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The initial idea of Robotic Process Automation (RPA) is the automation of business processes through the presentation layer of existing application systems. For this simple emulation of user input and output by software robots, no changes of the systems and architecture is required. However, considering strategic aspects of aligning business and technology on an enterprise level as well as the growing capabilities of RPA driven by artificial intelligence, interrelations between RPA and Enterprise Architecture (EA) become visible and pose new questions. In this paper we discuss the relationship between RPA and EA in terms of perspectives and implications. As workin- progress we focus on identifying new questions and research opportunities related to RPA and EA.
The ClearPET project
(2004)
The Crystal Clear Collaboration has designed and is building a high-resolution small animal PET scanner. The design is based on the use of the Hamamatsu R7600-M64 multi-anode photomultiplier tube and a LSO/LuYAP phoswich matrix with one to one coupling between the crystals and the photo-detector. The complete system will have 80 PM tubes in four rings with an inner diameter of 137 mm and an axial field of view of 110 mm. The PM pulses are digitized by free-running ADCs and digital data processing determines the gamma energy, the phoswich layer and even the pulse arrival time. Single gamma interactions are recorded and coincidences are found by software. The gantry allows rotation of the detector modules around the field of view. Simulations, and measurements a 2×4 module test set-up predict a spatial resolution of 1.5 mm in the centre of the field of view and a sensitivity of 5.9% for a point source in the centre of the field of view.
Producing fresh water from saline water has become one of the most difficult challenges to overcome especially with the high demand and shortage of fresh water. In this context, as part of a collaboration with Germany, the authors propose a design and implementation of a pilot multi-stage solar desalination system (MSD), remotely controlled, at Douar Al Hamri in the rural town of Boughriba in the province of Berkane, Morocco. More specifically, they present their contribution on the remote control and supervision system, which makes the functioning of the MSD system reliable and guarantees the production of drinking water for the population of Douar. The results obtained show that the electronic cards and computer communication software implemented allow the acquisition of all electrical (currents, voltages, powers, yields), thermal (temperatures of each stage), and meteorological (irradiance and ambient temperature), remote control and maintenance (switching on, off, data transfer). By comparing with the literature carried out in the field of solar energy, the authors conclude that the MSD and electronic desalination systems realized during this work represent a contribution in terms of the reliability and durability of providing drinking water in rural and urban areas.
The esophageal Doppler monitor (EDM) is a minimally-invasive hemodynamic device which evaluates both cardiac output (CO), and fluid status, by estimating stroke volume (SV) and calculating heart rate (HR). The measurement of these parameters is based upon a continuous and accurate approximation of distal thoracic aortic blood flow. Furthermore, the peak velocity (PV) and mean acceleration (MA), of aortic blood flow at this anatomic location, are also determined by the EDM. The purpose of this preliminary report is to examine additional clinical hemodynamic calculations of: compliance (C), kinetic energy (KE), force (F), and afterload (TSVRi). These data were derived using both velocity-based measurements, provided by the EDM, as well as other contemporaneous physiologic parameters. Data were obtained from anesthetized patients undergoing surgery or who were in a critical care unit. A graphical inspection of these measurements is presented and discussed with respect to each patient’s clinical situation. When normalized to each of their initial values, F and KE both consistently demonstrated more discriminative power than either PV or MA. The EDM offers additional applications for hemodynamic monitoring. Further research regarding the accuracy, utility, and limitations of these parameters is therefore indicated.
A second-order L-stable exponential time-differencing (ETD) method is developed by combining an ETD scheme with approximating the matrix exponentials by rational functions having real distinct poles (RDP), together with a dimensional splitting integrating factor technique. A variety of non-linear reaction-diffusion equations in two and three dimensions with either Dirichlet, Neumann, or periodic boundary conditions are solved with this scheme and shown to outperform a variety of other second-order implicit-explicit schemes. An additional performance boost is gained through further use of basic parallelization techniques.
