Effect of initial retinal thickness on outcome of intravitreal bevacizumab therapy for diabetic macular edema

Purpose: To investigate whether eyes with diabetic macular edema (DME) and central retinal thickness (CRT) >400 μm had better visual and anatomical outcomes compared to eyes with a CRT <400 μm when treated with intravitreal bevacizumab in a real-world setting. Patients and methods: Patients undergoing intravitreal bevacizumab therapy for DME were identified from the departmental database of a tertiary referral unit. Following the initial injection, a retreatment was performed for any persistent macular edema, unless there had been no previous response to repeated doses. Recorded parameters included visual acuity, CRT on optical coherence tomography (spectral domain optical coherence tomography [SD-OCT]), and SD-OCT characteristics. Comparisons were made between data at baseline and 12 months after the first injection, and differences were tested for statistical significance using the Student's t-test. Results: In all, 175 eyes of 142 patients were analyzed. Patients in group 2 (CRT >400 μm) had significantly more injections than group 1 (CRT <400 μm) (4.0 versus 3.3; P=0.003). Both groups had similar numbers of eyes with preexisting epiretinal membrane and/or vitreomacular traction at baseline. The reduction in CRT was significantly greater in group 2 when compared to group 1 (P<0.0001). In terms of visual gain between baseline and month 12, each gained significantly by a mean of 0.12 logarithm of the minimum angle of resolution units (P=0.0001), but there was no difference between groups 1 and 2 (P=0.99). Conclusion: These results do not support a 400 μm baseline CRT cut-off for treating DME with bevacizumab, in contrast to published data on ranibizumab. Our results also indicate that patients with a thicker CRT require more bevacizumab injections, making treatment less cost-effective for these patients. Our results could be used by practitioners to support the use of bevacizumab in DME without applying a CRT cut-off. © 2014 Mushtaq et al.

A roadmap for cost engineering in the automotive supplier sector

The advent of global competition has introduced the need for new competitive manufacturing strategies. The implementation of new strategies has a dramatic effect on measuring product cost compared to traditional management accounting methods. It is found that new cost management methods are required to measure success and support decision-making within the new strategies. One example is the consequences of using traditional management accounting methods for measuring the effects of lean having catastrophic results during reporting. Such results steer managers away from lean manufacture based upon a false picture of the potential benefits. This research examines cost management methods potentially applicable within the automotive supplier sector. Because of the lack of cost-related data collected within the supplier sector companies, this paper ends with a demonstration of a novel method for use in data scarce environments. Copyright © 2008 Inderscience Enterprises Ltd.

Serum-free process development:improving the yield and consistency of human mesenchymal stromal cell production

Background aims: The cost-effective production of human mesenchymal stromal cells (hMSCs) for off-the-shelf and patient specific therapies will require an increasing focus on improving product yield and driving manufacturing consistency. Methods: Bone marrow-derived hMSCs (BM-hMSCs) from two donors were expanded for 36 days in monolayer with medium supplemented with either fetal bovine serum (FBS) or PRIME-XV serum-free medium (SFM). Cells were assessed throughout culture for proliferation, mean cell diameter, colony-forming potential, osteogenic potential, gene expression and metabolites. Results: Expansion of BM-hMSCs in PRIME-XV SFM resulted in a significantly higher growth rate (P < 0.001) and increased consistency between donors compared with FBS-based culture. FBS-based culture showed an inter-batch production range of 0.9 and 5 days per dose compared with 0.5 and 0.6 days in SFM for each BM-hMSC donor line. The consistency between donors was also improved by the use of PRIME-XV SFM, with a production range of 0.9 days compared with 19.4 days in FBS-based culture. Mean cell diameter has also been demonstrated as a process metric for BM-hMSC growth rate and senescence through a correlation (R² = 0.8705) across all conditions. PRIME-XV SFM has also shown increased consistency in BM-hMSC characteristics such as per cell metabolite utilization, in vitro colony-forming potential and osteogenic potential despite the higher number of population doublings. Conclusions: We have increased the yield and consistency of BM-hMSC expansion between donors, demonstrating a level of control over the product, which has the potential to increase the cost-effectiveness and reduce the risk in these manufacturing processes.

