Showing papers on "Cost effectiveness published in 2017"

More Reliable Lithium-Sulfur Batteries: Status, Solutions and Prospects.

Abstract: Lithium-sulfur (Li-S) batteries have attracted tremendous interest because of their high theoretical energy density and cost effectiveness. The target of Li-S battery research is to produce batteries with a high useful energy density that at least outperforms state-of-the-art lithium-ion batteries. However, due to an intrinsic gap between fundamental research and practical applications, the outstanding electrochemical results obtained in most Li-S battery studies indeed correspond to low useful energy densities and are not really suitable for practical requirements. The Li-S battery is a complex device and its useful energy density is determined by a number of design parameters, most of which are often ignored, leading to the failure to meet commercial requirements. The purpose of this review is to discuss how to pave the way for reliable Li-S batteries. First, the current research status of Li-S batteries is briefly reviewed based on statistical information obtained from literature. This includes an analysis of how the various parameters influence the useful energy density and a summary of existing problems in the current Li-S battery research. Possible solutions and some concerns regarding the construction of reliable Li-S batteries are comprehensively discussed. Finally, insights are offered on the future directions and prospects in Li-S battery field.

Tree-Inspired Design for High-Efficiency Water Extraction.

Abstract: The solar steam process, akin to the natural water cycle, is considered to be an attractive approach to address water scarcity issues globally. However, water extraction from groundwater, for example, has not been demonstrated using these existing technologies. Additionally, there are major unaddressed challenges in extracting potable water from seawater including salt accumulation and long-term evaporation stability, which warrant further investigation. Herein, a high-performance solar steam device composed entirely of natural wood is reported. The pristine, natural wood is cut along the transverse direction and the top surface is carbonized to create a unique bilayer structure. This tree-inspired design offers distinct advantages for water extraction, including rapid water transport and evaporation in the mesoporous wood, high light absorption (≈99%) within the surface carbonized open wood channels, a low thermal conductivity to avoid thermal loss, and cost effectiveness. The device also exhibits long-term stability in seawater without salt accumulation as well as high performance for underground water extraction. The tree-inspired design offers an inexpensive and scalable solar energy harvesting and steam generation technology that can provide clean water globally, especially for rural or remote areas where water is not only scarce but also limited by water extraction materials and methods.

Canadian 24-Hour Movement Guidelines for the Early Years (0-4 years): An Integration of Physical Activity, Sedentary Behaviour, and Sleep.

Abstract: The Canadian Society for Exercise Physiology convened representatives of national organizations, research experts, methodologists, stakeholders, and end-users who followed rigorous and transparent guideline development procedures to create the Canadian 24-Hour Movement Guidelines for the Early Years (0–4 years): An Integration of Physical Activity, Sedentary Behaviour, and Sleep. These novel guidelines for children of the early years embrace the natural and intuitive integration of movement behaviours across the whole day (24-h period). The development process was guided by the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Four systematic reviews (physical activity, sedentary behaviour, sleep, combined behaviours) examining the relationships within and among movement behaviours and several health indicators were completed and interpreted by a Guideline Development Panel. The systematic reviews that were conducted to inform the development of the guidelines, and the framework that was applied to develop the recommendations, followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Complementary compositional analyses were performed using data from the Canadian Health Measures Survey to examine the relationships between movement behaviours and indicators of adiposity. A review of the evidence on the cost effectiveness and resource use associated with the implementation of the proposed guidelines was also undertaken. A stakeholder survey (n = 546), 10 key informant interviews, and 14 focus groups (n = 92 participants) were completed to gather feedback on draft guidelines and their dissemination. The guidelines provide evidence-informed recommendations as to the combinations of light-, moderate- and vigorous-intensity physical activity, sedentary behaviours, and sleep that infants (<1 year), toddlers (1–2 years) and preschoolers (3–4 years) should achieve for a healthy day (24 h). Proactive dissemination, promotion, implementation, and evaluation plans were prepared to optimize uptake and activation of the new guidelines. These guidelines represent a sensible evolution of public health guidelines whereby optimal health is framed within the balance of movement behaviours across the whole day, while respecting preferences of end-users. Future research should consider the integrated relationships among movement behaviours, and similar integrated guidelines for other age groups should be developed.

