Cost effectiveness

... This gap between what we know should be provided and what is provided is the result of a poorly structured health care financing system ... applied in a host of other settings where children are served, including schools, health clin-ics, child welfare agencies, and juvenile courts. ...

ncreasingly, the explosion in scien- tific knowledge is overwhelming both researchers and practitioners in the health professions. The man- aged care pharmacist today needs a con - stant and current sense of the basic phar- maceutical sciences, clinical pharmacy, pharmacy management systems, health policy and ethics, new drug introductions, pharmacoeconomics, and pharmacoepi- demiology. Monitoring the ever-changing pharmaceutical industry is now

In high-strength steels it is often difficult to distinguish between hydrogen embrittlement and various other brittle failure mechanisms. The objective of this work was to develop a sensitive analytical procedure based on secondary ion mass spectrometry (SIMS) that would allow in-service identification of local hydrogen accumulation, either during quality control or during failure analysis of electroplated items. Dynamic SIMS was found useful in identifying when baking of Cd-plated AISI 4340 steel was not carried out, thus potentially leading to hydrogen embrittlement. In all non-baked samples, an increase in the hydrogen signal was found at the Cd/steel interface. In baked samples, either a peak was not observed at the interface, or it was insignificant based on determination of the ratios between the hydrogen signals in the coating, interface and substrate. This reproducible effect was monitored even after 16 months storage in a desiccator. These observations make the procedure practical in suggesting more accurate, reliable and cost effective recommendations for prevention of failures. The main effect of baking was found to be effusion of hydrogen from the interface and the substrate steel into the atmosphere. A mechanism for delayed failure is suggested.

The current remediation technique of heavy metal from contaminated soil-water are expensive, time consuming and environmentally destructive. Unlike organic compounds, metals cannot degrade, and therefore effective cleanup requires their immobilization to reduce or remove toxicity. In recent years, scientists and engineers have started to generate cost effective technologies that include use of microorganisms/biomass or live plants to clean polluted areas. Phytoremediation is an emerging technology for cleaning up contaminated sites, which is cost effective, and has aesthetic advantages and long term applicability. It is best applied at sites with shallow contamination of organic, nutrient or metal pollutants that are amenable to one of the five applications; phytotransformation, rhizosphere bioremediation, phytostabilization, phytoextraction and rhizofiltration. The technology involves efficient use of plants to remove, detoxify or immobilize environmental contaminants in a growth matrix (soil, water or sediments) through the natural, biological, chemical or physical activities or processes of the plants. A brief review on phytoremediation of heavy metals and its effect on plants have been compiled to provide a wide applicability of phytoremediation.

Communications Systems (PACS) as the final step towards a completely digital clinical environment completing the HIS/EMR and 1,400 web/terminals for patient information access. Financial benefits throughout the hospital were assessed upfront and measured periodically. Key indicators (radiology exam turnaround time, number of radiology procedures performed, inpatients length of stay before and after the PACS implementation, etc.) were analyzed and values were statistically tested to assess workflow and productivity improvements. The hospital went Bfilmless^in 28 weeks. Between the half of 2004 and the respective period in 2003, overall Radiology Department productivity increased by 12%, TAT improved by more than 60%. Timelier patient care resulted in decreased lengths of stay. Neurology alone experienced a 12% improvement in average patient stay. To quantify the impact of PACS on the average hospital stays and the expected productivity benefits to inpatient productivity were used a Bhigh level^and a Bdetailed^business model. Annual financial upsides have exceeded $1.9 millions/year. A well-planned PACS deployment simplifies imaging workflow and improves patient care throughout the hospital while delivering substantial financial benefits. Staff buyin was the key in this process and on-going training and process monitoring are a must.

This study examines the relationship between a computerized neuropsychological assessment battery, the Automated Neuropsychological Assessment Metrics (ANAM) and a widely used ability measure, Woodcock-Johnson III Tests of Cognitive Ability (WJ-III). Results indicated substantial relationship between the ANAM throughput (accuracy/response time) scores and the WJ-III Cognitive Efficiency cluster. An unexpectedly strong relationship was evident between accuracy scores on the ANAM Logical Reasoning scale and the WJ-III General Intellectual Ability score, purporting to measure the g factor. The findings support the viability of the ANAM as a time- and cost-effective tool for appraisal of cognitive function.

