This article presents the development of a low-cost microcontroller-based interface for a microbioreactor operation. An Arduino MEGA 2560 board with 54 digital input/outputs, including 15 pulse-width-modulation outputs, has been chosen to perform the acquisition and control of the microbioreactor. The microbioreactor (volume = 800 µL) was made of poly(dimethylsiloxane) and poly(methylmethacrylate) polymers. The reactor was built to be equipped with sensors and actuators for the control of reactor temperature and the mixing speed. The article discusses the circuit of the microcontroller-based platform, describes the signal conditioning steps, and evaluates the capacity of the proposed low-cost microcontroller-based interface in terms of control accuracy and system responses. It is demonstrated that the proposed microcontroller-based platform is able to operate parallel microbioreactor operation with satisfactory performances. Control accuracy at a deviation less than 5% of the set-point values and responses in the range of few seconds have been recorded.
Objectives: The cost of acute exacerbations of asthma had not been well studied in literature. The aim of this study was to identify and quantify the (average) cost of moderate and severe exacerbations of asthma in patients attending tertiary-care setup in Malaysia. The related burden of exacerbations was also calculated.
Methods: The costs including lab investigation charges, unit costs of treatment per bed, medication charges, food costs, transportation costs and loss of productivity were calculated per asthma episode. Data was analysed by Statistical Package for the Social Sciences (SPSS) version 18.0 using various descriptive and inferential statistical tests.
Results: A median medical cost of acute exacerbation of asthma under Ministry of Health’s (MOH) perspective was USD 105.00 (RM338.47) per episode. Medication cost comprised the majority (52.38%) of the total medical costs. A median medical cost of acute exacerbation of asthma under patient’s perspective was USD 1.55 (RM4.99) per episode. ConclusionsAsthma exacerbation and length of stay in the hospital were proportional to the direct medical costs. In Malaysia, a substantial proportion of the direct medical cost of asthma treatment is heavily subsidised for the locals.
Objectives: Health care services in Malaysia are widely available and accessible at a minimal cost. However, in pursuing with the health care reform, policy-makers and hospital managers need to know the unit cost for the purpose of planning and efficiency of providing the services. This study estimated the cost of out-patient services in a public hospital
Methods:The study was conducted in a 341 bedded hospital that provide secondary level care to 24,486 in-patients and 127,389 specialist out-patients in 2010. The costs were estimated using a step-down approach where the costs were allocated to the different cost-centres. Capital costs were annualised cost of capital item with life expectancy of more than 1 year and recurrent cost were all inputs consumed within a year. Total costs were then allocated to the in-patient and out-patient services based on historical financial data with a ratio of 1: 4. This was then followed by a stepwise approach of allocating the ancillary department cost centres to the clinical department cost centres. The unit cost per patient visit was calculated based on the number of visits for each department. Base year of 2010 was used to calculate the cost and patients visits. Costs were calculated from the perspective of the hospital.
Conclusions: The findings provide an estimate of the costs for out-patient visit. At the current minimal fee of MYR 5.00 (USD 1.5), the Ministry of Health is subsidising more than 95.0% of the health care cost for each patient. These estimates provide the policy-makers with an understanding of the cost data should they need to establish a cost basis for payment rates.
Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are life-threatening dermatologic conditions. Although, the incidence of SJS/TEN in Thailand is high, information on cost of care for SJS/TEN is limited. This study aims to estimate healthcare resource utilization and cost of SJS/TEN in Thailand, using hospital perspective.
This study examines the issues of winner's curse, size effect and bandwagon effect in explaining the under-pricing phenomenon of Malaysian IPOs, for the period from January 2001 to December 2008. The average initial return for the Malaysian private placement IPOs (a proxy for informed investors) is significantly lower than that of the non-private placement IPOs (a proxy for uninformed investors), which gives support to the winner's curse hypothesis, where uninformed investors demand a higher initial return in the absence of informed investors. Using listing board as proxy for size of companies, we find that the smaller the company, the higher the average initial return, thus giving support to size effect, where investors usually demand higher initial return for smaller companies due to their higher perceived risk. The study also finds that the presence of a large number of informed investors as compared to uninformed investors in an IPO exercise will result in an increase in demand for that particular stock in the secondary market, which gives support to the bandwagon effect.
