MLTI-18. PRECISION IMAGING OF METASTATIC AND PRIMARY BRAIN TUMORS AFTER RADIATION WITH 18F-FDOPA PET-MRI IS FEASIBLE AND COST EFFECT

Abstract PURPOSE: Post-radiation changes in the brain can mimic tumor recurrence on MRI, requiring multiple short term follow-ups to differentiate tumor progression from radiation necrosis. We propose combining functional and anatomic imaging with FDOPA PET tracer in hybrid PET-MRI to improve detection of tumor recurrence. MATERIALS AND METHODS: Seventeen adult patients treated with radiation therapy were identified - four with metastatic disease from breast and lung cancer and thirteen with primary brain glioma (11 IDH wildtype glioblastoma and 2 astrocytoma). Patients were scanned on hybrid PET-MRI (GE Healthcare) with clinical MRI brain sequences and dynamic FDOPA uptake. Dynamic FDOPA uptake within these tumors over 45 minutes after tracer injection was analyzed and compared to ADC histogram analysis. RESULTS: For each of the patients, clinical multi sequence gadolinium enhanced MRI and dynamic PET imaging for up to 45 minutes with 18F-FDOPA amino acid tracer was obtained. The total cost savings of scanning 17 patients in groups was 51.4% ($28,321), as opposed to the cost of individual radiosynthesis performed for each study. Quantitative analysis of tracer uptake in striatum, internal carotid artery, and superior sagittal sinus were performed with appropriate accumulation and subsequent washout of tracer respectively. Successful dynamic FDOPA uptake within the tumor was seen in all patients and ratio of tumor to contralateral ROI were found to range from 1.8–4.5. While raw SUV values did not differentiate between recurrent tumor and radiation changes, T/C SUVmax ratios were elevated to 4.5 in recurrent glioblastoma, 2.5 in hypoxic treated glioblastoma, and 1.8 in non-recurrent metastatic breast cancer after gamma knife treatment. CONCLUSION: Batch imaging of patients with [18F]FDOPA PET-MRI is feasible and cost effective. Understanding radionuclide synthesis process is critical for increasing accessibility of novel PET tracers to patients and results in significant cost savings.

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Mineral/microfibrillated cellulose composite materials: High performance products, applications, and product forms

TAPPI Journal ◽

10.32964/tj17.09.507 ◽

2018 ◽

Vol 17 (09) ◽

pp. 507-515 ◽

Cited By ~ 1

Author(s):

David Skuse ◽

Mark Windebank ◽

Tafadzwa Motsi ◽

Guillaume Tellier

Keyword(s):

Composite Materials ◽

High Performance ◽

Aqueous Suspension ◽

Production Capacity ◽

Cost Savings ◽

Cost Effective ◽

New Materials ◽

Wet Strength ◽

Product Forms ◽

Cellulose Composite

When pulp and minerals are co-processed in aqueous suspension, the mineral acts as a grinding aid, facilitating the cost-effective production of fibrils. Furthermore, this processing allows the utilization of robust industrial milling equipment. There are 40000 dry metric tons of mineral/microfbrillated (MFC) cellulose composite production capacity in operation across three continents. These mineral/MFC products have been cleared by the FDA for use as a dry and wet strength agent in coated and uncoated food contact paper and paperboard applications. We have previously reported that use of these mineral/MFC composite materials in fiber-based applications allows generally improved wet and dry mechanical properties with concomitant opportunities for cost savings, property improvements, or grade developments and that the materials can be prepared using a range of fibers and minerals. Here, we: (1) report the development of new products that offer improved performance, (2) compare the performance of these new materials with that of a range of other nanocellulosic material types, (3) illustrate the performance of these new materials in reinforcement (paper and board) and viscosification applications, and (4) discuss product form requirements for different applications.