Social-Emotional Competence: An Essential Factor for Promoting Positive Adjustment and Reducing Risk in School Children.

Abstract: Social-emotional competence is a critical factor to target with universal preventive interventions that are conducted in schools because the construct (a) associates with social, behavioral, and academic outcomes that are important for healthy development; (b) predicts important life outcomes in adulthood; (c) can be improved with feasible and cost-effective interventions; and (d) plays a critical role in the behavior change process. This article reviews this research and what is known about effective intervention approaches. Based on that, an intervention model is proposed for how schools should enhance the social and emotional learning of students in order to promote resilience. Suggestions are also offered for how to support implementation of this intervention model at scale.

Oral anticoagulants for prevention of stroke in atrial fibrillation: systematic review, network meta-analysis, and cost effectiveness analysis.

Abstract: Objective To compare the efficacy, safety, and cost effectiveness of direct acting oral anticoagulants (DOACs) for patients with atrial fibrillation. Design Systematic review, network meta-analysis, and cost effectiveness analysis. Data sources Medline, PreMedline, Embase, and The Cochrane Library. Eligibility criteria for selecting studies Published randomised trials evaluating the use of a DOAC, vitamin K antagonist, or antiplatelet drug for prevention of stroke in patients with atrial fibrillation. Results 23 randomised trials involving 94 656 patients were analysed: 13 compared a DOAC with warfarin dosed to achieve a target INR of 2.0-3.0. Apixaban 5 mg twice daily (odds ratio 0.79, 95% confidence interval 0.66 to 0.94), dabigatran 150 mg twice daily (0.65, 0.52 to 0.81), edoxaban 60 mg once daily (0.86, 0.74 to 1.01), and rivaroxaban 20 mg once daily (0.88, 0.74 to 1.03) reduced the risk of stroke or systemic embolism compared with warfarin. The risk of stroke or systemic embolism was higher with edoxaban 60 mg once daily (1.33, 1.02 to 1.75) and rivaroxaban 20 mg once daily (1.35, 1.03 to 1.78) than with dabigatran 150 mg twice daily. The risk of all-cause mortality was lower with all DOACs than with warfarin. Apixaban 5 mg twice daily (0.71, 0.61 to 0.81), dabigatran 110 mg twice daily (0.80, 0.69 to 0.93), edoxaban 30 mg once daily (0.46, 0.40 to 0.54), and edoxaban 60 mg once daily (0.78, 0.69 to 0.90) reduced the risk of major bleeding compared with warfarin. The risk of major bleeding was higher with dabigatran 150 mg twice daily than apixaban 5 mg twice daily (1.33, 1.09 to 1.62), rivaroxaban 20 mg twice daily than apixaban 5 mg twice daily (1.45, 1.19 to 1.78), and rivaroxaban 20 mg twice daily than edoxaban 60 mg once daily (1.31, 1.07 to 1.59). The risk of intracranial bleeding was substantially lower for most DOACs compared with warfarin, whereas the risk of gastrointestinal bleeding was higher with some DOACs than warfarin. Apixaban 5 mg twice daily was ranked the highest for most outcomes, and was cost effective compared with warfarin. Conclusions The network meta-analysis informs the choice of DOACs for prevention of stroke in patients with atrial fibrillation. Several DOACs are of net benefit compared with warfarin. A trial directly comparing DOACs would overcome the need for indirect comparisons to be made through network meta-analysis. Systematic review registration PROSPERO CRD 42013005324.

Carbon Capture and Utilization Update

Abstract: In recent years, carbon capture and utilization (CCU) has been proposed as a potential technological solution to the problems of greenhouse-gas emissions and the ever-growing energy demand. To combat climate change and ocean acidification as a result of anthropogenic CO2 emissions, efforts have already been put forth to capture and sequester CO2 from large point sources, especially power plants; however, the utilization of CO2 as a feedstock to make valuable chemicals, materials, and transportation fuels is potentially more desirable and provides a better and long-term solution than sequestration. The products of CO2 utilization can supplement or replace chemical feedstocks in the fine chemicals, pharmaceutical, and polymer industries. In this review, we first provide an overview of the current status of CO2-capture technologies and their associated challenges and opportunities with respect to efficiency and economy followed by an overview of various carbon-utilization approaches. The current status of combined CO2 capture and utilization, as a novel efficient and cost-effective approach, is also briefly discussed. We summarize the main challenges associated with the design, development, and large-scale deployment of CO2 capture and utilization processes to provide a perspective and roadmap for the development of new technologies and opportunities to accelerate their scale-up in the near future.

