155 research outputs found

    The quality of life and cost utility of home nocturnal and conventional in-center hemodialysis

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    The quality of life and cost utility of home nocturnal and conventional in-center hemodialysis.BackgroundHome nocturnal hemodialysis is an intensive form of hemodialysis, where patients perform their treatments at home for about 7hours approximately 6 nights a week. Compared with in-center conventional hemodialysis, home nocturnal hemodialysis has been shown to improve physiologic parameters and reduce health care costs; however, the effects on quality of life and cost utility are less clear. We hypothesized that individuals performing home nocturnal hemodialysis would have a higher quality of life and superior cost utility than in-center hemodialysis patients.MethodsHome nocturnal hemodialysis patients and a demographically similar group of in-center hemodialysis patients from a hospital without a home hemodialysis program underwent computer-assisted interviews to assess their utility score for current health by the standard gamble method.ResultsNineteen in-center hemodialysis and 24 home nocturnal hemodialysis patients were interviewed. Mean annual costs for home nocturnal hemodialysis were about 10,000lowerforhomenocturnalhemodialysis(10,000 lower for home nocturnal hemodialysis (55,139 ±7651forhomenocturnalhemodialysisvs.7651 for home nocturnal hemodialysis vs. 66,367 ±17,502forin−centerhemodialysis,P=0.03).Homenocturnalhemodialysiswasassociatedwithahigherutilityscorethanin−centerhemodialysis(0.77±0.23vs.0.53±0.35,P=0.03).Thecostutilityforhomenocturnalhemodialysiswas17,502 for in-center hemodialysis, P = 0.03). Home nocturnal hemodialysis was associated with a higher utility score than in-center hemodialysis (0.77 ± 0.23 vs. 0.53 ± 0.35, P = 0.03). The cost utility for home nocturnal hemodialysis was 71,443/quality-adjusted life-year (QALY), while for in-center hemodialysis it was 125,845/QALY.Homenocturnalhemodialysiswasthedominantstrategy,withanincrementalcost−effectivenessratio(ICER)of−125,845/QALY. Home nocturnal hemodialysis was the dominant strategy, with an incremental cost-effectiveness ratio (ICER) of -45,932. The 95% CI for the ICER, and 2500 bootstrap iterations of the ICER all fell below the cost-effectiveness ceiling of 50,000.Thenetmonetarybenefitofhomenocturnalhemodialysisrangedfrom50,000. The net monetary benefit of home nocturnal hemodialysis ranged from 11,227 to $35,669.ConclusionHome nocturnal hemodialysis is associated with a higher quality of life and a superior cost utility when compared to in-center hemodialysis

    Femoral Neck Angle Impacts Hip Disorder and Surgical Intervention: A Patient-Specific 3D Printed Analysis

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    The purpose of this study is to investigate the femoral neck angulation for prediction of the complication associated with dynamic hip screw (DHS) surgery and hip deformity. Three sample patients' MRI images were selected to calculate the femoral neck angles. A total of six femur head geometries were reconstructed and three dimensional (3D) models printed. The calculation of neck angles was done in both computer models and 3D-printed models. Our results showed that 3D-printed models achieved high accuracy and provided the physical measurements, when compared to the computer models could not confirm. Neck angulations related to uncomplicated DHS surgery ranged between 129{\deg}-139{\deg}, and non-deformity of normal neck angles ranged between 120{\deg}-135{\deg}. Our study indicated that patient-specific 3D printed femoral head models provide useful information for medical education and assist DHS surgery. Further research based on a large sample size is necessary

