The efficacy of a shared-care surveillance protocol for asymptomatic renal calculi

2017 ◽  
Vol 10 (4) ◽  
pp. 368-373
Author(s):  
P Ravindra ◽  
J Voss ◽  
S Hall ◽  
RJ Stanford ◽  
SD Scriven ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Cost Effective ◽  
Renal Calculi ◽  
Shared Care ◽  
X Ray ◽  
Referral Criteria ◽  
Care Protocol ◽  
Asymptomatic Patients ◽  
Effective Manner

Objective: Patients at our institution with asymptomatic calyceal stones (<11 mm) are discharged to their GPs with a request for 12- and 24-month X-ray KUBs with specific re-referral criteria. We aimed to assess the effectiveness of this shared care protocol as well as to investigate long-term outcomes. Patients and methods: All patients satisfying the above criteria discharged during October 2009–June 2011 were reviewed for protocol compliance, symptomatic events and/or surgical intervention up to July 2015. Results: A total of 134 patients were identified. Out of 115 patients eligible for their first X-ray, and 100 patients eligible for their second X-ray, 43% and 26% respectively were performed. Of these, 75% demonstrated no progression. No patients were treated surgically solely on the basis of radiographic progression. Over a mean five-year follow-up, patients had a 39% chance of experiencing a symptomatic event and a 24% chance of requiring surgical intervention (ESWL, ureteroscopy and/or PCNL). Risk factors included a previous stone history and having a total stone size >10 mm. Conclusion: There was poor adherence to this protocol. Despite this, only symptomatic patients were treated surgically, challenging the value of indefinite surveillance of asymptomatic patients. Longitudinal studies are needed to determine a cost-effective manner in which these patients can be safely followed up.

Strategic planning in grassland farming: Principles andapplications

1997 ◽  
pp. 191-197
Author(s):  
W.J. Parker ◽  
N.M. Shadbolt ◽  
D.I. Gray
Keyword(s):  
Strategic Planning ◽  
Performance Indicators ◽  
Cost Effective ◽  
Key Performance Indicators ◽  
Strategic Plans ◽  
Effective Manner ◽  
Farm Business ◽  
Pastoral Farming ◽  
Financial Environment

Three levels of planning can be distinguished in grassland farming: strategic, tactical and operational. The purpose of strategic planning is to achieve a sustainable long-term fit of the farm business with its physical, social and financial environment. In pastoral farming, this essentially means developing plans that maximise and best match pasture growth with animal demand, while generating sufficient income to maintain or enhance farm resources and improvements, and attain personal and financial goals. Strategic plans relate to the whole farm business and are focused on the means to achieve future needs. They should be routinely (at least annually) reviewed and monitored for effectiveness through key performance indicators (e.g., Economic Farm Surplus) that enable progress toward goals to be measured in a timely and cost-effective manner. Failure to link strategy with control is likely to result in unfulfilled plans. Keywords: management, performance

scholarly journals Replacement and Maintenance Decision Analysis for Hydraulic Machinery Facilities at Reservoirs under Imperfect Maintenance

Energies ◽  
2020 ◽  
Vol 13 (10) ◽  
pp. 2507
Author(s):  
Sou-Sen Leu ◽  
Tao-Ming Ying
Keyword(s):  
Cost Effective ◽  
Maintenance Cost ◽  
Imperfect Maintenance ◽  
Term Operation ◽  
Engineering Economics ◽  
Hydraulic Machinery ◽  
Effective Manner ◽  
The Cost ◽  
Replacement Time

After the long-term operation of reservoir facilities, they will become nonoperational due to the material deterioration and the performance degradation. One of crucial decisions is to determine the maintenance or replacement of the facilities in a cost-effective manner. Conventional replacement models seldom consider the maintenance effect. The facilities after maintenance are generally not as good as new, but are relatively restored. The target of this study is to establish a replacement decision model of the reservoir facilities under imperfect maintenance. By combining the theories of reliability analysis, imperfect maintenance, and engineering economics, the best timing of replacement that achieves cost-effectiveness is analyzed and proposed. Lastly, based on the design of experiments (DOE) and simulation, the regression curve chart for the economical replacement decision is established. Once the failure rate, the age of recovery after maintenance, and the ratio of maintenance cost to replacement cost are estimated based on historical data, the cost-effective replacement time of hydraulic machinery facilities will be efficiently determined.