Novel biomaterial strategies for controlled growth factor delivery for biomedical applications

Abstract: Growth factors (GFs) are soluble proteins secreted by cells that have the ability to regulate a variety of cellular processes and tissue regeneration. However, their translation into clinical applications is limited due to their short effective half-life, low stability, and rapid inactivation by enzymes under physiological conditions. To maximize the effectiveness of GFs and their biologically relevant applicability, a wide variety of sophisticated bio-inspired systems have been developed that augment tissue repair and cellular regeneration by controlling how much, when, and where GFs are released. Recently, protein immobilization techniques combined with nanomaterial carriers have shown promise in mimicking the natural healing cascade during tissue regeneration by augmenting the delivery and effectiveness of GFs. This review evaluates the latest techniques in direct immobilization and relevant biomaterials used for GF loading and release, including synthetic polymers, albumin, polysaccharides, lipids, mesoporous silica-based nanoparticles (NPs), and polymeric capsules. Specifically, we focus on GF-encapsulated NPs in functionalized microporous scaffolds as a promising alternative with the ability to mimic extracellular matrix (ECM) hierarchical architectures and components with high cell affinity and bioactivity. Finally, we discuss how these next-generation, advanced delivery systems have been used to enhance tissue repair and regeneration and consider future implications for their use in the field of regenerative medicine. Nanomaterials can speed up the rate at which wounds heal and tissue regenerates. Songlin Peng from the Jinan University Second College of Medicine, China, and colleagues review the development of artificial materials that achieve this aim by mimicking the hierarchical architecture of the extracellular matrix. Cells can proliferate and migrate by secreting proteins that signal to adjacent cells. These proteins – known as growth factors – bind to specific receptors on the target cell. But it is difficult to harness this simple concept in clinical applications such as wound healing because the instability of growth factors limits their safety and cost effectiveness. Peng and co-workers review recent progress in the use of functionalized microporous scaffolds functionalized with growth factor encapsulated nanoparticles. They also outline its advantages over alternative approaches employing polymers, lipids and mesoporous silica-based nanoparticles. Schematic illustration of Biomaterial Strategies for Controlled Growth Factor (GF) Delivery for Biomedical Applications. (a) The direct approaches for the immobilization/encapsulation of GFs to biomaterials; (b) Nanocarriers for GFs encapsulation and release; (c) GFs encapsulated nanocarriers functionalized biomaterials for tissue regeneration.

Biosorption: An Eco-Friendly Alternative for Heavy Metal Removal

Abstract: Heavy metals occur in immobilized form in sediments and as ores in nature. However due to various human activities like ore mining and industrial processes the natural biogeochemical cycles are disrupted causing increased deposition of heavy metals in terrestrial and aquatic environment. Release of these pollutants without proper treatment poses a significant threat to both environment and public health, as they are non biodegradable and persistent. Through a process of biomagnification, they further accumulate in food chains. Thus their treatment becomes inevitable and in this endeavor, biosorption seems to be a promising alternative for treating metal contaminated waters. This technology employs various types of biomass as source to trap heavy metals in contaminated waters. The biosorbent is prepared by subjecting biomass to various processes like pretreatment, granulation and immobilization, finally resulting in metal entrapped in bead like structures. These beads are stripped of metal ions by desorption which can be recycled and reused for subsequent cycles. This technology out- performs its predecessors not only due to its cost effectiveness but also in being ecofriendly i.e., where other alternatives fail.