The Larnaca SWRO desalination plant has successfully operated for more than 6 years. It was one of the first major SWRO plants to have a tight boron specification. With some management of the membrane elements at the site, the plant has consistently met the water quality and quantity requirements of their customer. The unique plant design allows for changes in the second pass that optimize the power requirements, while ensuring boron quality is just made. This has made the plant very efficient and cost-effective. The performance of the SWRO and BWRO elements has met expectations and performed stably for a number of years. As a result, this process design has become a proto-type for other SWRO plants with tight (especially boron).

Background: Antiretroviral Treatment (ART) significantly reduces HIV transmission. We conducted a cost-effectiveness analysis of the impact of expanded ART in South Africa. Methods: We model a best case scenario of 90% annual HIV testing coverage in adults 15-49 years old and four ART eligibility scenarios: CD4 count ,200 cells/mm 3 (current practice), CD4 count ,350, CD4 count ,500, all CD4 levels. 2011-2050 outcomes include deaths, disability adjusted life years (DALYs), HIV infections, cost, and cost per DALY averted. Service and ART costs reflect South African data and international generic prices. ART reduces transmission by 92%. We conducted sensitivity analyses. Results: Expanding ART to CD4 count ,350 cells/mm 3 prevents an estimated 265,000 (17%) and 1.3 million (15%) new HIV infections over 5 and 40 years, respectively. Cumulative deaths decline 15%, from 12.5 to 10.6 million; DALYs by 14% from 109 to 93 million over 40 years. Costs drop $504 million over 5 years and $3.9 billion over 40 years with breakeven by 2013. Compared with the current scenario, expanding to ,500 prevents an additional 585,000 and 3 million new HIV infections over 5 and 40 years, respectively. Expanding to all CD4 levels decreases HIV infections by 3.3 million (45%) and costs by $10 billion over 40 years, with breakeven by 2023. By 2050, using higher ART and monitoring costs, all CD4 levels saves $0.6 billion versus current; other ART scenarios cost $9-194 per DALY averted. If ART reduces transmission by 99%, savings from all CD4 levels reach $17.5 billion. Sensitivity analyses suggest that poor retention and predominant acute phase transmission reduce DALYs averted by 26% and savings by 7%. Conclusion: Increasing the provision of ART to ,350 cells/mm3 may significantly reduce costs while reducing the HIV burden. Feasibility including HIV testing and ART uptake, retention, and adherence should be evaluated.

The introduction of highly active antiretroviral therapy (also known as combination therapy) has transformed the nature of HIV infection from a severe and ultimately fatal disease to that of a manageable chronic condition. HIV drugs are highly efficacious, but their use comes at ...

This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn.

To ascertain patients', providers', and managers' perceptions of the factors that contributed to the success of the Asheville Project. Design: One-time focus groups of patients and diabetes care providers and individual interviews with managers involved in the project. Setting: The City of Asheville and Mission-St. Joseph's Health System (MSJ), Asheville, N.C. Patients and Other Participants: Twenty-one patients with diabetes who were employees of the two self-insured employers participating in the Asheville Project; four specially trained pharmacists who provided diabetes-related pharmaceutical care and one diabetes educator, all of whom received reimbursement for their services; six managers employed by the City of Asheville or MSJ who were involved in the project. Intervention: A trained facilitator conducted four focus groups and six manager interviews in September 2001. Each session lasted 60 to 90 minutes, and the facilitator used a standard list of open-ended questions. The focus group sessions were recorded for subsequent analysis. Main Outcome Measures: Perceptions of focus group participants and managers of how the Asheville Project enabled patients with diabetes to become more responsible and successful in self-managing their condition. Results: Focus group participants and managers were enthusiastic about their experiences with the project. Patients valued the relationships they established with their pharmacist or diabetes educator; as a result of these providers' support, patients felt more in control of their lives and were healthier. The waived co-payments for diabetes medications and related supplies was the decisive incentive for getting many patients to enroll in the project. For the providers, the project was a source of professional growth and satisfaction. Managers felt the project helped them fulfill their health care responsibilities to their employees, reduced overall costs, enhanced their organizations' reputations in health care delivery, and resulted in less absenteeism. Conclusion: Patients, providers, and managers in the Asheville Project believed that aligned incentives and community-based resources that provide health care services to patients with diabetes offer a practical, patient-empowering, and cost-effective solution to escalating health care costs.

