Evaluation of AUSDRISK as a screening tool for lifestyle modification programs: international implications for policy and cost-effectiveness

OBJECTIVE: To evaluate the current use of Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK) as a screening tool to identify individuals at high risk of developing type 2 diabetes for entry into lifestyle modification programs.

RESEARCH DESIGN AND METHODS: AUSDRISK scores were calculated from participants aged 40-74 years in the Greater Green Triangle Risk Factor Study, a cross-sectional population survey in 3 regions of Southwest Victoria, Australia, 2004-2006. Biomedical profiles of AUSDRISK risk categories were determined along with estimates of the Victorian population included at various cut-off scores. Sensitivity, specificity, positive predictive value (PPV), negative predictive value, and receiver operating characteristics were calculated for AUSDRISK in determining fasting plasma glucose (FPG) ≥6.1 mmol/L.

RESULTS: Increasing AUSDRISK scores were associated with an increase in weight, body mass index, FPG, and metabolic syndrome. Increasing the minimum cut-off score also increased the proportion of individuals who were obese and centrally obese, had impaired fasting glucose (IFG) and metabolic syndrome. An AUSDRISK score of ≥12 was estimated to include 39.5% of the Victorian population aged 40-74 (916 000), while a score of ≥20 would include only 5.2% of the same population (120 000). At AUSDRISK≥20, the PPV for detecting FPG≥6.1 mmol/L was 28.4%.

CONCLUSIONS: AUSDRISK is powered to predict those with IFG and undiagnosed type 2 diabetes, but its effectiveness as the sole determinant for entry into a lifestyle modification program is questionable given the large proportion of the population screened-in using the current minimum cut-off of ≥12. AUSDRISK should be used in conjunction with oral glucose tolerance testing, fasting glucose, or glycated hemoglobin to identify those individuals at highest risk of progression to type 2 diabetes, who should be the primary targets for lifestyle modification.

Portable MP3 player as low-cost data logger

Non-audio signals have been recorded in the flash ROM memory of a portable MP3 player, in WAV format file, to examine the possibility of using these cheap and small instruments as general-purpose portable data loggers. A 1200-Hz FM carrier modulated by the non-audio signal has replaced the microphone signal, while using the REC operating mode of the MP3 player, which triggers the voice recording function. The signal recovery was carried out by a PLL-based FM demodulator whose input is the FM signal captured in the coil leads of the MP3 player's earphone. Sinusoidal and electrocardiogram signals have been used in the system evaluation. Although the quality of low frequency signals needs improvement, overall the results indicate the viability of the proposal. Suggestions are made for improvements and extensions of the work.

Cost assessment of efficiency losses in hydroelectric plants

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

HPF boost interleaved operating in discontinuous conduction mode for trolleybus application

This paper deals with results of a research and development (R&D) project in cooperation with Electric Power Distribution Company in São Paulo (Brazil) regarding the development and experimental analysis of a new concept of power drive system suitable for application in traction systems of electrical vehicles pulled by electrical motors, which can be powered by urban DC or AC distribution networks. The proposed front-end structure is composed by five boost power cells in interleaving connection, operating in discontinuous conduction mode as AC-DC converter, or as DC-DC converter, in order to provide the proper DC output voltage range required by DC or AC adjustable speed drivers. Therefore, when supplied by single-phase AC distribution networks, and operating as AC-DC converter, it is capable to provide high power factor, reduced harmonic distortion in the input current, complying with the restrictions imposed by the IEC 61000-3-4 standards resulting in significant improvements for the trolleybuses systems efficiency and for the urban distribution network costs. Considering the compliance with input current restrictions imposed by IEC 61000-3-4 standards, two digital control strategies were evaluated. The digital controller has been implemented using a low cost FPGA (XC3S200) and developed totally using a hardware description language VHDL and fixed point arithmetic. Experimental results from a 15 kW low power scale prototype operating in DC and AC conditions are presented, in order to verify the feasibility and performance of the proposed system. © 2009 IEEE.