Role of the pharmacist in reducing healthcare costs: current insights

Abstract: Global healthcare expenditure is escalating at an unsustainable rate. Money spent on medicines and managing medication-related problems continues to grow. The high prevalence of medication errors and inappropriate prescribing is a major issue within healthcare systems, and can often contribute to adverse drug events, many of which are preventable. As a result, there is a huge opportunity for pharmacists to have a significant impact on reducing healthcare costs, as they have the expertise to detect, resolve, and prevent medication errors and medication-related problems. The development of clinical pharmacy practice in recent decades has resulted in an increased number of pharmacists working in clinically advanced roles worldwide. Pharmacist-provided services and clinical interventions have been shown to reduce the risk of potential adverse drug events and improve patient outcomes, and the majority of published studies show that these pharmacist activities are cost-effective or have a good cost:benefit ratio. This review demonstrates that pharmacists can contribute to substantial healthcare savings across a variety of settings. However, there is a paucity of evidence in the literature highlighting the specific aspects of pharmacists' work which are the most effective and cost-effective. Future high-quality economic evaluations with robust methodologies and study design are required to investigate what pharmacist services have significant clinical benefits to patients and substantiate the greatest cost savings for healthcare budgets.

Uncovering Potential Applications of Cyanobacteria and Algal Metabolites in Biology, Agriculture and Medicine: Current Status and Future Prospects

Abstract: Cyanobacteria and algae having complex photosynthetic systems can channelize absorbed solar energy into other forms of energy for production of food and metabolites. In addition, they are promising biocatalysts and can be used in the field of “white biotechnology” for enhancing the sustainable production of food, metabolites and green energy sources such as biodiesel. In this review, an endeavour has been made to uncover the significance of various metabolites like phenolics, phytoene/terpenoids, phytols, sterols, free fatty acids, photoprotective compounds (MAAs, scytonemin, s, polysaccharides, halogenated compounds, etc.), phytohormones, cyanotoxins, biocides (algaecides, herbicides and insecticides) etc. Apart from this, the importance of these metabolites as antibiotics, immunosuppressant, anticancer, antiviral, anti-inflammatory agent has also been discussed. Metabolites obtained from cyanobacteria and algae have several biotechnological, industrial, pharmaceutical and cosmetic uses which have also been discussed in this review along with the emerging technology of their harvesting for enhancing the production of compounds like bioethanol, biofuel etc. at commercial level. In later sections, we have discussed genetically modified organisms and metabolite production from them. We have also briefly discussed the concept of bioprocessing highlighting the functioning of companies engaged in metabolites production as well as their cost effectiveness and challenges that are being addressed by these companies.

Interventions for increasing fruit and vegetable consumption in children aged five years and under

Abstract: Background Insufficient consumption of fruits and vegetables in childhood increases the risk of future chronic diseases, including cardiovascular disease. Objectives To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE, Embase Classic and Embase to identify eligible trials on 30 September 2016. We searched CINAHL and PsycINFO in July 2016, Proquest Dissertations and Theses in November 2016 and three clinical trial registers in November 2016 and June 2017. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included studies to identify further potentially relevant trials. Selection criteria We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. Data collection and analysis Two review authors independently extracted data and assessed the risks of bias of included studies; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures.We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. Main results We included 50 trials with 137 trial arms and 10,267 participants. Thirty trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Eleven trials examined the impact of parent nutrition education in increasing child fruit and vegetable intake. Eight studies examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. One study examined the effect of a nutrition intervention delivered to children in increasing child fruit and vegetable intake. Thirteen of the 50 included trials were judged as free from high risks of bias across all domains; performance, detection and attrition bias were the most common domains judged at high risk of bias of remaining studies. Meta-analysis of trials examining child-feeding practices versus no intervention revealed a positive effect on child vegetable consumption (SMD 0.38, 95% CI 0.15 to 0.61; n = 1509; 11 studies; very low-quality evidence), equivalent to a mean difference of 4.03 grams of vegetables. There were no short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.11, 95% CI -0.05 to 0.28; n = 3023; 10 studies; very low-quality evidence) or multicomponent interventions versus no intervention (SMD 0.28, 95% CI -0.06 to 0.63; n = 1861; 4 studies; very low-quality evidence). Insufficient data were available to assess long-term effectiveness, cost effectiveness and unintended adverse consequences of interventions.Studies reported receiving governmental or charitable funds, except for two studies reporting industry funding. Authors' conclusions Despite identifying 50 eligible trials of various intervention approaches, the evidence for how to increase fruit and vegetable consumption of children remains sparse. There was very low-quality evidence child-feeding practice interventions are effective in increasing vegetable consumption of children aged five years and younger, however the effect size was very small and long-term follow-up is required. There was very low-quality evidence that parent nutrition education and multicomponent interventions are not effective in increasing fruit and vegetable consumption of children aged five years and younger. All findings should be considered with caution, given most included trials could not be combined in meta-analyses. Given the very low-quality evidence, future research will very likely change estimates and conclusions. Such research should adopt more rigorous methods to advance the field. This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.