Cost-reduction using non-uniform traffic in optical networks

Next-generation networks are likely to be non-uniform in all their aspects, including number of lightpaths carried per link, number of wavelengths per link, number of fibres per link, asymmetry of the links, and traffic flows. Routing and wavelength allocation models generally assume that the optical network is uniform and that the number of wavelengths per link is a constant. In practice however, some nodes and links carry heavy traffic and additional wavelengths are needed in those links. We study a wavelength-routed optical network based on the UK JANET topology where traffic demands between nodes are assumed to be non-uniform. We investigate how network capacity can be increased by locating congested links and suggesting cost-effective upgrades. Different traffic demands patterns, hop distances, number of wavelengths per link, and routing algorithms are considered. Numerical results show that a 95% increase in network capacity is possible by overlaying fibre on just 5% of existing links. We conclude that non-uniform traffic allocation can be beneficial to localize traffic in nodes and links deep in the network core and provisioning of additional resources there can efficiently and cost-effectively increase network capacity. © 2013 IEEE.

A randomised controlled trial of the clinical effectiveness and cost-effectiveness of the levonorgestrel-releasing intrauterine system in primary care against standard treatment for menorrhagia:the ECLIPSE trial

BACKGROUND: Heavy menstrual bleeding (HMB) is a common problem, yet evidence to inform decisions about initial medical treatment is limited. OBJECTIVES: To assess the clinical effectiveness and cost-effectiveness of the levonorgestrel-releasing intrauterine system (LNG-IUS) (Mirena(®), Bayer) compared with usual medical treatment, with exploration of women's perspectives on treatment. DESIGN: A pragmatic, multicentre randomised trial with an economic evaluation and a longitudinal qualitative study. SETTING: Women who presented in primary care. PARTICIPANTS: A total of 571 women with HMB. A purposeful sample of 27 women who were randomised or ineligible owing to treatment preference participated in semistructured face-to-face interviews around 2 and 12 months after commencing treatment. INTERVENTIONS: LNG-IUS or usual medical treatment (tranexamic acid, mefenamic acid, combined oestrogen-progestogen or progesterone alone). Women could subsequently swap or cease their allocated treatment. OUTCOME MEASURES: The primary outcome was the patient-reported score on the Menorrhagia Multi-Attribute Scale (MMAS) assessed over a 2-year period and then again at 5 years. Secondary outcomes included general quality of life (QoL), sexual activity, surgical intervention and safety. Data were analysed using iterative constant comparison. A state transition model-based cost-utility analysis was undertaken alongside the randomised trial. Quality-adjusted life-years (QALYs) were derived from the European Quality of Life-5 Dimensions (EQ-5D) and the Short Form questionnaire-6 Dimensions (SF-6D). The intention-to-treat analyses were reported as cost per QALY gained. Uncertainty was explored by conducting both deterministic and probabilistic sensitivity analyses. RESULTS: The MMAS total scores improved significantly in both groups at all time points, but were significantly greater for the LNG-IUS than for usual treatment [mean difference over 2 years was 13.4 points, 95% confidence interval (CI) 9.9 to 16.9 points; p < 0.001]. However, this difference between groups was reduced and no longer significant by 5 years (mean difference in scores 3.9 points, 95% CI -0.6 to 8.3 points; p = 0.09). By 5 years, only 47% of women had a LNG-IUS in place and 15% were still taking usual medical treatment. Five-year surgery rates were low, at 20%, and were similar, irrespective of initial treatments. There were no significant differences in serious adverse events between groups. Using the EQ-5D, at 2 years, the relative cost-effectiveness of the LNG-IUS compared with usual medical treatment was £1600 per QALY, which by 5 years was reduced to £114 per QALY. Using the SF-6D, usual medical treatment dominates the LNG-IUS. The qualitative findings show that women's experiences and expectations of medical treatments for HMB vary considerably and change over time. Women had high expectations of a prompt effect from medical treatments. CONCLUSIONS: The LNG-IUS, compared with usual medical therapies, resulted in greater improvement over 2 years in women's assessments of the effect of HMB on their daily routine, including work, social and family life, and psychological and physical well-being. At 5 years, the differences were no longer significant. A similar low proportion of women required surgical intervention in both groups. The LNG-IUS is cost-effective in both the short and medium term, using the method generally recommended by the National Institute for Health and Care Excellence. Using the alternative measures to value QoL will have a considerable impact on cost-effectiveness decisions. It will be important to explore the clinical and health-care trajectories of the ECLIPSE (clinical effectiveness and cost-effectiveness of levonorgestrel-releasing intrauterine system in primary care against standard treatment for menorrhagia) trial participants to 10 years, by which time half of the cohort will have reached menopause. TRIAL REGISTRATION: Current Controlled Trials ISRCTN86566246. FUNDING: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 88. See the NIHR Journals Library website for further project information.

