Canadian ground ambulance services: provincial funding and standards for equipment and training.

There is an increasing demand for improved, up-to-date training and equipment for ground ambulance services across Canada. This paper presents the results of a survey of ambulance operations and their funding by the provinces, as well as a comparison of provincial legislation and recommendations on standards for equipment and the training of ambulance personnel. The training standards were found to be very diverse, and the legislated or recommended equipment standards did not meet those of the American College of Surgeons committee on trauma (ACSCT). The cost of ambulance services per capita and the cost to the user of an average 43-km run varied widely between the provinces. There was no correlation between the second cost and how well the province met the ACSCT''s equipment standards.     

Cost of the treatment of acute cerebrovascular insufficiency causing cerebral infarction]

Many countries are interested in the cost of therapy of the acute cerebral flow insufficiency leading to brain infarction. Total costs include: drugs, laboratory tests, nursing care, the cost of patients' food, equipment, amortization, hospital administration etc. The total expenditure for a 10-15-day treatment of the acute neurological incident depended on the severity of the disease and was 8 million ++ z?oty in case of mildly ill patient, 9 million in case of moderately severe disease, and 21 million z?oty in case of severely ill patient. If the costs of such tests as CT and TCD-scanning will be added, total cost will increase significantly.     

A Laboratory Exercise for Genotyping Two Human Single Nucleotide Polymorphisms

The dramatic decrease in the cost of sequencing a human genome is leading to an era in which a wide range of students will benefit from having an understanding of human genetic variation. Since over 90% of sequence variation between humans is in the form of single nucleotide polymorphisms (SNPs), a laboratory exercise has been devised in order to illustrate the importance of SNPs. Two separate SNPs are analysed, one of which has a significant effect on a person’s phenotype and one which does not. The genotyping protocol is relatively inexpensive and uses standard molecular biology reagents and equipment.     

Equipment selection and task assignment for multiproduct assembly system design

A multiproduct assembly system produces a family of similar products, where the assembly of each product entails an ordered set of tasks. An assembly system consists of a sequence of workstations. For each workstation, we assign a subset of the assembly tasks to be performed at the workstation and select the type of assembly equipment or resource to be used by the workstation. The assembly of each product requires a visit to each workstation in the fixed sequence. The problem of system design is to find the system that is capable of producing all the products in the desired volumes at minimum cost. The system cost includes the fixed capital costs for the assembly equipment and tools and the variable operating costs for the various workstations. We present and illustrate an optimization procedure that assigns tasks to workstations and selects assembly equipment for each workstation.     

A reassessment of mixing cost in fermentation processes

The gas–liquid oxygen transfer rate is a key step in the production of antibiotics in submerged fermentation. If the gas–liquid oxygen mass transfer rate is not equal to the required liquid–solid oxygen mass transfer rate at a particular cell concentration, then productivity of the particular fermentation operation will not be the maximum possible value. One way to increase the productivity of a given fermentation tank installation is to increase the cell concentration and to increase the oxygen transfer by changing the mixer and air supply to match the new requirements. In order to evaluate the cost of making this change to the larger mixing equipment, a typical cost example is given which can easily be modified for other combinations of production cost and mixer cost. As an example, it is seen that a considerable savings can result from a given installation by primarily changing the oxygen transfer ability of the equipment to utilize a given fermentor more efficiently. Production cost savings of 8 to 25% are shown in the example cited.     

How to estimate the cost of point-of-care CD4 testing in program settings: an example using the Alere Pima Analyzer in South Africa

Integrating POC CD4 testing technologies into HIV counseling and testing (HCT) programs may improve post-HIV testing linkage to care and treatment. As evaluations of these technologies in program settings continue, estimates of the costs of POC CD4 tests to the service provider will be needed and estimates have begun to be reported. Without a consistent and transparent methodology, estimates of the cost per CD4 test using POC technologies are likely to be difficult to compare and may lead to erroneous conclusions about costs and cost-effectiveness. This paper provides a step-by-step approach for estimating the cost per CD4 test from a provider''s perspective. As an example, the approach is applied to one specific POC technology, the Pima™ Analyzer. The costing approach is illustrated with data from a mobile HCT program in Gauteng Province of South Africa. For this program, the cost per test in 2010 was estimated at $23.76 (material costs = $8.70; labor cost per test = $7.33; and equipment, insurance, and daily quality control = $7.72). Labor and equipment costs can vary widely depending on how the program operates and the number of CD4 tests completed over time. Additional costs not included in the above analysis, for on-going training, supervision, and quality control, are likely to increase further the cost per test. The main contribution of this paper is to outline a methodology for estimating the costs of incorporating POC CD4 testing technologies into an HCT program. The details of the program setting matter significantly for the cost estimate, so that such details should be clearly documented to improve the consistency, transparency, and comparability of cost estimates.     

