Cost-effectiveness of zoledronic acid and strontium-89 as bone protecting treatments in addition to chemotherapy in patients with metastatic castrate-refractory prostate cancer: results from the TRAPEZE trial (ISRCTN 12808747)

OBJECTIVE: To evaluate the cost-effectiveness of adding zoledronic acid or strontium-89 to standard docetaxel chemotherapy for patients with castrate-refractory prostate cancer (CRPC).

PATIENTS AND METHODS: Data on resource use and quality of life for 707 patients collected prospectively in the TRAPEZE 2 × 2 factorial randomised trial (ISRCTN 12808747) were used to assess the cost-effectiveness of i) zoledronic acid versus no zoledronic acid (ZA vs. no ZA), and ii) strontium-89 versus no strontium-89 (Sr89 vs. no Sr89). Costs were estimated from the perspective of the National Health Service in the UK and included expenditures for trial treatments, concomitant medications, and use of related hospital and primary care services. Quality-adjusted life-years (QALYs) were calculated according to patients' responses to the generic EuroQol EQ-5D-3L instrument, which evaluates health status. Results are expressed as incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves.

RESULTS: The per-patient cost for ZA was £12 667, £251 higher than the equivalent cost in the no ZA group. Patients in the ZA group had on average 0.03 QALYs more than their counterparts in no ZA group. The ICER for this comparison was £8 005. Sr89 was associated with a cost of £13 230, £1365 higher than no Sr89, and a gain of 0.08 QALYs compared to no Sr89. The ICER for Sr89 was £16 884. The probabilities of ZA and Sr89 being cost-effective were 0.64 and 0.60, respectively.

CONCLUSIONS: The addition of bone-targeting treatments to standard chemotherapy led to a small improvement in QALYs for a modest increase in cost (or cost-savings). ZA and Sr89 resulted in ICERs below conventional willingness-to-pay per QALY thresholds, suggesting that their addition to chemotherapy may represent a cost-effective use of resources.

Exploring the effects of a universal classroom management training programme on teacher and child behaviour: a group randomised controlled trial and cost analysis

Teachers frequently struggle to cope with conduct problems in the classroom. The aim of this study was to assess the effectiveness of the Incredible Years Teacher Classroom Management Training Programme for improving teacher competencies and child adjustment. The study involved a group randomised controlled trial which included 22 teachers and 217 children (102 boys and 115 girls). The average age of children included in the study was 5.3 years (standard deviation = 0.89). Teachers were randomly allocated to an intervention group (n = 11 teachers; 110 children) or a waiting-list control group (n = 11; 107 children). The sample also included 63 ‘high-risk’ children (33 intervention; 30 control), who scored above the cut-off (>12) on the Strengths and Difficulties Questionnaire for abnormal socioemotional and behavioural difficulties. Teacher and child behaviours were assessed at baseline and 6 months later using psychometric and observational measures. Programme delivery costs were also analysed. Results showed positive changes in teachers’ self-reported use of positive classroom management strategies (effect size = 0.56), as well as negative classroom management strategies (effect size = −0.43). Teacher reports also highlight improvements in the classroom behaviour of the high-risk group of children, while the estimated cost of delivering the Incredible Years Teacher Classroom Management Training Programme was modest. However, analyses of teacher and child observations were largely non-significant. A need for further research exploring the effectiveness and cost-effectiveness of the Incredible Years Teacher Classroom Management Training Programme is indicated.

Evaluation of Weather Forecasting Services for the Iowa Department of Transportation, CTRE Project 02-126, 2003

The objective of the evaluation of the weather forecasting services used by the Iowa Department of Transportation is to ascertain the accuracy of the forecasts given to maintenance personnel and to determine whether the forecasts are useful in the decision-making process and whether the forecasts have potential for improving the level of service. The Iowa Department of Transportation has estimated the average cost of fighting a winter storm to be about $60,000 to $70,000 per hour. This final report is to provide an evaluation report describing the collection of weather data and information associated with the weather forecasting services provided to the Iowa Department of Transportation and its maintenance activities and to determine their impact in winter maintenance decision-making.