Using X-ray fluorescence core scanning to assess acid sulfate soils

Soil Research ◽  
2014 ◽  
Vol 52 (8) ◽  
pp. 760 ◽  
Author(s):  
Ulrike Proske ◽  
Henk Heijnis ◽  
Patricia Gadd
Keyword(s):  
Chemical Elements ◽  
Sediment Cores ◽  
Cost Effective ◽  
Transitional Zone ◽  
Initial Assessment ◽  
Acid Sulfate Soils ◽  
Acid Sulfate ◽  
X Ray ◽  
Effective Manner ◽  
Sulfate Soils

During the formation of acid sulfate soils (ASS), several chemical elements in the sediment are mobilised. These elements are removed from the sediment or become enriched as precipitates in distinct horizons. The stratigraphic depth in which these precipitates accumulate is element-specific and is located either within the oxidised or in a transitional zone between the oxidised and the reduced zone. Aim of this study is to demonstrate how X-ray fluorescence core scanning, together with detailed sediment descriptions, can be used to perform an initial assessment of these different zones in ASS in a fast and cost-effective manner. We measured the chemical element signatures of K, Fe, Pb, Sr, Zn, Ni, Y, Mn and Ca in two sediment cores from Western Australia where ASS are suspected to occur. The oxidised zone in both cores is characterised by the occurrence of jarosite, which is indicated by pale straw yellow mottling and synchronous peaks in Fe/Ti, K/Ti, Pb/Ti and Sr/Ti, and of other secondary Fe-oxides, which are indicated by reddish mottling and synchronous peaks in Fe/Ti and Pb/Ti. The transition zone into reduced material is marked by synchronous peaks in Zn/Ti, Ni/Ti, Y/Ti and Mn/Ti. Based on these characteristic signatures, we broadly estimated the depth of the oxidised and the transitional zone at both sites.

An empirical assessment of two-dimensional (2D) Debye–Scherrer-type image-plate X-ray diffraction data collapsed into a 1D diffractogram

2014 ◽  
Vol 29 (4) ◽  
pp. 337-345 ◽  
Author(s):  
Kirk C. Ross ◽  
Joseph A. Petrus ◽  
Andrew M. McDonald
Keyword(s):  
Single Crystal ◽  
Cost Effective ◽  
Unit Cell Dimension ◽  
Alumina Powder ◽  
X Ray Diffraction ◽  
X Ray ◽  
Image Plate ◽  
Effective Manner ◽  
Certified Value ◽  
Certified Values

X-ray diffraction (XRD) has been routinely employed in the Earth sciences to characterize the crystallography of rocks and minerals. Routine characterization of samples too small for analysis by classic automated powder diffraction methods becomes challenging without access to single crystal or micro-diffraction equipment. Here, we show that a traditional Gandolfi camera lined with an image-plate (IP) as the detection medium can return a fully quantitative diffraction pattern from a sub-milligram single grain specimen in a simple and straightforward manner. Data pertaining to peak positions (d-spacings) were assessed using SRM640c Si powder, while intensity data were compared to the certified values for intensity standard SRM676a alumina powder. The refined unit-cell dimension of Si powder differed from the certified value of 5.4312 Å by no more than 0.0003 Å with a standard deviation (σ) of 0.0002 Å among the three experiments. For intensity, the σ and disparity from the certified values of three diffraction experiments on SRM676a were both <2%. The results of a comparative study of the crystallographic parameters determined for a naturally occurring garnet and clinopyroxene given through the refinement of their crystal structure by single-crystal XRD method are presented. These show through Rietveld refinement of X-ray data obtained by the Gandolfi–IP method outlined here that both accurate and precise XRD data can be produced in a timely and cost-effective manner using only an IP, Gandolfi camera, and software freely available on the internet.

