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Summary Objectives To compare costs and clinical benefits of three additional therapies to metformin (MF) for patients with diabetes mellitus type 2 (DM2). Methods A discrete event simulation model was built to estimate the cost-utility ratio (cost per quality-adjusted life years [QALY]) of saxagliptine as an additional therapy to MF when compared to rosiglitazone or pioglitazone. A budget impact model (BIM) was built to simulate the economic impact of saxagliptine use in the context of the Brazilian private health system. Results The acquiring medication costs for the hypothetical patient group analyzed in a time frame of three years were R$ 10,850,185, R$ 14,836,265 and R$ 14,679,099 for saxagliptine, pioglitazone and rosiglitazone, respectively. Saxagliptine showed lower costs and greater effectiveness in both comparisons, with projected savings for the first three years of R$ 3,874 and R$ 3,996, respectively. The BIM estimated cumulative savings of R$ 417,958 with the repayment of saxagliptine in three years from the perspective of a health plan with 1,000,000 covered individuals. Conclusion From the perspective of private paying source, the projection is that adding saxagliptine with MF save costs when compared with the addition of rosiglitazone or pioglitazone in patients with DM2 that have not reached the HbA1c goal with metformin monotherapy. The BIM of including saxagliptine in the reimbursement lists of health plans indicated significant savings on the three-year horizon.

A negative-ion-based neutral beam injection (NBI) system, in which large caesium-seeded negative-ion sources are utilized, has operated reliably in the Large Helical Device (LHD) since it was operational in 1998. The injection power of the hydrogen beam has been increased up to 13.1 MW with three injectors. In one injector with modified ion sources utilizing a multi-slotted grounded grid, the injection power reached 5.7 MW with an energy of 184 keV, which exceeds the designed value of 180 keV and 5 MW. Individual control of the local arc-discharge with independently divided arc and filament power supplies is effective in improving beam uniformity in a large negative ion source. The injection duration has been extended to 120 s, during which the LHD plasma is sustained by the NBI alone with a reduced power of 0.2–0.3 MW using one ion source with a cooled plasma grid. These results demonstrate that the injection performance of the negative-ion-based NBI is comparable to that of the conventional positive-ion-based NBI. The progress of the negative-NBI in the LHD is reviewed in detail from the point of view of the improvement of the negative ion sources.

The results on high power injection with the neutral beam injection (NBI) system for the Large Helical Device (LHD) are reported. The system consists of three beam-lines with two hydrogen negative ion (H− ion) sources installed in each beam-line. In order to improve the injection power, a new beam accelerator with a multi-slot grounded grid (MSGG) has been developed and applied to one beam-line. Using the accelerator, a maximum power of 5.7 MW was achieved in 2003 and 2004, and the maximum energy of 189 keV was reached. The power and energy exceeded the design values of the individual beam-line for LHD. The other beam-lines also increased their injection power up to about 4 MW, and the total injection power of 13.1 MW was achieved with three beam-lines in 2003. Although the accelerator had an advantage in high power beam injection, extracted beams expand in the short side direction of the ground-grid slot. The disadvantage has been resolved by modifying the aperture shapes of the steering grid.

Reductions in bright-field (BF) scanning transmission electron microscopy (STEM) and high-angle annular dark-field (HAADF) STEM image calculations with the aid of Bloch wave symmetry are discussed under assumptions that an absorption potential is written by a local potential and a zero-order Laue zone lies parallel to the crystal surface. Translational symmetry allows us to take only partial incident beams in the first Brillouin zone instead of enormous number of partial incident beams in a large convergent disk. Two dimensional point group confines partial incident beams to an irreducible area in addition to factoring a dispersion matrix into noninteracting submatrices on a high symmetry line using the projection operator. The drastic reductions in computing time and memory enable us to readily calculate various BF STEM and HAADF STEM images. The validity and accuracy are demonstrated in comparisons with high resolution experimental BF STEM and HAADF STEM images.

In this article we describe the first results of beam injection using an improved negative ion source, which consists of a set of steering and multislot grounded grids. The set of the grids is designed to achieve high power beam injection for the large helical device (LHD). The main purpose in replacing the conventional multiaperture with multislot grids is to reduce the heat load onto the grid. By adopting the multislot grid, the frequency of voltage breakdown at the acceleration gap decreased considerably and the maximum beam energy attained was 180 keV, which is one of the target values of the LHD neutral beam injector (NBI). The maximum injection power reached 4.4 MW, consequently. The heat load onto the multislot grid was water calorimetrically measured and the load is suppressed by 50% compared to the multiaperture case. In the condition for maximum injection power, the beam profile obtained in the accelerator with the multislot grounded grid becomes vertically elongated due to the asymmetric electric field close to the grid slot. Although some part of this elongated beam is lost at the injection port, the multislot grid has enough performance for beam injection.