Cost-effectiveness Study of Antihypertensive Drugs in Mumbai, India

Hypertension is a serious global public health problem. It accounts for 10% of all deaths in India and is the leading noncommunicable disease.1 Recent studies have shown that the prevalence of hypertension is 25% in urban and 10% in rural people in India.2 It exerts a substantial public health burden on cardiovascular health status and health care systems in India.3 Antihypertensive treatment effectively reduces hypertension-related morbidity and mortality.1 The cost of medications has always been a barrier to effective treatment.

Resistive Embedded Heating for Homogeneous Curing of Composite Damage Repair

Thesis (Ph.D.)--University of Washington, 2016-08

Development of ultra-high-performance concrete (UHPC) using waste glass materials ─ towards innovative eco-friendly concrete

Le béton conventionnel (BC) a de nombreux problèmes tels que la corrosion de l’acier d'armature et les faibles résistances des constructions en béton. Par conséquent, la plupart des structures fabriquées avec du BC exigent une maintenance fréquent. Le béton fibré à ultra-hautes performances (BFUP) peut être conçu pour éliminer certaines des faiblesses caractéristiques du BC. Le BFUP est défini à travers le monde comme un béton ayant des propriétés mécaniques, de ductilité et de durabilité supérieures. Le BFUP classique comprend entre 800 kg/m³ et 1000 kg/m³ de ciment, de 25 à 35% massique (%m) de fumée de silice (FS), de 0 à 40%m de poudre de quartz (PQ) et 110-140%m de sable de quartz (SQ) (les pourcentages massiques sont basés sur la masse totale en ciment des mélanges). Le BFUP contient des fibres d'acier pour améliorer sa ductilité et sa résistance aux efforts de traction. Les quantités importantes de ciment utilisées pour produire un BFUP affectent non seulement les coûts de production et la consommation de ressources naturelles comme le calcaire, l'argile, le charbon et l'énergie électrique, mais affectent également négativement les dommages sur l'environnement en raison de la production substantielle de gaz à effet de serre dont le gas carbonique (CO[indice inférieur 2]). Par ailleurs, la distribution granulométrique du ciment présente des vides microscopiques qui peuvent être remplis avec des matières plus fines telles que la FS. Par contre, une grande quantité de FS est nécessaire pour combler ces vides uniquement avec de la FS (25 à 30%m du ciment) ce qui engendre des coûts élevés puisqu’il s’agit d’une ressource limitée. Aussi, la FS diminue de manière significative l’ouvrabilité des BFUP en raison de sa surface spécifique Blaine élevée. L’utilisation du PQ et du SQ est également coûteuse et consomme des ressources naturelles importantes. D’ailleurs, les PQ et SQ sont considérés comme des obstacles pour l’utilisation des BFUP à grande échelle dans le marché du béton, car ils ne parviennent pas à satisfaire les exigences environnementales. D’ailleurs, un rapport d'Environnement Canada stipule que le quartz provoque des dommages environnementaux immédiats et à long terme en raison de son effet biologique. Le BFUP est généralement vendu sur le marché comme un produit préemballé, ce qui limite les modifications de conception par l'utilisateur. Il est normalement transporté sur de longues distances, contrairement aux composantes des BC. Ceci contribue également à la génération de gaz à effet de serre et conduit à un coût plus élevé du produit final. Par conséquent, il existe le besoin de développer d’autres matériaux disponibles localement ayant des fonctions similaires pour remplacer partiellement ou totalement la fumée de silice, le sable de quartz ou la poudre de quartz, et donc de réduire la teneur en ciment dans BFUP, tout en ayant des propriétés comparables ou meilleures. De grandes quantités de déchets verre ne peuvent pas être recyclées en raison de leur fragilité, de leur couleur, ou des coûts élevés de recyclage. La plupart des déchets de verre vont dans les sites d'enfouissement, ce qui est indésirable puisqu’il s’agit d’un matériau non biodégradable et donc moins respectueux de l'environnement. Au cours des dernières années, des études ont été réalisées afin d’utiliser des déchets de verre comme ajout cimentaire alternatif (ACA) ou comme granulats ultrafins dans le