Mechanical forces/tensile stresses are critical determinants of cellular growth, differentiation and migration patterns in health and disease. The innovative “CellDrum technology” was designed for measuring mechanical tensile stress of cultured cell monolayers/thin tissue constructs routinely. These are cultivated on very thin silicone membranes in the so-called CellDrum. The cell layers adhere firmly to the membrane and thus transmit the cell forces generated. A CellDrum consists of a cylinder which is sealed from below with a 4 μm thick, biocompatible, functionalized silicone membrane. The weight of cell culture medium bulbs the membrane out downwards. Membrane indentation is measured. When cells contract due to drug action, membrane, cells and medium are lifted upwards. The induced indentation changes allow for lateral drug induced mechanical tension quantification of the micro-tissues. With hiPS-induced (human) Cardiomyocytes (CM) the CellDrum opens new perspectives of individualized cardiac drug testing. Here, monolayers of self-beating hiPS-CMs were grown in CellDrums. Rhythmic contractions of the hiPS-cells induce membrane up-and-down deflections. The recorded cycles allow for single beat amplitude, single beat duration, integration of the single beat amplitude over the beat time and frequency analysis. Dose effects of agonists and antagonists acting on Ca2+ channels were sensitively and highly reproducibly observed. Data were consistent with published reference data as far as they were available. The combination of the CellDrum technology with hiPS-Cardiomyocytes offers a fast, facile and precise system for pharmacological and toxicological studies. It allows new preclinical basic as well as applied research in pharmacolgy and toxicology.
The invention pertains to a CellDrum electrode arrangement for measuring mechanical stress, comprising a mechanical holder (1 ) and a non-conductive membrane (4), whereby the membrane (4) is at least partially fixed at its circumference to the mechanical holder (1), keeping it in place when the membrane (4) may bend due to forces acting on the membrane (4), the mechanical holder (1) and the membrane (4) forming a container, whereby the membrane (1) within the container comprises an cell- membrane compound layer or biological material (3) adhered to the deformable membrane 4 which in response to stimulation by an agent may exert mechanical stress to the membrane (4) such that the membrane bending stage changes whereby the container may be filled with an electrolyte, whereby an electric contact (2) is arranged allowing to contact said electrolyte when filled into to the container, whereby within a predefined geometry to the fixing of the membrane (4) an electrode (7) is arranged, whereby the electrode (7) is electrically insulated with respect to the electric contact (2) as well as said electrolyte, whereby mechanical stress due to an agent may be measured as a change in capacitance.
Tests with palm tree leaves have just started yet and scan data are in the process to be analyzed. The final goal of future project for palm tree gender and species recognition will be to develop optical scanning technology to be applied to date palm tree leaves for in–situ screening purposes. Depending on the software used and the particular requirements of the users the technology potentially shall be able to identify palm tree diseases, palm tree gender, and species of young date palm trees by scanning leaves.
A microscopic photometric method for measuring erythrocyte deformability. Artmann, Gerhard Michael
(1986)
In the present work, surface functionalization of different sensor materials was studied. Organosilanes are well known to serve as coupling agent for biomolecules or cells on inorganic materials. 3-aminopropyltriethoxysilane (APTES) was used to attach microbiological spores time to an interdigitated sensor surface. The functionality and physical properties of APTES were studied on isolated sensor materials, namely silicon dioxide (SiO2) and platinum (Pt) as well as the combined material on sensor level. A predominant immobilization of spores could be demonstrated on SiO2 surfaces. Additionally, the impedance signal of APTES-functionalized biosensor chips has been investigated.
Optimization of the immobilization of bacterial spores on glass substrates with organosilanes
(2016)
Spores can be immobilized on biosensors to function as sensitive recognition elements. However, the immobilization can affect the sensitivity and reproducibility of the sensor signal. In this work, three different immobilization strategies with organosilanes were optimized and characterized to immobilize Bacillus atrophaeus spores on glass substrates. Five different silanization parameters were investigated: nature of the solvent, concentration of the silane, silanization time, curing process, and silanization temperature. The resulting silane layers were resistant to a buffer solution (e.g., Ringer solution) with a polysorbate (e.g., Tween®80) and sonication.
