Cost-effective, viii

Several studies of continuous infusions of factor Vila, factor VIII, and factor IX in hemophiliacs undergoing surgery have shown that this mode of administration is safe and effective when steady plasma concentrations of the clotting factors can be achieved (53-56). The total dosage of clotting factor concentrates is reduced, and so continuous infusions are cost-effective (53,56). 

The individual responsiveness to desmopressin is consistent, and a test dose administered at the time of diagnosis or prior to therapy is the best predictor of response. Generally, DDAVP is more effective in vWD than in hemophilia patients, with an average 30% to 50% increase in vWF and factor VIII levels. In patients with an adequate response, desmopressin is first-line therapy because it allows for once-daily administration (elevates plasma levels for 8-10 hours), does not pose a threat in terms of viral transmission, and the cost is substantially less than that of the plasma-derived products. Fibrinolysis inhibitors (50-60 mg/kg of aminocapriotic acid every 4—6 hours or trenex-amic acid 10-15 mg/kg every 8-12 hours) and OCs are used successfully in the management of epistaxis and menorrhagia or as adjuvant treatments. 

The benefits of TES include [2] (i) reduced energy costs, (ii) reduced energy consumption, (iii) improved indoor air quality, (iv) increased flexibility of operation, (v) reduced initial and maintenance costs, (vi) reduced equipment size, (vii) more efficient and effective utilization of equipment, (viii) conservation of fossil fuels, and (viii) reduced pollutant emissions. 

Effect of Feed and Value of By-Products on Production Costs. The ethylene production costs for the six feedstocks considered and the relevant by-product dispositions are shown in Tables VII and VIII. 

A question that arises in connection with distillation processes is How does a vapor-compression process compare with a multiple-effect evaporation process on the basis solely of energy cost This is readily answered as follows. The work of compression as kilowatt-hours per 1000 gallons is given by a specific form of Equation VIII. 134... 

A separate study based on capital Investment requlremnts comparing RIM without IMR and RIM with IMR showed similar cost savings benefits, Table VIII . In this particular example, a 27Z reduction In cycle Increased productivity by 63Z. The combined effects of these benefits yielded costs saving on the order of 17%, which Is significant. 

The 45 and 90 metric ton/day facilities were designed to include two and four individual modules, respectively. The modules were operated three shifts/day, five days a week and included automatic ash removal. Heat recovery was included in all of the cases considered. Table VII details the capital costs for these units, both without a particulate control and with fabric filters for particulate control. Table VIII summarizes the operating costs for the installations. For both sizes of installation, particulate control adds 4/metric ton to the operating cost. Figure 3 illustrates the effect of steam value on the operating costs. 

The dose of desmopressin for von WiUebrand disease is identical to that used in the treatment of mild factor VIII deficiency, 0.3 mcg/kg diluted in 30 to 50 mL of normal saline and given intravenously over 15 to 30 minutes. In general, patients with von WiUebrand disease have a better response to desmopressin than those with hemophilia, with an average three- to fivefold rise in von WiUebrand factor and factor VIII levels. These levels remain elevated for about 6 to 8 hours. The response to desmopressin in a given patient is usuaUy consistent, and a trial of desmopressin should establish if the medication is likely to be effective for the individual. Desmopressin is preferable to the use of plasma-derived products for patients who have an adequate response because desmopressin does not carry a risk of viral transmission. An added benefit is that desmopressin is substantiaUy less costly than the plasma-derived products. (For a discussion of the side effects of desmopressin, see the section on the treatment of hemophUia A.)... 

System Safety. The application of engineering and management principles, criteria, and techniques to optimize all aspects of safety within the constraints of operational effectiveness, time, and cost throughout all phases of the system life cycle [p. viii]. 

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