béton, en fonction de la distribution granulométrique et de la composition chimique de ceux-ci. Cette thèse présente un nouveau type de béton écologique à base de déchets de verre à ultra-hautes performances (BEVUP) développé à l'Université de Sherbrooke. Les bétons ont été conçus à l’aide de déchets verre de particules de tailles variées et de l’optimisation granulaire de la des matrices granulaires et cimentaires. Les BEVUP peuvent être conçus avec une quantité réduite de ciment (400 à 800 kg/m³), de FS (50 à 220 kg/m³), de PQ (0 à 400 kg/m³), et de SQ (0-1200 kg/m³), tout en intégrant divers produits de déchets de verre: du sable de verre (SV) (0-1200 kg/m³) ayant un diamètre moyen (d[indice inférieur 50]) de 275 µm, une grande quantité de poudre de verre (PV) (200-700 kg/m³) ayant un d50 de 11 µm, une teneur modérée de poudre de verre fine (PVF) (50-200 kg/m³) avec d[indice inférieur] 50 de 3,8 µm. Le BEVUP contient également des fibres d'acier (pour augmenter la résistance à la traction et améliorer la ductilité), du superplastifiants (10-60 kg/m³) ainsi qu’un rapport eau-liant (E/L) aussi bas que celui de BFUP. Le remplacement du ciment et des particules de FS avec des particules de verre non-absorbantes et lisse améliore la rhéologie des BEVUP. De plus, l’utilisation de la PVF en remplacement de la FS réduit la surface spécifique totale nette d’un mélange de FS et de PVF. Puisque la surface spécifique nette des particules diminue, la quantité d’eau nécessaire pour lubrifier les surfaces des particules est moindre, ce qui permet d’obtenir un affaissement supérieur pour un même E/L. Aussi, l'utilisation de déchets de verre dans le béton abaisse la chaleur cumulative d'hydratation, ce qui contribue à minimiser le retrait de fissuration potentiel. En fonction de la composition des BEVUP et de la température de cure, ce type de béton peut atteindre des résistances à la compression allant de 130 à 230 MPa, des résistances à la flexion supérieures à 20 MPa, des résistances à la traction supérieure à 10 MPa et un module d'élasticité supérieur à 40 GPa. Les performances mécaniques de BEVUP sont améliorées grâce à la réactivité du verre amorphe, à l'optimisation granulométrique et la densification des mélanges. Les produits de déchets de verre dans les BEVUP ont un comportement pouzzolanique et réagissent avec la portlandite générée par l'hydratation du ciment. Cependant, ceci n’est pas le cas avec le sable de quartz ni la poudre de quartz dans le BFUP classique, qui réagissent à la température élevée de 400 °C. L'addition des déchets de verre améliore la densification de l'interface entre les particules. Les particules de déchets de verre ont une grande rigidité, ce qui augmente le module d'élasticité du béton. Le BEVUP a également une très bonne durabilité. Sa porosité capillaire est très faible, et le matériau est extrêmement résistant à la pénétration d’ions chlorure (≈ 8 coulombs). Sa résistance à l'abrasion (indice de pertes volumiques) est inférieure à 1,3. Le BEVUP ne subit pratiquement aucune détérioration aux cycles de gel-dégel, même après 1000 cycles. Après une évaluation des BEVUP en laboratoire, une mise à l'échelle a été réalisée avec un malaxeur de béton industriel et une validation en chantier avec de la construction de deux passerelles. Les propriétés mécaniques supérieures des BEVUP a permis de concevoir les passerelles avec des sections réduites d’environ de 60% par rapport aux sections faites de BC. Le BEVUP offre plusieurs avantages économiques et environnementaux. Il réduit le coût de production et l’empreinte carbone des structures construites de béton fibré à ultra-hautes performances (BFUP) classique, en utilisant des matériaux disponibles localement. Il réduit les émissions de CO[indice inférieur 2] associées à la production de clinkers de ciment (50% de remplacement du ciment) et utilise efficacement les ressources naturelles. De plus, la production de BEVUP permet de réduire les quantités de déchets de verre stockés ou mis en décharge qui causent des problèmes environnementaux et pourrait permettre de sauver des millions de dollars qui pourraient être dépensés dans le traitement de ces déchets. Enfin, il offre une solution alternative aux entreprises de construction dans la production de BFUP à moindre coût.