Development of a thermoeconomic methodology for optimizing biodiesel production. Part II: Manufacture exergetic cost and biodiesel production cost incorporating carbon credits, a Brazilian case study

The purpose of this study is to carry on a thermoeconomic analysis at a biodiesel production plant considering the irreversibilities in each step (part I: biodiesel plant under study and functional thermoeconomic diagram [1]), making it possible to calculate the thermoeconomic cost in US$/kWh and US$/l of the biodiesel production, and the main byproduct generated, glycerin, incorporating the credits for the CO2 that is not emitted into the atmosphere (carbon credits). Assuming a sale price for both the biodiesel and the byproduct (glycerin), the annual revenue of the total investment in a plant with a capacity of 8000 t/year of biodiesel operating at 8000 h/year was calculated. The variables that directly or indirectly influence the final thermoeconomic cost include total annual biodiesel production, hours of operation, manufacturing exergy cost, molar ratio in the transesterification reaction, reaction temperature and pressure in the process. Depending on the increase or decrease in sale prices for both biodiesel and glycerin, the payback is going to significantly increase or decrease. It is evident that, in exergy terms, the sale of glycerin is of vital importance in order to reduce the biodiesel price, getting a shorter payback period for the plant under study. © 2013 Elsevier Ltd. All rights reserved.

Cost Management Practices and Strategic Perspectives: a study in the construction industry of the State of Parana

The purpose of this paper is to investigate the cost management practices of building industry companies of Parana that follow the typology of Porter's strategies. The sample comprises member companies of the Association of Construction Industries of the State of Parana (PR-SINDUSCON) operating in the segment of residential buildings. The data were collected by means of questionnaires sent to 317 SINDUSCON members. 69 were returned and 54 used for our research. Exploratory Factorial Analysis of the data allowed us to identify two groups of cost management practices. Analyses suggest equality between the adopted cost management practices and the Cost Control Planning (CCP) practices among the companies of the Group 1, regardless of the generic strategy adopted. The companies of the Group 2 that adopted the differentiation strategy seem to use mainly the ACR cost management practice. Our findings differ from those obtained by Chenhall insofar as companies that adopt low cost strategies tend to use managerial controls focused on cost control and rigid budgetary controls.

Results obtained with a low cost software-based audiometer for hearing screening

Introduction: The implementation of hearing screening programs can be facilitated by reducing operating costs, including the cost of equipment. The Telessaúde (TS) audiometer is a low-cost, software-based, and easy-to-use piece of equipment for conducting audiometric screening. Aim: To evaluate the TS audiometer for conducting audiometric screening. Methods: A prospective randomized study was performed. Sixty subjects, divided into those who did not have (group A, n = 30) and those who had otologic complaints (group B, n = 30), underwent audiometric screening with conventional and TS audiometers in a randomized order. Pure tones at 25 dB HL were presented at frequencies of 500, 1000, 2000, and 4000 Hz. A "fail" result was considered when the individual failed to respond to at least one of the stimuli. Pure-tone audiometry was also performed on all participants. The concordance of the results of screening with both audiometers was evaluated. The sensitivity, specificity, and positive and negative predictive values of screening with the TS audiometer were calculated. Results: For group A, 100% of the ears tested passed the screening. For group B, "pass" results were obtained in 34.2% (TS) and 38.3% (conventional) of the ears tested. The agreement between procedures (TS vs. conventional) ranged from 93% to 98%. For group B, screening with the TS audiometer showed 95.5% sensitivity, 90.4% sensitivity, and positive and negative predictive values equal to 94.9% and 91.5%, respectively. Conclusions: The results of the TS audiometer were similar to those obtained with the conventional audiometer, indicating that the TS audiometer can be used for audiometric screening.