Cloud Computing in the Field of Rural Education

2014 ◽  
Vol 573 ◽  
pp. 593-599 ◽  
Author(s):  
R. Sukanesh ◽  
A. Kanmani
Keyword(s):  
Cloud Computing ◽  
Rural Education ◽  
Cost Effective ◽  
Scaling Up ◽  
Rural Students ◽  
Due Diligence ◽  
The Poor ◽  
Effective Manner ◽  
Software Renting

In this period of prevalence of Cloud Computing, SaaS, Virtualization and Software renting, what would be the magnitude of their impact in the field of education? As an academician, one can visualize a lot of benefits in a variety of ways, if the benefits offered by these concepts are exploited in a productive and cost effective manner. When the gap of availability of knowledge and guidance, among rural students is bridged, the results are bound to be tremendously exciting. Since this research is about spreading knowledge, targeting the rural population, the aim is to concentrate on renting software free of cost. This research takes cognizance of the fact; the evolution in the field of virtualization of hardware and software; sets out to explore, how the technologies be successfully married to education, for the empowerment of the poor and rich alike. This paper therefore analyzes the current advancement in virtualization, various aspects of SaaS and Software renting in detail and suggests that the best way is to take the cautious approach, at every step to adopt these technologies/concepts. This also suggests starting small and scaling up the entire adoption after performing the due diligence of long term impacts, gives the best results. Sticking to the same principle, a real time environment of sample education institutions under one umbrella is considered for this study in a relatively rural setup.

Evaluating a Workshop Model for Improving Diabetes Patient Education Programs: Is It Really Successful?

1986 ◽  
Vol 12 (1) ◽  
pp. 48-50 ◽  
Author(s):  
Sandy Cook ◽  
Rita M. Cohen
Keyword(s):  
Patient Education ◽  
Health Professionals ◽  
Cost Effective ◽  
Diabetes Patient ◽  
Education Programs ◽  
Commitment To Change ◽  
Effective Manner ◽  
Workshop Model

Over a threx-year period, 54 health professionals at tended three two-day workshops designed to improve diabetes patient education programs, par ticularly program manage ment and evaluation of skills. A commitment-to- change strategy was used to determine the long-term effectiveness of the workshops. Fifty-nine per cent overall of the com mitments to change were reported as attained in the six-month follow-up surveys. The evidence suggests not only that the workshops were suc cessful, but that measurable changes in participants' programs can be attained in a cost- effective manner.

Is there a continuing role for traditional surgery?

2015 ◽  
Vol 30 (2_suppl) ◽  
pp. 29-35 ◽  
Author(s):  
Patrick A Coughlin ◽  
David C Berridge
Keyword(s):  
Varicose Veins ◽  
Clinical Success ◽  
Meta Analysis ◽  
Cochrane Review ◽  
Surgical Techniques ◽  
Cost Effective ◽  
Long Term Results ◽  
Foam Sclerotherapy ◽  
Effective Manner

Despite recent NICE guidance there remains a definite role for surgery in the management of varicose veins. A lot of the available evidence that has driven the transformation of care towards endovenous treatments is of good quality yet published by enthusiasts. No endovenous studies have reported long term results as far out from intervention as the open studies, yet in the meta-analysis from Murad et al, the authors suggested from their results that when surgery was compared with all endoluminal ablation therapies, surgery was associated with a non-significant reduction in the risk of varicose vein recurrence (RR0.63; 95%CI 0.37--1.07). Much of the longer-term data on recurrence following open surgery for primary varicose veins dates back well over 15 years ago. This is prior to the inclusion of routine duplex assessment and sub-specialty designation. The recent Cochrane review (13 randomised controlled studies, 3081 patients). The overall conclusion was that UGFS, EVLT and RFA were at least as effective as surgery in the treatment of the LSV. This meta-analysis did not include the CLASS (Comparison of LAser, Surgery and foam Sclerotherapy as a treatment for varicose veins) trial in whichmeasures of clinical success were similar among the groups. Only 48% of the patients screened were eligible for the CLASS study and of these, only 24% of the eligible patients agreed to take part in the study. Similarly in the study by Carradice out of a total of 772 patients assessed for suitability, 442 did not meet the inclusion criteria. There is no doubt that endovenous surgery will increasingly become first line treatment for patients with symptomatic superficial venous reflux specifically in patients with SSV reflux. However, given the device related limitations with endothermal techniques specifically with regard to adverse anatomical features allied to the poorer results of UGFS within the treatment of LSV reflux, there is without doubt still a role for more traditional open surgical techniques that can be delivered with good short and long term outcomes and still being delivered in a cost effective manner.