Cellulose nanofibers with a size range of 5–100 nm have the potential to be a low cost renewable material that has application in a range of products. However, current chemical methods to produce crystalline nanofibers suffer from low yields and high chemical costs, while mechanical methods require high energy costs. Methods to lower the energy costs of the mechanical methods have not been well documented in the literature. A bleached softwood kraft pulp was processed using a mechanical dispersion mill and a homogenizer to produce cellulose nanofibers. Two different commercial enzymes were used to pretreat the wood fibers before the mechanical treatments. The resulting nanofibers were characterized by light microscopy, atomic force microscopy, and inverse gas chromatography. Results indicate that the dispersion mill does not affect the overall pulp fiber fibrillation, but does help prepare the sample for the homogenizer. Most fibrillation occurs after three passes through the homogenizer. The enzyme pretreatment has little effect on the size of the fibers, but does allow for higher solids to pass through the homogenizer without clogging. The dispersion component of surface energy of the resulting nanofibrils is impacted by the type of enzyme used. The measurement of acid–base properties proved to be challenging using current IGC experimental protocols.

Soft error tolerant design becomes more crucial due to exponential increase in the vulnerability of computer systems to soft errors. Accurate estimation of soft error rate (SER), the probability of system failure due to soft errors, is a key factor in design of cost-effective soft error resilient systems. We present a very fast and accurate approach based on enhanced static timing analysis and signal probabilities to estimate the probability of latching an incorrect value in the system bistables (timing derating). Experimental results and comparison with fault injections using timing accurate Monte-Carlo simulations show that the accuracy of our approach is within 1% while orders of magnitude faster.

Chronic condition management in general practice is projected to account for 50% of all consultations by 2051. General practices under present workforce conditions will be unable to meet this demand. Nurse led collaborative care models of chronic disease management have been successful overseas and are proposed as one solution. This article provides an interim report on a prospective randomised trial to investigate the acceptability, cost effectiveness and feasibility of a nurse led model of care for chronic conditions in Australian general practice. A qualitative study focused on the impact of this model of care through the perceptions of practice staff from one urban and one regional practice in Queensland, and one Victorian rural practice. Primary benefits of the collaborative care model focused on increased efficiency and communication between practice staff and patients. The increased degree of patient self responsibility was noted by all and highlights the motivational aspect ...

At-sea distributions of large scyphozoan jellyfish across the Irish Sea were studied using visual surface counts from ships of opportunity. Thirty-seven surveys were conducted along two[100 km long transects between Ireland and the UK from April to September in 2009 and 2010. Five species were recorded but only Aurelia aurita and Cyanea capillata were frequently observed. The first formal description of the seasonal changes in the abundances and distributions of these two species in the study area is provided. The highest densities of these species were more likely to be found *30 km offshore, but large aggregations were present both in coastal and offshore waters. Evidence for aggregations of medusae along physical discontinuities was provided by coupling jellyfish observations with simultaneous records of environmental parameters. The value of surveys from ships of opportunity as cost-effective semi-quantitative tools, to develop local knowledge on jellyfish abundance, distribution, and phenology is discussed.