BACKGROUND: Professional development is essential in the health disciplines. Knowing the cost and value of educational approaches informs decisions and choices about learning and teaching practices.
OBJECTIVE: The primary aim of this study was to conduct a cost analysis of participation in continuing professional development via social media compared with live conference attendance.
METHODS: Clinicians interested in musculoskeletal care were invited to participate in the study activities. Quantitative data were obtained from an anonymous electronic questionnaire.
RESULTS: Of the 272 individuals invited to contribute data to this study, 150 clinicians predominantly from Australia, United States, United Kingdom, India, and Malaysia completed the outcome measures. Half of the respondents (78/150, 52.0%) believed that they would learn more with the live conference format. The median perceived participation costs for the live conference format was Aus $1596 (interquartile range, IQR 172.50-2852.00). The perceived cost of participation for equivalent content delivered via social media was Aus $15 (IQR 0.00-58.50). The majority of the clinicians (114/146, 78.1%, missing data n=4) indicated that they would pay for a subscription-based service, delivered by social media, to the median value of Aus $59.50.
CONCLUSIONS: Social media platforms are evolving into an acceptable and financially sustainable medium for the continued professional development of health professionals. When factoring in the reduced costs of participation and the reduced loss of employable hours from the perspective of the health service, professional development via social media has unique strengths that challenge the traditional live conference delivery format.
Subspace quasi-Newton (SQN) method has been widely used in large scale unconstrained optimization problem. Its popularity is due to the fact that the method can construct subproblems in low dimensions so that storage requirement as well as the computation cost can be minimized. However, the main drawback of the SQN method is that it can be very slow on certain types of non-linear problem such as ill-conditioned problems. Hence, we proposed a preconditioned SQN method, which is generally more effective than the SQN method. In order to achieve this, we proposed that a diagonal updating matrix that was derived based on the weak secant relation be used instead of the identity matrix to approximate the initial inverse Hessian. Our numerical results show that the proposed preconditioned SQN method performs better than the SQN method which is without preconditioning.
Preventive tests and diagnosis of in-service power transformer are important for early fault prediction and increased reliability of electricity supply. However, some existing diagnostic techniques require transformer outage before the measurement can be performed and need expert knowledge and experiences to interpret the measurement results. Other measurement techniques such as chemical analyses of insulating oil may cause significant variance to measurement results due to different practices in oil sampling, storage, handling and transportation of oil. A cost-effective measuring technique, which is simple, providing fast and an accurate measurement results, is therefore highly required. The extended application of Polarisation and Depolarisation (PDC) measurement for characterisation of different faults conditions in-service power transformer has been presented in this paper. Earlier studies on polarisation and depolarisation current of oil samples from in-service power transformer shows that depolarisation has provided significant information about the change of material properties due to faults in power transformer. In this paper, a new approach based on Depolarisation Current Ratio Index (DRI) was developed for identifying and classifying different transformer fault conditions. The DRI at time interval of 4s to 100s was analysed and the results show that DRI of depolarisation current between 5/100s and 10/100s provides higher correlation on the incipient faults in power transformer.
BACKGROUND: To compare health care utilization and cost by asthma severity and type of health insurance in Thailand.
METHODS: A retrospective cohort study using an electronic database was conducted in patients with asthma. Patients who were diagnosed with asthma from 2009 to 2011, had at least two subsequent health care encounters for asthma during the first six months after the first asthma diagnosis, and had at least 90 days of follow-up were included. The primary outcome was direct health care costs of inpatient and outpatient care. We compared outcomes between groups on the basis of a proxy of severity (mild/moderate severe asthma vs. high severe asthma) and type of health insurance using a multivariable generalized linear model. Covariates such as Patients' demographic characteristics, comorbidities, and concurrent medications were included in the model.
