Organized blood pressure control programs to prevent stroke in Australia : would they be cost-effective?

Background and Purpose—: High blood pressure (BP) is the most important modifiable stroke risk factor. Worldwide high BP in many people is uncontrolled or people are unaware of their BP status. We aimed to assess whether a program of organized multidisciplinary care and medication would be cost-effective for improving BP control for the prevention of stroke.

Methods—: A novel aspect was to simulate the intervention to match recent primary care initiatives (eg, new Medicare reimbursement items) to ensure policy relevance. Current practice and additional costs of each intervention were included using the best available evidence. The differences in the cost per quality-adjusted life year (QALY) gained for the interventions were compared against current practice. Cost-effectiveness was defined as cost per QALY gained was less than Australian dollars (AUD) 50 000 (societal perspective; reference year 2004). The robustness of estimates was assessed with probabilistic multivariable uncertainty analysis.

Results—: For primary prevention, the median cost per QALY gained was AUD11 068 (95% uncertainty interval AUD5201 to AUD18 696) in those aged 75 years or older and was AUD17 359 (95% uncertainty interval AUD10 516 to AUD26 036) in those aged 55 to 84 years with >=15% absolute risk of stroke. Primary prevention interventions were not cost-effective if aged younger than 50 years. The median cost per QALY gained for secondary prevention was AUD1811 and AUD4704, depending on which medications were modeled.

Conclusions—: Organized care for BP control targeted at specific populations offers excellent value over current practice. Organized care for secondary prevention provided the greatest benefits and strongest cost-effectiveness. Translation into clinical practice requires improved use of relevant Medicare policy in Australia.

Cost planning and control : case study of design economics for constructability and prefabrication construction

Cost management includes planning and control, and constructability1 and prefabrication construction are two main design economics factors for early cost planning decision. Despite the fact that constructability and prefabrication have been considered in design and cost planning, there is no guarantee if the intention meets the expectation. This requires on-going control during construction stage. In fact, prefabrication construction has been encouraged for some years, application is not always positive. One of the reasons is its constructability. This paper investigates the appropriate research methodology to determine how design for prefabrication and constructability will contribute to cost planning through control and review during construction stage. Through a study of an Australian residential project using prefabrication in structural concrete, internal partitioning and internal fit-out, this research concludes that case study is a viable choice. Prefabrication construction does provide a positive impact on the major project objectives: time, cost and quality. Cost reduction is due to saving in time related preliminaries as a direct result of time reduction of onsite activities whilst quality is ensured due to better control of prefabricated components inside the factories. However, it can only be achieved after considering constructability: suitable materials choice, design for available skills, use of available plant, and clear communication. The keys are through plan at design phase and control in construction stage.

A low-cost neurostimulator with accurate pulsed-current control

A constant-current stimulator for high-impedance loads using only low-cost standard high-voltage components Is presented. A voltage-regulator powers an oscillator built across the primary of a step-up transformer whose secondary supplies, after rectification, the high voltage to a switched current-mirror in the driving stage. Adjusting the regulated voltage controls the pulsed-current intensity. A prototype produces stimulus of amplitude and pulsewidth within 0 less than or equal to I-skin less than or equal to 20 mA and 50 mus less than or equal to T-pulse less than or equal to 1 ms, respectively. Pulse-repetition spans from 1 Hz to 10 Hz. Worst case ripple is 3.7% at I-skin = 1 mA. Overall consumption is 5.6 W at I-skin = 20 mA.

Cost-effectiveness of intensified interventions to control healthcare-associated MRSA infections -- A systematic literature review