Prior to immobilization of biomolecules or cells onto biosensor surfaces, the surface must be physically or chemically activated for further functionalization. Organosilanes are a versatile option as they facilitate the immobilization through their terminal groups and also display self-assembly. Incorporating hydroxyl groups is one of the important methods for primary immobilization. This can be done, for example, with oxygen plasma treatment. However, this treatment can affect the performance of the biosensors and this effect is not quite well understood for surface functionalization. In this work, the effect of O2 plasma treatment on EIS sensors was investigated by means of electrochemical characterizations: capacitance–voltage (C–V) and constant capacitance (ConCap) measurements. After O2 plasma treatment, the potential of the EIS sensor dramatically shifts to a more negative value. This was successfully reset by using an annealing process.
This paper presents an approach for reducing the cognitive load for humans working in quality control (QC) for production processes that adhere to the 6σ -methodology. While 100% QC requires every part to be inspected, this task can be reduced when a human-in-the-loop QC process gets supported by an anomaly detection system that only presents those parts for manual inspection that have a significant likelihood of being defective. This approach shows good results when applied to image-based QC for metal textile products.
Background
True date palms (Phoenix dactylifera L.) are impressive trees and have served as an indispensable source of food for mankind in tropical and subtropical countries for centuries. The aim of this study is to differentiate date palm tree varieties by analysing leaflet cross sections with technical/optical methods and artificial neural networks (ANN).
Results
Fluorescence microscopy images of leaflet cross sections have been taken from a set of five date palm tree cultivars (Hewlat al Jouf, Khlas, Nabot Soltan, Shishi, Um Raheem). After features extraction from images, the obtained data have been fed in a multilayer perceptron ANN with backpropagation learning algorithm.
Conclusions
Overall, an accurate result in prediction and differentiation of date palm tree cultivars was achieved with average prediction in tenfold cross-validation is 89.1% and reached 100% in one of the best ANN.
One of interesting but not well known water properties is related to appearance of highly ordered structures in response to strong electrical field. In 1893 Sir William Armstrong placed a cotton thread between two wine glasses filled with chemically pure water. When high DC voltage was applied between the glasses, a connection consisting of water formed, producing a "water bridge"
Microfabrication, characterization and analytical application of a new thin-film silver microsensor
(2009)
Novel organic membrane-based thin-film microsensors for the determination of heavy metal cations
(2006)
A first step towards the fabrication and electrochemical evaluation of thin-film microsensors based on organic PVC membranes for the determination of Hg(II), Cd(II), Pb(II) and Cu(II) ions in solutions has been realised. The membrane-coating mixture used in the preparation of this new type of microsensors is incorporating PVC as supporting matrix, o-nitrophenyloctylether (o-NPOE) as solvent mediator and a recently synthesized Hg[dimethylglyoxime(phene)]2+ and Bis-(4-hydroxyacetophenone)-ethylenediamine as electroactive materials for Hg(II) and Cd(II), respectively. A set of three commercialised ionophores for Cd(II), Pb(II) and Cu(II) has been also used for comparison. Thin-film microsensors based on these membranes showed a Nernstian response of slope (26-30 mV/dec.) for the respective tested cations. The potentiometric response characteristics (linear range, pH range, detection limit and response time) are comparable with those obtained by conventional membranes as well as coated wire electrodes prepared from the same membrane. The realisation of the new organic membrane-based thin-film microsensors overcomes the problem of an insufficient selectivity of solid-state-based thinfilm sensors.