The Large Helical Device (LHD) is the only machine that relies upon negative ion-based neutral beam injection system (NBI) as the principal heating power source. Since the first injection in 1998, NBI has been used to heat over 3000 shots for 2 years. Performance has progressed step by step to reach an injection power of 4.5 MW, with beam energy up to 165 keV, and pulse lengths up to 80 s at 0.5 MW. System operating level has reached ∼30% of the design power and ∼65% of the H− design current. This tangential high-energy NBI system based on negative ions has proved to be as efficient a heating system in a helical device as in a tokamak. The ratio of injection neutral beam power to high voltage drain power (injection power efficiency) was typically about 0.3. This is a low efficiency compared to the design one. For long pulse injection beam blocking (such as observed on PLT) was encountered, but it did not limit the operation. In order to achieve the design output of 15 MW, a great R&D effort is underway on the negative ion test stand to improve the performance of 40 A 180 keV negative hydrogen ion source.

A fast response calorimeter has been developed for the neutral-beam (NB) shine-through measurement. This calorimeter has the following advantages. (1) Temporal variation of the heat load onto the calorimeter can be measured. (2) Measurement under the relatively high heat flux environment is possible. (3) The calorimetric measurement under continuous and steady-state heat load environment is also possible. The verification of the measurement principle was done using an NB-injection system on the compact helical system (CHS) at the National Institute for Fusion Science (NIFS). The measured NB power densities are compared to the power densities being evaluated by the CHS-NB profile database. It was experimentally confirmed that the time constant of the measurement is about 7 ms.

High power negative-ion-based neutral beam injectors for the LHD were constructed and started in operation in September 1998. Two beam lines with a pair of ion sources are installed tangentially in opposing direction. The maximum energy of the beam is 180 keV for hydrogen, and the total injection power is designed to be 15 MW with the pulse length of 10 seconds. One of the specific features of the negative-ion-based NBI system is the requirement on the vacuum pressure in order to avoid the stripping loss of negative ions as well as to realize the optimum gas line density for neutralization, which results in the long beam line. The system was then designed carefully by considering the focal length of the ion sources, neutralizing efficiency, and geometrical and re-ionizing loss of the beam. It is also considered the error magnetic field produced by the ferromagnetic materials that are indispensable for NBI for the magnetic shield over the long neutralizing region.

In order to evaluate the EEG of patients with epilepsy, chaos analysis was performed for the subdural EEG time series data. The chaos attractor was reconstructed in the phase space and the correlation dimension. KS entropy calculated from the Lyapunov exponents was evaluated. Before the seizure attack, the KS entropy showed a lower value when compared with the time series data recorded during healthy condition. The results of our study suggest that it is possible to predict the seizure attack by the chaos analysis of the EEG signal. Further, we aim at developing an automatic control system for predicting a seizure attack by the use of local cooling of the focus with Peltier elements.

Multipower supplies for the arc discharge are installed to improve beam uniformity of a large size of the neutral beam injection system in the large helical device (LHD). The plasma tends to shift on the upper side of the arc chamber when the same arc voltage is applied to all filaments. The arc discharge current distribution becomes uniform as a consequence of the individual voltage control, but about 20 V difference of the arc voltage between the top and bottom circuits is required. We have estimated the beam profile from each acceleration grid by comparing the calculation and measurement of the beam profile of Halpha and calorimeter. The uniformity of arc discharge has been improved in most regions without the discharge adjustment by a horizontal filament connection. The controllability of the arc discharge distribution of the horizontal filament connection is better than that of the vertical filament connection. The efficiency of the beam production is improved by about 10% in the case of the horizontal filament connection. As a result 3.7 MW of the beam injection has been achieved in the LHD 6th experimental campaign in 2003.

Studies of a multicusp source were recently done at the National Institute for Fusion Science by plasma grid masking. The maximal H− ion yield is ∼1.4 times greater for the shutter mask case than that for the standard source. Negative ion current evolution during the cesium feed to the masked plasma grid evidenced that about 60% of negative ions are produced on the shutter mask surface, while about 30% are formed on the plasma grid emission hole edges, exposed by cesium with the mask open.

Multibeamlet focusing of an intense negative‐ion beam has been performed using beamlet steering by aperture displacement. The apertures of the grounded grid were displaced as all 270 beamlets (18×15) in an area of 25 cm×26 cm are steered to a common point (a focal point) in both the two‐stage and the single‐stage accelerators. The multibeamlets were successfully focused and the e‐folding half width of 10 cm was achieved 11.2 m downstream from the ion source in both accelerators. The corresponding gross divergence angle is 9 mrad. The negative‐ion beamlets are deflected by the electron deflection magnetic field at the extraction grid and the deflection direction reverses line by line, resulting in the beam splitting in the deflection direction. This beamlet deflection was well compensated also using beamlet steering by the aperture displacement of the grounded grid. The beam acceleration properties related to the beam divergence and the H− ion current were nearly the same for both the two‐stage and the single‐stage accelerators, and were dependent on the ratio of the extraction to the acceleration electric fields.