Allergen immunotherapy for allergic asthma: A systematic review and meta-analysis

Abstract: Background To inform the development of the European Academy of Allergy and Clinical Immunonology's (EAACI) Guidelines on Allergen Immunotherapy (AIT) for allergic asthma, we assessed the evidence on the effectiveness, cost-effectiveness and safety of AIT Methods We performed a systematic review, which involved searching nine databases Studies were screened against pre-defined eligibility criteria and critically appraised using established instruments Data were synthesized using random-effects meta-analyses Results 98 studies satisfied the inclusion criteria Short-term symptom scores were reduced with a standardized mean difference (SMD) of -111 (95%CI -166, -056) This was robust to a pre-specified sensitivity analyses, but there was evidence suggestive of publication bias Short-term medication scores were reduced SMD -121 (95%CI -187, -054), again with evidence of potential publication bias There was no reduction in short-term combined medication and symptom scores SMD 017 (95%CI -023, 058), but one study showed a beneficial long-term effect For secondary outcomes subcutaneous immunotherapy (SCIT) improved quality of life and decreased allergen specific airways hyperreactivity (AHR) but this was not the case for sub-lingual immunotherapy (SLIT) There were no consistent effects on asthma control, exacerbations, lung function, and non-specific AHR AIT resulted in a modest increased risk of adverse events (AEs) Although relatively uncommon, systemic AEs were more frequent with SCIT; however no fatalities were reported The limited evidence on cost-effectiveness was mainly available for sublingual immunotherapy (SLIT) and this suggested that SLIT is likely to be cost-effective Conclusions AIT can achieve substantial reductions in short-term symptom and medication scores in allergic asthma It was however associated with a modest increased risk of systemic and local AEs More data are needed in relation to secondary outcomes, longer-term effectiveness and cost-effectiveness This article is protected by copyright All rights reserved

Ising Superconductivity and Quantum Phase Transition in Macro-Size Monolayer NbSe2.

Abstract: Two-dimensional (2D) transition metal dichalcogenides (TMDs) have a range of unique physics properties and could be used in the development of electronics, photonics, spintronics, and quantum computing devices. The mechanical exfoliation technique of microsize TMD flakes has attracted particular interest due to its simplicity and cost effectiveness. However, for most applications, large-area and high-quality films are preferred. Furthermore, when the thickness of crystalline films is down to the 2D limit (monolayer), exotic properties can be expected due to the quantum confinement and symmetry breaking. In this paper, we have successfully prepared macro-size atomically flat monolayer NbSe2 films on bilayer graphene terminated surface of 6H-SiC(0001) substrates by a molecular beam epitaxy (MBE) method. The films exhibit an onset superconducting critical transition temperature (Tconset) above 6 K and the zero resistance superconducting critical transition temperature (Tczero) up to 2.40 K. Simultaneously, t...

Diagnostic Impact and Cost-effectiveness of Whole-Exome Sequencing for Ambulant Children With Suspected Monogenic Conditions