Shortfall of equipment for neonatal intensive care and the introduction of budget holding contracts.

As adequate allowance must be made for the costs of purchasing, maintaining, and updating equipment during the development of contracts the current standing of neonatal units with regard to available equipment was assessed. Data were collected as part of a one year prospective survey of the 17 perinatal units in the Trent region. Adequacy of provision of equipment for recognised intensive care cost was assessed using the recommendations of the British Paediatric Association and British Association of Perinatal Paediatrics. It was assumed that units without recognised intensive care cost had to be able to equip one cot to a standard of intensive care level 1 in the short term. Equipment more than 5 years old was considered likely to warrant replacement or major maintenance within the next two years. With these guidelines over 600,000 pounds would be required to provide sufficient equipment for all recognised level 1 intensive care cost and to allow units without funded cost to provide this level of care in the short term and to replace existing equipment more than 5 years old for these cost alone. This amount could be reduced by 25% by subdividing intensive care cost into levels 1 and 2, thereby reducing equipment requirements, but this would impair the units'' ability to perform level 1 care at funded provision, which has already been shown to need expansion. Neither figure takes account of equipment requirements for infants requiring special care. In addition, no allowance has been made for purchase or update of ultrasound scanners or blood gas analysers. If the government''s proposed reforms are to be implemented clinicians need to revise guidelines regarding essential equipment, and plans must be made to correct any existing shortfalls so that they do not become inherited financial liabilities for future budget holders.     

Experience with a Hospital Laboratory Admission Screen

A comprehensive laboratory admission screen can be instituted in any large laboratory but only in one in command of conventional technology and with the co-operation of the laboratory, medical, nursing and admitting staff.The capital equipment required is costly and subject to early obsolescence. The operating costs are initially high, but the influence of the screen on the general work load indicates that the total overall procedures ordered by the physician will be reduced in number and that over a three-year period, in an economy subject to continuous inflationary pressure, the total cost will approach what might have been expected had the screen not been instituted.By presenting, shortly after admission, a truly comprehensive laboratory profile, the total number of procedures ordered will be reduced and this reduction bears no relationship to whether or not the data supplied are medically useful.The equipment more recently available for a large admission screen is far superior, from the point of view of speed of assay and cost of maintenance and production, to the equipment that has been available to us in this study.It is believed that the unit cost of assay will continue to decline and that the principle of unsolicited testing will be expanded in the future to include procedures not presently in the profile.It is predicted that in the relatively near future almost all of the laboratory procedures that a clinician could conceivably request will have been done prior to his examination of the patient.     

Single versus multiple bioreactor scale-up: economy for high-value products

The economy of scaling-up a bioreactor by increasing the number of units was investigated with respect to an integrated flowsheet. For the production of t-PA from animal cells, a base case flowsheet using a single large bioreactor was compared to a multiple bioreactor case. Simulation of the complete flowsheets for the two cases showed that a multiple bioreactor approach to scale-up increases the return of investment (ROI) of the base process by 122%. This enormous increase in ROI results from the smaller size of the downstream units compared to the base case, since downstream processing accounts for about 80% of the total cost for high value products like t-PA. Proper scheduling of the downstream units allowed sharing of the equipment by the bioreactors. A breakdown of the equipment purchase cost showed that cost related to cell culture equipment increased from 14% for the base case to about 37% for the multiple bioreactor case. The contribution from chromatography columns to the total equipment purchase cost, on the other hand, decreased from 52 to 33%.     