RESULTS: Among 1982 patients included, the average age was 40.3 ± 24.0 years, with 60.7% being males. A total of 1936 patients had mild/moderate severe asthma, whereas 46 patients had high severe asthma. There were 1293 patients under the Universal Coverage Scheme, 264 patients under Social Security Insurance, and 626 patients under the Civil Servant Medical Benefit Scheme (CSMBS). The average annual cost per patient was $598 ± $871. In adjusted analyses, the health care cost of patients with high severe asthma was $71 higher than that of patients with mild/moderate severe asthma (95% confidence interval $-131 to $274). The cost of patients under the CSMBS was $110 (95% confidence interval $29-$191) higher than that of patients under Universal Coverage Scheme.
CONCLUSIONS: Health care costs of patients with asthma were substantial and were higher in patients with high severe asthma and patients under the CSMBS.
Google Play Store was used to search for eye care-related applications the android simulator using various general terms related to eye care to review and categorize various interactive eye care-related applications in android platform from the details available in the application website. Data collected from application description and application developer's webpage include target audience, category of apps, estimated number of downloads, average user rating, involvement of eye care professionals in developing the application, and cost of the app. All these data were collected only from the details provided in the application website considering on online user perspective and the developers were not contacted to collect any other details. In total, 475 applications were identified and grouped into 13 categories depending on the type of service the application provide. Out of which, only 107 (22.53%) applications had mentioned about the eye care professional involvement in their design or development of the application. The applications were also stratified according to the target audience, and many had no user rating with very few downloads. The lack of evidence-based principles and standardization of application development should be taken into consideration to avoid its negative impact on the community, especially in eye care.
The changes on the vegetables oil trading environment might change the foundation of palm oil pricing and induce a structural change to the price model. Failing to take it account the structural change in a data series might lead to misspecification of the actual model. This study, however, showed that structural change was not present in the monthly, January 1983 to July 1995, palm oil price, but it was present on the unconditional variance. The underlying model of this series was ARIMA (3, 1, 0) with ARCH (1). The critical change of the unconditional variance took place in April 1989.
Perubahan dalam suasana perdagangan minyak sayuran boleh mengubah asas harga minyak kelapa sawit. Seterusnya ia merangsang perubahan dalam struktur model harga minyak tersebut. Kegagalan untuk mengambil kira perubahan struktur dalam siri data menjadikan model itu tidak menepati spesifikasi daripada model sebenar. Kajian ini mendapati bahawa perubahan struktur tidak berlaku bagi data harga minyak sawit dari Januari 1983 hingga Julai 1995. Tetapi perubahan berlaku pada varians tidak bersyaratnya. Model asas bagi siri ini adalah ARIMA (3,1,0) dengan ARCH(1). Didapati juga bahawa perubahan yang kritikal bagi varians tidak bersyarat berlaku pada bulan April 1989.
This paper considers the problem of a vendor or manufacturer supplying a final production batch to a single buyer under linearly decreasing demand for a finite time horizon. The vendor manufactures the product at a finite rate and ships the output to the buyer. In this model we considered the case where the holding cost at the vendor is greater than the buyer and propose a consignment model. The objective was to minimize the total cost of stock transfer from vendor to buyer and stock holding at the vendor and the buyer. We derived the structure of the optimal solution and illustrate the proposed models with numerical examples.
Recent bioinspired efforts of designing novel nanoenzyme-based electrocatalysts are driven by the urgency of making bioelectrofuels more affordable and efficient. Unlike natural enzymes, nanoenzyme-modified electrodes with large surface areas enclose numerous biomimicking active sites to facilitate enhanced microbial growth followed by increased reactant-to-bioelectrofuel conversion.
Food waste (FW) generation from hotel operations have a significant negative impact on the environment, society and economy. Hence, the urgent need to introduce sustainable food management to reduce both FW and operational costs in hotels. The aim of this paper is to identify the drivers of FW generation and barriers to sustainable food waste management (SFWM) in island based hotels. The data were collected using in-depth interview coupled with the observations conducted at 23 selected hoteliers in Langkawi Island, Malaysia. Based on the analysis, using qualitative content analysis (QCA), eight FW drivers were identified and the drivers were classified into three categories of factors, mainly internal, external and intermediate influence. There are four FW drivers identified as internal factors that influenced the implementation of food waste management namely (1) poor hotel management and policies, (2) lack of skills in food preparation, (3) lack of facilities and FW technology and (4) non-implementation of waste audit and waste separation. For external factors, there are two FW drivers, including (5) unsustainable food consumption patterns of the customers and (6) risk of food ingredients spoilage. As for intermediate factors, two FW drivers were identified, which are (7) ineffective communication and (8) inadequate education and awareness. Findings from this study contribute towards a better understanding on the complexity of FW issues, particularly for island-based hotel sector. It was also suggested that a holistic approach with multi-stakeholders is crucial to reduce food wastage towards achieving SFWM.