Abstract: Importance Optimal use of whole-exome sequencing (WES) in the pediatric setting requires an understanding of who should be considered for testing and when it should be performed to maximize clinical utility and cost-effectiveness. Objectives To investigate the impact of WES in sequencing-naive children suspected of having a monogenic disorder and evaluate its cost-effectiveness if WES had been available at different time points in their diagnostic trajectory. Design, Setting, and Participants This prospective study was part of the Melbourne Genomics Health Alliance demonstration project. At the ambulatory outpatient clinics of the Victorian Clinical Genetics Services at the Royal Children’s Hospital, Melbourne, Australia, children older than 2 years suspected of having a monogenic disorder were prospectively recruited from May 1 through November 30, 2015, by clinical geneticists after referral from general and subspecialist pediatricians. All children had nondiagnostic microarrays and no prior single-gene or panel sequencing. Exposures All children underwent singleton WES with targeted phenotype-driven analysis. Main Outcomes and Measures The study examined the clinical utility of a molecular diagnosis and the cost-effectiveness of alternative diagnostic trajectories, depending on timing of WES. Results Of 61 children originally assessed, 44 (21 [48%] male and 23 [52%] female) aged 2 to 18 years (mean age at initial presentation, 28 months; range, 0-121 months) were recruited, and a diagnosis was achieved in 23 (52%) by singleton WES. The diagnoses were unexpected in 8 of 23 (35%), and clinical management was altered in 6 of 23 (26%). The mean duration of the diagnostic odyssey was 6 years, with each child having a mean of 19 tests and 4 clinical genetics and 4 nongenetics specialist consultations, and 26 (59%) underwent a procedure while under general anesthetic for diagnostic purposes. Economic analyses of the diagnostic trajectory identified that WES performed at initial tertiary presentation resulted in an incremental cost savings of A$9020 (US$6838) per additional diagnosis (95% CI, A$4304-A$15 404 [US$3263-US$11 678]) compared with the standard diagnostic pathway. Even if WES were performed at the first genetics appointment, there would be an incremental cost savings of A$5461 (US$4140) (95% CI, A$1433-A$10 557 [US$1086- US$8004]) per additional diagnosis compared with the standard diagnostic pathway. Conclusions and Relevance Singleton WES in children with suspected monogenic conditions has high diagnostic yield, and cost-effectiveness is maximized by early application in the diagnostic pathway. Pediatricians should consider early referral of children with undiagnosed syndromes to clinical geneticists.

Low back pain and sciatica: summary of NICE guidance

Abstract: #### What you need to know Low back pain is the leading cause of long term disability worldwide.1 The lifetime incidence of low back pain is 58-84%,2 and 11% of men and 16% of women have chronic low back pain.3 Back pain accounts for 7% of GP consultations and results in the loss of 4.1 million working days a year.2 More than 30% of people still have clinically significant symptoms after a year after onset of sciatica.4 This guideline replaces the National Institute for Health and Care Excellence (NICE) guideline on early management of low back pain in adults (2009) and expands its remit. It summarises the updated recommendations from NICE for the assessment and management of low back pain and sciatica.5 For a visual summary, please see infographic. It is intended to overcome patchy commissioning of back pain pathways and pain management programmes6 and poor implementation due to clinicians’ beliefs that previous recommendations were constraining clinical practice.7 NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence …

Reducing the Global Burden of Cardiovascular Disease, Part 2: Prevention and Treatment of Cardiovascular Disease.

Abstract: In this second part of a 2-part series on the global burden of cardiovascular disease, we review the proven, effective approaches to the prevention and treatment of cardiovascular disease. We specifically review the management of acute cardiovascular diseases, including acute coronary syndromes and stroke; the care of cardiovascular disease in the ambulatory setting, including medical strategies for vascular disease, atrial fibrillation, and heart failure; surgical strategies for arterial revascularization, rheumatic and other valvular heart disease, and symptomatic bradyarrhythmia; and approaches to the prevention of cardiovascular disease, including lifestyle factors, blood pressure control, cholesterol-lowering, antithrombotic therapy, and fixed-dose combination therapy. We also discuss cardiovascular disease prevention in diabetes mellitus; digital health interventions; the importance of socioeconomic status and universal health coverage. We review building capacity for conduction cardiovascular intervention through strengthening healthcare systems, priority setting, and the role of cost effectiveness.