Malfunction of permanent vascular accesses remains a cause of frequent and costly morbidity in patients receiving chronic hemodialysis (CHD). Several recommendations for routine monitoring of these permanent vascular accesses for incipient failure have been proposed. In this study, multiple indicators of incipient vascular access dysfunction, including "venous" and "arterial" pressures at serial blood flows (200 ml/min, 300 ml/min, and 400 ml/min), percent urea recirculation, Doppler ultrasound, and access blood flow by ultrasound dilution technique were simultaneously evaluated in a total of 220 vascular accesses in 170 chronic hemodialysis patients in two separate study periods (6 months apart). The rate of thrombosis was determined within the subsequent 12 weeks of each study period to assess the short-term predictive power of access thrombosis. During the period of follow-up, there were 34 thrombotic events in 172 polytetrafluoroethylene (PTFE) grafts and only one thrombotic event in 48 arterio-venous fistulas (AVF). Therefore, the statistical analysis was limited to the PTFE grafts. When grafts with thromboses were compared to those without thrombosis by univariate analysis, access blood flow measured either by ultrasound dilution technique (875 +/- 426 ml/min with thrombosis vs. 1193 +/- 677 ml/min without thrombosis, P = 0.001) or by Doppler ultrasound (762 +/- 420 ml/min with thrombosis vs. 1171 +/- 657 ml/min without thrombosis, P = 0.001) were significantly different in the two groups. There was good correlation (r = 0.79, P = 0.0001) between the blood flows determined by both techniques. The grade of stenosis determined by ultrasound was also a statistically significant predictor (P = 0.02). "Venous" and "arterial" pressures were numerically similar and were not statistically different between the accesses that did and those that did not thrombose. When multivariate analysis was used, there was a significantly increased risk of thrombosis only with decreasing access blood flow determined by ultrasound dilution techniques after adjusting for other confounding variables. When the average blood flow of all grafts (1134 ml/min) is considered as the reference access blood flow (relative risk of 1.0), the relative risk of a PTFE thrombotic event within the subsequent 12 weeks was 1.23 at a blood flow 950 ml/min, 1.67 at a blood flow of 650 ml/min and to 2.39 at a blood flow of 300 ml/min. In summary, access blood flow measured by either Dilution or Doppler is a reliable indicator of subsequent short-term thrombosis risk. Other proposed methods of evaluating access dysfunction were not useful in our patients. If simple to use, cost-effective devices to measure dialysis access blood flow become readily available, the measurement of access blood flow will likely become the method of choice for screening of PTFE vascular access dysfunction in hemodialysis patients.

We describe the distribution and estimate densities of Grauer's gorillas (Gorilla gorilla graueri) and eastern chimpanzees (Pan troglodytes schweinfurthi) in a 12,770-km2area of lowland forest between the Lowa, Luka, Lugulu, and Oku rivers in eastern Democratic Republic of Congo, the site of the largest continuous population of Grauer's gorillas. The survey included a total of 480 km of transects completed

Virtual Reality Graded Exposure Therapy (VRGET) is an effective treatment for combat-related PTSD. We summarize the outcomes of a VRGET pilot study with 12 participants who completed one to multiple combat tours in support of the War on Terrorism and who were subsequently diagnosed with combat-related PTSD. Details of the collaborative program amongst the Virtual Reality Medical Center (VRMC), Office of Naval Research, the Naval Medical Center San Diego (NMCSD) and the Navy Hospital Camp Pendleton are discussed as is the VRGET outcomes of significant reductions in PTSD symptoms severity. We also described the estimated cost-effectiveness of VRGET for the treatment of combat-related PTSD, as contrasted to Treatment as Usual (TAU) for combat-related PTSD.

Background The incidence of colorectal cancer (CRC) has been increasing. We evaluated uptake rates and outcomes of faecal immunochemical test (FIT) and Guaiac test (gFOBT) kits as part of a two-step CRC screening. Methods A 3-year CRC screening program for a defined population of construction workers was conducted. Those satisfying the inclusion criteria were provided with gFOBT or FIT kits. Individuals testing positive were invited for a colonoscopy. Results A total of 909 faecal testing kits were distributed. Age range was 53-60 years. Compliance rate was higher for FIT (58.3%) as compared to gFOBT (46.7%) (p = 0.0006). FIT detected adenomatous polyps and CRC in 37.5 and 25%, respectively, whereas; gFOBT detected 23.5 and 18%. Colonoscopies were normal in 53 and 25% tested positive by gFOBT and FIT, respectively (p = 0.016).

