Objective Most patients with nasopharyngeal carcinoma (NPC) in the United States are diagnosed with stage III-IV disease. Screening for NPC in endemic areas results in earlier detection and improved outcomes. We examined the cost-effectiveness of screening for NPC with plasma Epstein-Barr virus DNA among Asian American men in the United States. Study Design We used a Markov cohort model to estimate discounted life-years, quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios for screening as compared with usual care without screening. Setting The base case analysis considered onetime screening for 50-year-old Asian American men. Subjects and Methods Confirmatory testing was magnetic resonance imaging and nasopharyngoscopy. Cancer-specific outcomes, health utility values, and costs were determined from cancer registries and the published literature. Results For Asian American men, usual care without screening resulted in the detection of NPC at stages I, II, III-IVB, and IVC among 6%, 29%, 54%, and 11% of those with cancer, respectively, whereas screening resulted in earlier detection with a stage distribution of 43%, 24%, 32%, and 1%. This corresponded to an additional 0.00055 QALYs gained at a cost of $63 per person: an incremental cost of $113,341 per QALY gained. In probabilistic sensitivity analysis, screening Asian American men was cost-effective at $100,000 per QALY gained in 35% of samples. Conclusion Although screening for NPC with plasma Epstein-Barr virus DNA for 50-year-old Asian American men may result in earlier detection, in this study it was unlikely to be cost-effective. Screening may be reasonable for certain subpopulations at higher risk for NPC, but clinical studies are necessary before implementation.

Additive Manufacturing (AM) offers design engineers new and advanced manufacturing processes to consider when developing new products or redesigning and evolving current products. AM includes 3D printing processes to quickly produce complex parts and prototypes, that were previously uneconomical or impossible to fabricate. Engineers and organizations have an increasing need to incorporate AM as part of product development; however, design heuristics, design methodologies, and design tools to support AM are nascent and only recently emerging. To enhance Design for Additive Manufacturing (DfAM), this research seeks to develop an accessible, computer-based design assistant that will aid designers in incorporating AM into their design processes. The design assistant implements a distinctive and user-centered Design Innovation (DI) process, set of methods, and set of principles based on a 4D design framework. This 4D framework encompasses the UK Design Council’s double diamond model and includes the phases of Discover, Define, Develop, and Deliver. The Discover phase entails user studies and a deep understanding and empathy for the user. The Define phase considers the reframing of design opportunities based on derived insights from the modeling users’ interactions. The Develop phase uses a variety of methods to create a large quantity of innovative ideas and concepts, and the Deliver phase implements a set of methods to prototype, test, pitch, and ultimately produce deliverables for a market or community. We demonstrate the design assistant tool for AM through the development of high-end bracket design for space applications. The design considers the Selective Laser Melting (SLM) process for productions and incorporated topology optimization approaches. This demonstrative case study shows how the tool includes design heuristics and approaches for each of the 4-Ds that assist designers in implementing AM capabilities as part of repeatable design processes. Assessment of the tool is carried out through systematic assessments performed by practicing design engineers that have knowledge of AM. Initial results show that the design assessment tool is very helpful when designers consider using AM and also in helping them use AM in effective and efficient manners.

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