The purpose of the current study in combination with our previous published data (Arampatzis et al., 2007) was to examine the effects of a controlled modulation of strain magnitude and strain frequency applied to the Achilles tendon on the plasticity of tendon mechanical and morphological properties. Eleven male adults (23.9±2.2 yr) participated in the study. The participants exercised one leg at low magnitude tendon strain (2.97±0.47%), and the other leg at high tendon strain magnitude (4.72±1.08%) of similar frequency (0.5 Hz, 1 s loading, 1 s relaxation) and exercise volume (integral of the plantar flexion moment over time) for 14 weeks, 4 days per week, 5 sets per session. The exercise volume was similar to the intervention of our earlier study (0.17 Hz frequency; 3 s loading, 3 s relaxation) allowing a direct comparison of the results. Before and after the intervention ankle joint moment has been measured by a dynamometer, tendon–aponeurosis elongation by ultrasound and cross-sectional area of the Achilles tendon by magnet resonance images (MRI). We found a decrease in strain at a given tendon force, an increase in tendon–aponeurosis stiffness and tendon elastic modulus of the Achilles tendon only in the leg exercised at high strain magnitude. The cross-sectional area (CSA) of the Achilles tendon did not show any statistically significant (P>0.05) differences to the pre-exercise values in both legs. The results indicate a superior improvement in tendon properties (stiffness, elastic modulus and CSA) at the low frequency (0.17 Hz) compared to the high strain frequency (0.5 Hz) protocol. These findings provide evidence that the strain magnitude applied to the Achilles tendon should exceed the value, which occurs during habitual activities to trigger adaptational effects and that higher tendon strain duration per contraction leads to superior tendon adaptational responses.
The Effect of Openings on Out-of-Plane Capacity of Masonry Infilled Reinforced Concrete Frames
(2018)
Objective
Hemodialysis patients show an approximately threefold higher prevalence of cognitive impairment compared to the age-matched general population. Impaired microcirculatory function is one of the assumed causes. Dynamic retinal vessel analysis is a quantitative method for measuring neurovascular coupling and microvascular endothelial function. We hypothesize that cognitive impairment is associated with altered microcirculation of retinal vessels.
Methods
152 chronic hemodialysis patients underwent cognitive testing using the Montreal Cognitive Assessment. Retinal microcirculation was assessed by Dynamic Retinal Vessel Analysis, which carries out an examination recording retinal vessels' reaction to a flicker light stimulus under standardized conditions.
Results
In unadjusted as well as in adjusted linear regression analyses a significant association between the visuospatial executive function domain score of the Montreal Cognitive Assessment and the maximum arteriolar dilation as response of retinal arterioles to the flicker light stimulation was obtained.
Conclusion
This is the first study determining retinal microvascular function as surrogate for cerebral microvascular function and cognition in hemodialysis patients. The relationship between impairment in executive function and reduced arteriolar reaction to flicker light stimulation supports the involvement of cerebral small vessel disease as contributing factor for the development of cognitive impairment in this patient population and might be a target for noninvasive disease monitoring and therapeutic intervention.
Digital twins enable the modeling and simulation of real-world entities (objects, processes or systems), resulting in improvements in the associated value chains. The emerging field of quantum computing holds tremendous promise forevolving this virtualization towards Quantum (Digital) Twins (QDT) and ultimately Quantum Twins (QT). The quantum (digital) twin concept is not a contradiction in terms - but instead describes a hybrid approach that can be implemented using the technologies available today by combining classicalcomputing and digital twin concepts with quantum processing. This paperpresents the status quo of research and practice on quantum (digital) twins. It alsodiscuses their potential to create competitive advantage through real-timesimulation of highly complex, interconnected entities that helps companies better
address changes in their environment and differentiate their products andservices.
Algorithmic design and resilience assessment of energy efficient high-rise water supply systems
(2018)
High-rise water supply systems provide water flow and suitable pressure in all levels of tall buildings. To design such state-of-the-art systems, the consideration of energy efficiency and the anticipation of component failures are mandatory. In this paper, we use Mixed-Integer Nonlinear Programming to compute an optimal placement of pipes and pumps, as well as an optimal control strategy.Moreover, we consider the resilience of the system to pump failures. A resilient system is able to fulfill a predefined minimum functionality even though components fail or are restricted in their normal usage. We present models to measure and optimize the resilience. To demonstrate our approach, we design and analyze an optimal resilient decentralized water supply system inspired by a real-life hotel building.