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Pound Wise and Penny Foolish? Weight Loss and The Dynamics of Health Care Spending

Forum for Health Economics & Policy ◽

10.2202/1558-9544.1220 ◽

2011 ◽

Vol 14 (2) ◽

Author(s):

Thomas G Koch

Keyword(s):

Weight Loss ◽

Cost Savings ◽

Cost Effective ◽

Economic Consequences ◽

Health Care Spending ◽

Order Of Magnitude ◽

Dynamic Measures ◽

The Cost ◽

The Impact ◽

The Relationship

Current estimates of obesity costs ignore the impact of future weight loss and gain, and may either over or underestimate economic consequences of weight loss. In light of this, I construct static and dynamic measures of medical costs associated with body mass index (BMI), to be balanced against the cost of one-time interventions. This study finds that ignoring the implications of weight loss and gain over time overstates the medical-cost savings of such interventions by an order of magnitude. When the relationship between spending and age is allowed to vary, weight-loss attempts appear to be cost-effective starting and ending with middle age. Some interventions recently proven to decrease weight may also be cost-effective.

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Cost Avoidance and Clinical Benefits Derived from a Pharmacy-Managed Anemia Program

Hospital Pharmacy ◽

10.1177/001857870003500218 ◽

2000 ◽

Vol 35 (2) ◽

pp. 169-175 ◽

Cited By ~ 3

Author(s):

Robert A. Quercia ◽

Ronald Abrahams ◽

C. Michael White ◽

John D'Avella ◽

Mary Campbell

Keyword(s):

Cost Savings ◽

Cost Effective ◽

Hemodialysis Patients ◽

Cost Avoidance ◽

Number Of Patients ◽

Epoetin Alpha ◽

Clinical Benefits ◽

Unit Dose ◽

One Year ◽

Alpha Therapy

A pharmacy-managed anemia program included distribution and clinical components, with the goal of making epoetin alpha therapy for hemodialysis patients more cost-effective. The Pharmacy Department prepared epoetin alpha doses for patients in unit-dose syringes, utilizing and documenting vial overfill. Pharmacists dosed epoetin alpha and iron (oral and intravenous) per protocol for new and established patients. Baseline data were obtained in 1994, one year prior to implementation of the program, and were re-evaluated in 1995 and 1998. Cost avoidance from utilization of epoetin alpha vial overfill in 1995 and 1998 was $83,560 and $91,148 respectively. In 1995 and 1998, cost avoidance from pharmacy management of anemia was $191,159 and $203,985 respectively. The total cost avoidance from 1995 through 1998 was estimated at $1,018,638. The number of patients with hematocrits under 31% decreased from 32% in 1994 to 21% and 14% in 1995 and 1998 respectively. We conclude that a pharmacy-managed anemia program for hemodialysis patients results in significant cost savings and better achievement of target hematocrits.

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The Future of Plasma-Based Surface Engineering Techniques in Tribology (Keynote)

World Tribology Congress III, Volume 2 ◽

10.1115/wtc2005-64180 ◽

2005 ◽

Cited By ~ 1

Author(s):

Allan Matthews ◽

Adrian Leyland

Keyword(s):

Surface Engineering ◽

Performance Enhancement ◽

Bulk Material ◽

Cost Savings ◽

Cost Effective ◽

Ceramic Coatings ◽

Performance Improvements ◽

Treatment Techniques ◽

Wide Range ◽

Macro Scale

Over the past twenty years or so, there have been major steps forward both in the understanding of tribological mechanisms and in the development of new coating and treatment techniques to better “engineer” surfaces to achieve reductions in wear and friction. Particularly in the coatings tribology field, improved techniques and theories which enable us to study and understand the mechanisms occurring at the “nano”, “micro” and “macro” scale have allowed considerable progress to be made in (for example) understanding contact mechanisms and the influence of “third bodies” [1–5]. Over the same period, we have seen the emergence of the discipline which we now call “Surface Engineering”, by which, ideally, a bulk material (the ‘substrate’) and a coating are combined in a way that provides a cost-effective performance enhancement of which neither would be capable without the presence of the other. It is probably fair to say that the emergence and recognition of Surface Engineering as a field in its own right has been driven largely by the availability of “plasma”-based coating and treatment processes, which can provide surface properties which were previously unachievable. In particular, plasma-assisted (PA) physical vapour deposition (PVD) techniques, allowing wear-resistant ceramic thin films such as titanium nitride (TiN) to be deposited on a wide range of industrial tooling, gave a step-change in industrial productivity and manufactured product quality, and caught the attention of engineers due to the remarkable cost savings and performance improvements obtained. Subsequently, so-called 2nd- and 3rd-generation ceramic coatings (with multilayered or nanocomposite structures) have recently been developed [6–9], to further extend tool performance — the objective typically being to increase coating hardness further, or extend hardness capabilities to higher temperatures.