Cost-efficient OFDM generation at 60-GHz by heterodyne technique with direct modulation and envelope detector

A cost-effective radio over fiber system to up-convert and transmit multigigabit signals at 60 GHz is presented. A low intermediate frequency OFDM signal is used to directly modulate a laser, which is combined with an independent unmodulated laser. The generated millimeter wave frequency can be adjusted by tuning the frequency separation between the lasers. Since no external modulator is required, this technique is low-cost and it is easily integrable in a single chip. In this paper, we present numerical results showing the feasibility of generating an IEEE 802.15.3c compliant 3.5-Gbps 60-GHz OFDM. We show that received signal quality is not limited by the lasers' linewidth but by the relative intensity noise. © 2013 IEEE.

Cost of illness in benign prostatic hyperplasia: A review

The paper provides a systematic review on the cost-of-illness studies in an age-associated condition with high prevalence, benign prostatic hyperplasia (BPH), published in Medline between 2005 and 2015. Overall 11 studies were included, which were conducted in 8 countries. In the US, the annual direct medical costs per patient ranged from $255 to $5,729, while in Europe from €253 to €1,251. In 2008, in the UK total annual direct medical costs of BPH were £180.8 million at national level. In the US, overall costs of BPH management in the private sector were estimated at $3.9 billion annually, of which $500 million was attributable to productivity loss (year 1999). Due to demographic factors and possible surgical innovations in the field of urology, the costs of BPH are likely to increase in the future. Over the next decade the age of retirement is projected to rise, consequently, the indirect costs related to aging-associated conditions such as BPH are expected to soar. To promote the transparent and cost-effective management of BPH, development of rational clinical guidelines would be essential that may lead to significant improvement in quality of care as well as reduction in healthcare expenditure.

Estimation and prediction of average vehicle occupancies using traffic accident records

As congestion management strategies begin to put more emphasis on person trips than vehicle trips, the need for vehicle occupancy data has become more critical. The traditional methods of collecting these data include the roadside windshield method and the carousel method. These methods are labor-intensive and expensive. An alternative to these traditional methods is to make use of the vehicle occupancy information in traffic accident records. This method is cost effective and may provide better spatial and temporal coverage than the traditional methods. However, this method is subject to potential biases resulting from under- and over-involvement of certain population sectors and certain types of accidents in traffic accident records. In this dissertation, three such potential biases, i.e., accident severity, driver’s age, and driver’s gender, were investigated and the corresponding bias factors were developed as needed. The results show that although multi-occupant vehicles are involved in higher percentages of severe accidents than are single-occupant vehicles, multi-occupant vehicles in the whole accident vehicle population were not overrepresented in the accident database. On the other hand, a significant difference was found between the distributions of the ages and genders of drivers involved in accidents and those of the general driving population. An information system that incorporates adjustments for the potential biases was developed to estimate the average vehicle occupancies (AVOs) for different types of roadways on the Florida state roadway system. A reasonableness check of the results from the system shows AVO estimates that are highly consistent with expectations. In addition, comparisons of AVOs from accident data with the field estimates show that the two data sources produce relatively consistent results. While accident records can be used to obtain the historical AVO trends and field data can be used to estimate the current AVOs, no known methods have been developed to project future AVOs. Four regression models for the purpose of predicting weekday AVOs on different levels of geographic areas and roadway types were developed as part of this dissertation. The models show that such socioeconomic factors as income, vehicle ownership, and employment have a significant impact on AVOs.