On obligations in the development process of resilient systems with algorithmic design methods
(2018)
Advanced computational methods are needed both for the design of large systems and to compute high accuracy solutions. Such methods are efficient in computation, but the validation of results is very complex, and highly skilled auditors are needed to verify them. We investigate legal questions concerning obligations in the development phase, especially for technical systems developed using advanced methods. In particular, we consider methods of resilient and robust optimization. With these techniques, high performance solutions can be found, despite a high variety of input parameters. However, given the novelty of these methods, it is uncertain whether legal obligations are being met. The aim of this paper is to discuss if and how the choice of a specific computational method affects the developer’s product liability. The review of legal obligations in this paper is based on German law and focuses on the requirements that must be met during the design and development process.
Energy-efficient components do not automatically lead to energy-efficient systems. Technical Operations Research (TOR) shifts the focus from the single component to the system as a whole and finds its optimal topology and operating strategy simultaneously. In previous works, we provided a preselected construction kit of suitable components for the algorithm. This approach may give rise to a combinatorial explosion if the preselection cannot be cut down to a reasonable number by human intuition. To reduce the number of discrete decisions, we integrate laws derived from similarity theory into the optimization model. Since the physical characteristics of a production series are similar, it can be described by affinity and scaling laws. Making use of these laws, our construction kit can be modeled more efficiently: Instead of a preselection of components, it now encompasses whole model ranges. This allows us to significantly increase the number of possible set-ups in our model. In this paper, we present how to embed this new formulation into a mixed-integer program and assess the run time via benchmarks. We present our approach on the example of a ventilation system design problem.
Cheap does not imply cost-effective -- this is rule number one of zeitgeisty system design. The initial investment accounts only for a small portion of the lifecycle costs of a technical system. In fluid systems, about ninety percent of the total costs are caused by other factors like power consumption and maintenance. With modern optimization methods, it is already possible to plan an optimal technical system considering multiple objectives. In this paper, we focus on an often neglected contribution to the lifecycle costs: downtime costs due to spontaneous failures. Consequently, availability becomes an issue.
Planning the layout and operation of a technical system is a common task
for an engineer. Typically, the workflow is divided into consecutive stages: First,
the engineer designs the layout of the system, with the help of his experience or of
heuristic methods. Secondly, he finds a control strategy which is often optimized
by simulation. This usually results in a good operating of an unquestioned sys-
tem topology. In contrast, we apply Operations Research (OR) methods to find a
cost-optimal solution for both stages simultaneously via mixed integer program-
ming (MILP). Technical Operations Research (TOR) allows one to find a provable
global optimal solution within the model formulation. However, the modeling error
due to the abstraction of physical reality remains unknown. We address this ubiq-
uitous problem of OR methods by comparing our computational results with mea-
surements in a test rig. For a practical test case we compute a topology and control
strategy via MILP and verify that the objectives are met up to a deviation of 8.7%.
Pure analytical or experimental methods can only find a control strategy for technical systems with a fixed setup. In former contributions we presented an approach that simultaneously finds the optimal topology and the optimal open-loop control of a system via Mixed Integer Linear Programming (MILP). In order to extend this approach by a closed-loop control we present a Mixed Integer Program for a time discretized tank level control. This model is the basis for an extension by combinatorial decisions and thus for the variation of the network topology. Furthermore, one is able to appraise feasible solutions using the global optimality gap.
In times of planned obsolescence the demand for sustainability keeps growing. Ideally, a technical system is highly reliable, without failures and down times due to fast wear of single components. At the same time, maintenance should preferably be limited to pre-defined time intervals. Dispersion of load between multiple components can increase a system’s reliability and thus its availability inbetween maintenance points. However, this also results in higher investment costs and additional efforts due to higher complexity. Given a specific load profile and resulting wear of components, it is often unclear which system structure is the optimal one. Technical Operations Research (TOR) finds an optimal structure balancing availability and effort. We present our approach by designing a hydrostatic transmission system.