    Predicting Hidden Links in Supply Networks

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    Manufacturing companies often lack visibility of the procurement interdependencies between the suppliers within their supply network. However, knowledge of these interdependencies is useful to plan for potential operational disruptions. In this paper, we develop the Supply Network Link Predictor (SNLP) method to infer supplier interdependencies using the manufacturer’s incomplete knowledge of the network. SNLP uses topological data to extract relational features from the known network to train a classifier for predicting potential links. Using a test case from the automotive industry, four features are extracted: (i) number of existing supplier links, (ii) overlaps between supplier product portfolios, (iii) product outsourcing associations, and (iv) likelihood of buyers purchasing from two suppliers together. Naïve Bayes and Logistic Regression are then employed to predict whether these features can help predict interdependencies between two suppliers. Our results show that these features can indeed be used to predict interdependencies in the network and that predictive accuracy is maximized by (i) and (iii). The findings give rise to the exciting possibility of using data analytics for improving supply chain visibility. We then proceed to discuss to what extent such approaches can be adopted and their limitations, highlighting next steps for future work in this area

    An agent-based approach for energy-efficient sensor networks in logistics

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    As part of the fourth industrial revolution, logistics processes are augmented with connected information systems to improve their reliability and sustainability. Above all, customers can analyse process data obtained from the networked logistics operations to reduce costs and increase margins. The logistics of managing liquid goods is particularly challenging due to the strict transport temperature requirements involving monitoring via sensors attached to containers. However, these sensors transmit much redundant information that, at times, does not provide additional value to the customer, while consuming the limited energy stored in the sensor batteries. This paper aims to explore and study alternative approaches for location tracking and state monitoring in the context of liquid goods logistics. This problem is addressed by using a combination of data-driven sensing and agent-based modelling techniques. The simulation results show that the longest life span of batteries is achieved when most sensors are put into sleep mode yielding an increase of ×21.7 and ×3.7 for two typical routing scenarios. However, to allow for situations in which high quality sensor data is required to make decisions, agents need to be made aware of the life cycle phase of individual containers. Key contributions include (1) an agent-based approach for modelling the dynamics of liquid goods logistics to enable monitoring and detect inefficiencies (2) the development and analysis of three sensor usage strategies for reducing the energy consumption, and (3) an evaluation of the trade-offs between energy consumption and location tracking precision for timely decision making in resource constrained monitoring systems

    Regression of left ventricular mass following conversion from conventional hemodialysis to thrice weekly in-centre nocturnal hemodialysis

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    <p>Abstract</p> <p>Background</p> <p>Increased left ventricular mass (LVM) is associated with adverse outcomes in patients receiving chronic hemodialysis. Among patients receiving conventional hemodialysis (CHD, 3×/week, 4 hrs/session), we evaluated whether dialysis intensification with in-centre nocturnal hemodialysis (INHD, 3×/week, 7-8 hrs/session in the dialysis unit) was associated with regression of LVM.</p> <p>Methods</p> <p>We conducted a retrospective cohort study of CHD recipients who converted to INHD and received INHD for at least 6 months. LVM on the first echocardiogram performed at least 6 months post-conversion was compared to LVM pre-conversion. In a secondary analysis, we examined echocardiograms performed at least 12 months after starting INHD. The effect of conversion to INHD on LVM over time was also evaluated using a longitudinal analysis that incorporated all LVM data on patients with 2 or more echocardiograms.</p> <p>Results</p> <p>Thirty-seven patients were eligible for the primary analysis. Mean age at conversion was 49 ± 12 yrs and 30% were women. Mean pre-conversion LVM was 219 ± 66 g and following conversion, LVM declined by 32 ± 58 g (p = 0.002). Among patients whose follow-up echocardiogram occurred at least 12 months following conversion, LVM declined by 40 ± 56 g (p = 0.0004). The rate of change of LVM decreased significantly from 0.4 g/yr before conversion, to -11.7 g/yr following conversion to INHD (p < 0.0001).</p> <p>Conclusion</p> <p>Conversion to INHD is associated with a significant regression in LVM, which may portend a more favourable cardiovascular outcome. Our preliminary findings support the need for randomized controlled trials to definitively evaluate the cardiovascular effects of INHD.</p
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