OBJETIVOS: Comparar custos e benefícios clínicos de três terapias adicionais à metformina (MF) para pacientes com diabetes mellitus tipo 2 (DMT2). MÉTODOS: Um modelo de simulação de eventos discretos foi construído para estimar a relação custo-utilidade (custo por QALY) da saxagliptina como uma terapia adicional à MF comparada à rosiglitazona ou pioglitazona. Um modelo de impacto orçamentário (BIM - Budget Impact Model) foi construído para simular o impacto econômico da adoção de saxagliptina no contexto do Sistema Suplementar de Saúde brasileiro. RESULTADOS: O custo de aquisição da medicação para o grupo de pacientes hipotéticos analisados, para o horizonte temporal de três anos, foi de R$ 10.850.185,00, R$ 14.836.265,00 e R$ 14.679.099,00 para saxagliptina, pioglitazona e rosiglitazona, respectivamente. Saxagliptina exibiu menores custos e maior efetividade em ambas as comparações, com economias projetadas para os três primeiros anos de -R$ 3.874,00 e -R$ 3.996,00, respectivamente. O BIM estimou uma economia cumulativa de R$ 417.958,00 com o reembolso da saxagliptina em três anos a partir da perspectiva de uma operadora de plano de saúde com 1 milhão de vidas cobertas. CONCLUSÃO: Da perspectiva da fonte pagadora privada, a projeção é de que o acréscimo de saxagliptina à MF poupe custos quando comparado ao acréscimo de rosiglitazona ou pioglitazona em pacientes com DMT2 que não atingiram a meta de hemoglobina glicada (HbA1c) com metformina em monoterapia. O BIM, para a inclusão de saxagliptina nas listas de reembolso das operadoras de planos de saúde, indicou uma economia significativa para o horizonte de 3 anos. OBJECTIVES: To compare costs and clinical benefits of three additional therapies to metformin (MF) for patients with diabetes mellitus type 2 (DM2). METHODS: A discrete event simulation model was built to estimate the cost-utility ratio (cost per quality-adjusted life years [QALY]) of saxagliptine as an additional therapy to MF when compared to rosiglitazone or pioglitazone. A budget impact model (BIM) was built to simulate the economic impact of saxagliptine use in the context of the Brazilian private health system. RESULTS: The acquiring medication costs for the hypothetical patient group analyzed in a time frame of three years, were R$ 10,850,185, R$ 14,836,265 and R$ 14,679,099 for saxagliptine, pioglitazone and rosiglitazone, respectively. Saxagliptine showed lower costs and greater effectiveness in both comparisons, with projected savings for the first three years of R$ 3,874 and R$ 3,996, respectively. The BIM estimated cumulative savings of R$ 417,958 with the repayment of saxagliptine in three years from the perspective of a health plan with 1,000,000 covered individuals. CONCLUSION: From the perspective of private paying source, the projection is that adding saxagliptine with MF save costs when compared with the addition of rosiglitazone or pioglitazone in patients with DM2 that have not reached the HbA1c goal with metformin monotherapy. The BIM of including saxagliptine in the reimbursement lists of health plans indicated significant savings on the three-year horizon.

For compensation of the magnetically deflected beamlets, a new type of grid system has been applied to a large negative ion source of a negative-ion-based neutral beam injector in the Large Helical Device (LHD) fusion experimental machine. Corresponding to deviation of the negative ion beamlet trajectory due to the electron suppression magnetic field at the extraction grid, the exit aperture of the extraction grid is displaced to cancel the beamlet deflection by electrostatic lens effect. As a result, the beamlet deflection was suppressed less than 2 mrad in a wide range of energy of 110–180 keV, and the port-through efficiency of the injected beam was improved to 90%–95% from 70%–75% in the case of the previous compensation by the grounded grid aperture displacement. The injected beam power was increased to 3.5 MW with an energy of 165 keV using one injector. To improve beam uniformity of the large area beam, individual arc currents through filaments are controlled for uniform plasma production, with ind...

Negative‐ion‐based neutral beam injection (negative‐NBI) system has been operated for 10 years in Large Helical Device (LHD). The injection power has been increased year by year, according to the improvement of the negative ion sources. Up to now, every injector achieves the designed injection energy and power of 180 keV‐5 MW with hydrogen beams, and the total injection power exceeds 16 MW with three injectors. In the multi‐round aperture grounded grid (GG), the diameter of a round aperture has been enlarged for higher GG transparency. Then, the GG heat load is reduced, as well as in the multi‐slotted GG, and the voltage holding ability in the beam acceleration was improved. As a result, the beam energy is raised and the injection power is increased. To improve the anisotropic property of the beamlet convergence condition between the perpendicular and the parallel directions to the slots in the multi‐slotted GG, a round‐shape aperture of the steering grid (SG) has been changed to a racetrack shape. As a r...