Methicillin Resistant Staphylococcus aureus healthcare-associated infections (MRSA HAIs) are a major cause of morbidity in hospitalized patients. They pose great economic burden to hospitals caring for these patients. Intensified Interventions aim to control MRSA HAIs. Cost-effectiveness of Intensified Interventions is largely unclear. We performed a review of cost-effectiveness literature on Intensified Interventions , and provide a summary of study findings, the status of economic research in the area, and information that will help decision-makers at regional level and guide future research.^ We conducted literature search using electronic database PubMed, EBSCO, and The Cochrane Library. We limited our search to English articles published after 1999. We reviewed a total of 1,356 titles, and after applying our inclusion and exclusion criteria selected seven articles for our final review. We modified the Economic Evaluation Abstraction Form provided by CDC, and used this form to abstract data from studies.^ Of the seven selected articles two were cohort studies and the remaining five were modeling studies. They were done in various countries, in different study settings, and with different variations of the Intensified Intervention . Overall, six of the seven studies reported that Intensified Interventions were dominant or at least cost-effective in their study setting. This effect persisted on sensitivity testing.^ We identified many gaps in research in this field. The cost-effectiveness research in the field is mostly composed of modeling studies. The studies do not always clearly describe the intervention. The intervention and infection costs and the sources for these costs are not always explicit or are missing. In modeling studies, there is uncertainty associated with some key model inputs, but these inputs are not always identified. The models utilized in the modeling studies are not always tested for internal consistency or validity. Studies usually test the short term cost-effectiveness of Intensified Interventions but not the long results.^ Our study limitation was the inability to adjust for differences in study settings, intervention costs, disease costs, or effectiveness measures. Our study strength is the presentation of a focused literature review of Intensified Interventions in hospital settings. Through this study we provide information that will help decision makers at regional level, help guide future research, and might change clinical care and policies. ^

Digital Control Implementation to Reduce the Cost and Improve the Performance of the Control Stage of an Industrial Switched-Mode Power Supply

The main objective of this work is the design and implementation of the digital control stage of a 280W AC/DC industrial power supply in a single low-cost microcontroller to replace the analog control stage. The switch-mode power supply (SMPS) consists of a PFC boost converter with fixed frequency operation and a variable frequency LLC series resonant DC/DC converter. Input voltage range is 85VRMS-550VRMS and the output voltage range is 24V-28V. A digital controller is especially suitable for this kind of SMPS to implement its multiple functionalities and to keep the efficiency and the performance high over the wide range of input voltages. Additional advantages of the digital control are reliability and size. The optimized design and implementation of the digital control stage it is presented. Experimental results show the stable operation of the controlled system and an estimation of the cost reduction achieved with the digital control stage.

Control of a solar dryer through using a fuzzy logic and low-cost model-based sensor

Solar drying is one of the important processes used for extending the shelf life of agricultural products. Regarding consumer requirements, solar drying should be more suitable in terms of curtailing total drying time and preserving product quality. Therefore, the objective of this study was to develop a fuzzy logic-based control system, which performs a ?human-operator-like? control approach through using the previously developed low-cost model-based sensors. Fuzzy logic toolbox of MatLab and Borland C++ Builder tool were utilized to develop a required control system. An experimental solar dryer, constructed by CONA SOLAR (Austria) was used during the development of the control system. Sensirion sensors were used to characterize the drying air at different positions in the dryer, and also the smart sensor SMART-1 was applied to be able to include the rate of wood water extraction into the control system (the difference of absolute humidity of the air between the outlet and the inlet of solar dryer is considered by SMART-1 to be the extracted water). A comprehensive test over a 3 week period for different fuzzy control models has been performed, and data, obtained from these experiments, were analyzed. Findings from this study would suggest that the developed fuzzy logic-based control system is able to tackle difficulties, related to the control of solar dryer process.

Cost effectiveness analysis of improved blood pressure control in hypertensive patients with type 2 diabetes: UKPDS 40

Objectives: To estimate the economic efficiency of tight blood pressure control, with angiotensin converting enzyme inhibitors or β blockers, compared with less tight control in hypertensive patients with type 2 diabetes.

Control and Guidance of Low-Cost Robots via Gesture Perception for Monitoring Activities in the Home

This paper describes the development of a low-cost mini-robot that is controlled by visual gestures. The prototype allows a person with disabilities to perform visual inspections indoors and in domestic spaces. Such a device could be used as the operator's eyes obviating the need for him to move about. The robot is equipped with a motorised webcam that is also controlled by visual gestures. This camera is used to monitor tasks in the home using the mini-robot while the operator remains quiet and motionless. The prototype was evaluated through several experiments testing the ability to use the mini-robot’s kinematics and communication systems to make it follow certain paths. The mini-robot can be programmed with specific orders and can be tele-operated by means of 3D hand gestures to enable the operator to perform movements and monitor tasks from a distance.

Immigration Reform and Control Act of 1982 : Mr. Rodino, from the Committee on the Judiciary, submitted the following report together with additional and dissenting views (to accompany H.R. 6514) (including cost estimate of the Congressional Budget Office).

"September 28, 1982."