cost or that green homes are only for the wealthy.
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The United States （U.S.） is facing a national opioid epidemic, and medical systems are in need of non- pharmacologic strategies that can be employed to decrease the public＇s opioid dependence. Acupuncture has emerged as a powerful, evidence-based, safe, cost-effective, and available treatment modality suitable to meeting this need. Acupuncture has been shown to be effective for the management of numerous types of pain conditions, and mechanisms of action for acupuncture have been described and are understandable from biomedical, physiologic perspectives. Further, acupuncture＇s cost-effectiveness can dramatically decrease health care expenditures, both from the standpoint of treating acute pain and through avoiding addiction to opioids that requires costly care, destroys quality of life, and can lead to fatal overdose. Numerous federal regulatory agencies have advised or mandated that healthcare systems and providers offer non-pharmacologic treatment options for pain. Acupuncture stands out as the most evidence-based, immediately available choice to fulfil these calls. Acupuncture can safely, easily, and cost-effectively be incorporated into hospital settings as diverse as the emergency department, labor and delivery suites, andneonatal intensive care units to treat a variety of commonly seen pain conditions. Acupuncture is already being successfully and meaningfully utilized by the Veterans Administration and various branches of the U.S. Military, in some studies demonstrably decreasing the volume of opioids prescribed when included in care.