Gearboxes are mechanical transmission systems that provide speed and torque conversions from a rotating power source. Being a central element of the drive train, they are relevant for the efficiency and durability of motor vehicles. In this work, we present a new approach for gearbox design: Modeling the design problem as a mixed-integer nonlinear program (MINLP) allows us to create gearbox designs from scratch for arbitrary requirements and—given enough time—to compute provably globally optimal designs for a given objective. We show how different degrees of freedom influence the runtime and present an exemplary solution.
Existing residential buildings have an average lifetime of 100 years. Many of these buildings will exist for at least another 50 years. To increase the efficiency of these buildings while keeping costs at reasonable rates, they can be retrofitted with sensors that deliver information to central control units for heating, ventilation and electricity. This retrofitting process should happen with minimal intervention into existing infrastructure and requires new approaches for sensor design and data transmission. At FH Aachen University of Applied Sciences, students of different disciplines work together to learn how to design, build, deploy and operate such sensors. The presented teaching project already created a low power design for a combined CO2, temperature and humidity measurement device that can be easily integrated into most home automation systems
Resilience as a concept has found its way into different disciplines to describe the ability of an individual or system to withstand and adapt to changes in its environment. In this paper, we provide an overview of the concept in different communities and extend it to the area of mechanical engineering. Furthermore, we present metrics to measure resilience in technical systems and illustrate them by applying them to load-carrying structures. By giving application examples from the Collaborative Research Centre (CRC) 805, we show how the concept of resilience can be used to control uncertainty during different stages of product life.
Nach Stand von Wissenschaft und Technik werden Komponenten hinsichtlich ihrer Eigenschaften, wie Lebensdauer oder Energieeffizienz, optimiert. Allerdings können selbst hervorragende Komponenten zu ineffizienten oder instabilen Systemen führen, wenn ihr Zusammenspiel nur unzureichend berücksichtigt wird. Eine Systembetrachtung schafft ein größeres Optimierungspotential - dem erhöhten Potential steht jedoch auch ein erhöhter Komplexitätsgrad gegenüber. Die vorliegende Arbeit ist im Rahmen des Sonderforschungsbereichs 805 entstanden, dessen Ziel die Beherrschung von Unsicherheit in Systemen des Maschinenbaus ist. Die Arbeit zeigt anhand eines realen Systems aus dem Bereich der Hydraulik, wie Unsicherheit in der Entwicklungsphase beherrscht werden kann. Hierbei ist neu, dass die durch den späteren Betrieb zu erwartende Systemdegradation eines jeden möglichen Systemvorschlags antizipiert werden kann. Dadurch können Betriebs- und Wartungskosten vorausgesagt und minimiert werden und durch eine optimale Betriebs- und Wartungsstrategie die Verfügbarkeit des Systems garantiert werden. Wesentliche Fragen bei der optimalen Auslegung des betrachteten hydrostatischen Getriebes sind dessen physikalische Modellierung, die Darstellung des Optimierungsproblems als gemischt-ganzzahliges lineares Programm, und dessen algorithmische Behandlung zur Lösungsfindung. Hierzu werden Heuristiken zum schnelleren Auffinden sinnvoller Systemtopologien vorgestellt und mittels mathematischer Dekomposition eine Bewertung des dynamischen Verschleiß- und Wartungsverlaufs möglicher Systemvorschläge vorgenommen. Die Arbeit stellt die Optimierung technischer Systeme an der Schnittstelle von Mathematik, Informatik und Ingenieurwesen sowohl gründlich als auch anschaulich und nachvollziehbar dar.