Budget impact analysis (BIA) is a useful tool for reimbursement decision-makers in health technology assessments by authorities across different countries. This study aimed to evaluate the financial impact from the Ministry of Health (MOH) perspective of different adoption rates of Biphasic Insulin Aspart (BIAsp) versus Biphasic Human Insulin (BHI) in treating type 2 diabetes mellitus.
An Excel basfed 5-year budget impact model was built to estimate insulin treated patients by public providers using local prevalence data. The published demographic, efficacy and adverse event data for ASEAN subgroup analyses of A1chieve study was applied. Both insulin acquisition costs and other medical costs for complications e.g. major hypoglycaemia, myocardial infarction, stroke, end-stage renal disease, blindness and amputation were included at a discount rate of 3%. The incidence rates of these complications were derived from the established UKPDS equations. The adoption rates were assumed and projected from the 2013 utilisation volume data of BIAsp and BHI by public providers. Sensitivity analyses were conducted.
The adoption rates of BIAsp were assumed to increase from 1.8% in 2013 to 4.5% or 6.9% in 2018 for base case and upside scenario, respectively. Compared to the base case, upside scenario of wider BIAsp adoption was associated with an increased insulin cost up to RM 8.2M which was offset by avoided complication costs resulting in an overall net budget saving of approximately RM 5.5M over 5 years, primarily driven by estimated reduction in major hypoglycaemia events for patients treated with BIAsp.
The higher and wider adoption of BIAsp would likely be associated with cost savings in Malaysia from the MOH perspective attributed to its superiority in H1Ac reduction and lower major hypoglycemia risk in comparison to BHI. More cost saving would be concluded if productivity loss is included from a societal perspective.
OBJECTIVES. Osteoporotic fractures are common in older adults and are often associated with high morbidity and mortality. As the incidence increases with age, it is natural that osteoporotic fractures have become a major health problem worldwide. Increasing number of patients with osteoporotic fracture will have a serious economic impact on the patient themselves and the society. The objective of this study is to study the cost-effectiveness of strontium ranelate compared to alendronate for patients with post-menopausal osteoporotic fractures in Malaysia.
METHODS. A Markov model was developed to project clinical and economic benefits of strontium in a hypothetical cohort of patients (N=1,000) over a 5-year time horizon. This study was conducted from a payer perspective. Model parameters including transition probabilities and costs of treating fracture at various sites were Malaysia-specific. Drug costs were obtained from a public teaching hospital in Kuala Lumpur. Utilities were derived from previous literatures and efficacy data were derived from two pivotal trials, i. e. SOTI and TROPOS trials. Outcomes were presented as cost per quality-adjusted life year (QALY) gained. A discount rate of 3% was applied. Both 1-way and multivariate probabilistic sensitivity analyses were undertaken to evaluate robustness of results.
RESULTS. Compared to alendronate, strontium could prevent 328 wrist, 192 hip, 7 vertebra and 115 multiple fractures respectively over 5 years, which was translated into 27.9 QALYs gained. Using strontium can lead to cost reduction of MYR1,416,595 (USD442,685), MYR478,257 (USD149,455), MYR22,784 (USD7,120) and MYR61,883 (USD113,088) due to reduced episodes of fractures at wrist/hip/vertebra/multiple sites respectively. The total reduction of direct medical costs of MYR2,279,519 (USD712,349) was larger than the extra drug cost, hence making strontium a cost-saving therapy.
CONCLUSIONS. It was shown that strontium appeared to be more cost-effective compared to alendronate and hence should be recommended in the public sector in Malaysia.