Developing residential wireless sensor networks for ECG healthcare monitoring

Abstract: Wireless technology development has increased rapidly due to it’s convenience and cost effectiveness compared to wired applications, particularly considering the advantages offered by Wireless Sensor Network (WSN) based applications. Such applications exist in several domains including healthcare, medical, industrial and home automation. In the present study, a home-based wireless ECG monitoring system using Zigbee technology is considered. Such systems can be useful for monitoring people in their own home as well as for periodic monitoring by physicians for appropriate healthcare, allowing people to live in their home for longer. Health monitoring systems can continuously monitor many physiological signals and offer further analysis and interpretation. The characteristics and drawbacks of these systems may affect the wearer’s mobility during monitoring the vital signs. Real-time monitoring systems record, measure, and monitor the heart electrical activity while maintaining the consumer’s comfort. Zigbee devices can offer low-power, small size, and a low-cost suitable solution for monitoring the ECG signal in the home, but such systems are often designed in isolation, with no consideration of existing home control networks and smart home solutions. The present study offers a state of the art review and then introduces the main concepts and contents of the wireless ECG monitoring systems. In addition, models of the ECG signal and the power consumption formulas are highlighted. Challenges and future perspectives are also reported. The paper concludes that such mass-market health monitoring systems will only be prevalent when implemented together with home environmental monitoring and control systems.

Technologies to support community-dwelling persons with dementia: A position paper on issues regarding development, usability, effectiveness and cost-effectiveness, deployment, and ethics

Abstract: Background: With the expected increase in the numbers of persons with dementia, providing timely, adequate, and affordable care and support is challenging. Assistive and health technologies may be a valuable contribution in dementia care, but new challenges may emerge. Objective: The aim of our study was to review the state of the art of technologies for persons with dementia regarding issues on development, usability, effectiveness and cost-effectiveness, deployment, and ethics in 3 fields of application of technologies: (1) support with managing everyday life, (2) support with participating in pleasurable and meaningful activities, and (3) support with dementia health and social care provision. The study also aimed to identify gaps in the evidence and challenges for future research. Methods: Reviews of literature and expert opinions were used in our study. Literature searches were conducted on usability, effectiveness and cost-effectiveness, and ethics using PubMed, Embase, CINAHL, and PsycINFO databases with no time limit. Selection criteria in our selected technology fields were reviews in English for community-dwelling persons with dementia. Regarding deployment issues, searches were done in Health Technology Assessment databases. Results: According to our results, persons with dementia want to be included in the development of technologies; there is little research on the usability of assistive technologies; various benefits are reported but are mainly based on low-quality studies; barriers to deployment of technologies in dementia care were identified, and ethical issues were raised by researchers but often not studied. Many challenges remain such as including the target group more often in development, performing more high-quality studies on usability and effectiveness and cost-effectiveness, creating and having access to high-quality datasets on existing technologies to enable adequate deployment of technologies in dementia care, and ensuring that ethical issues are considered an important topic for researchers to include in their evaluation of assistive technologies. Conclusions: Based on these findings, various actions are recommended for development, usability, effectiveness and cost-effectiveness, deployment, and ethics of assistive and health technologies across Europe. These include avoiding replication of technology development that is unhelpful or ineffective and focusing on how technologies succeed in addressing individual needs of persons with dementia. Furthermore, it is suggested to include these recommendations in national and international calls for funding and assistive technology research programs. Finally, practitioners, policy makers, care insurers, and care providers should work together with technology enterprises and researchers to prepare strategies for the implementation of assistive technologies in different care settings. This may help future generations of persons with dementia to utilize available and affordable technologies and, ultimately, to benefit from them.

Optimization and performance of cost-effective ultra-high performance concrete

Abstract: This paper presents a mix design method for ultra-high performance concrete (UHPC) prepared with high-volume supplementary cementitious materials and conventional concrete sand. The method involves the optimization of binder combinations to enhance packing density, compressive strength, and rheological properties. The water-to-cementitious materials ratio is then determined for pastes prepared with the selected binders. The sand gradation is optimized using the modified Andreasen and Andersen packing model to achieve maximum packing density. The binder-to-sand volume ratio is then determined based on the void content, required lubrication paste volume, and compressive strength. The optimum fiber volume is selected based on flowability and flexural performance. The high-range water reducer dosage and w/cm are then adjusted according to the targeted mini-slump flow and compressive strength. Finally, the optimized UHPC mix designs are evaluated to determine key properties that are relevant to the intended application. This mix design approach was applied to develop cost-effective UHPC materials. The results indicate that the optimized UHPC can develop 28-days compressive strength of 125 MPa under standard curing condition and 168–178 MPa by heat curing for 1 days Such mixtures have unit cost per compressive strength at 28 days of 4.1–4.5 $/m3/MPa under standard curing.