Open-Source Photometric System for Enzymatic Nitrate Quantification

Nitrate, the most oxidized form of nitrogen, is regulated to protect people and animals from harmful levels as there is a large over abundance due to anthropogenic factors. Widespread field testing for nitrate could begin to address the nitrate pollution problem, however, the Cadmium Reduction Method, the leading certified method to detect and quantify nitrate, demands the use of a toxic heavy metal. An alternative, the recently proposed Environmental Protection Agency Nitrate Reductase Nitrate-Nitrogen Analysis Method, eliminates this problem but requires an expensive proprietary spectrophotometer. The development of an inexpensive portable, handheld photometer will greatly expedite field nitrate analysis to combat pollution. To accomplish this goal, a methodology for the design, development, and technical validation of an improved open-source water testing platform capable of performing Nitrate Reductase Nitrate-Nitrogen Analysis Method. This approach is evaluated for its potential to i) eliminate the need for toxic chemicals in water testing for nitrate and nitrite, ii) reduce the cost of equipment to perform this method for measurement for water quality, and iii) make the method easier to carryout in the field. The device is able to perform as well as commercial proprietary systems for less than 15% of the cost for materials. This allows for greater access to the technology and the new, safer nitrate testing technique.     

大型医疗设备成本绩效考核数学模型的建立

目的探讨医疗设备绩效管理的新模式,提高医疗设备的经济效益。方法研制医疗器械成本效益分析评价模型,对医疗设备使用中影响成本的元素进行分析,并提出合理的改善方法。结果通过开展医疗设备使用效益分析,为决策提供可靠的数字依据,对医疗设备的投资及使用进行监督核算。     

Efficient generation of insect-based cell-free translation extracts active in glycosylation and signal sequence processing

A novel method for generation of insect-based cell-free translation extracts is presented. The protocol can be completed in less than an hour, and the resulting extracts are extremely proficient in N-linked glycosylation and signal sequence processing. No specialized equipment other than that usually present in an ordinary biochemistry laboratory is required. The novel approach dramatically reduces cost and time while rendering enhanced lysates compared to previously published strategies.     

Design, modeling, and analysis of a feedstock logistics system

Given the location of a bio-energy plant for the conversion of biomass to bio-energy, a feedstock logistics system that relies on the use of satellite storage locations (SSLs) for temporary storage and loading of round bales is proposed. Three equipment systems are considered for handling biomass at the SSLs, and they are either placed permanently or are mobile and thereby travel from one SSL to another. A mathematical programming-based approach is utilized to determine SSLs and equipment routes in order to minimize the total cost. The use of a Side-loading Rack System results in average savings of 21.3% over a Densification System while a Rear-loading Rack System is more expensive to operate than either of the other equipment systems. The utilization of mobile equipment results in average savings of 14.8% over the equipment placed permanently. Furthermore, the Densification System is not justifiable for transportation distances less than 81 km.     

Technical aspects of telepathology with emphasis on future development.

Pathology undergoes presently changes due to new developments in diagnostic opportunities and cost saving efforts in health care. Out of the wide field of telepathology the paper selects three prototype applications: telepathology in teleeducation, expert advice for preselected details of a slide and finally telepathology for remote diagnosis. The most challenging field for remote diagnosis is the application in the frozen section scenario. The paper starts with the mental experiment to map conventional procedures to counterparts in telepathology. Technical opportunities and economical restrictions of telepathology equipment are discussed with respect to the components: electronic camera, display devices, haptic sensors and displays, available telecommunication channels and telepathology software. As an example and for illustration of the state of the art for an advanced telemicroscopy system able to perform remote frozen section diagnosis, the HISTKOM equipment is presented in more details. The section concerning future developments regards the aspects of the acceptance by tentative users, legal aspects, costs and affordability of equipment, the market for equipment components and the adequate telecommunication services. Further is regarded the mutual influence of properties of existing systems and application experiences gained with them on the next generation of equipment and application software. Conclusions and references close the paper.     

A model for the minimum cost configuration problem in flexible manufacturing systems

This paper presents a mathematical programming model to help select equipment for a flexible manufacturing system, i.e., the selection of the types and numbers of CNC machines, washing stations, load/unload stations, transportation vehicles, and pallets. The objective is to minimize equipment costs and work-in-process inventory cost, while fulfilling production requirements for an average period. Queueing aspects and part flow interactions are considered with the help of a Jacksonian-type closed queueing network model in order to evaluate the system's performance. Since the related decision problem of our model can be shown to be NP-complete, the proposed solution procedure is based on implicit enumeration. Four bounds are provided, two lower and two upper bounds. A tight lower bound is obtained by linearizing the model through the application of asymptotic bound analysis. Furthermore, asymptotic bound analysis allows the calculation of a lower bound for the number of pallets in the system. The first upper bound is given by the best feasible solution and the second is based on the anti-starshaped form of the throughput function.     