Resumo-Este artigo apresenta um resumo de pesquisa realizada em bases eletrônicas, dos artigos publicados que contenham resultados e evidências do impacto sócio-econômico da telemedicina no Brasil. Ainda que a telemedicina tem trazido avanços para o debate nacional e crescimento dos sistemas de saúde, os seus benefícios sócio-econômicos não foram encontramos e muito menos considerados dos diferentes estudos empreendidos. Palavras-chave: Telemedicina, benefícios sócio-econômicos, custo-efetividade. Abstrata-This article shows an summary of research realized in eletronic bases , of articles published with results and evidences of socioeconomic impact of telehealth in Brasil. Although the telehealth brougth advances for the national debate and growth of health systems , your socioeconomic benefits doesn't met or took into consideration by the differents studies undertook.

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Synthesized-reference-wave holographic techniques offer relatively simple and cost-effective measurement of antenna radiation characteristics and reconstruction of complex aperture fields using near-field intensity-pattern measurement. These methods allow utilization of advantages of methods for probe compensations for amplitude and phasing near-field measurements for the planar and cylindrical scanning including accuracy analyses. The paper analyzes periodic errors, which can be created during scanning, using both theoretical results and numerical simulations.

Growing convergence among mobile computing devices and embedded technology sparks the development and deployment of "context-aware" applications, where location is the most essential context. In this paper we present LANDMARC, a location sensing prototype system that uses Radio Frequency Identification (RFID) technology for locating objects inside buildings. The major advantage of LANDMARC is that it improves the overall accuracy of locating objects by utilizing the concept of reference tags. Based on experimental analysis, we demonstrate that active RFID is a viable and cost-effective candidate for indoor location sensing. Although RFID is not designed for indoor location sensing, we point out three major features that should be added to make RFID technologies competitive in this new and growing market.

A membrane steady state simulator based on an open source concept is discussed. It is believe that this way of developing software will overcome weaknesses posed by available commercial membrane simulators. The application provides a cost effective state of the art tool for membrane modeling and object oriented design and its usage allows for easy incorporation of specific developments either open source or proprietary. This paper presents the components require to produce an open source membrane steady state simulator. This approach of development differs significantly from a close black-box approach. Several membrane models using the simulator will be elaborated and compared with literature results.

Since minimizing the co-channel interference in the conventional cellular technologies (AMPS, TDMA, and GSM) leads to better spectral efficiency, these technologies require a systematic frequency planning scheme. Generally, cells are grouped in a cluster of 7 (N=7). Each cluster reuses the same frequency to maximize bandwidth efficiency. To further minimize the co-channel interference from adjacent clusters, sector antennas are used. A cell is typically sectorized into three sectors (K=3) to achieve rapid frequency reuse. The deployment practices include using the N=7, K=3 or using the N=4, K=6 frequency reuse scheme.

Airborne laser scanning is a fast, cost-effective technique for the acquisition of 2.5D data, mainly for use in topographic and mapping operations. In recent years, however, the range of applications in which laser scanning can be used has greatly broadened and this has made higher data quality a necessity.

Purpose -The aim of the research was to evaluate the concept that utilizes structured planar substrates based on low temperature co-fired ceramics (LTCC) as a precision platform for the passive alignment of a multimode fiber and wide-stripe diode laser. Design/methodology/approach -Presents the manufacturing process for realisation of 3D precision structures, heat dissipation structures and a cooling channel into the LTCC substrate. The developed methodology for 3D modelling and simulation of the system was used to optimize structures, materials and components in order to achieve optimal performance for the final product and still maintain reasonably low fabrication costs. The simulated optical coupling efficiency and alignment tolerances were verified by prototype realization and characterization. Findings -The achieved passive alignment accuracy allows high coupling efficiency realisations of multimode fiber pigtailed laser modules and is suitable for mass production. Research limitations/implications -Provides guidance in the design of LTCC precision platforms for passive alignment and presents a hybrid simulation method for photonics module concept analysis. Practical implications -The three-dimensional shape of the laminated and fired ceramic substrate provides the necessary alignment structures including holes, grooves and cavities for the laser to fiber coupling. Thick-film printing and via punching can be incorporated in order to integrate electronic assemblies directly into the opto-mechanical platform. Originality/value -Introduces the LTCC 3D precision structures for photonics modules enabling passive alignment of multimode fiber pigtailed laser with high efficiency optical coupling. Demonstrates the hybrid simulation methodology for concept analysis.