New fuel cells system for portable application with low temperature cofired ceramic (LTCC) technology

Miniature direct methanol fuel cells (DMFCs) are promising micro power sources for portable appliction. Low temperature cofired ceramic (LTCC), a competitive technology for current MEMS based fabrication, provides cost-effective mass manufacturing route for miniature DMFCs. Porous silver tape is adapted as electrodes to replace the traditional porous carbon electrodes due to its compatibility to LTCC processing and other electrochemical advantages. Electrochemical evaluation of silver under DMFCs operating conditions demonstrated that silver is a good electrode for DMFCs because of its reasonable corrosion resistance, low passivating current, and enhanced catalytic effect. Two catalyst loading methods (cofiring and postfiring) of the platinum and ruthenium catalysts are evaluated for LTCC based processing. The electrochemical analysis exhibits that the cofired path out-performs the postfiring path both at the anode and cathode. The reason is the formation of high surface area precipitated whiskers. Self-constraint sintering is utilized to overcome the difficulties of the large difference of coefficient of thermal expansion (CTE) between silver and LTCC (Dupont 951) tape during cofiring. The graphite sheet employed as a cavity fugitive insert guarantees cavity dimension conservation. Finally, performance of the membrane electrode assembly (MEA) with the porous silver electrode in the regular graphite electrode based cell and the integrated cofired cell is measured under passive fuel feeding condition. The MEA of the regular cell performs better as the electrode porosity and temperature increased. The power density of 10 mWcm-2 was obtained at ambient conditions with 1M methanol and it increased to 16 mWcm -2 at 50°C from an open circuit voltage of 0.58V. For the integrated prototype cell, the best performance, which depends on the balance methanol crossover and mass transfer at different temperatures and methanol concentrations, reaches 1.13 mWcm-2 at 2M methanol solution at ambient pressure. The porous media pore structure increases the methanol crossover resistance. As temperature increased to 60°C, the device increases to 2.14 mWcm-2.

An assessment of novel biodegradable magnesium alloys for endovascular biomaterial applications

Magnesium alloys have been widely explored as potential biomaterials, but several limitations to using these materials have prevented their widespread use, such as uncontrollable degradation kinetics which alter their mechanical properties. In an attempt to further the applicability of magnesium and its alloys for biomedical purposes, two novel magnesium alloys Mg-Zn-Cu and Mg-Zn-Se were developed with the expectation of improving upon the unfavorable qualities shown by similar magnesium based materials that have previously been explored. The overall performance of these novel magnesium alloys has been assessesed in three distinct phases of research: 1) analysing the mechanical properties of the as-cast magnesium alloys, 2) evaluating the biocompatibility of the as-cast magnesium alloys through the use of in-vitro cellular studies, and 3) profiling the degradation kinetics of the as-cast magnesium alloys through the use of electrochemical potentiodynamic polarization techqnique as well as gravimetric weight-loss methods. As compared to currently available shape memory alloys and degradable as-cast alloys, these experimental alloys possess superior as-cast mechanical properties with elongation at failure values of 12% and 13% for the Mg-Zn-Se and Mg-Zn-Se alloys, respectively. This is substantially higher than other as-cast magnesium alloys that have elongation at failure values that range from 7-10%. Biocompatibility tests revealed that both the Mg-Zn-Se and Mg-Zn-Cu alloys exhibit low cytotoxicity levels which are suitable for biomaterial applications. Gravimetric and electrochemical testing was indicative of the weight loss and initial corrosion behavior of the alloys once immersed within a simulated body fluid. The development of these novel as-cast magnesium alloys provide an advancement to the field of degradable metallic materials, while experimental results indicate their potential as cost-effective medical devices.^