How well do radiographic absorptiometry and quantitative ultrasound predict osteoporosis at spine or hip? A cost-effectiveness analysis

Dual energy X-ray absorptiometry (DXA) is widely accepted as the reference method for diagnosis and monitoring of osteoporosis and for assessment of fracture risk, especially at hip. However, axial-DXA is not suitable for mass screening, because it is usually confined to specialized centers. We propose a two-step diagnostic approach to postmenopausal osteoporosis: the first step, using an inexpensive, widely available screening technique, aims at risk stratification in postmenopausal women; the second step, DXA of spine and hip is applied only to potentially osteoporotic women preselected on the basis of the screening measurement. In a group of 110 healthy postmenopausal woman, the capability of various peripheral bone measurement techniques to predict osteoporosis at spine and/or hip (T-score < -2.5SD using DXA) was tested using receiver operating characteristic (ROC) curves: radiographic absorptiometry of phalanges (RA), ultrasonometry at calcaneus (QUS. CALC), tibia (SOS.TIB), and phalanges (SOS.PHAL). Thirty-three women had osteoporosis at spine and/or hip with DXA. Areas under the ROC curves were 0.84 for RA, 0.83 for QUS.CALC, 0.77 for SOS.PHAL (p < 0.04 vs RA) and 0.74 for SOS.TIB (p < 0.02 vs RA and p = 0.05 vs QUS.CALC). For levels of sensitivity of 90%, the respective specificities were 67% (RA), 64% (QUS.CALC), 48% (SOS.PHAL), and 39% (SOS.TIB). In a cost-effective two-step, the price of the first step should not exceed 54% (RA), 51% (QUS.CALC), 42% (SOS.PHAL), and 25% (SOS.TIB). In conclusion, RA, QUS.CALC, SOS.PHAL, and SOS.TIB may be useful to preselect postmenopausal women in whom axial DXA is indicated to confirm/exclude osteoporosis at spine or hip.

A cost-effective surgical navigation solution for periacetabular osteotomy (PAO) surgery

In this chapter a low-cost surgical navigation solution for periacetabular osteotomy (PAO) surgery is described. Two commercial inertial measurement units (IMU, Xsens Technologies, The Netherlands), are attached to a patient’s pelvis and to the acetabular fragment, respectively. Registration of the patient with a pre-operatively acquired computer model is done by recording the orientation of the patient’s anterior pelvic plane (APP) using one IMU. A custom-designed device is used to record the orientation of the APP in the reference coordinate system of the IMU. After registration, the two sensors are mounted to the patient’s pelvis and acetabular fragment, respectively. Once the initial position is recorded, the orientation is measured and displayed on a computer screen. A patient-specific computer model generated from a pre-operatively acquired computed tomography (CT) scan is used to visualize the updated orientation of the acetabular fragment. Experiments with plastic bones (7 hip joints) performed in an operating room comparing a previously developed optical navigation system with our inertial-based navigation system showed no statistical difference on the measurement of acetabular component reorientation (anteversion and inclination). In six out of seven hip joints the mean absolute difference was below five degrees for both anteversion and inclination.

A cost-effective surgical navigation solution for periacetabular osteotomy (PAO) surgery.

PURPOSE To evaluate a low-cost, inertial sensor-based surgical navigation solution for periacetabular osteotomy (PAO) surgery without the line-of-sight impediment. METHODS Two commercial inertial measurement units (IMU, Xsens Technologies, The Netherlands), are attached to a patient's pelvis and to the acetabular fragment, respectively. Registration of the patient with a pre-operatively acquired computer model is done by recording the orientation of the patient's anterior pelvic plane (APP) using one IMU. A custom-designed device is used to record the orientation of the APP in the reference coordinate system of the IMU. After registration, the two sensors are mounted to the patient's pelvis and acetabular fragment, respectively. Once the initial position is recorded, the orientation is measured and displayed on a computer screen. A patient-specific computer model generated from a pre-operatively acquired computed tomography scan is used to visualize the updated orientation of the acetabular fragment. RESULTS Experiments with plastic bones (eight hip joints) performed in an operating room comparing a previously developed optical navigation system with our inertial-based navigation system showed no statistically significant difference on the measurement of acetabular component reorientation. In all eight hip joints the mean absolute difference was below four degrees. CONCLUSION Using two commercially available inertial measurement units we show that it is possible to accurately measure the orientation (inclination and anteversion) of the acetabular fragment during PAO surgery and therefore to successfully eliminate the line-of-sight impediment that optical navigation systems have.