The effectiveness of personalized-feedback interventions to reduce problem drinking has been evaluated in several RCTs and systematic reviews. A meta-analysis was performed to examine the overall effectiveness of brief, single-session personalized-feedback interventions without therapeutic guidance.

OBJECTIVE: An earlier economic evaluation showed that sorafenib was cost-effective compared to best supportive care (BSC) in advanced renal cell carcinoma (RCC) (ASCO 2006). Recently latest overall survival data from the Phase III TARGET study was presented (ASCO 2007). The objective of this study was to update the earlier economic model with the latest clinical data to evaluate the cost-effectiveness of sorafenib+BSC versus BSC alone in advanced RCC from a United States payer perspective. METHODS: A Markov model was developed to project lifetime survival and costs associated with sorafenib+BSC and BSC alone. The model tracked patients with advanced RCC through three states-PFS, progression, and death. Transition probabilities varied for each three-month period and were obtained from the TARGET data. Treatment effectiveness was measured in life-years gained. Resource utilization included drug, administration, physician visits, monitoring, and adverse events. Costs and survival benefits were discounted annually at 3%. Univariate and probabilistic sensitivity analyses were conducted. RESULTS: Lifetime per patient costs were $92,222 and $36,634 for sorafenib+BSC and BSC alone, respectively. The incremental survival benefit with sorafenib+BSC was 0.88 life years. The incremental costeffectiveness ratio (ICER) of sorafenib+BSC versus BSC alone was $63,219 per LYG. Results were sensitive to variation in sorafenib and BSC survival after progression as well as sorafenib cost. There was a 95% probability that sorafenib would be cost-effective vs. BSC alone, using a threshold of $95,000 or less. CONCLUSION: Updating the model with the most recent clinical trial data still resulted in an incremental cost-effectiveness ratio within the established threshold that society is willing to pay for cancer care (i.e. $50,000-$100,000 per LY). Thus, consistent with earlier findings, sorafenib+BSC appears to be cost-effective in the management of advanced RCC. Current cost-effectiveness models of prostate cancer prevention treatments examine the cost-effectiveness of preventative treatments from the perspective of patient populations specific to the treatment's clinical trial. However, factors such as age, race, family history, and prostate-specific antigen (PSA) levels are major predictors of patient risk for developing prostate cancer. OBJECTIVE: To create a model that examines potential clinical and economic benefits of preventative treatments in various patient populations as defined by prominent risk factors that can be used to identify populations who might most benefit from preventative treatments. METHODS: Similar to previously published cost-effectiveness models for preventative prostate cancer treatments, we developed a Markov model considering health states such as cancer-free, low-grade prostate cancer, high-grade prostate cancer, and death. We also consider the impact of avoiding benign prostate hyperplasia (BPH) and decreased quality of life due to treatment-related adverse events such as erectile dysfunction. Unlike previous models, our model incorporates prostate cancer nomograms developed from an analysis of a clinical database of at-risk men to estimate the probability of high and low-grade prostate cancer and recurrence. Nomograms consider age, race, family history, free-tototal PSA levels, PSA levels, and DRE results. The model can also consider incidence of prostate cancer by age and race as seen in SEER and high-grade prostatic intraepithelial neoplasia, family history, PSA levels, previous biopsy results, and BPH and DRE results as obtained from an analysis of the European Study of Screening for Prostate Cancer database. RESULTS:

Advances in molecular genetics have opened opportunities to enhance strategies for genetic improvement of pigs by directly selecting on genes or chromosomal regions that harbor genes that affect traits of interest. In this paper, we review molecular technologies that have become available, the current state of the use of gene- or marker tests in pig breeding programs, and future prospects.