Cost-Effectiveness of Rotavirus Vaccination for Under-Five Children in Iran

Background: Rotavirus diarrhea is one of the most important causes of death among under-five children. Anti-rotavirus vaccination of these children may have a reducing effect on the disease. Objectives: this study is intended to contribute to health policy-makers of the country about the optimal decision and policy development in this area, by performing cost-effectiveness and cost-utility analysis on anti-rotavirus vaccination for under-5 children. Patients and Methods: A cost-effectiveness analysis was performed using a decision tree model to analyze rotavirus vaccination, which was compared with no vaccination with Iran’s ministry of health perspective in a 5-year time horizon. Epidemiological data were collected from published and unpublished sources. Four different assumptions were considered to the extent of the disease episode. To analyze costs, the costs of implementing the vaccination program were calculated with 98% coverage and the cost of USD 7 per dose. Medical and social costs of the disease were evaluated by sampling patients with rotavirus diarrhea, and sensitivity analysis was also performed for different episode rates and vaccine price per dose. Results: For the most optimistic assumption for the episode of illness (10.2 per year), the cost per DALY averted is 12,760 and 7,404 for RotaTeq and Rotarix vaccines, respectively, while assuming the episode of illness is 300%, they will be equal to 2,395 and 354, respectively, which will be highly cost-effective. Number of life-years gained is equal to 3,533 years. Conclusions: Assuming that the illness episodes are 100% and 300% for Rotarix and 300% for Rota Teq, the ratio of cost per DALY averted is highly cost-effective, based on the threshold of the world health organization (< 1 GDP per capita = 4526 USD). The implementation of a national rotavirus vaccination program is suggested.

Nurses', midwives' and key stakeholders' experiences and perceptions on requirements to demonstrate the maintenance of professional competence.

Aim: To present the qualitative findings from a study on the development of scheme(s) to give evidence of maintenance of professional competence for nurses and midwives. Background: Key issues in maintenance of professional competence include notions of self- assessment, verification of engagement and practice hours, provision of an evidential record, the role of the employer and articulation of possible consequences for non-adherence with the requirements. Schemes to demonstrate the maintenance of professional competence have application to nurses, midwives and regulatory bodies and healthcare employers worldwide. Design: A mixed methods approach was used. This included an online survey of nurses and midwives and focus groups with nurses and midwives and other key stakeholders. The qualitative data are reported in this study. Methods: Focus groups were conducted among a purposive sample of nurses, midwives and key stakeholders from January–May 2015. A total of 13 focus groups with 91 participants contributed to the study. Findings: Four major themes were identified: Definitions and Characteristics of Competence; Continuing Professional Development and Demonstrating Competence; Assessment of Competence; The Nursing and Midwifery Board of Ireland and employers as regulators and enablers of maintaining professional competence. Conclusion: Competence incorporates knowledge, skills, attitudes, professionalism, application of evidence and translating learning into practice. It is specific to the nurse's/midwife's role, organizational needs, patient's needs and the individual nurse's/midwife's learning needs. Competencies develop over time and change as nurses and midwives work in different practice areas. Thus, role-specific competence is linked to recent engagement in practice.