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Is an integrated model of school eye health delivery more cost-effective than a vertical model? An implementation research in Zanzibar

BMJ Open Ophthalmology ◽

10.1136/bmjophth-2020-000561 ◽

2021 ◽

Vol 6 (1) ◽

pp. e000561

Author(s):

Ving Fai Chan ◽

Fatma Omar ◽

Elodie Yard ◽

Eden Mashayo ◽

Damaris Mulewa ◽

...

Keyword(s):

Implementation Research ◽

Cost Savings ◽

Cost Effective ◽

Integrated Model ◽

Health Screening ◽

High Coverage ◽

Health Delivery ◽

Screening Cost ◽

Eye Health ◽

The Cost

ObjectiveTo review and compare the cost-effectiveness of the integrated model (IM) and vertical model (VM) of school eye health programme in Zanzibar.Methods and analysisThis 6-month implementation research was conducted in four districts in Zanzibar. Nine and ten schools were recruited into the IM and VM, respectively. In the VM, teachers conducted eye health screening and education only while these eye health components were added to the existing school feeding programme (IM). The number of children aged 6–13 years old screened and identified was collected monthly. A review of project account records was conducted with 19 key informants. The actual costs were calculated for each cost categories, and costs per child screened and cost per child identified were compared between the two models.ResultsScreening coverage was 96% and 90% in the IM and VM with 297 children (69.5%) from the IM and 130 children (30.5%) from VM failed eye health screening. The 6-month eye health screening cost for VM and IM was US$6 728 and US$7 355. The cost per child screened for IM and VM was US$1.23 and US$1.31, and the cost per child identified was US$24.76 and US$51.75, respectively.ConclusionBoth models achieved high coverage of eye health screening with the IM being a more cost-effective school eye health delivery screening compared with VM with great opportunities for cost savings.

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The cost-effectiveness of atezolizumab in first-line for metastatic triple negative breast cancer is heavily linked to PD-L1 level

Journal of Oncology Pharmacy Practice ◽

10.1177/10781552211019462 ◽

2021 ◽

pp. 107815522110194

Author(s):

Jacopo Giuliani ◽

Beatrice Mantoan ◽

Andrea Bonetti

Keyword(s):

Breast Cancer ◽

Triple Negative ◽

Controlled Trial ◽

Metastatic Breast ◽

Cost Effective ◽

Phase Iii ◽

Line Treatment ◽

First Line ◽

Pivotal Phase ◽

First Line Treatment

The present analysis was conducted to assess the pharmacological costs of atezolizumab as first-line treatment in triple negative metastatic breast cancer (mBC). Pivotal phase III randomized controlled trial (RCT) was considered. Nine hundred and two patients were included. Differences in costs between the 2 arms (atezolizumab plus nabpaclitaxel versus placebo plus nab-paclitaxel) was 17 398 €, with a cost of 7564 €per month of OS-gain in the overall population and 2485 €per month of OS-gain in PD-L1-positive (≥1) population. Combining pharmacological costs of drugs with the measure of efficacy represented by the OS, atezolizumab could be considered cost-effective in first-line treatment for triple-negative mBC only in PD-L1-positive population, but a reduction of costs is mandatory.