The last decade has witnessed a rapid proliferation of superscalar cache-based microprocessors to build high-end capability and capacity computers primarily because of their generality, scalability, and cost effectiveness. However, the recent development of massively parallel vector systems is having a significant effect on the supercomputing landscape. In this paper, we compare the performance of the recentlyreleased Cray X1 vector system with that of the cacheless NEC SX-6 vector machine, and the superscalar cache-based IBM Power3 and Power4 architectures for scientific applications. Overall results demonstrate that the X1 is quite promising, but performance improvements are expected as the hardware, systems software, and numerical libraries mature. Code reengineering to effectively utilize the complex architecture may also lead to significant efficiency enhancements.

Cost-effectiveness analyses are important tools in efforts to prioritise interventions for obesity prevention. Modelling facilitates evaluation of multiple scenarios with varying assumptions. This study compares the cost-effectiveness of conservative scenarios for two commonly proposed policy-based interventions: front-of-pack 'traffic-light' nutrition labelling (traffic-light labelling) and a tax on unhealthy foods ('junk-food' tax). For traffic-light labelling, estimates of changes in energy intake were based on an assumed 10% shift in consumption towards healthier options in four food categories (breakfast cereals, pastries, sausages and preprepared meals) in 10% of adults. For the 'junk-food' tax, price elasticities were used to estimate a change in energy intake in response to a 10% price increase in seven food categories (including soft drinks, confectionery and snack foods). Changes in population weight and body mass index by sex were then estimated ba...

Purpose To assess the cost-effectiveness of water compared with normal land delivery. Methods A retrospective controlled study was conducted over a two-year period in a Northern Italian hospital. The cohort included all the 110 women who completed a water birth and 110 women who had a land birth during the same period. The two groups were compared with respect to labour duration, perineal tear and newborn's health status. The economic evaluation adopted a cost-effectiveness approach in relation to presence/absence of perineal tears. Results In the water delivery group 58 women (52.7%) experienced at least one perineal tear versus 80 (72.7%) in the traditional delivery group. The mean duration of labour was similar in the two groups. Neonatal well-being, expressed as Apgar score, did not differ significantly among the two groups at the first minute (9.48 vs. 9.28) and was slightly higher at 5 minutes in the water delivery group (9.95 vs. 9.84; P = 0.0269). Water delivery was found to be both more costly [DC = €279; 95% confidence interval (CI): 262-296] and more effective in terms of avoided perineal tears. The incremental health care cost per avoided perineal tear because of water delivery was estimated of €1395.7 (95% CI: 1049.2-3608.5). Conclusion Water birth, as compared with traditional delivery, allows for an increase in maternal well-being and is cost-effective.

The growing need of the driving public for accurate traffic information has spurred the deployment of large scale dedicated monitoring infrastructure systems, which mainly consist in the use of inductive loop detectors and video cameras. On-board electronic devices have been proposed as an alternative traffic sensing infrastructure, as they usually provide a cost-effective way to collect traffic data, leveraging existing communication infrastructure such as the cellular phone network. A traffic monitoring system based on GPS-enabled smartphones exploits the extensive coverage provided by the cellular network, the high accuracy in position and velocity measurements provided by GPS devices, and the existing infrastructure of the communication network. This article presents a field experiment nicknamed Mobile Century, which was conceived as a proof of concept of such a system. Mobile Century included 100 vehicles carrying a GPS-enabled Nokia N95 phone driving loops on a 10-mile stretch of I-880 near Union City, California, for 8 hours. Data were collected using virtual trip lines, which are geographical markers stored in the handset that probabilistically trigger position and speed updates when the handset crosses them. The proposed prototype system provided sufficient data for traffic monitoring purposes while managing the privacy of participants. The data obtained in the experiment were processed in real-time and successfully broadcast on the internet, demonstrating the feasibility of the proposed system for real-time traffic monitoring. Results suggest that a 2-3% penetration of cell phones in the driver population is enough to provide accurate measurements of the velocity of the traffic flow.

Miniaturization reduces package size, cost and board space. System on Chip (SoC) integrates a system on a common silicon substrate, however there are some shortcomings with this approach such as high manufacturing cost. Handling of different levels of voltage and current on a common silicon substrate with controller IC operating in the range of several volts and milliamps, while power