scholarly journals Nearly zero energy renovation concepts for apartment buildings

2020 ◽  
Vol 172 ◽  
pp. 18009
Author(s):  
Kalle Kuusk ◽  
Jens Naumann ◽  
Annina Gritzki ◽  
Clemens Felsmann ◽  
Michele De Carli ◽  
...  
Keyword(s):  
Large Scale ◽  
Cost Effective ◽  
Energy Performance ◽  
Building Envelope ◽  
Energy Calculation ◽  
Zero Energy ◽  
Apartment Buildings ◽  
Effective Manner ◽  
The Impact

Revised EPBD directive has set ambitious targets for renovation. It is stated that Member States shall establish a long-term strategy facilitating the cost-effective transformation of existing buildings into nearly-zero energy buildings. The long-term strategy should set out a roadmap with a view to the long-term 2050 goal of reducing greenhouse gas emissions in the European Union. This creates the need for cost-efficient renovation solutions which can be implemented in large scale. The impact assessment shows that roughly a doubled renovation rate of 3 % would be needed to accomplish the energy efficiency ambitions in a cost-effective manner. The objective of this study is to specify renovation concepts with adequate heating and ventilation, based on Estonian and German apartment buildings and corresponding local solutions. Energy performance and sizing analyses were conducted for selected multifamily apartment buildings typical for 1960-70es with three different renovation concepts. Energy calculations were conducted with national energy calculation methods and national energy requirements for major renovation. In the renovation, the building envelope insulation, air tightness, and heating and ventilation systems were improved so that the renovated building complies with national nearly zero-energy requirement for major renovation.

Planning for a Filmless Hospital

2010 ◽  
pp. 72-91
Author(s):  
Carrison K.S. Tong ◽  
Eric T.T. Wong
Keyword(s):  
Intensive Care ◽  
Real Time ◽  
Intensive Care Units ◽  
Emergency Departments ◽  
Cost Effective ◽  
Operating Rooms ◽  
Access To Information ◽  
X Ray ◽  
Effective Manner

Filmless hospital is transforming at an unprecedented rate. Physicians, nurses, clinicians, pharmacists, radiologists, emergency departments, local doctor’s offices, operating rooms, intensive care units, and insurance offices all must have instantaneous access to information from CT, MR, and X-ray images to treat their patients. Considering that these individuals could be on different floors of a hospital, across a campus, or scattered over several states, connecting them in real-time and in a cost-effective manner to the information they need is a monumental IT challenge. Detail planning is important in a filmless hospital project.

Reliability and Validity of a New Preadmission Acuity Tool for Long-Term Care

1995 ◽  
Vol 3 (1) ◽  
pp. 77-88
Author(s):  
Elizabeth A. Swanson ◽  
Orpha J. Click
Keyword(s):  
Health Care Professionals ◽  
Long Term Care ◽  
A Priori ◽  
Reliability And Validity ◽  
Cost Effective ◽  
Functional Independence ◽  
Term Care ◽  
Effective Manner ◽  
New Instrument

The purpose of this project was to develop a new tool designed to assess the acuity of applicants to long-term facilities. Using a known groups method, residents of long-term care facilities were categorized as independent (n=68), assist (n=71), and dependent (n=65) and assessed using the Preadmission Acuity Inquiry Tool (PAI) to generate the data base for examining its psychometric properties. The progression of the mean scores from independent to assist to dependent demonstrates the ability of the tool to differentiate across varying levels of functional independence. Using discriminant analysis, the degree of accuracy in predicting group membership for the independent group was 88%, for the dependent group 75%, and for the assist group 17% with the overall agreement between PAI scores and a priori classifications at 60%. Kappa coefficients for interrater reliability ranged from .54 to 1.0 with a mean of .90. The Cronbach’s alpha coefficient was .81. The PAI has demonstrated sufficient reliability and validity to warrant further refinement and testing. This new instrument may enable health care professionals to provide the appropriate level of care in a cost-effective manner.

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