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Variable Temperature Synthesis of Tunable Flame-Generated Carbon Nanoparticles

C – Journal of Carbon Research ◽

10.3390/c7020044 ◽

2021 ◽

Vol 7 (2) ◽

pp. 44

Author(s):

Francesca Picca ◽

Angela Di Pietro ◽

Mario Commodo ◽

Patrizia Minutolo ◽

Andrea D’Anna

Keyword(s):

Carbon Nanoparticles ◽

Variable Temperature ◽

Flame Temperature ◽

Cost Effective ◽

Synthesis Process ◽

Electrical Mobility ◽

Material Synthesis ◽

Online Measurements ◽

Degree Of Graphitization

In this study, flame-formed carbon nanoparticles of different nanostructures have been produced by changing the flame temperature. Raman spectroscopy has been used for the characterization of the carbon nanoparticles, while the particle size has been obtained by online measurements made by electrical mobility analysis. The results show that, in agreement with recent literature data, a large variety of carbon nanoparticles, with a different degree of graphitization, can be produced by changing the flame temperature. This methodology allows for the synthesis of very small carbon nanoparticles with a size of about 3-4 nm and with different graphitic orders. Under the perspective of the material synthesis process, the variable-temperature flame-synthesis of carbon nanoparticles appears as an attractive procedure for a cost-effective and easily scalable production of highly tunable carbon nanoparticles.

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Economic Development Based on a Mathematical Model: An Optimal Solution Method for the Fuel Supply of International Road Transport Activity

Energies ◽

10.3390/en14102963 ◽

2021 ◽

Vol 14 (10) ◽

pp. 2963

Author(s):

Melinda Timea Fülöp ◽

Miklós Gubán ◽

György Kovács ◽

Mihály Avornicului

Keyword(s):

Decision Making ◽

Ad Hoc ◽

Market Competition ◽

Optimal Solution ◽

Cost Savings ◽

Cost Effective ◽

Optimization Method ◽

Optimal Decision ◽

Environmental Damage ◽

Fuel Cost

Due to globalization and increased market competition, forwarding companies must focus on the optimization of their international transport activities and on cost reduction. The minimization of the amount and cost of fuel results in increased competition and profitability of the companies as well as the reduction of environmental damage. Nowadays, these aspects are particularly important. This research aims to develop a new optimization method for road freight transport costs in order to reduce the fuel costs and determine optimal fueling stations and to calculate the optimal quantity of fuel to refill. The mathematical method developed in this research has two phases. In the first phase the optimal, most cost-effective fuel station is determined based on the potential fuel stations. The specific fuel prices differ per fuel station, and the stations are located at different distances from the main transport way. The method developed in this study supports drivers’ decision-making regarding whether to refuel at a farther but cheaper fuel station or at a nearer but more expensive fuel station based on the more economical choice. Thereafter, it is necessary to determine the optimal fuel volume, i.e., the exact volume required including a safe amount to cover stochastic incidents (e.g., road closures). This aspect of the optimization method supports drivers’ optimal decision-making regarding optimal fuel stations and how much fuel to obtain in order to reduce the fuel cost. Therefore, the application of this new method instead of the recently applied ad-hoc individual decision-making of the drivers results in significant fuel cost savings. A case study confirmed the efficiency of the proposed method.

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Integrated positron emission tomography and magnetic resonance imaging–guided resection of brain tumors: a report of 103 consecutive procedures

Journal of Neurosurgery ◽

10.3171/jns.2006.104.2.238 ◽

2006 ◽

Vol 104 (2) ◽

pp. 238-253 ◽

Cited By ~ 102

Author(s):

Benoît Pirotte ◽

Serge Goldman ◽

Olivier Dewitte ◽

Nicolas Massager ◽

David Wikler ◽

...