A Microdata Analysis Approach to Transport Infrastructure Maintenance

Maintenance of transport infrastructure assets is widely advocated as the key in minimizing current and future costs of the transportation network. While effective maintenance decisions are often a result of engineering skills and practical knowledge, efficient decisions must also account for the net result over an asset's life-cycle. One essential aspect in the long term perspective of transport infrastructure maintenance is to proactively estimate maintenance needs. In dealing with immediate maintenance actions, support tools that can prioritize potential maintenance candidates are important to obtain an efficient maintenance strategy. This dissertation consists of five individual research papers presenting a microdata analysis approach to transport infrastructure maintenance. Microdata analysis is a multidisciplinary field in which large quantities of data is collected, analyzed, and interpreted to improve decision-making. Increased access to transport infrastructure data enables a deeper understanding of causal effects and a possibility to make predictions of future outcomes. The microdata analysis approach covers the complete process from data collection to actual decisions and is therefore well suited for the task of improving efficiency in transport infrastructure maintenance. Statistical modeling was the selected analysis method in this dissertation and provided solutions to the different problems presented in each of the five papers. In Paper I, a time-to-event model was used to estimate remaining road pavement lifetimes in Sweden. In Paper II, an extension of the model in Paper I assessed the impact of latent variables on road lifetimes; displaying the sections in a road network that are weaker due to e.g. subsoil conditions or undetected heavy traffic. The study in Paper III incorporated a probabilistic parametric distribution as a representation of road lifetimes into an equation for the marginal cost of road wear. Differentiated road wear marginal costs for heavy and light vehicles are an important information basis for decisions regarding vehicle miles traveled (VMT) taxation policies. In Paper IV, a distribution based clustering method was used to distinguish between road segments that are deteriorating and road segments that have a stationary road condition. Within railway networks, temporary speed restrictions are often imposed because of maintenance and must be addressed in order to keep punctuality. The study in Paper V evaluated the empirical effect on running time of speed restrictions on a Norwegian railway line using a generalized linear mixed model.

A Low Cost Controller Board for Teaching Robotics

This paper presents the Smarty Board; a new micro-controller board designed specifically for the robotics teaching needs of Australian schools. The primary motivation for this work was the lack of commercially available and cheap controller boards that would have all their components including interfaces on a single board. Having a single board simplifies the construction of programmable robots that can be used as platforms for teaching and learning robotics. Reducing the cost of the board as much as possible was one of the main design objectives. The target user groups for this device are the secondary and tertiary students, and hobbyists. Previous studies have shown that equipment cost is one of the major obstacles for teaching robotics in Australia. The new controller board was demonstrated at high-school seminars. In these demonstrations the new controller board was used for controlling two robots that we built. These robots are available as kits. Given the strong demand from high-school teachers, new kits will be developed for the next robotic Olympiad to be held in Australia in 2006.

The impact of planning delays and other holding costs on housing affordability

Housing affordability is gaining increasing prominence in the Australian socioeconomic landscape, despite strong economic growth and prosperity. It is a major consideration for any new development. However, it is multi-dimensional, has many facets, is complex and interwoven. One factor widely held to impact housing affordability is holding costs. Although it is only one contributor, the nature and extent of its impact requires clarification. It is certainly more multifarious than simple calculation of the interest or opportunity cost of land holding. For example, preliminary analysis suggests that even small shifts in the regulatory assessment period can significantly affect housing affordability. Other costs associated with “holding” also impact housing affordability, however these costs cannot always be easily identified. Nevertheless it can be said that ultimately the real impact is felt by those whom can least afford it - new home buyers whom can be relatively easily pushed into the realms of un-affordability.

Indoor environments : design, productivity and health

In a typical large office block, by far the largest lifetime expense is the salaries of the workers - 84% for salaries compared with : office rent (14%), total energy (1%), and maintenance (1%). The key drive for business is therefore the maximisation of the productivity of the employees as this is the largest cost. Reducing total energy use by 50% will not produce the same financial return as 1% productivity improvement? The aim of the project which led to this review of the literature was to understand as far as possible the state of knowledge internationally about how the indoor environment of buildings does influence occupants and the impact this influence may have on the total cost of ownership of buildings. Therefore one of the main focus areas for the literature has been identifying whether there is a link between productivity and health of building occupants and the indoor environment. Productivity is both easy to define - the ratio of output to input - but at the same time very hard to measure in a relatively small environment where individual contributions can influence the results, in particular social interactions. Health impacts from a building environment are also difficult to measure well, as establishing casual links between the indoor environment and a particular health issue can be very difficult. All of those issues are canvassed in the literature reported here. Humans are surprisingly adaptive to different physical environments, but the workplace should not test the limits of human adaptability. Physiological models of stress, for example, accept that the body has a finite amount of adaptive energy available to cope with stress. The importance of, and this projects' focus on, the physical setting within the integrated system of high performance workplaces, means this literature survey explores research which has been undertaken on both physical and social aspects of the built environment. The literature has been largely classified in several different ways, according to the classification scheme shown below. There is still some inconsistency in the use of keywords, which is being addressed and greater uniformity will be developed for a CD version of this literature, enabling searching using this classification scheme.