Economies of Scale and Cost Efficiencies: A Panel-Data Stochastic-Frontier Analysis of Real Estate Investment Trusts

This paper extends the existing research on real estate investment trust (REIT) operating efficiencies. We estimate a stochastic-frontier panel-data model specifying a translog cost function, covering 1995 to 2003. The results disagree with previous research in that we find little evidence of scale economies and some evidence of scale diseconomies. Moreover, we also generally find smaller inefficiencies than those shown by other REIT studies. Contrary to previous research, the results also show that self-management of a REIT associates with more inefficiency when we measure output with assets. When we use revenue to measure output, selfmanagement associates with less inefficiency. Also contrary with previous research, higher leverage associates with more efficiency. The results further suggest that inefficiency increases over time in three of our four specifications.

Cost Improvements, Returns to Scale, and Cost Inefficiencies for Real Estate Investment Trusts

This paper extends the existing research on real estate investment trust (REIT) operating efficiencies. We estimate stochastic-frontier, panel-data models specifying a translog cost function. The specified model updates the cost frontier with new information as it becomes available over time. The model can identify frontier cost improvements, returns to scale, and cost inefficiencies over time. The results disagree with most previous research in that we find no evidence of scale economies and some evidence of scale diseconomies. Moreover, we also generally find smaller inefficiencies than those shown by other REIT studies. Contrary to previous research, higher leverage associates with more efficiency.

On track for solar grade silicon through a siemens process-type laboratory reactor: operating conditions and energy savings

Polysilicon cost impacts significantly on the photovoltaics (PV) cost and on the energy payback time. Nowadays, the besetting production process is the so called Siemens process, polysilicon deposition by chemical vapor deposition (CVD) from Trichlorosilane. Polysilicon purification level for PV is to a certain extent less demanding that for microelectronics. At the Instituto de Energía Solar (IES) research on this subject is performed through a Siemens process-type laboratory reactor. Through the laboratory CVD prototype at the IES laboratories, valuable information about the phenomena involved in the polysilicon deposition process and the operating conditions is obtained. Polysilicon deposition by CVD is a complex process due to the big number of parameters involved. A study on the influence of temperature and inlet gas mixture composition on the polysilicon deposition growth rate, based on experimental experience, is shown. Moreover, CVD process accounts for the largest contribution to the energy consumption of the polysilicon production. In addition, radiation phenomenon is the major responsible for low energetic efficiency of the whole process. This work presents a model of radiation heat loss, and the theoretical calculations are confirmed experimentally through a prototype reactor at our disposal, yielding a valuable know-how for energy consumption reduction at industrial Siemens reactors.

The effect of electricity tariffs over the operating costs of the Spanish wastewater treatments plants

Given the complex structure of electricity tariffs and their steady growth in Spanish, we've studied its effect over the operating costs of the wastewater treatment plants (WWTP), concluding that in the last three years the revisions of electricity rates have meant increases in electricity costs of 64.5% in the rate 3.1.A and 79.1% in the rate 6.1. This has caused the cost of electricity, which was the most important, has increased from a 44% of total operating costs in the year 2009, to more than a 56% in the year 2012.

Implementation cost to consumers of Part 581 - Bumper Standard, Phase II; weight and cost study of three "X" body bumper systems; and consumer replacement cost for complete bumper systems studied. Final report.

National Highway Traffic Safety Administration, Washington, D.C.