Keyword(s):

Positron Emission Tomography ◽

Brain Tumors ◽

Mr Imaging ◽

Tumor Resection ◽

Tracer Uptake ◽

Emission Tomography ◽

Mr Images ◽

Pet Tracer ◽

Positron Emission ◽

Pet Scanning

Object The aim of this study was to evaluate the integration of positron emission tomography (PET) scanning data into the image-guided resection of brain tumors. Methods Positron emission tomography scans obtained using fluorine-18 fluorodeoxyglucose (FDG) and l-[methyl-11C]methionine (MET) were combined with magnetic resonance (MR) images in the navigational planning of 103 resections of brain tumors (63 low-grade gliomas [LGGs] and 40 high-grade gliomas [HGGs]). These procedures were performed in 91 patients (57 males and 34 females) in whom tumor boundaries could not be accurately identified on MR images for navigation-based resection. The level and distribution of PET tracer uptake in the tumor were analyzed to define the lesion contours, which in turn yielded a PET volume. The PET scanning–demonstrated lesion volume was subsequently projected onto MR images and compared with MR imaging data (MR volume) to define a final target volume for navigation-based resection—the tumor contours were displayed in the microscope’s eyepiece. Maximal tumor resection was accomplished in each case, with the intention of removing the entire area of abnormal metabolic activity visualized during surgical planning. Early postoperative MR imaging and PET scanning studies were performed to assess the quality of tumor resection. Both pre- and postoperative analyses of MR and PET images revealed whether integrating PET data into the navigational planning contributed to improved tumor volume definition and tumor resection. Metabolic information on tumor heterogeneity or extent was useful in planning the surgery. In 83 (80%) of 103 procedures, PET studies contributed to defining a final target volume different from that obtained with MR imaging alone. Furthermore, FDG-PET scanning, which was performed in a majority of HGG cases, showed that PET volume was less extended than the MR volume in 16 of 21 cases and contributed to targeting the resection to the hypermetabolic (anaplastic) area in 11 (69%) of 16 cases. Performed in 59 LGG cases and 23 HGG cases, MET-PET demonstrated that the PET volume did not match the MR volume and improved the tumor volume definition in 52 (88%) of 59 and 18 (78%) of 23, respectively. Total resection of the area of increased PET tracer uptake was achieved in 54 (52%) of 103 procedures. Conclusions Imaging guidance with PET scanning provided independent and complementary information that helped to assess tumor extent and plan tumor resection better than with MR imaging guidance alone. The PET scanning guidance could help increase the amount of tumor removed and target image-guided resection to tumor portions that represent the highest evolving potential.

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Self-fill oxygen technology: benefits for patients, healthcare providers and the environment

Breathe ◽

10.1183/20734735.013515 ◽

2016 ◽

Vol 12 (2) ◽

pp. 113-119 ◽

Cited By ~ 2

Author(s):

Phyllis Murphie ◽

Nick Hex ◽

Jo Setters ◽

Stuart Little

Keyword(s):

Positive Impact ◽

Healthcare Providers ◽

Cost Savings ◽

Cost Effective ◽

Evidence Base ◽

Environmental Benefits ◽

List Type ◽

Potential Cost ◽

Unlimited Supply ◽

Technology Benefits

“Non-delivery” home oxygen technologies that allow self-filling of ambulatory oxygen cylinders are emerging. They can offer a relatively unlimited supply of ambulatory oxygen in suitably assessed people who require long-term oxygen therapy (LTOT), providing they can use these systems safely and effectively. This allows users to be self-sufficient and facilitates longer periods of time away from home. The evolution and evidence base of this technology is reported with the experience of a national service review in Scotland (UK). Given that domiciliary oxygen services represent a significant cost to healthcare providers globally, these systems offer potential cost savings, are appealing to remote and rural regions due to the avoidance of cylinder delivery and have additional lower environmental impact due to reduced fossil fuel consumption and subsequently reduced carbon emissions. Evidence is emerging that self-fill/non-delivery oxygen systems can meet the ambulatory oxygen needs of many patients using LTOT and can have a positive impact on quality of life, increase time spent away from home and offer significant financial savings to healthcare providers.Educational aimsProvide update for oxygen prescribers on options for home oxygen provision.Provide update on the evidence base for available self-fill oxygen technologies.Provide and update for healthcare commissioners on the potential cost-effective and environmental benefits of increased utilisation of self-fill oxygen systems.

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