The utilization of chiral ion mobility spectrometry for the detection of enantiomeric mixtures and thermally labile compounds

This dissertation utilized electrospray ion mobility mass spectrometry (ESI-IMS-MS) to develop methods necessary for the separation of chiral compounds of forensic interest. The compounds separated included ephedrines and pseudoephedrines, that occur as impurities in confiscated amphetamine type substances (ATS) in an effort to determine the origin of these substances. The ESI-IMS-MS technique proved to be faster and more cost effective than traditional chromatographic methods currently used to conduct chiral separations such as gas and liquid chromatography. Both mass spectrometric and computational analysis revealed the separation mechanism of these chiral interactions allowing for further development to separate other chiral compounds by IMS. Successful separation of chiral compounds was achieved utilizing a variety of modifiers injected into the IMS drift tube. It was found that the modifiers themselves did not need to be chiral in nature and that achiral modifiers were sufficient in performing the required separations. The ESI-IMS-MS technique was also used to detect thermally labile compounds which are commonly found in explosive substances. The methods developed provided mass spectrometric identification of the type of ionic species being detected from explosive analytes as well as the appropriate solvent that enhances detection of these analytes in either the negative or positive ion mode. An application of the developed technique was applied to the analysis of a variety of low explosive smokeless powder samples. It was found that the developed ESI-IMS-MS technique not only detected the components of the smokeless powders, but also provided data that allowed the classification of the analyzed smokeless powders by manufacturer or make. ^

Estimation and Prediction of Average Vehicle Occupancies using Traffic Accident Records

As congestion management strategies begin to put more emphasis on person trips than vehicle trips, the need for vehicle occupancy data has become more critical. The traditional methods of collecting these data include the roadside windshield method and the carousel method. These methods are labor-intensive and expensive. An alternative to these traditional methods is to make use of the vehicle occupancy information in traffic accident records. This method is cost effective and may provide better spatial and temporal coverage than the traditional methods. However, this method is subject to potential biases resulting from under- and over-involvement of certain population sectors and certain types of accidents in traffic accident records. In this dissertation, three such potential biases, i.e., accident severity, driver¡¯s age, and driver¡¯s gender, were investigated and the corresponding bias factors were developed as needed. The results show that although multi-occupant vehicles are involved in higher percentages of severe accidents than are single-occupant vehicles, multi-occupant vehicles in the whole accident vehicle population were not overrepresented in the accident database. On the other hand, a significant difference was found between the distributions of the ages and genders of drivers involved in accidents and those of the general driving population. An information system that incorporates adjustments for the potential biases was developed to estimate the average vehicle occupancies (AVOs) for different types of roadways on the Florida state roadway system. A reasonableness check of the results from the system shows AVO estimates that are highly consistent with expectations. In addition, comparisons of AVOs from accident data with the field estimates show that the two data sources produce relatively consistent results. While accident records can be used to obtain the historical AVO trends and field data can be used to estimate the current AVOs, no known methods have been developed to project future AVOs. Four regression models for the purpose of predicting weekday AVOs on different levels of geographic areas and roadway types were developed as part of this dissertation. The models show that such socioeconomic factors as income, vehicle ownership, and employment have a significant impact on AVOs.