A convenient method for preparative peptide separation

A chromatographic system has been developed for the separation of peptides on a preparative scale. The principle of the method is to use the peptide bond absorbance in the 200–250 nm wavelength range as the basis for the peptide detection, and therefore to use only inorganic buffers that are transparent at these low wavelengths. Chromatography on phosphocellulose and on triethylaminoethyl-(TEAE-)cellulose leading to complete separation of the tryptic peptides of oxidized pancreatic ribonuclease is reported as an illustration of the method. The new system, which can be used both rapidly and conveniently and with simple equipment, appears to have broad applicability to peptide separation.     

A rapid method for the measurement of the unwinding angle of intercalating agents and the superhelix density of circular DNAs.

By incubating covalently-closed circular DNA in the presence of calf thymus topoisomerase and unwinding ligands (intercalating drugs and proteins) DNAs of different superhelix density can be produced. These changes in superhelix density can be monitored by an ethidium fluorescence assay, since the level of ethidium binding varies with the superhelix density of a DNA. Thus the equivalence point, in a titration between an unwinding ligand and a supercoiled DNA, can be found. This forms the basis for an extremely rapid method for measuring unwinding angles and superhelix densities. Results are presented which agree well with those reported by previous authors using different techniques. The present method compares very favourably with others when evaluated in terms of rapidity, cost of materials, cost of equipment, accuracy and also applicability.     

Considerations for laboratory animal imaging center design and setup

In vivo animal imaging is an outstanding noninvasive tool to study the pathophysiology of disease or response to therapy; additionally, serial imaging reduces the required number of experimental animals. Because of the tremendous capital investment, we recommend the imaging center be a shared resource to facilitate innovative and productive cross-disciplinary scientific collaborations. A shared center also enables a broader range of imaging, as equipment is often cost prohibitive for smaller facilities. A multitude of factors will determine the architectural design, facility efficiency, and functionality. Important considerations to determine during the planning stages include the types of animals to be imaged, types of imaging studies to be performed, types of imaging equipment and related services to be offered, and the location of the imaging center. Architects must work closely with manufacturers to accommodate equipment-related building specifications; facility planners and veterinarians can provide a practical logistical design that will ensure efficient functionality. Miscellaneous considerations include biosecurity levels, use of radioisotopes, and personnel safety in the imaging environment. The ideal imaging center will include space to house animals and perform necessary preimaging procedures, state-of-the-art in vivo imaging devices and the most up-to-date anesthesia, physiological support, and monitoring equipment. The center staff should include imaging specialists for technical development and data analysis. As it is difficult to provide a comprehensive manual for setting up an in vivo animal imaging center, we offer advice based on our experiences with the National Institutes of Health Mouse Imaging Facility. Because magnetic resonance imaging (MRI) is the most expensive imaging tool, requires specific building design considerations, and poses unique occupational health and safety risks, we focus on MRI as the foundation for an imaging facility design.     

Construction of a low cost and highly sensitive direct heat calorimeter suitable for estimating metabolic rate in small animals

Although the concept of a metabolic rate is readily understood, actual measurement of metabolism has proved much more difficult. The numerous strategies for estimation of metabolic rate all result in an incomplete accounting. Respirometry or gas exchange is the most widely used approach but mostly ignores the anaerobic component. Here, we describe a readily-built and low cost direct heat calorimeter that may be coupled with standard respirometry equipment to provide a more complete portrait of metabolism. The device is sensitive and provides a predictable measurement of heat flow from an organism.     

Economic evaluation of enzymatic hydrolysis of phenol-pretreated wheat straw

Experimental data from the enzymatic hydrolysis of phenol-pretreated Swedish wheat straw have been used to evaluate the cost fractions of capital and utility, enzyme, and raw material. Two different raw material prices and varying enzyme prices have been used. The evaluation is based on an empirical model for the enzymatic hydrolysis and a computer program where utility and equipment, enzyme, and raw material prices can be varied. The optimal residence time for the enzymatic hydrolysis is in the range of 70-110 h. A fed-batch procedure with substrate concentrations higher than 10% oven-dried material (ODM) and enzyme concentrations in the range (6-10) . 10(6) FPU/ton ODM should be used.