The new beam accelerator with multi‐slot grounded grid (MSGG) has been developed to increase the port‐through power into large helical device (LHD). Using the accelerator, the maximum power of 5.7 MW was achieved at the beam energy of 186 keV in the beam injection to LHD plasma last year. Although the port‐through power increased compared with conventional accelerators with multi‐hole grounded grid (MHGG), the accelerator with the MSGG includes a disadvantage of bi‐focal condition in parallel and perpendicular direction to the long side of the slots. When the beam width in one of those directions gets narrower, the width in another direction becomes wider. This disadvantage includes the loss of beam port‐through power and induces internal damages in neutral beam line. In order to reduce the disadvantage, an experiment has been done using a small‐scaled negative ion source with racetrack‐shaped apertures for the steering grid installed at beam upstream of the MSGG. By applying the racetrack apertures to the accelerator, it is observed that the beam widths in the parallel and perpendicular directions to the slot long side have almost the same focal condition to obtain minimal beam widths.

MethOdS: The Orizon database, an administrative database containing inpatient and outpatient claims to a pool of 102 HMOs representing 34% of the total Private Health System, was reviewed from Jan/2009 to Dec/2012. Eligibility criteria were patients starting CLL (ICD-10 code C911) treatment from Apr/2009 to Dec/2011. Outcome was direct medical costs (DMC) per patient-year, calculated as the sum of the medical claims for each patient included in the analysis, for a maximum period of 12-months or death or loss of follow-up, whichever comes first. DMC was categorized in chemotherapy, hospitalizations, and other outpatient costs. Further analysis was conducted for chemotherapy and hospitalizations.

Failures of flexible pavements (bituminous roads) have been prevalent in many developing countries, a trend causing concern to both the road users and the roads authorities. In this regard, it was found necessary that an investigation be initiated to determine the possible causes of such failures, and a case study was carried out on Nairobi-Thika Highway in Kenya. The investigations were conducted in several categories to determine the pavement characteristics such as structural strength by Benkelman Beam Deflection Test (BBDT), skid resistance by British Pendulum Tester (BPT). Traffic loading by Axle load measurements, Traffic volumes by traffic counting and ageing characteristics of the type of the bitumen used by cutting cores and extracting the bitumen for the standard tests, such as penetration, ductility, bitumen content, air voids, softening point and CBR using the Light Drop Weight Tester (LDWT). The visual inspection of the pavement showed that due to the hardening of the bitumen and overloading, cracks and potholes were very common for the whole stretch of the road. Axle load data revealed that, there has been a tendency to exceed the maximum allowed axle load limits, especially until 19th august, 1999, after that the enforcement of axle load limits was tightened. This fact together with the revelation that the road is a very busy one as depicted in the traffic counts, could be one of the major causes of the road's fast deterioration. (Journal of Civil Engineering, JKUAT: 2002 7: 13-26)

Atomic resolution low-angle bright-field (LABF) scanning transmission electron-microscope (STEM) images and high-angle bright-field (HABF) STEM images of [011]-orientated Si have been experimentally obtained together with high-angle annular dark-field (HAADF) STEM images. The contrast formation mechanisms of the LABF STEM and HABF STEM images are examined in comparison with HAADF STEM images. The HABF STEM images independent of defocus and thickness have spatial resolution comparable with HAADF STEM images, and are shown to be given as a simple convolution under the non-dispersion approximation of localized Bloch waves.

A high-power negative-ion-based NBI system is now under construction for Large Helical Device (LHD). The neutral beam injection power and energy are designed to be 15 MW and 180 keV, respectively, for hydrogen, and the pulse duration is 10 sec. Two beamlines are installed to LHD, the injection direction of which is tangential and balanced with each other. Two large negative-ion sources are attached side-by-side to each beamline, which produce 180 keV-40 A of the negative ion beam. The prototype ion source has just started operation in the negative NBI test stand, and produced 106 keV-21 A of the negative ion beam. The fabrication of the beamline components and the power supplies have been almost finished. The installation to LHD starts in October and is completed in March, 1998. After the commissioning and the conditioning, the injection to LHD is scheduled in September, 1998.

Development of the control and communication system for the plasma heating unit of Large Helical Device (LHD: an experimental machine for fusion science) has been continued. The system is composed of a distributed and concurrent client/server system by the use of several UNIX workstations, and its sub-systems are controlled by PLC (Programmable Logic Controller), VME (Versa Module Europe). Almost all of its control system are connected via Ethernet with IEEE802.3. Man-machine interface system and hardware/software of the control system have been completed.