Optimizing the Synthesis of AZN

Azulenyl nitrone (AZN) is a bright green compound that can be used to stain different compounds, including plastics. When these stained plastics are irradiated, as they commonly are in the sterilization of medical devices, AZN changes color from green to red, constituting a permanent change. This would make obsolete the current methods of radioactive labeling and maintain the integrity of medical equipment. Although a method of synthesis is already in place, the aim was to improve the yield significantly and find a more efficient and cost-effective procedure. Last year, the procedure used resulted in 18 to 20% of AZN synthesized at the most favorable conditions. With that in mind, this year modifications were done in the hopes of improving the yield. The solvent was changed to a mixture of isopropanol and triethylamine, a stronger base, and a catalytic amount of N-tertbutyl hydroxylamine hydrochloride was used (around 4 equivalents). The reaction time was also increased to 7 days, rather than 2. After several trials, the samples were run through column chromatography and the average yield was 70%, a much more promising result than that obtained last year. There is still research to be done to improve the technicalities of the procedure, including altering the amounts of N-tertbutyl hydroxylamine hydrochloride to try and obtain similar data with fewer amounts. This portion of the research will be done in the second half of the year. In the meantime, however, a novel and more efficient method of synthesis has been established for the production of AZN that can be potentially commercialized.

Optimizing the Synthesis of AZN

Azulenyl nitrone (AZN) is a bright green compound that can be used to stain different compounds, including plastics. When these stained plastics are irradiated, as they commonly are in the sterilization of medical devices, AZN changes color from green to red, constituting a permanent change. This would make obsolete the current methods of radioactive labeling and maintain the integrity of medical equipment. Although a method of synthesis is already in place, the aim was to improve the yield significantly and find a more efficient and cost-effective procedure. Last year, the procedure used resulted in 18 to 20% of AZN synthesized at the most favorable conditions. With that in mind, this year modifications were done in the hopes of improving the yield. The solvent was changed to a mixture of isopropanol and triethylamine, a stronger base, and a catalytic amount of N-tertbutyl hydroxylamine hydrochloride was used (around 4 equivalents). The reaction time was also increased to 7 days, rather than 2. After several trials, the samples were run through column chromatography and the average yield was 70%, a much more promising result than that obtained last year. There is still research to be done to improve the technicalities of the procedure, including altering the amounts of N-tertbutyl hydroxylamine hydrochloride to try and obtain similar data with fewer amounts. This portion of the research will be done in the second half of the year. In the meantime, however, a novel and more efficient method of synthesis has been established for the production of AZN that can be potentially commercialized.

Revestimento decorativo monocamada pigmentado, com resíduo de vidro temperado, para aplicação em fachadas

Although efficient from a technical point of view, mortar layers that make up the traditional masonry coating (slurry mortar, plaster and plaster) have to be in contradiction with the new construction technologies and more efficient methods of consumption and work rationalization. From an environmental point of view, the recovery of waste into new composites for the building has been a growing strand of studies in the scientific community, may prove to be a cost-effective solution in some cases. Thus, this research proposes the development of a mortar Decorative Coating Monolayer (RDM), for use in facades, produced on site, incorporating tempered glass waste (RVT) in the cement matrix, as a partial substitute for aggregate. Therefore, we adopted the binder respect / aggregate of 1: 6 (by volume), consistency index 250mm ± 20, sand substitution levels of glass waste 20%, 50% and 80% and relative water / cement varied in many traits. Two additives were used, a polymer, styrene-butadiene-based, and other chemical, besides mineral and silica fume inorganic pigment in colors red, yellow and blue. Mechanical tests were carried out on fresh pasta and hardened, as well as for the applied coating on masonry, so as to demonstrate the feasibility of the material. In addition, it verified the adequacy of the RDM built environment by means of thermal tests. The results demonstrated the feasibility of the proposed RDM with significantly higher values when compared to norms, especially the dash-added replacement content of 20% and addition of pigment in red. Therefore, the study shows the scientific community as an incentive to the use of technological innovations in construction, increasing the range of alternatives available for housing production, with the proposition of a material that achieves the desired functionality and obtain environmental gain, and may be adopted on construction sites as an alternative industrialized mortars.