Because of its minor environmental impact, electricity generation using wind power is getting remarkable. The further growth of the wind industry depends on technological solutions to the challenges in production and construction of the turbines. Wind turbine tower vibrations, which limit power generation efficiency and cause fatigue problems with high maintenance costs, count as one of the main structural difficulties in the wind energy sector. To mitigate tower vibrations auxiliary measures are necessary. The effectiveness of tuned mass damper is verified by means of a numeric study on a 5 MW onshore reference wind turbine. Hereby, also seismic-induced vibrations and soil–structure interaction are considered. Acquired results show that tuned mass damper can effectively reduce resonant tower vibrations and improve the fatigue life of wind turbines. This chapter is also concerned with tuned liquid column damper and a semiactive application of it. Due to its geometric versatility and low prime costs, tuned liquid column dampers are a good alternative to other damping measures, in particular for slender structures like wind turbines.
Background
Hip fractures are a common and costly health problem, resulting in significant morbidity and mortality, as well as high costs for healthcare systems, especially for the elderly. Implementing surgical preventive strategies has the potential to improve the quality of life and reduce the burden on healthcare resources, particularly in the long term. However, there are currently limited guidelines for standardizing hip fracture prophylaxis practices.
Methods
This study used a cost-effectiveness analysis with a finite-state Markov model and cohort simulation to evaluate the primary and secondary surgical prevention of hip fractures in the elderly. Patients aged 60 to 90 years were simulated in two different models (A and B) to assess prevention at different levels. Model A assumed prophylaxis was performed during the fracture operation on the contralateral side, while Model B included individuals with high fracture risk factors. Costs were obtained from the Centers for Medicare & Medicaid Services, and transition probabilities and health state utilities were derived from available literature. The baseline assumption was a 10% reduction in fracture risk after prophylaxis. A sensitivity analysis was also conducted to assess the reliability and variability of the results.
Results
With a 10% fracture risk reduction, model A costs between $8,850 and $46,940 per quality-adjusted life-year ($/QALY). Additionally, it proved most cost-effective in the age range between 61 and 81 years. The sensitivity analysis established that a reduction of ≥ 2.8% is needed for prophylaxis to be definitely cost-effective. The cost-effectiveness at the secondary prevention level was most sensitive to the cost of the contralateral side’s prophylaxis, the patient’s age, and fracture treatment cost. For high-risk patients with no fracture history, the cost-effectiveness of a preventive strategy depends on their risk profile. In the baseline analysis, the incremental cost-effectiveness ratio at the primary prevention level varied between $11,000/QALY and $74,000/QALY, which is below the defined willingness to pay threshold.
Conclusion
Due to the high cost of hip fracture treatment and its increased morbidity, surgical prophylaxis strategies have demonstrated that they can significantly relieve the healthcare system. Various key assumptions facilitated the modeling, allowing for adequate room for uncertainty. Further research is needed to evaluate health-state-associated risks.
Persistent infection with the high-risk Human Papillomavirus type 16 (HPV 16) is the causative event for the development of cervical cancer and other malignant tumors of the anogenital tract and of the head and neck. Despite many attempts to develop therapeutic vaccines no candidate has entered late clinical trials. An interesting approach is a DNA based vaccine encompassing the nucleotide sequence of the E6 and E7 viral oncoproteins. Because both proteins are consistently expressed in HPV infected cells they represent excellent targets for immune therapy. Here we report the development of 8 DNA vaccine candidates consisting of differently rearranged HPV-16 E6 and E7 sequences within one molecule providing all naturally occurring epitopes but supposedly lacking transforming activity. The HPV sequences were fused to the J-domain and the SV40 enhancer in order to increase immune responses. We demonstrate that one out of the 8 vaccine candidates induces very strong cellular E6- and E7- specific cellular immune responses in mice and, as shown in regression experiments, efficiently controls growth of HPV 16 positive syngeneic tumors. This data demonstrates the potential of this vaccine candidate to control persistent HPV 16 infection that may lead to malignant disease. It also suggests that different sequence rearrangements influence the immunogenecity by an as yet unknown mechanism.